Tom Zajac is CEO of Wellcentive of Alpharetta, GA.
Tell me about yourself and the company.
I’ve been in healthcare for a little over 30 years. I’ve had the great fortune to be on this journey of transformation. My first role at Jefferson Health in Philadelphia was when DRGs first came out. I moved on to things like cost accounting and looking at efficiency of care and effectiveness of care management.
At Wellcentive, our focus is on population health, which we’ve been doing since 2005. We don’t focus on the technology as much as the outcome. We try to help our customers drive true quality improvement; revenue growth, especially with the value-based care initiatives that are going on now; and business transformation, which is where I think the marketplace needs to be.
A Wellcentive tagline is “quality equals revenue.” What aspects of quality can be defined and measured and how should the patient’s point of view be incorporated?
Quality has historically been something of need for healthcare, but now with reimbursement, fiscal incentives are sitting there in the system to be able to drive those kind of capabilities. We have that tagline of “quality equals revenue” because the programs are now driving people to make better decisions. What are gaps of care? How can we look at patient engagement? How can we make sure that there’s better compliance for our patients to try to keep them out of our EDs? At the same time, it’s also driving them to look at better ways to focus on population health, not just on care.
The early years of my career were focused on how well we delivered care. Now with population health and this movement to value-based care, the focus has to be on how we’re treating holistically the entire needs of the patient. As healthcare organizations expand, their focus is not just on a hospital. There are multiple modalities of care among the primary care providers, specialists, urgent care centers, hospitals, etc. How do we best move a patient through that process so they not only get the most effective care, but also the best outcomes? Because it’s not just all about financial outcomes and not even just about clinical outcomes. It’s about human outcomes as well.
Is there enough incentive for providers to manage population health instead of just cherry-picking a particular metric or element they can latch onto to generate income?
You always wind up with that case. Sometimes the industry gets driven by federal mandates or insurance mandates. Typically the industry actually does the transformation. Healthcare has been very viable from that point of view. Exactly what you were saying … with some of the programs that initially come out, you’ll have a rush to revenue. I would almost make an argument some of the early ACOs were like this. Their interest was more in how to maximize revenue.
The more recent model that we’ve started seeing has an example the Delaware Valley ACO, one of customers. It’s a super ACO formed by trading partners in the Philadelphia area, such as Jefferson Health and Main Line, who are bringing together the right intentions — focus on care, focus on population health, making sure that you’re driving the best access, the best experience, and the best capability of healthcare for patients going forward. That is usurping just running for dollars going forward.
Even though a lot of these programs have been formed, we’re in a situation where organizations are forming with the right intent and the right purpose going forward. A lot of times, it’s Maslow’s hierarchy. PQRS is a perfect example. It’s a starter set, a gateway into focusing more on quality. It started out as a carrot, but now it’s starting to become a stick, and as the MIPS program is going to drive people to make sure that they’re measuring the right levels of quality.
One area we work with our customers on – and one that most healthcare organizations have to consider — is that you shouldn’t just be reactive to what programs and approaches are out there. By looking at population health, assessing data, and bringing together great analytics, you can start assessing where you operate best and how you can best treat those patients. Then use that in your dialog with payers going direct to employers to be able to set up better reimbursement approaches and better focal points.
If I were a skeptical consumer, which I often am, I would say that hospitals and medical practices could have been managing my overall health all along but didn’t until someone wrote them a check. Does population health management need to to be explained to consumers?
This is not a one-stakeholder issue. All stakeholders have to participate. We as patients have to take active participation in our health as well.
You can look at that and say that the healthcare system historically has been more fee-for-service based, so therefore they’ve only been interested in volumes. That’s not true. There are huge numbers of people in the healthcare process who’ve been trying to make sure that we put the right care together. However, now with better data and better analytics, we’re starting to be able to look at what decisions we should be making earlier.
For a 50-year-old hypertensive diabetic, how do we make sure that they don’t wind up trending into a case for stroke? How do we get ahead of that? It’s not just the physician’s responsibility or the hospital’s responsibility. The patient has to be part of that responsibility as well, making sure that they’re complying with their treatment protocols and having active discussions with their physicians and their providers.
The one thing I worry about is the consumer or the patient being passive in this model. Nothing should be more active than your own health.
Most of what constitutes health doesn’t involve the medical establishment, such as consumers who make unhealthy choices. Are we giving providers health responsibility without authority?
Providers are now in a role of trying to also be mentors for patients to take more control of this situation. There’s a huge amount of data out there and sometimes it can be purposed in the wrong ways. A lot of the point about population health is to try to create better dialogs, better outreach, better collaborations among patients, providers, physicians, and payers as we go through this overall process.
Hospitals are trying to focus on quality. Quality creates revenue. They also need to focus on access. They’re starting to look at where to treat patients. They’re starting to look at their markets. Where else they should compete? How should they keep an affinity with their overall practice?
For the patient, they’re trying to decide how to apply their affinity — their relationship with all of those various stakeholders — and how to get the best information. There must be a mentoring capability between providers and physicians with their patients to get the best overall outcomes.
We’re starting to hear more about the idea of consumer workflow. We focus quite a bit on physician workflow, maybe a provider workflow or payer workflow. You’re starting to see the rise of the CVSs of the world. They’re able to be successful because they’re focusing on consumer workflow — when healthcare is needed, when it’s convenient, how to get information out to patients, and how to help them focus on compliance.
Population health has to wrap that all together. It’s basically got to be able to help providers, organizations, and even payers focus on how we get the best information and aggregate information about longitudinal care, not just episodic care. Those are two different DNAs. An EMR being able to track episodic care is obviously focused on the episode. Population health has to also focus — not in conflict with — on the entire longitudinal path. What clinical data do we have? What claims data do we have? What personalized data might we be able to pick up for the patient to be able to use that to hone the best approach and the best knowledge you have with the patient? If you do that, then you’ll start to get a win-win strategy.
Employers and employer-led coalitions were not long ago seen as the best hope for influencing cost and outcomes using their purchasing power. Do they still have a role in what now constitutes trying to manage the health of populations?
Yes, absolutely. There’s been a lot of conversation, especially with the ACA, around what the employer’s role will be. Employers are still extremely important and they’re acting that way.
For example, we’ve got a customer, Blanchard Valley, who is working a care management program for Whirlpool in the Ohio area. Their role is to try to engage patients in their health. What we were just talking about before — making sure everybody has active participation. To do that, though, they’re putting in an active care management plan. They’re doing outreach, they’re following up with patients, and they’re making sure they’re complying with the visits that they need.
It’s not just that the employers are the stopgap for the cost of health. They’re getting directly involved in that. You’ve probably read recently about Boeing’s message that they’re going to look more as an employer direct to provider or employer direct to health system to try to make sure that they create the best cycle and the best access for their patients. They are in direct dialog, for example,with Evergreen Health to be able to talk about how to best treat their patients. They continue to be active participants, but not only from a dollar point of view.
The consumerism you were talking before has both of those relationships as well. With higher deductible plans, patients are now starting to focus on the financials and some of the decisions that relate to financials, but they also have to focus on compliance to their overall care patterns. It will impact employers and employees not only with regard to productivity, but also the well-being of their employees, which is an affinity or retention between the employee and the employer.
Are you seeing that analytics tools have improved but the underlying data are still of questionable quality?
Yes. When we start an implementation or a partnership with one of our customers, one of the key issues is trying to focus on that longitudinal DNA. Most of the larger healthcare organizations that are creating their future success are a combination of the original hospital as well as physician practices, urgent care centers, and extended care. All of that comes with disparate modalities of care and disparate data within that.
All of that data needs to be brought together and it has to be as complete a picture as possible. It can’t just be EMR data or specific EMRs and their data. It’s got to be all of the data sources that are out there – EMR, clinical, patient claims data — to try to build the richest picture that you can for those patients.
Realize that for some organizations, this is the first time they’re bringing together that type of disparate data. It’s not just aggregating the data. You have to focus on data quality and making sure it’s complete, it’s contextual, it gives you the best picture of those patients, and it’s accurate. A normal conversation I have with physicians is whether or not they trust the data they’re seeing.
Data quality is such that, as we’re going through an implementation, you’ve got to look at grabbing and aggregating that data together. Normalize it so somebody can use it in a focused pattern, and then from that point of view, figure out where the holes are. We’re not getting allergy information. Maybe the information that we have on patient outreach is weak. How do we improve that information?
Then we can go to the quality set and look at the measures we’re trying to attack. Are those measures, in fact, giving us the right information? Are they complete? How do we now turn them into programs?
Data quality is actually a journey. Sometimes people think that integrating the data is simple and it’s going to happen overnight. More times than not, it’s a journey to try to not only aggregate the data, but make sure we’re focusing on creating the best set of data and the most complete set of data. That does take work.
What’s on your technology capability checklist when you choose your own medical insurance and providers?
I may shift that question just a bit. Let me try this, anyway. In a lot of ways, there’s been a lot of conversation about big data and analytics and the technologies behind it. Those things are important and they’re necessary for this next step, but the real importance has to be transformation.
When I look at providers or I look at health systems that I want to work with, I want to make sure that they have a comprehensive view of care management. The Holy Grail for healthcare in general is true integrated care coordination. So many of us are polychronic at this point. How do all of those things interact? How do the various physician and the various caregivers we have interact with that information so that there is a holistic view of me going forward?
I don’t necessary look at an organization based on the technology they have, but rather the intent and the capability. It’s important to have big data and analytics to be able to drive a comprehensive approach to things like care management, being able to focus on quality, making sure we’re looking at transitions of care, and trying to figure how to best interrelate with me from a patient engagement and provider engagement point of view.
Where do you see the company in five to 10 years?
Population health has been a term. It’s turning to truly support value-based care. In supporting value-based care, Wellcentive has the ability and the intent to be the command and control across the longitudinal pattern for population health and value-based care. What we’re looking to be able to do is focus on quality programs and make sure that organizations are optimizing revenue. Focus on readmission, cost, and utilization so patients are getting the best experience. Focusing on care management and patient engagement so we know we’re getting the best compliance. Making sure that we’re combining the stakeholders — employers, payers, providers, and patients — so the communication is creating the best clinical, financial, and human outcomes that we can possibly create.
People have been saying, "We understand population health and value-based care. I’m not sure if it’s time for me to get into it." From what HHS and the commercials are doing, the incentives to move and the incentives to act are now. People have to realize that we’re losing time. We have to be able to act on value-based care now. The incentives are in place. Healthcare can be, because of what we deal with — privacy, patients, etc. — a little bit risk averse.
Really strong examples are forming on how organizations are putting care management in. The super ACOs that are forming. The trading partnerships, trying to figure out how to work between employers, payers, and other trading partners. The examples are there. Your peers are starting to work through that. This is really our time. I keep telling my staff that it’s not only our opportunity, but it’s our responsibility to drive the transformation in healthcare, and our time is now.