Tell me about yourself and the company.
I’ve been in healthcare for my whole career, over 25 years at this point. Like many young people, I started my career in consulting, but the bulk of my career has been on the technology side. I’ve worked with government agencies, employers, payers, and mostly providers. I spent a big chunk of my career at McKesson.
I joined the Healthagen arm of Aetna about 18 months ago as president of HDMS, which is an analytics technology company that mostly works with payers and employers. I became CEO of Medicity in October of last year.
If you had asked me six months ago to describe what Medicity does, I probably would have said that Medicity is an HIE. But now that I know the business a little bit better, I think it’s probably more accurate to describe Medicity as an organization that helps its customers build and grow clinically connected communities.
I think of Medicity’s expertise as aggregating, cleaning, and normalizing clinical data. We do about six billion transactions a year, so we have a lot of experience with that. Those data serve as the foundation for a lot of interesting things that our customers do. But at our heart, we are a data company.
How would you describe the relationship among Medicity, Healthagen, and Aetna and how their respective strategies overlap or compliment each other?
The answer to that has evolved even over the 18 months that I’ve been here. Healthagen was created to become the technology and innovation arm of Aetna. Some of those technology businesses have become integral to the operations of Aetna’s strategy, which is designed towards accountable care, value-based care, and value-based reimbursement.
Some of the pieces of Healthagen are getting more integrated into the operations of Aetna. A few months ago, we announced that we were dissolving the Healthagen name. There’s a lot of work going on at Aetna around branding and that will be a big focus for 2017, but one of the things that I’ve been impressed by is how we are bringing these various technology companies into the operations and the strategy of what’s going on in Aetna’s core businesses.
Do providers have the information they need to do population health management?
It’s a journey. We’re at very baby steps in that process right now. Having access to that information, having access to it in a manner that is complementary to the provider’s workflow, and then having access to it in a manner that makes it easy to act on — those are stages of evolution. Where are we right now? Somewhere at the beginning.
I see a lot of interesting things happening in the industry. But they still seem to neglect the reality that if you don’t try to solve the problem within the existing provider workflow, it’s just not going to happen. The good news is that I see a lot of acknowledgement of that.
We work with some of the joint ventures that Aetna has put together with large health systems to drive value-based care. They’re focused on just this issue. How do we get access to the right information, but in the way in which we provide care, the way we do our business? How can you help us with that so that we can drive towards some of the priorities that we have? If it’s not in the workflow that we use today, it’s just not going to happen.
What’s the state of integration between provider EHR data and the broader information maintained by insurance companies from multiple providers?
I’ll give you a couple of examples of things that we’re working on. There’s value in the EHR data to payers like Aetna to drive more efficiency in certain processes. A great example is standard care management processes that happen inside a payer. How can you automate pre-certification by using secure messaging with the provider? How can you bring in ADT feeds to help care managers and case managers understand early that patients are being admitted or that people are being referred to certain providers? There’s value to the payer to get access to some of that EHR data, no doubt.
Then the flip side of it is, how can the payer then provide data back to the provider? Leakage is example. We’re working with one of Aetna’s joint venture partners right now to help bring in data from other providers who are outside of their network, but who are in our Medicity network, to show them where their patients are being referred out of network so that they can try to ratchet some of that down. There’s obviously a lack of care coordination if you’re having that happen.
I’d say we’re in pretty much the early stages of figuring out who’s going to get the biggest benefit from which data stream and for what use cases. We’re taking them one at a time. Once we get a couple of clear use cases where there’s benefit to both parties, then there’s an enormous amount of enthusiasm to continue down that path on the rest of them. But you want to have those first pilot use cases to show everybody that this is worth the hard work, because it is hard work.
Does the competition among providers and among insurers impede progress? Do you think intentional data blocking exists?
I think it definitely exists. It’s been fascinating for me being on the payer side. Early in my career, I swore I’d never work for an insurance company, but here I am. [laughs] One of the things I like about it is that I get to watch some of the stuff happen real time. The types of joint ventures that we’re putting together with these large health systems are predicated on trust.
It goes both ways. Aetna pulls out of these markets. It removes its brand and allows all of the insurance to be offered to by the health system. It’s good for us and it’s good for the health system. I think you’ve got to have some of these fundamental pieces to these ACO arrangements that are predicated on trust and on information sharing or they’re not going to work.
We’ve seen first hand what leads to failure. We know that what leads to success is complete data transparency, among other things. Is that going to become the norm in the industry? I don’t think so. It works best with large, enlightened health systems. It’s not going to work with everybody. I think we’ll always have some degree of data blocking and and we will always have to deal with that.
What has been the impact of uncertainty about the future of the Affordable Care Act on Medicity’s business?
What I hear from a lot of providers is they have already made these strategic decisions. They are heading down this path regardless of what the government does. That’s the message we heard when the Supreme Court was ruling on some of the ACA issues last year.There is a pretty firm belief that moving towards value-based care, moving towards things like interoperability, are the right things to do regardless of what the government may do about it.
That said, some of our public HIE customers are very concerned about funding. Are certain grants that they rely heavily on going to go away under this administration? There are lots of concerns around things like that.
I do expect there to be a certain degree of anxiety that leads to retrenching. But I think in general that the direction that we’re heading is going to continue regardless of what the administration does.
The data exchange issues are both financial and technical, as evidenced by the HIE challenges in California and the Carequality vs. CommonWell discussion. What’s the big picture in getting data exchanged and the underlying fabric that either allows or doesn’t allow it to happen?
First of all, I’m excited to see that Carequality and CommonWell are working together. That’s a really great move. There’s never going to be one specific solution for interoperability and data exchange in this country. It’s just not going to happen. We’re not going to have everybody on one or even three EHRs. We still need to cobble together multiple solutions to get to a place where there’s a complete liquidity of clinical information. There’s a place for everyone.
If you look at KLAS’s report that they did in 2016 on interoperability — the one that was focused on EHRs — it showed that the public HIEs are still by far the biggest source of data that providers are taking from external organizations. They complain about the data that comes from the public HIEs, but those remain the number one source of external clinical information.
We’re going to have a patchwork quilt of solutions for many years. The combination of CommonWell and Carequality may give us a really good footprint, but we’re never going to get all of the data from one source. We’re going to need to learn to co-exist in a way that works for the end user, who is the provider. Their use cases are the ones that matter. I don’t think there’s a single solution that’s going to solve things for them.
Is the underlying data exchange solid enough to move on to the next frontier, placing that data into the provider’s EHR so it’s not a separate system or a separate lookup?
I’d like to think that’s the case. We’re certainly spending our time now more on how we can create documents, CCDs, that are integrated, normalized, and offer great value to the provider, Any provider will tell you that going through a CCD is a nightmare. We’ve got to get to the next stage of providing information to folks in the workflow that they’re in, in a way that provides value to them rapidly.
We’ve hit a level of maturity in this industry where now we’re dealing with the nuances. But the nuances are what’s going to make this mission critical to how a provider manages their patients.
Where do you see the company in five years?
Where I see us going is continuing to view ourselves as clinical data experts. We will have more and more ways to use that data to drive different business uses for our customers. I see the variety of data getting more complex, moving away from some of the standard transactions that most interoperability vendors work with today. Moving into maybe more administrative types of data and other kinds of clinical information that come from providers that aren’t normally pulled into this process.
At the base of it, I believe what we do is foundational to a lot of what people today throw into that big category of population health. That foundation has to be there if you’re going to do more sophisticated things. Building that foundation is a journey. We’re never going to be done with it. Medicity is going to be part of that journey for a long time, building out the foundation that we need.
Do you have any final thoughts?
I love having the chance at HIMSS to walk around and see all the shiny new things that are out there. I’m looking forward to getting a feel for what the themes are that we’re going to take away from HIMSS this year. Last year it was like population health 2.0, getting beyond the theory of what population health means and getting into some of the practical applications.
Whatever the industry trends are, we need to constantly bounce them up against whether they support the existing workflow of those organizations that would be able to take advantage of these technologies. That’s a critical question we have to ask. We won’t get adoption if we don’t see that.