The Health Care Innovation Accelerator Pitch Day staged by Penn Medicine was different from most start-up showcases. There seemed to be more at stake.

You could almost hear the angst in the Jordan center auditorium last week as presenters addressed treatment issues, some verging on life and death, that harm patients and push America's health-care costs sky-high.

So what ails the system? And what are the fixes?

Pre-Op+ project presenter and anesthesiologist Marc Royo aims to change the down-to-the-wire nature of pre-screenings for patients with scheduled operations. Nearly all of those phone chats are done at 5 p.m. the evening before surgery. Many cancel at the last minute.

At the other end, 51 percent of discharged hospital patients fail to show at their scheduled follow-up appointment, a dangerous situation being addressed by the BRIDGE Project.

"Our 'a-ha moment' was discovering that the appointment information was buried in the mound of discharge papers the patient takes home," said Rahul Banerjee, a resident physician at the Hospital of the University of Pennsylvania.

The overburdening of a hospital's emergency department by a small number of patients (often mentally unstable) is another shocker. These patients visit from five to more than 30 times a year, shared Anna Doubeni, a family medicine professor, promoting her plan for Superutilization Management. The goal is keep patients better cared for and calmer with human communiqués and the promise of regular appointments.

You may also be surprised by the old-school methods - "snail mail" and faxes - still being used by out-of-hospital labs to return test results. Digging those out is an inefficient and expensive process for providers. And reports can slip through the cracks, noted dermatology professor Carmela Vittorio, developer of the HiRPM (high risk patient monitoring) project.

"Going electronic" can eliminate a bunch of these concerns, presenters said. These include nudging patients better with text messages and posting how-to videos, urging them to take their meds, keep wounds clean, and get out of bed, detailed a team promoting ERAP: Engaged Recovery at Penn Medicine.

Three other Pitch Day presentations were eye-openers.

For the "one in four" pregnant women who now suffers a miscarriage, the innovative PEACE - Pregnancy Early Access Center, already ensconced at HUP - offers quicker and more enlightened care than the women will likely get in the ER, "where you might be seen by any of five different kinds of medical professionals," said Courtney Schreiber, program director of the Penn Family Planning & Pregnancy Loss Center. "By answering just six key questions, we can instantly determine if you need to visit the emergency room or can come to us."

Visiting PEACE instead of the ER cuts thousands in costs, and saves time.

Preparing an advance directive is normally a painful and unsatisfying chore. "The standard form has just a few yes/no options to check," noted Susan Kristiniak, Penn Med's associate director of Palliative Care.

Her new alternative - OurDirectives by Penn Medicine - is an Internet-accessed planner that "will let you 'turn dials' to adjust how, what, and when you want things done. Speaking as a nurse, I know if I was in a coma I would want to be given a couple weeks to wake up, come around. This program [at] lets you fine-tune that decision. And update-share the directive electronically."

Today, fewer than one-third of patients admitted to a hospital have an advance directive on file, she said. Savings could be big here too. Care during the last year of life claims 25 percent of all Medicare costs, the Kaiser Family Foundation estimates. Last year's Medicare budget hit $632 billion.

Without preventive treatment, diabetics run a high risk of retinopathy or glaucoma that can lead to blindness, said ophthalmology professor Thomasine Gorry. But "denial" often sets in "as the [retina-damaging] disease "has a long latency." Literally, the patient doesn't see it coming.

Also at issue, full dilation eye tests, which are standard procedure, "are a put-off for many, who complain it blurs their vision for the rest of the day," Gorry noted.

Now there may be a better way: the new breed, Italian-built, Eidon confocal scanner at the heart of Gorry's innovation project, dubbed Eyes On-Site. FDA-approved, the compact Eidon device needs no drops, painlessly scans each eye in under 30 seconds, and can be set up "close to where the diabetes patients are treated, so it becomes part of their regular checkup . . . In our early tests at HUP, we've had very good acceptance with patients and caught a significant number of cases in good time."

Bottom Line: No winner was declared at the end of Penn Med's Pitch Day, sponsored by the Center for Health Care Innovation. All are low budget with costs borne by Penn Med and Independence Blue Cross.

"In theory, all the projects we've been trialing could build out, go forward," said the system's chief innovation officer, Roy Rosin, a Silicon Valley vet and shepherd of the studies.

"Our primary focus is to make for efficiency and drive high value in health care," he said. The Affordable Care Act - aka Obamacare - has ratcheted up the urgency, Rosin added, "as it both rewards providers for good outcomes and penalizes you for readmissions."