What Wisconsin’s Healthcare Leaders Are Learning about Payment Innovation

In terms of provider readiness, it really is your classic bell curve. There are organizations doing the smaller projects; there are a handful and growing, of organizations that are going right to ACO [accountable care organization] development and global payments, something much more comprehensive; but the vast majority of organizations are the undecideds. They’re organizations where the small stuff seems too small, and the big stuff seems to risky, so the leaders of those organizations appear to be waiting to waiting it out for others to act first before they make any moves. And in fairness, we’ve just spoken for an hour and 15 minutes about all that we don’t know about all of this. So can they be blamed for waiting? The argument I’m going to make for “start somewhere,” is one of preparedness. How is doing nothing going to help you do anything big? And as I said, what strikes me is how even the smallest experiments have created so many learnings.

Are the provider organization leaders in Wisconsin having problems with the blocking and the tackling involved in these efforts?

A couple of our participant organizations have made the point, who are Epic [electronic health record (EHR)] users, that much of the Epic architecture is not well-designed for the kind of architecture they need to support bundled payments. Payment systems are not set up to support bundled payments, and neither are most EHRs. One of our participants actually went to an Epic user group meeting to talk about this. And it’s not so much that they don’t know what to do, but that the steps are labor-intensive and costly. There’s cost associated with workarounds to claims payment systems.

And what you were saying, with regard to the American College of Cardiology’s initiative around the care management of cardiac patients, about cardiology and manual coding, applies here, correct?

Yes, exactly. That gets back to this idea of complexity theory, where the system continues to evolve and change, and where one change helps in one way but also creates totally unintended results. So, capturing those unintended consequences and fixing them remains a challenge.

What should CIOs and other healthcare IT leaders do, as they try to help support their organizations in potentially going forward with accountable care and bundled-payment initiatives?

What leaders are beginning to discover is that their organizations lack strategies around what’s being called clinical business intelligence, which is a key success factor in this work. With regard to clinical business intelligence, healthcare IT leaders need to ask themselves and their colleagues, where does it live organizationally? And is it connected to their strategic business vision?

So to your question about what CIOs can do, in an earlier phase of my career, I was in human resources, so I know that all the support service groups tend to end up being pushed aside strategically. So, to begin with, CIOs need to get themselves to a seat at the strategic table, and make the promise of data-into-information real for the CEO; and then figure out how to get better at population-level analytics, even though the tools aren’t where they need to be. The reality is that, from a CIO perspective, it’s going to be all about managing populations of patients, and doing a better job of predictive risk modeling; that’s the work that has to be done.