The U.S. health care system faces dual challenges: a continuing quality chasm and costs that are growing faster than the economy. The unifying concept of value, or health outcomes achieved per dollar spent, simultaneously addresses these challenges. The mission of the Center for Innovation to Implementation (Ci2i) will be to produce health services research in pursuit of high-value health care through better access, quality and wiser use of resources. Ci2i will have three thematic research goals (focus areas): Fostering high-value mental health care (e.g., substance use disorder) where suboptimal access and underuse are common, Fostering high-value medical specialty care for chronic disease (e.g., heart, liver, and renal disease), where costly hospitalizations, procedures and drugs demand better management, and Advancing methods to assess and improve value through better modeling and informatics. Together, these clinical areas provide a generalizable portfolio of diverse domains in which value opportunities lie. The methodological innovations produced will support Ci2i's work and advance this field of inquiry. Though we concentrate on specialty care, our purview is not confined to specialists' offices; improving value may mean transforming some care now delivered in specialty settings to lower cost, more accessible venues, such as primary care or even self-care. The concept of the Value Frontier, or the optimal allocation of resources- given current technology-to produce health, guides our research agenda. We will examine where the Veterans Health Administration (VHA) currently operates below the Value Frontier, to identify opportunities for innovation. We will then evaluate clinical and organizational innovations that either move care towards the frontier or transform care more fundamentally by expanding the frontier, particularly through the use of provider-facing informatics. In so doing, Ci2i will take advantage of the exceptionally fertile local environment at our academic affiliates of Stanford University and the University of California San Francisco for enhancing cost-effectiveness modeling, implementation science and structured health systems redesign. In addition to value-oriented research, Ci2i will advance health services research more generally, with particular support for research into the special populations of women and older Veterans. It will continue Palo Alto's tradition as a leader in career development of junior investigators locally and nationally through innovative use of distance mentoring and collaboration. Promoting their career development will be central to Ci2i's commitment to growing the next generation of high value health care investigators. Core investigators' extensive, deep and longstanding network of connections to implementation research centers and delivery system partners will ensure that the innovations we test are relevant to health system needs. The local presence of three Quality Enhancement Research Initiatives (QUERI's) will facilitate hand-off of proven innovations for study of their implementation and for wider dissemination. Ci2i will provide infrastructure support to these and other health services researchers nationwide committed to having a role in VHA's continued journey toward being a learning organization that delivers high-value care. In all of its endeavors, Ci2i is designed to be a model for the new breed of health services research built for both rigor and relevance in support of Veterans' health.
This health services research center will produce innovations that augment the value, accessibility and quality of health care in the Veterans Health Administration and in the United States as a whole. Our extensive, deep and longstanding connections to implementation research centers and delivery system partners will ensure that the innovations we test make a difference. We will focus particularly on value-promoting opportunities in mental health care (including substance use disorder) and medical specialty care (including heart, liver, and renal disease). Improving value, accessibility and quality in these areas will significantly benefit both the Veterans we serve and the overall health care system.