Recently, I interviewed David Share, M.D., vice president of value partnerships at the Detroit-based Blue Cross Blue Shield of Michigan (BCBSM), regarding that health plan’s successful development of the largest patient-centered medical home (PCMH) program in the country. Under Dr. Share’s leadership, BCBSM, which covers 4.4 million members in Michigan, has already designated 994 medical practices, comprising 3,017 physicians, as PCMHs. It is by far the largest program of its kind nationwide, and its goals are as large as its size.
As Dr. Share told me, the point of the program is not just to sign up as many physicians as possible and bring them into the PCMH concept, but to spur clinical practice change by bringing them together to collaborate with one another. When I asked him whether part of the point was to aggregate physician practices, his answer was this: “Well, we’re channeling their aggregational activities. We don’t tell them which hospital to affiliate with, for example. We deliver reports to the communities of doctors who come together, so they can see their results within their self-organized communities. And we also share those reports at the office level and the doctor level. And it’s not for us to try to micromanage their practices.” For example, he said, “If you have a doctor, an internist, practicing in an impoverished neighborhood, and that internist has a special interest in people with multiple chronic illnesses, such as heart disease and diabetes—we’ve found that that doctor really wants that information. And if you just measure one doctor’s practice, you might conclude that that one physician is over-utilizing medications or procedures or something, when that wouldn’t provide the full picture. If you look community-wide, it provides the fuller picture.”
And that indeed is where so much of the new healthcare, as I’ve been calling it, is headed. For while physicians will always need to do their absolute best to care for the individual patients who come to see them with their healthcare issues, the bigger strides that our healthcare system needs to make—towards population health management, care management, and truly transparent and accountable care—are strides that will have to be made in concert, as providers come together among themselves, and yes, sometimes together with health insurers—to work on the broader issues facing our health system. This is particularly true as the aging of the population and a massive explosion in the incidence of chronic illnesses makes our current system unsustainable on so many levels—financially, capacity management-wise, clinically, and in other ways.
And what will help move us forward as a healthcare system? In a word, it will be the intelligent and strategic deployment of analytics, across all areas of endeavor. When I speak with leaders of pioneering healthcare organizations—hospitals, medical groups, integrated health systems, health plans—about the strides they’re making, I find that, without exception, the thoughtful use of analytics is one very essential element in what they’re doing. Indeed, BCBSM is a great example of this, not only in its PCMH program, but also in a number of other programs, such as its support of research, such as the recent study by Kavitha Chinnaiyan, M.D., and her colleagues at the Beaumont Health System, which found that the inappropriate use of coronary CT angiography in patient care organizations can be reduced by a full 60 percent with educational programs, increased physician collaboration, and close monitoring.
As Dr. Chinnaiyan and her colleagues found in their study, “The study suggests that voluntary, mutually established quality metrics reinforced by education and feedback can result in major changes in inappropriate use,” as Dr. Chinnaiyan said in a statement included in the press release announcing the results of the study. In other words, if everyone works together, they can address issues of appropriateness of utilization and others, by collaboratively leveraging data analytics in concert.
What seems clear from all these examples is that, in the journey of 1,000 miles that is the path to the new healthcare, analytics will increasingly play an essential role in the progress that must be made on so many fronts. I’ll be discussing the issues around the deployment of analytics in healthcare in the upcoming Healthcare Informatics webinar on September 25. Won’t you join us for a discussion of these incredibly important issues? While no one has all the answers—I certainly don’t!!—in this tremendously complex area, what you will find out if you tune in on that day is how the leaders at truly pioneering organizations such as Allina Health in Minneapolis, Southeast Texas Medical Associates in Beaumont, Texas, and Baystate Health in Springfield, Massachusetts, and other organizations, are leveraging analytics to fuel readmissions risk assessment, the patient-centered medical home model, bundled-payment contracts, and other exciting initiatives.