West Health Accelerator at Duke Margolis Powered by Policy and Learning Hubs

This month saw the launch of the West Health Accelerator at Duke-Margolis, born out of a longstanding collaboration between the Duke-Margolis Institute for Health Policy and the nonprofit West Health to advance accountable, value-based care.

Duke-Margolis catalyzes Duke University’s capabilities, including interdisciplinary academic research and capacity for education and engagement, to inform policy-making and implement evidence-based strategies for better health and healthcare. West Health is a family of nonprofit, nonpartisan organizations dedicated to successful aging and lowering the cost of healthcare in America.  

Since 2018, the two organizations have combined Duke-Margolis’ policy expertise with West Health’s practical experience in care delivery and innovation. The idea is that the Accelerator is powered by interconnected policy and learning hubs that operate a feedback system where evidence from the field informs policy, and policy guides practice. The policy hub translates complex issues into actionable, consensus-driven reforms, while the learning hub generates real-world evidence and facilitates implementation.

At a recent event hosted at Duke Margolis, Ana Tuya Fulton, M.D., M.B.A., president and chief operating officer of Rhode Island-based Integra Community Care, spoke about the benefits her organization has seen from participating in a West Health Learning and Action Network (LAN). 

A geriatrician by training, Fulton said she got into the ACO space when her health system formed an ACO, Integra Community Care, in 2014. “What excited me was the opportunity to change care delivery on a grander scale, and particularly to create models of care that could be delivered at home or in the patient's site of care, as opposed to in the hospital or the skilled nursing facilities,” she said. 

The ACO has  been participating in West Health LAN since 2018. “The benefit for us has been a way to take innovative ideas and pilot them and test them and really move with speed,” she said. “Instead of reading something in a journal about a cool idea done at this program and then testing it on a small scale at my own system, and then learn individually, you can learn in a group, and you can talk to people who've done this in multiple areas of the country and in multiple different states with different regulations and a different set of parameters,” Fulton explained. 

“We took a pilot program and were able to stand it up to almost at scale within about nine months, because we learned from everyone else's ROIs," she said. "We learned from everyone else's outcomes. We were able to really get best practices, and it probably shaved off three or four PDSA cycles for us to stand up the program and grow."

The strength of the LAN, she added, is that sometimes it's difficult to demonstrate the impact of their own pilot programs, because Rhode Island is a small state. When her organization does a project that touches 800 patients per year, a payer partner might say do it for five more years and let us know how it works out. “We were able to pull results from multiple programs in multiple states, show iterations and how these things could be successful,” Fulton said. “I think that's really been the biggest impact for us.” 

Another benefit of these interactions, she added, has been lasting relationships with other programs. “As things change in policy, as things change in environments, we still have those connections to reach out to each other and brainstorm potential solutions,” Fulton said. “We’re leveraging that actively now with our Integra at Home program and our hospital at home program with the waiver. We’re learning from other programs how to continue to operate and continue to deliver care.”

Fulton said that still another benefit was that selling an innovative program to a relatively risk-averse health system compliance and risk team was made much easier by saying, “Hey, we're part of this LAN and there are multiple systems who've done that, and here's the risk contact at health system X, who's willing to talk to you about how they bridge the gaps.”