NEJM Catalyst

NEJM Catalyst Practical innovations in health care delivery:

Ideas, solutions, and case studies to improve patient care and drive value in health organizations.

Health care delivery is undergoing a major transformation around quality, cost, and access. NEJM Catalyst brings health care executives, clinician leaders, and clinicians together to share innovative ideas and practical applications for enhancing the value of health care delivery. NEJM Catalyst brings insightful articles and real-life examples from a network of top thought leaders, experts and advisors to provide:

Practical innovations in health care delivery;

Impeccable quality and impact;

Active contributions from renowned authorities, thought-leaders, and advisors;

Independent and impartial curation; and

An exchange of ideas among executives and clinicians. NEJM Catalyst is produced by NEJM Group, a division of the Massachusetts Medical Society, located in Waltham, Massachusetts.

View the September 2025 issue of NEJM Catalyst Innovations in Care Delivery: https://nej.md/3HztCDc (link in bio)
09/02/2025

View the September 2025 issue of NEJM Catalyst Innovations in Care Delivery: https://nej.md/3HztCDc (link in bio)

Physician leadership that understands the financial aspects of health care can lead to unique roles that directly work t...
08/29/2025

Physician leadership that understands the financial aspects of health care can lead to unique roles that directly work toward improving patient care and financial operations. Read/listen to our conversation with Greg Esper: https://nej.md/45QK5uH

Cedars-Sinai Medical Center sought to learn from the national shortage of intravenous (IV) fluid created by a natural di...
08/29/2025

Cedars-Sinai Medical Center sought to learn from the national shortage of intravenous (IV) fluid created by a natural disaster.

IV fluid therapy should be tailored to patient needs, and giving all patients standardized fluid orders accomplishes very little and may indeed cause harm.

In parallel with the IV fluid conservation efforts, leaders looked for impact on patient outcomes. Ongoing efforts to decrease length of stay and improve hospital capacity were not interrupted by IV fluid conservation. In the aftermath of the fluid shortage, overall rates of IV fluid use settled at 75% of pre-hurricane levels: https://nej.md/45PW9O6

There is a growing interest for health care delivery organizations to focus more heavily on managing the health of popul...
08/28/2025

There is a growing interest for health care delivery organizations to focus more heavily on managing the health of populations, which can be a transition for organizations that traditionally concentrate on acute and specialized care.

Furthermore, many health care organizations may have limited experience in managing social drivers of health, which require critical strategies for improving community well-being.

Future of Health, an international community of senior health leaders, collaborated with the Duke-Margolis Institute for Health Policy to identify priority actions for advancing population health worldwide.

Key strategies were identified to embed a culture of accountability for population health within health systems, foster innovative partnerships between health care delivery and community organizations, and adopt value-based payment models that sustainably support population health strategies.

This article highlights real-world examples from health systems globally, illustrating successful implementations and the challenges faced in this paradigm shift. By focusing on collaborative approaches and long-term health outcomes, this research aims to guide health systems in advancing population health: https://nej.md/4lypLEd

Evidence-based, practical nutrition and cooking guidance is seen as a strategy to address rising chronic disease burden....
08/28/2025

Evidence-based, practical nutrition and cooking guidance is seen as a strategy to address rising chronic disease burden. However, this resource remains limited in health care settings due to lack of time, expertise, funding, and access to registered dietitian nutritionists (RDNs).

To address this challenge at an academic medical center, the culinary medicine (CM) clinical service line was developed and piloted at a community clinic beginning in December 2022. This unique, billable service provided outpatient consultations with both a physician and a dietitian certified in CM.

The pilot study focuses on the design and evaluation of the first 2.5 years after implementation of this novel service, specifically highlighting the patients referred to the clinic, the source of referrals, and how payers reimburse the CM service.

The model was developed as an interprofessional three-arm CM clinical service line with phased implementation of three billable encounter types: electronic consults (physician to physician or RDN electronic consult), one-to-one clinic consults (patient sees physician, physician discusses with RDN, patient sees RDN), and shared medical appointments (about 10–16 patients with physician, RDN, and volunteers at a community center with a kitchen).

This article provides analysis of the clinical encounter, scheduling, and billing data over 30 months for the novel one-to-one clinic consult implementation and includes description of patient demographics (age, s*x, race or ethnicity), referral data, referral diagnoses, appointment scheduling, reimbursement, and participant and stakeholder experiences.

The pilot demonstrated proof of concept of a novel, insurance-reimbursable CM service line. Initial data show successful reimbursement across payer plan types for common health conditions impacted by diet. Future directions include increasing clinic capacity, understanding patient-level impacts on health behaviors and disease control, and exploring the downstream economic impacts of this service: https://nej.md/4mGMVJB

Optimal glycemic control in type 2 diabetes (T2D) remains an elusive goal despite an expanding range of effective treatm...
08/27/2025

Optimal glycemic control in type 2 diabetes (T2D) remains an elusive goal despite an expanding range of effective treatments and technologies. Sustained, disciplined adherence to lifestyle modifications leads to positive outcomes in T2D, although converting medical recommendations into effective patient action is challenging in real-world practice.
The emergence of AI and machine learning (ML) presents innovative opportunities to prompt effective lifestyle modifications and diabetes goal achievements in highly user-specific and user-friendly ways.

The Twin Precision Treatment system is an AI-enabled bundled system of sensors and coaching that generates personalized recommendations through wearable Bluetooth-enabled technologies (including continuous glucose monitors), targeted laboratory data, Internet of Things, AI-ML algorithms, and human input.

The authors designed a study to explore whether or not this bundled system intervention (INT) could help individuals — with T2D and managed in a primary care setting — achieve glycemic targets while concurrently de-escalating glucose-lowering medications.

The primary end point was a hemoglobin A1c level (HbA1c)

This article examines how the Centre intégré universitaire de santé et de services sociaux du Centre-Ouest-de-l’Île-de-M...
08/27/2025

This article examines how the Centre intégré universitaire de santé et de services sociaux du Centre-Ouest-de-l’Île-de-Montréal (CCOMTL) leveraged a novel approach to health care command center operations, grounded in the Team of Teams framework, to address patient flow challenges across a complex health network.

Moving beyond crisis management, the CCOMTL’s C4 (for care, collaboration, creation, and communication) Command Center integrates social capital — trust, collaboration, and shared accountability — into its operational strategy.

By combining real-time data analytics, advanced communication platforms, and human-centered practices, the command center fosters efficient interprofessional collaboration across the care continuum.

The implementation focused initially on optimizing the flow of alternative level of care patients (i.e., those waiting for access to community care to enable discharge), achieving measurable improvements in access delays and length of stay.

The success of this pilot informed the scaling of the model across the ED, mental health services, virtual care, and overall hospital flow, creating a resilient and agile network. Central to this approach is a cultural transformation driven by face-to-face collaboration, structured daily huddles, and transparent data sharing.

This study highlights the C4 Command Center as a scalable model, demonstrating how the Team of Teams ethos can drive systemic transformation; improve patient outcomes; and create a cohesive, patient-centered health system. The article provides actionable insights for health care leaders aiming to replicate this framework in diverse settings: https://nej.md/46TH3br

Greg Esper, Chief Clinical Financial Officer at Emory Healthcare, discusses his unique role and how his position as a p...
08/26/2025

Greg Esper, Chief Clinical Financial Officer at Emory Healthcare, discusses his unique role and how his position as a physician on the financial team bridges the gap between clinical care and financial operations: https://nej.md/45QK5uH

Successful health care tech adoption requires moving beyond the boardroom to understand workflow integration, cultural d...
08/26/2025

Successful health care tech adoption requires moving beyond the boardroom to understand workflow integration, cultural dynamics, and operational processes that determine whether innovations become indispensable clinical partners or abandoned tools. https://nej.md/4lwAPli

Heart failure (HF) imposes a substantial health care and economic burden in the United States. The Bundled Payments for ...
08/25/2025

Heart failure (HF) imposes a substantial health care and economic burden in the United States. The Bundled Payments for Care Improvement — Advanced (BPCI-A) program, launched in October 2018, aims to reduce costs and improve care quality for conditions including HF.

National evaluations of BPCI-A have reported modest savings with inconsistent impacts on HF, particularly for readmission rates and post–acute care (PAC) utilization. This program evaluation at Houston Methodist, a BPCI-A participant since inception, assesses the program’s impact on HF care by comparing quality and PAC utilization between Medicare fee-for-service beneficiaries enrolled in BPCI-A and HF patients not participating in BPCI-A.

At Houston Methodist, HF care within the BPCI-A program spans admission and postacute phases, coordinated by a multidisciplinary team of value-based care case managers, nurses, social workers, physicians, and care coordinators, who ensure continuity of care from admission through 90 days post discharge. Efforts focus on proactive patient identification on admission, standardized inpatient care, and appropriate postdischarge support.

Clinical episodes from HF admissions (Medicare Severity DRG codes 291–293) between October 2018 and December 2021 were analyzed for 30-day and 90-day all-cause readmissions and discharges to home or home health, hospice, and PAC facilities. Of the 2,831 HF episodes analyzed during the study period, 21% were under BPCI-A. HF care under the BPCI-A program at Houston Methodist during the study period was associated with cost savings, fewer 30-day readmissions, and a greater use of hospice and SNF care after readmission: https://nej.md/4mPiHV3

An integrated maternity care organization, involving primary and secondary maternity care providers, working with the in...
08/25/2025

An integrated maternity care organization, involving primary and secondary maternity care providers, working with the insurer, redesigned two maternity care pathways — one for gestational diabetes mellitus and one for pain relief during labor — to develop an outcome-based shared-savings model, building on an existing bundled-payment arrangement.

The care pathways were evaluated using time-driven activity-based costing, process indicators, clinical outcomes, and patient-reported outcomes.

The new pathway for gestational diabetes mellitus led to fewer referrals to internal medicine, reduced need for insulin therapy, improved patient-reported experiences, and substantial cost savings. The new pathway for pain relief led to a reduction in obstetrician-led pain relief use, but clinical outcomes, patient-reported experiences, and costs remained largely unchanged.

Given the savings achieved in the diabetes pathway, a shared-savings model was developed, with the allocation of savings based on meeting an outcome-based benchmark. This model demonstrates how outcomes can be incorporated into payment models to reward value-improving behavior.

Despite the successful development of the model, there were significant challenges, including aligning cost data with existing reimbursement structures. Nonetheless, the collaboration built a foundation for future innovations in value-based maternity care delivery and payment reform: https://nej.md/3Uy4eRd

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Innovations in Health Care Delivery

Health care delivery is undergoing a major transformation around quality, cost, and access. NEJM Catalyst brings health care executives, clinician leaders, and clinicians together to share innovative ideas and practical applications for enhancing the value of health care delivery.

Since December 2015, NEJM Catalyst has brought together a network of health care leaders to share insightful ideas and real-life examples of innovations in health care delivery, in the form of articles, case studies, quarterly events, and monthly surveys of our Insights Council.

NEJM Catalyst is produced by NEJM Group, a division of the Massachusetts Medical Society, located in Waltham, Massachusetts.