{"id":9991,"date":"2014-04-30T12:12:17","date_gmt":"2014-04-30T16:12:17","guid":{"rendered":"http:\/\/n2value.com\/blog\/?p=9991"},"modified":"2014-04-30T12:34:03","modified_gmt":"2014-04-30T16:34:03","slug":"a-conversation-with-farzad-mostashari-md","status":"publish","type":"post","link":"https:\/\/n2value.com\/blog\/a-conversation-with-farzad-mostashari-md\/","title":{"rendered":"A conversation with Farzad Mostashari MD"},"content":{"rendered":"

I participated in a webinar with Farzad Mostashari MD, scM, former director of the ONC (Office of the National Coordinator for Health IT)\u00a0 sponsored by the data analytics firm\u00a0<\/span>Wellcentive<\/span><\/span><\/a>\u00a0<\/a> \u00a0He is now a visiting fellow at the Brookings Institution. \u00a0Farzad spoke on points made in a recent article in the American Journal of Accountable Care,\u00a0<\/span>Four Key Competencies for Physician-led Accountable Care Organizations<\/span><\/span><\/a>.\u00a0\u00a0<\/span><\/p>\n

The hour-and-a-half format lent itself well to a Q&A format, and basically turned into a small group consulting session with this very knowledgeable policy leader! \u00a0<\/span><\/p>\n

Discussed:<\/span>
\n1. \u00a0Risk Stratification. \u00a0<\/b>Begin using the EHR data\u00a0by ‘hot spotting<\/b>.\u2019 \u00a0Hot spotting refers to a technique of identifying outliers in medical care and evaluating these outliers to find out why they are consuming resources significantly beyond that of the average. \u00a0The\u00a0<\/span>Oliver Wyman<\/span><\/span><\/a>\u00a0folks wrote a great white paper that references\u00a0<\/span>Dr. Jeffrey Brenner of the Camden Coalition<\/span><\/span><\/a>\u00a0who identified the 1% of Medicaid patients responsible for 30% of the city\u2019s medical costs. \u00a0Farzad suggests that data mining should go further and “identify populations of \u2018susceptibles’ with patterns of behavior that indicate impending clinical decomposition & lack of resilience.\u201d \u00a0 He further suggests that we go beyond a insurance-like \u201crisk score\u201d to understand how and why these patients fail, and then apply targeted interventions to prevent susceptibles from failing and over utilizing healthcare resources in the process. \u00a0My takeaway from this is in the transition from volume to value, bundled payments and ACO style payments will incentivize physicians to share and manage this risk, transferring a role onto them traditionally filled only by insurers.<\/span><\/p>\n

2. \u00a0Network Management<\/b>. \u00a0Data mining the EHR enables organizations to look at provider and resource utilization within a network. \u00a0(c.f. the recent Medicare physician payments data release). \u00a0By analyzing this data, referral management can be performed. \u00a0 By sending patients specifically to those providers who have the best outcomes \/ lowest costs for that disease, the ACO or insurer can meet shared savings goals. \u00a0This would help to also prevent over-utilization – by changing existing referral patterns and excluding those providers who always choose the highest-cost option for care (c.f. the recent medicare payment data for ophthalmologists performing intraocular drug injections – wide variation in costs). \u00a0This IS happening – Aetna\u2019s CEO Mark Bertolini, said so specifically during his HIMSS 2014 keynote<\/a>. \u00a0 To my understanding, network analysis is mathematically difficult (think eigenfunctions, eigenvalues, and linear algebra) – but that won\u2019t stop a determined implementer from it (it didn\u2019t stop Facebook, Google, or Twitter). \u00a0Also included in this topic was workflow management, which is sorely broken in current EHR implementations, clinical decision support tools (like\u00a0<\/span>ACRSelect<\/span><\/span><\/a>), and traditional six sigma process analytics.<\/span><\/p>\n

3. \u00a0ADT\u00a0Management.<\/b>\u00a0 This was something new. \u00a0Using the admission\/discharge\/transfer data from the HL7 data feed, you could \u2018push\u2019 that data to regional health systems. \u00a0It achieves a useful degree of data exchange not currently present without a regional data exchange. \u00a0 Patients who bounce from one ER to the next could be identified this way. \u00a0Its also useful to push to the primary care doctors (PCP) managing those patients. \u00a0Today, where PCP\u2019s function almost exclusively on an outpatient basis and hospitalists manage the patient while in the hospital, the PCP often doesn’t know about a patient\u2019s hospitalization until they present to the office. \u00a0Follow-up care in the first week after hospitalization may help to prevent readmissions. According to Farzad, there is a financial incentive to do so – a discharge alert can enable a primary care practice to ensure that every discharged patient has a telephone follow-up within 48 hours and an office visit within 7 days which\u00a0would qualify for a $250 \u201ctransition in care\u201d payment from Medicare. \u00a0(aside – I wasn\u2019t aware of this. I\u2019m not a PCP, and I would carefully check medicare billing criteria closely for eligibility conditions before implementing, as consequences could be severe. \u00a0Don\u2019t just take my word for it, as I may be misquoting\/misunderstanding and medicare billers are ultimately responsible for what they bill for. \u00a0This may be limited to ACO\u2019s. \u00a0Due your own due diligence)<\/span><\/p>\n

4. \u00a0Patient outreach and engagement. \u00a0<\/b>One business point is that for the ACO to profit, patients must be retained. \u00a0Patient satisfaction may be as important to the business model as the interventions the ACO is performing, particularly as the ACO model suggests a shift to up-front costs and back-end recovery through shared savings. \u00a0If you as an ACO invest in a patient, to only lose that patient to a competing ACO, you will let your competitor have the benefit of those improvements in care and eat those sunk costs! \u00a0To maintain patient satisfaction and engagement, behavioral economics (think\u00a0<\/span>Cass Sunstein\u2019s Nudges.gov\u00a0<\/span><\/span><\/a> paper), gamification (<\/span>Jane McGonigal<\/span><\/span><\/a>\u00a0), A\/B Testing (<\/span>Tim Ferriss<\/span><\/span><\/a>) marketing techniques. \u00a0Basically, we\u2019re applying customer-centric marketing to healthcare, with not only the total lifetime revenue of the patient considered, but also the total lifetime cost!<\/span><\/p>\n

It was a very worthwhile discussion and thanks to Wellcentive<\/a> for hosting it! \u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

I participated in a webinar with Farzad Mostashari MD, scM, former director of the ONC (Office of the National Coordinator for Health IT)\u00a0 sponsored by the data analytics firm\u00a0Wellcentive\u00a0 \u00a0He is now a visiting fellow at the Brookings Institution. \u00a0Farzad spoke on points made in a recent article in the American Journal of Accountable Care,\u00a0Four […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"New N2Value post: A conversation with @Farzad_MD on physician led #ACO s.","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[4,2,7,14],"tags":[],"class_list":["post-9991","post","type-post","status-publish","format-standard","hentry","category-data-science","category-healthcare","category-leadership","category-patient-experience"],"jetpack_publicize_connections":[],"aioseo_notices":[],"jetpack_featured_media_url":"","jetpack_shortlink":"https:\/\/wp.me\/p4mtfP-2B9","jetpack_sharing_enabled":true,"jetpack_likes_enabled":true,"_links":{"self":[{"href":"https:\/\/n2value.com\/blog\/wp-json\/wp\/v2\/posts\/9991","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/n2value.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/n2value.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/n2value.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/n2value.com\/blog\/wp-json\/wp\/v2\/comments?post=9991"}],"version-history":[{"count":4,"href":"https:\/\/n2value.com\/blog\/wp-json\/wp\/v2\/posts\/9991\/revisions"}],"predecessor-version":[{"id":9996,"href":"https:\/\/n2value.com\/blog\/wp-json\/wp\/v2\/posts\/9991\/revisions\/9996"}],"wp:attachment":[{"href":"https:\/\/n2value.com\/blog\/wp-json\/wp\/v2\/media?parent=9991"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/n2value.com\/blog\/wp-json\/wp\/v2\/categories?post=9991"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/n2value.com\/blog\/wp-json\/wp\/v2\/tags?post=9991"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}