This past April, 14 CIOs from leading healthcare organizations convened at the Scottsdale Institute’s Spring CIO Summit in Arizona to discuss the most important health IT-related challenges facing CIOs and to share insights on key IT-enabled strategies for value-based care.
Driven by the accelerating trend toward alternative payment models that reward quality of care rather than volume of services rendered, many of the organizations represented at the Scottsdale Institute CIO Summit have been preparing for value-based care with the development of clinically integrated networks for some time, while others are just getting started. Last year’s passage of the Medicare Access and CHIP Reauthorization Act (MACRA), which rapidly accelerates the transition to value-based payments, has especially spurred health systems to optimize and expand their clinically integrated networks, which presents CIOs with a number of IT challenges.
The Summit was hosted by the Scottsdale Institute, a Minn.-based not-for-profit membership organization of health systems advanced in IT, and sponsored by Impact Advisors, a Naperville, Ill.-based healthcare IT consultancy and moderated by Ralph Wakerly of Minneapolis-based consultancy C-Suite Resources. Insights from the discussions at the spring CIO Summit are outlined in the report, “Creating Clinically Integrated Networks: Challenges, Successes, Lessons Learned.” The group identified several lessons learned to be successful in a value-based environment, including the need for CIOs to be willing to make strategic decisions and learn quickly from their mistakes, the importance of data analytics, how to manage the complexity of new partnerships and the need for collaborative leadership moving forward.
Following the Summit, Healthcare Informatics Assistant Editor Heather Landi spoke with two CIOs who were in attendance—George Conklin, Senior VP and CIO at the Irving, Texas-based Christus Health, a 60-hospital integrated healthcare delivery system, and Mary Alice Annecharico, Senior VP and CIO at Henry Ford Health System, a five-hospital health system based in Detroit—as well as Tonya Edwards, M.D., physician executive at Impact Advisors. In Part 1 of this story, Healthcare Informatics provides an inside look at building clinically integrated networks from the lens of CIOs and the challenges they face. Below are excerpts of those discussions with Conklin, Annecharico and Edwards.
What was the general mood of the CIOs involved in the discussions at the CIO Summit?
Edwards: There was a lot of energy and a sense of excitement about what the future holds, but also some nervousness about what the future holds, because so much is changing so very rapidly. Leaders from several organizations actually pointed out that there really is no roadmap. They are trying to make decisions quickly, be nimble and move forward on a path, but not knowing necessarily if the path they are going down is the right path. That said, there was a lot of excitement about being able to do some new things that could help drive health systems forward much faster, particularly around the area of analytics.
Conklin: Concerned, with a lot of focus around security, but also there was a sense of, How can we work together better to help protect all of us?
Cybersecurity wasn’t one of the key findings in the report from the CIO Summit, but it sounds as if it was discussed, so what were some of the takeaways from those discussions?
Annecharico: [Cybersecurity] was peppered throughout the conversations that we were having throughout the entire conference. It is a growing burden for our organizations to be able to keep the bad actors out and to manage our responsibilities at the federal level with managing the privacy and security of our data.
Mary Alice Annecharico
Conklin: Everybody is as focused as we are on it and there is a keen amount of interest. There was a concern relative to our ability to be able to respond effectively to all of the different evolving kinds of attacks that are occurring out there. There is a lot more cooperation amongst us, and evolving new ways of communicating when one of us sees something or is attacked by something, and communicating it out to other group members, and even enlisting each other to help in the event of an attack.
The CIO Summit specifically focused on the IT challenges of developing clinical integrated networks. Why is this a crucial time for healthcare organizations to build or expand their clinically integrated networks?
Conklin: What we’re seeing is, and particularly within Christus, is our traditional business is mainly focused around acute care, so hospital episodes. What we’ve now seeing is a steady and consistent decrease in admissions and discharges and, as a result, revenues, and increasing demand for newer, higher-end technologies that require capital investments. Patients are getting their healthcare somewhere else, such as free-standing ERs, surgery centers, doctor’s offices and clinics that are constructed to be convenient to them and to handle episodic needs for treatment and services, but are not geared up to be able to handle the long-term and evolving needs of people who might have multiple co-comorbidities. So our focus in our healthcare systems, and universally across all the Scottsdale Institute membership, is beginning to develop a more balanced portfolio of services and products that network together community-based entities and physicians to provide care where patients want it. And, where these services are not present, the focus is to put in physician practices, establish free-standing ERs, imaging centers and surgery centers. The big positive being that all these things are tied together into a service network so that your information moves with you as you need different levels or types of care. That’s the big focus from an IT perspective—how do we bring in new partners to integrate into our networks, how do we build out and establish these new centers ourselves and how do we tie them all together? One of the other things we’re doing as well is we’re beginning to move into the health plan space and become an insurer on our own.
Annecharico: The IT challenges of creating clinical integrated networks is an important topic for many reasons, but the major reasons deal with our population health environments and the thirst for us to be able to organize data and use it meaningfully, to manage our local populations, and also the health and welfare of our regions and our nations. Population health is a major driver to help us take a look at cohort data differently and help us to use data to create an insight-driven environment. The other major component that is of value to Henry Ford and other organizations at the Summit is to figure out how to leverage contracting in a way that enables us to have fair value from our payers. Right now, each one of our organizations are fighting with our insurance companies to get the best value out of fair cost. This will enable us to do that, because we are looking at a diversity of services as well as the basic foundation for primary care and we’re moving into ambulatory care. We are able to speak with a larger voice. But it’s important that as our inpatient populations continue to decline, we’re realizing that we have economies of scale to move much of that into the ambulatory market. At the same time, we don’t get reimbursed the same way, and it’s taking more density, more concentrated services to be able to attain a normal state,. Most of us have seen up to 30 percent of our revenues declining from the payment models that exist today and that shift is really requiring us to use data differently to help us think smarter and more strategically.
One of the key recommendations for CIOs from the report was “fail fast, learn fast.” What does this mean?
Edwards: I think the main reason speed is important is there’s a sense of this acceleration of change, particularly with some of the things that have gone on the last few years, with the CMS announcements related to changing over to more value-based payment. After the January 2015 announcements, when MACRA came along, people started to take all of the anticipated changes much more seriously. And, now we are starting to feel quite a bit of pressure because folks know that, while the first year is 2019, the first performance period starts six months from now. People are beginning to understand that speed is going to be very important to get to a place where we can perform well under MACRA, and then also the rapidly changing commercial market, there’s been an acceleration on value-based payment there as well.
Tonya Edward, M.D.
Conklin: There is a need for speed, and a need for capital. And so given the prior context of decreased admissions, the capital bases are shrinking for us, so at the time when we need to make heavy investments in IT and build out those kinds of centers and things I’ve talked about, such as new doctor’s practices, we’re also having shrinking basic cash to be able to do that. One of the challenges is certainly doing it fast, but also doing it inexpensively, which means moving toward more standardization and a cookie cutter build-out of these places. So when you go into a free-standing ER or doctor’s practice, the look and feel is particularly a Christus Health look and feel and it’s the same format and construction for these sites regardless of where they are located.
Annecharico: We can’t know it all or do it all, but to be successful you have to make strategic decisions and move forward quickly and nimbly. If you have an idea and can assemble a business strategy around it and can really look at your return on investment, then you can move forward and put it into a small enough environment. It’s about whether you can learn from what’s working and not working and be resilient enough to either make adaptations or bail on that and try something else.
It may very well be that you have a bridge strategy where you want to get to the other side of the bridge and you have a couple of stops and starts to get there, but you ultimately know what your goal is. I’ll give you an example. For us, during the period of time that we were implementing Epic, we worked on a framework to transform our clinical operations. We did the entire organization, all of the inpatient and ambulatory as well as all of our revenue cycle consolidation, in a 16-month period of time. And with that, we were also trying to build the future state of what our enterprise data warehousing strategy was. And, we realized that one of the partners that we chose was slipping and falling too often and so we had to create a very defined timeline and indicate the deliverables that needed to be managed, the quality and the content of them, and, if not, then we will void the relationship. That’s difficult to do when you have multi-million dollar contracts, but we were so clear and gave it enough attention that we had defined the scope of the work as well as our outcomes. We were realizing that we couldn’t deliver our products to our end-user communities because we had this barrier in there, so along the same line, we decided that this was simply not working, but what we did do, at the same time, was we started building a bridge strategy to get us over the hump and evolve a permanent strategy right behind it. So that we ultimately had a better solution and a better line of products that we could deliver to our communities of users.