FAQ: PCORI LHS Pilot Collaborative, Oct. 26, 2017

Q:  How many LOIs were submitted? Can you give any high-level comments on the LOIs?

A:  We received 11 LOIs.  As we expected, the networks are at different stages of their development. Across the range 11 PPRNs, the total potential for impact is very high.

First, we advise you to plan to make the work manageable, based on your current capacity.  If your network is very new, we would advise to think concretely about who are the patients and care centers. If you have an existing network of care sites, think about how you will scale up in the next 2-5 years. Each network should do the planning that is useful for them. Think of the application as describing your current stage of planning towards a desired direction.

Second, applicants should focus on collaboration across stakeholder groups and linkages of organizations to include care, improvement and research, which are traditionally separate.  Try to achieve an agreement that includes a shared aim, as well as how you will govern and lead the network. We preach a relentless focus on outcomes, which motivates groups to synchronize and bring all of their assets together, in a “stone soup” mentality, which creates a system that attracts even more clinical care sites.  If you will have agreed by Dec. 5 on an outcome and who will participate, you will be very well positioned to get going.

Finally, we expect everyone to sign up for 1:1 calls. Again, we are very excited by your interest and growing commitment to this idea, and we want to help everyone on the journey, so don’t hesitate to contact us!

Q:  Can you say more about what the Design period (first 9-12) months will be like?

A:   During design, you should think concretely what sites and patients will engage at the start, at 2 years, and what is the trajectory for 5 years.  It depends on your aspirations.  We typically recommend around 15 clinical care sites (maximum 30) to start with.  A network is very expandable once you have the basic pieces in place.  Some networks will be ready sooner to take big steps. Yet everyone is welcome to the community.  Being part of a community allows for knowledge sharing, but also a cadence and motivation to stay involved in doing the work of building the system.

Q:  What is a typical staffing model and cost of running a network? 

A:  When we start a network to support 15-30 sites, we have a typical network staffing model of about 2.0 FTEs, total, to sustain the LHS model.  That is possible in two scenarios: 1) you re-allocate existing people with the funds to support them; or 2) you raise funds to support those 2.0 FTEs.  Typically, running a network of 15-30 sites costs $500-$750,000 a year in annual operating costs.

We have laid out a standard staffing model on the PCORnet Commons.

Q: Are we expected to show matching support that goes beyond the 2-year life of the grant, or only a strategy to find funding support?

A:  The further along you can be by Dec 5, the better off you are.  Our team and PCORI are interested in helping networks both brainstorm and do fundraising in the community to pursue particular avenues. We are planning on devoting Office Hours time to this in Nov.

Q:  Should we plan on having support only from our core network team, or can we expect some people from Cincinnati to support us?

A:  Networks that lack someone to fill some of these roles — like an experienced collaborative improvement expert (QIC), project manager, data manager, etc. — can tap into Cincinnati Children’s and IHI’s resources, if you let us know your needs.  Our most important goal is for your network to build capacity in all of the different roles so you can do this work yourselves.

Q:  The RFA asks us to provide an organizational chart.  Is that the organization of our PPRN or the member organizations that constitute our PPRN?

A:  Including any organizational charts which help us to understand your governance and decision making processes as a developing LHS would be helpful.

Q:  Our “official” biosketches leave out some of our activities and publications. May we submit alternative  biosketches, for example a resume? 

A:  Yes. Biosketches are supplemental so please provide the information you believe to be most relevant to reviewers in understanding the key leaders, decision makers, etc. in your network.

Q:  By Dec. 5, are we expected to have received solid commitments from clinical sites to participate in the LHS?

A:  The further along you can be toward solid commitments by Dec. 5, the better off you are.  Remember, for clinicians and health systems, participation in a network brings immediate value:  CME credit, MOC credit, U.S. News & World Report rankings. Also, your network’s efforts might align with and support your hospitals’ own internal QI efforts, which are often wanting for funding.

Some additional care site recruiting may take place during design, but we recommend doing as much as you can before Dec. 5.

Q:  Can you help us with recruiting care sites?

A:  We can help you with recruitment materials.  Some networks said their patients could recruit clinicians; but we think network leadership has to go beyond relying on patients, because a clinic has to start standardizing their care and that takes resources from the care site. So network leadership probably has to be in touch with any care site.  In our experience, about one-third of potential centers will be eager to eager to join right away, so focus on them first.

Networks who already have centers and patients organized should think about their scale-up strategy 2-5 years out.

Q: Can you say more about other potential sources of outside support or funding?

A:  There are various sources of funding: CMS, Medicaid state health systems, health system funds, advocacy organizations, etc.  We think a mix of health system funding and advocacy funding is beneficial because this bespeaks strong commitment from two key stakeholder groups.

Q:  Between now and Dec. 5, are we expected to identify our desired outcome measures? For some of us, it might take 3 months of rigorous work to get to the right level of specificity. 

A:  It is an iterative process, but you should start now with all relevant stakeholders and get as far as you can by Dec. 5.  Do not wait to get started.  During design you will come to a rigorous measure that everyone can rally behind.  In your application, you can say what you think the measure(s) might be, and say you have a process to align your clinical sites — that would be a big step.  Our team is available to think this through on coaching calls as you get deeper into building your application.

Q:  What level of granularity in our big outcome do you expect?

A:  The more granular your outcome measure the better.  For example, ImproveCareNow’s main outcome measure is % of patients in remission; and 10 years on, that measure still brings the network together.  We would recommend a health-related outcome or outcomes that are meaningful to patients.  It could be a PRO outcome, but then you must figure out how to collect the data.

A process measure like # of visits is usually not compelling enough to motivate groups to work together. Your goal has to be fairly bold.

Your outcomes need to be specific, tangible and measurable.  If you can at least get to the concept of what goes in the numerator and denominator, then you can see how to measure it at a population level.

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