Have we reached an inflection point on strategy and IT development, as the industry evolves forward towards the new healthcare?
“Which outcomes matter most? Doctors look horizontally at episodes of care, but you need to make apples-to-apples comparisons with the same diagnoses,” Van Kooy asserts. “If you’re looking at your whole community in any ACO, you want to look at the bad outcomes, and their associations with particular drivers. So you need a disease registry function. Once you’ve created that, and you know the key drivers of undesirable clinical outcomes—then you need a governance structure that includes objective, collegial, and collaborative feedback at the individual provider level, followed by shared, accountable action planning.”
TRANSLATING OVERALL STRATEGIC IMPERATIVES INTO IT STRATEGIES
The implications of all this are huge for healthcare IT leaders, who will be tasked with working side by side with clinician and operational leaders to make these new models of care delivery and payment work. And the data and analytics demands will be extremely intense, says Intermountain’s Savitz. “You almost can’t separate the strategic and IT learnings” involved, she says. “The ability to do population health at an organization like Intermountain Healthcare, because of the availability and longevity of data, allows us to do this at a certain level. Basically,” she says, “what you’re trying to do with population health is to use largely clinical epidemiological techniques to be able to understand patterns and flows within the patient population, and that information can then be used in multiple ways, including in better designing healthcare delivery. We know that a very small percentage of the population tend to use the most resources. They tend to have three or more chronic conditions—it does not matter which three or which came first—that includes mental health, which is why we added depression. We know, for instance, that two-thirds of our diabetes patients have a co-morbidity of depression. Population health, with this kind of information, can help us target specific care delivery interventions, and keep them out of unnecessary admissions to the hospital and unnecessary ED visits.”
Savitz’s advice for healthcare IT leaders? “The fundamental message is that CIOs have to work in partnership with the clinical leadership team. The old siloed approaches caused a lot of problems early on,” she says. “This is a great environment” at Intermountain, she adds, “because first, there are a lot of physicians involved in informatics. Our Homer Warner Center for Biomedical Informatics has been a real leading light in that area. In fact, they’ll be involved in this particular project.”
MASTERING THE USE OF ANALYTICS—AND BEYOND
Keith Figlioli, senior vice president, healthcare informatics, at the Charlotte-based Premier health alliance, sees the very big picture on all this, as he and his colleagues at the national health alliance continue to develop tools and collaborations to help their thousands of hospital and medical group organizational members move forward in all areas of the new healthcare. For example, Figlioli recently helped launch PremierConnect, a data and information platform that will allow member organization leaders to share benchmarking and other data online, as they work together across a number of Premier collaborative groups (for ACO, bundled payment, and medical home development, among others) going forward.
“Everyone has been focused on analytics,” Figlioli notes; and he certainly agrees that analytics will be essential to success in the new healthcare. “But,” he quickly adds, “changing payment systems involves a great deal of change management, right? And yes, certainly analytics and infrastructure are extremely important—organizations will need core transactional systems, plus that analytical layer on top of it. But I think one of the unknowns is not only how you’re going to connect the data; but beyond that, how you’re going to connect knowledge and connect people. That’s why we’ve created PremierConnect. So many vendors out there are pushing dashboard products. The question I have is, then, did they change outcomes? We’re committed to truly changing outcomes.”
Figlioli says he believes strongly that “This idea of just having a dashboard is not enough. You need to put context around that data. Think about the EMR and CPOE journey, and how hard it’s been to put content in there; so imagine how hard it will be to wrap rich content around these information systems more broadly.” In the end, he says, the “three pillars” of the new healthcare will be “data, knowledge, and people, all connected seamlessly. And,” he warns, “if the CIO does not have a foot solidly in the strategic planning process of the whole organization, and if the CIO is not in on the very first strategic meetings around ACO developments, I would argue that they’re dead in the water.”
In the end, all those interviewed for this article agree, the future of the new, population-based, connected healthcare is one filled with both enormous opportunities and challenges; it is one that CIOs and other healthcare IT leaders will be deeply involved in building. The only question that remains is how soon leaders at individual patient care organizations hear the call and begin to move forward.
