Making the RCT more useful for innovation with evidence-based evolutionary testing

We propose a new innovation model designed to accelerate the rate of learning from provider payment reform initiatives. Drawing on themes from operations research, we describe a new approach that balances speed and rigor to more quickly build evidence on what works in delivery system redesign. While randomized controlled trials provide "gold standard" evidence on efficacy, traditional RCTs tend to be static and provide information too slowly given the CMMI tagline of "We can't wait." Our approach speaks to broader needs within health financing and delivery reform for testing that while rigorous recognizes the urgency of the challenges we face.