Day 1 of AcademyHealth’s inaugural Concordium 2015 kicked off with a welcome by AcademyHealth’s Lisa Simpson and Erin Holve and ARHQ’s Richard Kronick. The day was packed full of timely research and evidence on how to best use electronic health data to improve care and outcomes.
Key takeaways from selected sessions are recapped below by AcademyHealth staff:
Opening Plenary - Real Transformation: Paving the Road to Better Care, Better Spending
Frank Opelka of the American College of Surgeons and Louisiana State University Health Sciences Center kicked off today’s opening plenary presentation, Real Transformation: Paving the Road to Better Care, Better Spending, which focused on how evidence generation and data will improve health care and reduce cost.
Drawing on lessons learned from innovation models, Hoangmai Pham, Chief Innovation Officer, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, emphasized the importance of segmenting the marketplace and taking a targeted approach to data so that the right data is delivered to the right providers at the right time. Furthermore, she emphasized the need for better technology for providers - technology that is built around the care process, and not reimbursement. Technology should focus on the end goal of improving care. These lessons in innovation could not be determined without data, and data is “interwoven throughout every step of every process that the Innovation Center is engaged in,” Pham said.
Dana Gelb Safran of Blue Cross Blue Shield Massachusetts (BCBSMA) answered three questions about BCBSMA’s Alternative Quality Contract (AQC) program:
- •How are they using payment model end data to improve healthcare quality and outcomes while reducing costs?
- •What is the role that data and data exchange play in the above process?
- •How is our local environment in Mass accelerating or impeding this?
In 2007, when the state of Massachusetts was beginning to implement the coverage reform law, there was a need to begin thinking differently about improving quality and patient outcomes, which required a need for leadership and culture change. The success of BCBSMA’s AQC program was due in large part, she noted, by shared data, analytics, and best practices to help practices transform and act on data in front of them.
Gilbert Salinas drew on his own experience as a patient and outlined ways to “flip” primary care and make the system easier for patients to use and navigate. These principles include:
- Removing unnecessary face to face visits;
- Making the logistical virtual: locate face to face conveniently;
- Becoming more proactive about self-management;
- Focusing on patient-community interactions that affect health; and
- Allying with providers and payers.
These principles, along with new models for patients, should help remove barriers that impede healthcare use and accessibility for patients. Salinas stressed the need to think about equity and safety not just within the hospital setting, but also, outside of the hospital setting, in patients’ own communities.
Frank Opelka concluded the panel with a presentation on cloud web services in a safety net setting, focusing on the optimal use of resources to achieve better care. He discussed that the customization of measures to meet specific clinical and care management goals is imperative in designing systems to best use data. He also cited group-think as a good thing in building up health system data to meet measurement goals. Finally, he noted that data is addictive: healthcare leaders always want more than they have.
The themes that emerged from this session and the question and answer portion include: how to get “good” data, what to do with that data once you have it, and how to integrate patient perspective in using data.
Integrating Big Data into Learning Health Systems
Brian Leas presented on the Center for evidence-based practice (CEP) at the University of Pennsylvania Health System. The Center performs all reviews and summaries on a rapid timeline: full scale reviews are completed between 2 and 3 months.
Leas highlighted three important techniques to accomplish rapid review: narrowing the scope of review, compromise only where it makes sense, and reduce overhead. In conveying evidence, he noted that the cover page is the most read page of the reports, which includes evidence summary points. From a practical standpoint, that suggests the summary points should focus on the key takeaway message for clinicians.
Mark McClelland, of the Cleveland Clinic, presented his study to explore themes that describe a hospital’s culture related to transitions in care. His study was based on the idea that assessing a culture of 'teamness' and efficiency of 'teams of teams' is important in building learning health systems and that these health systems must improving the culture of transitions to increase quality and improve outcomes.
Adrian Meyer, UNC Lineberger Comprehensive Cancer Center, detailed his team’s experience in developing a virtual desktop infrastructure and cloud for linked, population-based data for cancer outcomes research. He noted that planning, financing, building and operating a secure computing and analytic system is an adventurous trip, but that when data can be unpacked for providers and patients, it can be incredibly useful and practice-changing.
Finally, discussant Ian Eslick noted that this session was less of a discussion on big data, and more on ‘big bureaucracy’ and change. The problems that the three speakers are attempting to address are organizational change problems. Panelists agreed for the need to standardize processes and collaborate across departments to get buy-in from all stakeholders in order to initiate organizational change. The more data that learning health systems have, the easier it is to bring that data to a localized, specific patient and therefore drives personalized, patient-centered evidence.
Collaborative Strategies and Tools in Public and Population Health
In one of the first concurrent sessions of Concordium 2015, four panelists and moderator David Tobano of Kaiser Permanente discussed data overload in the post-data implementation phase. Each speaker discussed specific successful case studies, where data was used to not only measure success, but implement policy.
Peter Eckart, Illinois Public Health Institute, discussed the RWJF initiative Data Across Sectors for Health (DASH) and the opportunities and challenges of connected data systems and collaborations that are sharing data amongst community organizations for the intent to improve community health. Next, Melanie Davies of the Harvard Pilgrim Health Care Institute used the model of the Census Projection Tool for Public HEalht Surveillance in Distributed Research Networks to show that distributed research networks provide many benefits for public healht surveillance by reducing the privacy, security, and proprietary concerns of clinical data partners to share data with public health agencies.
The latter half of the session featured Emily McCormick of the Denver Public Health Department and Remle Netwon-Dame from the New York City Department of Health. Both of the speakers’ presentations featured tools which preliminarily show the use of data to track and monitor vulnerable populations and risk factors.
Telehealth to Improve Outcomes: Is there an App for that?
Dr. Reed Tuckson, Managing Director, Tuckson Health Connections, opened the luncheon plenary conversation by noting that we are experiencing a unique time of great opportunity for the field of telehealth and big data, which is being propelled by the fundamental reorganization of care delivery and the financing of care. With so many new entrants into healthcare: engineers, digital companies, consumer marketing experts, he noted that “the fuel for innovation is strong.” This innovation, however, must lead to value and Tuckson called for more evidence to show that link.
Taha Kass-Hout, Chief Health Informatics Officer, U.S. Food and Drug Administration, spoke on the data-driven nature of the FDA. He noted that there is a need to share data but also protect patients' privacy in the current environment. With this existing grey area, the role of evidence is vital. He stated that the FDA is looking for the right data from many different sources to ensure that products are safe for patient use.
Ateev Mehrotra, Associate Professor of Health Care Policy and Medicine, Harvard Medical School, spoke on the impact of direct to consumer telemedicine. Calling direct to consumer telemedicine a “brave, new world,” he described it as blurring the lines between a health plan and a provider. He also noted an interesting tension between the direct to consumer movement that the patient will decide where to get the care suited for a specific issue, and the accountable, coordinated care movement that coordinated care from a single provider leads to sustained improvement in costs and quality. He agreed with Tucson that data should come together between the two movements and that a member of the health team should monitor it.
A Q&A session on addressing the balance between innovation and need for good evidence followed the conversation.