An interview with Mike Rhoades, CEO of Blaze Advisors, LLC
Mike Rhoades is founder and CEO of a boutique healthcare consulting firm specializing in supporting healthcare providers across all sectors in transforming how healthcare is delivered in line with population health philosophies and reimbursement models that emphasize pay for performance.
Rhoades has served in a variety of executive and advisory roles including COO of a multi-state IDN, CEO of an ambulatory multi-specialty network, and senior executive for a 2 million-life accountable care organization where he designed and commercialized a cross-platform care-management, analytics, and health-information exchange tool for 23,000 physicians and 120 hospitals. HIs perspectives on healthcare’s current transformation range wide and deep.
In addition to his work with Blaze Advisors, Rhoades is a member of the Healthcare Information and Management Systems Security (HIMSS), the National Association of Accountable Care Organizations (NAACOS) and a number of other investment and health-care organizations. He is also a mentor at tekMountain. Blaze Advisors will be featured presenters at the NC HIMMS Conference, May 3-4.
Dip your toes into a conversation about clinically integrated networks — to him, a mere “buzzword” that’s really nothing new — and be prepared for a deep dive into next-gen nursing and clinical support.
tekMtn: How is it that “clinically integrated network” is a 20-year-old buzzword?
Rhoades: We were talking about “clinical integration” in the ‘90s but back then that usually meant exchanging faxes. At its simplest, if you share clinical data with somebody else, you’re clinically integrated. There’s no requirement that it has to be digital.
The clinically integrated networks that we build at Blaze Advisers are not just EHR to EHR. While that’s the bulk of it, we’re also tapping into lab data, medication, financial, purchasing, and even credit history to formulate risk profiles on chronic patients.
So is clinical integration purely a technology issue?
Not at all. There are historical contractual and political winds designed to keep providers from working too closely together as it creates an opportunity for price collusion. That said, even the government, who insures the sickest population and represents 73 percent of every healthcare dollar spent, has started relaxing FTC rules in the belief that data sharing inspires care coordination which improves patient outcomes. That said, no such FTC protection exists outside certain Medicaid/Medicare contracts so providers must currently navigate a minefield of risk.
But we cannot continue forward with siloed, and arguably uncoordinated, care with healthcare costs rising to 17.8 percent of GDP (rising 5.8 percent in 2015). We cut rates and titrated care in the 1990s under HMOs only to have patients revolt to dwindling access to care. The only sustainable path forward is to incentivize coordination and better clinical outcomes.
It seems that pay for performance would be at odds with fee for service models. How does a provider manage living in both worlds?
That is the tough question. Most accept that if they do a good job managing your patients to help keep them out of the hospital and emergency room while not unnecessarily wasting healthcare resources, then they are staying true to their mission. That said, care coordination and population health cause an operational cascade. Once physicians learn a new model of care that improves patient outcomes, they will not ever return to their old way of practice. The trick is to find ways to make population health operationally efficient lest providers go bankrupt trying to implement it.
For example, let’s say you have a budget for five care managers. These are the people calling all your patients and asking, “How’re you feeling today? Do you need to see a doctor before you end up in the hospital?” It’s not feasible to call all 300,000 of your patients every day. So whom would you target? The sickest? The most recently discharged? The most costly? Sadly, the people who cost you the most are cases like end-stage renal disease but they are in hospice at end of life. So how are you going to redirect the trajectory of their care? The trick is to identify “emerging-risk” patients or, even better, “impactable” patients, who are at risk of high-cost care and at a stage and moment in their life where they can be influenced to change a behavior.
What are examples of an “impactable” patient?
Think of pediatric asthma. You’ve got motivated parents who don’t want their kids in the hospital. Or kids in foster care whose foster parents will follow a doctor’s order to the letter to avoid a lawsuit. But also think deeper about the moment of care. My father refused to follow his doctor’s diabetes counsel for years. A diabetic stroke lost him the use of his left eye and in the 48 to 72 hours post-discharge, he was still scared enough to listen to medical counsel. We need to capture people in their moments of anxiety and channel that into a commitment to change a behavior. Treat-and-forget does not cut it anymore in population health.
How does clinical integration influence this process?
What we have now that we didn’t have in the ‘90s is a ready means to access intelligence about those patients. Now we have this electronic database and, when it works as designed, we can plug and play all these EHRs and all these data sources and we can develop these rather sophisticated risk groupers and risk segmentation algorithms that can prioritize high opportunity patients. This tells us not just who is at risk, but predicts whose health is likely to decline in the next 30/60/90 days so that the provider can intervene accordingly.
In the real world, it’s not as easy as it sounds since data accessibility is lumpy and fraught with errors, but if the computer can automate the combing and analysis to profile risk, then every morning the care manager can review their dashboard for the top 10 people you should call today. And if we call them, they’re very likely to respond positively with “Thanks for calling. Your timing is impeccable as I was just thinking about recent changes in my health! Can I get to a doctor today? Oh! And you already know I don’t have transportation; you’ve already arranged my transportation. Wow! This is medicine working for me!”
It sounds like a utopia.
We are very, very far away from that. I hate to sound cynical, but we’re 50 years away from that, and that’s at breakneck speed for healthcare. But, we shouldn’t get discouraged. It’s taken us a long time to get to this position and we should find the pace exciting and challenging.
I’ve yet to meet a doctor who, armed with intelligence about a specific patient or a group of patients, or a better way of practicing medicine, said “I don’t want it. I don’t care.” I’ve never met a doctor who, faced with making the decision between improving care and making money, didn’t ALWAYS choose to improve the quality of care. The future is about empowering them with the right information, and they will make the right decisions. That’s the inspiring part.
So clinical integration is all about intelligence sharing.
Clinical integration is the process of aggregating data so that we can analyze that data and create dashboards and reports for providers to better practice medicine around a specific patient, or population, or cohort of illness.
Where does tekMountain fit into all that?
Recruiting. Education. Training. We’ve got a huge batch of doctors and nurses that are retiring over the next 10 years. The next generation of medical and clinical students are going to have to be much more technologically adept, more culturally flexible in a very transformational environment. They need to have a strong entrepreneurial spirit, even if they’re going to go work for a hospital.
In a transformational environment we need thought leaders, and that extends not just to the medical and clinical community but to the leadership too. The healthcare industry has been heavily regulated, and because of that, it has rewarded systemic operational thinkers. Not to take anything away from them because they play a valuable role for people who say “We have policies and we consistently do everything the same way every day so people don’t die. We’re a very regimented organization.”
With reproducible results.
Very reproducible, and we have historically rewarded that. So what kind of people are we going to hire? Regimented, organized, policy-driven thinkers.
Then, all of a sudden, you drop a huge, disruptive model on them and say “I need you to connect to people you’ve never even considered talking to before, and you need to build a network of partners and affiliates.” How to organize and govern an organization that has multiple tax IDs and boards of governors while you’re negotiating with a major payer around a significant shared contract designed to promote improved, and efficacious, patient outcomes. That’s a tough conversation that requires lateral and strategic thinking.
It’s so complex, it makes you wonder if it’s solvable.
If I said it’s solvable in 30 years, you might feel a little more optimistic. Is it solvable in the next two years? No, but the impacts of the efforts are already being felt. For the first time in its history, the American Hospital Association reported a decline in the building of new hospital beds. They are forecasting lower utilization as patients are better supported in an outpatient setting.
Talk about how the next generation of nurses can be helped through this transformation.
One example to explore right here in Wilmington is CB Bridges. Every time a nurse transitions from a school or employer, the documentation of their skills, training, and performance remains behind. CastleBranch has introduced CB Bridges wherein a nursed is given a lockbox with all their digital information in it, and as a service CastleBranch will maintain their credentials and backgrounds wherever they go, making the nurse more portable and valuable to an employer who does not need to rebuild this credentialing file. This relationship between CastleBranch and the nurse has created a communication portal to distribute knowledge, training and CMEs, and relationships.
It’s the nurse relationships that will be key because they unlock care coordination. “I know a nurse across town who can follow up with this patient if I ask him” is the foundation for trust. Nurses will be the glue that connects disparate, competitive organizations and individuals for the benefits of patients while we transition completely to a population health model.
Where does tekMountain fit in?
TekMountain is a bigger animal, being a corporate and community incubator. That means they can create an ecosystem of technology, an ecosystem of services, an ecosystem of content. It doesn’t have to be all technology; content is almost as valuable — anything from a revised medication lexicon, to something around diabetic care protocols, to a palliative care for renal disease, to best-practice models. The point is, there’s lots of content but not much of it is digitized into extractable libraries that can be licensed back into analytic, decision support, medical device, and/or patient engagement software. That content’s very valuable.