Look for a partner that understands the complexity of the environment. So, for us, we didn’t know what we didn’t know. We knew what an ICU was like and how to do things in the ambulatory setting; it is probably 10 times more complex than a hospital ICU patient and I didn’t appreciate how complicated that was going to be. You’ve got your own employed physicians and they are on a single medical record, so you write an interface to that. You’ve got other physicians, even if they are in your narrow network in the ACO, and with our group, there are 27 different EMRs. You’ve got a lot of political changes, because you’re in other people’s space and, in the Banner group, there are about 600 primary care physicians that we are trying to work with. If you’re only interfaced with 200 out of the 600, that means a lot of faxing and phone calls to do that. You’ve got the technology, which I think is the easy part, but if it’s just feeding you data and it’s not looking to tell you that out of your 600 patients, here are the three people you should be intervening within the next hour because if you don’t in the next 24 hours, you may have a problem, then you really haven’t solved your opportunity. You can’t just look at raw data for 600 patients, your brain can’t see the trend in that fashion. It needs to be actionable data.
Varma: It needs to be synthesized data. I would add that I wouldn’t recommend that you try to reinvent the wheel. We do see a lot of that in the market with people trying to do it from scratch on their own. I would say think about the full population in your ACO strategy or your value-based care strategy. If you can see the full population, then you can know what your incentives are for each population cohort and pick and choose. And then use the technology, but also make sure to work on things from a process standpoint, such as having the right team. To this point, when we first tried to recruit patients, we said, ‘You really need help’ and the patients said ‘I don’t need help. I’m fine.’ We realized we had to talk to people completely different from what everybody was accustomed to. So there’s a whole level of design element to this and we’ve learned a lot of lessons from that. We were stunned by how embracing people were of technology, especially the tablet, which makes so much difference as the user experience is very intuitive for people. Equally surprising for us has been that we thought it was going to be a set of medical issues, but it’s not medical issues—medical issues are almost the lagging indicator, because the issue is the patients are taking those medications twice, or they don’t have the expertise available for them, there is nobody helping them through this, which leads to all kinds of care gaps, which ultimately then leads to serious medical admissions. I think those socio-economic and day-to-day issues are a real challenge.
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