In this episode, CHESS Vice President of Value-based Operations, Josh Vire, talks with Wilson Gabbard, Vice President of Quality and Condition Management at Advocate Health, about how to gather and present meaningful data to providers in an easy and accessible way which enhances their delivery of better patient care.

Well, Wilson Gabbard, thank you for joining us on the Move to Value podcast.

Thanks, Josh. Thanks for having me. It's good to be here.

Great. Wilson, I know you have a wealth of knowledge, both population health and value based care. Can you just start by giving our audits an overview, a little bit about you, your background, where you've been, what you've been, what you're up to today, and your responsibilities at Advocate Health?

Yeah, absolutely. Well, again, Josh, good to be here. You know, value our friends and colleagues at CHESS and have long followed all the great work that you all have done. And so, it's a privilege to be here. Again, you know, by way of background, I'm a former practice operator, used to lead clinic operations in Eastern North Carolina and had the privilege of kind of pivoting into a population health focused role back in 2013. So, over a decade ago now helping build out some of this work in a prior life. And you know, over the years it's been really interesting to see the evolution of value and how we've gone to taking on more risk and building out more sophisticated programs and blending together Medicare Advantage and MSSP or different value-based programs together to ultimately really just better serve the patients and clinicians that were really just privileged to be able to serve on a daily basis. So, you know, today what I'm up to is here at Advocate Health, I have the pleasure of leading quality and condition management efforts as part of our enterprise population health structure. You know, we think about value-based work and kind of the formulaic equation that is driven based on three main components, which are quality, utilization and premium and lives. And how we do that, how we operationalize that is really around the two functions that I again have the privilege of kind of serving in or related to the quality and condition management work and have the again opportunity to do that along a really amazing physician dyad, who I feel very privileged to work alongside as we implement some of these programs.

That's great, Wilson, thanks for that background and I'm glad to share that with the audience. You mentioned you've been you've been at this for a while, you're very well versed on what drives and improves contracts in value-based care. So really excited about again having you here and could you go a little bit layer deeper in what is condition management and documentation? What does that mean specifically at Advocate and a little bit about what your how your role plays in supporting value-based care efforts.

Yeah, great question. I think that our approach to value and again I think value-based care is you know the corollary or antithesis maybe is the wrong word, but to fee for service, right. As we move from fee for service to value, we think about the premium and lives component that I mentioned earlier about ensuring that we are receiving the appropriate reimbursement for the patients that we're caring for. And the way that CMS, our government programs have implemented that financial model and value is through a risk adjusted payment mechanism. But at the end of the day, the way that we think about risk adjustment here at Advocate is that risk adjustment really at its core is just a population health fundamental that ensures that it's really, it's all about ensuring that patients and their conditions are not lost to care. In value-based care, I love that the focus is not about on widget counting, but rather on caring for conditions, ensuring that those conditions have treatment plans in place for them. So really that's, that's what it means to us when we talk about condition management and documentation is really what are we doing to ensure that we have care plans for patients’ conditions that they are persistently engaged with their primary care clinicians. And we think that that also has a huge driver in the utilization component. If we manage conditions proactively versus reactively, we can help avoid bad outcomes for those patients and help them stay in their homes where they prefer to be with their families.

Yeah, that's great. Wilson, you, you said some things that I really enjoy hearing it, as we both know, and as I've learned and, uh, been working with you more, I, I'm learning about how Advocate and, and your team thinks about, uh, risk adjustment. And, and while we may or may not like, umm, how it's, it's set up, it is the mechanism which we, we can accurately identify the health of the, of the patient. And that is the, where the focus should be. And I've, I've seen that from your team that that's what you guys focus on is really about making sure that patient is getting the right level of care and that their conditions are accurately documented. And it's an important part of value-based care. And I know in support of that data is extremely important. I'm sure you will agree. Can you talk a little bit how, how important is data to what your team does and how do you work with providers to address these areas of opportunity?

Oh gosh, data is just so critically important and the implications of ensuring completeness and accuracy of your data is just so important. And, and it's, you know, both in kind of our condition management space, but also in our quality space. I think that the data is important to translate. You know, different audiences translate the way that they think about data differently, what resonates with them? And I ultimately think about storytelling. What's the story that we're trying to tell with the data that we have? The story that we might tell to a group of executives or an ACO board is probably different than the story we want to tell with the data to an individual clinician. And the reason I say that is again, if even in, you know, quality, if we're just talking about quality from the perspective of hitting a number or getting to a goal, that's one story. But if we talk about it in terms of the patients whose lives are impacted by ensuring highly reliable, high quality care, that's a very different story. And you know, the number of cases of colon cancer that are likely to be present in our population that we haven't screened. Again, I found personally that those stories, that data resonates differently with clinicians whenever you're able to tell it in that way. And so, I think that I, I hit on some of that is that I think that leads into why getting data right and ensuring that we've got, again, completeness and accuracy in that data is so key. Because if you put data in front of a clinician that you know is incomplete and there's always some level of incompleteness to a data set, but you know, we have to avoid causing ourselves credibility issues in terms of the data that we're presenting. And, you know, if you put a bunch of data in front of a clinician and they can poke tons of holes in it, you know, you're, you've lost your audience because then you're talking more about the data versus the operation that we're working to transform. And so I also feel passionately as a former practice operator that we don't want our clinicians or care teams and clinics to be abstractors of data, right? We want to clean that up on their behalf. We want to ensure that we're going to where, you know, the source of truth is and curating that data for them to make it easy for them to do the right thing for the right patient at the right time. And so we've invested a lot of time and energy in going about getting that data from, you know, different EMR vendors through our ECQM efforts or, and even through just different data exchange interfaces with our EMR vendor and different folks who use that same platform.

Yeah, that's great. And I, I love the focus on making it as easy and as accessible as possible to the provider to be able to help them to do the right thing and, and not putting the, the onus on them to have to extract that data. That's that resonates and one of the things I love about how you guys approach this work. So, Advocate for many years has been engaged in value based care. I know you guys hold lots of different contracts, lots of different payers. As you know, every contract has different measures, particularly on the quality side. It's hard to manage and prioritize those. Can you talk a little bit about your approach and, and how you guys think about managing and prioritizing all the different quality measures across your various contracts with payers?

Oh, Josh, I mean, you know, there's probably as well as anyone and the breadth and depth of what CHESS has done to support your value partners in doing this work too. Again, it's something I've followed for a long time and learned best practices from. But you know, I, I think about we, we started a process a few years ago to get more granular in the way that we do this. And I think that it follows, it follows a process that's been long in place that it helps us look at kind of several different areas in value-based contracts of what measures we want to prioritize. For example, we followed this rubric where we look at the alignment of the measures we select and we prioritize in alignment with the various you mentioned, I think we have 108 value-based contracts across that portfolio, of 108 value based contracts. That's kind of pillar number one. Pillar two is the population health impact of the measure. So for example, a measure and I probably shouldn't pick on one specifically, but I will, osteoporosis management impacts so many fewer members and lives, not that it is not an important measure for the people that it impacts than a measure like colorectal cancer screening. The population health impact is just significantly more pronounced and measures that impact broader populations. So that's kind of pillar #2 and then pillar #3 is really how we think about performance. If we are like knocking it out of the park 10 out of 10 for a specific measure, maybe that's a measure we shouldn't kind of lift to the top in terms of improvement. We are constantly Advocate Health's pledge is to promote clinical preeminence and safety for the members that again we're privileged to serve. And so we are constantly looking at how are we getting to that top decile. And if we are at the top decile for a specific measure or measure set, you know that's going to be one that we maybe take our foot off the gas on in terms of the prioritization so that we can focus on the areas that we have more opportunity for improvement.

Yeah, that's great. I was just taking notes here and I love the rubric you guys have built and how you think about prioritizing those across 108 value-based contracts is just unbelievable. I knew it was a lot. I don't think I knew that number. So I learned something. So that's, that's amazing.

I should also call out there, Josh, we are privileged to have a really wonderful and sophisticated, this is obviously not me, but I'm privileged to have a really wonderful quality team across our footprint that really helps bring all this together in this thoughtful way. I wish I could even claim that this was my idea, but it wasn't. So we have fantastic leaders on our team that have helped pull that together.

Yeah, I know, I know you guys do having met many of them. So, I, I want to talk a little bit about, yeah, it certainly takes a team of people to do this right and perform well. And obviously clinicians on the frontline are an extremely important part of this. You've talked a little bit about how you guys help them to prioritize and where to focus and doing the heavy lifting on the back end. But what does your team think about how, how do you use your team think about clinical engagement and what have you all seen or done that that you think works well that others might be able to learn from?

Yeah, I think I mentioned this already, but I think at the end of the day from we try to tie all the work that we're doing back to transforming the operation. You know, kind of like the old adage, you know, teach a man to fish versus feeding him a fish. We really want to kind of bridge that gap of there are things that we can enable for clinicians and care teams to do, but there are also things where we want to, you know, activate their operational model to accomplish these value-based outcomes that we're driving at. And so again, very fortunate to have some fantastic partners in this space. So really strong team of physician leaders, medical directors and value-based performance teams. But across all of our teams who are working in this space, you know, again, quality, CMD, value-based performance, we're all focused, I think on trying to have a primary relationship management contact with that clinic and ensuring that they have one person to go to more or less right. And then complementing that team with subject matter experts who can be the “phone a friend” when things go deep. Maybe in a coding, clinical coding question about, you know, what does this diagnosis mean versus that one? And do these things, you know, do you have to do both of them or one of them? Or what's the correct coding guidelines or what's the exclusion criteria for a statin measure when a patient has an intolerance? What do I have to document? And so having those kind of broad level tools that can be deployed through relation like relationship management resources that then have kind of “phone a friend” kind of deep subject matter expertise with performance improvement focused expertise that can support them. I think that that's really our goal to kind of transform again the operation and support those clinicians and care teams of delivering the care while the patients are in front of them.

Well, Wilson, this has been a great conversation. I'd love to dig in a little bit deeper and ask you for more questions. Do you have, would you be able to stick around a little bit longer?

Yes, of course, I’d be happy to do so.