January 11, 2016

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January 11, 2016

Where it really becomes acute is with the mental health population. And that's before they get to us.

The key, though, with population health is the practical application of the incentives. That's the challenge. We are in a world where we are one foot in two canoes. And we have the fee-for-service world where it gives completely different incentives, where that's more volumes, high utilization—it's per click versus more of the risk sharing. That's where we're moving, but we're not there yet. The sooner we can align those incentives with the community physicians—whether they're Intermountain Medical Group physicians or Revere Health physicians, as well as with employers and providers and benefit managers—until we get there and can really do that, we're just going to continue to talk about population health.

Data, for the first time in our industry, seems to be more widely shared, or shared in a way that it's changing a lot of people's behavior—providers, insurers, consumers. What are the exciting things you're seeing with big data or how has it changed how you do your healthcare business?

BARLOW: Physicians are data masters. Their training is to take in subjective and objective information, make life or death decisions on the fly. So it requires a very robust capability of data.

When we looked at what we call gaps in care—anything that's not been done for a patient that needs to be done or they've never been in at all—we find now when we get these data sets from payers that around 67 percent of the care that's deemed to have not been given actually has been given. It's just documentation and data transfer issues. And the beauty of that is it gives us a more substantive picture of what we really need to do to make a difference in health versus things that become redundant, repetitive, perhaps not value added, perhaps even harmful to people simply because the data sets say that something is missing when oftentimes it's not.

The big issue now is patient engagement, the ability to give patients access to their medical record, for it to be portable across providers, systems, and even across state boundaries. That capability is now beginning to be reached.

BENTZ: From the consultant side, absolutely it's exciting because it's predictive modeling. It's being able to take the data we have and look to the future and say, here's our diabetic population. What can we do to back up and provide additional education or engagement, pharmacy management, those areas, rather than waiting till the claims have occurred? But being able to predict it and put some things in place for outreach programs to be able to lower some of those cost drivers.

BABITZ: We are doing really well in data, but we have a couple more big hurdles to accomplish. Number one is there's probably 15, 20 different electronic health records being used in Utah right now. They don't talk to each other. They don't share data. Second thing, most electronic health records, especially in the ambulatory setting, they're not made to retrieve data in any useful way.

The third thing is, nationally the average individual changes health insurance plans about every three to four years. Now, if that means they go into a different data system, how do we follow that patient? How do we know what's really going on with them so we can see if they've made changes or if they're improving?

BENTZ: Marc brings up a good point about the time span a company stays with a carrier or a network. But as you're seeing more the standalone total health options with the clinics within an employer group or even your standalone wellness program, not necessarily netted into the health plan that you have, that's where you're going to see the consultants like us that are collecting that data. So regardless of which carrier you're with, we're housing that data. And we're still able to do that predictive modeling over time regardless of where it is because we are the house that's collecting those data points.

TANNER: We have a lot of limitations on sharing data. HIPAA really restricts us and it always gets the attorneys in the room with us saying you can't share. We're out to protect the patient. But it also creates some real limits on being able to take advantage of many of the data points that Matt spoke about.

We need to find a way to bridge that and be able to share more data in a more useful way. Right now, total claims data gives you what's the CPT code, what's the diagnosis code, and what the charge was. But you've missed all the other pieces in a medical record that might help to truly follow population health as it should be.

CLAWSON: At some points we feel like we want to retain that information, to protect it, for one reason or another. All of us need to understand that if we don't allow it to go out and allow the clinicians to do what they need to do—and that is take that information, get on a one-to-one level with their patient, have a relationship—we can have as much data in the world, but if we're not building that relationship with the consumer, having them believe that we are working in their interests, then we're not using it correctly.

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