The Role of Tech Vendors in Value-Based Care Enablement

October 26, 2023 - Moving through the value-based care world presents many challenges for providers. Technology vendors can be essential to their journey.

Technology is a key factor in value-based care. Automation, in particular, is increasingly critical to the advancement of value-based care. But many providers are not equipped, technologically, to support these models. How can vendors step into this gap?

Defining value-based care enablement and improving data-sharing among healthcare partners can accelerate value-based care progress.

Jean-Claude Saghbini:

That is what enablement means, right? All incentives are aligned, and you don't have payer success at the expense of health systems or health system success at the expense of payer or both of them at the expense of patients.

Kelsey Waddill:

Healthcare Strategies hit the road! In our Industry Perspective series. We are coming to you from HLTH 2023, one of the top healthcare conferences in the US, to pull you into some of the conversations happening on the showroom floor.

READ MORE: How Advocate Health Keeps the Value-Based Care Momentum Going

We did record these episodes on site, so the audio quality isn't up to our typical standards, but we hope you enjoy the added ambiance. And with that, let's jump right in.

In today's episode, our VP of Editorial, Kyle Murphy, caught up with Jean-Claude Saghbini, president of value-based care enablement at Lumeris, to chat about building relationships between healthcare stakeholders to improve data sharing and--what exactly is value-based care enablement, anyway? This is Industry Perspectives from HLTH 2023.

Kyle Murphy:

To start things off, if you could just introduce yourself and tell me a little bit about your background.

Jean-Claude Saghbini:

Yeah, Jean-Claude Saghbini. I'm president of value-based care enablement at Lumeris. Been in technology since my school years. I got into healthcare in 2005, and I've worked in a variety of solutions that we brought to market, all the way from technology-based operational solutions to pure technology solutions, clinical decision support. And I've been at Lumeris now for about two and a half years, driving the technology portfolio there. So at Lumeris what we do is we are in the value-based care space, and we partner with health systems and provider networks to help them succeed in value-based care, both in terms of moving the needle on outcomes and quality as well as reducing operational costs related to that. We bring into these relationships a platform that's a combination of both technology capabilities as well as technology-powered operational capabilities. So it ends up being a long-term, multi-year partnership, where we are jointly transforming towards value-based care.

Kyle Murphy:

How would you define enablement in terms of--you say, "value-based care enablement"? I guess what does it need to push these organizations in that direction? Do they already have an appetite, or they're already interested in moving? I know there are a lot of federal initiatives that were pushing providers to move in that direction, but there's kind of some backtrack. There hasn't always been success in terms of building momentum. So, what does enablement look like from your vantage point?

Jean-Claude Saghbini:

READ MORE: How One Primary Care Organization is Boosting Value-Based Care for Seniors

Yeah, so before getting into enablement, two things to address. One is, you cannot start without there being an appetite, right? So that's a good one. The second part is that, whereas value-based care has been increasing, what we are seeing now is an imperative to move towards value-based care. We are getting to a point where we have about 64 million Medicare beneficiaries. That number is going to move to about 80 million by the end of the decade. Many of them, if not all of them, will be under some value-based care arrangement. And as such, the move to value-based care becomes an imperative. So different mechanics are needed to succeed.

And then that gets to "what is enablement." So enablement is--it's a multi-pronged thing. One is, what you need is powerful infrastructural capabilities in terms of technology, all the way from data technology that can aggregate hundreds of millions of records, whether it be claims data, clinical data, social determinants of health data.

We were just on a talk earlier today about social determinants of health data and its impact on care. So it's aggregating that data, the extraction of insights about these patients--both at the population level, but also at the end of one patient level--and on all the way to the action domain. So how do you take these insights and then drive action using technology to automate as much as possible? So that's part of it.

The other part of it is a transformation part of the enablement is the transformation of the health system or the provider network to leverage this data and technology to change operational processes. I'll give you some examples of those, right? It could range from changing primary care governance, changing primary care playbooks to make them more technology-powered playbooks, so operating model within primary care services, realigning incentives, so changing incentives, aligning contracts with these incentives.

So it's a multipronged approach in order to succeed. It's a team sport, if you will, and these are all the capabilities that you need to succeed in value-based care.

Kyle Murphy:

READ MORE: Healthcare Firms Plan to Increase Information Technology Spending in 2023

Our organization, actually, we used to do this thing called The Value-Based Care Summit. That's before the pandemic ruined things. We did live events, and we put providers and payers into a room, and it was the most interesting conversation you've ever heard, because each [one] thought they were just going to kind of spy on the other one talking and then figure out how they're going to gather information about each other.

Are you more focused on the provider side? You mentioned claims data, so you obviously have to work with payers, or if you're working in Medicare, I guess, you're getting the US or whatever.

Can you talk about how you get those different parties to the table? I've heard, historically, payers tend to be in a stronger position in terms of information and data than providers are, and providers tend to be a little hesitant to assume risk as a result of that. What do you see as these two groups who historically have been on the other side of the fence actually now working together towards a common goal?

Jean-Claude Saghbini:

Yeah, really good question. The only way to succeed--and it's feasible to succeed--is to have alignment across the board. And that can be achieved. So the right outcomes for the patient, first and foremost, the right outcomes from the health system point of view and the right outcomes from a payer point of view. Across both patient care and cost. And that is what enablement means, right? It's an enablement to make sure that all incentives are aligned and that you don't have payer success at the expense of health systems or health system success at the expense of payers, or both of them at the expense of patients. And that is feasible, right? Because at the end of the day, what is being extracted out of the overall healthcare system are inefficiencies that are detrimental to everybody, right? It's not like everybody's happy with data efficiency.

Everybody wants to extract them. So we power all of that with data and ensuring that--if that data is the same and everybody's collaborating based on the right metrics, the right measures, they compute it the right way, and they thought about ahead of time--that everybody can be successful in the model.

Kyle Murphy:

Now, when you mentioned Medicare. So, Medicare Part C with Medicare Advantage, obviously those plans have been growing in terms of popularity. Is the shift to value-based care at the system level essential to matching what the market drivers are, with more and more folks opting into these plans and we know that that boomer generation is about to increase the Medicare population astronomically?

Jean-Claude Saghbini:

Yeah, look, at some point you could have operated with a side project of value-based care. Probably the driver for it would've been Medicare Advantage and some other Medicare programs. But Medicare has been the biggest driver. CMS has been the biggest driver towards value-based care.

At this point in time, it has to become an essential component of a health system functions or how we're providing network functions. One is because there are also value-based contracts across commercial populations as well. So you have to deal with those. But also it's inevitable that, given the sheer volume of patients who are going to have some sort of a value-based arrangement or compensation model associated with them, it can no longer be an optional thing on the side. It's becoming now esstential to the success of health systems.

Kyle Murphy:

Do organizations need a strategic technology partner to do this? The successful groups that I've seen had these strong technology skills. The Reliants of the world and Atrius Healths of the world--before they got acquired or merged with other organizations, they had a strong data core. But to me, it doesn't seem to be common across many health systems, really. They don't really have that long history of experience in value-based care. So do they need to look outside their organization for that expertise?

Jean-Claude Saghbini:

I believe they do. One is because the data you need is data that's outside of your own four walls as a health system. You need data that's coming from a patient getting admitted at the ER one block down the street at another hospital. You need data about that patient when they travel to Florida and are getting care in Florida, and whether they are medication adherent or not. So the scope of the data you need as a health system goes far beyond the data you have yourself only. Do you need--again, we talked about claims data, lab data, pharmacy data, 360 data across the board? They need the best of breed of that data.

It's not only the data. The data is an extremely difficult component. Unfortunately, in 2023 in healthcare data, is an extremely difficult thing. And yet it's not sufficient. What kind of insights do you derive from that data that are the right insights for value-based care?

And then with that, it's not sufficient, because you need to figure out with that insight technology-based, what is the action to take? And then with that yet not enough, what you need is, okay, now that I'm taking an action, how do I operationalize how to take the action? And then the incentives around taking the action.

So it's a pretty broad transformation. What technology does is it makes it easier to adopt as a transformation, right? Because not everything is truly blocking and tackling, and every process has to be changed. Technology streamlines some of that change management, because you can relegate some of the tasks for technology to take.

Kyle Murphy:

Yeah. I was going to want to ask you about workflow, just how the value-based workflow, kind of, how it should operate. I've heard in the past that you need team-based models, so you need to have these care teams with different roles and assignments like that.

But I wonder if technology can also kind of streamline that too, based on [the fact that] not every organization's going to have the same staffing model. I'm curious about how that impacts the workforce.

Jean-Claude Saghbini:

Yeah, great question. I mean, the biggest impact is that it frees up the workforce to do the things that the workforce today is not able to do.

Kyle Murphy:

Patient care.

Jean-Claude Saghbini:

I'll give some examples. Very, very crisp examples. With the insights, you can derive what is the next best action for a patient and outreach for a patient to schedule a screening.

Any type of cancer screening, for example, an outreach for a patient because we detected they are non-adherent, and you need a pharmacist to talk to them to see if the barrier is affordability, transportation, they took their medicine. We just don't know. A patient gets admitted at an ED and then post discharge, you want to do a follow-up within X [amount of] time. All of these things are highly automated tasks. At the edge node, a human needs to interact and make a decision. But if we take away all of these automation tasks of knowing what's wrong with the patients, and then automating as much as possible to get them to a good state and hand off only the exceptions at the end to the experts/clinicians to deal with, [that] is how we scale the work of the clinicians.

But that is where we are seeing the biggest impact of technology, is that automation freeing up clinical resources to tackle the exceptions and focus on the highest need patients.

Kyle Murphy:

Now, you mentioned social need. Obviously, a lot of value-based care is built on population health, but there's also the individual within the population. How difficult of a challenge is it to acquire that data, those individuals' details, to understand that individual as part of a community, and then to make sure that the action actually leads to the outcome?

Jean-Claude Saghbini:

Yeah, yeah. This was literally the talk we just had.

Kyle Murphy:

Well, good. Then you had a warm up, so now you're ready to go do it again.

Jean-Claude Saghbini:

No, this is a fantastic question. The consumer based data about patients is available. In this case, it's not being used to market to them. We're using the data to further derive insights from a whole bunch of thousands of data points. We narrow that down to a series of healthcare impactful insights about social determinants. For example, affordability, language barrier, geographical challenges in transportation and whatnot.

And what we have seen is that if you take those data elements, and if you combine them with your typical data elements about a patient, which is the lab results, the comorbidities they have, the medication they're on, when they saw a patient's screenings, et cetera. If you combine those two data sets, typical datasets in healthcare with these datasets, and you build models based on that combination, predictive models, like risk of readmission or risk of ED utilization in a year or in a month or whatever, those models become extremely more accurate. Which is, after the fact, becomes logical because we as humans are more than the sum of our clinical data.

Kyle Murphy:

Yes, I would hope so.

Jean-Claude Saghbini:

We hope so, right? So what we tried to put is put in all the other data that matters in your care as a person, and we are finding great success in having more accurate models that are more believable. And then when you take action on them, you can truly move the needle.

Kyle Murphy:

Now, in terms of moving that needle, what are some of the obstacles you see in the way of coming full circle in terms of building momentum for this? So I guess each use case that you're working on kind of builds evidence for why this works. This is just really about educating the provider community. What's it going to really take to make this more widespread?

Jean-Claude Saghbini:

Yeah. Yeah. I would say, I'm going to call out three things. One is having the right incentive models.

Kyle Murphy:

Yeah.

Jean-Claude Saghbini:

The second thing is ensuring that you have success stories, and you hinted at that. That can start showing that by implementing these changes in workflow, we are truly delivering on the outcomes because there's a bit of a leap of faith. But we have many examples now, many, many examples of successful implementations. So one is showing some proof points.

And the third one is, physicians are overworked. Yet the 27th new workflow on the side to deal with. So how do you take insights in that change and make it integral in the typical workflow and to the extent that you're impacting workflow, "takeaways work" versus "add work". And again, there are many things, but these are the top three that I would call out.

Kyle Murphy:

And then my last question for you is--a conference like this, I guess, what attracts you to it, and what do you look to learn from an experience like this that brings together so many different types of organizations, really across healthcare and even into life sciences?

Jean-Claude Saghbini:

One is just be able to, on a periodic basis, I mean--fantastic conference, amazing, this conference--just be able to see what is the thinking. What are people thinking about practically? What are the things that work, that don't work? How do we all learn from each other? We haven't solved yet the problem in healthcare. So there's a lot of learning from each other to do. That's number one. The second one is just selfishly just getting exposed to new thoughts and new ideas, et cetera, just makes your neurons fire differently in your brain for the two, three days. And you just-

Kyle Murphy:

Got that brain itch.

Jean-Claude Saghbini:

Yeah.

Kyle Murphy:

You just want to learn new things.

Jean-Claude Saghbini:

Yeah, and then you leave humbled like, oh my God. I think it's just a fantastic opportunity. We don't do that every day because we do our normal work every day. But when we get to do that, it's an amazing experience.

Kyle Murphy:

So it's nice to get out again, after so many years of not being out. So we appreciate your time today. Thank you so much.

Jean-Claude Saghbini:

Absolutely. Thank you.

Kelsey Waddill:

Listeners, thank you for joining us on this first episode of Healthcare Strategies Industry Perspectives. When you get a chance, subscribe to our channels on Spotify and Apple and leave us a review to let us know what you think of this new series. More industry perspectives are on the way, so stay tuned.