Since leaving his position as Deputy National Coordinator for Health IT and CMIO at the Office of the National Office Health IT in October 2014, Jacob Reider, M.D. has been consulting widely in healthcare, including with a few healthcare IT vendor startup companies, as well as speaking widely at conferences, and continuing to participate actively in the healthcare policy arena.
At a time when the policy and reimbursement landscape is shifting very rapidly in healthcare, and when clinical informaticists, including CMIOs, are becoming more and more essential to transforming U.S. healthcare delivery, Dr. Reider spoke with HCI Editor-in-Chief Mark Hagland just shortly before the members of AMDIS—the Association for Medical Directors of Information Systems—hold their annual Physician-Computer Connection Symposium, to be held, as in past years, at the Ojai Valley Inn and Spa in Ojai, California, this time June 24-26. Below are excerpts from that interview.
It seems in some ways as though we’re at an inflection point in the journey towards the new healthcare, with regard to tipping forward into accountable care, population health, and other concepts in a bigger way. What are your thoughts on all this?
I would agree that we’re migrating towards different cultural norms that would align with the principles of value-based care. And I think we see two different possible scenarios emerging and possibly merging. One involves fully engaged, all-in, entrepreneurial thinkers, who are just doing it, in terms of value-based care. Examples are [the Miami Gardens, Fla.-based] ChenMed Health, [the Seattle-based] Qliance, and [the Cambridge, Mass.-based] Iora Health. Those are three organizations, each run by a visionary leader who wants to align their organization with the best interests of the individual—notice that I don’t say patient. So when the individual’s needs are perfectly aligned with the business interests of everybody taking care of their health, then everything fits together, and an amazing transformation occurs.
Some people have talked about the “quadruple aim”—the “Triple Aim,” plus a fourth aim, provider happiness, in addition to better care, lower cost, and a better patient experience. And ultimately there is also patient happiness… and maybe even payer happiness and UPS driver happiness! Are there others in the continuum whose happiness we should care about? Yes. Still, it’s not necessary to focus too much on provider happiness; I’m saying if we focus on that, we miss big-picture aims. Instead, if we align everything correctly, the providers will be happy.
And in those three organizations, one immediately recognizes that something is different. The atmosphere is lighter. You don’t see patients arguing with someone at the front desk. And often, the patients are happier because the providers are coming to them, sometimes virtually. And interestingly, every one of those organizations, they’ve created their own IT solutions to support patients, rather than to maximize reimbursement. People talk about note bloat, and doctors are getting 10 pages of documentation from the ER, and doctors can’t even figure things out. We’ve built solutions designed to solve the problem of needing to maximize billing.
But by thinking about this differently, they’re doing something different. They’re building solutions themselves around individuals, or patients. Not around billing. The difference is that we have the IT now. In the capitation of the 1990s, we couldn’t truly build IT-facilitated care systems that we can now. We didn’t have the IT infrastructure; it wasn’t as fluid, flexible, or ubiquitous. Now people are carrying computers in their pockets; their called phones. But they’re 10X as capable as the desktop computers of ten years ago. So there are going to be these little all-in activities and they’ll spread in a sort of michotic way. They’ll sort of bubble up, split in half, and replicate themselves all over the country.
And these all-in folks will attract clinicians, patients, and payers. That will be the revolutionary migration towards value0based care. Everything will be new, and those who join those organizations will be joining organizations that will be transforming everything.
The other trajectory is the evolutionary migration towards value-based care through accountable care vehicles. And while that will work, it is not sufficient to get there in the new term. I would say a seven-to-ten-year path towards the Triple Aim.
Those truly revolutionary organizations are smaller and less-known, then?
Yes, and that’s OK. Honda was smaller and less-known in 1973, right? I’m a big fan of Clay Christensen [Clayton Christensen, the Harvard Business School professor], and his model of disruptive innovation. It is in fact the small, disruptive leapfrogger, that defines the future, right? Look at Apple, compared to IBM and Microsoft. There was no way that Apple was going to disrupt IBM and Microsoft, right? But who has the biggest market cap [market capitalization] now? Other examples: Canon and Xerox, and Elon Mosk and the Tesla.
Are you at all concerned about the ongoing consolidation taking place among both healthcare provider organizations and health plans? Is all this bulking up a misdirection of energies in the current healthcare landscape?