What have proven to be some of the major stumbling blocks facing the stakeholders of U.S. healthcare as they pursue data analytics to support value-based care delivery and purchasing? A plethora of issues emerged during a discussion at the World Health Care Congress on Monday in Washington, D.C., during a session entitled “Analyze Delivery System and Payment Reforms to Drive Quality and Control Costs in Government Programs.”
The discussion was led by Enrique Martinez-Vidal, vice president, state policy and technical assistance, at AcademyHealth, a not-for-profit organization that, according to its website, “works to improve health and the performance of the health system by supporting the production and use of evidence to inform policy and practice. Martinez-Vidal was joined by fellow panelists Navneet Kathuria, M.D., M.P.H., vice president, population health and clinical quality, at Meridian Health, a Neptune, N.J.-based accountable care organization (ACO); Wayne Turnage, director of the District of Columbia Department of Health Care Finance (DCHCF); Jeffrey Spight, president of the White Plains, N.Y.-based Collaborative Health Systems consulting group; and Anna Keith, vice president of innovative solutions, at Lifeshare Management Group/the Centene Corporation (Washington, D.C.).
The panelists described a very broad range of challenges when it comes to leveraging data analytics in the new healthcare. Dr. Kathuria of Meridian Health noted that “My activities are focused on managing populations for all our populations. I oversee our system’s data warehouse. The biggest challenge,” he said, “is getting all the data from all these disparate systems, having it churn through our system, and then analyze the output, and partnering with the 1,200 physicians in our commercial network, 800 of whom are in our Medicare ACO. So our infrastructure for data analytics is an ongoing issue and challenge, because data comes in at different speeds. And how we work with our employed and non-employed physicians, is a challenge.”
Spight, noted of his organization, “We work with about 5,000 physicians around the country, on MSO and ACO operations. We have 24 MSSP ACOs and one Next Generation ACO across our portfolio. And everyone’s looking to expand into Medicaid and commercial as well.” And he said that, “For us, the biggest challenge was getting the right staff. We thought we could take people with medicare Advantage experience. That just didn’t work that way. We needed people who were problem solvers. And really, it was, how do you change culture, how do you change behavior?”
Turnage reported that, “From the government side, the environment has been favorable. We have not received any pushback from the District side or CMS [the federal Centers for Medicare & Medicaid Services] around innovation. As far as the policy, everybody’s on the same page.” That having been said, he quickly added, “The challenge in terms of the provider community is, how far do you go in leveraging risk? For me,” he said, “the most effective way to drive outcomes is for the provider to be entirely responsible for the cost of patient outcomes, still allowing them to make some money.” But that ideal ends up bumping against the reality that providers cannot always sustain a level of performance that will support any fixed payments that might come from agencies like the DHCF, he said, meaning, that they can easily find themselves in untenable financial positions, thus endangering the risk contracts they might sign in the first place.
With regard to the kinds of capabilities needed in these areas, Anna Keith noted that a year ago, the Washington, D.C.-based Centene Corporation had acquired the Manchester, N.H.-based LifeShare Management Group. “They purchased the company for its I/DD [intellectual and developmental disabilities] solution, so that as it went into markets that were seeking Medicaid I/DD managed care operations, we brought that expertise to the table. We also brought people services management to the table.” She noted that complex sets of capabilities are going to be needed to master population health and accountable care challenges going forward.
Learnings out of challenges
Still, the panelists noted, a lot has been learned from early data analytics work, despite the initial challenges everyone has faced. For example, Dr. Kathuria noted, “My organization saw the MSSP [participation in the federal Medicare Shared Savings Program] as learning to ride a bike with training wheels, and that’s what we’ve done. These were community hospitals where the majority of physicians are independent contractors, and the MSSP was a way for them to participate, in a non-threatening environment,” he said. “As a result, we realized there were a lot of gaps” in a variety of areas of performance, he reported.