Gregg Masters PopHealth Week is brought to you by Health Innovation Media. Health Innovation Media brings your brand messaging alive via original or value added digitally curated content for omni channel distribution and engagement. Connect with us at www.popupstudio.productions. Welcome everyone. I’m Gregg Masters, Managing Director of Health Innovation Media and the producer and co host of PopHealth Week. Joining me in the virtual studio is my partner, colleague and lead co host of PopHealth Week, Fred Goldstein, President of Accountable Health LLC. On today’s show, our guest is Lisa Rawlins, principal in the Seattle Office of Health Management Associates or HMA. Lisa is a proven leader in numerous areas within the healthcare system, including health policy, analytics, community strategy, government programs and the uninsured and healthcare delivery, development and redesign. She is also experienced and dedicated in the areas of health care Information Technology Advisory Services, as well as managed care, Medicaid market solutions, accreditation and public health. Lisa has extensive experience building branding and implementing innovative approaches to healthcare delivery, quality, safety, health policy and consumerism. Her experience also includes work in advanced primary care systems, planned care coordination and proactive Community Health assurance initiatives leading to meaningful engagement of technologies and consumer centric integrative health services for a wide variety of stakeholders. And with that introduction, Fred, over to you help us get to know Lisa.
Fred Goldstein Thanks so much, Greg. And Lisa, welcome to PopHealth Week.
Lisa Rawlins Thank you, Fred. It’s a pleasure to be here.
Fred Goldstein Yeah, it’s fantastic to have you on this time really excited about this opportunity to talk to you we’ve obviously known each other for a considerable period of time, why don’t we begin give our audience a little sense of your background?
Lisa Rawlins Absolutely. So as I was mentioning to Gregg earlier today, I have been in the healthcare industry about 30 years and I have seen the healthcare industry from many angles. As a former hospital administrator, I was the former vice president of Population Health Informatics for Providence St. Joseph’s health, which is the third largest not for profit health system in our country. I also did a lot of the Pioneer work for Massachusetts General Hospital and Brigham Women’s through a technology company that supported their population health strategy, and have spent not only from the provider side, it’s been about 10 years in the Florida House of Representatives where I’ve written more health care law than I can remember, everything from health insurance to Medicaid to public health, facility regulation, practitioner regulation, if it had anything to do with health care, have probably written a law about it. And I’ve also have worked in the IT space quite a bit after I left the legislature, I headed up an initiative for the great state of Florida, where we were publicly reporting on hospital outcomes for the very first time in the country. And interestingly enough, the program we launched in Florida was the model CMS use that now publicly reports on hospital outcomes. In addition to the work I did on the Transparency Initiative, I headed up the State Health Information Exchange initiative, which gave me a lot of experience and background on how data, clinical data is communicated in that care continuum. So I’ve had quite an interesting background and really have a broad spectrum view of the healthcare system in our country.
Fred Goldstein Yet, it’s fantastic, obviously, from the policy work to the operational work to the data and technology work, you’ve really covered a broad spectrum of it. And as we talked about earlier, back in the day, when we used to call it disease management. We were first kind of in this before we started referencing population health in the broader programs. So one of the things I found really fascinating in our discussion earlier this week, was your talk about change management, that it’s really about change management for organizations to get into population health. So you can you talk a little bit about that.
Lisa Rawlins Absolutely. Like any initiative, whenever you’re looking at a total redesign of any program. Change Management is really the foundation of any initiative that encompasses that level of change in an organization. You know, you have to look at the population health ecosystem in regards to you know, how is an organization ready to make that change, you know from an organization’s financial material, human resources and information systems in regards to, Are they ready to accept a change and in change management, it’s very critical that you have a key spokesperson. So in relationship to a population health strategy around executing health system redesign, I would highly recommend that your CEO of the health facility actually be that spokesperson on why the move from a heads in the beds business model to a more proactive care model is essential in their success moving forward. Some of the key of what I would classify as the seven change management best practices is to mobilize and activate and have a visible sponsor of your project, also dedicate change management resources, because not every organization is ready for change. Or today in today’s healthcare ecosystem, they’ve gone through so much change with COVID-19, that they’re changed burnout, it’s really important as you look at any change management initiative that you need to apply a structure change management approach, engage with employees, and encourage their participation in the process that you’re executing.
Fred Goldstein So some of the areas where it’s interesting, because we talked about this, IT companies have come out and said, we do population health, we we are a population health company, and you’ve obviously worked for these IT companies, where do they fit? And how how do you take that change you’re trying to implement and get it throughout the organization?
Lisa Rawlins So Fred, that is a great question. And the analogy I like to use is that IT although I am IT, data driven person, it is only a tool. And I often use the analogy, when you go to Home Depot and you buy a toolbox, and you’ve got a box full of tools, and you come home with your toolbox that does not translate into making you a carpenter in the ability to build a house. So IT is a tool in this process of change management. And it’s one of the key components in change management. But you have several different components in a true population health strategy, everything from how are you analyzing your data? What type of technology do you have in place for data visualization? What type of EHR platform are you working with? Are you executing telehealth services. And then population health also focuses from a clinical, you know, the foundation of clinical workflow redesign, looking at everything from behavioral health care coordination across that care continuum from primary care to tertiary care how referrals are made within your system and how that post acute care process is executed. So there are several key components from a population health perspective that you have to consider. And IT is a great tool to use and a necessary tool. There are some disadvantages in IT tools that you need to be conscious of, and the point a robust population health management strategy.
Fred Goldstein So can you give some examples where you’ve seen it effectively used and what were some of the things they did?
Lisa Rawlins Absolutely. So when you look at the let’s use an EHR platform, an IT tool that has been deployed, you know, over the last decade, the US has invested billions of dollars in EHR adoption, and EHR products were designed and developed reflective of episodes of care, you go in to see your doctor, you’re treated in your release, you go into the hospital, you’re treated and released. Those are what we defined as episodes of care, EHR platforms were the digitized version of that paper medical record. It really was not designed around that care continuum. What happens to that patient once they leave our four walls of our institution? And so you have to look at ways in which you can abstract that data from your EHR platform, communicate that information throughout the care continuum, even outside of your four walls, you can do that typically through an HIE process. You know, many states have invested several millions of dollars in trying to create a health information exchange to support that care continuum communication. But I would say we’re still sort of in our adolescent stage of an HIE exchange of data currently in our
Fred Goldstein and this is the issue that that the way we’re structured now we need to take these more continuous or continuum platforms and bolt them on to an EHR. Are you seeing good examples of them being built inside it? Or is it really bolt that on Bolt an HIE on? Okay, we got to get this out to the nursing home, bolt their system on etc.
Lisa Rawlins So that’s an excellent question. And quite honestly, I’m seeing a combination of all of the above. And so with the recent rules that have been proposed through CMS and OMC, around MIPS and interoperability in sharing data and the metrics required to meet those goals and targets under the MACRA, MIPS program, there’s a lot of focus for the EHR platforms to become more interoperable. But what we’re seeing in practice on a day to day basis is that the EHR platforms have not become as robust as the regulators would like to see. And so you have a combination of EHR platforms interfacing with local HIEs, and even internal HIEs to organizations in relationship to trying to build out that communication between provider to provider to provider. And it has been an interesting journey to watch the evolution of this process. And I’ve been thrilled to be part of that, and leading discussions both on a national policy level perspective, as well as from a organizational perspective from a hospital administrator in trying to execute this population health strategy.
Fred Goldstein And have you seen some good examples of that within communities or areas being served by play multiple facilities or things like that?
Lisa Rawlins I have. And so I don’t want to name names. But in one of the organizations I’ve worked with, there’s been there was a large ACO, for an industry, large industry in the community. And in that ACO, you had the Accountable Care Organization, you had many providers from many different systems working together. And so in the initial phase, we started to share claims data amongst each other to understand where that patient had been seen in the last few months within the medical service area. In addition to that, that was sort of like the first baby step we took. And then we started to ask how do we share that clinical information across the the spectrum, from facility to facility to organization to organization, and we worked with the local HIE initiative to share that information. And it was critical information about admissions, discharge and transfers, a list of diagnoses was shared between providers, so that as that patient would arrive either as an inpatient and or an ED patient in facilities, they had the background information on that patient beyond their four walls in regards to who they were treaing.
Fred Goldstein And what was the response from the providers to getting this the physician etc getting this new data sets and information? Did they find it highly relevant, hey, this is great stuff, or was it tough? Because obviously, you also talk a lot about workflow change and things like that. So how was that accepted?
Lisa Rawlins Another really great question, Fred, you’re putting me on the spot here. But it’s it’s been interesting in that I’ve seen it from one extreme to the other. And what do I mean by that? So for example, some of the emergency room doctors that are we’re working with, what we like to call in the ED is frequent fliers. They may be frequent fliers in our facility, or they may be frequent fliers in other facilities and just showed up in ours. And without that health information, exchange data. They were clueless that, hey, this patient has been seen at the hospital down the street, you know, 50 times in the last year with a backache, asking for pain medication. Well, now they’re over here at our facility. And we heard really positive comments from the ED staff in regards to having that historical information or in the case where you have a chronic patient who has comorbidities, we’ve heard the same response in that, it is very valuable to understand the different facilities that are treating the patient for the different comorbidities, and so that they will, they’re able to treat the patient from a whole person care perspective.
Fred Goldstein And it’s, it’s interesting, because it goes back to the days we were back back in the day we’re doing the HIV programs. And suddenly you’ve we identified one of the early patients was getting antiretroviral drugs from four different doctors. And none of them knew that the other been prescribing it until we’re able to get the information, and obviously wanted to be aware of that and help to help to solve that. So it was fascinating to see that, and it’s obviously still an issue today, we’re still working to try to get that data out to providers. But I think we’re getting a little better. It sounds like and and some of this gets back to your whole point about it is about change management and explaining, you know why we’re doing this, how we’re going to do this, what it ultimately will lead to, and part of that is we’re trying to move to this whole model of value based care now. So what are some of the things you’re seeing around change management to help providers and others get into that frame of reference? And I think when we talked about a little bit you mentioned, it really starts with where are they and you do this unique assessment of their capabilities to then figure out where they need to go, right.
Gregg Masters And if you’re just tuning in to PopHealth Week, our guest is Lisa Rawlins, Principal in the Seattle Office of Health Management Associates,
Lisa Rawlins correct. It’s a big transition from the heads in the beds business model that, you know, we are paid every time the patient comes in the door, and we treat that patient and release that patient. Now, organizations and facilities are being held accountable for the outcomes of that treatment. You know, I remember my days, my early days in process improvement, and I was in a class and I had colleagues from around the world. And we were talking about hospital metrics that, you know, 15, 10 years ago, and a simple hospital metric around the number of average length of stay in a hospital. So in a hospital system historically, you know, patient in patient out and the lower that average length of stay was, the better we looked internally and externally. I was talking to my colleagues in Canada, where their average length of stay was about six days to our 2.5 days. And they’re like how can you get the patients in and out so quickly? Without them returning? I said, Well, actually, they end up returning oftentimes, and we’ve seen the, the introduction of penalizing hospitals for readmissions in regards to better care for that patient. And with that being said, you know, it was a struggle. It was really a what I want to call a real shift in mindset for our hospital CEOs that I’ve worked with, and moving from that heads in the beds business model, to actually looking at that whole care continuum. And so we had the responsibility of trying to translate the value of that not only from a health outcome perspective, but from a financial perspective. And in an organization that is just beginning this process. We started through looking at our Medicaid population, because typically your Medicaid population is the lowest paying patient population in an ecosystem. And so we were able to demonstrate through our financial analysis and assessment, if the actual funds we were losing or the income we were losing as an organization, in following that typical heads in the beds business model. But as we were able to transition to a more robust population health strategy, we were able, again, to demonstrate the financial value of keeping those patients well, keeping those patients out of the ED, and assisting them in regards to a better lifestyle and better health.
Fred Goldstein Yeah, it makes a lot of sense. And you touched on Medicaid, which obviously near and dear to both of our hearts in a sense. And I know you’ve done a lot of thinking now about with COVID. So a lot of people are being put out of work. They’re gonna end up on Medicaid, and you’re seeing the differences based on state’s expansion or not, but it’s something hospitals really need to be considering and starting to do some analysis on, isn’t it?
Lisa Rawlins Absolutely. You know, I’m working with some hospital systems across the country currently where we’re looking at the financial impact, the loss of employer sponsored insurance to a large health system. And with that, you know, it coincides with now that you have a greater population in need of those Medicaid services that are hitting at a time when through COVID-19, where states have decreased budgets and money to spend on Medicaid programs. So that’s going to the end result, you know, my projections are, we’re going to see an expansion in that Medicaid program. But in many cases, we’re also going to see an expansion in the self-pay world. And I know with the change of administration that we’re starting to see in Washington, DC, that’s common knowledge of what’s happening. And there’s a lot of talk on the hill in regards to expanding Medicaid eligibility from a state perspective, as well as expanding that Medicare population.
Fred Goldstein So given that, as you said, the Medicaid population is the tends to be the lowest payer, and you’re now going to have more of this group potentially, within your community or state, is that going to be some incentive to begin to look at newer models, value based care, etc, to try and address that and put in these broader population health programs?
Lisa Rawlins So Fred, you make an excellent point there. And I think, as we have seen COVID-19, catapult us into the telemedicine world, I think we’re going to see that same long term effect from a value based care perspective, and that we can no longer as a nation afford a fee for service business model. It’s very expensive, as you know, the United States I think, has the highest costs in delivering healthcare, while we rank about 38th in the in the globe and healthcare outcomes. And so the focus is going to have to shift from a fee for service business model to a value base simply because of the economic impact COVID-19 has had in this country.
Fred Goldstein And are the providers themselves? Do you see this moving more towards, say, an incentive based model where you’ve got achieve outcomes, you get extra? Are we going to move further along to higher risk models like bundles and capitation as the value base models to use over time?
Lisa Rawlins Well, we’re starting to see that already. You know, in any in my experience from wearing a policymaker hat, you need to take baby steps in regards to moving an industry in an opposite direction. And I think we have spent at least the last decade and providing those incentives around improvements in health outcomes. You know, remember giving a speech about 10 years ago, when population health became sort of the the forerunner and I tried to compare population health to the days of HMOs. So remember, the days of HMOs, where it was a capitated process? Well, now we have a capitated process and value based care, that’s also tied to outcomes, which we didn’t have in the plain and simple HMO days. And so we’re taking baby steps that include, you know, incentives for improvements. And we also have a baby steps into penalizing providers for, you know, hospital acquired conditions, readmissions. And I think that will start to see that level out at some point in the next five years.
Fred Goldstein Yeah, it’s fascinating. You bring up the 90s. And Gregg and I have talked about this often, that it really was you said, the HMO back in those days, it was about cost,
Lisa Rawlins right
Fred Goldstein The cost, but as you said, you’re now bringing in this quality, which gets back to this whole idea of incentives for providers, how do you move that change that behavior? How do you provide the right data? How do you help the patient become a part of the system? So it’s really a very broad based approach to try and solve this problem and move us and population health just fits right in with that value based transition?
Lisa Rawlins Absolutely.
Fred Goldstein So are you fairly confident or excited or think we’re gonna finally get this? I know, at CMS, they said, you know, originally it was ACOs like you said, it’s going to be well, you make some adjustments, and we’ll pay a little extra more. And then they suddenly said, we’re not seeing enough change. So let’s just force you into these more risk based models. Are you are you pretty confident that we’re gonna make some good moves over the next couple years? Do you still think there’s some hesitancy out there in the industry,
Lisa Rawlins in my experience, you know, I remember reading The Institute of Medicine report years ago about hospital incidence and that you had a greater chance of dying of a hospital acquired condition or event than you did have a motor vehicle accident or breast cancer in this country. And those statistics are real people. And when I worked with a large public health system in South Florida, Broward health, I co chaired on the board, the quality and process improvement committee and our lead physician on that committee, you know, we would go over a monthly the statistics of issues that we were dealing with from a process improvement, population health perspective. And one of those statistics ended up being his his granddaughter. And so with that being said, I’m sure if we did a survey of everyone across the healthcare spectrum, Fred, you probably realize and know, someone that’s had an issue with a health care system and not the best outcome. I think we all know individuals like that, certainly, in my family, we’ve experienced that as well. And, you know, my passion in life is to make this world a better place than what I found it. And I have to say, with all the changes that I’ve seen over the last two decades, I really feel like we’re at that tipping point where we are going to see drastic change in our healthcare delivery system. And we will be competitive in regards to other nations across the globe. In our health outcomes. I mean, we have pockets of excellence within our healthcare delivery system in the US. And I’m starting to see that translate to great effectiveness in creating a population health strategy.
Fred Goldstein Well, I certainly agree with you on that and look forward to this continued progress in this field. I want to thank you, Lisa, for coming on PopHealth Week for all the work you’ve done in policy, operations IT across the spectrum and of course, population health. So thanks so much for joining us.
Lisa Rawlins Thank you, Fred. It’s been a pleasure to be here. It’s great seeing you again.
Fred Goldstein And with that back to you, Greg.
Gregg Masters And thank you, Fred. That is the last word on today’s broadcast. I want to thank Lisa Rawlins principal in the Seattle Office of Health Management Associates for her time and insights today. For more information on Lisa’s work at HMA. Go To www.healthmanagement.com or follow her work on Twitter by @LisaRawlins the number one (@LisaRawlins1) and please everyone we can get through this pandemic only together. So do mask up when in public, practice social distancing, and pay attention to personal hygiene. We can slow the spread of this deadly virus. Bye now.