Mastering the delicate act of transforming population health through technology

At Franciscan Health, Chief Medical Officer Albert Tomchaney, MD, has spent more than a dozen years exploring how technology can be used to gather the right data to help clinicians make the right decisions.

Albert Tomchaney, MDbecame Indiana’s first chief medical officer Franciscan Alliance, which operates as Franciscan Health, in 2008. He managed medical practices for a time and oversaw hospital operations such as pharmacy and care management. But all along, and especially now, he has focused on population health activities.

“If it’s related to pop health or value, I’ll probably touch on it somewhere along the way,” Tomchaney said.

In this conversation with HealthLeaders, Tomchaney describes some of the technologies the Franciscan Alliance uses to advance these goals. This transcript has been lightly edited for clarity and conciseness.

HL: What’s an example of the transformative power of this information, whether it’s patient engagement or just the cost curve?

Tomchaney: Patients always firmly adhere to their right to choose what they want to choose. Sometimes they still do it without real feedback from their primary care physician. So they’re making independent decisions, which is fine, but your only way to see the full picture of that patient’s care is to have a very large data stream of clinics, claims, and quality. If you can bring those three things together, merged into one set of data resources, it can give us a better picture of patients, linking costs and outcomes to know that, yes, it really does make a difference to use the Implant A versus Implant B, or whatever clinical decision you make. This has totally transformed care delivery platforms.

HL: You talked about clinical data, claims and quality as a single set of data resources. It is often called the single source of truth. Has technology made a big difference?

Tomchaney: You need these three redundant sources of information to really be sure you’re grasping the truth about the patient. With redundancy, you have a higher likelihood of capturing all the domains and data elements you need. These tools help us understand how to develop a comprehensive and coordinated care plan. It’s still a work in progress because we still need to be able to refine and define quality more subtly than what we’re probably doing today. And it allows physicians to have a more educated and informed decision about how they make referrals and how they use resources in the future.

Albert Tomchaney, MD, Franciscan Alliance Chief Medical Officer. Photo courtesy of the Franciscan Alliance.

It’s pretty impactful for doctors when they see it in real time and it’s our patients. This is the big change: you take full ownership of these patients, because now there is almost nothing you don’t know about the patients. [whereas], in the past, you made assumptions based on other people’s thoughts, feelings, comments, and issues that they had no control over and that were put on the table by anyone. Now this is their data. So I think that had a big impact.

HL: You’ve been using Cedar Gate’s analytics technology to uncover this information for several years now. Just before the pandemic, you announced that you had improved your ACO performance by $44 million in 2018. Now that the pandemic has hit, have you seen a continuation of these kinds of cost savings?

Tomchaney: Tools like Cedar Gate shed more light on the impact of COVID on patient care. Patients have clearly done less care during COVID, for many reasons. The tool can help us quantify and understand where there may be pent-up demand and medical needs for patients that have not been met. This helps us understand where we may see increases in usage. This allows us to understand where there is still a vulnerable population.

COVID was basically a two-year phenomenon that. when you talk to one of the actuaries, you throw all their assumptions aside, and now you have to factor in those unknowns. COVID was an event that changed the pattern of use in the population, mostly to the detriment. We’re picking up from that and trying to bring back the resources we need to fill in the gaps on things that haven’t been closed during COVID.

The Medicare population hasn’t done as much prevention, so we’re playing a lot of catch-up with awareness. The data systems really helped us understand where that vulnerability was in the population we needed to treat. It helped us stay closer to being on track to where we were before COVID. We are still going to see shared economies. Our quality scores, which are the measure, when we got our MSSP [Managed Security Service Provider] reconciliation for 2020, we got 100%. It’s not official of [the Centers for Medicare & Medicaid Services] Againbut I can tell you that we have equaled this score for 2021.

HL: What role do payers play in this transformation?

Tomchaney: When you talk about this single source of truth, there are numbers that we get from our claims pool that we go through Cedar Gate, so we have all of that claim information. And then you have the periodic information that comes back from a particular payer. They don’t match. I spoke to the payers, saying let’s try to unite so that your data, my data and the data of the world are all the same, however imperfect it may be.

I would like to see more data confluence between payers and providers. Sometimes small differences mean a lot. There’s also still a lot of activity that payers are doing along the lines of risk assessments that go into some of their proprietary products. We don’t have as much line of sight for that. But we’re all going to be in danger together. We want transparency in health care.

Today, the focus is on suppliers. We need to do a much better job of providing patients and the public with better transparency. There is nothing secret that I can imagine, in terms of calculation. Honestly, some payers don’t have the solutions or the sophistication that some vendors have.

HL: There is also an effort to expand the traditional role of health information exchange to encompass claims data. Indiana sort of wrote the book on health information exchange. Is there a silver lining to circumvent the proprietary silos that payers possess?

Tomchaney: The good news is that we are having discussions about it. In the past, you couldn’t even really talk about it. The less than optimistic news is that nothing has really been done to change this. In Indiana, most health care is provided by employers. We are told that 70% have self-funded plans. It will take some time. The employer base in Indiana is very, very focused on hospital costs and why are they higher than in other parts of the country.

HL: If there is a knock against the AI, it is that it is full of black boxes. People believe technology does what it says, but may not always be able to verify it.

Tomchaney: In most cases, it will always be up to the clinician to make this clinical decision. We keep telling the docs that AI doesn’t replace your brain. What really scares me about the variety of systems I’ve seen is the willingness to accept a solution, from a technological point of view, which is the simplest. It’s a push of a button, as opposed to something that takes maybe two buttons. I said to the doctors, you all understand in medicine that we live by the 80/20 rule. Whether it’s through our pattern recognition, when we make a diagnosis, or whatever the experience is, 80% of patients can follow one of those algorithms that you talked about, but the skill in this new era is identifying the 20% that doesn’t.

If you look at places like Geisinger, who has ProvenCare, they do an amazing job of making sure the person is comfortable with the ProvenCare solution before they even integrate it, but you need to keep reinforcing the “patient first” approach. And while yes 80% is the solution, you probably need to take more time and effort to identify the 20% that don’t, make sure there are checks and balances and reasons why that clinicians stop and not push whatever is the easy button.

Scott Mace is a contributing writer for HealthLeaders.

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