Jennifer Bright: “Collaboration has to happen”

Collaboration has to happen. An open learning environment and sharing of data has to be the norm. And we have to stop saying it’s difficult and instead leverage data for action by taking down the walls and making value assessment an open environment for learning and collaboration — so that we can determine a benefit to everyone. […]

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Collaboration has to happen. An open learning environment and sharing of data has to be the norm. And we have to stop saying it’s difficult and instead leverage data for action by taking down the walls and making value assessment an open environment for learning and collaboration — so that we can determine a benefit to everyone.

As a part of my interview series with leaders in healthcare, I had the pleasure to interview Jennifer Bright.

Jennifer is an Executive Director for the Innovation and Value Initiative (IVI). Mrs. Bright brings over two decades of health care policy, issue management, patient advocacy, and executive leadership to the position. She is president of Momentum Health Strategies and most recently served as Executive Director for the Society for Healthcare Epidemiology of America (SHEA), a non-profit medical society representing physicians, advanced practice nurses, and researchers with expertise in healthcare epidemiology and infection prevention. Jennifer’s prior executive leadership at the National Mental Health Association (now Mental Health America) focused on advancing policy initiatives at the state and local level. Her career has also included issue analysis and strategic issue management for corporate clients at state-focused lobbying firms.

Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?

I experienced the harsh realities of our healthcare system at an early age. When I was an 18-year old, both of my parents were diagnosed with late stage cancers. Neither of my parents had experienced any other health issues.

Even though my parents were in the military health system and had full access to care, their experience taught me that when it comes to health care, patients and families are on their own to navigate and advocate for care and treatment that serves both their physical and mental wellbeing but also their quality of life. And that’s not the way it should be.

The lack of communication, the fact that nobody even asked my parents what their treatment goals were, and the assumption that only the clinicians knew what was best — despite the fact that a lot of medicine is experimental — all led me to conclude that someone has to be an advocate for the patient.

I was 18. I didn’t understand policy. I didn’t understand oncology. But I couldn’t believe that nobody was listening to my parents.

Throughout my career I have worked to change this hard truth that, despite being the ultimate healthcare consumer, the voice of patients is often muted or overshadowed by other actors and by incentives that have less to do about health outcomes that matter to them. My true north as a patient advocate, in public policy, and now in the realm of value assessment has always been how do we use all the science, technology, data AND the insights from the patient to improve health and wellbeing?

The dedication to grappling with difficult questions in health care — how we allocate resources and think about optimizing choice and sequence of treatment — is exactly what we’re endeavoring to do at the Innovation and Value Initiative (IVI) and it’s what attracts me to this organization’s mission. Key questions we’re exploring include: How can we improve methods to incorporate patient perspectives and real-world data into value assessment models? How can we refine methods for identifying patient preferences that influence outcomes and should influence the entire research enterprise? How can we use modeling to foster a broader, more inclusive discussion about the concept of value in a way that serves the interests of both payer/purchaser and the community of patients?

Can you share the most interesting story that happened to you since you began leading your company?

Earlier this year, we hosted our first collaborative summit to examine gaps in both the methods to gather and assess value, as well as how to put novel evidence-based methods into practice. This was an incredibly diverse forum and we had leaders from patient communities, health economics, health plans, employers, providers and industry at the table.

My concern entering the summit was that stakeholder viewpoints regarding the best way to measure value were so polarized it would inhibit our ability to bring people together around a set of common principles. However, at the summit my “aha” moment was that we had far more consensus than I first assumed.

We had widespread agreement that we must create a learning laboratory to dig in and figure out the priorities for improving value assessment methods, for understanding the decision contexts that value assessment should seek to facilitate and for accelerating the methods and data inputs that will account for patient perspectives and other relevant real-world data. For example, how do we measure and account for factors like missed days of work, lost productivity, the power of hope, or the burden on caregivers when we examine the value of a new drug or healthcare intervention?

We’re building on this momentum with a robust research agenda and engagement that will build further collaboration among all stakeholders.

What makes your company stand out? Can you share a story?

What sets IVI apart in this field is our philosophy that value assessment science (the methods) and practice (the process) can be improved and the approach should be fully transparent, our steadfast commitment to putting patient perspectives at the beginning of value assessment, and our focus on bringing diverse stakeholders together in our laboratory to test and refine new approaches. At the end of the day, IVI exists to make value assessment both scientifically credible and relevant.

When we launched the Open-Source Value Project (OSVP) economic model to assess the value of non-small cell lung cancer treatments, the concept was to build a model in oncology that examines the sequences of available treatments, since typically in oncology a patient will take multiple courses of different drugs and therapies.

Our first action was to engage a diverse group of cancer patient organizations across disease states — lung, colorectal, prostate etc. — to give us insights about where new therapies were emerging, where patient diversity and perspectives on care might not be well represented in value dialogue, and where there was opportunity to challenge conventional thinking about calculation of cost-effectiveness. That led us to focus on non-small cell lung cancer, a disease state where many therapies are emerging, yet the clinical evidence is still unclear. This story highlights how we go about our work: we’re driven by patient’s needs and their input, which we discerned in concert with two patient organizations through our research and model development process.

Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?

We have seen an enormous amount of attention to healthcare pricing and the Institute for Clinical and Economic Review’s (ICER) attempts to determine fair and value-based prices. ICER’s work certainly contributes an important piece of the value conversation, but the approach has less transparency to all stakeholders and they continue to strive to improve the ability to involve patient perspectives. IVI’s role is to push us all forward; we’re driving a conversation about how healthcare leaders can explore better ways to measure value that includes the flexibility to see perspectives of patients that may not be represented in the gold-standard clinical data that traditionally feeds cost-effectiveness evaluation.

To give one example, I’m especially excited about one project we’re just starting to assess the value of treatments for major depression. We are bringing together patients, payers, employers and others to discuss what decision problems payers and employers face that can be addressed by modeling and to define what data inputs we need to consider and measure to understand treatment value. We know that depression is a highly prevalent condition and often occurs along with other chronic health conditions. We also know that depression has a huge impact on employers in the form of loss of work productivity, on the wellbeing of individuals and families and on total health care costs. At the same time, we haven’t yet leveraged all the data inputs that are available to really understand the optimal sequences of treatment (both pharmaceutical and non-pharmaceutical) for patients with this diagnosis or to examine how such optimal therapy might differ for subgroups. Beyond looking at price of an individual intervention, we think there are opportunities to improve care pathways and to rethink benefit design in ways that incorporate real-world data insights and patient perspectives.

What are your “5 Things I Wish Someone Told Me Before I Started” and why.

The top five things I wish someone told me before I started at IVI:

  1. Working in an open-source environment is challenging. Our value assessment models are all open source, and engaging communities in that environment is complex. Building crowdsourcing into modeling is difficult, but so important.
  2. That there will be a large amount of inertia to overcome especially when it comes to everyone staying in their silos. Out of the box thinking too often get stymied by a lack of motivation to collaborate. I understand why research or employer and payer data is proprietary. Creating an open forum for learning and rapid-cycle improvement is the goal, and doing so can benefit all of us. Defining how and what inputs yield a picture of value shouldn’t be the realm only of those holding the data or those invited by virtue of power, size or incentive.
  3. The large amount of patient input that is sidelined and lacks authentic energy. I’m very proud that IVI is working with our patient partners and advisors to advance the inclusion of patients into modeling and I’m very encouraged we’re seeing shifts in the process of other actors to accelerate patient involvement on the front end.
  4. That the focus in the US on price as analogous to value was going to be a hard paradigm to shift. While methods experts are working to advance approaches that address emerging issues, like how we account for the value of preventing spread of contagion or how we assess curative interventions, value assessment remains a complex math problem that requires significant skill and data to make it relevant to a decision maker. Wider considerations like how value assessment could inform clinical pathways or benefit design just don’t have enough traction yet, but I hope that will evolve.
  5. How challenging it would be to continue building the structure and narrative of an organization in the midst of its crucial proof of concept stage. Value assessment landscape is changing daily and is driven by external factors, namely the demand on our strained healthcare resources. Advocating for and testing concepts of change takes time and yet the demand for binary answers right now challenges our ability to command attention.

Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

A number of reasons stand out as to what’s wrong and needs to change to improve health and healthcare in the U.S.

  1. Our healthcare system is oriented around the business of healthcare rather than the health of people. The orientation should be about how to make society healthier rather than on delivery.
  2. The gross inequality in access, delivery, and appropriateness of care are so glaringly problematic. It’s just not acceptable in 21st Century America that too many worry about basic healthcare and being shut out of the system and left to die in a modern society.
  3. The false narrative that patients will storm the castle and demand high priced healthcare endlessly. That’s not accurate for anyone who is confronting a chronic illness or a crisis. People want a basic level of care they know works. So, we need to boldly say everyone should be able to walk into a clinic to get preventive care, dental care, a flu shot, or a screening for depression or for cancer. Access to care today avoids needless high-priced care tomorrow. Access to care is in service of good fiscal stewardship.
  4. We still have a broken payment system that doesn’t reward for value and shifts costs. The dichotomy is striking. In some private plans, we have an over-extension to high-priced, low value care at the same time we cannot extend basic Medicaid benefits for much needed high-value care, like preventive services. We know which healthcare interventions save resources in the long-term, yet we’re still not investing consistently in expanded access to those interventions.
  5. We have a data for action problem. We reward new research, which often takes a decade or more to be applied. While many historical disincentives exist to break down silos and share data for actionable research, the COVID-19 pandemic has had the effect of accelerating open science and shared data. And today, with remdesivir approved as an investigational antiviral drug for confirmed COVID-19 and clinical trials beginning on a vaccine, society is seeing some of those benefits now. But it shouldn’t have to take a crisis to force common-good thinking about solving our most pressing challenges in health care. We cannot be the globally revered healthcare system we think we are if we only act in a crisis.

You are a “healthcare insider”. Can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

My top five changes to improve health care:

  1. Agree on universal access on basic benefits. Doing so will reward high-value care and de-emphasize high cost care that delivers low value.
  2. Serious payment reform that improves access to high-value healthcare for all and moves us beyond tiered access to care based on societal factors.
  3. Make research transparent and focus on real world data and application, where it can make a difference. Spend more on changing culture and delivery of health care.
  4. Widen the value conversation by examining value for whom. We need to understand the impact of drugs and interventions on different populations. We can’t continue the status quo, for example, of having clinical trials with predominately white males when we know this doesn’t reflect the real patient population. We have the means to accelerate change, but we often lack the will based on legal, financial and intellectual property constraints. That needs to stop.
  5. Continue to make patient-centeredness the first order of healthcare. Put patients at the table at every phase — from defining the problem to be solved by an intervention to examining value and defining what interventions are worth, to measuring whether we achieve outcomes that matter to the individuals confronting disability or disease.

Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?

Collaboration has to happen. An open learning environment and sharing of data has to be the norm. And we have to stop saying it’s difficult and instead leverage data for action by taking down the walls and making value assessment an open environment for learning and collaboration — so that we can determine a benefit to everyone.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

The late great Uwe Reinhardt’s book, Priced Out, has inspired my thinking that we can find common ground to build a healthcare system that makes sense and works for the people receiving care.

John Carreyrou’s book, Bad Blood, is a reminder of how our system breeds bad actors and, to me, showcased the risks and consequences of creating an environment where no accountability exists if business investment takes precedence over everything else. To me, it’s a clarion call for the importance of accountability.

I am very inspired by Seth Godin’s blog. Seth thinks outside the box and his advice for authenticity in business speaks to me.

While I also read all the health and health policy journals, I am quite inspired by the trend for journals to move to open source. I believe this is essential to speeding up innovation.

And lastly, I’m inspired by everything IVI publishes!!

How can our readers follow you on social media?

You can follow IVI on Twitter, @IVI_health or on LinkedIn.

Thank you so much for these insights! This was so inspiring!

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