Tackling the realities of population health: Acupera

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Free: Some say the government unintentionally causes many problems within population health efforts. How would you rate the effectiveness of the government within this process? 

Razmi: I think  government has been a very positive force in this [the developement of healhtcare IT] because a lot of this could’ve happened without the government incentives. The EHRs have been there for a long time, but they weren’t gaining the adoption that’s necessary in order to facilitate solutions like ours because we plug into EHRs and pull that data out and make it actionable.

The government has been a positive force, however, that does not mean they can solve every problem. Their role could be that of an incentivizer, and a first mover with Medicare because Medicare often sets the pace for what commercial companys do. So I think government has done well. I don’t see enough to think that they’ve gotten in the way or that their role has not been positive.

For anyone who want to point fingers at the government, I would ask: How much more can they do? I’m not sure. They have been leading with both a carrot and a stick and, I think, they have to strike the right balance. That’s very important because if they make the penalties for readmissions, or the EHR options, too stiff, the industry reacts very negatively and it creates an adversarial relationship. If they go to easy, it’s not going to be enough to incentivize providers to move. So given the progress we’ve seen in EHR adoption and the movement toward value-based payments, we have to say that they have done pretty well.

Free: Many see the role of the patient becoming a critical component in population health, but they are still trying to determine the best ways to incorporate their involvement. How do you believe patients ought to be brought into the process?

 Razmi: Patients, generally, healthcare is not a topic that they would like to spend much time thinking about. A lot of the solutions being created right now to engage patients are, once again, too simplistic. They make some lofty assumptions on how patients will behave and, as a result, they missed the mark. Patients are an important part of the value chain, but the engagement with the patients needs to be done in a manner that’s realistic.

I think with increased out-of-pocket expenses and higher co-pays, there’s an opportunity to get higher engagement from patients, but still, the onus is going to be on the providers to figure out what needs to be done for patients. Providers must communicate and engage patients to follow their care plan in an as least-intrusive way as possible. 

In our platform, we consider the patient a member of the care team. So when care plans are generated, there are tasks assigned to the patient to perform. We have found by including the patient as a member of the care team, and giving them specific tasks to do, is a tremendous help. Other solutions can be vague about the role of the patient and assume that pateints are going to go to a portal, look up their lab results and a lot of other actions that they never do, or that they do not do for a long period of time. We give providers an opportunity to realistically engage their patients by expecting them to perform specific tasks that will improve their care, but not expect too much out of them at the same time.

Free: We have discussed the areas where you feel the industry often misses the mark in terms of population health management. Are there any organizations currently in the field that you believe provide a good example of strong execution?

 Razmi: I can name a health system that is doing a very good job with that: Montefiore in New York. They were the most successful Medicare pioneer ACO. There were 32 pioneer ACO’s. They were responsible for more than 50 percent of all of the savings put together. So one organization was responsible for, I think like, 55 percent of savings from 32 organizations combined.

We’ve been engaged with Montefiore for the last two years because we feel their organization is so much ahead of everybody else. We need to be close to them and learn from them. They have the largest care-management organization in the country, and they have developed a well-oiled machine that manages the population, a large Medicaid population in the Bronx. They have successfully lowered costs and improved outcomes, and being a witness to how they perform their work is quite astonishing.

Free: What do you see as the biggest hurdle to successfully creating a useful population health solution within today’s healthcare environments?

Razmi: The work that needs to be done to truly manage a patient population is quite complicated and the logic behind creating effective care plans is quite challenging. 

A lot of these other solutions that are out there provide software that allows people to communicate with each other, and for you to come in and create a care plan and create messaging between the team and so forth. The issue here is that [approach], unfortunately, does not solve the problem because there is so much that needs to be done, so many different factors need to be taken into account to figure out what tasks need to be performed and so forth. If that needs to happen in a manual fashion on a day-to-day basis, it’s a lot of work. It precludes health systems to meaningfully undertake [population health] because there’s just too much work to be done. 

Over the past four years, we have tackled this issue. We believe we have created a special product – something that’s really getting market traction amongst providers. We attribute our success to the fact that we decided early on that in order to crack this nut we have to create actionable intelligence, not just clear communication.

Our system automatically takes raw data, looks at it and says, “Oh, based on this information, these are the tasks that need to happen, and here are the people who need to perform these tasks.” It then distributes those tasks to the care team as individual members. There is less messaging, not more messaging, because the system is intelligent enough that it figures out, for each person in the care team, what he or she needs to do and allows them to complete those tasks within our system. By including the automation and intelligence, the process is industrialize so the care team can actually focus on completing tasks instead of figuring out what needs to be done. 

That’s why a population health management system is such a hard system to create. To build the sort of complicated logic that takes raw, often static, data and turns it into tasks for multiple people, and then compiles every task together into a single care plan, takes a great deal of work and a special set of expertise in terms of healthcare workflows. Until the rest of the vendors in the area recognize how these issues stand between many of them and success, it be a few more years before we find wide-spread success stories in population health.