Rewarding Success Initiative
Canada is spending an increasing proportion of its gross domestic product (GDP) on health care—an estimated $228 billion in 2016 (11% of GDPFootnote 1, and yet ranks close to last among comparative countries in measures of access, quality, and health outcomes. To sustain Canadian health care, we need to incentivize frugal innovations and process transformations that improve outcomes and value for our investment.
A significant challenge impeding the acceleration of economical, successful innovations in health research is the manner in which research funding is awarded. Current funding mechanisms tend to be conservative in nature and do not support riskier innovations, nor are they concerned with the probability of success in implementing interventions that will result in better outcomes at lower cost. Funding agencies are beginning to experiment with new models of funding that incentivize frugal innovation and success in addressing complex and important health problemsFootnote 2, these include challenge programs that reward the most successful person and/or team that solves a predefined problem, social impact bonds, and risk sharing agreements and performance contracting.
The Rewarding Success Model
To change the paradigm of how research is rewarded, CIHR designed a new funding model that will reward success as a means of incentivizing research teams and their healthcare partners to enhance value-based care, health system sustainability, and health outcomes. The research teams and their partners will design, implement, and evaluate interventions in healthcare organization(s) that that aim to produce healthcare cost savings and/or improved health system efficiency.
The Rewarding Success Initiative is similar to other funding models that have been developed to support innovation and impact. The basic principle is that teams of patients, healthcare delivery organizations, clinicians, and researchers identify potential solutions to identified problems and priorities in health care; solutions that will enhance patient and provider experience while also:
- reducing low value health care (e.g. unnecessary diagnostic tests/ drugs), and/or
- addressing health care inefficiencies (e.g. wait lists), and/or
- reducing avoidable morbidity (e.g. stroke)
Teams will partner with payers of health services (e.g. Ministries of Health, Regional Health Authorities, insurers, hospitals, etc) and/or charities and philanthropic organizations who recognize the identified challenges and agree to pay for successful improvement in outcomes, efficiencies, or reduction in low value services based on actual (e.g. lower drug costs) or measured but not readily retrievable savings (e.g. reduction in hospital admissions). Teams and their payers will work together to determine which outcomes will be evaluated, the metrics to be measured, the value of the payback, and the mechanism of the payback. If agreed-upon outcomes are achieved, the payer will redistribute a portion of the savings to the multidisciplinary research team and/or redirect the savings into an Innovation Fund, depending upon the agreements outlined.
Teams will take advantage of innovative clinical trial (iCT) designs to institute complex interventions that will allow them iterate to improve the likelihood of success. Use of an iCT design will also enable unambiguous attribution of the effect of the intervention(s) employed to improve value and efficiency in health care.
Rewarding Success Principles
Principle 1: Patients, clinicians, researchers and healthcare delivery organizations partner to design and implement value added interventions that address provincial priorities, improve health outcomes, and improve value for our investment.
Principle 2: Create conditions that will foster innovation in healthcare by engaging and rewarding patients, clinicians, researchers, and healthcare delivery organizations that can successfully partner and introduce interventions that advance the quadruple aim, i.e., enhancing patient care, improving population health, reducing costs and improving the work life of health care providers.
Principle 3: Foster methods that enable rapid iteration of interventions, which may involve adjusting the intervention, the target population, or the outcomes to optimize success.
Principle 4: To support the implementation of new innovations and scale up of successful pilots, a national process will be established to audit the cost and outcomes, reward successful innovators, and continue to fund innovation in healthcare.
Participants in a Rewarding Success Funding Model
The multi-disciplinary research team: will consist of researchers, clinicians, decision-makers from health care delivery organizations, and patients (in the context of SPOR, patient is "an overarching term inclusive of individuals with personal experience of a health issue and informal caregivers, including family and friends." Please refer to the SPOR Patient Engagement Framework for further information).
Other sectors are welcome to join the team but are not mandatory. These may include philanthropies, not-for-profits, industry, etc.
The Funder: CIHR and any other partner contributing upfront funding. This also includes the 1:1 matching with non-federal government partners required for the multi-year iCT Rewarding Success Team Grants.
The Payer: The organization(s) which agree to pay for successful improvement in outcomes, efficiencies, or reduction in low value services based on actual (e.g. lower drug costs) or measured but not readily retrievable savings (e.g. reduction in hospital admissions). The payer can be the organization which will benefit from the implementation of the idea (the payers of health services: Ministries of Health, Regional Health Authorities, insurers, hospitals, etc) and/or charities and philanthropic organizations which recognize the identified challenges. The multidisciplinary teams and the payers will work together to determine the outcomes, metrics measured, value, and mechanism of the payback. Payments are only made once the agreed-upon outcomes are achieved.
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