A lively discussion opened the Health IT Summit in San Diego, sponsored by the Institute for Health Technology Transformation (iHT2—a sister organization to Healthcare Informatics under the Vendome Group corporate umbrella), and being held this week at the Hilton Bayfront in downtown San Diego. On Monday morning, Jan. 19, Shadaab Kanwal, executive director, corporate services, and digital technologies, at the Oakland, Calif.-based Kaiser Permanente, led a panel of industry leaders around the topic, “Data & Analytic Strategies for Value-Based Care.
Kanwal’s fellow discussants were Carol Steltenkamp, M.D., CMIO at the University of Kentucky health system; Brett MacLaren, vice president of enterprise analytics at the San Diego-based Sharp healthcare; and Alex Eastman, senior director enterprise solutions, at the Premier, Inc. health alliance (Charlotte, N.C.).
Early in the discussion, Kanwal noted that “A lot of organizations are focusing on the delivery models, and there is a lot of activity going on. There is such a change from a care delivery model, so the perception of value is shifting from the provider space into other areas of care delivery.” He asked his fellow discussants, “In that context, what does value mean to each of you?”
“In terms of value, terms of how value ties to technology,” MacLaren said, “we need to think about how we can take differing incentives” and weave them together for greater alignment of all the stakeholders. “We have health plans, medical groups, and hospitals, and as we’re going through this process of transformation, not all the incentives are aligned. So we need to make sure that quality of care ties to reimbursement and everything else. I think there’s still a bit of misalignment, but we’re moving in the right direction.
(.to r.) Panelists Kanwal, Steltenkamp, MacLaren, and Eastman
Dr. Steltenkamp stated that “In terms of value, I always get back to quality over cost. Did you as a patient feel you had a quality interaction? Did you as a provider, feel that? Oftentimes, providers may be a little bit lost” when it comes to really connecting all the clinical documentation they’re required to do, with enhanced value for patients. At Premier, Inc., Eastman said, “We focus on doing data that makes it easy for people to analyze it. And I think of value as a ratio of benefits to costs, as Carol hinted at. So If I bought a car, I feel like I got a good value, with the features I wanted. The lowest cost doesn’t necessarily bring the best value.”
“How have you begun to collect, aggregate, and analyze data for value-based care in your organization?” Kanwal asked the panel. “It starts with the concepts of enterprise data management and data governance,” MacLaren emphasized. “We need to understand what we’re trying to measure, and close this loop of value. We expect our clinicians to document things, but they don’t always recognize the value. They often see documenting these things as a “necessary evil,” when in fact, it’s important to documenting value. So part of the challenge is making sure that we close that loop of value, and that we make it easy for those doing so to do so easily. Think of all the advances in natural language processing. For a long time, we tried to force all clinicians to structure, structure, and structure. Well, maybe that’s not the most efficient way to do it. I would hope that our technologies are going to help us move forward in that area. And I don’t think that our EMRs have necessarily done us a lot of credit in helping us to do that.”
“I would agree,” Steltenkamp said. “Intellectually, we know we need to do that, but sometimes, people haven’t taken responsibility for doing so. And I would say the clinicians are still in a position where they most often don’t see the benefit of what they’re documenting. They get that they need to document to be paid. And the bulk of clinicians do this because they want to help patients. And so they will appreciate the feedback or input that helps them do things. Because if you can help connect those dots for them around their helping their patients, that’s a win. Because if you show up and say, I’m here from the administration, and I’m here to help—that’s not a win.”
“So how can we physically make that happen?” Kanwal asked. “How do we ensure we have the clinical and business intelligence, and analytics, so we have focused, relevant information enabled by an agile, relevant, and able infrastructure, to help physicians to capture information? And that enables us to be equipped to deliver the care effectively across the enterprise and ultimately, across the community? And from a process perspective, what specific interventions did you have to make?”
“The University of Kentucky had an RFD out to bid on analytics,” Steltenkamp noted. “So we are in the process of building a data warehouse. I’m sure other organizations are much further down that path than we are. But like any decent university, we thought, we could do this ourselves! But after about three years of some really hard work, there was a self-realization that that was not going to happen. So we went out and said, we needed something appropriately scalable, to drive towards business analytics for healthcare, but also, to accommodate all the research that we’re doing.”