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HCI: What are the top issues for you at Hill Physicians Medical Group?
Craig Lanway: My to-do list keeps growing. And healthcare reform is changing the whole landscape. I wouldn't say that anyone at Hill completely understands this thing or how it will turn out; but I will say that what we've been doing at Hill for years in terms of managing care in terms of cost and quality is where we think healthcare reform is going. Certainly, California has had a lot of experience with that. You're familiar with the ACO-type arrangement we've already created in California, and we realize that we have to have flexibility for new arrangements.
WE'RE GOING TO HAVE TO SHIFT SOME OF OUR CORE COMPETENCIES AWAY FROM HARDWARE AND SYSTEMS AND TOWARDS EXPANDING OUR CONCEPT OF WHAT A NETWORK IS, AND TOWARDS A LOT MORE DATA INTEGRATION, AND DATA DELIVERY IN THE RIGHT PLACE AT THE RIGHT TIME.-TIM TERRELL
So we've been working with a consulting firm for the past five or six months on a plan for an overall care management strategy, because that's our business now. We are now moving into the realm of care management. And who is better-positioned than medical groups to manage the care of patients? It's not hospitals; it's medical groups. At the same time, we have to take care of some mundane things, like the transition to ICD-10; that's got to be completed. We've also got to continue to get physicians to adopt EMRs in their practice.
HCI: You still have a large percentage of physicians who are not yet fully electronic. How does that figure into your care management strategy?
Lanway: It figures in very strongly, because we still have a large number of very small physician practices that are working off paper. And only 20 percent of our patients are seen by PCPs who are using an EHR. And we've got a long way to complete that rollout. So we have a two-part strategy right now. One option is to do a full NextGen implementation [with Hill's core EHR vendor, the Horsham, Pa.-based NextGen Healthcare]; the other is an EHR “lite.” And we're still working on defining that second offering. We've started that process now.
HCI: What about at Cornerstone Health Care?
Tim Terrell: I'd put it like this: our immediate issues have to do with meaningful use and getting the stimulus money. But bigger than that is looking at healthcare reform, as well as industry consolidation, the big trend towards consumerism and consumer engagement, and the whole cloud computing trend. We're seeing that we're going to have to shift some of our core competencies away from hardware and systems and towards expanding our concept of what a network is, and towards a lot more data integration, and data delivery in the right place at the right time.
HCI: But that implies a strong data infrastructure to support all this new flexibility, correct?
Terrell: Correct. The difference, I think, is that for groups like ours, we're seeing this incredible growth in complexity in the systems environment, and it's hard for groups our size to keep up with that, and these new technologies such as cloud computing are coming along that will simplify things on our end-and that's very, very attractive for us. And another thing is that cloud could take some of the administrative burdens off us.
HCI: What kinds of data capture, data collection, and data sharing issues do you and your colleagues face?
Terrell: With healthcare reform, we're looking at integrating a tremendous amount of data across the community. There's all this talk of health information exchanges, and all of that may help a lot; still, our biggest challenge is not connecting across the entire state, but across our community. With the healthcare reform situation, someone is going to have to be the data integrator for individual communities, and we'd like to be that for our community, and we're going to have to learn how to be that in a rapid fashion.
There are all sorts of different tools, too. Everybody's looking at the electronic medical record as the tool, but that may not be the tool that's going to help you do population health management. It will certainly be a part of the solution, but it may not take you to that next level.
HCI: What about at SETMA, where you've focused so intensively on care management and population health management?
James L. “Larry” Holly, M.D.: An increasingly important element for us is clinical decision support (CDS) to support performance improvement continuing medical education, or “PICME.” [Editor's note: PICME involves a feedback loop between a CME-granting organization and an individual physician, assessing that physician's current practice with regard to his or her using evidence-based performance measures, and providing feedback to that physician through the benchmarking of his/her scores against those of peers.] So CDS to support PICME and transformational processes in the ambulatory care environment, to me, is one of the most important things to do. When we take a complex thing and reduce it to a one-second task, to me, that is worth doing.
ONE OF THE BIGGEST CHALLENGES WILL BE HOW TO INTEGRATE THOSE PEOPLE INTO AN OPTIMALLY FUNCTIONING ORGANIZATION, AS COLLABORATORS RATHER THAN JUST COOPERATORS.-JAMES L. HOLLY, M.D.
