Please Be An Engaged Healthcare Leader
By Zach Silverzweig, co-founder, CipherHealth
As the co-founder of a healthcare technology company offering tools to increase patient engagement, reduce readmissions, and improve patient outcomes, I am no stranger to the current prevailing opinion that analytics are one of the, if not the only, key determinants in predicting outcomes and costs. However, my experience at the Congress on Population Health Management conference in Orlando earlier this fall made me question whether we are truly open to the newest information related to healthcare outcomes and its potential implications.
The conference hall was packed with a hundred attendees: population health experts, ACO leaders, experienced care managers, social workers, home health teams; you name it.
There were engaging presentations that painted the picture of healthcare that we are coming to thoroughly understand: shifts towards risk-based contracts, shifts from fee for service, shifts to lower cost of care. Good stuff. Stuff everyone in the room should know.
Next up, Dr. Lindsay Jubelt took the mic to share findings from the Population Health team at Mount Sinai. She had great data: the top 1 percent of patients can account for 20 percent of costs, the top 5 percent of patients, 50 percent. She showed that care management can reduce costs for these cohorts by 50 percent. Everyone is nodding. This makes sense. Great results by a great organization.
But then she drops a bomb.
According to her research, “patients who are very high cost in one year are likely to be much lower cost the following year with or without high touch programs.” She shared another supporting study out of Denver showing that for a given group of superutilizers, fewer than 3 percent will remain in the super utilizer cohort in the following year (Tracy L. Johnson et al. Health Aff 2015; 34:1312-1319). The highest cost patients are rotational. It’s like unemployment. Most are in-and-out, even if you don’t do anything.
OMG! Let’s nerd out on this! This means cost stratification models fail to identify next year’s sick patients. This means we need to target the early phases of the care pathways used by physicians to treat the illnesses that will become expensive in the future. Care Coaches need to coach doctors as much as patients. In the words of the legendary Keanu Reaves, “Whoa.”
The implications were, are, huge. Dr. Jubelt had slide after slide of data to back it up and strategies carefully considered (and proven effective) in light of her findings. The audience clapped politely. We moved on.
I was surprised. Isn’t this revolutionary? If my understanding of everyone else’s understanding is near the mark, this should have been ground breaking. Have people secretly understood this and just decided to spend millions on analytics engines anyway?
The next speaker came from the familiar camp. She spoke of the importance of cost data in risk scoring for patients, exactly the position undermined by the earlier presentation. I thought someone would ask how we could reconcile the two wildly conflicting approaches, or that the moderator would force a short panel discussion to get to the bottom of this, or that the two speakers, completely at odds in theory, would arm wrestle. No such luck. The conference moves on.
Everyone talks about patient engagement as being a silver bullet in pop health. It’s an arrow in the quiver for sure, but another, just as important, is leader engagement. We can’t go to a conference and sit in the back row and check email. We can’t not change (or at least investigate change) when the data clearly shows us that our core assumptions may be incorrect.
About The Author
As a cancer survivor, Zach knows first-hand the importance of improving patient care. With CipherHealth he has achieved his goal of helping hundreds of hospitals deliver better care to millions of patients through risk stratification, care planning and, readmission prevention. Silverzweig leads CipherHealth’s product and development teams, managing the solution lifecycle from napkin to prototype to profitability and plays a key role in managing the company’s financial operations and helping to shape CipherHealth’s corporate architecture.