The Opportunities of a lifetime

November 21st, 2011

Is your organization part of the solution or part of the problem? The metrics for success in healthcare delivery now have to include cost effective quality, outcomes, patient safety and patient satisfaction, to name a few. If you are looking through the rear view mirror and you are measuring your efficiency by how many patients you see, how many procedures you do without correlating these activities to outcomes….well, the clock is ticking. Fee for service reimbursement is not only perverse, it is yesterday’s model.

If your GPO asks you to be part of the “coalition of the willing” to pilot an ACO, and you think this is an innovative strategy, you may be building a bridge to nowhere.

We are seeing a variety of stakeholders who want to be part of the solution. In some iteration or another, they are becoming centers for value based medicine. They have top – down consensus and are putting the resources – money, people, cultural shift etc. in place. There are no silver bullets. Changing the game will require breaking down silos of care delivery, information management, and a level of collaboration between consumers, providers, payers, pharmaceutical companies, PBMs, and the enablers of information sharing between.

It’s not just IT – having the data is necessary, but not sufficient. Having actionable information so that we eliminate care gaps, enable transitions in care and enable consumers and providers to have information at the point of care to make better choices is what we have to strive for.

So let’s go from 20,000 feet into the trenches. We have clients conducting national searches for world class candidates to direct these centers for value in medicine. MDs, RNs, PharmDs, with experience in quality research, health delivery science research and understand the new paradigm have opportunities right here, right now, to change the game. The following links will take you to some of the most forward thinking opportunities we are seeing:

Christiana Care
Rutgers University
Walgreens
Baylor Healthcare

Integrating data from across the enterprise so that they can evaluate care management programs, and know what is working and what isn’t….You can’t deliver quality unless you can measure it! They are developing analytics and reporting for diverse stakeholders so they can deliver the right information to the right place at the right time, and better clinical decisions can be made.

There are also opportunities for experienced health services researchers, epidemiologists, econometricians, biostatisticians, actuaries, data analysts, and SAS programmers who can serve as internal consultants across the organization. We are recruiting qualified people, who can identify program improvement opportunities, propose and test better evaluation methods, provide business requirements for production, design studies, understand relationships between program design and outcomes, aggregate and summarize data, identify issues with underlying and summary data, and produce trend and other reports. Look at the opportunities at:
CIGNA
and BCBS of Louisiana

Check out our opportunities page for a bunch of others. If you are interested in hearing more, we have plenty more to talk about. Great challenges, and great opportunities!

Why physicians are not on board

February 6th, 2011

Fee for service.  Until we start to change the way the healthcare dollar is spent, all the stakeholders will continue to do what they are incented to do….follow the money. That means that gastroenterologists will continue to see that one last patient each day, do that one last endoscopy, because that is what they get reimbursed for.  Even if docs get an EMR that is “meaningful use certified”, they still will not do the data mining, analysis and quality reporting that will result in amassing the necessary body of evidence for meaningful clinical decision support.

I found a great resource that really describes what needs to be done so that pay for performance, shared savings, bundled payments, etc. can get some traction. See Physician Payment Reform Introduction which is part of the NCBH Value Based purchasing guide.

We have some great opportunities with forward thinking payers and integrated delivery systems for senior candidates experienced in innovative reimbursement programs.  See our opportunities 

I guess this battle will be won in the trenches, and we will have to be satisfied with small victories.  We have early adopters, but are nowhere near a tipping point.

Please let me know if you see something more coherent and closer to fruition than I do.

2011 – New Models, New opportunities!

January 11th, 2011

Though we certainly don’t have clarity around the details of health reform, there are some definite signs that some early adopters are moving toward value based reimbursement models that reward quality, and incent consumers to adopt a culture of wellness.
Check out our new opportunities . Both in the Commercial and Government Payer sectors, we are seeing new models that evaluate programs for quality and effectiveness, and measure outcomes.  A shot across the bow…..efficiency for providers no longer will be measured by how many patients you see or procedures you do, and hospital executives will need new metrics for success other than keeping beds full.

Limiting Access vs. Limiting Quality?

November 18th, 2010

 

The Boston Globe on Saturday reports, “Health insurers are starting to sell policies that largely bar consumers from receiving medical care at popular but expensive hospitals such as Massachusetts General and Brigham and Women’s — a once radical idea that is gaining traction as a way to control soaring health care costs.” The paper further reports, “But even as state officials promote the idea, there are obstacles to its wide adoption. Some of the state’s largest insurers have contracts with powerful teaching hospitals and doctors’ groups that could make it difficult to exclude them. And Massachusetts consumers and employers have long cherished choosing from a broad range of providers.”
http://www.boston.com/news/health/articles/2010/04/17/some_health_networks_drop_elite_hospitals?mode=PF

The names were changed to protect the innocent

September 20th, 2010

The first few months here at Health Innovations have been very interesting.  Believe it or not, we are finding companies that everyone would consider “entrenched stakeholders” in the status quo are actually looking to be quite innovative, and willing to try out new models of collaborative care.  Of course, we are also identifying smaller companies that may have the disruptive technology, or the secret sauce for a model that will really shake things up!

I will be attending the Care Continuum Alliance Meeting in DC on Oct. 13-15.  Care Continuum Alliance Annual Meeting

Formerly known as the DMAA, I applaud the Care Continuum Alliance for putting such an important goal right in their name!  But to prevent Care Continuum from remaining an oxymoron (Care Continuum misalignment would better describe the current state of affairs), we will have to bring everyone to the table.

In my opinion, the fatal flaw of Disease Management v1.0 was the inability to get physician buy in.  How is it different now? I am still seeing physicians (particularly specialists) whose metric for success remains seeing as many patients as possible, doing as many fee for service procedures as possible; basically doing the things they get paid for under the current reimbursement system.  Right now, this does not include being part of the care continuum….

There are some companies that are addressing this most important “care gap”.  Phytel has a physician – directed model that is gaining traction, even in our fee for service world!  Pharos Innovations is going right at the heart of the problem. (no pun intended). They are showing dramatic decreases in the readmission rate for CHF patients.

My biggest question is, can we align incentives between physicians and the rest of the care continuum without “Kaiserizing” the world?  I don’t think we are ready to embrace a staff model for physicians universally, but I do believe that there can be shared savings models, where stakeholders are incented (and accountable) for sharing information.  That would be a Care Continuum Alliance!

Hope to see you in DC in October!

Please check out Our Opportunities page. We have only scratched the surface, but these are examples of organizations who are putting the pieces in place for some of the promising collaborative models.

Are an efficient practice and “Meaningful Use” mutually exclusive?

August 3rd, 2010

I think the tension between “efficiency” and “meaningful use” is causing a big rift in physician behavior and attitude, and there has to be some leadership.  I don’t see physicians changing their workflow, taking time out to key in data and doing reporting to meet meaningful use requirements for $44,000.  Will docs get on board because it’s the right thing to do? I don’t see it. This can’t just be something that happens at Geisinger and Kaiser, but at busy practices everywhere. Yes, you will see a few less patients initially while this reengineering takes place. But the status quo will eventually implode, and change will be forced upon us.  Let’s be proactive and stay ahead of the curve insted of keeping our heads in the sand like we did with managed care in the 90s.
So who will lead?

What keeps CIOs up at night?

June 29th, 2010

I’ve been thinking about this for a while now…..there is a big difference between implementing an EHR, or even a hospital information system, and getting actionable information in the right place, and at the right time – like at the point of care, so better decisions can be made by the provider and the patient.  On top of that, many EHRs don’t provide data analytics or reporting necessary to meet meaningful use criteria.  So what’s a CIO to do?  More questions than answers right now…

According to a PricewaterhouseCoopers’ report, many hospitals are behind the curve on the path to meaningful use. The biggest barriers include:

  • Lack of clarity and a final ruling hinder meaningful use implementation. Guidelines for system certification were issued by the U.S. Department of Health and Human Services on June 7, but final guidelines for meaningful use criteria are not expected until fall of 2010, leaving many CIOs and their vendors at an impasse. CIOs surveyed by PricewaterhouseCoopers are most concerned about reporting requirements. Ninety-four percent of CIOs said they are concerned they can’t meet government requirements about how to report meaningful use, and 92 percent are concerned about remaining lack of clarity in meaningful use criteria.
  • Shortage of skilled staff. There is a shortage of professionals in the labor market with the appropriate mix of skills to help integrate information technology usage into clinical, operational and administrative practices. The government predicts a shortfall of about 50,000 qualified health IT workers over the next five years. According to the report, hospitals are scrambling to hire additional staff, including clinicians with IT expertise and business skills.
  • Vendor readiness and fallout from consolidation are unclear. More than one-third of CIOs surveyed said they are concerned or very concerned about vendor readiness overall. In particular, 44 percent of CIOs said they are concerned that the external vendors they rely on in health information exchanges (HIEs) are not prepared for meaningful use implementation. Recent merger and acquisition activity of EHR and IT vendors reflects serious efforts by technology suppliers to better position themselves for rapid deployment of systems and integration support.
  • Existing infrastructure capabilities are being questioned. Complex networking capabilities and increased bandwidth are needed to reliably handle the massive influx of data that needs to flow 24/7, and hospital CIOs are concerned about the unknown cost of maintaining back-up plans should the system go down and they have to revert to paper records.

More to follow….

Works great at Geisinger, but what about the rest of us?

June 22nd, 2010

Great article in the New York Times today.
http://www.nytimes.com/2010/06/22/business/22geisinger.html?hp
But most primary care practices can’t pay nurses extra to “case manage” their sickest patients, or run down missing lab results, etc.
I guess my question is how we can implement innovative models like PCMH and ACOs without significant reimbursement reform so that the entire care team is incented to fill these care gaps?  Why aren’t there more collaborative models like Geisinger, Kaiser, etc. springing up elsewhere?  I guess I’m starting to feel frustrated rather than hopeful when I read about these “success stories” that are still outliers rather than the norm.

Meaningful Use, Comparative Effectiveness….Even if we build it, can they come?

May 26th, 2010

Recently, I have attended some planning sessions for State RHIOs, and I have also talked to some very forward thinking PCPs about their ideas on getting ready to meet meaningful use criteria. Even the ones with fully implemented EHRs and practice management systems don’t seem to have fully functional reporting and analytics to be able to do accurate PQRI reporting….let alone know which diabetics haven’t gotten an A1C in the last six months. And how on earth are the State RHIOs going to connect the rural primary care docs? Do they have the resources to visit every 1,2 and 3 doc practice and help them reengineer their IT? The clock is ticking…

Disruptive Innovation – Low Touch?

April 3rd, 2010

I was reading Clayton Christensen’s new book, “The Innovator’s Prescription” – I highly recommend it.  But it really got me thinking about high tech, high cost “innovations” in healthcare….is this the roadmap to a better healthcare system?  When I was doing my radiology residency, CT scans were relatively new, MR scanners were brand new, and PET scanners were being tested.  I remember when a patient was referred for an MRI scan with the diagnosis of “headache”. I had this great Bone Radiologist for a professor at the time, Jeremy Kaye.  Jeremy made the comment, “as we invent new tests and procedures, they don’t replace older tests, they are just done in addition”. Little thought is given to what will be the most cost-effective way to get the diagnostic answer….it’s more like, throw everything we have, and see what sticks.

My favorite House episode is the one with Dave Matthews as a savant piano player.  Whether you’ve seen it or not, check out this You-tube clip: http://www.youtube.com/watch?v=Er5uuCYi7q4

Anyway, House does a functional MRI scan on Dave’s brain to “see the music”.  Lots of high tech testing in House, right?

Now for the disrputive innovation: What if we segregate this expensive, high-touch “sick-care” stuff, and build a low-touch “well-care” system which rewards a culture of wellness? What if more of the population can be cared for at home and at retail clinics, with remote monitoring and deemphasized acute care?  Hospitals may need to change their model — reimbursement needs to incent “well-care” — but this is where we need to go.

They say we will have a physician and nursing shortage numbering in the hundreds of thousands in the next few years…..

The take home lesson for career development in healthcare is that the innovators may be the employers, care coordination teams, patient educators and consumers themselves. The disruptive innovation we all know is coming may be much more low-tech and low-touch than we expect.

Staywell, and Take Care.