The topic “Volume to Value: Transforming U.S. Healthcare Delivery,” the first panel discussion at the Health IT Summit in San Francisco, presented by the Institute for Health Technology Transformation (iHT2), focused strongly on the nexus between and among healthcare system reform, information technology strategy, and culture change, on Tuesday, March 25, at the Presidio Golden Gate Club in San Francisco.
A panel of experts, moderated by Greg Caressi, senior vice president, Healthcare * Life Sciences, Frost & Sullivan, discussed the topic in front of an audience of healthcare leaders and professionals. The event is sponsored by the Institute for Health Technology Transformation, which since December has been a partner with Healthcare Informatics and its parent company, Vendome Group LLC. The other members of the panel were John Showalter, M.D., MSIS, chief health information officer at the University of Mississippi Medical Center; Jan Oldenburg, principal with JanOldenberg Consulting, Richard Osborne, healthcare practice leader for the Point B consulting firm; and Vance Clipson, II, senior principal, healthcare solutions, with Varolii (now Nuance Outbound).
Panel members respond to questions from the audience on March 25. From
left to right: Greg Caressi, Jan Oldenburg, Vance Clipson, II, Richard Osborne,
John Showalter, M.D.
In a detailed discussion of the issues involved, a broad consensus emerged among panel members around the interrelationships between and among healthcare system reform and clinical transformation, on the one hand; and cultural change within healthcare; and IT strategy; and that success in each area was dependent on success in the others, as leaders in the U.S. healthcare system attempt to shift the system from being volume-driven to being value-driven.
Early on the discussion focused on how to conceptualize population health management, and what is truly important, as provider organizations begin to move forward. “The people in the most trouble [in terms of chronic illness and health status] are necessarily people we have to pay attention to, but they may not be the right opportunity” in terms of successfully making the shift to a value-driven system, said Oldenburg. “I’m a firm believer that if we’re going to do system-level transformation, we have to start working with people now” who are part of the mid-level health risk group of patients and consumers, she added. “Yes,” said Osborne in agreement, “and we need some tools for predictability as to which people will move in that direction; we need to know who’s going to become more ill over time.”
Expanding the scope of population health has strong economic elements to it, too, Showalter said. “In order to keep our doors open, we’re going to have to reduce the cost of that group [frequent flyers], and actually reduce the size of that group to keep our doors open tomorrow. And we have to get better at secondary and primary prevention. If we can reduce the size of that group by five percent, we can save a lot of money,” he asserted.
When it came to a segment of the discussion in which panel members mulled over how to leverage relationships with organizations outside their enterprises to do population health management, Showalter said, “We can’t afford to set up a kiosk everywhere. So if CVS can figure out how to make money off that and provide a worthwhile service, that [extends us]. There’s some amazing research to there that nobody reads, on markets in inner cities—fresh fruit markets, farmers’ markets. If you can figure out how to subsidize fresh produce, that’s a win” for public health, he noted.
Leveraging trust in providers
A wide-ranging discussion of the role of providers in communities and the types of relationships that healthcare consumers have with providers and payers elicited spirited commentary among panel members. “From a culture change standpoint,” Oldenberg noted, “one of the opportunities we have is to look at our communities. There are communities that are creating health ministries within churches, so that someone is doing diabetic foot exams after services, for example. Those are examples of where we can extend our reach beyond our walls. And that’s also a way to introduce electronic services. So thinking about the broader community aspects of what we can do to help people live differently and healthfully, is a big part of solving this problem.
Responding to that commentary, Osborne said, “The piece that’s missing is payers, providers, medical groups, all working together to share the data and worry less about the competitive nature of the data.”
“I think we really need strong partnerships to identify where the value is,” Showalter asserted. “And once we do that, the clinicians can determine what to do. I can go out and sit with pastors,” he added, referencing Oldenburg’s comment about leveraging relationships with religious communities to enhance community health. “I can’t see Aetna or Medicaid successfully having that conversation with that community; there’s just not that trust,” he said. “And we are working on those relationships. Our former vice chancellor or research is now the head of Mississippi Medicaid, and they’re a huge payer in Mississippi, so we’re working on that relationship,” he noted.
“ I think there’s no doubt that people trust their providers and don’t really trust their insurers,” Oldenburg commented. “And one of the things we know is that a trust relationship with provider is a key to enhancing health. And that’s where we can help people think about change, make sustained change, and help people do that in ways that meet their needs. And I believe we need different kinds of partnerships than we’ve had in the past. And some of that is around leveraging relationships with payers around doing analytics, and then putting the data into the hands of the people who can create change with that data. And some of those trends are changing that in very positive ways.”
How do medical leadership and IT strategy interrelate?
One of the most interesting segments of the panel discussion centered around the interplay between the demonstration of leadership on the part of physician leaders in patient care organizations, and the pursuit of IT strategy. A particularly pointed example of that interplay was shared by Oldenburg, who said, “We’ve been talking about ground-level initiatives, but we shouldn’t underplay the role of medical leadership. The CMO of one region at Kaiser, when I was working with them, said, ‘Our physicians are going to respond to patient e-mails. And if you don’t want to respond to patient e-mails, go practice medicine somewhere else,’” Oldenberg reported. “And the physicians in that region were begging to be involved in that pilot. So that speaks to the importance of physician leadership.”
What’s more, said Showalter, “The predicting” involved in predictive analytics work “doesn’t do a lot of good unless there’s a firm ‘This is what you’re going to do with this information’ statement attached to it. So let’s say we’ve predicted your top 20 potential readmissions in the month,” he said, “You have to then say, ‘This is the action you’re going to take.’ We’ve made hard choices in that way, but trhey’ve worked,” he affirmed.
What’s becoming clear, Osborne said, is that, “Historically, we’ve looked at IT as the solution. And we’re seeing everywhere now that IT is the enabler, not the solution. It’s the data out there that we need to use differently. I’m not sure that the tool is really the differentiator there,” he added; it’s more about use an asset that we’ve historically used poorly.”
“And I’ve been trying to push the idea that good enough is good enough,” Showalter emphasized. “If you have a patient portal and secure messaging, figure out how to best get patients to use the portal. And that may be legwork. And if you have basic reporting, use basic reporting and Excel spreadsheets to do predictive analytics. I’ve used very basic tools to separate out patients with a 30-percent chance of readmission and a 5-percent readmission. So use the tools you have now, or we won’t have the money to invest in tools for the next generation.”
“The predictive analytics, the risk stratification, the identification of who the people are whom we need to touch today—that’s all a huge piece of what we need to do,” Oldenburg affirmed. “But also, we may identify the right people, but then if we still employ 1980s-style approaches to how we engage them… the telephonic nurse case manager approach didn’t work all that well back in the 1980s, and yet that’s still the most common approach to follow-up management,” she noted. “So this is one of the opportunities to take some learnings from the emerging science of behavior change, and add it into technologies like apps, even, for example, to text message alerts to an underserved population that doesn’t have smartphones, and combine those things with the right high-touch approaches."
Oldenburg added, "So I’m not sure that there’s necessarily one technology” to pursue in any of these cases. Instead, she said, “it seems that [success comes from] thinking about our touch points and connection points,” and then developing and implementing the right IT strategies to the right kinds of broad goals for population health management, in the context of knowing and working with our communities.