At the Midwest Healthcare Innovation Summit, a Meeting of (Provider and Health Plan) Minds
Today, at our Midwest Healthcare Innovation Summit, it was terrific to sit down with three healthcare leaders who represent the integrated health system, provider-sponsored health plan, and not-for-profit independent health plan segments of the industry, discussing the landscape around payer-provider collaboration in the emerging value-based healthcare world.
Following the opening keynote presentation by Shahid Alam, chief analytics & information officer at the Egan-based Blue Cross and Blue Shield of Minnesota, entitled “Health Care Reinvention Hinges on the Integration of Payer/Provider Data and Technology,” Alam sat down with Stacy Mays, senior vice president and COO at the Minneapolis-based PreferredOne plan, Salim Saiyed, M.D., system vice president and CMIO at the Pittsburgh-based UPMC Pinnacle health system, and myself, to discuss “How Health Plans and Providers Are Working Together to Keep Patients Healthy.”
All three executives are helping to lead major work around payer-provider collaboration, population health management, and clinical performance improvement, and all three of them are in organizations that are actively leveraging data and analytics to help move their organizations forward. All agreed not only that the challenges remain many, but also that the opportunities the lie ahead are exciting and compelling.
Among the issues that remain urgent are data availability, data integrity, data usability, and data timeliness; and the perpetual challenges around marrying clinical and claims data remain just that—perpetual.
That said, one of the most important elements in all this, as we all agreed, is that there clearly now is a burning platform for change, and it emerges out of the fact that our healthcare delivery system’s costs are sending our country collectively over a cost cliff. As I noted, the Medicare actuaries continue to prophesy impending fiscal doom: their latest estimates speak of our system’s going from a current $3.3-ish trillion a year in overall U.S. healthcare system spending, to around $6 trillion in the next six to seven years. That is a cost cliff that could be crippling for our economy and our society, as our population ages, and as the percentage of Americans of all ages with chronic illnesses explodes.
What’s clear is that, while we collectively face massive challenges, we also are beginning to see real, genuine progress, in terms of improving outcomes and lowering costs, through a combination of population health risk stratification, targeted and individualized care management, and continuous clinical performance improvement. And none of this can really be optimized without payer-provider collaboration. Indeed, some of the most advanced forms of collaboration are taking place between health plans and multispecialty physician groups—which is only natural, given that physicians and nurses in clinic-based outpatient care are inevitably the closest to patients. Hospitals can play a major role in all this, too, at least in the context of accountable care and value-based care delivery and payment, as the corporate centers of integrated healthcare delivery systems.
But physician practice really is the ground zero of reengineering the healthcare delivery system to make it more clinically effective towards improved patient outcomes, more cost-effective, and more efficient overall. What’s more, organizations like Preferred One, Blue Cross and Blue Shield of Minnesota, and UPMC Pinnacle, are among the many that are figuring out how to innovate, and are sharing their experiences with others through published case studies and through participation in conference like ours. What’s more, hospital-based health systems have the capital, the human resources, and the IT expertise that few physician practices have, to purchase, implement, and optimize the clinical, operational, and data analytics systems to facilitate the shift into value. Hospitals can help physicians do what few physicians can do on their own—advance the digital revolution that can help fuel the profound change that physician practice needs to succeed in the emerging new healthcare world.
It’s wonderful to be able to sit together with colleagues from both the health plan and provider worlds at our summits, and to share ideas and perspectives, at this very fecund time in U.S. healthcare. Transformational change is truly upon us. And, after so many years of prediction, authentic payer-provider collaboration really is happening now—and that’s something for everyone to rejoice in, even as broader and deeper collaboration is right on the horizon.
