Dr. Richard Milani is the Chief Clinical Transformation Officer and Vice-Chairman of the Department of Cardiology at Ocshner Health System, and the author of the soon-to-be-released book Death and Dollars: Solving the Epidemic of Chronic Disease. Dr. Milani was a guest on the Datica Healthcare Innovators Podcast on January 19, 2018, and discussed the role of transformation in healthcare with Datica’s Chief Data Officer, Mark Olschesky.
The role of a chief transformation officer
Healthcare, in the US and around the world, is undergoing enormous change — the biggest transformation since Hippocrates, according to Dr. Milani.
We realize and recognize that we have to transform ourselves in order to be more cost-effective and achieve better quality outcomes.”
The “sole purpose” of a transformation officer “is to be able to ready health systems for the needed transformation that is coming,” says Dr. Milani. Change is inevitable, and transformation officers are helping healthcare systems prepare.
Dr. Milani likens healthcare systems to big ships, An ocean liner can’t turn on a dime, and a healthcare system needs time to change how it does business.
Incentive is the key to transformation
“Generally what drives incentive in our economy is where the dollars flow,” says Dr. Milani. The payment system that healthcare systems have used is based on volume, so that more patients meant more payments.
The current transformation is from volume to value. Healthcare systems will be paid based on the quality of care they provide, rather than the number of patients they see. “So if you are doing a better job, you’ll get paid better than if you did a poor job,” says Milani, adding, “That means changing how you deliver care.”
Healthcare systems that have done well with the old model don’t have much incentive to change, but the direction of care, in the US and the rest of the world, is towards value-based care. “I think that it is the best thing that could happen for people, because at the end of the day what you want is to see a physician or go to a hospital that’s going to deliver high value, high quality, safe care, in the most efficient way possible for you so you can get whatever you need done, get out safely and not have problems that occur, or repeat hospitalizations for whatever procedure you might have had,” says Dr. Milani.
The patient experience matters
In the current healthcare landscape in the US, patients are consumers. The rising costs associated with healthcare have led to more high-deductible insurance plans. “As a result of that out-of-pocket [cost], people are sensitive to what we would consider a consumer-based strategy,” says Dr. Milani. Things like wait times, overall treatment, and cost are becoming increasingly important.
I don’t think that health systems in general across the US have spent time learning what patients want and looking at patients as consumers of healthcare as opposed to just recipients of healthcare,” says Dr. Milani.
Recognizing that, along with asking questions that lead to an understanding of what patients need and want are critical parts of the current transformation in healthcare.
A frictionless experience from vendors improves everything
Dr. Milani says that when tech vendors make things easy for the health system, the relationship is much smoother and more likely to succeed — and interoperability is the key to a frictionless experience.
“This only works well if we can share information appropriately and of course, the keyword is interoperability,” says Dr. Milani. He notes that stakeholders are coming together “more collegially than in the past,” and that has demonstrated the benefits of interoperability.
More than just making technology easier to use, interoperability allows health systems to use the data in ways that make sense.
Having the information in one location where we can now categorize and do all kinds of things with that information to interact with the patient at the right moment, at the right time, and at the right place is critical for us.”
Ocshner is transforming chronic disease care
One area where the transformation in healthcare is having a fairly immediate impact is that of chronic care. Dr. Milani points out that 86% of all the money spent on healthcare in the US is spent managing chronic disease.
Ocshner launched a digital medicine program for people with hypertension two years ago and, more recently, one for people with diabetes. Dr. Milani says, “We can see things getting out of control before they get out of control and we can make adjustments on the fly.”
In the hypertension program, which was designed for people with uncontrolled high blood pressure, 71% of the participants enrolled were in control within 90 days of being enrolled in the program. “We are much more effective in controlling chronic disease digitally than we are in a face-to-face, every three-to-six-month model that is the way we do chronic care today in the US,” says Dr. Milani.
It’s a much better experience; it’s a much better quality of care, it’s at a lower cost, and it’s also reducing the burden on the provider. It’s a great example.”
Learn more about the role of transformation in healthcare by listening to the entire podcast interview with Dr. Milani on the Datica Healthcare Innovators Podcast.