In the proverbial journey of a thousand miles that begins with the single step, when it comes to leveraging healthcare IT to support value-based reimbursement models, provider leaders are still just steps from the beginning of that journey. That was the consensus of a group of industry experts participating in a panel discussion on March 4 entitled “Supporting Value-Based Reimbursement Models With IT,” held on March 4 at the Hyatt Fisherman’s Wharf, as part of the Health IT Summit in San Francisco, sponsored by the Institute for Health Technology Transformation (iHT2—a sister organization to Healthcare Informatics under our corporate parent, the Vendome Group LLC).
The panel was moderated by Deanne Primozic Kasim, director of research at IDC Health Insights. She was joined by Davin Lundquist, M.D., vice president and CMIO, Physician Integration, Dignity Health (San Francisco); Howard M. Landa, M.D., CMIO at Alameda Health System (Oakland, Calif.); Arien Malec, vice president, strategy and product marketing, at Relay Health (Alpharetta, Ga.); and Steve Shihadeh, senior vice president, North America sales and customer operations, Caradigm (Bellevue, Wash.).
Panelists (from l. to r.): Kasim, Malec, Lundquist, Shihadeh, and Landa
To begin with, as Alameda’s Landa noted, some organizations, like his, are going into the value-based purchasing arena with limited resources. “We are very involved in value-based purchasing and in PQRS,” he said, referring to both the mandatory Medicare value-based purchasing program and to private health insurer-based programs, as well as Medicare’s mandatory Physician Quality Reporting System; “it’s going to be hard to participate in other things,” he noted. “We have a panel for sickest patients, something called the Hope Program,” he reported. That program focuses on optimizing care coordination for “frequent flyer” patients, something that Landa noted has already reaped rewards. Meanwhile, he added, “We’re looking to population health on a broader level.”
Dignity Health’s Lundquist, speaking of a recent announcement from the Department of Health and Human Services in January around value-based payment goals, that federal health authorities announcement “that they will be moving to value in a few years, “signaled to us that we shouldn’t hold off long” on preparing for that shift. “We do have tons of accountable care in the Sacramento area,” he said, referring to Dignity Health’s accountable care organization (ACO) involvements in that region. Meanwhile, he added, “Down in Ventura [in Southern California] where I am, probably half of our contracts are capitated. And many of our hospitals have co-management programs.” What’s more, his health system is involved in an Arizona-based Medicare Shared Savings Program (MSSP) ACO. The bottom line, Lundquist said, referring to the full spectrum of possibilities, is that “We’ve been trying just about every [payment and delivery] model possible. And we definitely believe that the proportion of at-risk patients in every market will continue to rise.”
Asked about some of the core data challenges facing organizations plunging into a variety of value-based payment and delivery models, Caradigm’s Shihadeh noted that the key thing is “getting the different data types onto one data platform. We’re doing bundled payments in St. Louis,” he noted, and that his company’s customer organizations there “need all that data available to them in order to be able to bid, and then manage disbursement,” in a complex operating environment.
Asked by IDC Health Insights’ Kasim how patient care organization leaders can get physicians on board, Relay Health’s Malec said that one key is “helping them to understand their true risk profile and patient population. All providers have a long way to go,” he said, relative to their being able to fully understand their patient panels in a comprehensive way.
Still, Lundquist said, “Physicians practicing now are much more accepting of technology. Most who said they would retire before they got onto an EMR have since retired. So I think we’re there,” in terms of physicians’ acceptance of using information systems and information technology in their practices. “But there are still a lot of challenges,” he said. “We kind of went through this with meaningful use. We wondered, how can we get them engaged with this process? How do we create workflows that allow them to accomplish this, without adding a lot of burden? And some of my data informatics partners are always wanting physicians to check more boxes, so we have better data to report on.”
In fact, Lundquist said, referring to the informaticists he and his colleagues work with on clinical performance improvement and other initiatives, “I’ve always told them, we have to align our incentives with what we’re asking our physicians to do. Physicians will find the most efficient way to do their jobs, and if checking boxes doesn’t align with what they need to do, they won’t be checking boxes. But the minute you align incentives so that they will be incented to check boxes, particularly around reimbursement, they will be asking for boxes to click. So you have to align incentives.”