On data-driven medicine
MH: Interoperability provides you with the ability to coordinate care, and coordinating care is all about the quality, safety and, ultimately, the financial performance of your organizations. Where are you on the journey to building the analytics and using data to support care coordination and deliver better care?
From a population health perspective, we’re on the first mile of our journey. I think everyone is, whether it’s in the technology underlying it or in understanding what we’re going to do analytically with that data to really change healthcare.
If you just extrapolate some of the best-practice care processes that happen in John’s organization, and the lives that are saved because of that, the problem is that the knowledge won’t transfer to Texas and Utah and other places. It’s pretty unique to what he can do in his organization. The ability to share that knowledge is going to save lots of lives.
Is that big data? It’s just kind of general analytics and understanding how what we do to a patient impacts that patient, and being able to share that knowledge. That’s what saves lives. Halamka:
I don’t know what big data is. I work on small data. It’s actually the new thing. (Laughter)
How have I used that in clinical practice? My wife was diagnosed with Stage IIIA breast cancer in December of 2011, Korean female, Stage IIIA with HER-2 negative, estrogen-positive progesterone markers. The question I asked is, of the 10,000 patients like her who have been seen in the past, how were they treated and what were their outcomes? We actually did that across 17 Harvard hospitals, about 5 million patients. We queried and found that Asian females are very sensitive to Taxol.
So we took the clinical trial data that said this dose of Taxol is good and divided it in half. She was treated, cured, and has no side effects or any residual issues. Why shouldn’t every patient in America in the future get this treatment? The technology is there today.
Chambers: What’s a viable financial model for these things to occur? We can lament the death of the state healthcare exchanges, but as soon as the federal funding went away, they went away. There was no commercial viability to those models.
The financially integrated healthcare provider is uniquely positioned to address a lot of these issues … if we have per-member premiums. The payer side of the equation is the only way to fix this. If you look at huge disruptors in every place in the economy, it is based on a per-month, per-member model. … That’s what healthcare needs. We need to be on PMPM so we can get that patient, make adjustments, interact with their behavior and have a financial model where we can actually reward them as well.
MH: What about managing populations within your health systems? Don’t you already have the data from across the care continuum to do that?
Halamka: I’m from New England, and I am from your future. Today, 70% of the income at all of our clinical sites are risk-based alternative payment contracts with no fee-for-service. What do we have to do? It’s a totally different IT. It’s not the transactional bill. It’s focused on quality and outcomes.
We centralize data into a single store across the community, and then a team of care managers enroll, by disease, individuals into a guideline or protocol. We then manage them as customers to determine gaps in care and to ensure compliance. We’ve gone beyond
If you look at huge disruptors in every place in the economy, it is based on a per-month, per-member model. … That’s what healthcare needs.
that in some disease states like congestive heart failure. We bought them all bathroom scales with Bluetooth low-energy interfaces and get daily weights. If your weight goes up 7 pounds in a weekend, we double your Lasix (a diuretic) and take away your Doritos.
If you’re risk-based, you must treat patients as a customer in their homes and in their communities. We are the No. 1 accountable care organization in the country and saved Medicare $50 million last year.
Probst: We have been using data to drive the decisions on how we should care for our populations for a long time. If you have enough data, you can understand the best practices to care for any given population. At Intermountain, we’re doing a really good job on chronic disease because we have a long history of data that we can use. We’ve organized ourselves around how to analyze that data, look at outcomes, and then improve that population.
We’re not as aggressive or understand yet how we can reach out to our population and take their Doritos away. But we’re on our way. We believe in analytics. Whether it’s big data, little data or whatever kind of data, we believe in having that data, being able to analyze it, and then showing proof of outcome. We’ve been able to change behavior of physicians and people.
MH: How are the Doritos police doing in Texas?
Chambers: I’m not from the future and if you lay your hand on another man’s Doritos in Texas, boy, I’m going to tell you what. There’s a lot of concealed handgun carriers in the state of Texas. In all seriousness, personal responsibility is the key. So you’re obviously not appealing to their brain. They know that they shouldn’t be doing it.
So you’re going to ding them in the wallet or ding them somewhere. Somebody in our system said recently, “We’re addicted to the crack of the fee-forservice model.” We know it’s going away. The question is when and how quickly? It’s faster in New England, apparently.
We believe in analytics. Whether it’s big data, little data or whatever kind of data, we believe in having that data, being able to analyze it, and then showing proof of outcome.