Important Dates:

• Expected launch date: August 2017
• Expected application deadline: November 2017
• Funding start date: March 2018

Rewarding Success Overview:
To change the paradigm of how successful innovative implementation research is rewarded, CIHR has designed the SPOR Rewarding Success Initiative that will incentivize multidisciplinary research teams and their partners to enhance value-based care, health system sustainability, and health outcomes. Teams will design, implement, and evaluate interventions in healthcare delivery organization(s) that aim to produce healthcare cost savings and/or improved health system efficiency.
 
The SPOR Rewarding Success Initiative is an experimental funding model that is being piloted in five provinces: British Columbia, Alberta, Manitoba, Saskatchewan, and Newfoundland & Labrador. This initiative is similar to other funding models that have been developed to support innovation and impact, such as risk sharing, social impact bonds, and innovation prizes. The basic principle is that teams of patients, healthcare delivery organizations, clinicians, and researchers identify potential solutions to identified problems and priorities in health care; solutions that will enhance patient and provider experience while also:

1. reducing low value health care (e.g. unnecessary diagnostic tests/ drugs), and/or
2. addressing health care inefficiencies (e.g. wait lists), and/or
3. reducing avoidable morbidity (e.g. stroke)

Teams will partner with payers of health services (e.g. Ministries of Health, Regional Health Authorities, insurers, hospitals, etc.) and/or charities and philanthropic organizations who recognize the identified challenges and agree to pay for successful improvement in outcomes, efficiencies, or reduction in low value services based on actual (e.g. lower drug costs) or measured but not readily retrievable savings (e.g. reduction in hospital admissions). Teams and their payers will work together to determine the outcomes, the metrics to be measured, the value of the payback, and the mechanism of the payback. If agreed-upon outcomes are achieved, there will be redistribution of a portion of the savings by the payer, which may be returned to the multidisciplinary research team, and/or redirected into an Innovation Fund, depending upon the agreements outlined.

Rewarding Success Design:
There are three phases to this initiative to enable the realization of the creative solutions to provincial challenges: ideas will be generated in collaboration with health system payers, relevant ideas will and be pitched to a peer review panel, successful teams will have the opportunity for promising ideas to be developed, and finally the feasibility of potential solutions to be tested and adapted. Teams will take advantage of innovative clinical trial designs to institute complex interventions that will allow them to fail fast and iterate to improve the likelihood of success. Use of an iCT design will also enable unambiguous attribution of the effect of the intervention(s) employed to improve value and efficiency in health care.

Phase 1: Idea Brief and Travel Awards (Letter of Intent)
The Idea Brief provides applicants with the opportunity to outline their proposed idea to enhance value-based care, and/or address novel ways to scale and spread successfully implemented innovations that improve value for money. Ideas should address one or more of a participating province’s priorities or on a significant challenge the applicant identifies and believes to be of importance. All Idea Briefs must identify the multi-sectoral team (researcher, clinician, patient and healthcare delivery organization), as well as the payer that will work together to develop and implement the idea in the health system delivery organization. The top four Idea Briefs per participating province will be invited to the Ideathon to pitch their idea. Travel Awards will be available to offset travel and accommodation costs for those invited to attend the Ideathon.
 
Phase 2: Ideathon and Business Case Development Grants (Full Application)
The Ideathon is a national two-day event hosted by CIHR in February 2018 to bring together all successful Idea Briefs. Three individuals (i.e., two members of the multi-disciplinary research team and the payer) will represent each team to pitch their ideas to the review panel. There is no additional written application required. The two top-ranked pitches within each participating province will be awarded a Business Case Development Grant which will support the following activities:

• Feasibility testing and adaptation of the intervention idea and the implementation approach to optimize the likelihood of successful execution in a healthcare delivery setting
• Aligning partnerships
• Refining  selected targets
• Establishing all outcomes and metrics
• Establishing  timing and value of pay back
• Working with payer(s) to determine payback mechanism
• Developing contracts and agreements
• Establishing independent evaluation/audit partner

Strengthening Workshop: During the business case development stage, there will also be a Strengthening Workshop on adaptive, complex intervention trials and financial and legal frameworks that can be employed in a Rewarding Success financial model. All teams who receive Business Case Development Grants will be required to have two representatives attend this workshop. Funds from the grant may be used to offset travel and accommodation costs associated with the workshop.  
 
Phase 3: iCT Rewarding Success Team Grants
Only projects funded through the Ideathon for a business case will be considered for the iCT Rewarding Success Team Grant phase. The multi-year iCT Rewarding Success Team Grants will focus on the implementation and evaluation of programs/interventions to improve value in a healthcare delivery setting. Outcomes, both intended and unintended, and savings will be measured, and audited through an external auditing process. If agreed-upon outcomes are achieved, the payer will pay back the agreed-upon amount to the research team, and/or an Innovation Fund, depending upon the agreements outlined in the Business Case Development Grants. CIHR’s contribution will be $12M over four years with 1:1 matching from non-federal sources of funds. With this budget, a minimum of five teams can be funded, with each participating province having one funded project, if the team meets the fundable threshold for excellence.

       Rewarding Success Funding: 

• The total amount available for Phases 1 and 2 of this funding opportunity is $1,050,000.
• Phase 1- Idea Brief:  The total amount available for this phase of the initiative is $50,000, enough to fund approximately 20 travel awards, up to four (4) per province. The maximum amount per travel awards is $2,500.
• Phase 2 – Ideathon: The total amount available for this phase of the initiative is $1,000,000, enough to fund approximately ten (10) grants, up to two (2) per province, for the duration of one (1) year. The maximum amount per grant is $100,000.
• Matching funds from non-federal government partners are NOT required for Phases 1 and 2 of the initiative.

       Rewarding Success Provincial Priorities:

Alberta

1. Addictions and Mental Health
2. Home and Community-based care, including rural, remote and indigenous communities
3. Health Information Management
4. Health Workforce

British Columbia

1. Coordinated primary and community care:
   • Complex medical care and/or supports for frail patients (including people living with dementia)
   • Complex mental health and/or substance use
2. Improved access to surgical services (perioperative services)
3. Consideration for accessibility of services in rural, remote, First Nations communities
4. Innovative health technologies to facilitate patient-centered, team-based care, and to enable secure access to health care services and information

Manitoba

1. Optimal Health System design to support fiscal and clinical efficiencies
   • What models of care in other jurisdictions have been effective in improving health outcomes, individual experience of care, reducing per capita costs and inequities? Such as accountable care style organizations, where a network of doctors and hospitals share responsibility for providing care to patients or  provincial /localized models
   • How to improve transitions to and from hospitals and facilities to community based primary health care and community supports?
   • The spread and scale up of interventions that support population health improvement and reduction of health equities.   This could involve the scale up of successful projects that have worked on a smaller scale such as translating research in elder care in personal care homes.
   • To engage and evaluate the impact of patients as partners in health system redesign.  
2. Performance management and economic evaluation to measure efficiency and effectiveness
   • Explore funding mechanisms and payment systems that meet patient needs, reduce barriers to collaboration and endeavor to fund the optimal mix of providers and/or organizations for the complexity of care provided.
   • Support the development of data and methods to support identification of cost effective programs to inform decisions, planning, resource allocation, program evaluation, and impact assessment.   For example, economic evaluation methodologies such as cost effectiveness and return on investment analysis or role of surveillance across the continuum.
3. Redesign of community care to support continuity of care and reduced health system utilization
   • Determine how to best optimize service integration and coordination across community primary health care services with special attention to underserved or structurally disadvantaged populations and patients with complex needs. Populations of interest include Indigenous peoples, elderly and again adults, infants and children, new Canadians and individuals living in rural and remote communities.
   • Develop tools and capabilities to support Manitobans (and their health care providers) better manage their health, wellness and treatment. 
4. Mental Health and Addictions services to support improved outcomes
   • Explore interprofessional models that integrate health and social services and physical and mental health care to improve coordination along the continuum of services from health promotion to management, treatment and acute care services.  
   • Redesign of mental health and addictions services to support access to mild to moderate mental health services in primary care settings

Newfoundland and Labrador

1. Home and Community Care
2.  Mental Health and Addictions
3. Primary Health Care
4. eHealth / Health Information Management

Saskatchewan

1. Improving patient flow through the system and reducing waits for care in emergency departments. Saskatchewan’s connected care strategy aims to ensure appropriate care (i.e., right care, right place, right time) in both acute an primary health care settings; focusing on high quality care transitions between acute and community care and strengthening primary health care delivery through the development of primary health care networks.
2. Mental health and addictions – Testing innovative models for prevention and treatment delivery that address gaps in access, cultural appropriateness, equity, and effectiveness.
3. Appropriateness of care – focusing on clinical quality improvement through: addressing inappropriate/unnecessary treatments and testing; increasing uptake of evidence based clinical best practices, guidelines and decision support tools; reducing unwarranted clinical variation; and reducing medical errors and patient harm related to clinical practices exploring their effectiveness (e.g. stroke care; complex patients with multi-comorbidities)
4. New models of physician engagement – a demonstration project to co-design, test, and evaluate a model to address/develop physician leadership, relationships, data and accountability, and compensation (e.g., applying learnings from Kaiser Permanente model).

 
Where can I learn more?

• Stay tuned for the new Rewarding Success Initiative website
• Information webinars:
  • Tuesday September 5 from 11:00 am – 12:00 pm
  • Wednesday September 6 from 2:00 pm – 3:00 pm
  • More information on how to register for webinars to follow
• For questions, please contact SPOR at spor-srap@cihr-irsc.gc.ca