Phytel's Chief Medical Officer on transforming healthcare

Posted: 02/19/2014
Richard Hodach and Jerry Green
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Healthcare is in the midst of a minor revolution. Developed countries struggle under the burden of aging populations and processes that were never designed to support such large numbers creak under the pressure.

In this interview, Richard Hodach, Chief Medical Officer of Phytel, a healthcare software provider, and Jerry Green, Vice President of Quality also of Phytel discuss how the solution to healthcare woes lay in improving both technology and process and changing the way we look at healthcare entirely.

Editor’s note: this is a transcript of a recent video interview and has been edited for readability. Watch the original interview here.

PEX Network: Improving healthcare has become a bit of a hot-button issues in many countries today, what do you see as the key issues?

Healthcare on life support?

Richard Hodach: There’s a transformation taking place right now in health care. We’re moving from a fee-for-service towards a value-based system, which is a big transformation for physicians to go through.

At Phytel, we call ourselves a physician-directed population health management company; we generate the software for physicians, so that they can take on this challenge, and better manage patients at the population level.

For instance, if we were to take something like diabetes, we are able to identify people who have diabetes in a population, using the data from their systems, and then be able to tell that person to come in to the office. When you come into the office, the doctor can see whether or not that person had their A1C test, or some of the other tests that are standard for care of diabetes, and then they can take action on it.

Up to this point, people are just coming into the doctor’s office because they’re sick. Now doctors are going to be able to look at their entire population of diabetics, and manage them in different way. And they’re going to be able to do that not only by just seeing them. Instead, they’re going to have to high-performance teams, which will need data that can show the whole population - show the threats, show where there are situations that they need to attend to - and have somebody on the team manage the population.

PEX Network: So how are Process Excellence methodologies, like Lean and Six Sigma, helping your clients - which are some of the largest health care systems in the United States - address some of those challenges?

Richard Hodach: They need to be able to do population health management. Up until now, they’ve been doing a reactive type of health care. Their office practices and workflow are not in sync with the population health model. What we’re finding is that they need to change their workflows in the office, and we’re approaching them and helping them to do that – and we’re doing it with Lean Six Sigma.

PEX Network: Jerry, as Vice President of Quality, can you expand on some of these points?

Jerry Green: As our healthcare industry moves from volume to value, it’s important that they use Lean and Six Sigma methodologies to help them remove non-value-added activities from their clinical workflows. In the past, those activities may have had value. But as things have changed over time and the focus is moving towards value, it is important that healthcare providers remove non-value-added activities so that the clinicians can spend the time with the patient that they need, and not in doing non-value-added tasks, and activities in the workflow.

By using a value-added flow analysis, for example, a clinic can identify areas that are not providing any value to the patient. If they can eliminate those - or remove them out of the process - then, it allows the providers and the care coordinators to work at the top of their licence, and spend more time with the patient.

PEX Network: Can you take us through an example to help illustrate this?

Jerry Green: Recently, we worked with a client who had purchased a product to help automate some of its workflow. Anytime that you change your technology or system, it’s very important to look at the process to make sure you optimise the process around the workflow. With that, also, comes changing how people work - maybe even changing their job descriptions - to allow them to work at the top of licence.

Going through the workflow and mapping it out, we found that there were many things that the client was doing in their activities that was causing wait time. In this process, we mapped out the information that comes through from the patient at the very beginning of the process all the way until the point where they leave that process and come back into it again.

By doing that, it allowed the office to do a value-added flow analysis, and determine which activities could be eliminated. Where were the constraints on the process that we needed to reduce in order to speed up that process?

Again, it allowed the providers to spend time in the process where they were needed. The doctors could spend time doing what they needed with the patient. The clinical coordinators could spend the time upfront in the process to make sure that the patient is "touched", willing to be touched, and that the wait time, and the non-value-added time was completely removed from the process.

PEX Network: Thank you Jerry. So, Richard, in addition to process improvement, what else do you think is necessary to bring about meaningful change in health care?

Richard Hodach: We need for the data to be good data. In order to look at the population, you need to be able to look at data, and a lot of the data that the doctors have as this point is not very good. Data integrity is a big issue for them.

Also, being able to change from seeing patients in the office to a population health model where they have to do something with these patients – whether they come into the office or not, whether they’re compliant or not, they have to find the ways to engage patients in the process. So that is the other thing that is important – patient engagement.