The Future of Healthcare: Innovations in Provider Strategy

Hello everyone and thank you for joining us for our thought leadership webinar, the Future of Healthcare Innovations and Provider Strategy. I'm happy to introduce our speakers for today, Mike Bonetto and Ted Jackson. Mike is a co founder of Tedfold Health with over 20 years of healthcare strategic planning and policy experience. Ted is a co founder of clearpoint Strategy and an expert in strategic management and performance methodologies. The audience will be muted, but please feel free to submit any questions into the Q and A tab. Without further delay, I'll pass things on to Ted.

Thanks, Jenna and Mike, thank you for joining us. Why don't you tell us a little bit about your background that led you to tenfold health?

Sure. Thanks, Ted. Excuse me. Thank you. I've been in the healthcare field for about 30 years in all shapes and sizes, so been on the health plan side, been on the health system side, and then also been on health policy side. So worked in state government for many years as senior health policy advisor and a chief of staff in the Oregon Governor's office. So really have kind of seen healthcare evolve from many different angles, which I think has really been helpful.

That's great. You really sound like a true expert in healthcare. So tell me a little bit about tenfold health.

So we work with healthcare organizations all across the country and those vary. They are health systems, they are health insurers, they are states, they are local regional health collaboratives. Everybody who's trying to kind of rethink their organizations around how they can think about a different strategic vision. There's been a lot of changes in the environment with value based payments, the focus on social determinants of health, and it's a challenging environment and it's really pushing organizations to think differently than 10 or 15 years ago.

And, and so within tfold, you know, do you consult to all the different types of organizations? Like, tell me a little bit about how your work.

We do. That's kind of, I think, kind of a sweet spot for us. We really love to be at the center of that and really kind of help a health system kind of think differently about what they could or should do differently and then how they can partner with health payers to kind of get the better value and better quality of care for the people who they're trying to serve. So we really try to kind of be at that intersection as much as possible.

Okay, that's great. So if we focus on provider organizations like hospitals, clinics, healthcare systems, what are some of their biggest challenges today?

Well, there are many, there's no question about that. They do operate in this very challenging environment many times when they are serving their patients, their customers or the residents in their area. But it not always those individuals who are actually paying for the healthcare. Right. So we have a, we've had this bit of a disconnect for a very long time where it could be the employer, could be the government paying for that healthcare and those health systems are responsible for meeting those, those metrics, those contractual deliverables by those payers and at the same time they're trying to deliver this quality of care and they've been in a very challenging regulatory environment. So we really have seen that change over the years as well.

And so it sounds like a straightforward strategy, right? Like everyone's just saying how do I, how do I make my, my payers happy while also increasing the quality of care. Do you see like all organizations taking the same strategy playbook or are they kind of different depending on where they live?

I think it is, it's varied. I mean incredibly west coast, east coast. I mean we see a small rural versus an urban setting. It absolutely is very different from every community that we have worked in. So yeah, I say there's vast differences.

Where does like innovation come into play? Like or like is it different from a small rural to an urban hospital? Like what, like what are the strategies that you've seen?

To some degree, I think a lot of it has to do just with how much capital folks have to invest. And I think many times you have some smaller rural organizations that have been somewhat cash strapped to make those, to make those investments. But I think everybody's trying to figure out a way how they can become more efficient and more effective. And some of those innovation, newer technologies, newer breakthroughs have allowed some of those organizations to do just that. But I think everybody's constantly looking for kind of the latest and greatest to help them kind of meet their bottom line and improve quality of care.

So that sounds pretty straightforward, right? So if we look at a few of the key players and the in the hospital network, you know, how can we make their lives easier? So tell me about like the role of the chief medical officer.

So the chief medical officer, the cmo, very common in a big health system hospital organization for the most part, that individual is going to be responsible for the quality, overall quality of the organization. They are going to be looking at outcomes, readmissions, disparities, anything on that quality side. But also I would say they're going to be looking at patient satisfaction scores, effectiveness from the doctor's perspectives and those practices. So they really have a large task and they talk about overall the patient experience, patient outcomes and quality and then how do they create a system to then deliver on that.

And so does, does every organization end up with a cmo? Are they all.

Well, not necessarily. I mean most do have a CMO like individual but sometimes there can be a chief quality officer as well that works kind of hand in hand with that CMO and that's chief quality officer is in kind of zeroed in on those quality metrics and the dashboards and then you know, how, you know, and having specific actions that trying to improve those.

Okay, so what keeps this CMO up at night? Like what makes them the most most worried when it comes to the strategy?

Well, over the last, as I was kind of saying 10 to 15 years there really has been this bigger shift around value based payments and linking the quality to the actual payment or the finances. So what really has been the challenge is having performance measures that are tied to payments and that really then starts to bring everybody together. So I've got a, now a chief financial officer who's very interested in those outcomes, a chief quality officer, chief medical officer, you know, really all looking at that. And those metrics have been around for a while. We've got Hedas, we've got star measures, we've got, we've got, you know, each state may have their own Medicaid quality measures that somebody may have to adhere to. Each commercial health insurance company may have specific quality measures for a health system that they are trying to hit. So it really becomes a much bigger play around how an organization can deliver on their quality to then get a value based payment or to get it, to get a performance payment.

So, so for those that don't know, can you tell us a little bit more about like the HEDIS measures and maybe even what's different? And well, let's start with just kind of what are these HEDIS measures? How long have they been around?

Been around a while that really, you know, he just talks. You know, obviously we have a lot of healthcare lingo in our world but the healthcare effectiveness data and information set, right. So it's a, you know, something that's used by gosh, probably close to 100% of health plans to measure performance on everything from, you know, care and service. So you know, but then that is a translation of how they're going to hold health systems accountable, right in terms of what they're going to get reported on. So you know, emergency room use, you know, readmissions, bed occupancy, you know, overall cost of care. So those sorts of things really start to get incorporated and really start to get zeroed in on and looked at every day, every week, every month around how that organization is performing.

So your reimbursement rates are going to be based on how you're doing with HEDIs.

They can be, I mean, certainly. And, and I think, you know, you have some payers who really start to then look at taking contracting to a health system and say, hey, we want to pay you for this better performing outcome. And that's really what we've seen started to take hold with a number of payers and health plans.

And so separately from that, there's been like a star rating system that seems to have seven categories and a bunch of measures there. How is that different from HediS?

So the, the star side is much more focused on the Medicare side. And that really has been, you know, we've got star ratings for hospitals and we've got star ratings for health plans. Right. So as, and, and they've been very much focused on the consumer. So as a consumer, I can go see what the star rating is for a health plan before I enroll in that or for a hospital in terms of understanding what those outcomes are. So you're really, I think, trying to produce much more transparency for the consumer so that you really have an apples to apples comparison around how plants are operating as well, as well as health systems.

So here in the Washington, D.C. area, as a consumer, I'm going to look at hospitals and health organizations for their star ratings. But my insurance plan may also be looking at these hospitals for their HEDIS measures. So a hospital is kind of, they got to measure a lot of different things, right?

They absolutely do. And, and those star ratings on the hospital side are very important because you have health plans that will be contracting differently with your different star rating. And if I'm a, if I'm the highest star rated, you know, hospital system, that means I'm, I'm delivering high quality care. So a health plan has higher assurance that that is going to happen to their, to their members, which can result in a different type of contract. So it really behooves everybody to really have kind of the highest quality delivered possible.

And then to layer one more, I'm kind of, I'm breaking down your earlier statement. So then to layer on top of that, you may have a state put in additional measures or a county health department or something like that layer on some additional measures for these health providers or healthcare providers.

That's right. So our Example, I live in the state of Oregon and Oregon has a Medicaid system that has its own kind of quality outcomes that are responsible for those. We call them CCOs, coordinated care organizations. But Medicaid MCOs that then have to work with hospitals on those quality measures. So yes, it becomes very complicated.

Right. I think we saw a little bit of this in my last webinar with Riverside Community Health in Southern California. They were kind of playing this role between like some of the providers and the health department and the payers. And there are just a lot of measures playing around in here. So, so when I look at all these measures and then think about value based care, are is it easy for like a chief medical officer or a chief quality officer to, to tie those measures together or is it, is it a mess?

Short answer, it's kind of a mess.

Okay.

So everybody is kind of working in their own silos and trying to pull data. I mean you think about trying to get your arms around the measures and the data for, for multitude of of variables is incredibly complex and incredibly difficult. So you end up kind of like whack a mole of trying to figure out like what is the, the hot topic of the day and then trying to tamper that down based on the data but not necessarily having a comprehensive view of the entire picture. And so we've got all these data sources and how do we pull those together to see that big picture? That is not an easy task.

And you know, from what I know of the data, a lot of the data can be cost efficiency measures like utilization or you know, number of days you stay. And then there can be some quality ones that would be like readmittent rates and you know, your ability to solve real health problems. Does it. And it's like the chief medical officer doesn't always control all of those measures.

No, no, very true. I mean so with within an organization I can have a chief operating officer, chief finance officer, have aspects of some of those measures as well. So many times like how that organization runs on, on the operational side, a COO would be responsible that anything on those finance, those true finance metrics, you're going to have the cfo. So again, everybody's kind of can live within their own world. So to bring that all together, that can be extremely difficult.

Yeah, it seems like you may run into some conflicts around what projects you do or where you're spending resources inside.

Of a hospital and to on top of that and how they are then having to work with it to pull the data to get what they need and how are they actually getting that? So then all of a sudden I've got multiple requests going into the IT department around how I'm kind of extracting those data reports to get what I need.

Yeah, I would imagine your HEDIS data and your Medicare star rating data and your health department requirements from Oregon or for wherever you are may end up slightly cutting the data differently and creating different measurement stresses in your organization.

Well, and it does. And again, think about these bigger state or federal monitoring, you know, reports that come to an organization sometimes six months after the year has ended. So you're getting it, you know, far after the work has been done. But to do this effectively, you've got to stay on top of that real time data. Right. So many organizations try to then set up a internal process like, well, how do I, how do we monitor these measures on a weekly monthly basis so we know exactly where we are. We don't have to wait for the annual report to come out and show us what our kind of our star measures are. We really want to know that ahead of time.

Oh, so I see. So some of the measures are tracked just annually for some of this large governance reporting, but if you're surprised by dip in performance, it could cost you millions or tens of millions of dollars in reimbursements.

That's exactly right. And it, and we've seen that, you know, we've, it does cost millions of dollars. So to, to make this proactive investment to figure out, okay, well, how do we actually get our arms around all of this at the same time and be monitoring this on an ongoing basis that can yield again, can save millions.

Okay, interesting. So, so this is around the time where I'm going to say, okay, clearpoint can help with that. But one of the reasons why we can help with this is we've partnered with you and many of your clients to see it unfold kind of in real time. So what I'm going to do is I'm going to share my screen and this isn't really going to be a demo because I'm going to show some things in clearpoint. But what I would like you to do, Mike, to put you on the spot is to react to it and to tell us, oh, I've seen it this way with one client or they've organized it a different way with another client just to, to, to allow our audience to, to get a feel for how different it can be in different organizations. Because in the, the demo account I'm going to share, it's going to, it'll be organized one way, but I think we'll be able to, to see information in other ways as well. So let me, let me share my screen and usually I'm, I'm letting other people share their screen and I'm poking holes in what they're doing. So I want you to, to use this as an opportunity to, to poke holes in what, what I'm sharing. So here I have a, a fake healthcare system called clearpoint Health. They have a strategic plan that is broken into priorities like patient centered care, financial management, quality improvement. They have a set of goals. In this case they're called objectives with some measures associated with them and with some initiatives. And the initiatives can be linked to multiple areas. So we can see kind of a whole list of big picture items in here. And then this organization has a Chief Medical Officer scorecard, Chief Operating Officer scorecard and a Chief Finance Officer scorecard. So if I were to drill into kind of my medical officer area, what I may see here is a drill into particular information like my patient satisfaction, my hospital acquired infection rates and I can see how I'm doing over time and see some analysis and recommendations. Like when you see this, is this a typical approach for, for an organization like having kind of two different views or tell me a little bit about what you think when you see something like.

Well let me, let me first say this is the first time I've seen this, this built out like the way you've done it. You've done a great job. I really do like the way you've laid this out. Makes a lot of sense. So what, what we normally see is we don't see this all brought together at one spot. So again the, the CMO may have something like this that is specific to them but not integrated in a way that I can then see kind of side by side or kind of go in and look from the CFO and look at the, the global, the kind of the enterprise picture. So this is to me this, this is always a game changer with clearpoint that I can bring this all together under one umbrella and how all of this, all of this presented in a way that's going to make a lot of sense and it is tied strategic plan. I mean it's one thing to kind of talk about your, your HEDIS or your STAR measure, where are you? But where does that then fit within everything else you're trying to do as an organization? And it's not just some one off, but it's actually integrated into the plan.

Right. Okay. Cool. And, you know, I've made up a scenario where underneath the chief medical officer, they may have all of their departments or practices. And so if we looked at something like a cardiology practice, you could imagine a scorecard in here. Right. And the scorecard may break down information in a variety of ways. Show me some real data and how we're doing. Give a weighted score which would ultimately say, hey, in cardiology, we're at 60% of our target. Of course, this is fake data in a fake world. But some of this information, like my finances or my budget may roll up to a different department and other ones may live just specifically in a department. Is it common to have like a cardiology or practice scorecard? And does that always report to a, a cmo?

Doesn't always, but it does at times. But the bigger one with a health system is most likely primary care. So primary care gets the bulk of this because that is where a lot of the incentive payment from the insurers are focused. So that that focus on primary care is usually a critical piece as well. And that when you see kind of a grid like this, you have these, your measures or your targets, those targets then become, you know, financially, you know, financially tied to a, to a certain payment. And that's where this kind of gets kind of laser focused on how, how well we doing. Are we close to target? Because that's going to yield a bigger potential payout.

Right. And so in primary care, if you're, if you're worried a lot about your reimbursement rates and things like that, you may end up connecting a lot of these to, you know, your quality benchmarks.

Absolutely.

In this scenario is I just created some, like a HEDIS area just to track, you know, everything, you know.

Yep.

For those of you in directly in healthcare, this would be really familiar to see effectiveness of care. And then, you know, underneath that is prevention and screening. We know we have weight assessment counseling, you know, and you. If we drill down into one of these measures, we may see, you know, not only why it matters from HEDIS directly, but see how we're doing with, you know, BMI for, you know, youth. Our counseling, our counseling not only for nutrition, but also for physical activity. In clearpoint, I cheated. I used our AI to analyze the data.

Oh, that's great.

Need some quick analysis for why I'm, I'm going this way, but I could have my data here. Do you, do you normally see like a hedis department or is that like, does.

How does that live usually within the quality department? If There's a quality department there. So they usually have their arms around all aspects of quality, whether it's federal reporting, state reporting, anything like that. So it would usually fall under that. But again, Ted, I haven't seen this before, but the way you've laid this out, this really looks good. I mean, I think this has a lot of applicability, and many times, again, even from the heated side or star side, it's done. You can have your own report, but it's not embedded in a tool where I can see it across everything and see how it fits within the organization. So this is, it's really powerful.

Yeah. And one of the things our clients are asking for is, you know, the, the way that you said like this, these are annual numbers. But I need to make sure I'm taking action, so I don't.

That's right.

You know, lose some reimbursements or ideally I can even gain in my performance. So I want to be able to tie my, my action items or my, my initiatives or programs, and then I can battle it out with the, the cfo, the CEO and the CMO to look at all of the, the, the actions or the initiatives and say, this is where we want to spend our money and this is why we believe these things will help our reimbursement rates ultimately.

That's right.

Help influence a measure.

And, Ted, I mean, when you think about laying it out like this, this, it starts to tell a great story. Tells a great story to the executive team, but then also to the board. You know, as the board's kind of leaning into strategy and understanding where they want the organization to go, you now have, you know, some data and some data points to how you, how you can move that forward.

Right. And so I know there's a lot more in here to show. We didn't even scratch the surface on talking about revenue cycle management and how important that is to a hospital. I know I was listening to a Wall Street Journal podcast about one of the, the big reimbursement technologies is, has been hacked recently. And then people are having trouble getting their reimbursement rates. And for smaller organizations, it's been quite a challenge. But I know overall, this is a challenge. Let me. Since we only have a few minutes left, what I'm showing here, just in a simple world, is just a list of the organizing framework for this healthcare system, like it's called clearpoint Health. So the medical officer might have some practices. It sounds like I might want the general practitioners, like the, the primary care, as you called it that would either go under a CMO or a chief quality officer. There's operational goals, financial goals. Obviously my, my revenue cycle management, my quality benchmarks. Maybe my chief quality officer would live here, but potentially this would be broken down in a different way for, for my primary care and, and, and other environments. Any other ways that you've seen this, like, does it matter exactly how it's organized?

I don't think, I don't think it. I think everybody, as we talked about earlier, everybody does do this typically. I mean, the one thing that I also would think about is, you know, you could kind of embed your chief. If some have a chief strategy officer, which then starts to pull all that stuff together as well. So we're not, we're trying to make sure that we have connect the dots between all of this activity and then where the organization is going overall.

Yeah, that's what we've seen is just in our, in our healthcare clients alone, some have a chief strategy officer.

That's right.

Do not. But when you talk to them, they have a strategy. So they're still, they're either implementing it through their quality officer, their medical officer, and sometimes as a direct report into their finance department. Because the, while a healthcare organization is not in business for finances, if they're, if they don't have their finances in order, they don't have any money to invest in other parts of their strategy.

But what most of them are, many that we have dealt with don't have, is a tool like this to bring it all together and that's the missing piece. So it's great that they've got the strategy, but how, I mean, where are they looking at their improvement or their progress towards that strategy? And then how it relates to Hedis or Stars or anything else, they're looking at separate pieces, separate documents, separate tools. So to have this all embedded, I mean, that's kind of the secret sauce with clearpoint.

Yeah. And so that's what I was going to say is one of the takeaways. I know we're about out of time that I've heard is, is not only are measures everywhere, you're getting pulled from different organizations, whether they're the reimbursers or policy regulators, for lack of a better word, but they're also not even owned by the same people in your organization. And you're trying to impact those measures with a limited budget in some places, a very, very limited budget. And you have to have the ability to see all of this data in one place to make Those good decisions.

100% agree.

In the last minute. I know we're. We're basically out of time. Do you want to talk a little bit about how it tenfold you make this happen, your. Your innovation lab, or give anybody a piece of advice as they try to. To attack this challenge?

Well, we do. We. We love working with organizations that are looking at making that change and kind of, you know, kind of resetting that strategy. And we just. We obviously have found clearpoint to be just an amazing tool to kind of work with organizations through that process. Yeah, I. We would welcome, you know, any. Any anybody who's interested, but we have nothing but great things to say about. About clearpoint and everything that you guys have built. It really built a phenomenal organization.

Yeah, Mike, it's been great partnering with you, and I really appreciate you taking the time today on this webinar, especially making you get up early for our.

All good. All good.

Always a Pleasure coast audience.

Always a pleasure.

All right, thank you again.

All right, you got it. Take care. Thanks.