Making the leap to true population health management is turning out to be a herculean task for healthcare providers of all types. Healthcare leaders from various sectors of the industry described their trajectories to Editor-in-Chief Mark Hagland in interviews conducted for the May/June cover story of Healthcare Informatics.
Among the numerous nationally respected leaders Hagland interviewed for that cover story was Donald W. Fisher, Ph.D., president and CEO of the Alexandria, Va.-based American Medical Group Association (AMGA). Fisher and his colleagues are putting the vast bulk of their efforts into helping prepare physician group leaders for the transition to population health-driven care delivery and value-based payment. “We’re not quite there yet, and as we change to a new reimbursement system, even the large, sophisticated medical groups are going to need a few years to make the transition,” Fisher says. “You’ve got to put the infrastructure in place, and the large integrated health systems have been putting those elements in place—EHRs [electronic health records], alert systems, analytics systems, data warehouses—and some have teams of people mining the data to assess patient status.”
Below are excerpts from Hagland’s extended interview with Dr. Fisher.
Looking at the transition to population health-driven value-based payment, what kind of timeframe are we talking about for a transition these days?
We’re not quite there yet, but as we change to a new reimbursement system, even the large, sophisticated medical groups are going to need a few years to make the transition.
Where do you see the main gaps right now in terms of processes and other elements?
Some medical groups still have gaps in their primary care base; and if you’re going to do population health, you need a very good primary care base. So some are still struggling in that area. And then there is the cultural piece, which encompasses reimbursement-related goals related to this. You can try to change your culture, but if you’re still being paid FFS and still mostly paying your doctors FFS, you need to change that, and that is something they’re trying to get over pretty quickly.
What are the most advanced things that AMGA member groups are doing right now?
There are several, in different areas. Many of our member groups are attaching themselves to very large data sets. My members are using what used to be Humedica, and that was acquired by Optum, and it’s housed within the Optum Analytics shop, and it’s called Optum One. They’re using this large database to measure themselves across physicians and across sites and even comparing themselves with other medical groups across the country. And since Optum has taken over the Humedica database, they’re actually adjudicating claims, and are able to compare claims data. Second, the groups are using a couple of tools Optum has built to do predictive analytics—and they’re in four areas now—diabetes, congestive heart failure [CHF], asthma, and COPD [chronic obstructive pulmonary disease]—and what they’re doing is that they’re infusing the data, and looking at predictive analytics.
And the predictive analytics model will tell them, particularly for CHF, which patients are most likely to be hospitalized within six months. And that’s a great window of time, because they can figure out how to avert hospitalization. Aurora actually reduced admissions by over 60 percent in the third quarter of last year. That’s the first admission. And if you ask a cardiologist, they’ll say you’ve got to prevent the first admission, because it’s a downward spiral after that. And you can’t do that with claims; but with a sophisticated data warehouse that combines the clinical and claims data, you can predict. And actually, with this predictive analytics tool, you’re predicting CHF admission before the first claim. And they’re reaching out to these patients and making sure they don’t get admitted.
The thing is that you have to go beyond the data; you have to reengineer the care process. The way it is today, it’s a reactive kind of care process. If you’re using predictive analytics and data sets, you’ve got to be proactive, and reach out to patients in advance. And that requires different skill sets, different providers; it’s a very, very big job to work with these data sets and predictive analytics, but it can make a very big difference in patients’ lives; patients are just doing so much better as a result.
Are doctors understanding that things are changing, and are they moving forward into change?
Yes, they are. But even though change is coming, no one can tell you exactly how and when. We don’t know what percentage of our revenue will be FFS, will be modified risk, will be full-risk? So that’s a challenge. You don’t want to get there too fast, because you can sort of shoot yourself in the head a bit, and that can be a big challenge, if you get ahead of yourself reimbursement-wise. And I don’t agree with the idea that physicians don’t like change; they do, if it’s warranted, and they can get to it. But the perverse incentives, the fact that you still get paid more under FFS for doing more, that is completely at odds with value-based healthcare.
And not so much in our membership, but out in the country as a whole, many still haven’t invested in electronic health records yet.