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Driving the Shift to Value-Based Care through Population Health Management

by John Moore III | March 03, 2022

Creating a Sustainable Path for Providers

The path to implementing value-based care in the U.S. healthcare system has been fraught with challenges and peril. There’s quite a bit of momentum when it comes to maintaining the current model, as well as the financial incentives already in place. As COVID drags on, hospital systems are facing staffing shortages, physician burnout and a slew of financial setbacks.

It’s no surprise that switching to a VBC model has often taken a backseat as a priority, as providers around the country focus on putting out the immediate fires and making sure they can stay afloat. But as always, there is potential to grow and change. Health IT vendors are developing solutions that can assist providers with data collection and management, patient monitoring, and more, with the goal of enabling a shift away from the volume model.

Aiming to eliminate “alert fatigue” and aid in physicians being able to care for more patients at once, without spending a disproportionate amount of time fiddling with an EHR or platform, organizations like Lightbeam Health Solutions are setting the stage for a transition to value-based care.

We sat down with Lightbeam President, Jerry Shulz, at HIMSS ’21 to discuss this issue, how providers can both save money and better serve their patients, the future of value-based care, and more. Check out the latest episode of Chilcast: Healthcare Tech Talks below, or wherever you get your podcasts!

AI transcription below (via Sonix.ai):

Jerry Shulz: [00:00:00] These are preventable, avoidable things that happen, catching a breast cancer at stage one or zero, helping people understand the importance of being screened helps drive down costs and helps improve people’s lives.

John Moore III: [00:00:22] Today, I am sitting with Jerry Shulz, president of Lightbeam Health. So could you tell me a little bit about what you do with Lightbeam and what you focus on at the company?

Jerry Shulz: [00:00:30] Sure. Hi, my name is Jerry Schulz, Lightbeam’s president. My focus is helping to make sure our clients are succeeding in their transformation to value based care. As you know, our industry is in a generational transformation from fee for service to value based care, which is something this country desperately needs to help reduce overall spending and improve overall quality. We cannot afford this current spending curve we’re on. There’s also a couple of other real dynamic convergences coming together. There’s a generational shift in the way patients view the relationship with their providers. They don’t necessarily view the traditional relationship that they had for 30 or 40 years with their doctor in the same way. It’s more consumer driven, they’ll do the research on the internet, and then they’ll choose to go to the most convenient doctor, not necessarily the doctor who they have a relationship with or as the best quality. And then there’s a transformational generational shift in in the way technology is affecting the patient in their home. Wearable devices, remote patient monitoring. A number of government initiatives that are paying for health and wellness and preventive screenings to be done in the patient’s center, which are really good initiatives. My focus is making sure that our clients can effectively ingest all of that information, put meaning to it, serve it up to the providers in an actionable way without creating undue stress in the provider’s normal workflow.

Jerry Shulz: [00:01:50] Physicians already have too many–the phrase you hear is alert fatigue. Physicians are already getting way too many alerts, so now we have to do a really nice job of making sure that the right alerts, the right messages, the right patients getting to the right person, the right care team in order to drive down cost and make sure that the the population is being served properly. We do that by aggregating data from about. We have over ten thousand unique sending facilities or sources that we receive data from nightly and now in real time. We run it through our warehousing tools where we identify high risk patients, high risk behaviors, social determinants of health factors that can help us see where an intervention can help move the needle and make a difference in a patient’s life. My mission is really make sure that our systems are helping our clients generate savings and generate industry leading results. Our customers have generated collectively over $2 billion in savings, which it’s not just about the money, but as the saying goes, no, no margin, no mission. Those savings are helping drive down health care spend and drive up quality. Our results for our customers, we’re very proud are about two, two and a half times higher than non ACO. So I think we’re doing a pretty good job for our customers. Fantastic.

John Moore III: [00:03:03] That’s are great numbers. Thank you. So with the pandemic and all of that shift towards remote care, did you guys see much of an impact on how virtual care can shift that needle and can actually change the care continuum for into less expensive modes of care and less expensive encounters? How are you guys tracking that with your system? What what have you seen play out both during the pandemic and then since things have started to return to normal as those virtual visits start to decrease, but still balance out a little bit?

Jerry Shulz: [00:03:30] Great question. Yeah, we actually did. A lot of our clients did see obviously a drop off in office visits, so a lot of their nurses were redirecting to managing patients in programs like chronic care management, managing patients remotely. A lot of our clients implemented telehealth programs. We modified our analytics to help track COVID and COVID related expenses. And we also saw back that earlier point a generational shift in the way people view technology. I saw a survey that seventy five percent of patients have now indicated a willingness to to wear a remote device or to participate in an RPM remote patient monitoring kind of program, whereas I don’t think with COVID that might have been so high. They’re very comfortable now helping Co. manage their own condition at home with the assistance of these devices that report data back on a real time what that can really help our system do and our customers. The next looming, I think, problem for our clients that are moving to value when they get this 60, 70, 80, 90 percent of their portfolio or their patient load is value based care. That’s a lot of patients to surveil. That’s a lot of data to surveil, and it’s a lot of activities that they currently aren’t staffed for. And that I think is is going to be the biggest, I guess hangover from COVID is there’s a labor shortage already.

Jerry Shulz: [00:04:47] Health systems are having trouble staffing these care models around these opportunities to generate improvements in health for these cohorts of patients. And it’s only going to be made worse by the fact that there’s all this additional information coming in from the patients home. So we think that the opportunity really needs to be the problem needs to be viewed differently. And by that, I mean, how can a care manager manage to three thousand patients instead of one hundred and hundred and fifty patients? And it’s with technology giving us daily feeds from the patient to let us know, Oh, these are the folks who. Look like I should intervene with today. So it’s where fewer people can more efficiently manage and scale to handle larger patients by having technology help really manage the patient in a noninvasive way, using technology that speaks to the patient in their home via their Alexa. Mrs. Johnson, how do you feel today? Do you feel like you had any shortness of breath? And if she says yes, that gets kicked up in the care manager to intervene and, you know, help keep Mrs. Johnson out of out of the hospital.

John Moore III: [00:05:52] I know a lot of people are going after that right now. A lot of people are trying to figure out how you can kind of preempt major events because those are always the big cost drivers. So looking at the cost of care and all of these expenses that you’re referring to recently, Biden issued his latest executive order, that big executive order that had something like seventy five different specific call outs around a number of topics within the American economy both anti-competitive behavior, health care, all kinds of things. So as far as we’re looking at that anti-competitive behavior, specifically health affairs and a few other research organizations have recently published articles showing that industry consolidation in this industry is actually creating a lot of anti-competitive environments and microcosms where you only have one health system to go to and they’re jacking up prices. So how do you guys see because obviously you’re going to be a lot of the companies that you would work with are these larger organizations that actually do have this kind of ACO value based model. So how do you see what you’re doing, potentially helping to contain those costs and ideally preventing this kind of monopolistic behavior? Is that not really something that you guys are too focused on, but you’re hoping that the A. You know that competitiveness stays in the industry?

Jerry Shulz: [00:07:03] Great question. It’s actually worse than that. Not only are they monopolistic gouging prices or setting prices in a noncompetitive way, but they’re also not complying fully with the data blocking rules. So if we have a small ACO in a city that has a major health system, the nine hundred pound gorilla and their patients go into that health system, and those health systems do not make that data available. That creates blind spots for us that are significant. We’ve developed tools, for example, that help manage referrals and the cost of referrals and better manage the patient and help prevent problems like 30 to 40 percent of all patient referrals go unfulfilled. And those are data driven tools that look at cost and quality and outcomes as one of six or seven factors to help make sure that we’re getting this patient to the right hospital and the right cardiologist. But you’re spot on in some markets, we’re not able to use the right hospital or all of the hospitals within, especially in rural markets within. There’s a reason why some of those same hospitals, health systems, payers are creating contracts with satellite hospitals out into the countryside. So, yeah, the patients are doing the research. Health systems should be able to do the same thing. We should be able to have complete transparency and to start doing creative things like if you’re willing to to get your MRI in the evening, the co-pay is not is no longer being charged or or use this, you know, radiology facility for these benefits and these price benefits.

Jerry Shulz: [00:08:38] So it’s something that’s going to have to change. But I think the health systems realize it as well as they shift the value. Think about the catch twenty two for them as a greater percentage of their margin and mission is tied to quality and cost. There they have a catch twenty two by being the high cost provider. Yes. And so they’re going to have to start to drive those costs down, and their incentives are to keep people out of their facilities in the first place as well, at least value based care. So as the market shifts to the slow move, the value based care which is accelerated now we’re seeing commercial payers accelerate. We have several commercial payer clients that are accelerating their shift to commercial ACOs, the Blues. Many of the Blues have now put a very high percentage of that. So, so the incentives were the physicians are the gatekeeper now. Are there in place to try to put pressure on that. So hopefully that pressure from below and above will and the economic models will drive change.

John Moore III: [00:09:36] Ok, that makes sense. I mean, that’s what we’re hoping. That’s what we’re hoping from our perspective. And it’s what drives us, Atul, Marc, to do the research that we do because we see how broken and screwed up. The way that the system works now is when everything’s fragmented, everything is so specialized. And then, you know, as you get more specialized, the cost increase. But if you treat the whole patient to begin with, those costs are going to get so high

Jerry Shulz: [00:09:59] In the first place. Yeah, I do have one client who’s an ACO and I won’t tell you where they are, but the person who runs the value based care contracts for them said to me something along the lines of my hospital is much higher cost. My health system is a much higher cost structure than a couple across the street. So it’s a catch twenty two. I’d love to have my cardiac and orthopedic cases stay in my own health system and bring that revenue in-house and keep the patient in house. But for my ACO and my physician bonuses and total spend bonuses, I really should be referring them to my competitive health system

John Moore III: [00:10:41] Or to those specialized MRI places instead of doing it in hospital to where it’s so much more expensive.

Jerry Shulz: [00:10:45] Yeah, exactly.

John Moore III: [00:10:46] Tell me about what really drives you to do your job right now, like what motivates you in health care? Because everybody’s brought. I feel like everyone I talked to that is on the hems floor or just is working in health care, I.T. in some capacity. Most people have a personal reason that’s driving them to want to solve an issue in this system. So what motivates you in healthcare? What’s really driving you? What’s making you passionate about this?

Jerry Shulz: [00:11:07] That’s a great question. So I’ve been in health care it since nineteen eighty three. Oh, wow. Yeah. Billing and scheduling through the eighties and nineties medical records helped build a very large, successful EMR company, which about ninety thousand physicians, four or five thousand customers, some of the largest health systems in America. And along the way, the larger mission you try to serve is is how’s that saying? Do doing well while doing good? That’s our

John Moore III: [00:11:35] Thing is,

Jerry Shulz: [00:11:36] Yeah, is to help improve the lives of our customers and their patients and the EMR. The promise of the EMR was to improve quality and improve outcomes, improve quality, and it didn’t really achieve that. It did successfully digitize a lot of data that is now being used to make data driven and decisions on where the right cost and quality choices are to be made or improvements are to be made. I think my passion is this country is on a spending curve that it cannot afford, and I’ve got children and I think we’ve got the best system in the world and I’d love to see to help do a little to play a part in leaving this system in a better place for the next generation in terms of the spending curve and not see the system implode in X years and for people not to fall through the cracks. I have a client who does. We’ve made them aware of with our social determinants of work tools. People have food pressure, transportation pressures, income lost their job and they do really creative things like if an 88 year old lady living on the Rio Grande border in a 90 percent, one hundred and ten degree Texas day doesn’t have enough money to pay her electric bill. A couple hundred dollar electric bill and one hundred and fifty dollars air conditioner from Walmart is a heck of a lot less money than an ambulance trip to the hospital and a three or four day stay. And and helping identify those kinds of people where you’re helping a person see their granddaughter get married. These are preventable, avoidable things that happen catching a breast cancer at stage one or zero, helping people understand the importance of being screened helps drive down costs and helps improve people’s lives.

John Moore III: [00:13:21] So, OK, two rapid fire questions What are you listening to right now? Like any good music you’d recommend?

Jerry Shulz: [00:13:28] Oh my gosh.

John Moore III: [00:13:29] I’m a music guy! Got to ask.

Jerry Shulz: [00:13:32] I guess I’ve been listening to Brothers Osborne lately. Ok. Love me. Some brothers, Osborne. Ok.

John Moore III: [00:13:37] Yeah. Any good books you’d recommend?

Jerry Shulz: [00:13:40] Oh gosh. I just read a couple of history books, but I love reading military history. Ok, I just read a book called Spearhead. What’s it look like? Yeah, I just read a book called Spearhead, which is a U.S. bank based tank crew. Ok, in Europe. Ok, so and the plight that those folks went through, I think there’s a lot of lessons in military history that are really applicable to the business world.

John Moore III: [00:14:07] That makes sense. All right. Three words to describe him this year.

Jerry Shulz: [00:14:12] Mission driven attendees.

John Moore III: [00:14:14] Ok, I like that. And then finally, how do people find out more about you and what you’re doing with light beam?

Jerry Shulz: [00:14:20] Great question. Our website Light Beam Health Solutions, please visit, register email LinkedIn. Jerry Schultz with no see. We’d be glad to come out and talk to you. Ok, great. Thanks a lot for your time today. Thanks.

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