As more and more U.S. patient care organizations take on financial risk, whether as part of formal accountable care organization (ACO) contracts, or through any other kind of risk-based contracting, including bundled-payment contracts or other value-based contracts, the leaders of patient care organizations are finding that the analytics and other solutions available simple aren’t keeping up with their needs in optimizing their operations for risk-based involvement.
In that context, the editors of Healthcare Informatics named IT for risk-based contracting as one of their Top Ten Tech Trends in 2016. Among those interviewed for that article was Bob Schwyn, a Columbus, Oh.-based director in The Chartis Group, a Chicago-based consulting firm. Below are excerpts from the interview that HCI Editor-in-Chief Mark Hagland conducted with Schwyn this spring, in preparing the Top Ten Tech Trends feature for the March/April issue of HCI.
What do you see as the biggest challenges overall, as patient care organizations go into risk contracting?
Starting at 50,000 feet, there’s a need for conceptual readiness, for understanding who you are as an entity, and what your relationships are in your defined market spaces, in order to take on risk. So if I’m in an organization in a market that’s starting to take on more and more risk,” Schwyn says, “the question becomes, how prepared am I as an organization to meet a growing level of risk in the value-based world? Do I have the operational infrastructure? The relationships I need to cover a population? How will I establish those relationships? Do I have the technology infrastructure to support that?
And where do I want to be in the market? Is this an opportunity for us to lead our market in a certain context? Do we want to be the market leader? Or might we be a follower in that arena? And other questions that help set the context for planning, would be, what would the types of relationships—commercial, Medicaid, Medicare? And what kinds of relationships will I need to build with other providers? Will this be a clinically integrated network? Do I want to take all this on my own? Typically, we would look at a three-to-five-year planning arc. And how quickly you more, and how many people will be under risk, will be very important to understand. So being thoughtful is going to critical.
What are the biggest challenges, IT infrastructure- and planning-wise, right now?
That’s a great question. I would tend to agree that the IT industry right now is not where we need to be to support higher levels of risk. However, as an industry, we’re underestimating the capabilities right in front of us. We’ve made tremendous investments in EHR infrastructures, and generally, those EHR solutions do come with some basic EDW and analytics capabilities. So there are ways to achieve some of the short-term needs while still building a more robust and intensive environment in the future. When we talk to organizations, it’s so hard to get them to understand that they don’t need to do everything—to be able to slice and dice in a million different ways across many payers, for example—we’re finding that you may need to do that as you move into a more robust environment.
In other words, you don’t need to start out buying the Cadillac right away, then, when it comes to infrastructure, correct?
Yes, and sometimes, buying the Cadillac when you don’t even know how to drive yet, isn’t going to help you a lot. So as you begin to develop a clinically integrated network or begin to take on risk, it’s important not to get lost in, “Gosh, we’ve got to get into this big data environment.” Typically, you need to streams of data—from claims and from your electronic health record, whatever providers are in your network. And you can get lost and overwhelmed in trying to do data normalization and aggregation, and that can become a data governance nightmare. So instead, say, look, we’ve got three risk contracts in the next three years, and those contracts will be based on certain elements. So let’s get clear about the key data elements we need. And so if I’ve got to get my data cleaned up, and there are 10,000 data elements, you’re going to get lost in that. But if you say, these are the top 10 or 20 data elements we need to understand risk, to understand patient status elements, etc., you don’t get lost in boiling the ocean.
What are the few biggest learnings we’re hearing from pioneers so far, in this transition?
The organizations that have done this well seem to have a higher level of maturity at integrating their IT planning as part of their overall enterprise planning. So they know, if I’m going here, I can’t wait until after I’ve gone into the risk contracts to go to my IT people and ask for things. At the same time, the smart CIOs are trying to make sure they’re not asleep at the wheel. But the organizations doing well tend to have more integration between overall strategic planning and IT strategic planning. And they tend to be mindful of, are we going to do this more at a corporate level or local facility level, for example? They’re very explicit about data governance functions and maturity. So processes are being led by clinical and other front-line operational leads.