The Impact of Health IT on Value-Based Care

 

Harry Greenspun, M.D.

Chief Medical Officer, Managing Director, Health Solutions

Korn Ferry

March 20, 2018

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Riffing on an old saying, “Ask four doctors a question and you’ll get five opinions.” With that, I was honored to speak at the National Quality Forum’s annual conference last week in Washington, DC., discussing value-based care (VBC) alongside three other physicians. Joining me on the panel were Asif Dhar, MD, MBA, Chief Medical Informatics Officer, Deloitte @Deloitte, Keith Fernandez, MD, National Chief Clinical Officer, Privia Health, and Bharat Sutariya, MD, Vice President and Chief Medical Officer, Population Health Leadership, Cerner (@bsutariya). 

 

While we were originally tasked with discussing the impact of health IT on VBC, the conversation quickly went to broader issues. Moderator Kathleen Giblin, the NQF’s SVP for Quality Innovation (@GiblinKathleen) opened by asking us what the future of VBC looks like. Among the panelists we all agreed that VBC was the future, but that the question was when and where. Some parts of the U.S. and many countries were rapidly embracing VBC, while others were deeply entrenched in traditional fee-for-service medicine. What gets tricky is identifying when the shift to VBC is occurring. Some health systems seem to be pursuing VBC by expanding their networks through acquisition and partnerships with physicians. However, when you dig a bit deeper, the underlying business driver is an effort to protect their volume.

 

Moving to the promise of population health, the conversation then shifted to a fascinating discussion of social determinants and how to promote health and wellness. The healthcare people receive accounts for only about 10% of their actual “health.”  The majority is determined by social factors and behavioral choices (70%), with only 10% from biology and genetics. As I often say when this comes up, “I can more accurately predict your risk of a heart attack from your VISA bill than from your genetics.” The challenge this presents is that the data needed to truly understand what’s happening in communities is not the data health systems typically have. 

 

Interestingly, the relationship between employer and employee is a complex one.  While many companies offer “wellness programs,” often the motivation is not to improve health or lower costs, but instead to recruit and retain employees.

 

Eventually Kathleen was able to get us to talk bit about health IT. Interoperability remains an issue, but appears to be moving in the right direction, driven by customer demand and governmental pressure. Equally promising, some of the less desirable “side effects” of EHR adoption are being addressed. One of the most frustrating for patients and doctors alike has been the impact of the computer on the interpersonal interaction. Every moment spent typing is less time spent talking, so a lot of effort has been put into streamlining that process. Use of in-room scribes (somewhat intrusive) and trials of Google glasses (eerie) have evolved to incorporate offsite, medically knowledgeable assistants to improve the quality and relevance of data recorded. Also, on the horizon: “conversational” EHRs.

 

As we took questions from the audience, a woman named Pat came to the microphone and introduced herself as both a patient advocate and a patient herself. Trying to manage a complex disease across multiple providers and facilities, she could discern little if any coordination or communication among them. Her case highlighted the challenge so many face. Aside from those treated within fully integrated health systems, most of the responsibility for ensuring that care is coordinated (and not counter-productive) falls on patients and their families. Our current systems are focused on documenting individual encounters, not monitoring workflow across multiple sites. In fact, in the current fee-for-service world, there is a disincentive to share information or cooperate. Hopefully, with incentives aligned in VBC, we will see a new breed of systems that can support the quality, safety, and service that people like Pat so desperately need.

 

harry.greenspun@kornferry.com

@harrygreenspun
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