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Catching Up with Tim Zoph, and Parsing the Current Inflection Point in U.S. Healthcare

September 19, 2016
by Mark Hagland
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Tim Zoph shares his perspectives on where things are headed next in U.S. healthcare

Chicagoan Tim Zoph has spent decades in healthcare executive leadership, including 21-plus years at Northwestern Memorial Hospital in downtown Chicago, between January 1994 and October 2015, where he served in a few different positions, including CIO and as the chief executive over facilities development for that organization. While he was at the organization, it grew to become a $5 billion academic medical center, and a recognized leader in quality, education and technology. In addition to his CIO role, Tim had management responsibility for the Facility Design and Construction team and Enterprise Project Management Office, where had oversight for designing, building and activating over $1 billion worth in new facility projects.

Zoph is particularly well known among the members of the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) as a long-term faculty member and program director for the CHIME Boot Camp program. He also was one of the CIOs whose insights provided material for Graham Weller's recent book The CIO Edge: Seven Leadership Skills You Need to Drive Results, from Harvard Business Press Books.

This spring, Zoph joined the Naperville, Ill.-based Impact Advisors consulting firm as client executive and strategist. At Impact Advisors, he splits his time almost evenly between working directly with client provider organizations on strategy, development work, new facilities planning, and cybersecurity, and on helping the consulting firm overall with its own strategy and client service direction. He spoke recently with HCI Editor-in-Chief Mark Hagland about his perspectives on where healthcare and healthcare IT are headed these days. Below are excerpts from their interview.

You seem to be enjoying the work you’re doing these days. Tell me a little bit about how you’re dividing your time between direct client consulting and strategizing with the firm.

I’m spending about half of my time working directly with clients, which is great. I’ve got clients in both New York and Seattle. It has to do with where my time can be most valuable in working with clients. It tends to be with larger, academic organizations—the more complex organizations that I’ve worked in, in the industry, capitalizing on that. And when you run big organizations as a senior executive, in some ways, it’s hard to be an individual contributor, because your time is so tight and is so tied into management priorities. So this is a great time for me to have the focus and the thoughtful time to really research and be more reflective about where we’re headed. So I feel like I’m a better individual contributor now than when I was a senior executive, simply because of the challenges of managing those roles.


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Tim Zoph

Looking around at the overall landscape of the industry, it seems clear that U.S. healthcare is at something of an inflection point. I’ve often compared it to the moment during the building of the Transcontinental Railroad when people were having to break ground in the Rocky Mountains, literally in some cases with picks and shovels, to lay track. Does it feel to you as though there is an analogy there with what’s going on in the U.S. healthcare industry now?

Yes, I agree, I would use a lot of the same analogies. We’ve made significant investments in foundational systems in the industry. Yet I still think the industry is challenged to get the most value out of those systems and to make sure that we’re laying those foundations correctly and moving to the next steps. So having simplified, scalable, interoperable systems, is so important to get to the next level. And to me, that next level involves knowledge-based systems, and the population-based systems. How do I aggregate those systems and harvest the knowledge inside those systems? That’s so important. And interoperability involves a combination of challenges facing vendors, CIOs, and the industry as a whole; yet we’re not today still exchanging information at key points in transitions of care, and that’s holding us back. And patients today are still left fundamentally being the messengers. So we have to make the systems simpler, scalable, interoperable, and more easily manageable. So we have to turn the page on that foundational strategy, to get to begin to become knowledge-based.

We need to get to the next level in healthcare, and a lot of that will relate to how we better connect with patients—really engaging patients directly in their health, and engaging them so that they feel that they’re true members of the care team, and are contributing directly to their record. We talk about being patient-centric, but that still leaves us with a very small footprint overall in patients’ lives. And mobility, among other things, will be so important. So we have to take advantage of these foundational technologies, and layer up on them. So not only do we have to scale up, but also scale in, by allowing innovation to occur more organically. And part of that is about technology, but it’s also about collaboration and attitude. And we have to be prepared for that, because it will transform our system as we know it today.

Do you think that the leaders of inpatient organizations fully understand how much things will shift to outpatient over the next decade?

With CMS’s incentives and announcements [recent mandates from the federal Centers for Medicare and Medicaid Services], and the care being based more on outcomes than encounters, it’s clear that that’s a better way to manage health—for many leaders, it still feels like a very long way to get there. You have emerging ACO experience, but it hasn’t reached scale yet. So people see the transition coming, but you need to put the management and leadership structures together to build the systems that will help us move forward. And right now, most organizations just don’t have the information yet to go fully at risk. So you see an evolution. And in many ways, the incentive systems are still built around fee-for-service performance, so you’re seeing some very early evidence that this is going to happen.

And if you look at the Geisingers of the world and others that have had the structures in place already, where they’ve already blended the physician organizations and inpatient organizations together, they’ll move faster than others. In the shorter term, you overestimate the progress, but in the longer term, you underestimate the change. This is one of those where you may well soon get to a tipping point; it will come through changes in leadership and management; incentive models; and information. And those things really need to come together to make their way out of the traditional structures and fully embrace at-risk healthcare.

They’re having to build the care management processes and the data analytics systems at the same time, correct? That seems to be one of the heaviest lifts right now.

Yes, that’s right. And the other piece of this is the whole engagement of the patient. Patients need to become true members of the care team and their contributions and insights need to be valued. And we truly need to be managing with them, and not just managing them. And that is a cultural change.

So how do we get there, in terms of patient engagement, and the cultural change needed to make that engagement possible?

Let me talk about information and trust for a moment. One of the ways in which patients will feel like they’re part of the team is if you share information with them. OpenNotes is one element there. One of the ways you get them to feel like they’re a trusted member of the team is to share information with them more readily. And then they’ll begin to understand that they’re part of the team, because their information will be part of the record, and will travel with them. So you have to culturally be prepared to onboard patients in ways we haven’t done that before. We need to know things like, are patients taking their medications or not? What’s their blood pressure on a given day? And are they exercising as planned? We need to do know the day-to-day trends that occur outside the health system. So part of this is transforming the model of care to fully incorporate the patient and family as part of the care team, and have the trusted information-sharing both ways.

The vendor tools for data analytics and population health are just not there yet: that is what every single patient care executive I’ve interviewed has told me. Your thoughts?

In fairness, in some cases, some of these products are just plain old care coordination tools; and the vendors are trying to figure out how they can build and evolve their solutions. And I’ve been in the industry a long time. I think we feel as providers, and some of this is back on us, too, and perhaps we just haven’t been sophisticated enough consumers. I do think that providers need to be far more declarative about what they need, and the capabilities they need, and actually be directly engaged in the innovation. I don’t believe this is something where you simply sit around and wait for the products to arrive. You simply have to roll up your sleeves and get involved in the development itself. You’re only going to discover what you need by doing it; otherwise, it’s not going to happen.

As I wrote in a recent blog, commenting on a previous commentary that had appeared recently in The New England Journal of Medicine, there are provider organizations beginning to do that kind of development now.

With the consolidation of healthcare delivery in this country, you now have larger, more sophisticated organizations than ever before. Second, we’ve consumed this now ourselves, and paying attention to end-user-based design—we’ve learned some lessons. And we are going to be forced to be innovative, because we’re going to have to scale in, not just scale up. We’re going to have to take advantage of commercially-based technologies from other industries that have worked with their consumers. So I think that innovation is going to have to be a core competency; there’s no other way to get there. Sometimes, you have to fail rapidly to figure out what works and what doesn’t. And you’re going to have to have innovative cultures to develop technological innovation.

So I do think, per the inflection point that we’ve been discussing—that we needed to let the industry (vendors) bring solutions to us, and go through that beauty pageant phase around evaluating functions and features, to get to where we are now, which will demand that we become more declarative. And I think it doesn’t do us anybody any good to say, gee, I don’t like this, don’t like that. But what are we going to do this time around, if we were less than satisfied. So we’ve learned a lot about what works and doesn’t work. But fundamentally, it goes back to those who buy the technology, to make sure the market meets their needs.

Will the “big-box” clinical information systems vendors then respond? They’ve consolidated, too, acquiring smaller EHR and other vendors.

There’s always that fear that there won’t be a competitive edge in the industry. On the ambulatory side, though, we still have a lot of competitors. And if the systems won’t respond, some consolidation is actually healthy. But it’s incumbent on the industry to be far more declarative about what our needs are, and we’re getting to that point where we’ll need to be more demanding consumers, because if our clinicians aren’t satisfied, and if our patients aren’t having confidence about how they engage with us on their health, we’re failing them. So we need to make sure the solutions in the marketplace will enable this really, really important transition in the healthcare system to occur. So we need to be demanding and take on some of this ourselves. I just think we have to be better this time around; we’ve got to be better; and we’ve learned from this rapid deployment. We’ve got to learn and recalibrate.

What is your read of attitudes towards change right now among U.S. healthcare executives and clinicians?

Yes, I do think so. And the caring cultures that we have, and the work that goes on in these healthcare systems every day, despite the high level of regulation and the lack of the most advanced tools, I’m really impressed by the high quality of care they deliver. There’s a lot of stress around dealing with a concomitant set of changes happening at the same time, and it’s a very challenging time in the industry. I do think there’s greater awareness of the need for change. You do see variation. The more sophisticated organizations are way out ahead. I do worry about the organizations that aren’t fully aligned, especially among organizations in rural health. The pace of change is dividing the ends of the system quite rapidly. So part of this is making sure we can provide the quality of care, including specialty and emergency care, that’s going to be needed as we go through these changes. I’m not a health planner, but those with the best leadership and strategic planning, and others are falling behind.

You’re also very involved in consulting on facility development, of course, too.

Yes, and I think we have an amazing opportunity to build the next-generation health facilities that are really smart and adapted and really will give us a significant step up in the environments of care; and technology is a huge part of it, not only in the systems that will go inside it, but in the design itself—the biomedical systems, security systems, communications systems. And thinking about how all those systems integrate and adapt. And thinking about how patients will interact with these buildings; it’s a very interesting time. You can get some of those thoughts out of my blog (LINK). We’re getting much smarter in how we prototype these buildings, in terms of safety and efficiency. So it’s a really exciting time to think about smart buildings in healthcare. I’m working on some project work in Seattle, where we’re using some of these concepts, and some of these concepts, I’m weaving.



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NCQA Moves Into the Population Health Sphere With Two New Programs

December 10, 2018
by Mark Hagland, Editor-in-Chief
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The NCQA announced on Monday that it was expanding its reach to encompass the measurement of population health management programs

The NCQA (National Committee for Quality Assurance), the Washington, D.C.-based not-for-profit organization best known for its managed health plan quality measurement work, announced on Dec. 10 that it was expanding its reach to encompass the population health movement, through two new programs. In a press release released on Monday afternoon, the NCQA announced that, “As part of its mission to improve the quality of health care, the National Committee for Quality Assurance (NCQA) is launching two new programs. Population Health Program Accreditation assesses how an organization applies population health concepts to programs for a defined population. Population Health Management Prevalidation reviews health IT solutions to determine their ability to support population health management functions.”

“The Population Health Management Programs suite moves us into greater alignment with the focus on person-centered population health management,” said Margaret E. O’Kane, NCQA’s president, in a statement in the press release. “Not only does it add value to existing quality improvement efforts, it also demonstrates an organization’s highest level of commitment to improving the quality of care that meets people’s needs.”

As the press release noted, “The Population Health Program Accreditation standards provide a framework for organizations to align with evidence-based care, become more efficient and better at managing complex needs. This helps keep individuals healthier by controlling risks and preventing unnecessary costs. The program evaluates organizations in: data integration; population assessment; population segmentation; targeted interventions; practitioner support; measurement and quality improvement.”

Further, the press release notes that organizations that apply for accreditation can “improve person-centered care… improve operational efficiency… support contracting needs… [and] provide added value.”

Meanwhile, “Population Health Management Prevalidation evaluates health IT systems and identifies functionality that supports or meets NCQA standards for population health management. Prevalidation increases a program’s value to NCQA-Accredited organizations and assures current and potential customers that health IT solutions support their goals. The program evaluates solutions on up to four areas: data integration; population assessment; segmentation; case management systems.”



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At the D.C. Department of Health Care Finance, Digging into Data Issues to Collaborate Across Healthcare

November 22, 2018
by Mark Hagland, Editor-in-Chief
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The D.C. Department of Health Care of Finance’s Kerda DeHaan shares her perspectives on data management for healthcare collaboration

Collaboration is taking place more and more across different types of healthcare entities these days—not only between hospitals and health insurers, for example, but also very much between local government entities on the one hand, and both providers (hospitals and physicians) and managed Medicaid plans, as well.

Among those government agencies moving forward to engage more fully with providers and provider organizations is the District of Columbia Department of Health Care Finance (DHCF), which is working across numerous lines in order to improve both the care management and cost profiles of care delivery for Medicaid recipients in Washington, D.C.

The work that Kerda DeHaan, a management analyst with the D.C. Department of Health Care, is helping to lead with colleagues in her area is ongoing, and involves multiple elements, including data management, project management, and health information exchange. DeHaan spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland regarding this ongoing work. Below are excerpts from that interview.

You’re involved in a number of data management-related types of work right now, correct?

Yes. Among other things, we’re in the midst of building our Medicaid data warehouse; we’ve been going through the independent validation and verification (IVV) process with CMS [the federal Centers for Medicare and Medicaid Services]. We’ve been working with HealthEC, incorporating all of our Medicaid claims data into their platform. So we are creating endless reports.


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We track utilization, cost, we track on the managed health plan side the capitation payments we pay them versus MLR [medical loss ratio data]; our fraud and abuse team has been making great use of it. They’ve identified $8 million in costs from beneficiaries no longer in the District of Columbia, but who’ve remained on our rolls. And for the reconciliation of our payments, we can use the data warehouse for our payments. Previously, we’d have to get a report from the MMIS [Medicaid management information system] vendor, in order to [match and verify data]. With HealthEC, we’ve got a 3D analytics platform that we’re using, and we’ve saved money in identifying the beneficiaries who should not be on the rolls, and improved the time it takes for us to process payments, and we can now more closely track MCO [managed care organization] payments—the capitation payments.

That involves a very high volume of healthcare payments, correct?

Yes. For every beneficiary, we pay the managed care organizations a certain amount of money every month to handle the care for that beneficiary. We’ve got 190,000 people covered. And the MCOs report to us what the provider payments were, on a monthly basis. Now we can track better what the MCOs are spending to pay the providers. The dashboard makes it much easier to track those payments. It’s improved our overall functioning.

We have over 250,000 between managed care and FFS. Managed care 190,000, FFS, around 60,000. We also manage the Alliance population—that’s another program that the district has for individuals who are legal non-citizen residents.

What are the underlying functional challenges in this area of data management?

Before we’d implemented the data warehouse, we had to rely on our data analysis and research division to run all the reports for us. We’d have to put in a data request and hope for results within a week. This allows anyone in the agency to run their own reports and get access to data. And they’re really backed up: they do both internal and external data reports. And so you could be waiting for a while, especially during the time of the year when we have budget questions; and anything the director might want would be their top priority.

So now, the concern is, having everyone understand what they’re seeing, and looking at the data in the same way, and standardizing what they’re meaning; before, we couldn’t even get access.

Has budget been an issue?

So far, budget has not been an issue; I know the warehouse cost more than originally anticipated; but we haven’t had any constraints so far.

What are the lessons learned so far in going through a process like this?

One big lesson was that, in the beginning, we didn’t really understand the scope of what really needed to happen. So it was underfunded initially just because there wasn’t a clear understanding of how to accomplish this project. So the first lesson would be, to do more analysis upfront, to really understand the requirements. But in a lot of cases, we feel the pressure to move ahead.

Second, you really need strong project management from the outset. There was a time when we didn’t have the appropriate resources applied to this. And, just as when you’re building a house, one thing needs to happen before another, we were trying to do too many things simultaneously at the time.

Ultimately, where is this going for your organization in the next few years?

What we’re hoping is that this would be incorporated into our health information exchange. We have a separate project for that, utilizing the claims data in our warehouse to share it with providers. We’d like to improve on that, so there’s sharing between what’s in the electronic health record, and claims. So there’s an effort to access the EHR [electronic health record] data, especially from the FQHCs [federally qualified health centers] that we work closely with, and expanding out from there. The data warehouse is quite capable of ingesting that information. Some paperwork has to be worked through, to facilitate that. And then, ultimately, helping providers see their own performance. So as we move towards more value-based arrangements—and we already have P4P with some of the MCOs, FQHCs, and nursing homes—they’ll be able to track their own performance, and see what we’re seeing, all in real time. So that’s the long-term goal.

With regard to pulling EHR information from the FQHCs, have there been some process issues involved?

Yes, absolutely. There have been quite a few process issues in general, and sometimes, it comes down to other organizations requiring us to help them procure whatever systems they might need to connect to us, which we’re not against doing, but those things take time. And then there’s the ownership piece: can we trust the data? But for the most part, especially with the FHQCs and some of our sister agencies, we’re getting to the point where everyone sees it as a win-wing, and there’s enough of a consensus in order to move forward.

What might CIOs and CMIOs think about, around all this, especially around the potential for collaboration with government agencies like yours?

Ideally, we’d like for hospitals to partner with us and our managed care organizations in solving some of these issues in healthcare, including the cost of emergency department care, and so on. That would be the biggest thing. Right now, and this is not a secret, a couple of our hospital systems in the District are hoping to hold out for better contracts with our managed care organizations, and 80 percent of our beneficiaries are served by those MCOs. So we’d like to understand that we’re trying to help folks who need care, and not focus so much on the revenues involved. We’re over 96-percent insured now in the District. So there’s probably enough to go around, so we’d love for them to move forward with us collaboratively. And we have to ponder whether we should encourage the development and participation in ACOs, including among our FQHCs. Things have to be seen as helping our beneficiaries.

What does the future of data management for population health and care management, look like to you, in the next several years?

For us in the District, the future is going to be not only a robust warehouse that includes claims information, vital records information, and EHR data, but also, more connectivity with our community partners, and forming more of a robust referral network, so that if one agency sees someone who has a problem, say, with housing, they can immediately send the referral, seamlessly through the system, to get care. We’re looking at it as very inter-connected. You can develop a pretty good snapshot, based on a variety of sources.

The social determinants of health are clearly a big element in all this; and you’re already focused on those, obviously.

Yes, we are very focused on those; we’re just very limited in terms of our access to that data. We’re working with our human services and public health agencies, to improve access. And I should mention a big initiative within the Department of Health Care Finance: we have two health home programs, one for people with serious mental illness issues, the other with chronic conditions. The Department of Behavioral Health manages the first, and the Department of Health Care Finance, my agency, DC Medicaid, manages the second. You have to have three or more chronic conditions in order to qualify.

We have partnerships with 12 providers, in those, mostly FQHCs, a few community providers, and a couple of hospital systems. We’ve been using another module from HealthEC for those programs. We need to get permission to have external users to come in; but at that point, they’d be able to capture a lot of the social determinants as well. We feel we’re a bit closer to the providers, in that sense, since they work closely with the beneficiaries. And we’ve got a technical assistance grant to help them understand how to incorporate this kind of care management into their practice, to move into a value-based planning mode. That’s a big effort. We’re just now developing our performance measures on that, to see how we’ve been doing. It’s been live for about a year. It’s called MyHealth GPS, Guiding Patients to Services. And we’re using the HealthEC Care Manager Module, which we call the Care Coordination Navigation Program; it’s a case management system. Also, we do plan to expand that to incorporate medication therapy management. We have a pharmacist on board who will be using part of that care management module to manage his side of things.



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