The Big Unlock podcast- episode 7

Episode #7: “Data is the coin of the realm today” with Dr. L. Patrick James, Chief Clinical Officer of Quest Diagnostics

In this episode, Dr. James will discuss the findings of their third annual survey on the shift towards value-based care.

Over two-thirds of physicians feel we are still in a fee-for-service environment today. Physicians are being overwhelmed by the flood of data available to them. Many physicians believe they do not have the tools or the data to succeed in a value-based contracting environment. The lack of tools for making the data actionable is a key challenge in driving this shift.

As CMS and FDA gets more consumer-centric and tries to speed up technology and care models to make it easier for physicians to take care of patients, consumerism will continue to drive the shift towards value-based care. Listen to the podcast to know more.

[00:00:09] Welcome to the big unlock where we discuss data analytics and emerging technologies in healthcare. Here are some of the most innovative thinkers in healthcare information technology talk about the digital transformation of healthcare and how they are driving change in their organizations.

[00:00:25] Hello everyone and welcome back to our podcast the big unlock. It’s my privilege and honor today to have as my special guest Dr. Patrick James, Chief Clinical Officer of Quest Diagnostics. Dr. James welcome

[00:00:49] Paddy, it’s my pleasure. Thank you

[00:00:53] You’re very welcome. So, Dr. James you’re going to spend maybe another 15 20 minutes or so on talking mostly about very provocatively titled report that Quest Diagnostics is publishing which is based on a survey that you did, and the title of the reporter is ‘stalled progress on the path to value-based care’. Now obviously it looks like you had some surprises in the survey. We wonder what you want to start by telling us what the key takeaways were and what surprised you and what led to that provocative title.

[00:01:35] Paddy, I would be delighted to do so. So, Paddy as I believe you’re aware this is the third annual survey where we’ve been canvassing opinions from physicians primary care physicians several hundred and also a large number of health plan executives at the director level or above. So, we’ve been watching the voice of the customer if you will the people we’re working with both physicians and health plan executives get their perceptions of a how is the movement going, is the migration accelerating or perhaps not as much as we had expected several years ago. And also understand what they’re viewing as both challenges to adopting this mode of dealing with the changing healthcare landscape. So, this is the third installment I think early on we felt the movement was progressing with the current study. I think we’re getting some good data showing that there’s less optimism about this movement. There were both physicians and health plan executives feel that you know it’s not moving at the speed we’ve had imagined that we’re still very much at a fee for service environment and this year’s study shows less optimism of catalyzing that movement going forward

[00:03:10] Right. Did you see any nuances in the responses as obviously you know several hundred respondents so I imagine they cover a very broad spectrum from the clinician community and also in the health plan community. Did you see any nuances in terms of certain types of organizations maybe the larger ones being more receptive to value based care or otherwise were there any subtext so to speak in the broad findings.

[00:03:45] You know Paddy I would say in the broad text up there concerning the physicians and these executives over two thirds 67 percent believe that you know we are very much in a fee for service environment as opposed to a value-based system about 26, 27 percent had that perception and the fee for service was actually up 4 percent over last year. And the group that felt we were in value-based care system actually dropped by 2 percent. So you know that was surprising. We didn’t specifically breakdown you know whether the plans that are feeling maybe this stalling are the larger or perhaps a regional or smaller regional plans. We do work with a number of health plans right, I engage with our health plan colleagues on a daily basis. And you know many of the larger national plans have moved forward with various value-based arrangements some with a CEO partners. It does seem like our discussions about these kinds of initiatives are not as frequent or energized perhaps as they were maybe a year or two ago.

[00:05:13] Right, Well I know the survey doesn’t specifically cover this but do you have from your own experience an estimate of how much of the healthcare payment dollars are flowing through a value based care arrangement as opposed to a fee for service arrangement.

[00:05:34] Yeah Paddy. I don’t have current information I know most of the, first of all you know CMS came out with some very bold goals a few years ago in terms of moving away from fee for service towards more quality-based risk sharing sort of arrangements. On the commercial health plan side, most of the Nationals have also come out with you know going back 3 years or so two or three years you know fairly aggressive movements turn those sorts of arrangements. I know our experience on the diagnostic services provider we’ve had a number of those discussions. We’re still very early though in the process in terms of what they might look like and how we might engage the provider segment.

[00:06:29] Yeah. And I know the CMA had set a goal of 50 percent of all day care payments by 2018. Is it safe to say that the goal is not going to be achieved this year.

[00:06:41] You know I would say it’s that less likely I know with the new administration some of the changes that are ongoing in HHS and CMS, in some of the attempts to try and relieve the administrative burden on physicians you know whether it’s CMS or the American Medical Association, there’s a lot of discussion and initiatives trying to call back cut back on the administrative burden placed on practices whether it’s pre-authorization or trying to document quality measures for [00:07:16] Macker [0.3] as examples so I think both CMS and certainly many of the health plans are hearing a lot of pushback around [00:07:27] ministrate [0.0] of burden. So, people are trying to simplify quality measures. There’s also an attempt to try and make physicians doing their work particularly primary care physicians right, where offices are quite hectic and overburdened those stresses of trying to deal with some of these many requirements have just become overwhelming so I think there’s a number of things that may be at play and perhaps easing the push towards value based care in terms of some of the mechanics and management of data becoming easier.

[00:08:04] Right. And you know you mentioned quality metrics and that clearly seems to be one of the spotlights in the report in terms of the degree of agreement or disagreement about whether you know these query metrics are helping, [00:08:23] enduring , and whether you know the tools are even in place correct. And there’s there’s a lot of commentary around that and some interesting differences as well as convergences. So if I call it right in the survey it seems like know health plans are finally coming around to agreeing more with the physicians that quality metrics tools are not adequate in order to meet the needs of a value based care system. Did I read it correctly.

[00:08:54] Paddy you absolutely did, its interesting you know I was traveling last week and on a flight back to my home I was reading the most recent issue of modern health care and they had a summary report of the recent healthcare financial management association meeting and actually value based care was a very dominant theme that permeated the conference and it was interesting they came away with a couple of key themes. One is that is king and we in Quest Diagnostics have realized that in recent years specially under Lydia’s leadership that you know data is incredibly important and the tools that we can use to help transform data into knowledge that becomes useful in context and eventually becoming wisdom, we’ve really put a lot of effort in developing our suite of tools which we call quantum to deal with, whether it’s an electronic health record system we can put into practices, whether it’s some of the analytics we can overlay to help physicians look at gaps in care closer in quality measures, we know that data is very important it’s the coin of the realm if you will that many physicians are overwhelmed with data. Actually many health plans are also overwhelmed with data. So you know in our mission to really develop and deliver insights you know using our tools to make all the insights that are available in a very rich database it is a laboratory study is really a focus. The second thing that came out of the Healthcare Financial Management Association’s theme was really the risk cast and the incentives need to be aligned. More downside risk they state incentives are going to be necessary. Third they talked about a matter of trust and that’s another area we’ve really tried to develop are our value proposition what we bring to our colleagues our customers whether their physicians our health plans you know one of our themes is trusted medical advisor so we understand this space very well. We understand how to apply tools to this data to enrich it and make it more insightful. So that’s something we’re really been pushing in our dialogue with health plans and it seems to be resonating quite well that the last of the four pillars that the Healthcare Financial Management Group came on value based and changing physician preferences. So we’re also trying to help give physicians data driven choices you know can they go to high quality low cost venues and get worked on like laboratory studies. So as I was reading that article and then you know Lidya and I and Cheneau and others had some discussions internally about the study. It just underscored to me how this study really is aligned and in pace with what we’re seeing in some major national dialogues

[00:12:17] Very interesting, you know going back to the to the point about the tools that physicians require in order to meet quality metrics. Your survey says that health plan executives and physicians are now increasingly agree that the tools to succeed under based care are lacking. Dr. James, I had a question on that. Do you think that that is because people are not investing enough in the tools or is it because the tools themselves aren’t available or are mature enough to meet the needs of value best care according to the metric system on the value best care

[00:13:02] you know Paddy, excellent question and our perspective it seems to be elements of both. So in the in the Quest study you know the majority of health plan executives about 57 percent believe that physicians do not have the tools to succeed. Many of those tools of course relate to you know data management really getting the insights. It was interesting in this year’s survey which was a distinct departure from prior years. Now many of the health plan executives agree with physicians that they don’t have the robust toolset or the necessary data to really drive success and a value based contracting environment.

[00:13:53] Yeah and I saw too, that the question of Data and having enough data about patients is coming up as a theme in the responses. I was curious about one thing. The survey talks very specifically about the electronic health record systems and how much of the information within EHR systems is usable in the context of quality metrics program. At the same time it seems to me that there is a lot of data that is emerging about patients that can potentially provide a physician with a more comprehensive view of the patients, so we talk about genomics data as an example or wearables. These are just two prominent examples but there’s lots and lots of emergent data sources, social determinants and so on that are now being harnessed in order to provide a more complete view of the patient. So this a comment, you know that physicians are making that they don’t have enough data about patients seems to be in some ways contradictory to the fact that there’s not a lot of emerging sources of data. So what would one make of that.

[00:15:13] You know Paddy, again another, you would say one’s view that seems to be dichotomy right it seems to be a dichotomous series of statements but I think when we talk about Data, the amount of data is overwhelming. You know there was an article published in Health Affairs this May that says you know that said there’s 75000 different genetic tests available to our position to order and about ten new test genetic tests come on the market every day. Well even if you’re an expert in genomic medicine you know it’s hard to make sense of what exactly is the right test for my patients so many physicians are becoming overwhelmed whether it’s about choosing genomic tests whether it’s about making sense and the flood of data they’re seeing on their patients so even if physicians are seeing the data through their EHR getting that data filtered and analyzed appropriately so it becomes actionable is really the key challenge right now. Right. So there are some physicians some practices that are not having as much access to data as they would like. I think when we talk about the tools to deal with that data that’s even a much larger problem. I know we have a quantum electronic health record which actually is configured to really help practices deal with requirements whether it’s macro or other CMS regulatory environments to try and make it much easier and intuitive for physicians to try to deal with this enormous amount of data

[00:17:05] Right now Dr. James you know I was looking for some good deals in all this and it seemed to me like this, there’s a couple at least a couple pieces of good news in the survey and one of them seems to be that in all your survey respondents demonstrate a lot of support for technology and technology solutions. So you know block chain address analytics you do you consider that to be a positive sign, and how does that play in to eventually accelerating the shift towards value based care assuming that that’s a desirable shift.

[00:17:43] Yes. So Paddy yes I think you’re absolutely correct. I think the information our survey really emphasize that both physicians and the health plan executives do see you real value in some of these evolving technology. You mentioned block chain. There’s also the fire technology. You know some smart application program. We’ve all been asking for interoperability between these various EHR systems right. And we’re still not there yet. It’s somewhat of a tower of babble that physicians trying to deal with information on his patients and different systems. So some of these new platforms and tools and application programming platforms are really going to accelerate the movement to true interoperability. So we’re very excited about that. You know Lydie and her team as part of quest have been in the forefront of a collaborative with block chain, we call that block chain Alliance. We think that’s going to really help from both a security standpoint but also from an access and data retrieval standpoint so that technology is interesting which really evolved from the crypto currencies looks to have significant applications in healthcare so that is something we are very excited about.

[00:19:10] Yeah you know I did speak with Lydia on this and one of my earlier podcasts about the collaboration that you launched with Optum and Humana and a couple of others. So that was exciting and that was focused on provider data management in particular if I recall it as the problem that is being addressed through the block chain pilot and I’m really interested to hear more about it as and when you know the results become available in terms of the benefits that you get out of it. You know coming back to the whole you to the whole question around value based care. One of the things that I do in this part of my work with health systems and others is really look at digital transformation. There is this whole shift towards using visual technologies to reimagine processes, reimagine customer experiences in this case patient experiences or even caregiver experiences. And that’s a big focus and trust for many health systems today. There’s a couple of things that I wanted to run past in your survey, there was an interesting observation that the doctors value patient engagement but they don’t necessarily believe in consumerism and I scratch my head a little bit on that it just couldn’t quite [00:20:37] fathom [0.3] what that meant. But at the same time it seemed to me like with the with the support for all the emerging technologies and so on so forth and the value that’s been placed on improved patient engagement it seems like there is definitely a desire towards digitally reimagine and transforming the experiences or improve patient engagement and by extension improving the lives of caregivers whether it’s to reduce workload or reduce burn out where it was. Do you have any thoughts on that.

[00:21:13] You know Paddy, one the results of the questionnaire that really caught me by surprise because I deal with these issues and daily you know much of the most of the results really reinforce what I’m seeing the results from consumerism you know the fact that there was a 20 percent 20 percentage point gap between how physicians and health plan executives you know whether putting more emphasis on a consumer based approach to health care will help advance value based care. You know 75 percent of the executives said yes versus 55 percent of them physicians. I was really struck by that because you know everything we’re doing as a company is trying to get to that consumer get to where they’re going how they live their lives whether it’s a partnership with Walmart or Safeway where they shop digital and name woman you know apps they can use it. It’s interesting. We have about 45000 employees Paddy and those employees have several thousand dependents that are part of our self-insured health plan. In recent years the medical team have been leading a change in how we approach those individuals, our employees are consumers and we’ve been using many of these tools. We’ve been eating our own cooking if you will to really push digital empowerment really make sure that our employees have data information and tools to make good decision. It’s really made a difference both in outcomes both financial and clinical so I know our medical teams and most of the physicians I deal with, in my travels absolutely understood underscoring the consumerism that’s growing ever more important so I was really surprised to see that gap. I would imagine next year or in the next two years that gap is going to close dramatically.

[00:23:20] Right. That’s really truly encouraging. You know one thing that we have to we have to also acknowledge and consider is the role of the regulatory authorities right CNS in particular and CNS has been in a series of announcements, I think they made some significant announcements, very recently about the reimbursements virtual care and so on. What is your view on some of the more recent announcements that have come out from the CMA.

[00:23:53] You know Paddy, it’s interesting we track their announcements not only on some of the value based models. You know them trying to get these physicians across the country to adapt and also how they’re you know how they’re really walking the talk if you will in regulatory activities. So you know we talked about genomic testing recently there has been a number of discussions to accelerate the adoption you know get both the FDA and CMS involved in making determinations on what genetic test should be covered. So we are seeing some movement there some acceleration of the process. We’re looking at some of their pronouncements to ease Data’s submission to make that a little bit easier or less cumbersome to deal with and on the quality initiatives you know we’ve not heard anything formally from CMS hasn’t been announced but it seems like because we talk to them Medicare Administrative contractors and others who work very closely with CMF I think there is there are changes afoot to speed the responsiveness. We talked about consumerism it seems like CMF and the FDA are also getting more consumer centric in trying to speed up technology’s applications models of care that will make easier for providers physicians to take care of their patients do it with less administrative burden and also experience the rewards that come with that.

[00:25:42] Right. That’s excellent. So I know we’re running out of time here. I had just one last question for you Dr. James if in the light of all of the all of the findings from the survey you had to take an alternate title to the report something that focuses on a positive development and that really gives us hope in terms of who you know a potential acceleration of the shift towards value based care. What would you say is your takeaway from your from your survey

[00:26:20] Well Peddy I think you know the stalled progress on the path I think is adequate but I would add you know there are some part I think the support for technology to better deal with that and make that data more available. So it really becomes knowledge physicians can make actionable. And also I think the support for some of the newer technology tools whether it’s the fire platform or block chain technology. And then finally consumerism will continue to drive many of these things and it’s likely to be another catalyst to get value based care moving again.

[00:27:04] Fantastic. Well Dr. James as always a pleasure speaking with you and thank you so much for your time. I look forward to speaking with you again soon. Thank you.

[00:27:15] Thank you very much. Take care.

[00:27:17] Bye now.

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About our guest


Dr. L. Patrick James, MD, is the Chief Clinical Officer, Health Plans and Policy, at Quest Diagnostics. Prior to assuming this role in 2014, he served in other senior leadership roles within Quest including Sr Managing Director of the Kansas Business Unit. In his current role, Dr. James works closely with Health Plans and National Accounts to drive collaborative engagement. Before joining Quest Diagnostics, Dr. James served in LabOne as Executive Vice President for Pathology and Laboratory Services. He spent nine years with Health Midwest, a 14-hospital integrated delivery system in Kansas City as Medical Director of Hospital Integration which included oversight of the health systems’ service lines. Dr. James’ experience spans Research Medical Center, St. Joseph Hospital in Denver, Colorado, and National Naval Medical Center in Bethesda, Maryland where he held leadership positions in the clinical laboratory and oversight of quality assurance programs. Dr. James earned his medical degree with honors from St. Louis University. He performed his internship and residency training in anatomic and clinical pathology with board certification at the National Naval Medical Center and post-graduate training in cytopathology with board certification at Johns Hopkins Hospital.

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