Optimizing Technologies to Drive Population Health Performance

Episode Overview

Transcript:

Daniel J. Marino:

Welcome to Value-Based Care Insights. I'm your host, Daniel Marino. As organizations are moving into value-based care and focusing on managing their populations, oftentimes they're really driven by, say, some of the contracts they have with their payers. And many of the payers that we've talked about before have come to the organization saying, you know we want you to eventually enter into a risk-based contract, be more responsible for managing a population and so forth. So they have an idea of where they want to go from a contracting standpoint, but from transitioning their organization to one of a fee for service structured culture to more of a population health focused culture. That's a shift in vision. And oftentimes what I see when I'm talking to leaders is there appears to be this disconnect between the vision of where they want to go and the technology that's important for them to get there. 

 
So you never want to lead with the technology, but the technology becomes an important conduit on helping the organization really achieve their goals. And I firmly believe that couldn't be any more important than in the shift that we have moving ourselves into population health. Well, I'm really excited today to have three great guests join us in this discussion. The first is Julie Bonello. Julie is someone I've known for quite a few years, a former CIO has been instrumental in working with leaders and health systems across the country on implementing technologies and really allowing organizations to experience the true opportunities related to technologies, data, and so forth. I'm also joined today by Brian Bentley and Nick Frenzer, both from Epic, Epic Health Technologies, as we all know, is the leader in electronic health technology within health care and with health care providers. So, welcome, all, very excited to have you as part of the program. Thank you. So Julie, thank you. Maybe we could start with you from your experiences, you know, as organizations are really focusing on their vision of population health. Why do you think this disconnect exists between the technology and vision? 

Julie Bonello: 
 
Thanks, Dan. I think what we're finding is there needs to be a fundamental shift into how we implement technology for population health. If we look back at our history of implementing clinical systems from 2000 to 2010, we were implementing the electronic health record. And what we were doing back then is we were implementing an electronic health record for existing workflows. And often what we did back then, we implemented a system to support our current workflow. So we didn't perhaps redesign like we should, or oftentimes we might have actually overcomplicated the implementation. And then it impacted the efficiency of our providers and care teams. Now as we look to population health, we're implementing systems across a population health technology platform with components that all need to be interconnected and so now we need to ensure that we have the kind of rigor to plan the kind of IT structure processes are implemented and integrated with the population health programs right upfront, actually during strategy, so that you develop your strategy and your technology platform direction at the same time and you just evolve over time. Right? So there’s a different commitment now and rigor needed for when you're designing new clinical care delivery models for population health. And so that's the real big distinguishing item that we now have to do across all of our health systems. 

Daniel J. Marino: 

Well, bring up a great point. You know, when in the past when we were implementing technology, you're implementing technology based on sort of a project and a problem that we want to solve for being that population health is very complicated. It's very integrated. There's multiple different elements of that. We really do need to think about it more as a program base, more as a culture shift. But, I'll tell you, we've done a lot of strategy projects around helping organizations move into value-based care. The care model redesign, in my mind is the foundation, right? People, physicians, providers, we need to deliver care differently. So, Brian, in your opinion, as organizations are starting to evolve that care model, how do they need to align both the vision of where they want to go with the technology to support how they need to get there? 

Brain Bentley: 
 

Thanks, Dan. So what I've observed and sitting in an IT role, but working with organizations on the strategy side, what I've observed is the evolution of team-based care and supporting primary care is really where most of the success stories start, at least for organizations. And when it comes to that it's first choosing operationally, what are you going to focus on? And then bringing it along with that to help make sure that it's done in the best way possible. But first we have to understand what are those key focus areas for the organization that align with value-based care, but can be standardized in a care model, so that as an individual provider and the staff working for that clinic, that we're aligned on the same things for every patient as appropriate. And then we want to get into making sure that we have the preventative care happening, that the access is prioritized for the right individuals who needs the most help, and most preventative care, where you have to deal with the fact that the censorism of me, how consensus want interact with health system is changing and the fact that that, staffing models are changing and we now need to automate as much as possible. 
 
So within those areas, and we can go into more detail later, but within those areas, there's choosing the goals and how to meet them as operations, but then having it be the solution to help them do it most efficiently. 

Daniel J. Marino: 
 

Yeah, absolutely. And I think drawing that link becomes critical, and I've been fortunate enough to work in numerous organizations across the country, and I've always been very fond of the epic product of solutions. But, there's a lot of them, right? And they need to be integrated in order to support some of the care model redesign, support some of the analytics that need to be required, support us to really perform. Nick, in your experience, how has Epic helped support organizations sort of drawing that link, right? Bringing it all together? Is it done after the fact? I would think they should almost be at the table, right? To really be part of that strategy to help really drive where we want to go. What's been your experience, or what have you seen as you started to work with organizations? 

Nick Frenzer: 
 

I think you're exactly right, Dan. As we look at a organization standing up a population health program, as Julie put it, the most successful organizations have the stakeholders altogether. What we see as a challenge and a risk is when we have an IT group focused on one direction, we have an operations group focused on another direction. And oftentimes we have, for example, primary care, not even at the table from a leadership perspective, that creates this dissonance of goals. So I think the key is to get together your primary care leadership, your population health leadership, your IT team, and your finance leadership to understand, are we all marching towards the same direction? Is this what our CEO's vision of population health looks like? Because when you ask different stakeholders, what does population health mean to you? There can be very different expectations. 

 
So we need to start and understand what are our goals within primary care? How are we going to change behavior, and how are we going to incentivize that type of behavior change? Because one of the interesting facets of population health and value-based care is, you can talk about it a lot, but until we've started to influence behavior to change how we approach patient care, then we're not going to achieve those goals. When we see groups that are starting to misuse shared savings and start to not quite see that outcome that they're looking for, it is usually that behaviors and incentives are not aligned. So by starting at day zero when we're setting that strategy and that vision, that's where the magic really happens. And Julie, I'm curious your take on that, because I think that gets very much to the program approach that you were talking about. 

Julie Bonello: 
 

Yeah, absolutely, Nick. I mean, it's interesting because when you put your governance structure together, you're really bringing together all your stakeholders. And those are stakeholders that include some of the providers that may not be affiliates, right? So it really is across the continuum to bring together all the stakeholders. And then when you're thinking about your technology platform, your platform also has to include the technology of all your stakeholders as well, which is really important. Now, the other piece is bringing your technology vendors to the table and also bringing your payers. So when you put together your tiers of governance you have to figure out how you can do that successfully. And Nick, I'm sure you can add on to that, you probably deal with that every day. 

Nick Frenzer: 
 

<laugh>, absolutely. You're speaking my language. I think the key here as well, and Julie you touched on this, is not to focus on a tools based solution, not to look at, well, I think I need a tool for a specific component of this, but instead to think, what is that business objective I'm trying to accomplish? Do I have specific programs that the Medicare advantage that I want to focus on? Do I want to focus on the specific clinic with a value-based care approach? And then the tools will come from there. Everybody within the industry is providing a number of ways to approach this problem, but successful organizations start with the problem and then solution around that versus identifying the latest and greatest tool that they think will solve their problems. Because if you don't start with that business objective, the tools will not solve the problem. 

Daniel J. Marino: 

Yeah, that's very true. And you know, the other thing too, and I guess I'd like to talk about this for a second. Many organizations now are moving into Medicare Advantage and associated with Medicare Advantage are a lot of performance activities that will better define the risk factors, capture HCCs and so forth. And that is definitely a paradigm shift that has to occur both with the use of technology, the care models, in order to drive those results. So when organizations think about that, and let's say they're going to get more involved in Medicare Advantage and eventually more risk-based contracts with their commercials where do you believe, and, and Julie, we'll start with you, where should the technology, where should the CIO be in that conversation? Should they be part of those discussions and those negotiations? Should they be part of the strategy around activation? How do you start to align those conversations? 

Julie Bonello: 

Your IT leader should definitely be a part of it, right? Whether depending on the organization, whether it's the CIO or your main IT leader for pop health, but you definitely want to start building in all of your technology and interoperability requirements to support all of your contract requirements. In the future, in order for us to really manage two performance measures regardless for what program they might be for we have to improve our interoperability and our data sharing so that we have the full compliment of data to actually bring in, calculate and then provide to the care team so that they have real-time actionable insights to follow up on care in, in order for us to do that, it gets back to that plat population health technology platform I was talking about before, and ensuring that everyone understands that, that they need to share data and they need to support an integrated workflow as a point of working together. 

Daniel J. Marino: 

So if you're just joining us, I'm Daniel Marino, you're listening to Value-Based Care Insights. We're having a wonderful discussion on how the technology and the platforms associated with IT does need to really drive and support population health initiatives of organizations. So Nick, when we think about what Julie just mentioned, there's evolving aspects of the use of technology. There's interoperability, there's the data and the extraction of data making actionable insights. There's the workflow design that helps us, not only incorporate the data that we need to use, but really to drive a lot of more prospective outcomes. Related to that, how should organizations begin to approach the use of that technology? Do they focus it on a module by module perspective, or should they be really thinking about more of a technology plan that does grow and align with where that vision and, and the performance goals should be? 

Nick Frenzer: 

I think it starts, you know, you mentioned it, Dan, this is an exercise in data and in a lot of ways data analytics, and I think in a fee for service world, it was well understood that we needed those components of understanding what goes into that to make decisions and design workflows around that. Within population health, where I like to start is say, let's look at your clinical data. Let's look at the information you have, let's evaluate other sources to understand how we can get more insights. But then let's look before you go into a payer negotiation, or you look at your next level of risk and say, what are you successful at? Where do you have opportunity? So that the organization is equipped with that to make good decisions. And starting with areas where we know that they're successful. So if we know that the colorectal screening rates within the organization are very good, that's very powerful information that we know how we need to act. 

 
If we see that mammography screenings are not as successful, well then we know where to change behavior. And I think one thing, Brian, I'm curious, you're taking a minute, but Julie, something you mentioned that I just want to add onto is this often should start when you're going into those negotiations or you're evaluating CMS programs like M S S P to understand where are you, what data do you need, and what are the insights that, for example, it can provide to equip you with that? Because this is a new world with a bit of a different way of thinking, although many of the same discipline and rigor sold bias. 

Daniel J. Marino: 

Right? Well, and I'll tell you Nick, I don't see any organizations having that discussion proactively, as you've mentioned. Julie, I don't know if you've been part of those discussions, but in my mind, in order to accomplish what Nick just laid out, it needs to be there, right? You need to have that conversation in different type of a governance structure, or at least a governance conversation. 

Julie Bonello: 

Yeah, I totally agree. Dan and Nick. I have had the opportunity to be a part of contracting meetings with payers where we talk about the data and the technology requirements and the goals, right? So that we're all on the same page and they are baked into our contracts, and then they flow down into all of our network contracts with our providers as well, right? So that all of our stakeholders, so the goals of our population health program are known at an organizational level, but they're also embedded in our contracts, they're embedded in our governance structures as we design new joint operating committee meetings, they are embedded with our collaboration agreements with our provider network. 

Daniel J. Marino: 

But when we then think about that, right? So you're setting the vision, you're setting sort of the governance initiatives. How are we activating that, right? From an epic standpoint, Brian, maybe you can speak to this, how is that then influencing the care model redesign or a team-based approach, say, of primary care? So they're really able to latch onto that technology and truly use it as a tool. 

Brain Bentley: 

I think it starts at a couple places. And I want to just go back to something that Nick mentioned, and that is starting with the data that you have. I think we all agree that data is everything and the use of data is everything. But too often groups may try to boil the ocean first. And really there's an opportunity here to make sure you're starting with what you already know while simultaneously building, having an eye towards the future of where you need to get. And in that meantime, to your question, Dan, on the activation, we want to work with groups on saying, well, from what you have already, this is where we know you can focus on with respect to quality. And in the meantime, we're also going to start building out in scaling for where you're going to get other data so you have a broader picture. But we want start with what, what you have, bring what we can into primary care to have 'em focus on with their current state capabilities. What with an I towards in the future, how are we going to, let's, let's give up on the idea of these fee for service RVU based models. How can we empower primary care and support them in a transition towards a model where what matters most is that they, I identify the right patients and proactively outreach and engage with the patients that need the most care upfront, 

Daniel J. Marino: 

Right. So I think what we're saying is that it needs to be a formidable partner in aligning the vision. I think being part of those governance discussions, and then obviously supporting the care model redesign. And then I think some of the end result as we think about, say, the delivery of primary care differently, the compensation model should support it, right? And we talk about that many times, aligning the incentives. But an important element in helping organization physicians in particular be successful in say, a new compensation model is how they use the technology, right? How they understand the data. And then frankly then the support system that helps to drive that success care management as an example, right? So that as a tool has to be fit into the whole plan that helps that transition into population health outcomes and into where we want to go within value-based care. Julie, any thoughts? 

Julie Bonello: 

Sure. Dan, what you say is so important about the data. I would hate for us to recreate some of the inefficiencies that we implemented through our E M R or E H R implementations with the inefficiencies for our providers now with population health implementation. When we look at data, we have to make sure that we get the data through interoperability. We have to make sure that we have the rigor to do that now, and we have to know the technology of our trading partners in order to make that a reality. And that is an important component of their responsibility in working with us. If we don't do that, we're going to make providers, our care team and our patients, , care even more fragmented because the data won't be available for follow up and real time action.  

Daniel J. Marino: 

And even the use of the technology will be too fragmented. Right. 

Julie Bonello: 

Exactly. We just continue to add on to the fragmentation. 

Daniel J. Marino: 

Nick, let's talk about that for a second, because as you know, as I mentioned, and certainly in my experience in with Epic, there are a lot of great tools. There are a lot of great modules. And I think one of the values that Epic brings to the table is that from a technology standpoint, it is integrated. But, but do you feel like providers do, do they understand it? Do they understand truly the integration of that technology? And if they were to use it properly aligned with where their strategy is and their vision of population health, they could truly see those as outcomes? Or, or are they still focused on implementing certain modules to solve a problem being, you know, sort of supporting what Julie kind of talked about that fragmentation of the technology? 

Nick Frenzer: 

Yeah, but Dan, when I think of the providers who are on the ground in clinics providing care or in a hospital setting, providing care, they're too busy to worry about the technology deployment strategy. What they want are actionable insights at the point of care that makes sense and allow them to focus on the patient and not on the computer screen. So I think as we talk about setting this strategy, you know, our approach at Epic for over 40 years has been an integrated system. That is one place that is a cohesive view for a patient to provider to care for a patient. And I think when we start to stack things on top of that, you know, there are always products that will add value mm-hmm. <affirmative> within an integrated EMR system. But what we need to think about is what is that provider's experience and what does that patient's experience? 

 
Because making a provider go to another screen or do something else is the surefire way to make sure it doesn't happen. The way to do it is to load it into an integrated view and integrated process and workflow for a provider so that when they're with the patient or when they're looking at a patient's chart before a visit, that they can quickly load those things in and take action on them. So I think approaching, it can't just be from a, well, we have a new solution that's going to make the world better, but what are we going to put in front of the provider? What is that view that they are going to have that then we can go to provider leaders and get their feedback and say, is this going to work for you? Because ideally, a provider doesn't have to think about, about that technology deployment. It just makes their life easier. 

Daniel J. Marino: 

Yeah, I agree. And I'll tell you, it's the old adage people, process and technology, right? So if we have the vision of where we want to go, our people have to evolve. Our processes have to evolve, and our technology has to evolve in such a way that it's the partner of achieving the strategy. I firmly believe that. And that's a great point you made. So I want to thank all three of you for joining me today. Just a great discussion. I know this is an area that many organizations struggle with.I know that firsthand because I'm in conversations with many of the leaders and aligning the technology with the vision and achieving some of the population health goals are certainly a top of mind issue. Julie, we could start with you. If there's any advice that you would give to your colleagues out there who may be listening, what would you say to them about, you know, what they need to think about with data interoperability, alignment of that technology to meet their pop health goals? 

Julie Bonello: 

A couple things, Dan. The first thing is that really redefining the way we're now implementing for pop health is also the same for digital health too, quite frankly. But it is really implementing across a platform now and it requires a different rigor and a different way of working than we've had in the past, which requires that we embed it best practices into the front-end programs of the pop health program into the collaborative structure. The other thing I just want to mention because so many great points have been mentioned through the podcast is when we talk about clinical redesign and workflows, the best opportunity we have and toward really improving efficiencies in implementing pop health with your platform, is having it be clinically led. 

Daniel J. Marino: 
 

Oh, absolutely.  

Julie Bonello: 

The best way is by having really clear roles and responsibilities from clinical leaderships at every single level of the pop health program so that these systems can really be implemented to support care efficiently. 

Daniel J. Marino: 

Yeah, I couldn't agree with you more. I think having IT physician led, clinically led, that's what really brings it together and frankly, I think keeps all of us, particularly in organization focused. Brian, when you think about, given some advice or think about how organizations could advance some of their care models or team-based models or even frankly implementing care management aspects, what advice would give them about where to start and, and how to better ensure that they're integrating the technology? 

Brain Bentley: 

It starts with making sure that for any changes you have planned, you know, how you will measure the before and then the after. So measuring that improvement that you made with your changes. So much of the discussion today appropriately is around how do we get, use the data to find what's the right next step for us to focus on operationally in it, how do we bring it to the point that the provider can act on it easily or the care team around the provider? But then lastly, we have to remember that we need to be able to measure and prove that this is making the right changes or otherwise we need to change and adapt. So being able to measure as you go. 

Daniel J. Marino: 

Right. That's great. That's great. And then, Nick, given the different components of Epic any advice on how organizations should maybe either, you know, leverage Epic differently or think about integrating the technology closer to their strategy? Any thoughts there? 

Nick Frenzer: 

Yeah, well I love having these conversations with our health care providers, the executives within our community. So, love to talk to people about that. And we do many times throughout the week. I think there are three things that I tell leaders to focus on as they go down this journey. As you gain, as you get together your stakeholders and you put together that team of key leaders that I mentioned earlier, there are three things that you need everybody to know. One, what are our value-based arrangement factors? What goes into that arrangement? What are the things that we are going to be rated on that we need to evaluate and determine where we are good and where we have opportunity? Two, what is our care delivery model and what changes are needed? Do we have effective team-based care? Do we have morning huddles? Are we showing the appropriate clinical acuity to drive decision making? And three, then what is our technology enablement strategy to wrap around those first two? That has to be part of the conversation, but it has to be that third thing we talk about so that we're building that enablement strategy around the first two factors and it supports it versus being the driving force. 

Daniel J. Marino: 

Great. No, I couldn't agree more. That's fantastic. Great advice. Well, I want to thank all three of you for joining me today. Definitely an important discussion top of mind from any organization, especially as they move into risk-based contracts and undertake a lot of the new Medicare Advantage activities that are coming our way. I'd love to have you back sometime down the road. Maybe we can get into one or two of the technologies or even data. I know a great future discussion. So thank you. Thank you all. I appreciate it. Thank you. I want to thank our listeners today for listening until the next insight. I am Daniel Marino, bringing you 30 minutes of value to your day. Thanks and take care. 

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners