As digital health technology becomes more of a priority for hospitals, strong clinical leadership remains critical to leveraging that IT to manage populations, improve health and ultimately lower costs for healthcare organizations across the country.
That's why healthcare solutions provider Evolent Health, based in Arlington, Va., has hired John R. Mach Jr., MD, as its new CMO. Evolent said Dr. Mach has a unique view of what it takes to build a successful, effective clinical operation because he has vast experience on both the payer and provider side of healthcare, combined with a business background from his time as CEO of EverCare, the UnitedHealthcare business unit that owns and manages all of United's Medicare special needs plans, based in Minnetonka, Minn.
In his new role, Dr. Mach, a geriatrician, will focus on aligning Evolent Health around a single clinical vision and unified clinical/IT strategy that can be scaled for Evolent's health system partners.
Dr. Mach recently gave an exclusive interview to Becker's Hospital Review, where he discussed his background, his relationship with Evolent and how IT can support clinical strategy.
Note: Interview has been lightly edited for length and clarity.
Question: How did your career in healthcare start?
John Mach: I was a primary care doctor in a relatively medium-sized group working in the fee-for-service system, and I experienced first-hand the challenges in getting paid on volume and productivity as opposed to outcomes. I was frustrated by that. I also had the opportunity to spend 10 years in the [Department of Veterans Affairs] as a geriatrician. In geriatrics, you learn the value of team care; instead of having the department of nurses, medicine and physical therapy in different places, we brought that together. You could do that in a system like the VA as opposed to other places where they're all battling for time and energy and fee-for-service billing. That health system orientation was very informative for me. In the middle of my time at the VA, I was exposed to EverCare, and I was able to get in on the provider side. I was actually a practicing geriatrician in a nursing home in the context of managed care and became really intrigued by the managed care model.
Q: What led you to Evolent?
JM: One of my employees had a stroke. He was pretty young, and I remember talking to him and his family about how four different providers gave him different information about his prognosis and what was going to happen with his care, which is a common experience in healthcare today and something that I feel needs to change. Along comes Evolent with a dozen health system and health plan partners that have raised their hands and said, "We're going to do things differently. We're going to really switch this over from waiting for acute care to happen to being proactive about value-based care." Evolent has the technology that can enable this transformation as well as impressive company leadership. Plus, the organization is not so big that it is burdened by bureaucracy, but not so small that resources aren't available. Finally, one of the senior leaders of Evolent I had worked with in the past had been asking me to look at the company for years, and I just couldn't resist anymore.
Q: What are you looking to accomplish as the CMO of Evolent, in the near-term and also down the road?
JM: In the near-term, I'm looking to learn and listen to all the people who have been working so hard at Evolent and its customers and partners to understanding where they are in the transition to value-based care. A ton of progress has already been made, but care management for the industry in general is just scratching the surface. I'm interested to identify specific areas where we can have additional impact.
Longer-term, I hope to replicate and scale the models that are working. It's really about making best-in-class population health management faster, better and more cost effective than it is today. For example, I believe there is great potential in strengthening integration of the home care setting and caregivers. Finally, I'd like to see even more improvement in efficiency and effectiveness.
Q: What are the biggest challenges facing healthcare today, and what needs to be done to alleviate these?
JM: This transition that the country is attempting to go through to move from fee-for-service to value-based care is really, I think, the biggest challenge. Medicare has stated its goal of transitioning half of payments to value-based care models by 2018. How do we accelerate that goal? How do we make that transition? I think part of that value needs to be redefined. We've got to elicit, understand and put a plan together that meets every patient's individual needs. Instead of value being strictly about dollars, it should also be about delivering care that aligns with the values of the patient.
Q: How can IT support clinical strategy, especially as digital health becomes more of a priority for hospitals?
JM: The first thing you have to do, whether you're talking about technology or care management, is identify who the high-risk people will be for the next 12 months or so. You can do this by using the technology, the data and the expertise around how to analyze claims and EMR data together to predict next year's costs and the people that are most likely to incur them. Once you identify those individuals, the question becomes where to find them and how to reach them. This is where the interoperability of various IT systems becomes critical to putting actionable data in the hands of providers. Once providers are given the claims data and the clinical information, they need real opportunity to use it. You want clinicians making the clinical decisions, but IT can help organize the information and highlight those things they need to pay attention to. Not only do providers need to know who the high-risk patients are, they can be better supported by technology that prompts patient outreach, and they need access to clinical information about those patients to make more informed medical decisions—all in a fluidly integrated workflow. Also, once you have responsibility for a population and you've identified high-risk people, the truth is that 99 percent of the time they're at home. How do you connect the home environment, whether through monitoring or apps that help you engage and monitor people? Those things need to tie into the overall picture.
It's an emerging opportunity for technology to contribute to care.
Q: Do you think true care coordination is possible? If so, how do we achieve this?
JM: It's clearly possible. The challenge is about engaging the people involved. For example, providers have to be more team-oriented. There has to be processes where we're [providers] listening to patients, listening to each other and understanding who the higher-risk people are so we can focus first on them instead of delivering the same care coordination to everyone when some people do not need it. We then need to work collectively toward the goal of better health for the patient in question. Another thing to ask is, "Are we leveraging every encounter?" and ensuring we're utilizing technology effectively to do so. It's been slow adoption on the care management side. There's still more that can be done to streamline and make processes more efficient using the technology that's been developed.
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