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The Journey Towards a Value-Based Healthcare: A Discussion

February 25, 2014
by Rajiv Leventhal
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Healthcare leaders give insights on effective population health management

The healthcare industry is under increased pressure, as the change from volume to value brings on unprecedented adaptation. Many providers are finding the need to re-invent themselves, as care delivery networks start to focus on patient populations. As such, care management and population health are becoming organizational priorities. 

At HIMSS 2014, this was the main topic of discussion on  the morning of Feb. 25 at the McKesson media briefing, "Value-based Reimbursement: Charting a Path to the 'New Normal.'" On the panel to share their thoughts on the challenges and strategies for this shifting landscape were: Michael Hunt, CMIO at the Bridgeport, Ct.-based St. Vincent's Health Partners; Christopher Stanley, M.D., vice president, care management of Catholic Health Initiatives in Englewood, Co.; and Jonathan Niloff, M.D., vice president and executive medical director for population health at McKesson.  The panel moderator was Catrina Funk, M.D., vice president of medical affairs at McKesson. Below are excerpts from the panel discussion. 
Funk: What are your biggest challenges in this transition to value-based reimbursement?
Stanley: There are two key areas for us—one is around culture change, and the other is around working around this reimbursement model. We are a hospital-formed system, and have been driven by fee-for-service. In the future, we will be paid by value, and that is fundamentally changing how our physicians and hospitals are thinking. That us really an organizational shift for us. 
And data and IT infrastructure will be key to driving that change, as will how we align our incentives. Also, how do we understand our populations to provide more value? We see patients in the ER, the hospital, the physician clinic, but they are siloed events. We need to interact with the patient across the care continuum. Patients are actually customers throughout their entire healthcare journey. Now, instead of patients, we are trying to think of them as consumers or customers who have touch points throughout that journey. This is part of that cultural change. 
Hunt: In Connecticut, where we are, physicians are lacking technology. We were the 49th state to adopt electronic medical records (EMRs) and are struggling to keep up.  Now, we're asking physicians to re-think what they have been successful at and asking them to manage populations, which they might be uncomfortable doing. 
Funk: How are data and information solutions helping address these problems?
Hunt: We are working towards taking care of the patient in two ways: face-to-face contact, and also developing everything around how we manage the population. So, how do you manage to take care of the patient in each setting with his or her discrete information, but at the same time, also take care of the population? We're caring for the individual, and simultaneously, caring for a community.  Who needs to see the doctor and who is not getting necessary preventative care? I need to do that all at the same time and I need a tool to help. 
Stanley: I fully agree [with Michael]. Data is nice and important, but it can be overwhelming . The challenge is turning data into information and knowledge. If you take data and package it, it becomes information. And if you take information and package it, it's knowledge. So we are focusing on two areas around that knowledge. Within populations,  who are the high-risk individuals? Second, at a system level, how do we use data to drive performance? 
We have so many different disparate systems where data may reside. So we recently looked at how many different practice management systems we have with all of our affiliated physicians, and it turns out we have 70 different systems in this market. Extracting that data out is a monumental task. If you can't do that, you can't study your populations well or move the ball down the field. We do have an initiative, called OneCare, in which we are spending more than $1.5 billion over several years to try to connect our disparate systems together to get them talk to each other. 
Hunt: We're trying to participate in accountable care organizations (ACOs), and are developing contracts with payers that force us to take care of that patient everywhere he or she goes. Different stakeholders need to play together and take care of the patient as he or she keeps moving.
Stanley: As you start getting into this world with population health management, there are huge amounts of data out there. The reality is, data doesn't exist in the same form. It's important to start small and not have all of your data there, but instead build it over time. If you have 20-30 percent of all that discrete data, you could do a huge amount of good before building on that.
Following the moderated discussion, the panelists took further questions from attendees in the media. When asked about the importance of physician engagement, Hunt said that engaging physician needs to be done strategically. "We need to manage their fear of the future and try not to be a huge burden to their practice, but rather add IT and gently move them across the continuum," he said.
Often, physicians don't see their documentation as fundamentally addressing patient care, but now the push is to get them to see that their accuracy serves as an opportunity to better understand populations, adds Stanley. "If your only reason to document is to generate a bill, thats not enough. Documentation needs to be understood so it's patient-focused. Once physicians get that, the light bulb will go on," he says. 
Answering a question pertaining to the culture change for the patient, Stanley said that it's important to really understand the consumer in terms of his or her expectations and needs. "Most patients today say they love their doctor, but hate their healthcare experience," he said. "Reporting and data are how we will improve ourselves, but we need to think like the consumer as well."
Hunt agreed, and gave an example of a diabetic patient in his health system who made 30 trips to the ER in the last year. He worked from 10 a.m. to 10 p.m. and never got to see his primary care physician, explained Hunt. "But once we understood those barriers to care for him, we stopped calling him at work and set up after hours assistance in the home. And the patient loves that, as he doesn't need to go to the ER anymore." Added Stanley, "You never would have known that if not for data."

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