many specialists out, we have a perfect
time to be able to continue to look at
utilization and trim it back because
demand is beginning to outstrip some
of the people we have to be able to do
that work. It could not have happened
when there were such excesses. Our physicians have not previously been given
the data to let them know that they are
a higher cost than one of their peers.
That causes physicians to talk to other
physicians about how they practice.
SIMPSON: Another issue we’re going
to have to solve is consent and security.
As you’re formulating a clinically integrated network, who sees what? What is
the patient granted access to? What are
they not? The rules change from place
to place. As an industry we’re going to
have to grapple with that and finally
get to the bottom of it. It’s sad that Visa
knows more about you and what you
do than any doctor does in the continuum of care simply because this doctor
doesn’t have a trust relationship to see
that data. With the number of break-ins that providers are facing right now,
chief security officers are trying to go
back to not sharing data. Because when
they send their data out to the payer or
to somebody to do advanced analytics
on it, it’s out of their control.
NEORR: There’s already much more
aggregation with clinical and claims,
and you’re seeing some employers
struggle with how much they get to
see. You have to navigate that carefully
even with your own data. Just with Cone
Health employees and dependents, we
have a lot of the clinical information. We
have all the blood pressure information.
Assuming they’ve been to a doctor and
the labs, we have that. But there’s a lot of
concerns about what we can have access
to. Once you start opening the door to
having access to clinical information
especially when you get to behavioral
health, people are very sensitive.
BROWNSWORTH: Georgia has a law
that says we can’t share mental health
information. We can’t share drug and
alcohol abuse information. We can’t
share sexually transmitted disease
information. So we have to have scrubbers in our system that ensure we do
not have that information. So if you
can keep it where you are only dealing
with utilization and which drug they’re
using and it’s a cost discussion, that’s
one thing. But to the view that you’re
trying to associate it with the disease
management program around those
three categories, you’re in trouble. Physicians can know it as long as they are
treating the patient. But when you’re
dealing with it from analytic standpoint it can’t be used. As we start looking further into the future, we’re going
to have to understand how we can connect that clinical information. Today
we’re using the minimal use rule on
mainly claims information. But when
you start bringing in other information, we will have to give patients the
option of whether more of their health
data can be used at the physician level
to improve outcomes.
HEALTHLEADERS: Ultimately a lot of the
change that we’re talking about driving is
physician implemented. How do you get
physicians to lead the change?
BROWNSWORTH: I believe most physicians are starving for a significant focus
on improving the care around patients.
They’re so busy dealing with the day
to day, all they hear are the financial
46 HealthLeaders n March 2015 Sponsored Material n
aspects. When we get back to basic
principles that drove most of them into
medicine, suddenly they become energized. Our job is to find individuals
who are open to change, who are open
to challenging how we do things, and
who are respected by their peers, and
you help lead through that.
SIMPSON: When you talk about how
to influence a physician’s mind-set,
it’s actually the easiest group to convince—as long as you have the data. They
need data and they need respect. With
change management, it’s a slow process.
Trying to keep that physician engaged
while you are trying to get a new supply
chain working, or while you are trying
to change out the way they are doing
remuneration--that’s the hardest part.
NEORR: One thing that helps when
you are starting this process is to have
expertise on how an ambulatory practice works. You really have to understand what they are currently facing
and what you are asking them to do
and be realistic about that. For Cone
Health, we not only give them respect
but we give them opportunities to lead.
DINGER: First, we just ask them to work
with us, not to do anything differently,
so take our call when we call. If we ask
you to do something, really think about
doing it. And there may be good reason
not to, but we really want you to think
about it. In an ideal world, that first
year they get a shared savings check
for hitting their quality metrics. Their
response is, “This happened from just
working with you?” Second, you celebrate the folks who are hitting it out of
the park in terms of quality and value.
And then when a practice is big enough
we put resources in the practice. Last is
communicate. We ran a report to determine the single biggest factor explaining
improvements in quality scores among
physicians. The biggest factor was how
often they logged in to look at their
data. It was amazing how much of an
explainable event that was.
ROUNDTABLE: BRIDGING THE CHASM