Most Americans think the U.S. health care system is troubled. Nearly three-quarters say it is “in a state of crisis” or “has major problems,” according to a 2018 Gallup survey.
Dr. Kevin Carr concurs with that diagnosis. The Milford resident is the chief executive of the National Coordination Center, a newly formed, Washington, D.C.-based corporation dedicated to sharing health care best practices through a network of national collaborators. The NCC intends to address some of the nation’s most pressing health care issues by “connecting the brightest minds from the most successful organizations” in medicine to aid patients, insurers and health care networks.
Carr, a 45-year-old internist, completed his undergraduate studies followed by medical school at the University of Alabama at Birmingham. A chief residency at Yale led to a four-year stint on its faculty, where the seed of mission-focused work was planted. During a Yale residency at Waterbury Hospital, he was part of a program called Project Access, which enrolled underserved patients without insurance into charity networks. “We were able to get 300 volunteer providers to see patients for free,” Carr recalls. “We were very tactical: participants had a test, they got a medication or had surgery and were able to return to work, so that cycle of being sick without insurance and bouncing in and out of the ER got broken.”
Carr saw how true collaboration across organizations and tapping into the strengths of each could drive systemic change to a patient’s experience.
Over the past 15 years, Carr went on to serve health care organizations in the U.S. and internationally. He’s found that both federal and commercial health care organizations need outside help to overcome the largest challenges, often turning to sprawling consulting firms. “My experience with consulting firms is that you can find a talented team or person, but the thing that made them challenging is their profit-driven native environment and incentives don’t always align with certain types of really intelligent individuals. Particularly clinicians; at their core, they want to do something good. If you uproot them, put them on the road 3-5 days a week, then they stop seeing patients, stop engaging with their network, miss their families … in short, the ability to use them as effectively is diminished.”
The National Coordination Center takes a different approach, leveraging industry professionals while allowing them to continue working at their organizations. The NCC then supports the individuals with project management specialists who are full-time NCC employees.
The power of partnership
After assessing the landscape came shaping the core network of health care talent. Carr began reaching back to friends and colleagues who had complementary industry and content knowledge, whose acumen fell under three interwoven categories: navigation, interoperability and technology.
Dr. Harlan Krumholz is a leading cardiologist and quality measure improvement leader at the Yale Center for Outcomes Research and Evaluation (CORE). He was one of the first people Carr called when forming the NCC. As a key leader in shaping the collaborative, Krumholz says, “The old mindset that academic medical center leaders have to all create their own siloed teams is becoming a thing of the past. If the NCC stays true to its mission, it can become a major catalyst for change by breaking down organization barriers and connecting people that did not even know each other existed previously.”
Carr explains, “Dr. Krumholz is a senior leader with a large number of impactful projects already on his plate. I couldn’t ask for 100 hours of his time on a particular project; his commitment to Yale precludes that. But I could reasonably request 10, and have other NCC professionals or CORE team members assist with the heavy lifting.”
Another of the first recruits was Dr. Harold P. Freeman, renowned cancer treatment pioneer and founder of the Institute of Patient Navigation in New York City. A mentor of Carr’s, Freeman was director of surgery at Harlem Hospital, and saw first-hand that many impoverished patients were coming in too late, especially those with breast cancer. “People had difficulty getting into the system and being treated in a timely way … similar to the challenges veterans are facing today,” Freeman says. “I found a way to get women breast cancer screenings free of charge. But there was still a gap between discovery and resolution. I came up with ‘patient navigation’ in 1990, to get people through the system with good quality care. This is one of the major problems with American health care today.”
A recent five-year, $25 million National Cancer Institute study revealed patient navigation has the power to increase the number of screenings from vulnerable populations, and shorten the time from finding to diagnosis to treatment.
Freeman says, “At first I received some resistance from Harlem Hospital administrators. But that subsided as they realized patient navigation saves money. It was delivering [insured] patients, and marrying primary to tertiary care.”
Freeman brings the institute’s three guiding principles to the NCC table: 1. be patient-centric, 2. eliminate barriers, and 3. help navigate people across disconnected systems of care.
The next NCC puzzle piece: increase data liquidity, or the ability to freely share information across multiple devices and systems. Enter Ed Cantwell, chief executive of the 6-year-old Center for Medical Interoperability in Nashville. CMI is drawing up a common set of technical standards for companies like GE and Philips, and building a certification center to verify that health devices and systems will run on those standards.
“The principle of data liquidity says, in a highly functioning digital industry, all data should be able to go anywhere,” Cantwell says. “Most hospitals don’t have the plumbing; faxing is still the norm. On top of the plumbing is a trust network, which governs what data goes where under what circumstance for how long, who stores it and the attributes needed to do so. Data liquidity then becomes the currency of innovation.
“Our U.S. health care system should have been built like an interstate highway, but we had no Eisenhower.”
But what of the challenge of overcoming administrative resistance? “You do it like every other industry,” Cantwell says. “Get all the CEOs that own the health systems and write the checks in a room. Motivate them to be leaders at this point in history, wrap a tech team around them, develop architectural fixes, use your procurement power to drive it into their system. Stand up to the vendor community, and stand up to the dysfunction in the industry.
“In 2026, Medicare/Medicaid will run out of money. CMI is an attempt to structurally address the inefficiency of our health care system, because it’s not a system. I’m a veteran and former fighter pilot. If you’re an active-duty warfighter, retired, or a wounded vet, my God, why shouldn’t you have a unified longitudinal record? Wherever you go, your data should go with you.”
One of the first populations to benefit from the National Coordination Center will be military veterans. “The Veterans Administration has always been near and dear to my heart,” Carr says. “There are so many veterans in my family … my grandfather, brother, nephew. My brother came back from war with certain issues; he had melanoma a few years back. Even with VA insurance, it took him nine months to get with a provider. I thought, there has to be a more expedient way for vets in need to receive treatment.”
The Veterans Administration is an NCC client. Brought in to assist the VA was tech solutions provider Cerner, a Missouri-based manager of electronic health records whose products are used at more than 27,000 facilities around the world.
“A lot of large transformation projects have a federal component, like what we’re doing with the VA … implementing electronic medical records at 1,700 sites of care,” Carr says.
This year, Carr hopes to add another three to five health plans, hospital networks or provider organizations to the client roster, with projects like increasing the quality of care insurers pay for.
“What really strikes me about the NCC is that so many smart people really care about making patients the No. 1 priority,” Carr says. “What makes me happiest? What I tell my patients, partners and employees all the time: I can’t wait for you to meet each other and realize how amazing you are.”