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LIVE FROM HIMSS16: Looking at the Nuts and Bolts of Population Health Work

March 2, 2016
by Mark Hagland
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Thomas R. Graf, M.D., national director, population health, at The Chartis Group, shares his perspectives on some core challenges

Thomas R. Graf, M.D. jointed the Chicago-based consulting firm The Chartis Group seven months ago, after 12 years in executive positions at the Danville, Pa.-based Geisinger Health System, serving for the last five years there as chief medical officer for population health and longitudinal service lines. The Pennsylvania-based Dr. Graf sat down with HCI Editor-in-Chief Mark Hagland during HIMSS16, taking place at the Sands Expo Center in Las Vegas this week. Below are excerpts from that interview.

What kinds of organizations are you working with now in your new-ish position at The Chartis Group?
I'm working with a wide variety of patient care organizations, from large IDNs [integrated delivery networks] to academic medical centers, to children's hospitals. A lot of the very first work I did here was with children's hospitals.
One of the themes that seems to be emerging in presentations, panel discussions, and conversations this year at the HIMSS Conference is the actual alignment of payers and providers. Do you see actual convergence beginning to happen?
I do. It is a complicated phenomenon. For example, when I was at Geisinger, the fact was that though the Geisinger Health Plan has 500,000 members, only one-third of Geisinger patients are covered by the plan, and only one-third of plan members are Geisinger Health System patients. That's true partly because the Geisinger Health Plan is operating in all the states surrounding Pennsylvania. Meanwhile, when I was at the Henry Ford Health System, prior to Geisinger, the relationship between the health system and its owned plan was different still.
The reality is that for the convergence and alignment of health plans and providers to occur, both the function and structure need to become aligned. And a lot of folks out there have the structure but not the function. Recently, I was working with an IDN that had its owned health plan, and they said, 'This [population health work] will allow us to get down from the 85-percent medical loss ratio.' But that's not the point. The point is to better manage the 85-percent medical loss ratio.
What do CIOs and CMIOs need to know and do?
As a healthcare system, we need to be able to show cost and quality data graphically, in real time. Organizations can create things like real-time alerts in their clinical information systems based on financial elements, for example. The key is being able to monitor facts in real time. So if I turn this knob, what happens to quality and cost?
Where is our U.S. healthcare system in terms of population health evolution, in the proverbial journey of 1,000 miles?
We're past the first step. There's a multi-part analogy that is sometimes used; I might not apply it directly to this situation, but here's the analogy. People talk about four stages of learning, from unconsciously incompetent to consciously incompetent, to consciously competent, to unconsciously competent. That means that a person or organization starts out not even understanding what they don't know; moves to understanding what they don't know; learns and moves to a level of capability that involves the absorption of learning; and finally, reaches a mastery stage where they no longer even need to think about what they know, because it's internalized. I'm not saying that that analogy applies to population health, but the point I would make is that with regard to the population health journey, we as an industry now at least know what we don't know.
And the data integration problem is becoming solved; but the challenge of marrying clinical and claims data? Not so much. we need many multiple data flows, involving clinical, financial, and operational data, all flowing into one another and combining.
My own vision for population health is this: we who are managing your health status should know your health status at all times, and be able to match clinical complexity and urgency with the cost of the resource deployment of your care. There are many complexities there. For example, you might be too sick for what we can do for you in an outpatient setting, but also may not need to be an inpatient. There is a lot of nuance to work with.
Where do you see CIOs and CMIOs being challenged in all this?
I think that they're being asked to solve operational and leadership challenges with IT, and doing so is an impossible challenge. What CIOs, CMIOs, and other healthcare IT leaders need to do is to partner with the rest of the c-suite to address the broad operational and leadership challenges.
Many provider leaders are expressing dissatisfaction with the solutions available right now in the commercial vendor market. What are your thoughts there?
We've started that journey also, but we're not there yet. There are some rudimentary tools now; they're not fully sophisticated yet; but compared to even just a year or two ago, there's tremendous promise now in that area.

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