In this H&HN video interview, CAPP Chair Robert Pearl, MD, discusses a significant problem with new health care technology: HIT designers create the technology and then look at ways to apply it to healthcare. The better way to approach HIT development is to find the problem that needs to be solved and then figure out the technology that can help solve it, says Dr. Pearl, who is also executive director and CEO, The Permanente Medical Group; president and CEO, Mid-Atlantic Permanente Medical Group; and co-CEO, the Permanente Federation, LLC.
Keynote Speech Cites Physician-Driven Innovation and Technologies to Re-invent Healthcare Delivery
Washington, DC – With healthcare now 18 percent of the Gross National Product and climbing each year, Robert Pearl, M.D., keynote speaker for the American Medical Group Association 2016 Institute for Quality Leadership (IQL) conference, underscored the innovative and disruptive thinking needed among physician leaders to transform healthcare delivery and achieve the Triple Aim.
“Economics, not politics, is ultimately the most powerful driving force in healthcare today,” noted Pearl, who is chairman of the Council of Accountable Physician Practices (CAPP), a coalition of high-performing multi-specialty medical groups and health systems, as well as CEO of The Permanente Medical Group and president and CEO of the Mid-Atlantic Permanente Medical Group. “If we change the structure, modify how care is reimbursed, and embrace 21st century technology, we can improve quality and access, while at the same time lowering the cost of healthcare delivery overall.
“For example, through capitated payments, financial incentives will reward keeping people healthy, encourage prevention, maximize patient safety, and lead physicians to diagnose sooner and treat more effectively,” he said.
During his presentation, Dr. Pearl noted that attempts to change the healthcare cost equation in the past focused on reducing access to care, rationing medical care or reducing provider payment. None have proven effective, and all decrease quality and patient satisfaction. He supports the movement towards payment based on value, rather than volume, and recommends that the nation stay the course.
As part of the shift, he outlined various opportunities for clinical and operational improvements. Examples included approaches to reduce the time between surgeries and ways to minimize hospital care delays over weekend days. Dr. Pearl cited the success of the various CAPP medical groups in implementing digital communications and electronic connectivity as the types of innovations that have lowered operating costs across multiple sectors when implemented through large, physician-led multi-specialty medical groups. Similar innovative applications need to be widespread in health care in order to flatten the trajectory of health care inflation across the entire nation.
Dr. Pearl cited three specific technologies that are changing the way healthcare is delivered, including improving quality while reducing cost:
- Video and digital photography that enable physicians to diagnose patients remotely and secure appropriate care immediately. One example of this technology in action is the use of video consultation with a neurologist to quickly evaluate a patient in the emergency department who might be having a stroke. This practice has already reduced the time for a patient to receive appropriate treatment by 50 percent.
- Data analytics that can identify groups of patients and individuals who are at risk for specific conditions, or who require additional care.
- Use of the electronic medical record not just as a repository of data, but as a communication tool between healthcare providers. This technology enables the best patient care decisions to be made at every point in the care continuum.
“When payment is tied to patient outcomes, and the re-engineering of healthcare delivery is led by physicians, we will see a reduction in the inefficient fragmentation that is so costly today, and improvement in the quality of care that patients receive,” concluded Dr. Pearl.
For information on patients’ experience of coordinated care and the use of technology with their doctors, see results from two Nielsen Strategic Health Perspective Surveys from 2015 and 2016, sponsored by CAPP.
Browse the pages of this site for more information on accountable care. To learn more about physician leadership in the work to achieve accountable care, and to receive updates on key health care issues, follow CAPP on Twitter at: @accountableDOCS.
By Robert Pearl, MD, Chair, Council of Accountable Physician Practices
With thousands of political offices up for election this November, health care will continue to be a complex and frequently debated issue. To help focus discussions, the Council of Accountable Physician Practices has produced an original primer, “What Every Candidate Should Know About Health Care.” This primer is for candidates running for local and national elected office and details the most critical health reform topics they must understand to ultimately improve the medical care their constituents receive.
The three primary issues highlighted in “What Every Candidate Should Know About Health Care” are:
- Payment system reform to enable acceleration of the move towards value-based payment and away from the current volume-based fee-for-service model, aligning incentives to reward better patient outcomes, safety and efficiency.
- Expanded use of health information technology so care providers always have the information they need to make the best care decisions.
- Consistent and meaningful quality measurements to accurately identify high-performing medical groups and health systems.
By bringing these healthcare issues into the political discourse, the leaders of CAPP believe they can educate and inform elected politicians on the accountable approaches that produce the highest quality and best health outcomes for patients.
We encourage you to read and share “What Every Candidate Should Know About Health Care” and send us feedback on twitter @accountableDOCS.
All agree that a more coordinated value-based healthcare system is required to achieve accountable care.
By Laura Fegraus, Executive Director, Council of Accountable Physician Practices
The leaders of the Council of Accountable Physician Practice (CAPP) have long been committed to accountable, physician-led, patient-centered care. It is our belief that neither the quality of American health care nor its cost can be improved without real systemic change. Such change must be completely focused on the needs of both physicians and patients to be sustainable.
Our Better Together Health events, coupled with our annual physician and consumer survey, are designed to highlight the concerns and experiences of both stakeholders as the American health system continues its journey toward accountable care.
Our most recent Better Together Health event was held on June 15 at the Kaiser Permanente Center for Total Health in Washington, DC. Once again, we announced the results of our annual CAPP-sponsored Nielsen Strategic Health Perspectives study. Designed to assess progress in achieving coordinated care, the study surveyed 30,007 U.S. consumers and 626 physicians to understand their experiences related to the hallmarks of accountable care: care team coordination, prevention, 24/7 access, evidence-based medicine, and use of robust information technology.
The survey results were both promising and concerning: The use of care teams and care coordination is improving. However, it appears that technology and 24/7 access to care is still not widely available. In addition, preventive primary care is critically lacking.
“This survey is evidence of the failure of American health care to provide coordinated, technologically enabled, high-quality care to the majority of people,” said Robert Pearl, MD, chairman and CEO of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group and chairman of CAPP. “While it is encouraging that the use of care teams and care coordination seem to be increasing, access and the effective use of technology still need improvement, and tactics that help to prevent illness are still woefully ineffective.”
Following the release of the survey results, policy makers, patient advocates, and medical group and health system leaders convened to discuss meaningful healthcare delivery reform at “Better Together Health 2016: Patient Expectations and the Accountability Gap.” The event was sponsored by CAPP and the Bipartisan Policy Center. The town-hall format of the meeting featured patient videos demonstrating the benefit of integrated care delivery at Southern California Permanente Medical Group and at Billings Clinic, both CAPP member groups.
Sen. John Hardy Isakson (R-GA), co-chair of the Senate Finance Committee’s Chronic Care Solutions working group, served as a featured speaker. Tim Gronniger, deputy chief of staff and director of delivery system reform at the Centers for Medicare and Medicaid Services (CMS) also spoke. Both shared strong support for moving our healthcare system toward a more coordinated, value-based healthcare system. The panel discussion was moderated by Ceci Connolly, CEO of the Alliance of Community Health Plans.
The first patient story featured Jenny, a Billings, MT high school teacher who underwent bariatric surgery after a lifelong battle with obesity. Dr. Karen Cabell, director of quality and patient safety at the Billings Clinic, explained how system-ness and integrated, patient-centered care supported Jenny to reach a positive outcome.
“To us, system-ness means having an integrated medical practice where it is the expectation that all of the physicians, nurses and other members of the team coordinate together and communicate with each other on behalf of the patient,” said Dr. Cabell. “The patient is part of that multi-disciplinary team.”
The event’s second story featured Jesus, a food services professional and father of three, who developed severe diabetes resulting from poor nutrition and lack of exercise. Dr. Marc Klau discussed how the Southern California Permanente Medical Group’s Diabetes Complete Care program helped Jesus overcome his chronic condition.
“It’s the best of all worlds,” said Dr. Klau. “You have a team, you activate the patient with resources and then behind it you have this high tech technology world that’s constantly monitoring to make sure Jesus gets everything he should be and if he doesn’t, the system activates.”
By bringing together the nation’s leading and most respected healthcare organizations, patient advocates, and policy experts, CAPP’s Better Together Health series seeks to amplify and accelerate the momentum on changing the health care delivery system so that it is patient-centered, integrated, and physician-led. We look forward to continuing this meaningful and relevant conversation at future events, and monitoring the nation’s progress towards true accountability through the two most important voices – the patient and the physician.
By Steven Green, MD
Chief Medical Officer, Sharp Rees-Stealy Medical Group
Secretary, Council of Accountable Physician Practices
The Council of Accountable Physician Practices (CAPP) is encouraged and excited by recent movement on Capitol Hill to expand access to telemedicine services in the Medicare program. For example, the CONNECT for Health Act, a bipartisan bill authored by Senators Brian Schatz (D-HI) and John Thune (R-SD) will create new opportunities for Medicare beneficiaries to receive high-quality, convenient care through telehealth. Like many of the medical groups in CAPP, my organization, Sharp Rees-Stealy Medical Group (SRSMG), was an early adopter of telemedicine, and we embrace its value, particularly when the technology is applied appropriately, backed by coordinated, organized systems and used to enhance existing patient and physician relationships.
Despite the barriers in regulation and legislation, Sharp-Rees Stealy has moved forward with testing and implementation of novel ways to deliver care via telehealth, including using video visits with our patients. As you can see from Felipe’s story here, the experience for both the patient and our physicians has been remarkable. As noted in this video, we see the potential of telemedicine to expand the capacity of our delivery system to serve our patients more effectively and efficiently while maintaining the high quality care they expect. Removing the barriers that exist with telemedicine will allow more patients to experience from the kind of service and quality that Felipe enjoys.
We know that we have much ground to cover if we hope to bring technologically-enabled care to everyone who needs it. Further improvements in reimbursement for telehealth services will lead to appropriate expansion of these modalities other payers so that accountable, coordinated groups like ours can deliver care to our patients when and where they need it most.
Challenging the Digital Divide Between Patients and Doctors
By Laura Fegraus, Executive Director, Council of Accountable Physician Practices
If you’re like most Americans, you make your travel reservations online, do your personal banking online, and use your phone to board a plane.
And if you’re like most Americans, you can’t perform any of those digital transactions with your doctor’s office. You most likely don’t have the option of texting your doctor, making an appointment by e-mail, checking your medical records online, or having a video visit with your doctor when it’s convenient to you.
This digital divide was dramatically revealed in the results of a Nielsen Strategic Health Perspectives Survey – “How Americans Use Technology for Healthcare,” sponsored by the Council of Accountable Physician Practices (CAPP) and the Bipartisan Policy Center, and presented at the “Better Together: High Tech and High Touch – The Patient-Physician Relationship in the New Millennium” event, held in Washington D.C., last November.
Highlights of this event are now available for viewing at bettertogetherhealth.org. CAPP’s Better Together Health event evolved from our desire to raise the voices of two key stakeholders who are often less prominent national discussions on the health care system– patients and physicians. This research, and our event, represented a major step forward toward fulfilling CAPP’s mission to advance the discussion toward truly accountable healthcare. While the media, healthcare marketers and technology companies hold up technology as the solution to America’s healthcare problems, our 2015 survey results showed that most Americans don’t even get the “old school” phone and mail reminders about appointments. Only two percent have ever experienced a video doctor visit. Even people with complex or chronic illnesses didn’t have much access to the digital tools to help coordinate their care.
Our survey found that the reasons for this lack of access are complicated and multi-factorial. Despite the financial and regulatory barriers that exist to expand the use of telemedicine, the multi-specialty medical groups and integrated systems that are members of CAPP are leading the way — using their long-standing commitment to coordinated, patient-centered care to deliver solutions that are both high- tech and high-touch. Once again, You can see videos about how access to technology has transformed the lives of our patients here.
Meet Felipe, who lost his eyesight and now manages his diabetes through telehealth video consultations, saving him from the tremendous burden of traveling on public transportation across town to see a physician.
Watch Baby Emma recover at home from a burn wound while being monitored by video by her specialist.
Listen to Karen describe how her ten-year treatment for cancer is seamlessly coordinated through technology and her various careteams.
And to Teresa, who now enjoys her active senior lifestyle after a heart problem was resolved conveniently and safely through her tele-connected team of health specialists.
We hope our Better Together Health event raised awareness of how the appropriate use of technology can improve patient care, reduce stress, and delivery quality outcomes.
This June, in 2016, we intend to continue the conversation as we ask what Americans really expect from their healthcare system. To get more information about our upcoming events and activities, please visit www.bettertogetherhealth.org to sign up for updates. We hope you will join us.
Nielsen survey shows gaps in availability that must be fixed to improve patient care
WASHINGTON, D.C. (November 04, 2015) – Today, Americans manage much of their lives through digital and electronic tools, except when it comes to healthcare. According to a new Nielsen survey released today by the Council of Accountable Physician Practices and the Bipartisan Policy Center, a majority of Americans are unaware of or don’t have access to the technology they could use to communicate with their doctors for better quality health care.
“Having ready access to a doctor is vital to high quality healthcare. Yet the busy schedules of consumers and physicians alike often prevent timely attention to routine and urgent healthcare problems in the traditional 9 to 5 physician office visit options. Digital technologies can help overcome the barriers to accessing medical care, yet our survey shows that these tools are not available to most Americans,” said Robert Pearl, M.D., Chairman of the Council of Accountable Physician Practices and CEO of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group. “Healthcare providers must step up our adoption of these common-sense and available solutions if we are truly going to reform healthcare delivery.”
The survey, conducted by Nielsen Strategic Health Perspectives, polled more than 5,000 Americans ages 18 and over, and looked at attitudes about and use of technology to inform, access and manage their medical care.
Results from those surveyed showed that:
- Less than half – 45 percent – receive even the traditional telephone appointment reminders.
- Only one in five – 21 percent – have access to online appointment scheduling with their doctors.
- Fifteen percent use email to communicate with their provider.
- Just 14 percent have 24/7 access to medical advice.
- Fewer than one in ten – 9 percent – receive reminders by text.
- Only a small percentage – 3 percent – are able to send a photo of a medical condition over email.
- Just 2 percent have access to video visits.
The survey also highlighted four consumer groups who were most interested in gaining greater access to their doctors through digital and electronic technology: parents with children covered under their health plans, chronically ill patients, patients with acute conditions, and adults under 35 years of age.
The data also showed that consumers who don’t currently have access to their providers through electronic or digital communications are most interested in ready access and online interactions: 36 percent preferred traditional telephone-based medical advice, while 34 and 36 percent, respectively, expressed interest in one-way engagement such as online appointment scheduling and online portals to access test results.
“These findings emphasize how few patients and providers are actually using the technologies that we use in most other aspects of our daily lives,” said Janet Marchibroda, Director of Health Innovation at the Bipartisan Policy Center. “A lack of appropriate incentives as well as regulatory and legislative barriers have prevented many healthcare providers’ from implementing these technologies. Yet as healthcare organizations are increasingly responsible for improving the health of large populations, they must rely more on efficient, technology-driven patient-physician relationships to achieve performance goals. That means society must create incentives that facilitate adoption of these tools and technologies.”
Some technologies showed wider gaps between usage and interest than others among the people surveyed: 36 percent of adults were interested in a 24/7 telephone line for medical advice, yet only 14 percent had used such a tool; 28 percent were interested in text appointment reminders, yet only 9 percent had used them; and 26 percent were interested in submitting photos of conditions in preparation for phone or email consultations, yet only 3 percent had used such tools. Additionally, “virtual care” innovations, such as telemedicine, were found to be almost completely inaccessible to the average patient.
“Within these survey findings, it is important to note that the gaps between usage and interest levels may be an awareness issue. Consumers who expressed low interest levels in certain technologies may actually have limited awareness of available tools and the possible beneficial impact these applications may have,” noted Jennifer Colamonico, VP of Healthcare Insights and Chair at Strategic Health Perspectives, Nielsen Consumer Insights North America. “If consumers aren’t familiar with all the options, or cannot imagine how those options could enhance their healthcare experience, they place little value in such options. But consumer education can increase demand for and usage of these tools.”
Pearl concluded, “Our CAPP medical groups and health systems are committed to integrating the appropriate technologies to ensure that patients receive the high quality, coordinated and convenient care they deserve. The findings in this survey show that we all must ramp up our efforts to use technology to support the patient-doctor relationship and improve medical outcomes. Appropriate technology used in the context of accountable, coordinated care settings will improve access and produce better results. If we don’t take these steps, our efforts in population health management and in delivering accountable care will be seriously hampered.”
To see videos of real-life patients whose lives and health have been impacted by the appropriate use of healthcare technologies, click here.