John Glaser is the senior vice president of population health management (PHM) for Cerner. He is the former CEO of Siemens Health Services, CIO and vice president of Partners HealthCare, a former president of HIMSS, and the founding chair of CHIME. In his current role, Glaser is leading Cerner’s PHM technology and product strategy, along with focusing on interoperability and government policy. At Convergence, Glaser will share his personal insight into the ability for payer-provider convergence to catalyze the change necessary to facilitate more coordinated care.
This is the second in a series of interviews that Chilmark Research will conduct with Convergence speakers prior to the event. The interview has been lightly edited for grammar and clarity.
Why is it important for the healthcare industry to take the emergence of payer-provider convergence seriously? What do you see in your work that makes this important to you?
I see convergence at multiple levels, driven by the shift in reimbursement making providers more accountable. There’s a blurring of traditional barriers between providers and payers. I also see some health plans getting into the care businesses. Frankly, some of the life sciences players are getting into disease management and care management – and they have been for years.
Another level of convergence is around what it means to have a consumer – a person who makes choices about goods or service and then acquires those goods or services. Patients aren’t just choosing a doctor or hospital, but whether or not they will follow a care plan. All patients are consumers, because they make choices all the time.
Third, the EHR is very clinically oriented. It lists your blood sugar, the drugs you’re taking. If you’re looking to keep people healthy, you start see how huge social determinants and genomic information can be. Increasingly, we see not just a clinical plan for heath, but a clinical and social plan for health. If you’re a patient who’s isolated, how are we addressing that?
Which stakeholders need to be at the table when strategic conversations about convergence take place?
There’s the classic communities of payers and providers. But you have to realize that “providers” is huge tent – there’s hospitals but also specialties, nurses, etc. Payers includes the big players, the Aetnas, the Cignas, but also the regional payers as well.
You do need government. It’s the biggest payer, the biggest provider of care, and the federal government is the biggest employer. You need to involve government at the federal, state, and even county level in some places.
You need consumers – and that’s a huge, diverse group. An 88-year-old in poor health is not the same as a 25 year-old in great health.
You need life sciences and biotech. They’re working on novel ways to cure diseases. Look at how the survival rate of childhood leukemia has changed in the last 20 years.
You need the tech industry – the classic Epics, Cerners, and Meditechs, but also tech giants like Microsoft and Google.
The most aggressive and innovative people have been state Medicaid organizations. By many state constitutions, legislatures have to balance the budget… – and in most states, Medicaid is the big-budget item…You do see aggressive movements by private sector, but they are large nationally and small locally, and they don’t have enough clout in any given market to move the needle.
How is your organization beginning to focus on convergence? How widespread is the effort?
It’s the future. Like all futures, you can find some places where the future is here now, but in other places it’s several years away. Intermountain Healthcare, Memorial Hermann, they’re here now. We see organizations all over consumer orientation, like Dignity Health.
Part of the challenge is catering to both communities. How do you balance the needs of today versus tomorrow, being careful of how replicable things are? Can I learn from the early guys? Yes, but you have to be careful, because they’re different from the later adopters.
With changes in business models, such as retail and financial services, it’s hard to say in the moment, “This is the mature form.” What percent of retail is done over the Internet? It’s 8%. After 20 years, you’d think it was more. That said, people live in fear of Amazon, and JC Penney and Sears are going south. Twenty years ago, you wouldn’t anticipate the Internet being a disruption to the grocery business. You need to anticipate and engage in mid-course correction.
Are you prioritizing convergence of data ingestion, analytics, care management, or patient engagement? Which of these key area(s) are you focused on?
I think about it in terms of profound technological advances, in terms of what they have enabled: The Web, mobility, even refrigeration. For convergence, I see two categories of profound advances.
We capture a phenomenal range and volume of data – not just in the EHR but from devices, our social behaviors, the trail we leave on the Web when we buy or search. There’s also social data and environmental data. Never in the history of the human race has there been this much data. Uber has such high value because it has data on what people do, and when. But how will we use that data? We don’t know.
There’s also potent intelligence. On Amazon, you see that people like you bought X. In our systems, it’s cleaning up data. For the caregiver, information changes dynamically based on the data that’s available, or based on patient preference. Treatment A is better than treatment B, that’s in the data. The tech giants are all over this. Cerner and Epic are all over this. Startups are all over this.
Do you think the roadblocks to broader acceptance of convergence are more strategic, tactical, operational, or cultural in nature?
All of the above, unfortunately. The legal and regulatory environments aren’t supportive. Up until two years ago, you couldn’t legally write a prescription without putting pen to paper.
Then there are companies that can’t get out of their own way. Kodak and Digital Equipment Corp. saw change coming, but they couldn’t react. For all kinds of complex reasons, they just couldn’t do it.
If you see the doctor, and you have 12 bills, it’s easy to say there should be one bill. It’s process change, it’s organizational change, it’s attitudes.
And amid all of these things, consumers just want to be taken care of by their doctor.
Convergence and value-based care are closely linked. What will it take for the industry to accelerate the shift toward value-based care?
We’re at the point on the adoption curve where the early adopters have embraced this. We’re getting into the early majority cusp. They’re different. They’ll move if it’s clear that they should move and why. They’ll move as a result of regulatory requirements, like they did with ICD-10 or meaningful use. Or, the business model is so compelling that you have to move. The driver will be the feds: How aggressively will they move the regulatory model, the reimbursement model?
What is driving this more: public or private payers? How much interest do you see in this as a mandatory vs. voluntary process?
The most aggressive and innovative people have been state Medicaid organizations. By many state constitutions, legislatures have to balance the budget. They have to get to 0 – and in most states, Medicaid is the big-budget item. It’s the states, followed by the federal government, followed by the private sector, which is trying hard but has the economy of scale in the way. You do see aggressive movements by private sector, but they are large nationally and small locally, and they don’t have enough clout in any given market to move the needle.
What organizations other than your own do you consider to be leaders in convergence?
Our base has a lot of larger health systems with the wherewithal and the geographic advantage – Advocate Health Care, Memorial Hermann, Dignity Health, Banner Health, Intermountain Healthcare, the Pediatric Children’s Hospital of Orange County. You also see it overseas, too. Oxford Health System in the United Kingdom, as well as Scandinavia and the Middle East.
What are the major non-technical barriers to achieving convergence?
It’s regulation and business models. You can wind up with group of leaders in provider organization, and they say they need to get closer to being a health plan, but they don’t know language, processes at all. It’s hard if you have competency in one area but you want to get competence in another area. It’s also hard when one part of an organization is trying to reduce care and another is trying to increase case. That’s been happening for a long time. Plus, there’s a complex tangle of affiliated relationships. Managing these things, and creating integrated systems, is a daunting challenge.
How will convergence bring the change needed to facilitate coordinated care?
There will be a motive to make it happen. Coordinating care costs money. All of a sudden, there are incentives or penalties. A lot of the arrangements are specific to what you have to do – we don’t want people bouncing back [through readmissions], we want to coordinate care for the sickest of the sick. It’s very specific contracts that target what you want to do.