Treo Solutions Interview: “Data Brokers” Build Legacy Relationships in Health Care
Rich Keller, VP Government Programs at Treo Solutions recently spoke at the 2013 State Healthcare IT Connect Summit about the foundational elements of analytics. We recently had a more in-depth conversation with him about the Summit and also about an article he published titled “Three Ingredients for Real health care Transformation: It’s Not Only about Fixing the Payment System.”
In the article he addresses real solutions to a “broken” system and payment model. Keller encourages state and federal government with employer payers, health planners and delivery systems to come together to challenge the fracture with four fundamental solutions: alignment, collaboration, transparency and of course actionable data.
As expressed in the article, Keller explores models, which “incentivize well care over sick care, treating the whole person rather than diseases or body parts and rewarding population health.” Treo Solutions currently provides clients with web-based dashboards with actionable data to support this transformation.
Anna Belle Abraham: Thank you, Rich, for taking the time to go a bit deeper on this topic with us. Firstly, how is actionable data aligned with the new reformed incentives of “treating the whole person” in our health care delivery system?
Rich Keller: Often times the ‘fix’ cited for reform is all about payment, which is a requirement and subsequently the cause of the current system’s problems. However, the solution is not as simple as fixing payment and calling it a day. In a payment model that rewards value over volume we are asking the health care delivery system to completely remake itself. We are asking providers to focus on keeping people healthy and we are asking hospitals to keep people out of hospital beds. The entire health care complex was built for sick care. This is a really big change. Providers and delivery systems need access to detailed data that is actionable and tied to interventions. Telling a provider that their patients had more ER visits than expected is valuable and directional, but it is not actionable.
ABA: Can you give us an example of what actionable client data might look like?
RK: Sure. For example, we understand that providers need to know why ER visits are higher than expected, right? So they may ask what is causing the variation. Is the problem with system level issues like access, or clinician level issues like continuity of care, or person level issues like illness burden and/or low self-confidence? Providers also need to know what to do about it. What interventions should be deployed based on what the data is telling them? So for this frequent ER visit example – interventions at the system level might be rotating evening clinic hours; from the clinical level an intervention might be distributed work through care teams and from a person level interventions might be skill set intervention. Treo’s clients can use an online analytic platform that delivers this level of actionable data.
ABA: Besides actionable data, what else do you provide your clients for this transformation?
RK: In addition to actionable data, Treo also enables alignment, collaboration and transparency. Alignment in performance measures is critical for everyone involved in making transformation happen. From the plan or state level all the way down to the front line providers – everyone needs access to the same measures. If health systems are going to scale any of their work in a new value based paradigm this is a requirement and I would suggest that without scale no transformation initiative is sustainable.
Transformation also calls for collaboration among health systems, providers, health plans and payers in ways that will test legacy relationships. Until now these relationships have been zero-sum, or in other words, if the other guy wins – I lose. This has to change for real transformation.
Treo works as a “data broker” with dozens of health plans, several states and several delivery systems. We see the value firsthand of having a “neutral” third party to provide analytics that support their programs as these legacy relationships are tested.
We are also seeing many transformation initiatives expand to be multi-payer, so now not only are health plans and systems required to collaborate for success – so are competing health plans. You need to have one single source of truth that all parties can agree to. They may not like the results – but at least they can trust them. That is the role Treo plays for clients. Transparency is as much about what to share as it is what not to share.
ABA: There were many other speakers at the State Healthcare IT Connect Summit, was there any one presenter that stood out and seemed to be on the same page?
RK: Many of us at the Summit shared the same views, but I recall when Sonny Bhagowalia, CIO, State of Hawaii – made a great observation: the old paradigm of “protect everything and share what you must” needs to be transformed to “share everything and protect what you must.” This is really transformative and scary for lots of folks, but necessary. Treo works with its clients to develop a data distribution platform that includes detailed role based access and a transparency protocol that strives for the new paradigm referenced by Sonny.
ABA: Before we talked about reform in payment plans for hospitals and clinics. If hospitals and clinics no longer make money on the patient volume how will their business stay afloat?
RK: Well, under this new paradigm they will make money on patient volume, just not necessarily on service volume. Payments models are pivoting to reward providers (clinics/hospitals) for keeping people healthy. The healthier they are the fewer services they need – currently those services generate revenue.
New payment models that accommodate this shift include performance payments that reward high quality and low cost, just as Medicare penalizes hospitals if they have more readmissions than expected. They also include shared savings models. In other words, there is an established ‘budget’ for treating a population and if the total cost of care is below that budget the providers share in that savings.
Lastly there is full risk or capitation where the providers are simply paid a per-person budget and that is all they get, all of the ‘costs’ associated with caring for the individual are borne by the provider. So the idea is what was revenue to the providers in the old paradigm increasingly becomes cost in the new paradigm.
This essentially gets to the heart of accountability. These are the financial vehicles used to align providers with the payers in managing to total cost and quality of care by making the providers accountable for cost and quality outcomes.
ABA: Data acquisition is major topic among health care organizations and workers. Everyone is rushing, educating and incentivizing to collect as much as they can with overall continuity. What challenges are being confronted in data acquisition?
RK: So, the challenges are many – for sure. Our clients represent over 100 providers of health care data. The range among the complexities of the data itself and the process of collecting that data across all of these sources is varied. If I had to point out what I see as the biggest challenge in the industry is data acquisition without clarity in use case.
As often as not – we see health care data acquisition exercises that are IT projects in search of a use case. Those never end very well. We all see tremendous value not only in the health care data that is currently available to us – but also in the multitude of things we think we can do with it. The possibilities are endless given new models of aggregating and risk adjusting. It’s really easy to get caught up in just trying to grab all of it and worry about the details later. For our clients we start with use case. Honestly, we have passed on many new business opportunities for which we were more than qualified, but realized early on that the use case weren’t defined or were so varied that the end product lacked clarity. We partner with our clients and seek long-term relationships. Projects without clarity would threaten our ability to do that, so we steer clear of them.
ABA: So with all of this data available where do you start?
RK: We have started with claims data for most of our projects; we use claims data to build the data asset foundation and then add on that. Our reason is simply that we have found claims data to be the most readily available and standard; also as it is tied to payment it tends to be pretty accurate. It is also a cost efficient starting point. From this longitudinal claims data set we then layer in other non-claims data that will add value to the use case. This includes clinical data as well as socio-economic data, functional status data, survey measures etc. Understanding which data can be captured efficiently in order to serve the common needs vs what can be captured tomorrow is critical for building out the appropriate analytic model.
ABA: Who is Treo currently partnering with?
RK: Treo is the data partner with the Centers for Improving Value in Health Care (CIVHC) to support the All Payer Claims Database in Colorado – http://www.cohealthdata.org/#/home. Today this website shares performance on several key indicators of cost, utilization, access and quality for the largest payers in the state. Treo was able to get this website up and running and available to the public in 11 months which we believe is unprecedented. This was due in a large part to the development of a clear use case for the project. What you see on the website now is only the first phase. We are hard at work on the next versions. But key to the program was being able to put some high level information in the hands of key stakeholders quickly and efficiently. I think this is a great example of how you work your way through big data projects, meet deadlines and stay within budget.
ABA: How has and is the Affordable Care Act changing the way you and your company transform health care?
RK: The funny thing is – we have been building the analytics to serve this purpose since our inception. We have been waiting for this for some time. The biggest difference from our perspective is speed to market and demand that is significantly greater than it was leading up to the affordable care act. We used to have time with our clients to present new ideas, test them and vet them. Now we are seeing clients looking for more off the shelf products that can be up and running in 90 – 100 days. Luckily we had about 10 years to prepare for this.