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Closing the Gap Between Providers and Payers to Create Patient-Centric Healthcare
Episode 17 β€’ 7th April 2022 β€’ This Week Health: Community β€’ This Week Health
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April 7: Today on TownHall, Brett Oliver, Family Physician and Chief Medical Information Officer at Baptist Health interviews Michael Adcock, VP Population Health at Magnolia Health about remote patient monitoring, the payer perspective on HIT and payer and provider relationships. Where is RPM headed? Can we make it more than just monitoring? There’s a bunch of new big tech players out there. Is there a disconnect between the digital opportunities out there and where the investment dollars are going? How does this relate to bringing EHRs, the Cures Act and interoperability together? And can payers and providers lessen the chasm in healthcare?


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Today on This Week Health.

One of the things that I see as a failure in RPM is people are just measuring or monitoring, which is great. There's nothing wrong with that, but if you're not educating the patients so that they can not continue to have the same issues over and over, You're really not maximizing what you can do with RPM.

Welcome to This Week Health Community. This is TownHall a show hosted by leaders on the front lines with πŸ“ interviews of people making things happen in healthcare with technology. My name is Bill Russell, the creator of This Week Health, a set of channels designed to amplify great thinking to propel healthcare forward. We want to thank our show sponsors Olive, Rubrik, Trellix, Hillrom, Medigate and F5 in partnership with Sirius Healthcare for investing in our mission to develop the next generation of health leaders. Now onto our πŸ“ show.

All right. Welcome. As again, I'm Brett Oliver, CMIO for Baptist Health, and I'm tickled to death to have Michael Adcock with me today. Good friend of mine and the Vice President for Population Health Management and Clinical Operations for Magnolia Health. Michael. Welcome.

Good afternoon Brett.

Yeah. And you as well. Before we get started, I wanted to, you do tell the listeners a little bit about your digital health background. Population health from a payer's perspective is one thing, but that's not really where a lot of your background comes from and where I first met you from. So could you just give the folks a brief background check on where you come from from a digital health perspective?

Sure. I'll be happy to, so I'll start, I'll start early on and go through my career very, very briefly, but I am a nurse by training. Hospital administrator, former hospital administrator. And then about seven or eight years ago, I got into digital health at the university of Mississippi medical center. Center for telehealth as executive director.

have been with Magnolia since:

Fantastic. And that's kinda that's where we met. We met at the federal hot tech and just in terms of exchanging ideas on digital. I'd love to hear your thoughts on remote patient monitoring to start there. Where we're headed both in general and perhaps from a payer's perspective as you have that perspective now.

Sure. RPM as we call it as one of my. One of my passions. And one of the things that I really enjoyed as a part of the center for telehealth and people have different definitions of remote patient monitoring, and some of them are truly just monitoring and some of them are more chronic disease management in the patient's homes.

I'll tell you that our program, when I was at the university of Mississippi medical center was much more focused on not just monitoring, but actually providing. Real-time interventions and education and engaging with the patients to try to teach them about their disease, but also on the other end, providing actionable information back to the providers.

One of the things I see as a, a failure especially when people say RPM really fast. One of the things that I see as a failure in RPM is people are just measuring or monitoring, which is great. There's nothing wrong with that, but if you're not doing something about it, or if you're not educating the patients so that they can not continue to have the same issues over and over You're really not maximizing what you can do with RPM.

What I'm enjoying, I've seen lots of things during the pandemic where people have deployed RPM tools into people's homes to measure temperatures, to measure all these different metrics, which is great. And it certainly helped me. To connect with folks where they are. But I'm starting to see now more and more people really focus on chronic disease and getting into patient's homes and trying to engage with people to change behavior because that's the beauty of RPM is if you have real time data and you have education and you're able to engage with patients where they are, you can actually change behavior, which should be the point of all of what we're doing is to actually engage with these people and teach them about their disease, teach them how to address what happens when they eat the piece of apple pie and their blood sugar does really, really high what to do about that, how to address that and not end up in the ER, not end up in the ICU but how to really engage and educate and empower them to take care of themselves. So I'm seeing more and more of the platforms really start to focus more on the clinical programs instead of the technology, which is one of the things I've I've preached ever since the beginning of my digital days was the technology is out there. It's not about the technology on the technology, certainly got better and faster and smaller and cheaper and all those things are great.

But it's about building clinical programs into that and extending the care that you would receive in a clinic or in a hospital or in the ICU. In the patient's home and reaching in them where they are.

Yeah, it's really exciting to see operational partners mentioned that before you do from a technology perspective and I a hundred percent agree with you. I think one of the true advantages to RPM in terms of it being in a program are those additional touch points outside of the office. If I see you for your blood pressure twice a year, which would be fantastic that's standard of care type of thing. How much more effective could I be, if I'm looking at your blood pressure monitoring, perhaps making adjustments presenting me with actionable data multiple times in a six month period to really get that blood pressure under control. Yeah, I agree. It's really exciting.

Using that technology as an extension of the care team, actually getting into people's homes and being able to get that data to the data, but more importantly, the actionable information to you as the physician and to a pharmacist to help manage the medication and to the nurse, to be able to engage with those people, with the patients directly and to health coaches, to be able to help change that behavior. So I really do see it as an extension of the care that's being provided.

It really does allow for that care team to expand without a lot of effort being able to route the same messages to multiple care team members. Yeah. I, I agree with you. Well, so you made this switch a couple of years ago to the payer side and I know we've talked offline before, about how much you've learned from that perspective or that it was very unique and different. So I'm just curious, what have you learned maybe specifically to health it from the payers perspective, that would be helpful.

Sure I get, I still get lots of comments. When I moved from nursing to hospital administration, I went to the dark side and now I've gone to the insurer side. So I'm definitely I guess I'm double, dark side. I don't know, but it's been fascinating to me to see how much data is available on the payer side. So I mean the availability of data and information, and the ability to go in and analyze that data and look for trends, especially in my role as VP of pop health, to be able to go in and look at populations and see where those different trends are, where those things are that we can actually impact.

And how maximize our effect and impact on those patients' lives and on the provider side, being able to dig in with our, our provider groups that we contract with to be able to go in and say, Hey, here's a population that, that is, is yours. And we want to do what we can to help you impact that population or make changes or improve their health, or hit your heat of scores or whatever that might be.

But the overwhelming amount of data that's available on the, on the payer side. Has been huge for us, but also one of the things that's been, I guess, refreshing is when I started my digital career. It was always from the center for telehealth, we were already moving towards the value based care and moving towards value based contracts and trying to really improve preventive care and wellness care and education.

And now from the payer side, going in and contracting with big provider groups or small provider groups or hospitals or health. And really pushing that value based care to where our incentives are aligned. That's been the biggest piece from back in my days as an actual clinical practicing nurse is the payment methodologies were not remotely aligned.

What was going on, what the payers wanted, what the providers wanted, even what the hospitals. May not align at all, but being able to go in and work with people to say, okay, if we improve these quality metrics and actually improve the health care of this population, we can all we can all do what we need to do.

And I think that's been wonderful and something that we push really hard as trying to align the value based care. And the piece that we can bring to it is here's this wealth of data and here's these resources from a care management standpoint. And here's what we can do to help you. Meet the needs of the population that you're entrusted to care for.

Well, that's a great one online to then set or align incentives. Regarding that data, did you find, do you just feel like the data trove that the payers have, or at least your experience is just because they've been doing it longer? It's just been a focus why haven't we seen the same data on a healthcare organization side, or at least to the same extent.

Yeah, I think some of it is, is healthcare. Unfortunately, it's still very fragmented. And I think that if if a patient comes to Baptist health and then goes to UK and then go somewhere else, if there's not some way to exchange that data it's going to remain fragmented, unfortunately. And I think being on the payer side, I'm responsible for and the biggest challenge for me has been changing from the terminology patient to member, which I still don't say because it can't, I don't, I don't necessarily like the terminology, but. Going from a payer to a member. So I am responsible for this individual person and all the healthcare that they receive regardless of where they go.

So that data from wherever they end up, comes back to our system because we have to pay for the, we have to pay for the experience. So when it's claims data, I'm able to get all that information back in order for me to pay the claim. I need the clinical data. I need all these pieces.

So wherever Brett Oliver goes, in the country to receive care, I'm going to get that information back, whereas that might not happen if they come to Baptist and then go to a different facility, especially Mississippi, where there are a couple of health information exchanges we don't get, we don't have the flow across the, the systems that we need to be able to get that data back.

But as the payer, I always get it back. And where I think that we need to go as an industry and as a healthcare team, because the way I see our payer relationship is we're part of the healthcare team. We're the ones that pay for. it But we're part of that team. And if I have all this information and this information can help you provide better care for a patient, why wouldn't we share, why wouldn't we work together to try to make sure that you have what you need outside of some formal health information exchange relationship, how do we work together to make sure you have what you need so that that patient gets what they need.

Does it concern you? It concerns me. I'm just curious with these digital startups we just spent all this effort to get EHRS and then cures act and bring interoperability together. And now we've got all this venture capital going into these siloed startups that are handling really well, but isolated issues, but they have no motivation to get that information to us unless I'm paying for it. Do you, I guess, as long as you're paying for it, you guys are going to get the information. But if not I'm just curious if that's come up in conversations from a payer's perspective.

It certainly has from our perspective, and I guess we're in a little bit different situation in the fact that we are paying for it. So we will get the information back in most situations. And I think that's how we approach everything is we have to be responsible for. That person's care and the data that goes along with it. So we expect to have a, a solid medical record or a solid record of where that, where that patient has been, what they've received what's happened, why it's happened.

Any prior authorizations that had to happen to make that care happen. We want to keep all of that data so that we can justify the care that we've received, whether it be to regulatory bodies, whether it be to accrediting bodies. Whether it be back to the providers, we want to make sure that we have that information, but yes, it is frightening.

And it certainly was to me when I was on the provider side was yeah. These, these new startups are great and they're really accelerating things and they're disrupting the healthcare system, which is great unless it creates just another fragmentation of care. They're providing great services, but if you, as the physician of record, doesn't know about those services. It creates potential for harm. I mean, so it's, it's something that's very, very concerning to me.

So we're talking to payers and providers and just from a digital health perspective there still seems to be a chasm and I'll use the example of that. We've had conversations with payers or parents will come to us and say, Hey, we've developed this great tool to help you, Dr. Oliver it will help you at the point of care, et cetera, et cetera. Yet we have tools like that already built into our EHR and and then we, if we were to implement these payer tools, we could potentially have 5, 6, 7 of them with differing recommendations based on what guidelines they're following, et cetera.

Just as a specific example, how can we get closer together? How can we bring this chasm together? And instead of independently developing a tool, come and say, here's, here are our goals as a payer. What tools do you have? How can we get this particular quality metric or these metrics improved? I think you spoke first about aligning incentives and I think that's, that's key, how we're being paid is, is probably the most important thing, but are there other things that we can do either from a healthcare system perspective to bring that chasm closer.

I think one of the things that I've noticed, and I still sit in on, I'm still a part of the Mississippi hospital association and still sit on lots of meetings through the tele-health association where this, because we're not the same entity, we can't have a conversation standpoint. I think that a lot of where we're successful is going in and building relationships with provider groups and working together and having those conversations. In the beginning before we start developing the payment methodologies, or before we start developing our own new tools, but sitting down with Michael Edcock and Baptist health, to be able to say, okay, this is what we can bring to the table.

This is what you already have. Here's the gap. How do we close it together? Is that something that you can do with a tool that you have, or is that something that we need to invest in as the payer to bring to the market? Because it just doesn't exist or if it does exist, who hasn't, how do we bring it to bear?

How do we maximize that? But I think it it's just like everything else, even though we're talking about health, IT It's all about relationships and having conversations and communications with each other. I think that's part of the reasons that we've built friendships through high tech and different groups is being able to have conversations, regardless of which part you play in someone's health care, that part is important. Somebody's got to pay for this. Someone has got to actually deliver the care. Someone has to make sure that that information is available. Someone has to start that of idea it's. no different to me as, as we have used to do rounding in the hospitals you wanted as many different members of the team as possible there at that discussion.

I think the same thing could be said for payers and provider groups. How do we come together and have those discussions? And I think there are some groups that just don't want to have that discussion at all. And I think that's a shame. I know that where we are, we certainly believe in sitting down and having those discussions and seeing what we can do to help you improve the lives of those that you're empowered to care for.

I wonder if it's, if it's a lack of understanding that we would, we would welcome those conversations. If they think that we wouldn't want to have those conversations.

Yeah. And I think some of it's the fact that we have to get together and negotiate at some point. And negotiate rates and negotiate how someone gets paid for whatever it creates this.

Okay. Well that's the relationship? Well, no, that's a piece of the relationship. And at some point we've got to get past that and talk about how we're going to work together to care for this person. I think if we could all focus on the fact that what's at the center of all this is someone's life and someone's care.

And if we focus our conversations around that, I think we can actually get to where we need to be. I think it's when we try to. The payer at the center of the relationship or the healthcare system at the center of the relationship or the provider at the center, the relationship or the technology at the center of the relationship.

It doesn't work. It's got to be the patient, the member, whatever you want to call them. The person has got to be person centered. If we keep that in mind, it's not hard to come together and really rally around. What's best for those people. As a payer, I can tell you that I don't always know or representing a payer. I don't always know what's best for a member as the provider, there are pieces, there are things that you need from other people on the team to know what's best for that patient. I can tell you as a patient. I always want input and what's best for me I know what I'm going to be able to do, and I know what I'm not going to be.

If you ask me to stop eating things that I really like to eat, that's not likely to happen. Let's come up with another solution. How do I exercise that extra, those extra calories or layer? How do I take a, take a pill to get rid of that cholesterol. Let's talk about often that solutions, because what may be best may not be best for me.

You bring up a I mean, humerously, but it bring up a great point that if the patient is excluded from that, you can provide the best care, the standard of care and yet get nowhere with it. So I think that's just a perfect little sample of how or why everyone needs to be engaged. The whole team needs to be engaged from payer to provider, to patient to make sure that the best outcomes are in place.

I think if you look at, I think people trust different parts of their healthcare teams to do different things. But if you look at the initial, even the immunization or the vaccination standpoint, when we were all going, getting vaccinated, either at our health care provider, because I mean at our hospital system, because they were immunizing their employees or the rest of us had to go to a tent out in the middle of a parking lot with people with guns getting our vaccine, which I was happy to get first, I'm gonna drop my truck out there. I don't mind. Who's got the big suit on, it looks like a something from a scary movie. But once we started allowing providers and the people that, that the patients actually trusted to give these immunizations, give these vaccines.

Our rates anyway, started going up. It's it's making sure that we're, we understand where people are in that healthcare in the healthcare continuum.

Well, final question for you. little bit shifted gears. We'll get away from the specific payer questions, but I'm wondering as you look at digital health and the billions 30 plus billion being invested just last year, in other words, I see a little disconnect between the problems at least that I deal with as a healthcare provider and where this money is being invested.

There's a lot of neat ideas, but I'm just wondering if they're missing the fact that sometimes in healthcare, we haven't done the blocking and tackling maybe as good as we could do for patient experience or whatever. I'm just wondering, do you see that that disconnect or is this maybe just something I'm seeing from a provider's perception?

Oh, no, that's absolutely not something that just you're seeing. It's something that has been going on ever since people started investing money into healthcare it or digital health, is that the things that seem to be. Getting the most attention to getting the most money are those things that are cool.

I'm the shiny new object, the technology. And I've said it a million times and I'll say it again. The technology is honestly the last thing that we should be thinking about when we're talking about how we're going to improve, somebody's self the, is there, I mean, we can improve it and we can make it better, but that's not where the money's going.

The money's not going to improving it, making it better. It's going to some cool new idea to come out with a new piece of technology. To have a new piece of technology where the focus needs to be is how is this going to improve health? How is this going to improve education? How is this going to improve engagement and then sitting down and having a discussion with somebody like you, or some nurses, groups, or different groups to say, okay, we've got this great idea. What do you think? Oh, well, that's not going to work at all because our men, our patients will never, ever do that.

Is that the disconnect where they're not having those conversations with frontline folks to say, is this a problem that you're addressing? Is this a top 10 problem for you? Because I bet you, if you showed me a bright and shiny and said, is this cool? I'd say, yeah, this is cool. And are they taking that and saying, oh wow, we've got some doctors that have said, this is cool and we need to run with it. Versus is this something that. Really really help you day to day.

I think that conversation is just not being had. And I can remember in some of my previous roles, having conversations with very, very large innovative it companies that are coming forth with products, and they'll say they would come and sit down and say, Hey, we've got this on our roadmap. I would look at it and go, well, that's great for the 10% of the population that's already healthy and is doing this, this and this, but the 90% that we really need to use it are never going to use that. And here are the reasons why, and here's how it can be improved, but it still comes to market the way it, it's not, again, it goes back to relationships and having conversations. I think that we need to sit down and really felt okay. Here are the top 10 problems that we have with our diabetic population.

How do we address these? Is this address best through technology? Probably that's the only way to really scale it. We don't have enough providers, enough, enough caregivers throughout the country to be able to deliver things, to really improve it. Or is this best done in person or is this best done through a drone flying into somebody?

I don't know, but let's sit down and have that discussion on how we best address the issues. I think we're getting the solutions ahead of the actual issues. Here's a solution. What's the problem. I don't know, but here's the solution. Well, that that's not the right way to look at it.

That's right. You heard in America, we're open for discussion.

We are open for discussion.

A hundred percent. Well, I appreciate it. It's awesome to catch up with you and I appreciate all your insights. My pleasure. Take care.

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