Season 1, Episode 11: Transcript

Introduction

Angela Greenwell: Welcome, everyone. Thank you for joining us. You’re listening to Atlanta Business Impact Radio with Veanne Smith, and I’m your cohost, Angela Greenwell.

Atlanta Business Impact Radio is a podcast that showcases some of Atlanta’s most innovative and forward-thinking business and technology professionals. In our first season, we take a deeper look into the world of healthcare IT. In today’s podcast, we talk about value-based care, where physicians must look at the entire patient experience across all care settings to provide a better quality of care, and the data and analytics required to make this possible. Both Veanne and I are very excited to welcome as our guest Kirk Elder of WellCentive.

Veanne Smith:        Welcome, everyone. Thanks for joining us. This is Veanne Smith with Atlanta Business Impact Radio. In this episode of our podcast, we will look at how data analytics is helping us to deliver value-based healthcare. I’m excited to welcome Kirk Elder as our guest today to talk on this topic.

Kirk is a 15-year veteran of internet business models, and his goals are to create revolutionary population health analytics solutions for WellCentive, where he currently serves as their chief technology officer. Previously, Kirk held senior management positions at healthcare, abstraction, and analytics firms as well as industry-leading SAS-based medical record documentation solutions. He has deep experience in the development of innovative clinical analytics, dictation, speech recognition, natural language processing, and B2B solutions. He is an expert in product-to-market initiatives and agile and open-source engineering techniques.

Kirk holds a BS in physics with a certificate in mathematics from Georgia Institute of Technology. During his education, he worked in experimental nonlinear dynamics, chaos theory, and quantum mechanics.

That’s a quite impressive resume, Kirk. I don’t know if I can keep up with you, so welcome here to Atlanta Business Impact Radio.

Kirk Elder:                Thank you very much. Glad to be here.

Top 10 Innovator Award

Veanne Smith:        Good to have you. I wanted to start out just by saying congratulations. I had read recently that WellCentive was named a Top 10 innovator by the Technology Association of Georgia. Each year, I know TAG recognizes companies whose products or solutions are changing their industries and putting Georgia on the map as a state where technology innovation can thrive. You and your team must be so excited about it.

Kirk Elder:            Yeah, absolutely. It’s wonderful to be recognized for something that you’ve been working really hard on for a long time with a singular focus because it’s always chaotic. You don’t ever get that opportunity to just stop and pat yourself on the back, and so I love what TAG’s doing with that program. It was a very large event, and I was amazed to see how many people where there, so that just made it feel all the more special.

Veanne Smith:      It was a great list, and I think I saw where they had such good participation and so many companies to recognize this year, I think they even added one to the list, [laughs].

Kirk Elder:            Yeah, that’s right.

Veanne Smith:      I was excited to see so many good companies on there that I’m aware of in the industry, so congratulations again.

Kirk Elder:                I even saw some companies I might try to work with.

What Is Value Base Care?

Veanne Smith:      Like I said, I was impressed with the list. Let’s talk about what you have going on and our topic here today. I understand that much of what WellCentive does is around value-based care. This is a relatively new term for me, so I think it would be great if you could start out by explaining to our listeners what value-based care is and how it differs from fee-for-service.

Kirk Elder:            Yeah, absolutely.  Understanding that is probably the most important part of the equation here because I think when I talk to most people about it in layman’s terms, they say, “Yeah, that makes sense.”

Today, if you go to a physician or healthcare system and you have something wrong with you, when you visit that doctor, they will treat you, and they will get paid for treating you no matter how good of a job they do or don’t do. Really, what’s happening in the healthcare system is that payers are sick and tired, and when I say payers, I mean insurance companies, but I also mean the employers and the consumers themselves, are sick and tired of the complexity in the healthcare payments and the fact that they pay without really achieving the outcomes that they’re looking to achieve. It’s difficult to measure the outcomes, it’s difficult to understand how much you’re going to pay, and as prices keep going higher and higher, it is just frustrating for everyone. Even the physicians are frustrated because they’re trying to understand how do they compete in the marketplace and demonstrate their quality because many of them really do produce high-quality care.

Veanne Smith:      That’s why they’re doing what they do, right? They want to help patients.

Kirk Elder:            Yep, they do. They’re very passionate about it.

Veanne Smith:      Really, they’re in that position because they want to help people, right?

Kirk Elder:            Exactly. Many times, technology can be an impedance for them, and high-quality care is not really always in the physician’s control. It’s largely a systemic issue and a process issue across a healthcare system, and so the healthcare system has to be incented to change their processes and their work flows so that they can produce a better result.

If I go to the doctor and I have lower back pain, I might actually see six to eight clinical resources across two to three different facilities, and so that forms a work flow across those facilities. To make sure that I’m tracked throughout that entire process, and that the best decisions are being made, and high-quality but low-cost care decisions are being made, unless the healthcare system really aligns its software and its processes to that, it won’t happen on its own.

Where Did Value Based Care Come From?

Veanne Smith:      That totally makes sense. I’m curious, where did the whole idea of value-based care originate, and then, what’s really going on, if you can talk about behind the scenes, that’s driving this change?

Kirk Elder:            I wouldn’t say that it originated as much as I would say that it’s evolved forever. I think people have tried to measure the quality of care for a long time, and there’s many industry-standard organizations out in the nation today that create evidence-based guidelines for defining what is high-quality care.

Over the past 20 to 30 years, there’s been an evolution and a maturation of different pilots, and programs, and opportunities to try to structure and quantify the quality of care and to try to pay the physicians and the healthcare employees based on the severity of the case, based on the complexity of the case, and based on how well they do.

It’s really evolved. One of the things that’s really changing today is that prices have increased enough and that consumers and the payers are frustrated enough that they’re really trying to take it away from these pilots and these one-off test cases, and they’re really trying to scale value-based care across their entire system. That’s where the challenge comes in because there are not many tools out there that really recognize that the quality of care goes across the ecosystem. You need a complete longitudinal patient chart, and you need to make sure that everybody who has access to that chart understands what the goals are.

What’s happened over the past four or five years, really, is a resurgence of belief that we can do this because cloud-based tools, better accessibility to technology, the roll-out of EHRs across the industry the past ten years has really created an information platform such that the population health management tools can sit on top of that platform and then really benefit to give insight to the quality of care across the continuum of the healthcare system.

Veanne Smith:      I think it’s without a doubt the pace of change is so rapid, as you indicate. All these things that I’ve been learning about here over the last months are coming on at the same time; it’s such a convergence. I really love where it’s headed, all about focus on the patient and making sure they’re getting better and they have more information at their hands to make the right choices. I guess I’m curious to know from you. It seems like we’ve gone a long way, but I suspect we’ve got a long way still to go. I guess I’m curious, in your opinion, where do you think we are in that spectrum?

How Long Until Value Based Care Is more Prevalent?

Kirk Elder:            Absolutely. I think some people will argue whether or not value-based care will ever take over the predominant payment mechanism. There are things about value-based care that don’t necessarily make sense in some settings and where, if a healthcare organization needs to get paid for an event, they may not be really responsible for the overall quality of care.

Fee-for-service will be around for a long time, and value-based care will just take up a larger and larger percentage of that, but we’ll find a balance based on the types of patients and events that are occurring in different regions. That’s why it’s very regional. I would say that we have about a ten-year runway to really transform the healthcare system and transform its processes, and its systems and the people’s thinking to fully adopt value-based care.

Veanne Smith:      Do you think we have another ten years ahead of us?

Kirk Elder:            Yes.

Veanne Smith:      I don’t know. That’s why I asked the question. I’m curious. I guess that’s probably, in the scheme of things, not that far, but yet it probably seems like there’s a lot to do, right?

Kirk Elder:            Yeah. Hospitals just started introducing a particular type of severity code called a DRG in the 80s, and those are still around and working well in a lot of cases. What we’re setting up is something that’s going to last for a very long time.

What Needs To Happen To Make Value Based Care A Reality?

Veanne Smith: You talk about the ecosystem changing. You talk about the health system versus, I guess you’re talking about, just standalone hospitals and clinics. Is there anything we haven’t covered, anything else that you can offer about what really needs to happen to make this a reality in terms of relationships with payers? Is there anything else happening that we haven’t talked about?

Kirk Elder:            Yeah, absolutely. If you’re getting paid based on the quality of care, you need to control it. To control the quality of care, you have to own the patient, you have to own the data, and you have to take the responsibility to advise the patient, based on the data, where they need to go.

Healthcare organizations are transforming, and they’re transforming so that they have a complete continuum of healthcare providers that can provide complete care for the patient. Healthcare businesses are looking at, “How do patients access all of my services? Do I have all the healthcare services I need? What is my market for my patients, and how do I actually get to the point where I own the patient so I can therefore guide them through the process the best?”

If the patient can go, based on their insurance, to any provider they want to in the nation, some of those providers are going to only get half the information and only have half the control to guide the patient to the best outcome. Providers are contracting with payers so that they can better own the patient and be more responsible for the clinical quality and take on more risk. Therefore, they’re aligning their systems, and their facilities, and their doctors’ offices to support that.

Veanne Smith:      I’m sitting here listening to you thinking how impressed I am that you, as the chief technology officer at your company, know so much about this business. I guess you have to, and you probably do because of all the data you’re looking at all the time. It’s really impressive how much of a business savvy you have about everything, and here you are on the technology side of the house.

Kirk Elder:            Thank you very much. I consider myself a student of healthcare. I think it’s a very interesting problem to solve for the nation and for humans in general.

Veanne Smith:      It’s a passion. It’s always great when you can have a job where you’re passionate about what you’re doing. The end result, what you’re doing, is something you’re passionate about. That’s awesome.

Kirk Elder:            It’s something that is a long-term problem, so it’s something you can dedicate your life to.

Veanne Smith:        There’s plenty of opportunity for you ahead.

Kirk Elder:            Yeah, exactly [laughs].

How Is WellCentive Helping Providers To Enable Value Based Care?

Veanne Smith:      [Laughs] All right, it might be a good segue. I’d love to have the opportunity for us to talk a little bit more about WellCentive. Maybe you can tell us about how is WellCentive helping providers to enable this value-based care? Just maybe tell us a little bit about what’s going on in your organization in this regard.

Kirk Elder:            Yeah, absolutely. All of these value-based contracts that we’re talking about take the form of different quality programs. There are some that you may’ve heard of, some you might not have heard of. CMS has several value-based programs, ACO programs.

Veanne Smith:      Define CMS.

Kirk Elder:            I’m sorry, the Center for Medicaid Services.

Veanne Smith:      There we go. Some people call that content management systems. [Laughs]

Kirk Elder:            That’s true [laughs]. They have a couple of different programs. They have the ACO Program, the Meaningful Use Program. They have a program called PQRS. CMS is just another insurance payer. Many different payers will create many different types of programs.

WellCentive essentially configures our system to help the providers and the healthcare businesses really understand where they’re standing withinside that contract and that program. The way we do that is we call it the four As. We do data aggregation. We collect data across the community. We’ll go to every facility, every physician practice, every hospital, and we’ll connect to their EHR, or their laboratory system, or their practiced management system. We’ll take that data in, and we’ll aggregate that to form one normalized, clean, longitudinal chart.

The second A is analytics. We take all those charts, and we walk through clinical quality analytics, risk stratification, predictive models, and total-cost-of-care analytics, to really make sure that we understand how certain populations that they’re managing are faring and how well they’re doing from a clinical quality and a cost perspective and how those numbers might change over the next 12 months based on rising risk or falling risks patients.

The third A is the action. Essentially, our customers need to not just look at the metrics and the numbers, but they need to do something about it. The work flows, like the letter outreach, automated voice outreach, or care management human outreaches working directly with patients, integrate directly into the analytics. When a patient is triggered for a particular metric, that patient directly goes into the work flow that’s going to help improve and manage that patient’s condition according to the guidelines that all the quality organization standards are specifying.

Physicians are really, really frustrated, and these organizations are really frustrated because each of the payers have so many different programs that all the metrics are just slightly different. They’re having to contend with all these different clinical quality specifications, or worse, they log into five different systems, one for each payer, to record how they’re doing. It’s really difficult to prove the value when you have 10,000 patients in your practice and those are across 10 different payers.

That’s where the fourth A comes in. We talked about aggregation, analytics, and action. The fourth A is accountability, and that’s really being able to prove to the payers what your clinical quality is and how well you’ve done in managing costs.

Veanne Smith:      Which I would imagine, then, allows or enables them to get paid more often and more completely, I would imagine.

Kirk Elder:            Yeah, absolutely.

Veanne Smith:        It helps in the revenue, I would assume.

Kirk Elder:            Absolutely. It makes a significant revenue impact. We look at as much as $60,000 per physician that they can get. Some of our oldest customers are now operating inside of at least ten value-based programs across their network, and they self-fund their own evolution and maturation.

Veanne Smith:        You can show very good, real ROI, which I imagine helps you all be successful, then.

Kirk Elder:            Absolutely. We have to do that out of the gate, so typically, when we get a new customer, we mandate that there is some value-based program that we show results in in the next three to six months.

Where Will Technology Take Us In The Next 3-5 Years?

Veanne Smith:      I love the four A. I think I’ll even be able to remember that, so [laughs] that’s great. It’s always helpful. Based on everything you’ve done and seen in your past, I like to always tie technology in a little bit more, if we can, than we have. I’d like to talk about technology and data science and how you think it’s going to actually change things and impact us in the next three to five years. We talk about a ten-year window, but what do you think we’re going to accomplish in the next three to five?

Kirk Elder:            That’s a great question because the system, the healthcare system, is so fragmented, and there are so many technology vendors. It becomes really hard to work across all of your work flows and processes to achieve an outcome.

Veanne Smith:      I was thinking as I was listening to you how many integration points you have to have and how many EHRs there are out there.

Kirk Elder:                We’re really just scratching the surface. We have about 3,000 live interfaces. We process a billion data points each month into our data center, and these are clinical events that are occurring out there in the real world. We are just barely scratching the surface. It’s really about operationalizing it and allowing it to continue to scale even though we have 3,000 interfaces and process a billion data points, it’s really about making sure that we can do this across every physician, every specialty, every medical condition, across an entire healthcare business.

If you look at one of our customers, Columbia University up in the northeast, they have a thousand physicians, and there aren’t programs out there for a thousand physicians. It’s very difficult, even with today’s tools, to really excel in every facet of every medical condition, every specialty in healthcare. It’s really about continuing to broaden the support for these programs, and medical conditions, and physician types.

We have a data science team that’s actually helping to accelerate that through a concept we call value discovery. When a provider contracts with a payer, typically they’re contracting for a set number of patients. When we get the data from the healthcare business, we’re actually able to do analytics on their entire patient base. Our data science team is looking at that data, helping advise the customers of where there’s an opportunity for more and more contracting to essentially fund the improvement of quality of care.

One of the reasons why quality care isn’t perfect is because in all cases, it’s just not funded. The payers are not paying that way. They need to support all the measures and all the modalities of care to be able to really roll that out to all the different types of patients that are out there.

Will The Data From Value Based Care Be Available To Patients?

Veanne Smith:      It makes sense. This has been enlightening. Value-based care makes a lot of sense to me. It seems that, armed with data, it would be likely that patients could make more informed decisions and choices. I think when we buy a car or a major appliance, we wouldn’t think of doing that without doing some research or checking out Consumer Reports.

I’m curious what your thoughts are. Is there an initiative where this data will be or can be provided to the patients? Does WellCentive do that, or is there an initiative going on in that regard?

Kirk Elder:            Absolutely. First of all, WellCentive really believes in an open system. Certainly, we take security extremely serious and do everything we can to make sure that we are as compliant with HIPAA as possible, but it’s very important for all the people who are contributors to the goal of quality of care have access to the same information to make better decisions.

Patient compliance is a huge factor, patient adherence, and you can’t really comply unless you really understand what you’re trying to do and what those goals are. We produce patient report cards. We have a patient portal.

Veanne Smith:      Who gets the patient report card?

Kirk Elder:            The physician and the patient do, so what actually happens is we firmly believe that value-based care is going to succeed first with physician engagement and then with patient engagement. We don’t necessarily advocate for the patient coming directly to WellCentive to get the record independent of the physician.

Veanne Smith:        They get it through the physician.

Kirk Elder:            They get it through the physician, yeah.

Veanne Smith:        That makes sense.

Kirk Elder:                Whether it’s a physician or a care manager, they have someone to walk them through what it means. Even though I do this for a living, if I were to look at my own record, I wouldn’t have a clue as to what it says, so how would someone who’s not even in healthcare really have a chance at understanding that? We firmly believe that it’s got to come through the healthcare system to the patient so that they can be hand-held through the process.

Closing

Veanne Smith:      That makes total sense. Listen, I’ve learned a lot today. This has been fantastic. I would imagine there are some listeners out there that may be interested in learning more or making contact with you. What would be the best way for them to do that?

Kirk Elder:                Yeah, definitely. Come visit us at www.WellCentive.com or look for any healthcare conferences, and we’re most likely there and definitely willing to chat.

Veanne Smith:      Kirk, it’s been an absolute pleasure having you here with me today on Atlanta Business Impact Radio. Thanks so much for your time. I know you’re really busy.

Kirk Elder:            Absolutely. I enjoyed it.

Angela Greenwell: You have been listening to Atlanta Business Impact Radio with Veanne Smith, and I’m your cohost, Angela Greenwell. This program is brought to you by SolTech. For more information about the podcast, including other episodes, you can visit our website at Soltech.net or find us on iTunes. Thank you for listening, and we look forward to having you join us again.