“The big problem with fee for service is that nobody owns the patient. Everyone just throws the patient over the fence,” commented Marc Berg, Principal at KPMG. Despite the onerous task of working with claims data, the Health Datapalooza panelists presented their organization’s success turning this messy data into actionable and reliable information for the end user whether consumers, providers, payers and health systems. Here is a synopsis of challenges posed on each organization or corporation and the benefits they were able to deliver.
The panel moderator was Francois de Brantes of HCI3 and distinguished panelists included:
- Simeon Schwartz, President and Founder, WESTMED Medical Group
- Marc Berg, Principal, Advisory KPMG
- Ariel Bayewitz, Vice President of Provider Analytics, Anthem
- Robin Gelburd, President, Fair Health Inc
- Mark McAdoo, Chief Executive Officer, HealthQX
Data Feed Back Loop for Physician Engagement
From your perspective as a physician leader what got the physicians to act on what they want?
From Dr. Schwartz’s viewpoint, “Telling doctors what to do results is an extremely challenging career that is short lived.” Which is why 350 physicians at WESTMED Medical Group have dashboards with a couple of hundred items, updated daily for 50 to 60 specialties. Even the compensation model parameters that determine bonuses for primary care internists has between 50 and 60 items. It took about a decade WESTMED to become a data-driven organization. “But increasingly, our physicians do not want to be bombarded with a million things to do. So much of those metrics are built into their daily workflow and much of it is done by their staff and they don’t have to do it. Physicians want to deal with diagnostic dilemmas deal with interpersonal relationships with their patients which takes time. The only way to make the 15 minute office visit effective is to take all of the things like gaps in care, routine follow ups and wellness questionnaires and move it to the non-physicians staff, which we have done and has improved physician satisfaction,” explained Dr. Schwartz.
When WESTMED targeted various cost saving strategies, they looked for the top 50 to 100 diagnoses to find the “low hanging fruit” for a meaningful chance in reducing cost. And with some the target areas, they have been very successful despite the fact that unit cost is going up due to consolidation and the tremendous lack of competition that is taking place. “If you have a colonoscopy at your local hospital, your total cost for the doctor, facility and anesthesia is running today about $4000. That same procedure done within the group is under $1000, and is extremely profitable,” shared Dr. Schwartz. He explained that in many areas because of the site of service differential, they had to choose targets that gave a big economic bang for your buck upfront. They chose the top 50, 60 or 70 things that they were going to work on around economic impact. And completely redid their infusion services and had to make sure the physicians did not have incentives over their prescribing patterns. This resulted in a 20% to 30% reduction in the number of infusions. “So all these issues can be tackled without having to go after new neurosurgical protocols. The waste of your system is probably 20% or 30% of which 80% of that, in my opinion, is low hanging fruit,” Dr. Schwartz apprised the audience.
Reconciling Measures: The State, Managed Care and Provider
How do you create parsimonious measures amidst a tension of differences?
“The very first thing that people need when moving from volume to value, is finally giving someone the responsibility for the entire pathway,” stated Mr. Berg, who led the New York State redesign project for Medicaid, “Let’s say we want to contract payers in this Medicaid environment. First, they want to know indeed if I am responsible for my own cost center. Then I need to know the total cost of care of the people for whom I am responsible. It’s fascinating to see what an eye opener it is when you start to give providers data. When you show the obstetrician what are made costs before, during and after delivery in the new born, they have absolutely no clue,” Mr. Berg point out. When the New York obstetricians discovered that half of the cost of the pregnancy, deliver and first month of baby, was more than half was the cost of the baby, they had absolutely no clue. The redesign always starts from seeing the low lying fruit from the data.
Second, one of the biggest challenges is the constant confusion between the different layers of accountability. Having 200 more data items refreshing every day makes sense for managing a physicians practice. However, when payers or government start to think that data is really important, they want to have those 200 measures on i.e. how good you are for getting your sugar in control or blood pressure in control. Every payer chooses a couple of these measures to reward on or not reward. “It drives providers completely nuts,” Mr. Berg told the audience, “You are spending a lot of money and a lot of time, but you are not driving anything in terms of improved outcomes.”
For potentially avoidable complications, one must look at the total cost of care and once you got that covered you can start to look at utilization. From the government and payer’s perspective, potentially avoidable complications are an incredibly obvious. Every day individual measures are changing and 90% of that roll up is to avoid people with diabetes going to hospital or people with depression going to the ER. In the State of New York, if you pay for outcomes, then focus on the 2 or 3 things that really matter. “Potentially, the same things you want to focus on, and let all that process based individual measures part of HEDIS and the part that you have to report to Medicare and CMS. Let’s stop doing that. Let’s leave those measures to the doctors to improve and facilitate some of the data interchange that is helpful. And let’s stop paying for hundreds and hundreds of individual measures just focus on the key ones that really matter,” contended Mr. Berg.