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"The Dish on Health IT"
Engaging discussion around Health IT with perspectives from across the healthcare landscape. This informative and entertaining rotating panel of senior health IT consultants and their guests will keep you in the know about the latest innovations, policies and industry shifts impacting healthcare and point out the opportunities that lie within.
Episode 12: Innovation in Healthcare with Aneesh Chopra
This episode features guest Aneesh Chopra, the first Chief Technology Officer of the United States and more currently, the co-founder and president of CareJourney. Hosts Gary Austin and Ken Kleinberg sit down with Aneesh to discuss smarter choices the industry can make to move more quickly towards value based care, specifically direct contracting and third party apps.
Aneesh first gives some background on his company CareJourney. He explains that CareJourney is, in many ways, the private sector implementation of his passion of serving in government around open data, open APIs and payment reform. His primary mission is to make sure we use all these open resources to help patients, through the organizations they trust, make smarter decisions throughout the healthcare delivery system.
Gary asks Aneesh to overview direct contracting as well as what’s to win here for providers. Aneesh says direct contracting is ripping the band-aid off the move to value-based care. Direct contracting is Medicare Advantage-like, but without the insurance company and without the consumer changing their actual insurance benefits. They retain all their Medicare benefits, but they have their capitated dollar. They can bring their resources to a primary care group and integrated delivery network to help them better manage their care without taking away any of their rights to see any doctor they wish. This model is a leapfrog from training wheels to full downside capitated risk.
Aneesh explains that remote patient monitoring could be a category. CMS explicitly invites applicants who have proposals who can reduce the cost burden and improve quality for high needs patients, especially those who have historically fragmented care. The model allows for these entrants to drive the process and bring along a physician network that may help administer some of the services. Aneesh thinks it is traditional doctors and networks applying from Medicare Shared Savings to direct contracting.
Gary asks Ken how interoperability plays into these arrangements. Ken says risk is about what you know and what you can control. The more you know, the better you can control that risk. Interoperability can bring in all kinds of data about that patient, traditional clinical data, social determinants of health and claims data. We can pull information from many different sources and understand our population in ways we’ve never been able to before. That gives you the power to control risk and do a better job.
Gary asks Aneesh what he thinks of the “patient gets everything from everyone, on demand, delivered anywhere model.” Is it good for the marketplace? Aneesh says it’s great for the marketplace. It builds the healthcare data sharing infrastructure on a foundation of “must share.” One of the challenges we’ve had for the last 20 years is that we’ve built all these data sharing networks and policies that try to square a complicated circle. We are saying we want all of the information flowing where it’s needed, but we have to honor the HIPPA minimum data necessary provisions. So, the broader the network, the broader the use cases, the weaker the signal because by definition, someone is on the network to do something that is only entitled to a minimum amount of data. If I have to join a network where I’ve got to meet the lowest common denominator, I’m not going to get the information I need nor am I going to help make better decisions for people because limited information, limited affect. What we need is a mechanism to right size the information sharing to the legal frameworks under which those information sharing provisions exist. The consumer’s right to access health information by being bedrock as a foundational right in HIPPA. Now technically materializing through these two rules is a smarter method of sharing data because no matter what I am entitled to my full medical record and if I choose to share it with my primary care doctor, that’s my choice and that’s my right.
Gary asks Aneesh how to get payers moving along. Aneesh suggests that instead of just working to meet the letter of the rule, payers should ask themselves what they are doing to meet the spirit of the rule and how that benefits the strategic plans of their organizations. His overarching message is shift from defense to offense. How can the investments you’re making advance the goals you have? What apps are you putting in the hands of your consumers? Are you working to get those apps connected to every single EHR in your network?
Ken agrees with Aneesh on the compliance. He says these organizations often ask themselves what is their bigger fear? Is it financial penalty? Losing some business? Will we do the best by just giving the minimum possible? In the end, what you’re really trying to do is meet the business objectives, which is increase your brand and gain loyalty. You do that by providing information in a format that’s more usable. That’s where a lot of these technologies can play a role. That’s where we get into these apps. You have the potential to give people information in a format that’s usable to them.
Gary moves the conversation to third-party health apps. Aneesh views CommonHealth and Apple Health as infrastructure. He notes there is a hypothetical fear that Google, Amazon, or Apple are going to swoop in and take over healthcare, but he does not believe that is the case. Aneesh says if anything, Google, Microsoft, and Amazon are going to be infrastructure partners to existing players in healthcare or these new direct contracting entities who are managing risk, building clinically integrated networks and engaging patients.
Gary asks Ken what he thinks of third-party apps. Ken agrees with Aneesh in that trust starts with primary care physicians. Primary care physicians are likely going to go with apps that work with the EHRs and the portals that they are already familiar with. With regulations coming up, some consumer-type apps may surface that tend to do a better job than what might have been offered to the physician and their EHR vendor. As community pressure builds, the physician may go back to their EHR vendor and ask why they can’t support this. That can drive some advance here.
Gary asks Aneesh if this is an opportunity for payers to engage their members more deeply. Aneesh explains that high need patients suffer from terrible care fragmentation. It’s so obvious that the plan can do a better job here. The decision support to go from fragmentation to coordination is best done by an entity that is trusted by the consumer to do that coordination. You want to trust an app that can be connected to a portal, get the updated feeds and have other context about my healthcare needs.
Gary asks Ken for his closing remarks. Ken says this really has been a long journey, measured in decades. He is optimistic that things are getting better. Interoperability in the past decade or two has been like the wild west. Now, he thinks we are aiming with FHIR, projects like Da Vinci and USCDI to be much more practical. That’s going to benefit everyone.
Aneesh shares in Ken’s optimism. We don’t have the luxury of waiting decades for this chapter to have success. So, while it does take decades, we must move faster and make smarter decisions to comply with the rules, embrace value-based care and better engage consumers. These things will help accelerate that timeline. Let’s do it smarter, together.