Becker's Health IT + Clinical Leadership 2018 Speaker Series: 3 questions with Commonwealth Care Alliance Chief Medical Officer, Joel Reich, MD

Joel Reich, MD, MMM, FACEP, serves as the Chief Medical Officer for Commonwealth Care Alliance.

On May 10th, Dr. Joel Reich will present at Becker's Health IT + Clinical Leadership 2018. As part of an ongoing series, Becker's is talking to healthcare leaders who plan to speak at the conference, which will take place May 10-11th 2018 in Chicago.

To learn more about the conference and Dr. Reich's session, click here.

Question: Who or what are the disruptors that have your attention?

Dr. Joel Reich: Uberization of healthcare headlines are getting old. It's no question that Uber uprooted the taxi industry, and in doing so, it redefined consumer-centered, on-demand service expectations. Precisely how this will apply to healthcare, though, has yet to be seen. Healthcare is, and will certainly continue to, experience disruptive innovation, but it will not come in the form of a single innovative technology or entity as occurred in the taxi industry. In fact, there is a much higher likelihood that healthcare's biggest disruptors will be politically-motivated policy changes and provider and insurer mega-mergers of every imaginable variety.

Several forces affect the timing and manner in which incremental change is occurring and present barriers to new entrants. These include the healthcare system's sheer size, infrastructure complexity, economic impact and regulatory environment. Healthcare's dependency and expenditures on highly-skilled and extensively-educated, trained and licensed personnel differentiate healthcare from other industries. For example, Uber recruited an ample supply of licensed drivers with cars, while healthcare has serious across-the-board manpower shortages.

That's not to say that healthcare isn't already experiencing significant change. There is wide recognition of the need to provide genuinely person-centered services like those we have seen in other industries. As Clayton Christensen observed in his groundbreaking work, disruptive technology changes typically take root in simple applications at the bottom of the market — those that are less expensive and more accessible. In healthcare, this presently equates to programs focused on keeping people at home and out of emergency departments, in-patient beds and skilled nursing facilities. And that's where technology becomes the great enabler. These programs are built on a foundation of enhanced primary care and care coordination, as well as management services, and are enabled by technologies such as communication apps and platforms, remote patient monitoring, pill-tracking compliance technology, interactive voice response, telemedicine and a creative use of predictive analytics. New provider groups are building risk-based business models with platforms built on a convergence of these technologies.

Health systems and hospitals are generally not early adopters. Until there is better alignment of financial incentives, keeping people at home reduces revenue, resulting in perverse incentives for health systems and hospitals. Health systems are holding on to fee-for-service traditions while waiting for the value-based payment system to "evolve," while new entrants build at-risk payments into their business models. Whether these new entities grow to large scale on their own or get acquired by insurers or health systems remains to be seen.

Q: What did you notice about your healthcare experience the last time you were at the receiving end as a patient?

JR: There was a lot of paper and some duplication of efforts. HIPAA forms, payment consent forms, insurance information and medical history were still done on paper and manually entered by the reception staff and care providers. I was unable to determine how much was attributable to a long-time process still being used, and how much was lack of system capabilities. And, online appointments still weren't made available. It left me thinking how easily all of this could have been done in advance via a well-designed patient portal.

In all fairness, there has been improvement over the past few years. Now that the EHR has a few years of history, everything about me was there and readily accessible to compare history and prior test results with current information and to send reminders regarding immunizations. It seems like many things slowed down or stopped following the meaningful use funding period — perhaps a bit of fatigue and shortage of funds.

It's hard not to compare this to a recent visit for another family member. In addition to accessible free parking, visitor waiting room computers, and biscuits, prior medical records and lab results, including those from the primary care vet, were available in the specialist's EHR. Non-urgent medical imaging studies were scheduled for an hour later on the same day, and we were notified by text as things progressed. I have not reviewed all of the vet records, but those I have seen were focused on medical issues, without all of the coding-for-billing required elements that have driven much of EHR design and configuration. And, there were no HIPAA forms and no consent forms, which in retrospect, was fortunate because the patient cannot hold a pen.

Q: As a leader, what is the best investment you made in your own professional development in the past five years?

JR: Without a doubt it was completing my graduate degree program in health and medical informatics. As the CMO of a health system without designated physician informaticists or a CMIO, I was responsible for many IT medical staff-related decisions and policy issues. I worked closely with the CIO and IT staff on system implementation, change and adoption of provider order entry. We were very early 1990s adopters of EHR. We were repeatedly reminded that the "promise" was a long way off, that change-management was the leadership challenge of the decade and that when properly selected and implemented, IT was a powerful tool. But, it was, and is, very difficult to learn on the job.

My decision is validated daily as I review my calendar and project lists. Almost all involve informatics. Ranging from predictive analytics for identifying individuals at high risk for ED visits or in-patient admissions or readmissions, to telemedicine that can improve engagement while reducing staff and patient travel times, informatics has become a core healthcare leadership skill.

Transforming to a value-based care model depends upon our ability to link clinical and business functions so that we can improve quality, experience and outcomes while reducing cost in a thoughtful manner with clearly demonstrated outcomes. It's far more preferred to "slashing and burning" expense budgets. While we will always need leaders with specialized skills in the clinical, technical and business aspects of healthcare, our best path to value-based care depends on all of us embracing informatics as a bridge connecting these disciplines.

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