Interoperability and Population Health: Key Excerpts

The event brought together population health experts from across the industry to discuss the impact of interoperability on the future of population health in a post-pandemic world. The discussion included the following panelists:

• Steven R. Peskin, MD, MBA, MACP, executive medical director of population health, Horizon BCBSNJ
• Jeffery Wajda, DO, MS, FACEP, CMIO, UC Davis Health
• Chirag Patel, MD, AVP, medical director of population health, Clinical Integration, Wellstar Health System

This blog will highlight some of the key excerpts.

Interoperability is key to successful population health (and other thoughts on the 21^st Century Cures Act):

Dr. Wajda: First of all, the 21^st Century Cures Act, it sort of alarms me that it was signed into law in 2016. It’s been around for a while, and it really has a lot of teeth because it’s tied into conditions of Medicare participation for hospitals so we, for the first time, have even more incentives than we have had in the past. As often is the case, the regulatory environment sort of forces our hand, but all of us want value-based care to play a larger role.

Dr.  Patel: If you look at CMS’s reporting requirements for 2022’s ACO, it will require significant interoperability infrastructure to be added for most ACOs going forward. It is a complex ask by CMS, and I think there are different regulatory environments coming from different angles to get organizations, payers, and FQHCs to pivot to a place of increased interoperability. That’s the first piece. And then, the second piece, organizations probably should start to talk about data transparency, data governance, and guiding principles within the four walls of their business model to really be successful in an environment that’s externally changing at a very rapid rate.

The biggest challenges in realizing interoperability:

CP: I think it really is about horizontal and vertical integration. There are so many other industries that have been great at this, and I think the healthcare industry has been slower to adopt some of these basic business fundamentals. Adopting some of those is critical, and then having the right incentive alignment is also critical. There’s nothing like an incentive to move somebody.

How our panelists believe the pandemic has moved us forward in the value-based care journey:

JW: It has definitely moved us forward.  There’s the quote that goes something to the idea that you shouldn’t waste a good crisis. We realize that we went from nothing to thousands of virtual visits a day in an academic medical center and a very, very large community practice with a large primary care network.  And it’s like, OK, we have everybody’s attention, and the providers are telling us they like this.

Dr. Peskin:  Virtual care without question is going to continue to be with us. It will be integrated and coordinated with in-person care, which I still believe is very important in a lot of circumstances to accelerating payment innovation. The huge cash flow issues maybe didn’t affect [large institutions] as much, but independent practices were teetering. It has accelerated the move toward value-based type reimbursement arrangements from volume-based reimbursement arrangements.

CP: While the pandemic has accelerated healthcare innovation, we’re learning consumer preferences between more tech-savvy patient populations and less tech-savvy. We now know that there are significant broadband deserts in the United States all over the place. I think the angle that we’ve put a tremendous amount of effort into is provider burnout and resiliency. As we ask physicians and clinicians to do more, we have to also take awayso they can be more efficient and more specific in their clinical duties, and I do think that is an overlay of interoperability.

As we transition out of the pandemic, our panelists believe this is how we will continue the journey towards interoperability and population health:

CP: Overall, there are social determinants of health applications within our EHRs now.  We just haven’t historically used them to their fullest capacity, but I do think it’s time to start employing those as best as possible.

SP: Social drivers are, as everyone has come to appreciate, vitally important. And how that gets interwoven so that we have the ability, at the moment of truth, at the point of care, to be able to say that we know what we need for this person, but I don’t have time to make fifteen phone calls and drop everything I’m doing, and I don’t have a social worker sitting next to me. I’d love it if I did. So one thing we’re doing is enveloping this part of care management and care enhancement into the interoperable architecture.

JW: I think anybody that looks at their data from the implementation of their virtual visits over the last year is going to learn a lot about their patients and the demographics of their patients that they didn’t realize.

The future of population health

Our panelists believe that we need the right incentives in place to further drive interoperability and population health:

SP: We’re working with a couple of health systems now in that construct with Medicare Advantage and a joint venture—I think it’s called ‘Payvider’ —this move from volume to more of a prepayment. I know capitation sometimes is a dirty word to some people, so I see that re-emerging and clinical organizations taking on the appropriate level of risk with backstops and re-insurance and things like that.

How our panelists believe non-traditional entrants like Amazon are going to shape the future of population health:

SP: Clearly, Amazon’s most recent announcement has caused some quaking within the healthcare arena.  And that’s probably a good thing.  We need to be uncomfortable sometimes, and we sometimes need to be pushed out of our complacency.

CP: I think what Amazon brings to the table is…horizontal and vertical integration, which we have historically not had in healthcare at that scale…What they’re introducing now to the market, I think, could be very much a game-changer and accelerate all of us to do better.

JW: We speak of the engineering firms with healthcare verticals as being competition.  It’s been years since we’ve talked about the other health systems, you know, that we can see from our office windows as competition.  We think they are on an even level with us as another provider.  Some of these other organizations, including one Steven referred to [Amazon], are ahead of us in the way that they’re envisioning how delivery can look.

The type of leadership needed to take us into the future:

JW: I think we need leaders who work across competencies, maybe a different type of leadership, maybe a more vulnerable leader who is willing to listen, somebody who is comfortable not only with patients, but equally comfortable with technology, payers, and culture.