Interviews

In terms of managing hospital readmissions, Stephen Rosenthal, senior vice president of population health management at the Montefiore Health System, said that a hospital must not only consider the care given to a patient but the social situation he or she may be coming from.

While body mass index is a good indicator for obesity, there are various other factors and clinical symptoms that need to be taken into account when diagnosing and treating a patient for obesity, explained Ted Kyle, RPh, MBA, principal at ConscienHealth.

Medicaid programs must find a balance between confidentiality and patient safety when prescribing opioid painkillers, says Matt Salo, executive director of the National Association of Medicaid Directors.

The funds that the Patient Access Network (PAN) Foundation provides to patients are often used to help with the cost of medications, and there has been a large increase in the number of patients looking for assistance for the cost of cancer treatments, explained Daniel J. Klein, president and CEO of the PAN Foundation.

While working for Horizon Healthcare Innovations, Linda Schwimmer, JD, president and CEO of the New Jersey Health Care Quality Institute, gained insights on how best to transition to a pay-for-outcomes system and was able to actively work with healthcare stakeholders who were engaging in these models.

CareSource is helping to bridge the gap in a patient’s care by working within that space to pull together the various stakeholders and put the patient’s care needs at the forefront of the conversation, said Karin VanZant, executive director of Life Services at CareSource.

Digital health programs like telehealth have already made progress in fields like mental health by expanding access and lowering costs, but there are opportunities to achieve much more in the future, according to Susan Dentzer, president and CEO of The Network for Excellence in Health Innovation.

Personalized medicine looks at a patient’s genome, but precision medicine takes more of their social and individual determinants into account, said Leonard M. Fromer, MD, FAAFP, executive medical director of the Group Practice Forum.

CMS reached its goals for value-based payments in part because of providers’ enthusiasm for new programs, said Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS.

Patience and compromise will be key to healing political rifts caused by Medicaid expansion, explained Matt Salo, executive director of the National Association of Medicaid Directors.

The integration of data analytics into everyday use has allowed physicians to better engage in the patients care by intervening and taking action early, which ultimately improves quality of life and outcomes, said Lidia Fonseca, senior vice president and chief information officer of Quest Diagnostics.

While Omada Health’s Prevent program is designed for individuals with prediabetes, it can be adapted to patients who already have diabetes, because the program is built on behavior change and modification, explained Mike Payne, MBA, MSci, former chief healthcare development officer at Omada Health.

The integration of behavioral healthcare into a medical setting is being delayed by resistance from those benefiting from the current payment model, said Roger Kathol, MD, president of Cartesian Solutions, Inc., and adjunct professor of psychiatry at the University of Minnesota.

The commonly held perception of obesity as a personal failing on the part of the patient is outdated and unhelpful, said Janine V. Kyrillos, MD, FACP, of Thomas Jefferson University Hospitals and the Sidney Kimmel Medical College.

Ideally, the healthcare industry needs to be more consumer driven, so that solutions and programs are built with the patient in mind, said Jay Sheehy, senior vice president of product innovation at EmblemHealth.

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.

The use of on-demand data in the healthcare setting has gone through an evolution from the beginning, which was about pulling information into 1 pool and then understanding how to analyze it. The next step in this process is integrating this technology into the workflow of physicians and using the information in a real time and impactful way, according to Lidia Fonseca, senior vice president and chief information officer of Quest Diagnostics.

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.