|An Interview with
Tariq Dastagir, M.D.
Lead Medical Director
Transcend Insights, a subsidiary of Humana, Incorporated
Global BU Leader
Senior Vice President, Transformational Health
Frost & Sullivan
Payors are the drivers of value based care structures and are taking on a more collaborative role in working with providers to drive a successful transition to Value Based Care. Dr. Tariq Dastagir shared his insights on how stakeholders can be successful in transforming the industry.
Interviewee Dr. Dastagir has been on all sides of the healthcare triangle, business, payor and patient. Dr. Dastagir stated that U.S. spending on healthcare is not sustainable and that we are not seeing the results, or value, for expenditures. Leveraging his multiple perspectives, he shared a new collaborative solution for healthcare that addresses patient over-charging, physician burnout, and payor difficulties within the system: Value Based Care.
- A benefit of value-based care is that it motivates hospitals and facilities to get patients home faster where they have a support system and are engaged socially
- Physician burnout is a problem. Transitioning to value based care can help doctors focus on being doctors, not medical scribes
- Payors can help providers transition to the new value based care model
- Quality outcomes are what payors are going to be looking at first – if your device or solution is using admission, hospitalization, or readmission rate as a metric, everyone is going to love it
- Typically, hospitals don’t want electronic medical records (EMRs) to talk to each other
- We have been struggling with creating a universal health record partly because we don’t want one person to be in control and have all the information
- Blockchain may provide some solutions for patients to have control of their data without having a central agency in control of it
Can payors help us make this transition by empowering members to make choices, such as where to seek care, so they don’t go to the ER as a first option?
Patients and caregivers are most empowered in a familiar setting. In an emergency room, it’s someone else making a decision. But we are all comfortable making decisions in our own home. Once a patient gets into a healthcare setting, they slowly start losing control of their journey. Families try to advocate for the patient, but the information isn’t always communicated in a way that enables patient and family conversations.
Home health is not a reimbursement-heavy area, because reimbursements are associated with hospitals. But this is where everyone wants to be. There is often a better support system at home, it’s more comfortable. We are focused on supporting these new models of care.
Home health is a frustrating space for healthcare business models and technology innovations. In order for it to work, we have to have some investment up front. If we don’t have the right kind of tools, such as remote monitoring sensors, heart rate monitors, blood pressure and other sensors, we will not be able to deliver on the promise. We have to continue to find ways to make sense of this approach and use all the data that we are collecting.
Electronic Medical Records
EMR’s have done good work in helping us digitize data. We have to share those values and problems as payors, and understand that transitioning to value-based care is not going to be a natural thing for a lot of providers to do. We are also at the forefront of providing support for providers. We have developed a framework to support their practices in the transition to value based care throughout their journey.
We can start with EMR’s and support them with simple, quality metrics, and then make a shift toward what we call global value: helping understand the capability and ability to take risks. And we have technology solutions to help providers get to that stage.
Fee-for-service models still prevail
A lot of reimbursement practices are still based on a fee-for-service model. Even with readmission penalties, (which is starting to have some impact on practices), a lot of providers are still unwilling to focus solely on value based care. For example, one physician related that he only has to see two more patients each day in order to generate the revenue to take care of penalty fees – that is hardly the spirit of change management. We’re starting to see burnout; some of those physicians aren’t going home until 9pm. Electronic records haven’t made it easy – there’s a workflow problem, and a technology problem, and we’re still trying to figure out how it makes business sense.
Need for predictive models
We need to develop predictive models to support the care manager’s or nurse’s work. If you have a care manager who is managing hundreds of patients, developing tools to identify who the high risk patients are, and what to look out for with certain patients will be invaluable. Technology isn’t the obstacle to developing these kinds of solutions, workflow is.
As technologists, we are so excited to develop solutions. But at the end of the day, we need physicians, nurses and caregivers to use the devices. When we’re developing those solutions, we need to be mindful of existing workflows, resistance factors, and the user’s experience with technology. As long as we can show improved outcomes, as opposed to just showing episode-based metrics, we’re moving in the right direction.
The digital companies are going to come in, and it will be good, because we can learn from them. The technology companies can help us understand what works and doesn’t work, test solutions and make improvements.
How to develop a framework that supports practices in their transition to value based care:
- Design simpler quality metrics
- Shift to global value
- Understand abilities and how to take good risks
- Create the ability to address problems proactively when possible
- Think about how payors can help providers collaborate
In the fee for service world, there is limited reimbursement for at home care. How would you address a technology provider to make it attractive for them to benefit from more at-home solutions? From the design stage on, what do we need to be thinking about to get reimbursement approval?
Dr. Dastagir emphasized that we have struggled to achieve universal healthcare because there is resistance to centralized control. Addressing these fears can help people see the value in centralizing. It’s not about fighting for power. It’s about working together for a more effective and efficient healthcare system. The end goal should be providing quality service to patients and motivating them to manage their health.