Susheel: Dana, thank you for taking time out of your busy schedule to talk with us. DistilNFO appreciates it!
To start with, tell us about yourself, your career journey so far and your current role.
Dana: I am currently the Chief Executive Officer for the Wisconsin Health Information Organization (WHIO). The WHIO maintains Wisconsin’s All-Payer Claims Database (APCD) and provides analytical products and service to organizations that are interested in improving health outcomes, health care and health care value. My role at WHIO is a long way from where my career began as a Registered Nurse in a large urban hospital. But it was through my nursing that I found my passion: Improve health and the outcome of the care that patients receive. At that time, there were no practice guidelines or safety standards, and as a nurse, I could see that different physician order sets often led to different, yet predictable, patient outcomes. When I combined my nursing experience with my business degree, I could not let go of the fact that some patients were not receiving the care that nurses knew from many years of clinical experience would lead to a better outcome. So, instead of going into health administration, I focused on quality improvement (now referred to as performance improvement or population health management) which was a new field in health care. My first quality improvement position was at a large multispecialty clinic where I worked with the physicians to write and implement clinical practice guidelines. But we didn’t have any data to measure our results. So, I moved over to our health plan to use their claims data to evaluate the care provided by our health system. From there, I assumed a role at a state hospital association to develop their first statewide quality improvement program for hospitals. I started this work by creating an innovative public website where consumers could compare the quality of care provided by each hospital in the state using standard CMS measures. I also implemented multiple statewide safety and quality improvement projects in partnership with the hospitals and many other organizations. I then assumed a position with a national physician association where I worked with the national medical specialty societies who support clinical registries and created the National Quality Registry Network, a learning network to accelerate the development and use of these clinical registries. Four years ago, I returned to Wisconsin to assume the CEO position for the WHIO. As Wisconsin’s APCD, the WHIO information system includes data on about 4.9 million insured lives and tracks $50 billion in annual charges. In 2019, I moved our data to a state-of-the-art cloud computing system to support new, innovative analytics. I am currently working to add clinical and social risk data to our claims data so that we can create a state-wide comprehensive view of care processes, patient outcomes, the cost of care and health disparities that lead to sub-optimal outcomes.
Dana: From a treatment perspective, I am most excited about the potential of genetic therapy and the use of stem cells to treat diseases. From the perspective of transforming the health care delivery system, I am most excited about expanded computing power, data interoperability and advancing analytics. While science has increased our knowledge of which treatments lead to better health outcomes, it takes a long time to adopt these treatments into standard practice industry wide. This means that a lot of people are not getting optimal care. One of the contributing factors to this lag is that the health care industry has struggled to create and advance the measurement systems needed to support new care and financial models. When electronic health record (EHR) systems came into health care, it was assumed that the data housed by EHR systems would be digitized, standardized, and accessible. This assumption has not been fulfilled. We now know that integrating and processing health data from the multiple sources in varying formats is extremely expensive; and codifying rules for such data collection and manipulation—often called “interoperability”—are challenging. Currently, the Center for Medicare and Medicaid Services and the Office of the National Coordinator for Health IT are leading this work through regulations and financial incentives, but to fully realize the interoperability needed to drive change across the delivery system, health plans and other payers will need to move the majority of their business to value based payment models. Large scale data system, such as APCDs provide value to this transition since they can integrate utilization, clinical, financial, and patient reported data to inform these models.
When electronic health record (EHR) systems came into health care, it was assumed that the data housed by EHR systems would be digitized, standardized, and accessible. This assumption has not been fulfilled.
Susheel:The whole economy is finding a new normal amid this [COVID19] pandemic. How is this impacting the providers and their relationship with the patients?
Dana: When the COVID-19 pandemic began, providers had to first establish policies and procedures to keep everyone safe. At the same time, providers needed to obtain more personal protective equipment to keep their patients and employees safe. Because providers did not know if a surge of COVID-19 patients would happen or if hospitals would have the capacity to care for these patients along with other patients, providers needed to make resource allocation and staff deployment decisions. At the same time, many states issued “Safer at Home” orders. The combination of these activities required providers to defer nonemergency care such as non-urgent surgeries, patients with chronic diseases and those needing preventive services. Now that providers are better equipped to render care to patients in a safer environment, many are working with patients to catch up. However, people are still concerned about contracting COVID-19 if they go to the hospital or clinic; and some patients are not coming to the hospital—even if they are very ill. Some patients are deferring doctor appointments.
Because of the situation described above, virtual care or telehealth is one solution widely embraced by both patients and providers. From what I have observed, providers that had already implemented telehealth technologies could quickly expand the use of these technologies to stay connected with their patients. But providers who did not have these technologies in place had to scramble a bit. In Wisconsin, we have seen telehealth visits increase from 2/1000 patients to 76/1000 patients since March 2020 with about 60% of these visits serving behavioral health needs. Anecdotally, I have heard that the learning curve for clinicians and patients in embracing telehealth has been challenging. Providers needed to figure out what types of care these technologies work best for and what reimbursement models should be used in the future. Even so, telehealth is here to stay, and more adaptation is needed.
From what I have observed, providers that had already implemented telehealth technologies could quickly expand the use of these technologies to stay connected with their patients. But providers who did not have these technologies in place had to scramble a bit.
Dana: Based on my experience in performance improvement, I believe that innovation will need to come from within the health care industry; and be supported by the technology industry with financial incentives to spread large scale change.
Why? When the quality improvement movement started in health care, we adopted improvement models from the manufacturing industry. While these models provided a framework, they required extensive modification and many years of training before they were successfully deployed throughout the industry.
The health care industry will need to work closely with technology companies to maximize the value of what technology can do to advance our clinical care and reimbursement models. Unfortunately, there is a limited supply of people that can operate between these two complex industries. But there are examples of patient centric, technology enabled care models out there. Think about the typical relationship between a patient with a chronic disease and their primary care physician (PCP). Patients schedule their routine disease management visit months in advance and then attend these visits–even if they are not having problems. The visit starts with “How are you doing?” Technology enabled care models turn this interaction upside down. By facilitating patient and PCP access to a patient’s health care information (e.g., medical history, medications, lab results) augmented by information provided by the patient (e.g., functional status or pain levels), both parties can continuously monitor the patient’s well -being. Patients can track their own progress and see how changes in their medications or activity level have affect their health and their health goals. It also changes the structure of an in-person visit as the PCP and the patient can now focus on ongoing issues and solutions–not gathering data. You can see that a care model like this would require a population-based payment method as the PCP would be monitoring the patient between visits and the number of clinic visits would likely go down.
The health care industry will need to work closely with technology companies to maximize the value of what technology can do to advance our clinical care and reimbursement models. Unfortunately, there is a limited supply of people that can operate between these two complex industries.
Dana: As the cost of technology and other regulatory requirements increase and as higher acuity care is transitioned to less intensive settings, hospitals are working to determine how they can maintain access to high acuity services and, at the same time, provide care at lower costs. In Wisconsin, we have experienced a relatively fast transition to integrated delivery systems. Most community hospitals and physician practices are now either fully owned by the integrated delivery systems or are connected through a service contract. The health systems provide consolidated administrative supports, human resource and managements services, shared technologies such as EHR systems, and ensure that new regulations are met. While extensive resources are needed to integrate new organizations into these health systems and there is increased complexity in care coordination, the objective is to foster more standardization.
Dana: Skills needed to be a C-suite executive has changed dramatically. The traditional model of training in finance and then moving into a CEO position is no longer common. Many of the C-suite executives in Wisconsin are coming from a clinical background like medicine, nursing, PT, or pharmacy. I believe this is due to the shift in reimbursement where some portion of reimbursement is based on the quality of care their patients receives creating an intersection between financial and clinical management. C-suite executives would also be well-served through a general knowledge of technology since these are large, long term purchases, and how to use technology and advanced analytics to drive strategic and operational decisions. Finally, I believe that C-suite executives today need to have people skills and the ability to create long term partnerships with health plans and employers to gain a better understanding of what is of value to those buying health care.
Many of the C-suite executives in Wisconsin are coming from a clinical background like medicine, nursing, PT, or pharmacy. I believe this is due to the shift in reimbursement where some portion of reimbursement is based on the quality of care their patients receives creating an intersection between financial and clinical management.
Dana: My call to action is consistent with my view as a nurse: Put the best interest of the patient first when you are making decisions and embrace innovations that will enhance each patient’s health and their quality of life. While this may sound simple, there are a lot of competing demands which make it difficult to do in practice.