As more and more U.S. patient care organizations take on financial risk, whether in the context of participation in any of the federal Medicare-sponsored accountable care organization (ACO) programs, or any of a vast number of private health insurer ACO programs, or participate in any other kind of risk-based contracting, including bundled-payment contracts or other value-based contracts, the leaders of patient care organizations are finding that the analytics and other solutions available simple aren’t keeping up with their needs in optimizing their operations for risk-based involvement.
In that context, the editors of Healthcare Informatics named IT for risk-based contracting as one of their Top Ten Tech Trends in 2016. Among those interviewed for that article was Bill Russell, CIO at St. Joseph Health, an Orange, Calif.-based, 16-hospital health system. Russell’s organization is participating in a wide variety of commercial ACO contracts. Below are excerpts from the interview that HCI Editor-in-Chief Mark Hagland conducted with Russell this spring, in preparing the Top Ten Tech Trends feature for the March/April issue of HCI.
What are your top-of-mind issues around the shift into risk-based contracting, and your organization’s IT needs in that context?
We’re moving from fee-for-service payment to population health and consumer-driven healthcare. Population health is really about enabling the clinical integrated network. So we’re doing an awful lot of work around data sharing and exchange. Obviously, quality is a significant initiative, and we’re looking at enhancing our predictive models. And per consumer-driven healthcare, we’ve made some investments in developing companies. We’ve developed our own portals—in fact, they’re engagement platforms. We’ve got about 100 developers working on Android and iOS apps, to put power into the hands of the patients and consumers.
You’re involved in a range of commercial ACO contracts?
We have risk contracts with Blue Shield [of California], and others. At a CIO level, I’m dealing with essentially, how do we deal with the challenge of managing risk in the health system?
What are the IT challenges related to risk contracting, in your experience thus far?
As you take on risk, you’re typically delivering that across a network, and the network is not necessarily all internal to your system. So how do you manage quality across a network? How do you manage outcomes, access, across a network? So you have to start building out capabilities to look at the data outside of your silos. We’re leaving an EMR world to deliver on risk contracts across your network—and it’s like working with 100 EMRs.
Yu have to create a layer on top of your EMRs to build analytics capabilities and also engagement platforms to interact with people for the 300-some-odd days when they’re not in front of a doctor. So we have platforms, including video visits, online messaging between you and your doc, we have analytics platforms, to deliver analytics down to the level of providers regardless of their EMR, so they can make the most informed decisions.
What key thoughts do you have for your fellow CIOs, as their organizations move into risk contracting?
First of all, I would say, don’t go down an alley. There are so many alleys in healthcare where you end up boxed in. Other industries have given us the roadmap for this; and most CIOs don’t believe it’s possible—but it has to be, in healthcare—and that is, the ability to overlay your clinical data with systems that allow you to access that data programmatically, not just through an interface.
If the only way to access clinical data is through the EMR, your hands are going to be tied, with regard to doing population health management. So you have to think five or ten years out. And how did other industries do something like this? They didn’t try to standardize on one platform; there’s a data layer, a logic layer, and a presentation layer, and these things are separate. So there’s clinical data in here, there’s logic in here, and there’s presentation in here. And when you break it down that way, you say, we’ll present it one way for the clinicians and one way for the patients. This is not an exaggeration: there are several hundred EMRs in Orange County across our clinical network, and that’s a losing proposition. It’s unnecessary and it’s too expensive.
So everyone needs true interoperability to make risk contracting really work.
Yes. We ended up investing in a company called Hart, out of Newport Beach. And we sat down with them and said, look, we have all this healthcare data in silos and we need to bring it into a big data platform, but big data platforms are not very usable. So we need different layers—for big data and unstructured data, but also a layer for transactions. So we built a platform with multiple layers of different database technologies and technologies around big data, and essentially moved our clinical and some other data into that platform; and on top of that there’s a set of APIs, so we can programmatically get to that data. So we’re getting other partners to develop on top of this, first with anonymized data, give them access to the data structures and APIs, and then we’re starting to partner with college and universities, and say, we have this distinct problem, say, diabetes, and then let’s engage your smart programmers, to engage on these problems.
Would you agree that other CIOs will have to do what you’re doing, reaching outside their walls for partnerships, to be successful in this area?
Yes. You can’t out-innovate the market. I would also say that an awful lot of my peers are hopeful that the interoperability challenge will be addressed. And there are some promising things out there like FHIR [the Fast Healthcare Interoperability Resources standard] and CommonWell [the CommonWell Alliance]. And as a CIO, you can sit back and see how things play out; but the other option is to be proactive with your EMR provider and others, to really push them to make your data available for other applications and potential use cases as you move forward.
What will happen with vendor-vendor interoperability in the next couple of years? Will the federal government will have to point towards it?
I think you’re probably right, yes. A cynical person might say, you know what? EMR providers are businesses, and businesses have shareholders that require them to act in a certain way. And we want them to act in a very beneficent way… but do EMR vendors want to do that? I don’t think Cerner won that DoD contract because it was done altruistically; I think they won that contract because openness was needed and they had it. I think the government will step in, but there’s an awful lot to do here. Remember, we’re going to consumerism in healthcare. There’s going to be a push around convenience, transparency, and choice, that’s coming. You’re going to say, look, this is how I want to engage my doc, and before you do my referral, I want to know the three docs you’re going to refer me to, and I want to know their satisfaction ratings, etc., They’re going to want a “Yelp” of healthcare. And you can’t out-innovate the market. So there’s going to be groundswell from the consumer up. Consumers just don’t care about Epic, Cerner, Meditech, etc.; they just don’t care. And per the clinically integrated network, there are problems facing healthcare CIOs that they’re not going to be able to solve sitting across from their one EMR provider. But there are hundreds of EMR providers. So it could be the federal government, or it could be a collective group that gets together for financial reasons.
