Hi everyone. This is Erica Spicer Mason, a writer and editor with
Becker's Healthcare. Thanks so much for tuning into the
Becker's Healthcare podcast series. I'm excited to be joined by two
guests today. We have Kevin Colleton, the founder, and c e o of
Curation Health, and Nick Redding, curation Health's Chief Product Officer. Today we'll discuss how clinical
workflows and processes are evolving in value-based care. With that, Kevin
and Nick, I'd like to welcome you. Thank you so much for joining us today. Thank you, Erica. It's an
honor to be here and, uh, to be able to speak with
the Becker's audience. Uh, my background founder and c e o
of Curation Health, I, with Nick, have had the great privilege of
working together a long time. Uh, and we get the, we have the gift of, of focusing our attention on
solving one problem all the time, which is how to make it easier for
organizations to transition to value-based care with support, success,
and sustainability. Thanks for, thanks for the opportunity
to be here today. Good morning from my end, Erica. Uh,
uh, nice to speak with you and with the, with the audience. Um, as Kevin said,
we've, we've worked together for, uh, quite some time, um, and
I've been in the, the, the product development space for
a little bit over a decade, but, but really specializing in the domains
of provider engagement and clinical integration strategy. So, uh, just to give you and the folks listening
in a little bit of my background, thanks for, for talking
with us this morning. Wonderful. Well, thank you
both so much for being here, and I'm really excited to speak with
you today about value-based care, which we know is continuing to
really gain traction in healthcare, but at the same time, there are so many changes taking place
that can sometimes make it challenging for providers to achieve the
aims within that model. So, looking forward to digging
into this topic today. Um, but to get us started,
Kevin, I think you might, um, be able to help kind of set the
scene or set some context for this, but I'm wondering if you can say how some
of the changes that we've seen in the payment landscape are affecting healthcare
organizations levers for success in a value-based care model. Yeah, absolutely. Uh, the, the changes are being driven primarily
with the changes in the reimbursement model, but the need to manage those two
processes is really important to think about the workflows and to
think about how organizations need to engage the individuals at the
point of care in sustainable value, value-based care success. I think the perfect example
is in a fee for service world, the providers in their practices were, were mostly focusing their attention on
who are the patients that are here today and, and likely who are the patients
that will be in our clinic tomorrow In a value-based care world, you have to scale that up across all of
your patients across the calendar year and managing and having a
prospective mindset. That's at the, at the biggest picture
change and an obvious one. I think the challenge is we're never
going to have a clean cutover for most organizations where all of the patients
moved to the value-based care model or all of the patients were made
in a fee-for-service model. Most of the organizations
we're partnered with, and we get the privilege of a
front row seat to their transition, are challenged by living in two
worlds at the same time. The, the classic analogy of
a, a foot in two canoes. And that makes it complicated to design
workflows that are repeatable and easy, cuz there's a tremendous
amount of cognitive load
associated with figuring out which patient maps to which
programs and how do I organize the pre-visit activities and the point
of care activities and the post-visit activities between two very
different parallel, uh, paradigms. And on top of that,
within value-based care, that segment of, of a, of a practices patients
that map into that world, that itself continues
to get more complicated. There's a drastic amount of change. There's program programmatic change
and regulatory change and clinical compliance change and expectation
management of the patients and all of this, um, put together makes it very
challenging to sustain practice and deliver maximum value
to your patients and your community, but also have all of the key
stakeholders benefit from, from the, uh, the
value-based care paradigms. So the goal is simplicity. How do we distill this down
into the easiest actions that organizations can take,
providers can take, and their care teams can take to
maximize the care of the patients, but also get appropriate reimbursement
for the care they're rendering. Yeah. If I could just pile onto that,
I think, you know, simplicity, uh, there is is kind of
the operative term. Um, there are sweeping changes that have
been introduced by BBC incentives and, and various program structures
over the last, uh, uh, decade plus. But they all bring us back
as we think about, um, ultimately how do we help
providers to, um, navigate, um, some of what's being asked for,
uh, from of them. In the BBC world, it all comes back to simplicity.
But we oftentimes bucket, um, some of the work that we do, uh, to, uh, improve performance, uh, on, on
the part of providers, just as a, as a partner to them
into three categories. And they all tie back to simplicity in
some, in some way, shape or form. Um, we want, uh, uh, there to be
efficient prep, uh, for a, a patient visit. Uh, so someone
coming in who is polychronic, um, it's, you can have a much more effective
visit if you've prepared for it, uh, to, to, uh, kind of set things up for,
for the provider, uh, within the visit. Uh, thinking about how do we
give the provider guidance and, and insight about a care management
opportunity or a care gap to be closed in a really
friction, frictionless way. How do we avoid becoming part of the
noise that so often overwhelms them at the point of care? Um, and then
sort of after the visit, how do we sort of wrap around the
provider different, um, uh, supports, uh, such that, uh, we can be
sure that documentation is, is completed effectively and that
we don't have, uh, uh, codes, uh, and, and conditions going out the door
on bills that, that don't have the, the, the, the proper documentation to back
them up. So, uh, all three of those, um, are really simplifying, if you think
about it, the, the work that the provider, uh, has to do with the patient, uh, to
get to a, a, a BBC outcome that, um, that, that, that, that folks want. I appreciate how you both
outlined these issues. It sounds like the complexities are
stemming kind of from those bigger picture issues of compliance
and regulatory changes, like you mentioned Kevin and then
Nick at the provider level and during the care interaction, certainly there's a lot to keep in
mind in order to meet those aims of value-based care. And Nick, I'm wondering if you can
elaborate a little bit more, um, from this provider perspective, how do you anticipate the new c
m s risk adjustment updates will affect providers? And maybe you can say a little bit about
what that new risk adjustment update is too. Sure. So, you know, it's a,
it's a fairly significant, uh, update to the payment
regime, if you will, that has been sort of designed
and, and launched, um, with blazing speed. If you, uh,
consider the, the, the normal arc of, of payment change and how those get
worked through as C m S process, um, what what we've found is that, uh,
it's, it's pretty complex actually, the way things work out. There
are three different, uh, uh, ways in which a lot of, uh,
provider organizations are, are, uh, are going to be affected. Um, so
there have been changes to what are, what are called the demographic, uh, weights that are used to calculate
risk adjustment factors for, for these risk adjusted v BBC
populations. Uh, there are changes, uh, to the clinical weights themselves of
various codes or conditions that are captured and and managed. And there's also been a change
just structurally to how, uh, complexity bonuses are, are
calculated and paid out. So when you get a patient
who has several, uh, conditions that are
under management, if you, if you have a certain
number of conditions, it sort of qualifies you for a kicker,
if you will, because, um, you know, you've, you've, you've, you've crossed
a threshold into higher complexity that, um, c M s has, has, is considered worthy
of additional payment consideration. So, so that is, is actually is,
is harder now to hit as well. So a number of different ways
that, um, payments, uh, are, are, are going to, are going to
be affected, um, by, uh, what C M S has done with risk adjustment
factor weights. Um, I think that, uh, just given the complexity
of it, um, you know, uh, what what I would
encourage people do is, um, spend time understanding what
this means for your organization. And if you need help, um, you, you can
definitely talk to, uh, curation health, and I'm sure there are other
organizations, uh, that
do work like this as well. Curation has kind of a free
assessment that we can provide to, to organizations to really give them a
feel for how the changes that are going to be rolled out, um,
beginning in 2024. Um, so we talk about 2026 as being, uh, a
year when the transition is complete. That transition actually starts, um, in
about, in about six months. And so, um, we want, we wanna be sure that
every organization knows what's, what's coming at them, because for
some organizations, the, the impact is, is fairly significant. Um, but I think
that there's a couple of big, uh, risks that are, are, are, are either
introduced or, or exaggerated, um, with B 28 as that, as that emerges. So number one is, um, uh, it takes away certain, um, types of opportunities that have been, um, captured in the past and frankly have
been lucrative to provider organizations. So there are narrow, narrower
corridors in which, uh, provider organizations are
really going to find, um, the clinical conditions that
have risk adjustment value, um, with respect to the work that
they're doing on, on the, the, the conditions that
remain part of the model. I think it creates some execution
risk, um, in order to maintain, um, traditional performance.
Not, not, not just to improve it, but just to maintain it. Um, organizations are going to have to do
better than they have traditionally at, um, closing, uh, care gaps and, and
managing the conditions that that, that present in their population.
Um, I also think that there's, um, gonna be, uh, increasing focus
on, uh, condition specificity. And with that, uh, an important,
uh, increasing focus, um, on, um, the, the, just the efficacy of
documentation. Um, there's been a lot of, there's been a lot of discussion around,
um, you know, as, as these payment, um, changes take hold, and frankly,
the discussion far predates that. But especially as these, um,
payment, uh, changes take hold, are organizations going to be, um,
hit, uh, more aggressively with, with audits. Um, and they
may be, depending on how, uh, much backlash there is and
how much whiplash there is
in the market in terms of the, the, the scramble that, um, you know, CMS sees with providers trying
to change their coding practices. So I think there's just gonna
be a lot of focus on, um, documentation and making sure that
from a compliance standpoint, um, things are things, things are, things
are buttoned up, but all of those feel, uh, important a as well as just
expansion of current BBC uh, initiatives. One of the things that
I think presents an opportunity, an interesting one, um, for a lot of provider organizations is
how just fundamental expansion in terms of, um, lives under management can actually make
some of the financial headaches of V 28 go away. And I don't know if that's by
design or if it's just coincidental, but certainly in our own modeling,
um, for, for, for clients and, and also non-client because we,
we, we, we do the work, um, as a, as a service for free. But
one of the things that we, we are seeing with organizations
that we're supporting in this, in this math is that, um, most
organizations do have a, do have a, a, a path, a path forward here. Um, but it it's a little bit different
than than it than it was in the past. Yeah. And Erica, if I could just add, uh, from a big picture standpoint and
our conversations with leaders in the industry, there's three things that they're
focused on with these c m s regulatory changes, which V 28 is essentially the
technical definition of these new c m s regulatory changes. Uh, the first
one is revenue challenge. Like it's, you know, some of these, the codes that people used frequently
and were very beneficial are, are no longer viable or appropriate. Um, so there's global revenue pressure, um, there's increased operational
complexity of understanding what to do, what to focus on, and
there's a need for precision. And then third is the greatly and enhanced
compliance approach of, of just, uh, rad v audits and, and other, making sure there's accountability for
the code selected and the documentation to be matched, mapped to, um, which all drives to
getting precision support. How do organizations get the right level
of support for their provider network to select the appropriate
clinical conditions, vet the right clinical
opportunities at a patient level? Because at the end of the day,
value-based care is about accuracy. How do we determine the most accurate
diagnosis and corresponding code for each patient? And, and getting the support
to do there, to do and to, to, um, succeed in that category is going
to be absolutely essential, um, in the new c m s regulatory model. Mm, yeah. Really important
considerations here. And I think this is something that Nick
stated that these changes are expected to go into effect and
six short months . And I'm just thinking about provider
organizations and really all healthcare organizations kind of struggling
with healthcare, staffing shortages, administrative staff
shortages, and, you know, navigating all of these changes with
fewer staff and all of these changes to things like coding and
compliance expectations. It's, it's a tall order for organizations. And so I'm sure they're looking
for support. And, you know, I, I'm curious to know what
tools or approaches are you
seeing really move the dial for organizations that do
well in value-based care? And I'm also curious if AI
something that is really ubiquitous right now, if that
fits into the picture as well. Um, I'd love to hear both of your
take on this, but maybe Nick, you can get us started. Sure. Yeah. I think, you know, some
of the areas where, where we see, um, folks investing in performance
improvement are consistent with a, with a couple of the things that I
mentioned, uh, a few minutes ago. So we do see, uh, lots of,
uh, investments happening, uh, in, uh, both, both people process
and technology that really help to, to set up for an efficient visit, uh, between a provider and a patient.
Um, we see a there being a lot, a lot of investment in, uh, analytics, uh, so we'll come back to this issue
in just a, a moment, but, uh, across reams of data, um, there,
you know, there's now I think, uh, AI and, and other techniques
reminding that data that have, uh, matured to the point where, where we can
start to extract from those data, um, real meaning that, uh, can be, can
be leveraged, uh, clinically, uh, in, in treating with, with patients.
And I, and I, I exaggerate, I exaggerate the term clinically
because there, there's actually, uh, behaviorally is a, is another way
in which we're seeing, um, a lot of, a lot of ai, uh, uh,
technologies, uh, deployed. But, but we'll come back to that. Um, I,
I do think that, uh, there is, um, more, uh, to, to be said, uh, about the process of, uh, confirming compliance post-visit. Uh,
this is a conversation that we have with, uh, many of the organizations
that we serve. And we, we, we go about the work a a
little bit different in
different cases to sort of suit the organization, but from
health plans to providers, I think there've been a lot of,
uh, in investments, uh, and, and there will be continued investment
cuz I think historically it's been an area of underinvestment, but there'll be a lot of investment in
sort of methodologies that, that, uh, give, uh, organizations some, some
comfort and satisfaction that their, that their compliance, um,
approach is, uh, is up to snuff. Um, in terms of, uh, ai, uh, we see AI being used in all kinds of
different ways. Um, you know, I, I think, uh, uh, in innumerable innumerable
ways, really, because I, I think of AI like math, um, you
know, where are we gonna do math? We do math everywhere. Same, same with ai, but a couple of the AI
applications that, um, we're seeing a lot of experimentation
with, as well as ROI from, are in the space of, um,
identifying conditions for
management. So, like I said, there's, uh, there, there are technologies now that I
think have unlocked the value, uh, in a lot of unstructured data that
previously was pretty impenetrable. Um, and so just the ability of, uh,
advanced intelligence to, to, to recognize certain entities and,
and, and concepts in fields of data, um, some of it handwritten, um,
is certainly rocketing us forward. And our ability to, to predict, uh,
conditions, um, preventing, uh, sorry, predicting events and behaviors,
um, recommending interventions, um, automating certain process steps.
We see it playing out in, in a, in a lot of different ways. And I
think, think, um, you know, really, it'll be really interesting to see
what unfolds here in the next, uh, two to five years, because there's just so many different
applications of AI in our space. I'm excited to see what progress is made.
Um, you know, we, at Curation Health, uh, our approach to AI was pretty
light in the beginning of our journey, but we recognized that it was gonna
become more and more important. So we built flexibly to
accommodate more and more. And I would say that now our own
AI footprint is pretty diverse, and all of those different approaches are
bringing something new to the process. But I'm sure we're gonna continue to
discover different ways that AI can be supportive of the, of the V B C
goals. And, and I'm excited to, to, to continue to learn for ourselves, but also see what others are learning
as they, as they move forward. And Erica, the, I think that
overview of Nick was excellent. I think the only thing I would add is
that we started predominantly with humans, and humans are the ideal solution
for almost everything in healthcare. Uh, human experts interpreting
data is, is powerful. That's how you can make appropriate
diagnoses. Health experts, physicians, healthcare teams are the ideal
participants to make a final determination. And in our
world of prospective, uh, risk adjustment are legally
required to perform that action. So when we approach technology and ai, it's how do we augment the
superpower of the humans in the workflow and in the value care chain
to allow them to do heroic acts with spending less time
sifting through noisy data. How do we pull out the bright
spots, deliver them to, and, and to them in such a way where that they
can capitalize on them to benefit the patient in the equation. Yeah, that is so well said, Kevin.
It really sounds like, you know, based on, um, Nick's overview,
technology plays such a significant role, and it is really exciting to see what
will happen in the next few years, especially with ai. Um, but
to your point, of course, this is all to leverage
human capabilities. So, um, yeah, thank you both for
sharing your thoughts there. And so I wanna zoom out again. Um, I know we're talking about technology
and how that fits into the value-based care model, but also I, I'm curious to know which of the levers
for success in value-based care are proving more or less difficult
for providers to master, and what is it that's really
getting in the way? And Kevin, maybe you can say a little bit about that. Yeah, thanks, Erica.
From our view, we, you, we started our conversation today
about the importance of simplicity. And today in healthcare delivery,
we usually see the opposite, which is massive complexity, gigantic data sets, hundreds of things to sift through to
make the appropriate determination for a patient. And the, the real vexing problem
is all of this volume has good intentions. All of
the technologies and the, and the capabilities that
we have at our disposal are developed, engineered, and deployed to help. The challenge is sometimes the
byproduct of that solution is volume. And we have this, the term we
frequently talk about in the industry, a and from a curation health perspective
of the challenge of data maximalism where we're perceiving value in
the potential of a large data set versus we subscribe to
data minimalism, which was, what is the minimum data this
physician and care team needs to maximize the health of the
patient and only deliver the, that. If I was to say, one of the biggest
headwinds is just access to data, access to a very small data
set that's highly actionable is one of the key barriers. Because if a physician is not
being supported by technology, they have to go through lots
of records, lots of lab values, uh, gigantic medication,
lists, other notes, and other, uh, documents from other
healthcare organizations. And the biggest constraint is time. Most of our organizations are still
operating in a very limited time module where the physician has limited
time to prepare for a clinical visit and limited time with a patient.
So because of that constraint, the, the challenge is trying to
sift through tons of information. And our goal as an organization and an
industry should be how do we develop the right information in the
smallest and easiest way possible, deliver it to the end user to enable
those superpowers we talked about, and we get 'em the right information
for them to make the right clinical diagnosis and action for the patient. Yeah, just, uh, to,
to, to add to that, uh, that distraction concept is so
important and it's so problematic. Um, one of the, the, the things that curation health learned
a couple of years ago in our own work was that, um, in lots of situations you
could actually facilitate, uh, more provider engagement of some of
the clinical opportunities that were presenting for the patient with
a shorter list of opportunities, right? And, and, and it could be the
same things that were there before, but because, uh, the provider wasn't
looking in their sidebar at, uh, uh, uh, I'm sure a daunting, uh, list of items that didn't have much to
do with the patient's reason for visit, uh, you know, I think that, that they
were regularly being, uh, discouraged, uh, from, from engaging with
some of the opportunities. So we figured out just for ourselves,
that by, by narrowing the aperture, in some cases, you could actually
get more action. So I think, and it's just a perfect example of what
Kevin was saying, just getting rid of, uh, distraction sometimes,
um, uh, you know, more, uh, opportunity and more
guidance works against you. Um, the other thing that I would just
point out, and I don't think I'm, I don't think I'm blowing any minds
by saying this, but in, in healthcare, we have a, we have a, a, a longstanding change
management management challenge
just as an industry. Um, and so I think this because of how
many new things we're talking about, from technology to workflow to incentives,
it takes a while for organizations, um, to, to, to make some
of the maneuvers, um, uh, that are required to really
do well in V B C. And I think, I think we still see and suffer
for some from some of that, although it's certainly better than I
would say it was 10, 15 years ago. Uh, change management just remains an
achilles heel in the industry and, and something that we always, um,
will, will spend time working on. Yeah, for sure. And I appreciate
both of your responses. I'm really picking up on that theme
of the need for simplicity. Um, and I love the, the term that's new to
me now, data minimalism that's really, uh, smart. And I know that in order to really
empower healthcare organizations and our providers at the point of care,
it's what's needed. So, um, thank you again for
your explanations there. So I think to kind of
close our discussion today, I'm sure those who are listening
are probably wondering, you know, if they're grappling with these issues
of complexities in value-based care, achieving that simplicity
that we're talking about, I'm sure they're curious to know what
challenges or opportunities they should really be prioritizing first. Um, so I'm wondering if you can speak to
any kind of prioritization mechanism or a sequence that they
might abide by. Um, Nick, wondering if you can share
your thoughts there first. Yeah. Well, one of the things Kevin said
is certainly true, uh, which it, well, um, all the things that
Kevin has said are true, but the one that he just said that is
true at this particular situation is the one, is the one about
access to data. So, uh, this will certainly trip up
a lot of organizations. Um, data and data management is not a strength
of a lot of provider organizations. Um, I don't think I'm, I'm offending anyone by saying that I
think it's pretty widely recognized as true, but how do we get,
um, how do we get, uh, our, our hands on, um, the, the right kind of data and preserve
good data hygiene such that it can inform really important decisions
that we're trying to make in bbc? Um, a lot of the ways that we're
accustomed, uh, to archiving, uh, decisions and data in, uh,
fee for service world are, are not adequate to support kind of the
continuous management required in a, in a VBC context. So I
think there's, there's that, there's just kind of thinking
about, um, what data is needed to, to do some of, uh, the, the important new work and how
do we get it into shape for use. I think the fast following
concept is how do we generate, uh, performance visibility? Um, it's really
something as we work with, with clients, what happens when we turn on
certain types of reporting where suddenly a provider or, uh, a a provider administrator for the first
time can see and, and has access to, you know, near-time data
on the decisions, um, that are being made sort of
at the point of care. Uh, so being able to, um, create that visibility and start
conversations around it, I think is, is, is super, um, essential,
um, in terms of, you know, what else, uh, organizations can be be
thinking about. You know, it's a little, it's gonna be a little bit different
from organization to organization, but I would say as you step back and
think about starting to engage your provider organization, you, you,
you want to find the champions, but also I see a lot of organizations, um, taking as early steps this
idea that they're gonna, they're gonna pick the bottom
performers and, and, and, and go in and, and engage them and turn things around.
I just don't see that happening much in, in, in our, uh, experience.
Um, I see them coming along, but coming along after some
time in, in my mind, uh, if you really want to start moving
the organization, uh, uh, toward, uh, a better posture with respect to e bbc,
you have to engage the middle of the, the, the, the, the medical staff,
and you have to engage the, the providers that just
need the extra support. They're not philosophically opposed
to a lot of what we're trying to do. They just need things to be easy enough
for them that it's not a big hassle, uh, to participate. And I think
that's the right place to, to, to start when it comes to engaging the
organization. Um, my final thought, and I, and I talk about this
a lot with organizations, um, because it it makes or breaks your AI
is you really have to know what you're aiming to do, um, as, uh, as a provider organization or as
a health plan. And by that I mean, what are your, what are
your KPIs? Uh, what are, what are the goals that you're trying to
advance? I think in, in all of the, um, the, the thrill that is, uh,
accompanying, um, AI innovation, uh, a lot of organizations lose sight a
little bit of what they're actually trying to do with it. And you can find yourself wandering in
the wilderness with AI for a long time and spending a lot of money and getting
nowhere if the investments that you're making don't focus on your, your,
your key performance goals. Uh, and you're not actually, uh, driving toward AI outputs that
are gonna help to make a decision. So I always think, you know, be
focused, especially as you get started, you need some early wins. Um,
and so, uh, I, I think, uh, having a sense of where you can get
those wins and how you can start driving momentum in the, in the organization and
then add to complexity and
nuance after that point is a really important concept that, that
folks would, uh, do well to, to, uh, consider. And Erica, the only thing I'd add to what
Nick was just describing is when we're approaching organizations that
are new to value-based care or seeking to really enhance
their value-based care efforts, the mantra, think big, start
small is really important. I think sometimes organizations boil
the ocean and change 50 variables, and at the end of the day, don't know which ones are the
levers that are making an impact. And that level of noise, chaos, and change management required to go
big from the start is very daunting. So thinking big about where we're
trying to get to as an organization, I think Nick's description of the classic, what's the problem we're trying to solve? What information do we need to
solve it, who needs to participate, and how do we measure success is germane to value-based care
in the journey to, um, to, to get to an end point that
is successful and matters. Absolutely. Thank you both so much, Kevin and Nick for your time
and your insights today. I, I think that what you just said, Kevin,
about thinking big, but starting small, really sums up the pragmatic ways
that you've outlined how to approach value-based care, whether someone's just starting or
they're kind of in the thick of it. Um, so I'd like to thank you
both again for being here. Pleasure to speak. Thank you,
Erica. It was a pleasure. Thank you. Likewise. And we'd also like
to thank our podcast sponsor today, curation Health. You can tune into more podcasts
from Becker's Healthcare
by visiting our podcast page at becker's hospital review.com.