David Muntz Looks at Dallas, at Texas, and at Nationwide Healthcare Trends—in Context

David Muntz is a nationally known and respected healthcare IT leader best known for serving as Deputy National Coordinator for Health IT in the Office of the National Coordinator for Health IT, from January 2012 through October 2013.

But prior to that, Muntz had served as senior vice president and CIO at Baylor Health Care System in Dallas from October 2006-2012, and prior to that, had served as senior vice president and CIO at Texas Health Resources from May 1990 through October 2006. In other words, he spent decades as a leader in Texas healthcare before going to Washington.

Meanwhile, Muntz is now one of several nationally recognized healthcare leaders participating as the principals in the Starbridge Advisors consulting firm. Healthcare Informatics Editor-in-Chief Mark Hagland spoke recently with Muntz about the Dallas and Texas healthcare markets and what lies ahead in the evolution of healthcare operations and strategy in the Lone Star State. Below are excerpts from that interview.

When you look at the nationwide journey from fee-for-service healthcare delivery and payment to value-based delivery and payment models, where are Dallas and Texas? Of course, Texas itself is diverse. But what particular aspects of Dallas and Texas healthcare should people from around the country be aware of?

The thing is that all of the major players in the Dallas market are moving forward. We’ve seen a pretty early embrace of accountable care, and strong movements towards that, and all the things that that involves, particularly population health. And there are some pretty remarkable innovations going on, and some partnerships between competitors, and the natural consolidation and lengthening of the continuum, which is consistent with what’s been happening in the rest of the country. So I’ve been impressed by the evolution of this market.

Is it because Dallas has in common with some other healthcare markets a landscape involving a relatively small number of dominant payers?

Yes, and the discussions that those payers have been leading with providers have been quite impressive. At Baylor, we had quarterly meetings with all the payers, who were competitors in the marketplace, coming in for meetings with the c-suite team, to talk about what was best for the community, and to inform each other on what was going on. They all came together for lunch. We had quarterly lunches, where we discussed the state of the market, and its evolution. And each time, each of the payers gave updates, and our healthcare system did. And each of us had our own roles to talk about, and of course, IT was a strong component of that, and interoperability was and is important to that advancement. We had wonderfully candid discussions about where healthcare was going, during that 2006-2012 period. Even then, there was already a lot of movement taking place, which I thought was fabulous.

What adjectives might you use to distinguish the Dallas healthcare marketplace?

The one thing that I found fascinating was the civility with which the communications between competitors showed, in terms of focusing on the health of communities. I think the Dallas-Ft. Worth Hospital Council provided a significant forum where all the players could come together as well. And it was Dallas-Ft. Worth and surrounding counties. So, in a state where “maverick” is the term used to describe the people and the professionals, we did anything but act in a “maverick” fashion; there was in fact a stark contrast between the stereotype and the reality.

What would you say about the characteristics of the healthcare IT landscape in the context of the geography of your state? It’s huge, of course, to begin with.

Yes, that’s right; and in fact, distance is indeed the biggest challenge. So, for the state, the ability to use telehealth to reach out, has been and continues to be critically important. We’ve had it for a long time, but it’s a real necessity. And one of the biggest challenges for rural residents is access to the Internet. And one bill passed a long time ago, and referred to as “the House bill,” set the rates, around bandwidth, to make bandwidth affordable for healthcare and education. That was 15 years ago or more now. And bandwidth still is a barrier. And the fact is, one huge barrier is around forcing people to travel for healthcare. And that has an impact on the economy. If you force a farmer or rancher to have to travel a long distance for care delivery, that has a tremendous economic impact. So the farther away you are, the bigger the challenge. This was in the late 2000s—we had to put up a microwave carrier in, and tower, at Texas Health Resources, because we couldn’t get fiber to one of the communities we were serving. That’s no longer the case, but at the time, that was a huge challenge.

The heterogeneity of healthcare organizations in Texas is a challenge, too, correct?

Well, I think it’s actually a benefit; the ability of an organization to adapt to its community’s needs is important. So the diversity actually works for consumers. But you want to watch how services are delivered. You used to go to your physician for a flu shot, but now you go to your local pharmacy, or even grocery store, for it. I see the heterogeneity as a plus; where you want homogeneity, is in the consistency of care delivery; you need consistency in how it’s delivered.

It’s fascinating to consider the cross-hatch in this moment between geography as one element in the landscape, and the emerging new elements in the healthcare industry. I’m thinking of the disruptions that we can expect, with the CVS bid to acquire Aetna, and other, similar potential moves. What should these developments in the broader healthcare marketplace be saying to provider leaders and to healthcare IT leaders specifically?

What’s beginning to emerge now, challenges this notion that healthcare has to be centered around the acute-care setting. We’re headed from everything happening in a central location, to things happening in all sorts of places. And I think it’s great. It’s just a fascinating thing, and when you think about the information revolution, the availability of robots; I was just reading about the potential for the use of autonomous, closed-look insulin pumps. Everything is moving along at a pace that was once unimaginable. I’m thinking about all the possibilities in the next five years.

With regard to technology, as many have been predicting, it will be possible to outfit “smart homes” that will bring patients back to their own homes far more quickly than is possible even now; and that factor of course holds tremendous implications for hospital-based organizations.

Yes, consumers will have smart homes, smart cars, smart everything. Let me share an interesting example in that regard. When I was in the government, I had an employee who put motion sensors in his father’s home in Hawaii. He wanted to know when his father wasn’t moving. And of course, that’s the smart thing to do. And my dad was a physician. And I used to go on house calls with him; but ultimately, he had medical malpractice liability. And isn’t it interesting that now, the incentives are moving towards, moving back into the home.

What should CIOs, CMIOs, and other healthcare IT leaders be thinking right now, in the face of all of these emerging trends and possibilities?

It’s a wonderful opportunity to extend care. And the ability to touch patients without having to physically touch them, will be a great opportunity. On the other hand, the ability to secure that, and make it reliable, and make sure you’re reaching the right people in the right way, will be critical. So there are an awful lot of possibilities. But it’s key that you be able to provide care in ways that make sense and are reliable.

In that context, do you have any explicit advice for CIOs and CMIOs?

My recommendation is that you read everything, and that you try to stay abreast of all the trends as they’re happening. People used to avoid “the bleeding edge,” and they used that as a pejorative term. But I think you have to grab hold of the leading edge; innovation, and the desire to do things differently, will be important. It’s got to be a lot more than just the technology. We’re the technology enablement group—but move forward on a sustained focus on people, processes, and then technology.