I went to a conference this morning at the Hope Street Group, a DC-based think tank. They had a panel of doctors, PhDs, a lawyer, consultants, John Podesta (Clinton's healthcare czar) and an economist discussing Using Open Innovation to Reinvent Primary Care.

Panel moderator was former Washington Post healthcare policy reporter Ceci Conelley who jumped ship to McKinsey probably for gobs more money.

While no one mentioned the P-word (price) a great deal of the discussion centered around reducing costs.

Some points were really interesting. Among them:

One of the panel's recommendations is 'Use new people, places and tools to achieve greater capacity at lower cost'. Great idea and that's why so many primary care practices are relying more heavily on Physician's Assistants and Nurse Practitioners.

They wanted to take it much further and have a third tier of community healthcare worker who could perform basic services such as giving injections and many of the other functions at primary care facilities.

The problem with this, as someone pointed out, is you have to redraw the boundaries of what different medical practitioners are allowed to do. Patients are taught to give themselves shots, but in a licensed medical practice no one below a nurse can do that.

This kind of 'circle the wagons' thinking reminded me of a nurse practitioner friend who wanted to teach and was doing so at the University of San Francisco where she got her masters. She taught one semester and was booted out even though she was very popular with the students.

Why, you ask? Because she was teaching at the nursing school and the Board didn't want a nurse practitioner teaching those studying to be RNs. That our role is sacred philosophy in healthcare is part of why reform is so hard. And it's not going to change easily or quickly.

There's a program called 'Texting for Healthy Moms and Babies' that sends weekly text messages to pregnant women timed to their babies due date. So far 18,000 women have signed up and it's just rolling out. But it could create new models for how to deliver information about routine healthcare issues

Empower consumers to take personal responsibility for improving their health through education, interactive tools and incentives. Bush 41 started this and we haven't come very far with it in how many years has it been - 20? There are new tools though that can be used in new ways.

Someone mentioned the development of a Facebook for healthcare - Healthbook as they called it. Not really sure how it would work but I think it's a good idea to have a place where the general public can get together and network about about healthcare challenges, providers, etc.

Electronic medical records that are portable and accessible (within privacy guidelines) can help spur this process along.

Leverage technology, patient engagement, population management and payment reform to accelerate smart processes. The Veteran's Affairs (VA) healthcare information and services provides a model for how to do this. When logged into HealtheVet consumers can refill prescriptions online, get wellness reminders and participate in secure messaging from their healthcare team.

Another technology is Virtual Doctors and Healthcare Providers who talk to their patients via computer and even conduct routine exams that way. I can't really imagine how it would work but it's being tried in a number of hospitals and provider settings.

If you are interested in learning more go to www.hopestreetgroup.org.