Forbes is known for its lists – America’s richest people, most expensive zip codes, most promising companies and more. This year, for the first time in its 94-year history, Forbes released a new list – the top 30 social entrepreneurs. We’re proud to announce that Pioneergrantees made the list – twice!

Jay Coen Gilbert, Bart Houlahan and Andrew Kassoy made the list for B Lab, a nonprofit that certifies businesses as “B Corporations”—companies that adopt a legal structure requiring them to create value for a broad set of stakeholders—employees, communities and the environment–not just their shareholders.  Their hope is that certified “B Corps” will flourish by attracting consumers who are looking to support businesses that align with their values and helping investors to drive capital to higher-impact investments with greater social responsibility, as well as financial returns.  To be certified, companies must adopt the legal structure and pass an annual B Impact Assessment. Under their Pioneer-funded grant, B Lab will develop the first set of criteria to assess a corporation’s performance in areas of employee and community health and safety to be included in the annual assessment.

Sara Horowitz is listed for founding Freelancers Union, which provides affordable health insurance to freelancers, consultants and temps who don’t have access to employer coverage. Her grant from Pioneer enables the Freelancer's Union to expand its group purchasing health-benefits program from New York into New Jersey and Georgia.  A previous grant established the for-profit Freelancers Insurance Company to design a health plan model for freelancers in New York state that combines catastrophic insurance coverage with coverage for prevention and wellness services.

RWJF’s Vulnerable Populations Portfolio is also excited to see two grantees on the list. Jill Vialet made the list for founding Playworks, which improves the health and well-being of children by increasing opportunities for physical activity and safe, meaningful play. Playworks sends trained, full-time coaches to low-income, urban schools, where they transform recess and play into a positive experience that helps kids and teachers get the most out of every learning opportunity throughout the school day. Rebecca Onie is included for co-founding Health Leads, which mobilizes undergraduate volunteers to help patients fill “prescriptions” shared during provider visits for basic resources needed to be healthy, like food, heating assistance, child care or housing. Health Leads is one of many promising models addressing social needs through the health care system.

As team director of the Pioneer Portfolio, I’m thrilled to see our grantees singled out as innovative entrepreneurs. These innovators represent the kind of leadership and ingenuity that can help us tackle the tough health and health care problems we face in the U.S. Check out the story and don’t forget to congratulate Jill Vialet (@jillvialet), Rebecca Onie (@rebeccaonie), Sara (@Sara_Horowitz) and the B Lab crew (@BCorporation) on Twitter using the #Impact30 hashtag.

BY DR. JASON HWANG, Executive Director of Healthcare, Innosight Institute

Jason Hwang, MD, MBA is an internal medicine physician and executive director of healthcare at Innosight Institute, a nonprofit social innovation think tank he co-founded with Harvard Business School professor Clayton Christensen, the world’s foremost authority on disruptive innovation. Through a grant from the Pioneer Portfolio, Dr. Hwang has worked to apply the principles of disruptive innovation to the health care delivery system. Disruptive innovations occur when new business or delivery models displace overly complex and costly, expertise-intensive models. Highlighting work from the Pioneer-funded studies, Dr. Hwang recently described the need for innovation in health care in a post on CNBC.com and was featured in a Human Ingenuity series on Forbes.com.

Why have select integrated health systems outpaced their peers across nearly all quality and cost measures? More than one year ago, Innosight Institute–a nonprofit think tank co-founded by innovation expert Professor Clayton Christensen of Harvard Business School –set out to answer this question by identifying the critical factors and decisions that led to successful, integrated health systems.

Our findings are documented in the paper "Disruptive Innovation in Integrated Care Delivery Systems," which is the culmination of research on seven different organizations representing a wide spectrum of health systems around the country. Major observations and findings include: 

• Successful innovations that may be incorporated into today’s ongoing integration efforts, including mergers, accountable care organizations, and virtual assemblages being formed to participate in bundled payment programs and pay-for-performance contracts;
• The importance of expanding the scopes of practice of various clinical staff, including nurse practitioners and physician assistants, to ensure access to quality care through disruptive delivery models;
• Best practices in the use of electronic health records and health IT that should be implemented across all health systems as stimulus funds promote their widespread adoption.

Identifying these success factors is a crucial step forward in paving the way for similar organizations to be cultivated elsewhere and ensuring that one day every American will have access to high quality, affordable care.

Innosight Institute is also pleased to release its latest case study in conjunction with this project, which documents the experience of Sentara Healthcare in Virginia as it prepares for significant changes in how health care will be delivered and priced in the future. Pilots focusing on chronic disease management, bundled payments for procedures, and a patient-centered medical home are underway, yet Sentara is also acutely aware of the challenges these new delivery models pose to its successful, hospital-led health care system.

Not content with simply reacting to change, Sentara also created a test bed for wellness initiatives by targeting employee health with a program that includes a $500-per-employee rebate and has resulted in a return on investment of $6 for every $1 invested in the program. Meanwhile, the organization’s health plan, Optima Health, has sought to grow its consumer-directed, high-deductible health plans by first developing information and pricing tools for patients.

I invite you to read about Sentara and our other case study subjects: HealthPartners, Lancaster General Health, Presbyterian Healthcare Services, Group Health Cooperative, Grand Valley Health Plan, and Baystate Health (forthcoming).

Finally, I offer my special thanks to Robert Wood Johnson Foundation’s Pioneer Portfolio, whose financial support made this work possible.

 Over the past several months the Innosight Institute, a think tank that applies Clayton Christensen’s theories of disruptive innovation to the social sector, has been exploring the critical factors necessary for facilitating disruptive innovation in health care in integrated delivery systems to achieve increased quality, reduced cost, and access improvements. The work, which is funded by the Pioneer Portfolio, has already produced five case studies, including recent additions that look at processes at Grand Valley Health Plan, Group Health Cooperative, and Presbyterian Healthcare Services.

To learn how Grand Valley provides a high level of access at a low cost of care, how Group Health is employing a successful Medical Home program and how scarcity became “the mother of invention” atPresbyterian Healthcare Services pleasecheck out the full case studies here.

I'm thrilled to attend TED this week. In addition to being open to new ideas that might morph into fundable projects for RWJF, I’ll be expanding and refining my thoughts about measuring “pioneer-ness.” This means trying to distill a core definition of "pioneering" and validating this definition – seeking, in the end, a scale and/or indicators rwjf staff and others can use to objectively score the ideas we support.

I plan to collect data by having each RWJF program officer here rate presentations as "pioneering, innovative, interesting, or not that interesting" and by interviewing fellow attendees about how they make determinations about the ideas they're hearing.

As the week goes on, I may find I have a checklist I can use to score each idea.

 I may not.

If I had to answer the question today of "what is pioneering”—and how you measure it – I'd say, without taking credit for the language: 

“Pioneering ideas have potential for breakthrough solutions to emerging or persistent problems."

If I had to answer the question today, how do you make decisions about pioneering (vs merely innovative) ideas, I'd say:

“RWJF pioneer team members seem to know it when they see it.”

If I had to answer the question today of  "how do you measure ‘pioneeringness,"  I’d say:  

“I don't yet have good indicators, but a scale to measure "pioneer-ness" would surely include elements of newness, unexpectedness, risk (carefully defined),and  the potential for a leap in progress. These projects also have the potential to transform health care with out-of-the-box solutions.”

I'm not sure if I would include the elements of elegant or simple, but I'm expecting to be most blown away by ideas that I understand but never would have come to me.

I hope a few new ideas will come to me as well.

Update to original post: I’ve been asking each of my colleagues (and TED attendees I’ve interviewed) to rate the ideas presented as Pioneering/innovative/interesting.

I found that scale limiting, and have expanded to: Pioneering/innovative/important/interesting. Though something can be innovative, but not important technically, so I’m going to work with this scale until it breaks down.

Here are some words and concepts that are being associated with the concept of pioneering:

• (un)Predictability: However, it’s not always clear what’s better in terms of impact. Julie Taymor talks about the value of not knowing where you are going to end up, so I think that having a project that allows for unpredictable outcomes will have  more pioneering potential.
• Simplicity
• Understandable
• Done before?
• Tried before: This is a real challenge. I’ve started with a score of pioneering for more than one idea, until speaking with others and finding out that someone else has done this before.
• Redefine rules?
• Suggest an infrastructure?: This is likely to result in lasting social change (no need to define the type of change..maybe that’s unpredictable)
• Hypothesis driven?
• About discovery?

I’ll continue to hone this scale throughout the remainder of TED and will let you know how things shape-up after the conference. 

TED2010 – the Technology, Entertainment and Design conference – kicks off today and runs through the 13th in Long Beach, CA, with the Pioneer Portfolio resuming its role as an event sponsor.  There’s an amazing lineup of speakers, and we’re especially excited that two Pioneer grantees will take the main stage.  Nicholas Christakis of Harvard Medical School will be speaking on Thursday about the power of our social networks to influence the spread of health and social phenomena, including obesity, happiness and smoking cessation.  And Phil Howard, chair of Common Good and leading spokesperson for the work we have supported to test administrative health courts to overhaul our broken system of medical justice, will address the TED audience on Saturday.  

They’ll be among impressive company, joining speakers and performers including HIV vaccine researcher Seth Berkley, molecular technologist George Church, Bill Gates, musicians David Byrne and Sheryl Crow, behavioral economics founder Daniel Kahneman, game designer and Pioneer friend Jane McGonigal, chef Jamie Oliver and former CIA operative Valerie Plame Wilson, among many others. 

We’ll be leading two activities at TED – a luncheon on Thursday that will highlight the future of data-driven, patient-centered care.  We’re teeing up the following questions – in a world with abundant, accessible, actionable health data, how will our level of engagement in our health and health care change?  What expectations of doctors, nurses and other providers will we have, and what expectations will they have of us?  If we have and use our data – both those logged in our electronic medical records and those generated in the course of our everyday lives – how might our decisions change?  Behaviors?  Demands? 

It’s a fascinating conversation, and one that will feature Pioneer team director Paul Tarini as moderator WIRED executive editor Thomas Goetz and Beth Israel Deaconess primary care visionary and Open Notes grantee Tom Delbanco.  Thomas is releasing a book called The Decision Tree later this month that explores this new approach to health in which patients harness their data and use decision trees – essentially health-oriented flow charts – to engage more meaningfully in health decisions and manage their care more intentionally, leading ideally to better outcomes.  Tom will spotlight the role for providers to innovate in this space.  He’s leading the way in making health data for the patient – not just about the patient – by placing the information doctors enter in our medical records and clinical encounter notes,directly in our hands and revolutionizing our role in our health care.  We'll record the event and post it as a Podcast later in the week.   We’ll also be running an exhibit space all week, the centerpiece of which is a video drawn from interviews with a range of Pioneer staff, grantees and other experts on the leading edge of this data-driven, patient-centered vision.  A big shout out to our partners at DDB Issues and Advocacy, who turned hours of telephone interview transcipts in to a beautiful, dynamic and thought-provoking brief video that makes text – and these ideas – jump off the screen and challenge you.  I love this video and urge you to check it out and add your ideas and reactions on our YouTube page.

Pioneer will be live-tweeting from TED and we invite you to join us in the conversation on Twitter, where you can provide your answer to this: In a world rich with actionable health data, how will our relationship with doctors change?  Use the #pioneerdata hashtag and spread the conversation online.

Finally, we’ll be blogging the sights, sounds and stories of TED this week, so check back frequently.