Ideally, healthcare providers should avoid unnecessary admissions and readmissions and work instead to improve their patient population’s health and hospital experience. This may require getting timely, high quality metrics on factors such as emergency room efficiency, cost management, patient flow, staff productivity, clinical outcomes, efficacy of treatment, and “Meaningful Use”. This, in turn, would require high quality, near real time, highly actionable analytics which will be delivered leveraging state of the art operational, clinical, and financial analytics platforms. Are we just getting started with these platforms or riding the maturity curve? What related people, process, and technology challenges will have to be overcome before accountable care can be delivered consistently and reliably?

Contributors

• • C. Scott Blanchette, SVP & Chief Information Officer, Vanguard Health Systems
  • Dr. Michael Bakerman, Chief Medical Information Officer (CMIO), The UMass Memorial Healthcare System
  • John Mattison, Assistant Medical Director, Chief Medical Informatics Officer, Kaiser Permanente, Southern California

Transcript (Driving Accountable Care Through Analytics)

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Here’s Sanjog Aul.

Sanjog Aul [00:01:10]:
Good morning and welcome to CIO Talk Radio. To learn more about the show, please visit www.ciotalkradio.com. Today’s topic is Driving Accountable Care Through Analytics and our guests for today’s show are Scott Blanchett, who is the Senior Vice President and CIO with Vanguard Health Systems. Good morning, Scott. How are you?

Scott Blanchette [00:01:29]:
Good morning. Doing very well, thank you.

Sanjog Aul [00:01:31]:
Very good. So is the world coming together for you where everything is going well?

Scott Blanchette [00:01:37]:
It is indeed. And we’re optimistic about not only today’s conversation, but the journey it talks about.

Sanjog Aul [00:01:45]:
All right, great. And we have Dr. John Matison, who is the Assistant Medical Director and Chief Medical Informatics Officer with Kaiser Permanente in Southern California. Good morning, John. How are you?

John Mattison [00:01:57]:
Good morning. Doing just great, thank you.

Sanjog Aul [00:02:00]:
So how’s Southern California treating you? Hot, humid, or good weather?

John Mattison [00:02:05]:
It’s just right.

Sanjog Aul [00:02:07]:
Just right. Okay, so you’re expecting some rain, so your grass could start looking a little greener.

John Mattison [00:02:12]:
Hopefully, so we can use it like everyone.

Sanjog Aul [00:02:17]:
Okay. We also have Dr. Michael Bakerman, who’s the Chief Medical Information Officer for UMass Health System. Good morning, Mike. How are you?

Dr. Michael Bakerman [00:02:26]:
Good morning. I’m doing fine.

Sanjog Aul [00:02:27]:
All right, so we have three esteemed guests, and thank you so much for joining this conversation. Now, the premise is that we are trying to put this accountable care out and put that into action and there are so many things that we want to achieve where we are talking about accountable care organizations, and they are supposed to be, by definition, accountable to patients and insurance for the quality, appropriateness and efficiency of the healthcare provider and I’m Just literally reading a bookish definition. Now, this accountability, when it comes down to accountability, is this truly quantitative criteria that we have really nailed down and then we’re going to measure against it, or this is just going to be another subjective measure? Now, let’s start with you, Scott.

Scott Blanchette [00:03:14]:
Well, thank you again for allowing me to join you this morning. I would suggest it’s probably an overstatement that we’ve solved all of the elements of the question you’ve asked. If that were the case, I think this discussion would be significantly less interesting. We’d be talking about this in our rear view mirror and then at the same time, I think there’s an argument to be made that we’re undertaking a very purposeful direction that should lead us toward delivering on what Dr. Don Berwick indicated was a triple aim. So it’s not surprising that the body of science that delivers on that quantitative element suggests that the triple aim is not only noble, but achievable and that body of science, I believe, is starting to underscore realization

Scott Blanchette [00:04:00]:
and that realization is creating less debate about, I think, the where we are going, but rather the how and maybe more importantly, the how long. So I think to answer your question directly, I’d argue that we’re undertaking a subjective journey that’s directionally correc but we’ve been building a quantitative statistical body of science research for many years now that support that direction and I think my colleagues from Kaiser and UMass have a substantial head start on the rest of the country. So I’m very interested in their points of views on this.

Sanjog Aul [00:04:35]:
All right, so John, when you hear what Scott just mentioned, do you think accountable care or developing this whole model is like boiling the ocean and we are getting started and we have taken on something which is a Herculean task to begin with and if at all we fail, we can say, hey, we tried, but the task was almost impossible anyways.

John Mattison [00:04:59]:
Well, and as Scott pointed out, we do have at Kaiser Permanente an advantage of having some very visionary founders who created a model of care from the outset that was intended to be highly integrated and accountable. So there’s a lot in our rearview mirror that helps inform our path forward. And so we are not intending to stay in the place where we are in terms of being able to deliver highly integrated, highly coordinated care with automation and digital support. We’re looking at what the next steps and the next big opportunities are, and there are many. So to answer your question about is this really too big of a challenge to take on all at once, our organization was essentially founded on many of the same principles as ACOs, and it is very much doable but the longest journey begins with a single step and so how the roadmap is created and how any particular institution gets from where they are to an end state may vary quite a bit and trying to boil the ocean is generally not an effective strategy.

John Mattison [00:06:17]:
But there are certain critical things that resonate in the principles underlying the ACOS and the foundation of Kaiser Permanente, and those are that you deliver truly comprehensive care across all venues of care and take the opportunity to really implement preventive care so that you can improve the health of an entire population with both proactive as well as highly competitive, competent, highly specialized care when the need arises.

Sanjog Aul [00:06:51]:
So, Mike, in your world, I know Scott mentioned that UMass has really gone multiple leaps ahead of many others in terms of how to implement this. Is this something that you envisioned or your organization envisioned multiple years ago? Do you have surprisingly good crew and good insight into how this is to be done? What’s that magic bullet that you were able to land?

Dr. Michael Bakerman [00:07:13]:
So I appreciate Scott’s comments, but the reality is I don’t think that UMass is much farther along in ACO than many of the other places. Even in the pioneer ACO initiatives that have been done by CMS, New England and Massachusetts is heavily represented. But most of those groups are really just starting to formulate their plans and I would agree with the rest of my colleagues is that this is really going to be a journey and when we talk about accountable care, we kind of mix the euphemism that this is integrated care and that will lead to better outcomes but I think most of us recognize that integrated care is very far away. We work in so many different silos and just in broad strokes, inpatient care versus outpatient care, and how we integrate the specialists, the consultants, and the plans of care is very complicated.

Dr. Michael Bakerman [00:08:10]:
The basic tenets of ACO, I think, are based on quantitative criterion so there are quality measures, there are patient satisfaction measures, there are preventative measures in there, plus overall cost trends and the other really very discrete elements that you can measure. However, the actual makeup. Putting those puzzle pieces together, I still believe will take a lot of work and a lot of hard conversations with the different groups to make sure that when they say we’re accountable, we understand what that accountability means.

Sanjog Aul [00:08:48]:
So, John, when we look at the actual journey that we’re talking about here, would you say that the problem is in the data quality, data integrity, the very data model? We do not understand what we need to capture or the things that we want to capture. It’s a pain.

John Mattison [00:09:08]:
It’s actually, I think it’s a great question because you hit on quite a few different things that all are relevant to producing quality, timely and actionable data. So I think one of the biggest challenges and opportunities is to understand what questions are important to ask so that when you do the analytics and you’re trying to tune operations or tune care delivery, that you know, what are the important parameters that you need to manage and you can learn that through analytics but there’s always much more data than is either relevant to a particular question or is necessary to include. So it’s pretty easy to drown in mountain of information that emerges from a clinical care situation. So carefully identifying what are the important questions and how do you use the data, you have to answer those questions and tune your operations so I really believe that the data quality issue is often overstated as an impediment. It’s more often about really making the best use of the data you have.

Sanjog Aul [00:10:33]:
Now, Scott, when you look at your world there, and I’m sure everybody’s dealing with a lot of data, is it the sheet complexity and the volume that has to be handled is what is making people just be standing on the fence and not crossing over? Or where are we stumbling and. Or where are we even having this inertia, not even able to get over that inertia?

Scott Blanchette [00:10:55]:
Well, you know, it’s interesting. I think your question is relevant to some of our markets and not all of our markets. So we operate in six metropolitan areas and in the areas where we have disproportionate market share and relationships with one or two large payers, we don’t tend to have the types of challenges we have in the marketplace that is more common where we don’t own a market share and the payer space is highly fractured and that drives the sort of collaboration and coordination that your problem, your question would suggest and so, you know, I think to Dr. Madison’s point, data standards and the quality of data is problematic, but I don’t think it’s the most foundational issue that faces us. I think one of the more fundamental issues is around data exchange, the rules of the road that will govern data transfer. And I believe a lot of that is still embryonic and further challenging.

Scott Blanchette [00:11:57]:
That is the basic business model that supports the types of investments required to build truly integrated regional and national information exchanges and, you know, this isn’t a new problem. This has been plaguing us since the beginning of time, whether it’s HIEs today or RIOs in the last decade, or CHINs or Community Health Information Networks in the 90s, and you could even make the argument that this has gone back to the 80s with community health monitoring systems. So, you know, we’ve been at this information exchange and collaboration and coordination problem statement for a long time and I don’t know that many of us can point to too much in the way of respectable progress and so I think my comments have been focused largely on challenges inherent in the exchange of information but I would suggest that we’re going to encounter many of the same experiences and challenges around governance and sustainability of business models when we start talking about collaborative analytics and coordinated accountable care efforts.

Sanjog Aul [00:12:53]:
So, Mike, based on what Scott just said, does it look like our dream and to some extent initiatives that we started on having a healthcare information superhighway which connects the providers to the patients and every other person or entity in the whole ecosystem that has not come to fruition completely as we otherwise dreamt because it seems like if we had this information superhighway, exchange would become easier and these will be moot points then.

Dr. Michael Bakerman [00:13:21]:
Right? So I would agree that no, it has not yet come to fruition certainly in our area of the country yet. There are models across the country where there is some exchange but here we’re fortunate that we do have a state run initiative and then we have several private initiatives but again, the trick is to integrate them. In our area of central Massachusetts, you know, we have a very disparate community where we have probably seven different ambulatory electronic medical records and we have two primary inpatient electronic medical records. So to get information shared at the point of care and not relying on claims information, but concurrent real time clinical information is really, I think the challenge for the future. That’s where I think accountable care organizations will either be successful or not successful in the larger aggregate so we can get data into our systems, but it’s hard to have them exchanged and have our special C information that our primary care people develop and vice versa, and to see what happened actually in the emergency room and then create logical analytics about episodes of care, treatment, efficiency of care, all that.

Dr. Michael Bakerman [00:14:36]:
So I don’t know that that highway currently exists it’s certainly under construction there’s certainly a lot of work going into it. There’s a lot of transaction based work, but in terms of actually getting analytics and good data is still a ways off.

Sanjog Aul [00:14:52]:
Let’s take a quick break listeners. We’ll be back and when we come back, John, the question I’d like to pose here for you is that suppose we do get the information superb highway in place and perhaps the infrastructure, we could come up with a workaround which will allow you the exchange. Bottom line is do we today have the ability to build visibility into areas such as healthcare delivery operations overall at the required depth so that if that data was available across different entities, we were actually one step ahead in this whole accountable care delivery? Please stay tuned. We’ll be right back.

Sanjog Aul [00:17:04]:
Welcome back. So John, here, suppose we had the infrastructure, you had the information superhighway or a workaround to get the exchange going. Do you think we truly have been working diligently and creatively and finally have the results with respect to insight into the healthcare delivery operations to the degree you need in order to achieve this ACO dream?

John Mattison [00:17:27]:
I think we’re getting closer every day. As has been alluded to by my colleagues, are still many gaps that remain between different institutions that have different health records and different information systems. I think that if you look at what we’re doing internal to Kaiser Permanente, where the vast majority of care for each one of our members occurs. We have highly integrated systems and we do have deep visibility into how care is being delivered and again, asking the right questions and knowing how to tune and optimize is very critical. So even though we have the highly integrated and very comprehensive set of information for all of our patients from our Internal systems. There’s still a lot of opportunities for us to continually tune. I think one of the big opportunities though is in the mountain of information that characterizes healthcare today, being able to generate good, actionable summary level data in dashboards is increasingly important.

John Mattison [00:18:37]:
So I think a lot of the emphasis that we’ll be seeing over the next couple of years is creating dashboards for physicians, dashboards for department managers, dashboards for executives, dashboards for hospital capacity management, similar to the dashboards that we use for IT systems to look at performance of various components of the system. So I think we have a model in some of the dashboards that are used to monitor large scale IT infrastructure, but there’s a big opportunity to replicate that at the operational level at multiple levels throughout the organization. With respect to health information exchangeaAnd how far along are we and how important is that? Well, we’re one of the founding members of the CCC, the Continuity Care Consortium that is intended to exploit the existing data standards for exchange and we’re already live with all five institutions exchanging documents. Mayo Clinic Group, Health Cooperative, Geisinger Intermountain Healthcare and Kaiser Permanente and that’s in addition to the National Health Information Network, which uses precisely the same data standards for interoperability. So as one of my colleagues alluded to earlier, there’s a lot around governance sustainability models that are still very difficult, but we do have very successful models like the one in Regan street in Indiana, where information exchange is taken for granted across multiple diverse institutions with different systems

John Mattison [00:20:14]:
so do we have to worry, will it work or not? No, absolutely not. It works quite well and there are some shining examples of. But getting the entire nation to that state does take time and that’s why Kaiser Permanente and these other four institutions have committed substantial resources towards advancing that cause, working in concert with the National Health Information Network and its coordinating committee as we move forward.

Sanjog Aul [00:20:40]:
Scott, do you think while we all want to do, in fact, you mentioned about collaborative analytics and we’ll get into what it means, but more importantly, any type of collaboration also requires a willingness and the intent and I’m sure there would not be malintent on behalf of different entities that are involved, but perhaps inability to collaborate, where could those inabilities lie?

Scott Blanchette [00:21:06]:
Well, you know, I think there is the potential that competitive forces in a market will impede opportunities and progress toward collaboration. That may be one dynamic to consider. Another dynamic to consider is the notion that not everyone’s incentives today are fully aligned and across full books of business. So there is the incentive dynamic to contemplate as well. And then you have basic infrastructural issues around governance and sustainability that we’ve addressed before. So, you know, I think, you know, as Dr. Madison alluded to, there are shining examples of this having worked and worked at scale across a number of places in the country. Unfortunately, the road toward those shining examples is littered with the bodies of many organizations that have been unsuccessful on this journey as well

Scott Blanchette [00:22:15]:
and so I think I agree with Dr. Madison’s sense that this isn’t a question of how, but more a function of how long. And I think addressing some of these issues around incentives and governance are going to be requisite to getting there.

Dr. Michael Bakerman [00:22:35]:
This is Mike, so I can tell you from Massachusetts, which is a highly competitive healthcare environment, we have multiple academic medical centers here that have overlapping boundaries that, you know, may compete at several hospitals together. You know, information exchange is still quite complicated, where we have groups asking for requests to view electronic medical records from our organization, but, you know, declining to reciprocate from their organization. So I think the alignment of incentives, trying to identify that the patient really is in the center of this really becomes, you know, the primary thrust of what we want to do to really manage the risks inherent in this. The other piece is, I think, you know, there are some the incentives out, are out in front of some of our provider base, so that we have not got good buy in from some of our specialists in terms of identifying how much risk they’re willing to share and how they fit into the governance with these ACO models. So primary care is much more aligned with what they want to do but in trying to work through much more of the governance and the details of the ACO environment or even the, you know, the alternative quality contract work that we have, it’s still, ee still have a ways to go with the provider base to really manage that as well.

John Mattison [00:24:09]:
Now, I just amplify one point that both of my colleagues have made is putting the patient first and really arguing for the solution set that creates the greatest opportunity for the triple aim and for high quality and safe clinical care is really a fundamental principle that needs to be the primary focus of these discussions. We can’t have these discussions and ignore these other issues about competitive market spaces. But unless there’s a clear and persistent focus on what’s in the best interest of the patient, these kind of discussions can unravel pretty easily.

Sanjog Aul [00:24:57]:
So, Mike, if we were to look at marketplace, so suppose we were able to get over some, or maybe come up with some creative ways to get over that competitive Mindset, so people start sharing and then you build some analytics to start getting the data. Now comes the part of transparency. So once you’ve triggered this, then how do you know that there is a consistent process followed in terms of how the data is being generated, how has that been massaged and sliced and diced and then presented as a dashboard report which is available to a provider and, or a physician or a patient, and we can rely on that data.

Dr. Michael Bakerman [00:25:36]:
So I think part of that is primarily in transparency and I would think that some of that battle is already over with. I think, you know, for the quality measures and the perspective of the ACOs and the alternative quality contract that we see in Massachusetts, most of the measures, although they have some inherent tweaks or weaknesses that people have identified, they’re well known. The issues of how to obtain them, how to manage them are pretty consistent. So, you know, I don’t have difficulty as soon as I can compile the data and get the data. You know, my concern is how we demonstrate it, how we show it, and you know, in our hands, and I’m sure in my colleagues hands, it’s much more of an instrument of discussion, how do we improve, how do we manage, as opposed to a punitive, you know, quote, you didn’t do the right thing or you have to do it in this way. So it’s much more about collecting the data and then using it as an instrument to constantly improve performance, look for innovative ways to manage patients better, provide better communication and get buy in from it.

Sanjog Aul [00:26:43]:
So Scott, do you think this is based on voluntary ethics and inherent reliability and honesty and integrity that is expected out of all entities involved for this to really be used as reliable source?

Scott Blanchette [00:27:01]:
Well, I certainly agree with my colleagues that if you’re approaching this in any other way than putting the patient first, then you probably have some headset issues that are going to be an impediment to progress and you know, that philosophy would trigger some fundamental assumptions, which is the universal availability of data and the consistency of different risk management measures and transparency into that and I would argue that, and I think my colleagues would too, that we’ve been after that problem statement for a number of years. So much so that we’ve, you know, we’ve aligned our financial incentives behind the delivery of high quality care, whether that’s pay for performance or pay for quality. A number of the initiatives in Massachusetts are aligned similarly and I think are starting to demonstrate some progress and some outcomes. I wouldn’t want to revisit the World Health Organization rankings, which I just yet I think we were 37th or so last time they studied our progress. We were roughly right behind Slovenia and ahead of Costa Rica. So there’s obviously still a lot of work to be done on that path

Scott Blanchette [00:28:21]:
but your question actually got into a different area which I think it’s important to differentiate, and that is the transparency of analytic methodologies and I would say there’s a qualifying answer here which is transparent to whom? As an organization, we anticipate actually competing on the back of our analytic acumen and we think this is going to be a differentiator for physicians who would like to take risk with us and I don’t know if listeners have had the opportunity to read Davenport and Harris work on competing on analytics, but we think this is a dimension that we’re interested in investing in building a team and capabilities around and positioning this as a foundational offering that we intend to use as a differentiator in the marketplace and I think that is a very different recognition than just the availability and transparency of universal data around the patient.

Sanjog Aul [00:29:25]:
Let’s take a quick break, listeners. We’ll be right back and when we come back, John, the question I’d like to pose here is the risk identification and the segmentation model that we have been using. How does the ACO model, how does new form of analytics attempt to change it or even change it, even though it is involuntary change? Please stay tuned. We’ll be right back.

Sanjog Aul [00:31:23]:
Welcome back. So, John, about the risk identification and the segmentation model that we have been using earlier. How does this new ACO entity building and or this whole initiative is altering it, or can it actually, should it be altering it?

John Mattison [00:31:45]:
Right. Well, risk stratification segmentation is intended to identify populations where intervention offers the greatest benefit. And so the real purpose of those strategies is to really allow you to focus your attention and focus your resources on improving outcomes. That will work to the extent that everybody’s aligned around the notion of putting the patient first and around how well each individual ACO establishes their incentive models. So if you identify a problem and the incentives are not aligned with fixing that problem, you won’t see the same kind of benefit as if you have the alignment of incentives so I think there’s going to be a lot of permutations in the different ACO organizations in terms of how different incentives do or do not effectively reinforce the biggest opportunities for improving the care and service to the patient and so the privilege that we have within Kaiser Permanente as an integrated delivery organization is that everybody is a member of the team and everybody understands their accountability and opportunity to focus resources. And I’ll just give you one example.

John Mattison [00:33:01]:
We have many patients who are alive today who otherwise would not be because they saw the optometrist or someone in the lab who indicated to them that they were due for a mammogram or a Pap smear and sure enough, they were detected early in the course of their disease and an intervention provided for a cure rather than a prolonged anguish course. So the way that we’ve achieved that kind of integrated service is we’ve made it clear that everybody has a role to play and that everybody has aligned incentives around the same key initiatives to focus on preventive care and focus on the quality of the patient. Absent those kind of incentives, it’s very difficult to get an optometrist to pay attention to who’s due for a mammogram or not. So the system support for that is important. But aligning the incentives of what your true priorities are is fundamental and will vary. So that’s not prescribed as to how to do that. In fact, a lot of the CMS Innovation Fund is intended to explore different models to see how that works.

John Mattison [00:34:11]:
We have, again, the luxury of having one that works quite well, and we continue to exploit that in every way possible in the best interests of our patients.

Sanjog Aul [00:34:22]:
So, Mike, do you think that we spoke about all external factors and things which could put a damper on the way we are proceeding. But then if suppose everything remaining the same and or perhaps improving from an external environment standpoint, do you think the organizations themselves internally are equipped to be able to pull this off when it comes to people, process and technology?

Dr. Michael Bakerman [00:34:45]:
So I think that varies across the country. I think there will be some examples and you have them on the phone that are very well and then you’ll have other examples where, you know, the infrastructure is just not there. So, you know, for our personal example is that we’ll be entering into the ACO and AQC market in January but there was a lot of upfront infrastructure changes, building of registries, changing our data model, you know, working with our primary care groups to build up their ability to manage higher risk populations, keep them at home, keep them managed, have some telemedicine involved that took a lot of work and a lot of upfront dollars in investment and time. So I think, and certainly in this economy, in these troubled times for some of the academic medical centers, the way we portion finances really needs to kind of think about what our strategy is for patient care. So, I think internally there’s still work to be done.

Sanjog Aul [00:35:47]:
Now, do you think the things that you mentioned that has to be done and you also mentioned that there’s a lot of upfront infrastructure related investments to be put in. Typically funding is not available for it for other purposes, that’s a chronic issue with many of the organizations. But is this because there’s a compliance mandate, that’s why people have opened up their purse strings, or do you see a business opportunity here?

Dr. Michael Bakerman [00:36:13]:
I think there will be a business opportunity because if you don’t do some of these things, there will be penalties. There is. Unless we change the model from fee for service to a different way of managing patients. We recognize at the get go that it is not a sustainable model, that our current practices in healthcare don’t lead to the best outcome. So there is a business model, there is a strategic model, and then there is an ethical model in the way we manage patients that will drive us in that way.

Sanjog Aul [00:36:46]:
Now Scott, if you were to bring up your book of projects or initiatives that you would want to kick off and or like to put more focus on with respect to fortifying this whole ACO model and looking at from a people, process and technology standpoint within your organization, which one would those be? What may be the top three?

Scott Blanchette [00:37:07]:
Well, I’ll probably give you the top two because we’re, I think, laser focused on some key gaps that we have and I think my colleagues have alluded to the human linchpin here, that developing an organizational core competency around analytics is not going to be easy. I would argue it’s going to be easier in New England than it is the rest of the country because much of the thought leadership in this area has come from there but even in New England, it’s not going to be easy so for the rest of the country we have a talent acquisition challenge. You know, historically we’ve had an analytic team with expertise in financial, operational and clinical quality analytics and because similar to Kaiser, we’re a large idn, we have existing expertise in places like lab, drug payer provider and other related data sources. I think the two areas that we’re going to be making investments both in people and technology are the following. The first is becoming laser focused on actionable predictive modeling and analytic opportunities

Scott Blanchette [00:38:16]:
and then the second is more traditional customer relationship management or CRM skills. The clinical predictive analytics skill set, as my colleagues have alluded to, is in high demand and short supply supply and we continue to scatter the earth to find exceptionally competent people to help in this area. The second area, CRM, is one that we’re looking very purposefully, entirely outside of healthcare into other industries that have solved this problem statement better than we have and longer than we have and that type of thought leadership back into the healthcare space and maybe potentially bring an application portfolio with them that isn’t organic to healthcare that we believe would be applicable in this new model.

Sanjog Aul [00:39:00]:
So you’re saying. So just to recap, you got of course a challenge with getting the right talent acquired and you’re looking at perhaps buying that particular competency from someone from a solution standpoint? Is that what you just said?

Scott Blanchette [00:39:15]:
Well, I think there is the potential to own none, some or all of this, and that’s a decision process that we’re going through right now. I think the potential for very key strategic, very important strategic partnerships going forward is of high potential and you know, quite frankly, I’m not going to be surprised when we show up at HIMSS next year and a quarter of the booths are analytics companies and another quarter of the booths are large integrated IT companies that are showcasing their analytic acumen. So I, I think this space is going to be a very interesting one to watch for the next couple of years.

Sanjog Aul [00:39:53]:
Mike, do you think it is a good idea for us to start looking at outsourcing as one of the ways versus everybody trying to build their own internal competencies and maybe companies which may be able to Showcase center of excellence around this.

Dr. Michael Bakerman [00:40:09]:
Yeah, I think there will be different solutions for different groups so that outsourcing has its inherent advantages and then has some disadvantages to it as well. But for an individual organization that may have a lack of capital, that may have a lack of homegrown talent or the ability to recruit talent, that may be the solution for some others are going to develop their own solution where they have more control and more strategic design over it.

Sanjog Aul [00:40:38]:
All right, so John, when you are looking at all the discussions that we are seeing that are happening here, where do you think you would want to put your energies in in the next six months for you to say my organization, anyone around me or who we are touching, they are enabled to come closer to this ACO dream?

John Mattison [00:41:04]:
Well, I may not be the best of the three of us to answer that question because the vast majority of our care already occurs within an integrated delivery network. What we’re trying to do for the less common circumstance where one of our members receives care outside our organization, or even onboarding a new member from another institution that may or may not have a digital trail that they can transfer to us, is we’re really focusing on developing the health information exchange capacity so that we can more readily receive information for the patients we’re caring for from other institutions and so we’re around the country and again in concert with the Mayo Clinic Group, Health Intermountain Healthcare and Geisinger, trying to advance those health information exchange capabilities with the intention of making those kinds of utilities and services available to everyone, every institution and every consumer in the country. So we have a pretty robust set of analytics and delivery mechanisms for continually enhancing how we deliver care and so the focus that we have is continuing to tune everything that we’ve been doing in our internal operations and there’s still lots of opportunities for improvement of how we maximize the use of all of our information analytics and predictive analytics but in addition, we’re looking and to help extend the capabilities of health information exchange across the country.

Sanjog Aul [00:43:02]:
Scott, what’s the expectation from your executive management and perhaps the people under you to do differently or more of in order to make a difference and bring this ACO dream to fruition?

Scott Blanchette [00:43:17]:
Well, it’s safe to say that, but everyone in this space is confronted with a similar issue and that’s how do you transform a successful going concern into a newly architected entity and not break all the china and the china shop while doing it? And I think, you know, a part of our role here is obviously to provide some leadership on this front and some direction on this front and I think your question is spot on and I believe that, you know, perhaps more than anything, we’ve drastically understated the amount of time that it’s going to take to transform the healthcare system. And I would argue that one of the additional roles we play here is expectation management and also providing focused, committed, disciplined leadership during what I believe to be will be a much longer transition timeline than anticipated. So I might summarize that by saying, you know, let’s pick a vision, let’s commit to that course and then let’s buckle up for a long ride, take the long view and commit to very long term sustained improvements which I believe all of us recognize as necessary and beneficial.

Sanjog Aul [00:44:38]:
So Mike, do you see any explicit dampers or anti coaches or stumbling blocks which would unnecessarily slow you down and you are aware and is there an intervention strategy for that?

Dr. Michael Bakerman [00:44:53]:
Yeah, so.

Sanjog Aul [00:44:54]:
And within the organization, I want to qualify within the organization?

Dr. Michael Bakerman [00:44:57]:
Yeah, no, I think we alluded to some of those. You know, it’s, I think primary care may be more easily aligned than specialist to this cooperative, accountable kind of work ethic. The alignment of different incentives between inpatient, outpatient work is still tenuous in some regions and in some contracts and then the issues of how we continue to implement new technology while we go through the transformation in identifying workflow challenges, data, discrete data capture points, and then new technology that comes in. So I think that as has been said before, we do underestimate the amount of work and the amount of time to really transform. We’ve asked our providers to do a lot more work, spend a lot more time with their patients, and yet the reimbursement models haven’t really changed that much. So there’s a lot of undercurrent of frustration, being burdened but at the same time, the providers still want to take care of patients.

Dr. Michael Bakerman [00:46:08]:
That’s why they do it every day. So there’s a lot of frustration, a lot of work, but there is hope that we can move forward because, you know, it’s the right thing at the right time.

John Mattison [00:46:20]:
And John, I’ll just add one other frame of reference and so if you just take a step back and look at what we’re trying to achieve in reforming the healthcare system, it’s really, it can be decomposed into a supply and a demand problem and the supply really is how we organize care and how we deliver care and that’s what we’ve been focused on in this discussion so far. On the demand side, it’s very clear that one of the most compelling and challenging threats to the health of our country, and as a consequence the economy of our country, is the rising epidemics of obesity, diabetes and all the associated comorbidities and so technology really has a role to play, a very substantial role to play here and I’m sure my colleagues are actively engaged in their organizations, as we are at Kaiser Permanente, in trying to understand the behavioral aspects of what motivates people towards healthier lifestyle and healthier decisions. So in concert with our Thrive campaign to get people to eat better, exercise better, sleep better pay attention to their health, be mindful of the decisions they make in their everyday life, there’s a huge opportunity in consumer directed and mobile healthcare to use some of the emerging technologies and tools to drive healthier decisions outside of our clinical and hospitals

John Mattison [00:47:49]:
and at the same time that we are moving in the ACO direction as a nation, we need to be very careful not to be so distracted by that and so focused on that that we neglect the opportunities to address some of the foundational issues that are driving the demand on our healthcare system and failing to do so would be be a very perilous form of neglect. So we’re focusing a fair amount of our efforts on trying to understand how to use emerging technologies in the mobile space, gaming, social networking, health coach avatars to essentially support people in making healthier decisions in their everyday lives. So no matter what we do on the supply side, we really need to very assiduously address the demand side as well and the relationship to ACOs is that the accountability towards the total health of the individual pretty much requires that we address that demand side and that’s something that we’ve always been focused on, but are intensifying our efforts given the new technologies in the mobile space.

Sanjog Aul [00:49:06]:
So Scott, when we spoke about the challenges that we have, whether it’s talent acquisition error technologies, and it seems to be a good problem for the solution providers and many times they would come and try to impress with what they can deliver. Now, do you think they have a clue or are they as close with their ears to the ground and understand truly what the problem is? And is there a standardization that has already happened with respect to what is it that is going to be looked at for them to build a robust solution that would meet your needs?

Scott Blanchette [00:49:41]:
Well, admittedly I’m a bit of a skeptic about old dogs learning new tricks. So many of the incumbents in this space which have recently announced competencies here, whether they are new applications that support deeper and more predictive analytics, whether they are new service lines, either consultative or outsourced service lines, I just, I am skeptical that many of these organizations that employ tens or in some cases hundreds of thousands of health IT specialists are going to be effective at transforming that part of their business. I think there is a role here for some fairly innovative and entrepreneurial companies that have been, that I’ve been impressed with over the last, I would say, six or eight quarters that have really gotten, I think, some tremendous intellectual property on board. I think they brought some key talent on board. I think they’ve developed reasonably innovative business models and I’m pretty bullish about those. One I heard our national coordinator, our deputy national coordinator speak of the other day. It was a company called Explores out of Cleveland, a spin off from the Cleveland Clinic that I’ve been impressed with as well.

Scott Blanchette [00:51:12]:
So I think this is an emerging market where entrepreneurs are going to be successful. I think in terms of raw talent acquisition, we’re all faced with a tremendous supply and demand challenge there and I would just finish with saying that I’m skeptical with large strategic partnerships with some of the incumbents that have been in this space for a long time.

Sanjog Aul [00:51:34]:
So, Mike, any thoughts on what do you think these provider community should do now, provider in the sense vendor community should be doing in order to start getting a better understanding on what the problem is, what solutions could work well and perhaps then as informed partners, work with you?

Dr. Michael Bakerman [00:51:55]:
Yeah, I think as we just go back to basic building blocks, I think for each organization, they have to frame the right requirements for them because each market, each provider healthcare is very local. So each group will need to assess their own strengths and weaknesses and then to ask the question of what do we take first and prioritize, and we’ve heard it before, laser like, focus on what we need to do and then move forward and continuously improve on that. Take the next step and do the next thing. But unless you have a clear set of requirements and a clear set of priorities that the local environment can support and sustain, then it really doesn’t matter what you do because you won’t do any of them well and you won’t do any of them effectively or efficiently. So it’s to get that core group and there’ll be different constituents in there to identify their core strengths, their core requirements, and then move forward from there.

John Mattison [00:52:52]:
And I just want to add that there are so many things changing so quickly right now. The challenge to focus on the critical few priorities has never been greater because there are so many challenges and so many opportunities to do things differently and do things better. So I really agree that I think every institution is struggling with the number of major initiatives all underway simultaneously and so really understanding how to achieve focus in a world where everything’s changing so quickly is quite the challenge.

Sanjog Aul [00:53:35]:
Thank you so much for your input. Scott, John and Mike. I hope people see the light at the end of the tunnel and gear up and buckle up with this new challenge. That is something that we all have to work on together. Thank you so much.Thank you,Thank you

Sanjog Aul [00:54:08]:
And listeners, hope you enjoyed the conversation. If you have any questions or thoughts, send us to viewsciotalkradio.com that is viewsciotalkradio.com. Thank you again for listening to CIO Talk Radio.This is Sanjog Aul your talk show hosts till next week. Take care and God bless.

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