Paul Taylor, MD is CMIO and co-founder of Wellcentive of Roswell, GA.
Tell me about yourself and the company.
I’m an internal medicine physician. I practice clinic-based internal medicine about half time. I see patients five days a week. I also chair the clinical integration committee for our PHO. Our committee oversees all the different quality work.
We’re part of the Trinity Health System. We’re in the process of forming a tiered network and just signed up as an ACO. That along with the experience as a practicing physician and chief medical information officer for Wellcentive … it’s been such a lot of fun to put those three different things together.
Wellcentive is a population health management company. We provide population health management solutions that help physicians and their organization across the entire spectrum of population health management, including point of care, care gap analysis, outcomes reporting, automated patient outreach, predictive modeling, risk assessment, care management, and care coordination.
We’re taking a broad view of what population health management means and providing tools developed by a physician for physicians and their organizations. We also focus on aggregating and normalizing data from a variety of sources to make the solution as useful as possible.
The concept of providers being responsible for population health management got thrown into their laps without much warning. Do you get the sense that they are ready to take that on?
I would say most of them are not ready. This is a whole new set of tasks and responsibilities that physicians are being called upon to execute, and lot of the time, don’t really understand. They also have a hard time changing. Most physicians are set in their ways. For us to practice medicine in a different way than we’ve done for potentially decades is a tall order.
The conversation around improving outcomes, cutting costs, and to a certain extent the payment reform of accountable care is going much faster than most physicians can keep up with.
Providers are always suspicious of payers and insurance companies, and those payers have been aggressively investing in analytics and population health management technologies for a long time. Do you think that providers are at a disadvantage against companies that have made analytics a core competency?
I would say that they are. There are some gun-shy physicians as well when it comes to technology. I don’t think that electronic medical records have been as well received by physicians as they could have been. Some physicians are frustrated by the interruption to their workflow.
Using a population health management solution is really different than an EMR that would be just one more thing. Some physicians are reluctant to dip their toes in that water. Payment reform is going to push them hard in that direction, though.
There weren’t many incentives for physicians to implement technology, but now they’re going to need the information from systems that contain their data. Will this need for analytics drive technology adoption, specifically of electronic medical records?
The need for the data and for the reporting — but also the need for the ability to proactively make improvements in your clinical outcomes and financial outcomes for your patients — is really going to drive that technology adoption. It’s not enough to be looking backwards.
Analytics are knowing where you’ve been, but it’s having the tools, processes, and programs in place in your office to look forward, know where you want to go, and put the programs in place to get there. That’s where we are and should be going.
EMRs can be helpful in some regard to that end. The amount of actionable data that you need to have good insight and to how you’re doing — that predictive, forward-looking analytics to know where your patient may be over the next year — that type of technology is a lot different than a traditional EMR ,though.
Let’s say you’re a health system with a large hospital, a couple of smaller ones, and perhaps some owned and affiliated practices that use several different EMRs and exchange information through an HIE. What technology pieces are you missing that you’ll need under this new paradigm?
One of the important components is an interfacing platform that can aggregate and normalize data from EMR systems, practice management systems, e-prescribing solutions, local and national labs, health information exchanges, payers, and a variety of other different data sources. That’s a core competency and a core need.
Data analytics is important to be able to do flexible outcomes reporting, so that you can tailor the reporting that you do for your organization to your specific organizational goals and metrics. Having some sort of outreach tools where you can communicate with patients and help close the gaps in care is important. For organizations that are working with risk-based contracting, risk assessment tools and predictive modeling to give them a good idea of their financial risk and patient panel so that they can properly negotiate with payers and employers.
The one big concept that’s important to understand is that if you look at an accountable care organization, they have to take into consideration the whole landscape in their communities. They have to tie all of that together with their different EMR systems, different practice management systems, different e-prescribing tools, and so on. They need a tool that can do that to help with their different business and clinical objectives, too.
EMRs are driving an unintended consequence in causing small practices and hospitals to align with bigger and more technology-astute providers, such as practices either selling out to hospitals or turning their IT management over to them. Will the need to manage populations provide another push for small organizations to align with larger ones?
I do think so. The likelihood is that the development of accountable care organizations and tiered networks with their more community-based reporting requirements are going to drive alignment of physicians with healthcare systems and their specific overarching umbrella technologies in ways that are probably a little different than with EMRs.
EMRs dictate workflow in physician offices to a certain extent. Because of that, there’s a lot of personal preference for which physicians like this EMR system, or which like another. Having an EMR that a health system offers can be helpful, but it also can be polarizing. Whereas if you have a population health management solution that‘s just a core business function for your accountable care organization, all the physicians are going to be engaged with it, using it, and have their outcomes reported through it. I do think that’s a phenomenon we’re going to see again.
After all the time and money that hospitals and practices have spent implementing EMRs, do you think they will be able to implement these new tools?
I do. We work with physician groups and organizations that have EMRs and some who don’t. The value a population health management solution brings is significant, even for those offices that have an EMR system.
The way that the systems are used in an EMR office is different than the way it is in a paper-based office. In a paper-based office, it does tend to be more point-of-care, hands-on use — looking at clinical decision support tools and doing medication reconciliation directly in the tool as opposed to through an interface with an EMR. With an electronic medical record, we tend to rely a little more on electronic communication between the population health management tool and the EMR, so there is not a duplication of the workflow and effort.
If I’m the typical hospital or practice with an EMR, what’s the bang for the buck in looking for additional technologies to move toward with managing populations?
You are going to need a population health management tool — one that can help you with the reporting, one that can help collect actionable data from a variety of different sources in your community to help make the reporting that you get out of it meaningful to help make the identification of high-risk patients accurate.
For example, if you’re implementing a case management program, having a strong population health management toolset that’s highly integrated with the pertinent data sources within your community is really probably the next step.
Do you see an overlap between what EMR vendors offer and the more specialized tools you provide, and is it hard to convince providers that they need those tools?
It’s beyond just simple functionality. You can have a rules engine that does analytics, but if the data that you’re running the analytics on isn’t accurate, it’s not up to date, it’s not complete, then the reporting that you’re going to get out of it is not going to be very meaningful. The physicians aren’t going to trust it. They’re not going to pay attention to it. They won’t get engaged.
EMR vendors generally are not focusing on integration and interfacing of actionable data across a community. That’s an easy argument, and a very valid argument to make.
Some of the toolsets that you find in a solution that’s geared towards population health management are beyond what most EMR vendors do. For example, predictive modeling and risk assessment, using vetted algorithms to help identify patients that are high risk of poor outcomes, using different types of tools that way so that you can enroll them in case management programs, or help you in your conversations with payers through case mix adjustment, that sort of thing. Those technologies are a little beyond EMRs.
Being able to track the cost and utilization of healthcare across a population of patients is something that’s really valuable information for physicians, especially ACO-type organizations. That’s also something that you really don’t see in EMRs.
We generally don’t think of a population health management solution as being in competition with an EMR. We see them as different types of workflow, parallel technology tracks with some overlap in the uses of the systems. But the goal of the population health management solution is primarily improving the clinical outcomes for a whole population, and also improving the cost of the healthcare delivered to them at the same time.
I see population health management solutions shining in community-wide implementations, which is a distinct and parallel technology track with respect to EMR implementations. Population health management and EMR solutions are complementary, and I don’t see them as being in competition with each other. Their clinical and business purposes are very different.
If I’m a patient now being covered by your tools through my provider organization, what changes in my care will I see?
You might find that you get some automated outreach to you, maybe on a quarterly basis. You get a phone call telling you all the different things that you’re due for, like a diabetic foot exam, mammogram, colonoscopy, that type of thing. The information that’s given to you on that phone call is more likely to be accurate.
You will also probably find that your physician is little more engaged with population health, in that they might be more likely to have care management work that’s being done in their office, a care team that’s involved with helping with your care. You may find that there are other people inside the office who, at a visit or between visits, are using the solution to help improve your care. That’s something that patients generally notice.
As hospitals acquire or align with medical practices, what information do they need to manage that relationship?
Without the appropriate toolset, it’s difficult for health systems or physician organizations to have a good feel for the quality of care that their physicians are providing. If they want to have more insight into that, they need the core set of data — the patient demographic information, accurate information about what’s the patient’s medical history is, what their diagnosis is, what medication they take, what sort of procedures or tests have been performed, and what immunizations have been given and what should not be given.
It’s also important in today’s environment to have an understanding of which payer those patients have. Also, to be able to use a benchmarking tool to help see how an individual physicians stacks up against his or her peers within the office, their specialty, or within their region. A lot of times we see health systems or physician organizations proactively working with those physicians whose performance rates are not as good, trying to help bring them along. Which is, of course, good for everybody.
What changes would you expect the average hospital or physician practice to see in the next five years in terms of the things we’ve talked about, and what should be their priorities in doing something now to be ready?
We’re going to see a lot more collaboration. We’re going to see much tighter relationships between hospitals and the physicians around quality, cost, and outcomes. We’re going to see the business structures of those relationships change significantly, and I would imagine fairly quickly, over that time frame, such that there’s less, “Well, that’s the hospital and this is my clinic here,” more of a feeling like, “We’re all on the same team trying to work together to take care of patients.”
I believe that the financial incentives are going to be rewarding a community of physicians to help improve those outcomes. The only way you can really do that is by care collaboration through communication, through being proactive, looking forward, and doing things that require a care team to accomplish, like case management, care management programs, that sort of thing. I think we’re going to see a lot of changes over the next five years.
Any concluding thoughts?
Wearing my physician hat, I look at all the technology in this conversation around solutions, data, and interfacing. In my mind, the technology is just enabling. It won’t get the job done for you, but it’s going to help you get there if you choose to put the effort in.
I’m a firm believer that this kind of quality improvement work needs to be led by physicians and managed by physicians. Patients don’t want to be taken care of by some stranger at the case management program. They want their doctor to take care of them.
I also think that it’s important for physicians to roll up their sleeves in their offices and change the way that they’re doing things, so that they utilize the staff that they have in different ways to help drive outcomes and put together an office-based clinical quality improvement program centered around trying to take care of all patients, not just the ones who were in the office that day.
I see all that technology helping to enable, that but it’s just critical that the physicians are leading the charge.