When the nonprofit eHealth Initiative put on a May 25 webinar to release the results of its annual survey on population health trends, the discussion that followed was probably more interesting than the survey results themselves. After all, as noted by moderator Charles Kennedy, M.D., chief population health officer at Healthagen, Aetna’s population health solutions company, more than 60 percent of respondents reported participating in some type of accountable care organization, so the progress they have made probably is not representative of the industry as a whole. More than 68 percent said they have created new roles or hired new staff for population health management, and 76 percent have purchased or developed health IT or analytics for population health management. “The results are probably skewed toward the organizations that are already thinking about how to move to value-based care,” he said.
Nevertheless, the discussion with two Texas-based leaders in accountable care was fascinating. Kennedy interviewed Shawn Griffin, M.D., chief quality and informatics officer for Houston-based Memorial Hermann Physician Network, and Tricia Nguyen, M.D., executive vice president for population health, Texas Health Resources, and president of the Texas Health Population Health, Education & Innovation Center.
Nguyen said she had several takeaways from the survey results. First, there is no turning back from value-based payments. She said she hears people say they are taking a wait-and-see approach, thinking this could be a passing trend, but she said that is not the case. Second, she said, there is no single platform that covers all the technology needs to manage populations. “There are best-of-breed solutions across multiple vendors to make up a complete stack to manage populations,” she said. Texas Health Resources has invested in technology for data aggregation and integration in order to generate actionable information into the workflow of physicians and care managers to mitigate clinical risk.
Griffin said Memorial Hermann worked on clinical integration with primary care practices for several years and helped them become patient-centered medical homes. “That was useful for bringing their capabilities up,” he said, “but the problem with patient-centered medical homes and Meaningful Use is that you get so focused on checking boxes, you don’t actually change what you are doing.” He said he believes the updated regulations in MACRA represent an enlightened view that EHRs have been getting overbuilt, leading to a loss of efficiency and usefulness. “I am hopeful there will be greater flexibility, so providers can focus on work flow and outcomes, and not did they check the boxes on the screen.”
Nguyen said a lack of interoperability remains a deterrent. “We need to be able to deliver evidence-based pathways at the point of care, and the only place that has impact is in the EHR,” she said. Care management platform are wraparounds. The care managers use those, but they don’t integrate well or offer bidirectional information with the EHR and vice versa, she added. Then data is collected and recollected, even within an integrated delivery network, not to mention payers and post-acute providers. She said one study found that patients who return home after a hospital and post-acute rehabilitation are contacted 15 times in the days after they return home by multiple people trying to mitigate readmission, because those providers cannot easily share data. “It’s a tremendous challenge. If we could solve that, and make data transferable across care settings and providers, it would be a huge win.”
“We are all burdened by current EHRs, which are monuments to Meaningful Use requirements,” he said. He said physicians are accused of not adapting to technology readily, but he said what they don’t adapt to is bad technology. “They are looking for multipliers of benefit, not work,” he said. Most EHRs are far too complicated and make many physicians say, ‘Gee, I wish I could retire.’
“Reducing that burden on physicians has to be one of the benefits we go after as an organization,” he said.
For groups thinking of taking on risk, Nguyen recommended first focusing on the top 5 percent of patients who make up a significant percentage of cost. She said health systems should look at the low-hanging fruit to manage and close care gaps for diabetics or chronic heart failure patients. “You don’t need sophisticated predictive models to do that. I am hopeful that over time there will be more sophisticated tools to help you better identify and stratify populations.”
Griffin and Nguyen agreed that behavioral health is key to success with population health. “We are all going to have to do a better job on behavioral health,” Griffin said. “It is a massive untouched opportunity.” Nguyen said that today primary care providers end up providing many behavioral health services, even though they have little training. “We have to have some mechanism to retrain those physicians or increase the number of behavioral health specialists out there.”