The challenges and opportunities facing the pioneers showing the way to the new healthcare were on full display on Thursday afternoon, May 17, in educational sessions at the Healthcare Informatics Executive Summit, being held at the Sir Francis Drake Hotel in San Francisco.

In his afternoon plenary presentation, Keith Figlioli, senior vice president, healthcare informatics, at the Charlotte-based Premier healthcare alliance, began the afternoon’s sessions by speaking very forcefully about his perceptions of the path forward towards the “new healthcare”—a reformed U.S. healthcare system that provides higher-quality patient care more cost-effectively, with greater transparency, accountability, and responsiveness to healthcare consumers and communities. Figlioli spent some time at the outset of his plenary address describing the recent trip that he and other Premier health system leaders and senior staff took to Edinburgh and Glasgow, Scotland, to understand how Scottish healthcare leaders are approaching the concept of population health, in a very different healthcare system and society. Of particular interest, he told his audience, were discussions he had had with Sir Henry “Harry” Burns, chief medical officer of the National Health Service-Scotland, about population health management; and work that Sir Harry and his colleagues at the NHS-Scotland have done around trying to understand the “Glasgow effect”—the impact of multigenerational post-industrial poverty and economic decline on sectors of a society.

Keith Figlioli

Above all, Figlioli noted, the Scots healthcare leaders that he met with seemed eager to plunge into very significant population health initiatives, under capitated payment systems; speaking of which, he predicted, “We’re headed towards capitation” in the U.S., “whether right or wrong; it’s just a matter of time.”

Meanwhile, the core challenge facing providers in this country, according to Figlioli, is this; “Providers are telling us they have to take $500 million out of their fixed cost structure over the next five years,’ based on reimbursement cuts and contracting demands from public and private payers. “So what can you actually do to reallocate your assets and prepare for the future?” he asked his audience.

And if population health is the solution to the core problem of providing value for purchasers’ monies spent on healthcare, “The reality from an informatics standpoint when it comes to population health is many data silos, all across the continuum of care and service,” Figlioli told his audience, invoking what he called a “massive master data management problem in healthcare.’

Data and information issues broadly discussed

Such themes reverberated throughout the panel discussion that followed, whose title was the question, “How Will Population Health and Analytics support ACOs, Bundled Payments and the Medical Home?” On that panel, Figlioli was joined by Richard Bankowitz, M.D., enterprise-wide chief medical officer at Premier health alliance; Terry Carroll, Ph.D., senior vice president for transformation and CIO, at the Minneapolis-based Fairview Health Services; and Ferdinand Velasco, M.D., chief health information officer at the Arlington, Tex.-based Texas Health Resources.

One core challenge facing leaders across the U.S. healthcare system, said Fairview’s Carroll, is that “Even the smartest innovation can’t keep up with the cost trajectory” for this country’s healthcare system. Carroll, whose organization is a pioneer ACO under the Medicare Shared Savings Program for accountable care, described some of the challenges facing his organization, which has accepted downside financial risk for population-based payment in year 3 of the pioneer ACO program.

Meanwhile, Texas Health Resources’ Velasco, whose organization likewise is now a pioneer ACO, said that, on the path towards mastering population health management development, the three areas of learnings so far have been around “creating the building blocks” to execute on population health; as well as learning how to do collaboration and innovation.

A lively discussion emerged around the core question of what population health should be, and how to determine what it should be. All the panelists agreed that the conceptual formulation depended on how one conceived of the role of patient care organizations in caring for whole populations of community members. “Peter Drucker, the management guru,” Bankowitz noted, “used to ask people to decide what business they were in. Once we can decide what business we’re in—whether it’s taking care of sick people or actually improving the health of communities, for example—then we can decide how we go about organizing things and moving towards our goals.”

All the panelists at the afternoon session agreed that electronic health record implementation is a necessary step in moving towards population health; but also an insufficient one on its own.

Meanwhile, the path forward towards true population health management will inevitably be a long one, everyone agreed. As an example, Carroll noted, as of recently, “We probably had 2,000 people in our organization doing data management at any one time, but only two doing real analytics, to be honest.” At the same time, he said, the work that those two people are doing goes to the heart of the profound transformations that must take place if the U.S. healthcare system is to move successfully forward towards true population health management.