All good things must come to an end. Cavalcade of Risk’s swan song

Hank Stern launched the Cavalcade of Risk blog carnival back in 2006, a year after we each launched our own blogs, and the same year Twitter started.

After 224 editions, it’s time to say goodbye to the Cav. It’s been a great run, and I have had the privilege to host several times myself and to contribute often.

The Swan Song edition is posted at InsureBlog, so go check it out. I’m looking forward to continuing to read InsureBlog and to seeing what Hank does with all his newly found free time!

Axial Exchange CEO Joanne Rohde discusses patient engagement

Joanne Rohde, CEO of Axial Exchange

Joanne Rohde, CEO of Axial Exchange

Axial Exchange is a patient engagement solutions company that serves hospitals and health systems. In this podcast interview, Founder & CEO Joanne Rohde discusses:

  • The meaning of patient engagement
  • Why it matters
  • The personal story behind the founding of Axial
  • How the company combines software and services in its business offering
  • The expected impact of Apple’s move into personal health

By healthcare business consultant David E. Williams, president of Health Business Group.


Evolent CEO Frank Williams on transforming healthcare (transcript)

Frank Williams, Evolent Health CEO

Frank Williams, Evolent Health CEO

This is the transcript of my recent podcast with Frank Williams, CEO of Evolent Health.

David E. Williams: This is David Williams from The Health Business Group. I’m speaking today with Frank Williams. He is Chief Executive Officer at Evolent Health.

Frank, we were at the Connected Health Conference last month and while there you said that there was a need to help organizations transform clinically, but also make it work for them financially. Can you say more about what you meant?

Frank Williams: One of the biggest issues with transforming healthcare is directly related to the incentive system. If you think about changing the way you care for patients — taking a population health perspective, keeping people out of the hospital, much more proactive integrated care teams — in some ways you are reducing revenues and adding cost to the system in a fee-for-service context. You really do need to openly change the reimbursement system. You need to have enough patients that are getting reimbursed in a performance-based context, so that you’re really getting the physicians engaged in a new model of care. Ultimately, organizations can do well financially by moving in this direction but if they’re simply just taking on increased cost and losing revenue, the model’s not going to work.

David Williams: The most notable form of those risk-bearing provider organizations that we’ve seen are accountable care organizations, which were featured heavily in the Affordable Care Act. Do you think ACOs are likely to succeed and what will they need to do to really transform the healthcare system?

Frank Williams: I haven’t liked the term ACO because to me it relates back to some of the pilot programs that were part of the government’s initial launch, and in some cases, involved a very small number of patients. But if you think about accountable care organizations, ultimately being those that take a large portion of a premium dollar and therefore at risk for performance, I do think there’s an opportunity for them to do something very different in terms of a greater value for patients and a greater value for payers.

It starts with engaging the physicians. If you engage the physicians effectively and build care teams around the physicians, you can provide much better care at lower costs. It becomes much more rational, which ultimately aligns with clinical programs by using data from the population, identifying those that have different needs or need more intensive support and ultimately managing care more effectively.

Then, you eventually need to get the financing piece right as well. You need to have good pricing and solid risk arrangements. A lot of the traditional payer yields for ACOs are not good deals, so you’re not making enough up for the revenue that you defer. You need to really put a lot into your financial analytics and understanding the population that you’re managing. You need to structure the arrangement so you’re getting paid fairly for improved care and lower cost for the population that you’re serving.

David Williams: We’re seeing a lot of provider consolidation in Massachusetts, but also in markets around the country. It’s both horizontal integration, by which I mean, hospitals merging with one another and physician groups growing. Then, vertical integration as well, where you’ve got hospitals purchasing physician practices and post-acute facilities and so on. It’s happening pretty fast. I’m wondering, do you think we’re heading for just a few big systems in this country? Or is there a role in the long run for smaller players and even start-ups like there are in other industries?

Frank Williams: You’re going to see a mix. If you think about the traditional consolidation strictly on the hospital side, where you might cover multiple geographies – for example 30 hospitals in different markets combining with another 20 hospitals in another market or two in very different geographic locations – that doesn’t necessarily get you a lot from a population health perspective. It does get you more mass. So if you think about a world where you have to invest increasing amounts of capital and technology and infrastructure, it obviously helps to be larger. But in a population health context, you would much rather have assets that go across the continuum of care.

This continuum of care means from hospital to physician network, to home health, to outpatient care. You really are putting the assets together to more effectively take care of a population. You will see a lot of that consolidation going on where people look at ways of building out their integrated delivery system, and therefore being able to capture the financial benefits of that and also deliver a better clinical experience for patients, because you own more of the continuum.

On the consolidation piece, I think you’re going to see people move away from the traditional approach of merging very large hospital systems together.

David Williams: Frank, you spent quite a few years building up the Advisory Board Company, and I’m wondering if there are particular things you learned there that are informing what you’re doing now.

Frank Williams: First of all, it’s understanding what’s really going on in the industry. What are the up-at-night issues that health systems and physicians face, and how can you design a service offering which really helps drive them positively into the future? A really intimate understanding of the customer, is important.

The second thing has been designing an offering that can scale repeatability in terms of results, and provide benefit across multiple markets and very different geographic situations.

Third, is around talent. We spent a lot of years at the Advisory Board figuring out how to build a value system that attracts the best talent; people with deep provider care experience. How do we get them into the organization and how do we meet the demands and pace of our customer base. We’ve been able to recruit over 700 people in a short period of time. It’s not by accident; we’re really investing ultimately in the HR side.

And then, the last piece, is mission. I really believe that culture is king, and that if we can really focus on the improvements we can drive to the healthcare system and there’s a real aspiration to what we’re doing then we’re going to attract people who are going to be willing to run through walls for this. This is hard work that we’re taking on but people really believe in what we’re doing and that ultimately makes a big difference.

David Williams: Frank, talk a little bit about what Evolent does and what your business model is. We’ve been talking about it a little bit indirectly here, but what specifically does Evolent do?

Frank Williams: We’re really trying to help systems in their full journey to value-based care. So there are a few elements of that. The first is ultimately devising the strategy, the operational plan that would be “board-ready” that the executive team could really attach to and fund over multiple years. The second piece is getting in the technology infrastructure, the analytics, to do population health well. You need to understand the population, be able to stratify them, orient around your clinical programs, and then cascade it directly into your workflow and treating patients on a day-to-day basis.

The third piece is your clinical model and your population health platform, so how ultimately are you engaging the physicians, how you’re developing clinical programs, how you’re sharing data and driving performance that’s really supporting them in all those efforts.

Then, the last piece is the risk and financial management infrastructure, so if you’re going to be taking on performance-based contracts, how are those being priced? What are the incentive systems? How do you have actuarial knowledge? How do you develop your network? All the things that ultimately allow you to manage the administrative part well.

So, in terms of a model, there’s some component of what we do that’s fee-based. There’s a performance-based component. We tend to work with our customers on average for ten years, then hopefully much longer. Our relationships are about becoming an embedded operating partner and ultimately helping to bring technology, platforms and processes as a means to execute strategy successfully.

David Williams: Frank, this has been very insightful discussion. I’m wondering if there’s anything else that we should touch on today.

Frank Williams: Well, I think we’re at a point in the industry where we have a great opportunity in front of us. I think the market is really beginning to move. We’re seeing purchasers of all kinds, from government to employers, to exchange participants very focused on value, who are wanting to get more out of their healthcare dollar and ultimately wanting to get better care. I think we now have a number of organizations that have integrated physician networks and that have a series of assets across the continuum that see the financial urgency to move in this direction.

I think we’ve got an unbelievable opportunity to really improve care across the United States and move the model that many of us had wanted to see for many years that’s much more proactive and integrated in terms of the care that’s being provided.

It’s a really exciting time. We’re happy to be a part of it and play a role, but it’s going to take a lot of organizations working together to make it happen, but in general, it’s a really exciting time in healthcare.

David Williams: I’ve been speaking today with Frank Williams. He is Chief Executive Officer at Evolent Health. Frank, thanks so much for your time.

By healthcare business consultant David E. Williams, president of Health Business Group.

In praise of FDA collaboration: the cardiac safety example

Making it happen

Making it happen

The Food and Drug Administration gets a lot of grief. Some think the FDA is too restrictive, keeping useful drugs and devices off the market and thus harming patients. Others complain that the agency is too lax, letting dangerous products get through. What many people don’t realize, however, is that FDA has established an excellent track record of collaboration with stakeholders that’s leading to better, faster development pathways.

I’m directly aware of FDA’s longstanding constructive, collaborative efforts in the areas of HIV and HCV through the Forum for Collaborative HIV Research. Those efforts are now expanding into liver fibrosis and beyond.

So I was encouraged to to receive the following correspondence over the weekend from Mikael Totterman, founder of iCardiac Technologies, where I’m a board member.

On Friday, I attended the Cardiac Safety Research Consortium meeting hosted by the Food and Drug Administration announcing the results of a new study that promises significant advances and improvements to the way cardiac safety is assessed for new drugs being developed by pharmaceutical companies.

It was a great opportunity to review  over a decade of work that had gone into enhancing one of the key areas of drug development and to reflect on how industry and government collaboration can lead to dramatic enhancements for all parties, especially patients.

Where It All Started – The FDA’s Critical Path Initiative

Back in March of 2004, the FDA launched the Critical Path Initiative to “drive innovation in the scientific process through which medical products are developed, evaluated and manufactured.” The document identified broad critical bottlenecks in drug development that, if tackled, promised to deliver significant improvements to the process of developing new drugs.

Specific Opportunities – Cardiac Safety – Traditionally Very Costly and Hard to Assess Well

By March of 2006, and as result of broad-based industry support, the FDA continued their collaborative work, and rolled out a highly targeted list of specific opportunities for industry collaboration to improve the overall effectiveness of drug development.

One of the key areas highlighted by the FDA across several specific opportunities was how drugs were assessed for cardiac safety issues, specifically for the potential to cause potentially lethal cardiac safety side effects.

“#18. Predicting Cardiac Toxicity. New tools for early identification of cardiac toxicity would improve product development for a wide array of conditions. Research investments that could produce tangible benefits quickly include creation of an ECG library from clinical trials that could be used for identifying potential early predictors of cardiac risk.

#46. Identification and Qualification of Safety Biomarkers. …For example, a robust database of preclinical and clinical data on cardiac arrhythmic risk could help us understand the clinical significance of QT interval prolongation, reduce the need for clinical studies, and, possibly, help identify individuals who are at risk for this side effect….”

Cardiac Safety – Consortia are Born

The level of interest in these opportunities was intense and so two separate industry/FDA consortia were developed to provide a venue and process for validating tools and methods that could tackle the issues in cardiac safety.

The Cardiac Safety Research Consortium was formed in 2006 through an FDA Critical Path Initiative Memorandum on Understanding and the Telemetric Holter ECG Warehouse was formed in 2008.

Significant Progress Unveiled at Cardiac Safety Research Consortium Meeting at the FDA

The Cardiac Safety Research Consortium meeting this past Friday was particularly exciting as it was the culmination of many years of work on the part of the FDA as well as many industry participants and thought leaders.

As the recommendations from the meeting are rolled out, the expectation is that cardiac safety testing in clinical trials will become ever more thorough and at the same time accomplished at a lower cost.

This is something that everyone should celebrate; patients, drug developers and regulators are all better off as a result of this long-term collaborative approach.

photo credit: ePublicist via photopin cc

By healthcare business consultant David E. Williams, president of Health Business Group.


Guest post: Playing with fireball

My long-time friend Gregory Stoller teaches entrepreneurship and international business in Boston College’s MBA program. He’s not really a healthcare guy, so you haven’t heard about him from me before. However, he is the chair of two committees at Hebrew SeniorLife, which provided inspiration for the guest post below.

Gregory Stoller

Gregory Stoller

To climb the corporate ladder, you must consistently deliver against strategic plans for which you have primary responsibility. Most successful C-level executives share that resume item. But with fires constantly appearing, how do you focus on the big picture without getting sidetracked?

A non-business world experience offers good inspiration. I recently attended a seminar hosted by one of the non-profits where I volunteer. It traced the orthopedic patient’s journey through physician consult, to surgery, rehab and eventual discharge, via a series of live, inter-departmental “warm handoffs.” You can’t just throw something over the wall but must thoughtfully pass it to others.

Albeit filled with daunting medical nomenclature, the perioperative lessons are quite transferable to business: Across a patient panel comprising thousands of complicated surgical procedures and unpredictable results, it’s possible to implement systems, bringing order to natural chaos. Even if occasionally imperfect, with enough data, practice and time, entropy eventually does become predictable.

Being productive is as equally personal, as it is classroom content. I have run my own business for well over a decade, so am well versed in plan implementation, extinguishing unexpected roadblocks and keeping investors informed. How to navigate these minefields is part of what I teach to my MBAs.

Yet well removed from teaching anecdotes and boardroom banter, everything still seems eerily reminiscent of Harold Ramis’ film Groundhog Day. Each morning, I calmly review the day’s schedule; the word “planner” is at the top of the page but the irony is never lost. By 5:00 pm, my actual activities could have been associated with someone else’s calendar. Sound familiar?

We have more technological firepower than ever before: instant information access, telephonic phone-in capabilities and an unlimited choice of customized pings as task reminders. In theory, we can plan better than we ever have. But it always comes down to working through those unexpected interruptions.

The secret of the tail not wagging the dog is deconstructing a big picture plan into a series of more attainable, and shorter-term, metrics and milestones. You’ll feel like you’ve accomplished “something” by scaling the smaller plateaus, and cumulatively, should eventually reach the peak of the overall target over time. But don’t ignore the 800-pound gorilla: the path is not linear and nearly always requires twice as much effort and three times your budgeted expense.

Additionally, the top leaders are effective due to their delegation. They’re paid to “think about” the work, not “do” it. By being removed from the daily trenches, they can see the fireball coming, and either deftly hand it off or stop it in its tracks, well before it affects their staff.

Mutually negotiate attainable metrics and rise above the fray of being sidetracked by a passing disruptive breeze. You’ll eventually hit your mark. And be nice to the people cleaning your surgical wound dressing. They might not speak COGS, but they’re Harold Ramis fans, too.