Healthcare Insider Podcast: Why value-based care demands improved data visibility

Deeper insight into provider utilization can empower organizations to deliver quality, cost-effective care and accelerate success under value-based care contracts – even in the face of complex technical and operational challenges.

In this conversation, Leah Quartano Bowling, vice president for insurance and healthcare at Hitachi Solutions, offers strategies for harnessing the data necessary to deliver on value-based care contracts and shares how these insights can help shape provider incentives.

Listen to the full episode below.

Camille Baxter: Hello and welcome to Healthcare Insider, a sponsored content podcast series from Modern Healthcare Custom Media. I'm your host, Camille Baxter, and today I'm excited to be joined by Leah Quartano Bowling, Vice President and General Manager for the healthcare industry at Hitachi Solutions. Leah focuses on helping insurance and healthcare industry clients and partners transform their business with the Microsoft platform and supporting technologies. With over a decade of experience across hundreds of deployments and a wide range of workloads within insurance and healthcare, she currently leads go-to-market strategies and innovation centered around customer engagement and experience, data management, business intelligence, application modernization and change management.

In this conversation with Leah, we will discuss how gaining visibility into provider data can help organizations succeed at delivering value-based care. Leah will also share strategies for leveraging provider data to enhance tracking and reporting under value-based contracts, even in the face of complex technical and operational challenges.

Before we launch into the conversation, I'd like to thank Hitachi Solutions for their sponsorship of this podcast. Hitachi Solutions is a global systems integrator with leading capabilities in Microsoft applications and technologies. Through its advisory services, industry and technology expertise and implementation excellence, Hitachi Solutions supports and accelerates healthcare customers modernization initiatives and business transformation goals end-to-end.

Leah, thank you so much for being here today. I'm excited for the opportunity to speak with you.

Leah Quartano Bowling: Thank you for having me, Camille. It's exciting to be here.

Camille Baxter: You have had such an interesting and illustrious career. Can you tell me a little bit more about how working in healthcare and technology has been personal to you?

Leah Quartano Bowling: I can. So I was diagnosed with a chronic condition at the age of 21 and I was still deciding and selecting which career I was going to go into. I leaned towards tech and that seemed like something that I could really have a long career and that had a lot of avenues to go into, but at some point I had to focus on an industry and healthcare just made sense.

It's personal. I'm in and out of hospitals and in out of clinics relatively often or more often than your average person. So feeling like I could contribute to the success of that market and elevate the experience for patients in that market has been really important to me throughout my career.

Camille Baxter: Technology is becoming more and more of an important piece of how good healthcare delivery is provided. So it sounds like it's a really natural and personal fit. Let's dive right in. So can you talk about why a foundation of provider data and insights are critical to value-based care delivery?

Leah Quartano Bowling: Yeah Camille, that's a great question. So providers are really at the center of this universe. It requires moving them from a fee for service interaction to a value-based care interaction. It's really on the onus of the provider in order to be able to accomplish this and bring better healthcare and better services to their patients, to the members of the plan.

So really getting at the crux of supporting them and understanding how we do business with our providers at a very simple level, like which clinics they work at, which hospitals they report to can support their ability to work more efficiently. This is a set of data that is essentially required to contract with them to eliminate claims being kicked out, to eliminate some of the disparate silos that you have when you're trying to do contracting with them.

So it's absolutely required that you get this data set right, that you feel good that you can trust this data set in order to support them switching from a traditional way of doing business to a newer way of doing business.

Camille Baxter: How can better visibility into provider interactions help improve the delivery of quality cost effective care?

Leah Quartano Bowling: So I really think that time is the biggest factor in fee for service. You have to get so many different patients in the door in a short amount of time, and although value-based care does open up the doors for you to be able to spend more time with patients because you're being measured on a different scale, I still think it's really important to have the appropriate insights and the appropriate visibility to reduce as much admin or overhead time as possible.

The critical moment between the provider, the physician and that patient, that's really where the care is happening and we want to use our insights and use the information about these providers in order to give them as much time back. We want them to have the most effective interaction in that clinical setting and in order to do that, we can't have them be concerned with how they're going to code this or whether this claim's going to get kicked out or not.

So I think giving them time back by looking at exactly how long things are taking or visibility into those different interactions is extremely important. I think that's the name of the game here in order to help them be successful.

Camille Baxter: It sounds like with the timing and restrictions on time it really allows them to focus in on what they do best, the delivery of patient care, and like you said, not having to worry about some of the other things.

Leah Quartano Bowling: Absolutely Camille, and that's where they want to spend their time. Doctors don't go to med school because they want to be administrators of claims. They don't go to med school to do other administrative tasks. They go to med school to take care of people and to make people more well. So the more that we can do as organizations to help them accomplish that and to take all the complexity out of it, the better we are off helping our providers provide better care, provide valuable care to the patients and members. So that's really why those insights and that data and having that foundational layer is extremely important.

Camille Baxter: Let's talk a little bit about the organizations. What are some of the biggest challenges that healthcare organizations today face with regard to tracking and leveraging provider data and trends?

Leah Quartano Bowling: I mean, Camille, I think just the complexity of the data that they're looking at and the complexity of the landscape is probably one of the biggest challenges. I mean, if you look at a single provider, let's say that they have a clinic that they work at three days a week, a hospital they do surgeries at two days a week, maybe another private practice that they work at, they're not even physically in the same location all of the time. So just tracking that provider across the different locations and knowing where they work and who they work with, even that alone is complex. Then you layer in the complexity of doctors who live on territory lines. So you've got a doctor that lives by a state line, so they might be seeing patients from across state lines and a lot of healthcare products for the insurance companies are based on the state you live in. That layers in an additional complexity.

Then you layer in the fact that rosters change regularly. Doctors move. We live in a more transient society and so moving isn't as big of a deal as it used to be. You've got providers moving to different places and these rosters changing every month as far as who's at that hospital, who's gone, who's there, what specialty they have.

So the complexity of this data, I think, is definitely one of the biggest challenges that they face. You can see evidence of that in some of the third party solutions that you see in third party providers of claims analysis. It's a billion dollar industry to analyze claims data for these payers, for these providers because of the complexity of the dataset that we're talking about.

Camille Baxter: It sounds like the more the organizations can get their arms around this, the better they can utilize their providers and the providers can deliver better and more timely patient care.

Leah Quartano Bowling: Yeah, absolutely.

Camille Baxter: Taking that a little further about how healthcare organizations can get their arms around provider utilization data, can you speak about what strategies are realistic and effective given the staffing shortages and budget constraints they face?

Leah Quartano Bowling: Absolutely Camille. So we feel like a holistic approach of people training, organizational change management plus the technology approach is really the best strategy to focus on.

I mean, as a technology implementer, of course, selfishly, I want it to be a hundred percent focused on what the tech can do. But what we've realized, and even some of our own support advisory services what we've seen really work out, is having a good combination of training your individuals, making sure that they are prepared for the new technology that you're layering in, and then layering on the more modern technologies.

I mean, there's a lot of solutions out there for master data management. There's a lot of inexpensive RPA solutions that can help with simple things like duplicate entry. There's a lot of inexpensive solutions for machine learning that can follow an individual and learn how they're editing or changing data, learn from that and then go take some of that manual work and automate it.

So we really encourage our customers to, one, not be afraid to lean in on some of the more modern tech, some of the more cost effective tech, but don't forget about your people. Don't forget about the training that should accompany all of the new technologies that you want to layer in. We really feel like that holistic approach is going to support these healthcare organizations to really get their arms around that foundation layer of provider data management and then really support them moving into the future of value-based care and value-based care contracting.

Camille Baxter: Yeah, I think if they can see how it's going to help them and the change is a little bit easier to make.

Leah Quartano Bowling: Yeah, absolutely right, Camille. When you have the newer technologies and you're leaning on it, of course it's great to leverage those. But sometimes I think to your point, the ability for those end users, those internal users, those employees of the provider or of the payer to get a really good idea of how this tech is supporting them, not replacing them, it is augmenting their ability, not taking their job. I think that's a critical success factor in relaying that message and making sure that they feel empowered by these tools and not replaced by these tools. I think that's how you really have a happy marriage between the people and tech.

Camille Baxter: What are some steps that organizations can take today to better manage provider data, especially if they're just getting started on this path?

Leah Quartano Bowling: Yeah Camille. So we really encourage our customers to start with getting clear organizational definitions of what the problem set is. This really applies to any complex problem that they're facing, but that's definitely step number one. Things like user stories and journey mapping can really help lay that out for any company.

We then also want them to set a strategy. How are you going to tackle this? We think it needs to include people, process and tech. We highly encourage that. Then once you set that strategy of how you're going to accomplish this, then you have to prioritize and get rolling. So maybe you choose some low-hanging fruit areas, maybe some RPA quick and easy solutions. Then maybe you tackle some larger organizational change management. Then you tackle some bigger data issues and more bigger data strategies like master data management.

But the key is to prioritize and then get going, get rolling and start taking down just step by step each of the items on your prioritized list.

Camille Baxter: So by looking at all of the journey mapping and building the strategy beforehand, it sounds like they can really understand where the quick wins are and create the longer term steps for improvement.

Leah Quartano Bowling: That's absolutely correct, Camille. I mean, it really is a road mapping exercise, and although that might be an overused term or something that people don't get as excited about, it's required. It's necessary. A solid roadmap that includes, to your point, the quick wins, the lower hanging fruit and then your longer term goals, your two year, three year, four year, five year goals. I think even in this area, especially in these more complex areas is essential.

Camille Baxter: Leah, are there any other final thoughts you'd like to add before we wrap up?

Leah Quartano Bowling: Sure. So I always tell customers when you're looking at complex data sets and when you're looking at problems that feel like they're the size of an elephant and you don't know which bite to take, we always encourage them just to get moving. You can have analysis paralysis, but if you do your mapping and your journeys and it's good enough and then move on, get your strategy. It's good enough and move on, and then prioritize and just start moving, you'll have a lot more modernization a lot faster than you thought.

We see a lot of organizations who see this massive problem and they get paralyzed by just analyzing the problem and it's never going to be perfect. So we always want to encourage our customers that it's okay to not be perfect. As long as we have traction and as long as we have action, it's better than it was yesterday. I think that's really the key to improving healthcare all up.

The complexities within healthcare and the issues within healthcare are big and requires a lot of players, and we feel like incremental improvement really matters at the end of the day. So that's the piece of advice we kind of leave all of our customers and our listeners with, is get moving.

Camille Baxter: How do you eat an elephant? One bite at a time. It sounds like that's really the process that you're guiding them through with the road mapping and the extensive planning process to help it to be less overwhelming. Leah, thank you so much for this conversation and for taking the time to discuss how provider data can help organizations meaningfully advance value-based care delivery.

Leah Quartano Bowling: Thank you for having me, Camille. It's always fun to talk about how we can improve this system.

Camille Baxter: This has been a sponsored episode of Healthcare Insider created in collaboration with Hitachi Solutions. To our audience, thank you for tuning in today. To listen to more episodes of Healthcare Insider, go to the multimedia section on modernhealthcare.com or subscribe at your preferred Podcatcher. I'm your host, Camille Baxter. Thanks for listening.