COVER STORY · STATE OF THE INDUSTRY


to take on the value contract, and have the support and the infrastructure to do well.” Impact Advisors’ Zoph agrees, and


says he sees hospital and health system leaders moving forward with alacrity in that area. “I’m seeing analytics being harnessed dramatically now,” he says. “One [way] is for performance and capacity management, just to understand how and where you’re providing services. You realize that being a data-driven organization is really important, when you’re trying to determine how you’ll operate tomor- row. Second, the pandemic has had a big impact. So, what’s going on with my stroke patients? And mortality is up across the board. So organizations, facing limitations on how they’ll care for their patients, are really having to examine what’s going on with their populations. And the third element is related to health screening,” where he also sees progress going forward.


“Fee-for-service payment is still the dominant payment system in the country; and though value- based delivery is something that all of our members embrace, it involves a significant clinical, financial, and operational redesign. Our members are all committed to it, but it’s not easy; it’s very complex, and takes time. And the payers have to follow suit as well.”


—Chet Speed


Artificial intelligence breaks through


One key element in the data analytics revolution has been the rapid emer- gence of artificial intelligence (AI) and machine learning tools to turbocharge analytics processes in patient care orga- nizations. As seen below, progress is being made now in the leveraging of AI and machine learning in the clinical, financial (including revenue cycle management), and operational/


administrative spheres. Survey respon- dents were asked:


In what areas have you begun to adopt


artificial intelligence and machine learning into your operations? • Clinical: 33 percent • Financial/RCM: 31 percent • Operational/administrative: 25 percent • No areas: 46 percent Per all this, Impact Advisors’ Zoph


says, “The chatbot and patient interac- tions in health screenings are great examples of the use of AI in care delivery, to help guide and navigate the initial contact with the healthcare system. That’s a big change. The other area is support for diagnosis in diagnos- tic image interpretation. Our diagnostic capability continues to grow. In terms of video capability, as we’ve extended the use of the eICU, you can actually monitor patients for fall risk, and you can monitor patients in the room. So creating ambient information around what’s going on with your patients is a really interesting area,” he says. Zoph adds that leveraging natural language processing for physician documentation support will need to continue to move forward. “We have to return physicians to the practice of medicine, and reduc- ing their time in the record has to be part and parcel of how we improve the provider experience,” he says. And, he notes, AI will also be leveraged very significantly in clinical trials.


Looking at the social determinants of health


The discussions around the social deter- minants of health (SDOH) have intensi- fied in the last few years, as providers and payers alike look to try to enhance health status much farther “upstream” and much more globally, meaning, influencing the lives of patients outside the sphere of pure patient care Asked whether they’re incorporating SDOH into their population health management and care management work, 44 percent said yes, while 34 percent said they’re planning to do so soon. Only 22 percent said they have no plans to do so. With regard to that broad question,


Kelly Robison, president and CEO of the 1,700-physician San Francisco-based Brown & Toland Physicians group, which last August affiliated directly with Altais Clinical Services specifi- cally to enhance its ability to leverage data to enhance health status, includ- ing to address SDOH, says, “The social determinants of quality will pose both an opportunity and a challenge. There are a lot of factors that come into play


in terms of how to better deliver care and achieve holistic outcomes—how to integrate mental health back into care as well as nutrition, transportation, etc. That’s something that the entire healthcare industry has to prioritize.” And in that, Robison says, the for-


ward evolution of physician culture will be an essential element to reengineering how physicians care for patients more holistically. “I think that physicians by nature tend to be entrepreneurial, and I’ve been in healthcare for nearly three decades,” she observes. “Over the years, the management of healthcare has become so complex, and there’s been such a squeeze on reimbursement, and on top of that, there’s been so much con- solidation that now, a physician’s range of choices is so different. So for those physicians who want to remain entre- preneurial, and who want to remain independent and not have their destiny controlled by a hospital-based system, they need some kind of help. And that’s where organizations like ours can help: we can support physicians in their practices, while allowing physicians to retain an entrepreneurial spirit.” “I’ve noticed an evolution” in that


area, says Shannon Decker, Ph.D., Brown & Toland’s vice president of clinical performance. “It’s important to recognize that it’s a symbiotic rela- tionship. And when we approach physi- cians, it’s not about telling them what to do; they already know what to do.” And in that regard, she says, “We need to consider the place where people are coming from, and the messaging, and the best practices for moving people forward. When you think about change theory, that involves finding out where they’re at, and showing them the data— maybe only one piece of the data rather than all of it. And it becomes a place of service” for physician group and other patient care organization leaders, she emphasizes.


Cybersecurity concerns seen ever-present—and intensifying Even as the leaders of innovative patient care organizations move forward with alacrity to shift from involvement in payment for volume to involvement in payment for value, one area of huge concern for them, as data and infor- mation are shared increasingly widely, remains that of cybersecurity. So while provider organizations are sharing and analyzing more data than ever before, the threat vectors menacing provider organizations are only intensifying. Survey respondents were asked several questions in this area:


JANUARY/FEBRUARY 2021 | hcinnovationgroup.com 11


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