HIStalk Interviews Susan DeVore, CEO, Premier

Susan DeVore is president and CEO of Premier, Inc. of Charlotte, NC.

Describe what Premier does, especially with regard to healthcare IT and data.

Premier is, I think, the largest healthcare improvement alliance in the country. We are integrating data from hundreds and thousands of hospitals on our platform to solve the cost, quality, safety, and population health or outcomes problems.

We’ve got a 59 percent footprint. We’re serving 3,000 hospitals in various ways. We have about 110,000 non-acute care sites. We have insights with data on one in three patients in the country.

It’s a massive business intelligence platform that we’re wrapping around services and capabilities to help these healthcare systems transform from the inside.

Premier was a hospital group purchasing alliance and is now a publicly traded informatics company that offers solutions for supply chain, labor management, population health, and quality. How does that all fit together to help hospitals as payment models change?

We’ve been building these data assets and this supply chain capability for a long time. Over the last three or four years, we’ve fundamentally rebuilt our entire foundational infrastructure. It was clear to us that all of these one-off solutions and individual vendor solutions aren’t going to solve the complexity of healthcare problems.

We decided a while back that providers needed to be able to connect the data, have the business intelligence come from all vendors and all payers, and be normalized and cleansed and standardized. We needed a social business capability on the front end so that we could accelerate the best practice sharing, content review, and knowledge transfer among these healthcare systems. We decided this was going to be the only way you could really solve the cost, quality, and outcomes problems.

As a provider, knowing where you stand in the continuum and not just how well you improve on your own is a pretty big deal. Will vendors struggle to compete as the market finds that their single tools may not offer enough?

The problem for any single vendor is that they only have a piece of the picture. Even EHR vendors. In our mind, they’re only one system of probably 12 or 13 different sources of data that you need to solve the problem. Any one payer that tries to solve the problem, or comes from a payer, has a view into only the payer population.

When we set out to do this, we said, we’ve got to be vendor agnostic and we’ve got to be payer agnostic. Health systems want to change the way patients get cared for, regardless of which EHR system they use or which payer they have a contract with. They want to change the way care is delivered for a patient population.

We think it’s a differentiator. We think that it will be critical that vendors are required to make their information exchangeable and not require that our health systems have to pay every time they want to make the information exchangeable.

How do you see that happening? It’s been a sore spot with providers that systems are supposed to be interoperable, yet they often aren’t unless you write a check and probably accept less functionality than you want.

I think there are three things that are going to drive it. The first is that providers are going to drive it, a coalition of providers who need the information to be more effective at what they do. Providers are increasingly dissatisfied with the lack of the exchangeability or the interoperability, so I think they’re going to require it.

Secondly, I think consumers are going to require it. Consumers are going to say, I need to make the decisions. I need the transparency to the information. I want it.

Thirdly, we need policy change. The thing that will accelerate it is if policy makers start to realize we can’t solve the cost, quality, and outcomes problem in healthcare without it. Those three things could push it faster.

Hospitals are trying to figure out what role they will play in the retooled healthcare system. How can information help them determine their business model?

Because we have this 59 percent footprint and we cover basically every geography, we see health systems that have been morphing now for several years. They have affiliated physicians. They have affiliated nursing homes. They have partnerships in the community. They’re building virtual IDNs, virtual ACOs, real IDNs, and real ACOs and have been for a long time.

They also usually have in those community markets more sophistication, maybe, and more capital to help build the integrated capabilities and to help access the integrated capabilities.

From our perspective, if and when the healthcare system moves to a more bundled payment world — whatever form that takes — this integrated data is going to be extremely important. It doesn’t have to all come from the source system. Many of our health system’s big IDNs are saying, do I really have to switch everything out? Or in an open data, big data, cloud-based, shared infrastructure world, can I find ways to go get the data and put it together?

These health systems are going to be an integral part of what healthcare looks like in a future state world. They’ve been starting to build this capability and put these pieces together for a long time.

If the pie gets bigger for our healthcare system, and they have a lot of pieces as opposed to one singular hospital piece, I think this is a pretty natural evolution.

Are providers jumping too quickly into ACO arrangements?

I think they’re experimenting with ACO models. As opposed to jumping all in, they’re trying it on a population. They’re now receiving data from CMS, which was something healthcare systems had never historically been able to do. They’re learning a lot. They’re figuring out how to manage the provider risk.

What we say to them, and what they say to us is, we’re trying to future-proof them and they’re trying to future-proof themselves. Whether it’s an efficiency measure that is measuring cost three days before acute care stay and then post, a bundled payment program, an ACO, or Medicare Advantage — if you’re able to connect data and you’re able to turn that data into business intelligence, pulling it from all vendors and all payers and putting it in the hands of your providers and change the way care is delivered, then there may be multiple models for a while we’re in the transition. That infrastructure is going to position you to navigate through those various models.

How will it be different for an academic medical center versus a community hospital?

They have different challenges. Community-based systems are integrating physicians very significantly. They have to have data and connected information in order to influence the practice of medicine.

In an academic center, you’ve got a more employed model that you can deal with, but you have other challenges. How do you fund research? How do you fund all the other activities and pay for and compete in the community healthcare system?

We have them all. We have academics. We have small. We have large. We have big IDNs. Some of our academics will tell us it’s easier for small community systems to drive change. Our community systems will say it’s easier for academics because they’re larger with more funding and more resources.

The truth is, this is performance improvement. You need the data. You need the data connected. You need to operate and change your operation. Whether you’re an academic or whether you’re a community health system, we can see the change happening in both and in neither. It has more to do with the culture, the measurement, the data, the infrastructure, and the willingness.

You’ve suggested the possibility of acquisitions. What areas interest you?

We report publicly in two segments — a supply chain segment and a performance services segment, which is where all of our HIT assets, informatics, and consulting and collaborative activities are.

We have said, and continue and to say, over on the performance services side, we are interested in ambulatory data acquisition and connectivity of ambulatory data to acute care data. We’re interested in all kinds of population health and data analytics technologies and capabilities for our members to build this population health capability. We’re interested in major things in both of those buckets.

We’re also interested in the area of patient-reported outcomes and in the implementation of standardized, more cost-effective, clinically-effective healthcare. We’re looking at all kinds of things in those areas.

On the supply chain side, we think there’s still a ways to go in changing supply chain capabilities in healthcare systems. We’re looking at workflow kinds of capabilities, alternate site capabilities, and the connectivity for supply chain between all the alternate site locations and the hospital or health locations. We have a specialty pharmacy. We think it’s a critical element to population health, so we have some interest there also on the supply chain pharma side.

Do you have any final thoughts?

It’s a very dynamic time. Integrated information that’s vendor agnostic and payer agnostic is critical.

Health systems have spent hundreds of millions of dollars installing EHRs. They’re increasingly dissatisfied with the inability to exchange information. They’re not so interested in spending hundreds of millions more to build data warehouses.

We think there’s a real opportunity for shared infrastructure and shared integrated data management capabilities. We are making significant investments there.