I attended the HASummit’22 as a first timer, accompanying our seasoned leader and expert analyst John Moore. He summarized his thoughts in a blog post that I highly recommend you read before reading mine.
Key Attribute: Trust
John referred to the strong relationships between Health Catalyst (HC) and their 300+ clients. That loyalty was indeed visible, and quite justified, given how so many of the clients who presented shared some truly impressive results.
HC is embedding themselves deeply within the heart of healthcare value-generation and decision-making activities, at a scale where change that affects the entire sector takes place first. Tech outsiders have failed in the past because they do not understand the historically complex relationships throughout the sector and fail to build the trust needed – not because their technology couldn’t do the job.
While I agreed with many of John’s conclusions, some of mine were a bit different, probably because they drew in large part – much to his chagrin – from the fifteen years I spent working in healthcare myself. Making change happen in healthcare is incredibly difficult, and to see it taking place at such scale, at so many different institutions, was truly extraordinary for me. I am profoundly inspired by the energy of so many people who truly believe in making a difference.
Key Capability: Aggregating Clinical, Operational, and Financial Data
The ability to aggregate and analyze disparate sources of operational, financial, and clinical data is the technology underlying all these success stories, across their wide variety of applications, all at the healthcare system level. While John felt that HC was doing itself a disservice by not pursing the life sciences and payer markets at this time, I disagree with him there. I think that the targeted focus of internal alignment at the healthcare system level will bring them tremendous competitive advantages in the longer run (as long as their cloud migration and changes to the data architecture model have no disasters). While providing analytics to payers may support the payer-provider convergence that would accompany the VBC transition, HC seems to be leaving that role in the hands of health systems, while empowering them for those conversations.
Sure, the business model will not generate as much immediate revenue as would selling de-identified clinical datasets with analytics capabilities to life sciences and payers. But consider the depth of knowledge that can be harnessed from the HC vantage point with such a targeted focus – data on healthcare system level optimization that aren’t subject to forced sharing via the Information Blocking Rule. Surely, these would become very valuable data assets to hold when everyone else eventually holds the same massive clinical and claims dataset – not to mention that a reputation built upon trust will hold great value in a market where trust is currently in very short supply.
Key Approach: Alignment Within the Health System
While Health Catalyst’s client base is health systems and not directly the providers within them, they may be one of the first to provide a platform with the right tools to align all of the internal forces for the health system. Nearly every one of the most recognized and respected healthcare systems still struggles with misalignment of incentives within their own organizations. This is not limited to provider versus non provider leadership – it is pervasive throughout the healthcare system at all levels.
Addressing this can empower providers in a truly meaningful way – not only mitigating the effects of immediate burnout, but also helping to ensure that the future of medicine is shaped by empowered physician voices – the ones who take that all important oath.
We talk about the healthcare sector moving into the world of VBC, but it is the healthcare systems that make up the majority of the entities tasked with the heavy lifting of that journey. Their success or failure matters to all of us. Health Catalyst’s platform appears to be doing an effective job of providing technology that works within the existing structures, that addresses the most immediate financial and labor pain points right now, while also helping with the longer-term transition to value based care.
Analysts: Internal, Outsourced, or Blended, but Always Dedicated
All of the health systems that presented at HASummit had a dedicated analyst team in some form or another. Not one health system had simply reconfigured their existing IT department into an analytics department. Regardless of internal or external labor sourcing, nearly every health system reported restructuring the reporting hierarchy away from the common initial set-up of analytics managed under IT. Most had shifted analytics to report alongside traditional IT; one especially bold health system had gone so far as to have their IT team reporting to the analytics team.
Dr. Patrick McGill of Community Health System was a vocal proponent of the analyst outsourcing service line from HC. Dr. McGill acknowledged that the optics of outsourcing were a challenge, but one best handled by addressing it early, head on, and often. Like many health system groups, they found their labor costs alone had increased by $100 million in just the past year; not including increases in the costs of medicines and utilities, two of the other largest cost drivers.
At the very least, the outsourcing of analyst expertise seemed to play a powerful role in improving the financial health of Community Health System. Informal conversations with other attendees revealed similar experiences for a number of Health Catalyst clients. The message seemed to be this: at a certain point, there is no choice but to structure more flexible labor models that take advantage of outsourcing options, particularly for the data analyst roles. Clearly, it is becoming increasingly difficult for health systems to find, recruit, and retain analysts, as demand for this skill set continues to increase.
Documentation Compliance and Physician Engagement: Surprising Bedfellows
Documentation workflow is the heartbeat of any practice, hospital, or health system, because it ultimately drives the bill drops that generate revenue payments. A great challenge currently being addressed is how to engage physicians in handling the non-clinical part of the work that is associated with the transition to value-based care – much of which centers around this documentation.
There is no technology band-aid to install that can fix this. It begins with building the right team of stakeholders and physician champions that work together in developing workflow processes first. Then, apply the technology to the processes. Finally, one adds artificial intelligence capabilities to strategic parts of the workflow that can incrementally enhance efficiency, while mitigating risk.
Consider one example from a HC client that was presented at the conference on the use of real-time nudges for providers when they are charting notes during encounter. If the phrase ‘kidney disease’ is entered into the note, but the stage of the disease is not entered, a real-time alert will pop-up on the screen asking them to confirm disease stage. Not only is this needed for documentation requirements to optimize revenue, but also, consider how this can significantly improve the quality of these clinical data for all sorts of analytics applications.
There is also the patient facing end of documentation: the patient medical record. As one client stated, “We owe patients an accurate story.” Where does the story become the medical record? The rubber meets the road during the patient interactions with their medical providers. The goal of complete and accurate medical records is only one part of this; the real value driver comes from tying back into the upstream part of the clinical care process.
Simplifying the Increasing Variability and Complexity of the Contract Mix
One of the underrecognized aspects of the VBC transition is that health systems and hospitals no longer have just a mix of different fee for service contracts with their myriad of contractually determined rates for each CPT code. Now, we add in extra confusion as most of them also have a number of outcomes-based population contracts in place. There are contracts that provide incentive to achieve better health outcomes, and others that incentive reducing risk, depending on which patient we pluck from the mix.
In some circumstances, a provider is managing the patient; in others the same provider must be managing a population. While infrastructure on population health management has made good progress, the administrative side of things haven’t kept up the same pace.
This generates substantial variability in not only contract models, but critically, the payment cycles are quite different. Imagine waiting an entire calendar year, and then having to undergo a reconciliation process that can take up to 18 months to complete, before one can gain visibility of the interplay between performance and financial bottom lines. This lack of visibility can create a lot of financial planning challenges when peeling apart the components of risk, and their various timetables must be done manually. This is where that HC analytics engines powered by the trifecta of clinical, operational, and financial data are playing an admittedly unsexy – but critically needed – support role for a growing number of their clients.
Health Catalyst is big on culture as a force for positive change. A journey of improvement within healthcare can only begin by first building the right culture, and that culture is driven by physician engagement. A lack of physician engagement is a big reason why VBC isn’t happening – because of physicians not being engaged in that process. They aren’t incentivized, they are burnt out, and as aptly stated by one presenter – they simply don’t understand it. It is time to change this, and HC is doing an impressive job helping to facilitate just that by providing the tools and building the trust that health systems really need right now for stability, with the support to transition to VBC reimbursement models in the longer term.