Interviews

Since the implementation of the Affordable Care Act, more and more individuals are gaining access to insurance. Therefore, part of the New Jersey Health Care Quality Institute's responsibility is to make the complexities of the healthcare industry more easily understandable for members, according to Linda Schwimmer, JD, president and CEO of the New Jersey Health Care Quality Institute

Patricia Salber, MD, MBA, of The Doctor Weighs In, said that geographic location is one of the largest disparities impacting healthcare today, for it affects not only the types of plans available to individuals based upon where they live, but it also has an impact on the actual health outcomes of communities across the nation.

Different value frameworks offer different things, as Alan Balch, PhD, CEO of the Patient Advocate Foundation, explained that each framework has various other objectives in mind. Balch differentiates frameworks based upon whether their objectives reach individual or population-based levels.

Academic work has the potential to demonstrate positive outcomes for patients, but practically speaking, Lonny Reisman, MD, CEO of HealthReveal, said physicians simply don’t have the time to read, comprehend and apply the data when they are seeing and treating patients continuously all day.

Project ECHO works as a telementoring program with a team of specialists consulting with primary care physicians and sharing their knowledge, explained Mark Lovgren, director of Telehealth Services at Oregon Health and Science University.

As leader of the Robert Wood Johnson Foundation, Risa Lavizzo-Mourey, MD, MBA, has worked to advance the Culture of Health, a vision in which everyone in America can live longer, healthier lives.

Large insurers reducing their involvement in the Affordable Care Act health insurance exchanges doesn't necessarily indicate failure, but success is not guaranteed, said Michael E. Chernew, PhD.

Scott Breidbart, MD, MBA, chief clinical officer of EmblemHealth, explained that paying patients for adherence could be efficient when the payment initiatives are targeted towards members who have not shown to be adherent; however, he added that there are several limitations in paying for adherence, including the sustainability of the system and whether it will incentivize patients who are adherent to stop taking their medications.

CareSrouce’s Life Services program is a voluntary program in which individuals can decide on their own whether they would like to participate, a feature that Karin VanZant, executive director of Life Services at CareSource, said is especially appealing to their members.

Remote patient monitoring is one of the most exciting innovations in diabetes care, as it allows both the patient and the physician access to real-time data that wouldn’t have been accessible in the past when patients only went to see their doctor once every couple of months, said Kristen McGovern, JD, partner at Sirona Strategies.

Payment reform's impact on socioeconomic disparities may not matter if the growth in healthcare expenditures in the United States means the government or payers can’t afford to pay for the medicines, said Andrew L. Pecora, MD, FACP, CPE, chief innovation officer professor and vice president of cancer services at the John Theurer Cancer Center.

While speaking at the National Association of Accountable Care Organizations Spring 2016 Conference, Stephen Nuckolls, CEO of Coastal Carolina Quality Care, said that care coordinators have played an important role in his ACO to reach out to the patient and motivate them to become more engaged in their care. What makes a difference is showing the patient how much you care, he added.

Performance measurement is at the heart of improving healthcare, and part of this transition to value-based payment means creating measures that track the improvements of quality care, said Marcia Wilson, PhD, MBA, senior vice president of quality measurement at The National Quality Forum.

Ted Kyle, RPh, MBA, principal at ConscienHealth, explained that in order to prevent diabetes, a patient’s health-related risks needs to be addressed, and part of these risks stem from obesity. He added that a program like Medicare’s diabetes prevention program is exactly the tool the curb this progression.

Marilyn Tavenner, president and CEO of America’s Health Insurance Plans (AHIP), explains some of the biggest transitions she faced in moving from the public sector of working with HHS to the private sector of now working with AHIP.

Rethinking the ways in which hospitals get reimbursed and removing barriers to patient centered care are just 2 ways in which hospitals can consider moving from volume to value, said Stephen Rosenthal, senior vice president of population health management at the Montefiore Health System.

Jay Sheehy, senior vice president of product innovation at EmblemHealth, explained that improving customer experience is important in engaging the individuals, which can only be done if the health plan thinks more like a consumer and less like a healthcare company. Research and analysis as well as figuring out what is most important to the consumer is critical in engaging patients with their care.

While the implementation of the ACA helped to manage healthcare costs in the beginning, Patricia Salber, MD, MBA, of The Doctor Weighs In, said that there are just certain factors that will always make dealing with growing costs very difficult.

Not only are patients with prediabetes benefiting from Omada Health’s Prevent program, Omada benefits as well by learning from the enrolled patients about how to better serve the Medicaid population, Mike Payne, MBA, MSci, chief healthcare development officer at Omada Health.

Rocco Perla, president of Health Leads, explained that not only do stakeholders in the health system need to come together, but that the conversation also must be patient-centered to truly make headway in care reform.

In a series of video interviews, Donald M. Berwick, MD, MPP, president emeritus and senior fellow of the Institute for Healthcare Improvement, discussed the lessons learned from the Aligning Forces for Quality initiative.

Digital technology has great potential to improve the communication between providers and members, said Albert Tzeel, MD, MHSA, FAAPL, regional medical director of senior products at Humana. However, there are also drawbacks that come alongside digital technology that Dr Tzeel said is worth considering.

Getting people to change their mentality when it comes to their health is a very difficult prospect, but one that researchers attempted to tackle as part of the Aligning Forces for Quality (AF4Q), explained Donald M. Berwick, MD, MPP, president emeritus and senior fellow of the Institute for Healthcare Improvement. Berwick served as the special guest editor for the supplement publishing results of the AF4Q initiative.

Karin VanZant, executive director of Life Services at CareSource, explained that 1 issue in trying to improve the US healthcare system overall is that stakeholders are not taking a macro perspective approach. She said that what individuals and industry stakeholders should be focusing on is overall American well being, which includes aspects like housing and food access.

Medication adherence is a complex issue, and Lonny Reisman, MD, CEO of HealthReveal, emphasized the importance of better understanding what methods or strategies will help motivate patients to do what is in their best interest.

While Joe Antos, PhD, the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute, believes that the ACO model is here to stay, he said that the way these organizations operate are likely to change.

Pathways have a unique ability to bring a personalized experience to the patient if the provider and care team can access the evidence they need to do so, said Alan Balch, PhD, CEO of the Patient Advocate Foundation. Therefore, the subgroups of larger patient populations must be considered closely when constructing those pathways.

Healthcare is moving toward integrating data systems and eliminating silos but economics and logistics remain barriers to electronic health records, according to Andrew L. Pecora, MD, FACP, CPE, chief innovation officer professor and vice president of cancer services at the John Theurer Cancer Center.