Presentation given at the 7th RISE Summit at the Hilton Nashville, 11MAR13 - panel discussion entitled, "Let's hear from the providers"

1. THRASYS
Let’s hear
from the
Providers!
Wayne Pan, MD, MBA
Chief Medical Officer
Thrasys, Inc.
7th Annual RISE Summit • Nashville, TN • March 11, 2013

2. 5 myths about physicians

3. or walk a mile in a physician’s shoes

4. How can you realistically change practice
patterns?
Risk-sharing practices explored
Which P4P programs actually work?
What can plans do to ensure good physician
documentation practices?
How can plans and practices effectively
engage providers?

5. take-aways

6. THIS IS ABOUT BEHAVIORAL CHANGE
SHOW ME THE DATA
TRY SOMETHING DIFFERENT, REALLY

8. why?

9. doing the
same
thing over
and over
and
expecting
different
results
is
insanity

10. change

11. MYTH
YOU CAN CHANGE A PHYSICIAN’S PRACTICE
#1

12. BUT THAT DOESN’T MEAN PHYSICIANS
WON’T CHANGE THEIR PRACTICE

13. FROM WITHIN, CHANGE MUST COME

15. motivation1.0

16. motivation2.0

17. motivation3.0

18. MOTIVATION
Learning & Challenging Incentives & Punishment
intrinsic extrinsic

19. MOTIVATION
Learning & Challenging Incentives & Punishment
intrinsic extrinsic

20. MOTIVATION
Learning & Challenging Incentives & Punishment
intrinsic extrinsic

21. MOTIVATION
V
Learning & Challenging Incentives & Punishment
intrinsic extrinsic

22. V
Learning & Challenging Incentives & Punishment
intrinsic extrinsic

23. reframe

24. how?

26. rethink your assumptions
that physicians don’t care
about quality

27. rethink your assumptions
that physicians don’t care
about quality
give us all of the data
work with us to help us analyze it
do this in small groups
stand back and watch what happens

28. take advantage of
where physicians
come from

29. take advantage of
where physicians
come from
we are high achievers
we are competitive
we recognize patterns
we use data to solve problems
we always want what’s best for the patient

30. use bj fogg’s
behavioral design
methodology

31. “changing
behavior
leads to
changed
attitudes”
BJ Fogg, PhD
Director, Persuasive Technology Lab
Stanford University

33. this is not a
physician
behavioral change
problem

34. this is a
human
behavioral change
problem

35. risk

36. MYTH
PHYSICIANS DON’T KNOW HOW TO MANAGE RISK
#2

37. no one was born
knowing how to
manage risk
it’s a skill that you
have to learn
just like riding a bike

38. why?

39. in the hands of a group of
trained providers, healthcare
resources are best managed at
the provider level, if the
incentives are properly aligned

40. how?

41. shared savings
bundled payment
ACO
partial capitation
full risk

42. performance

43. MYTH
PHYSICIANS WILL RESPOND TO P4P BONUSES
#3

45. don’t worry, it’s just a horse that’s playing dead. really.

47. why don’t P4P programs work?

48. why don’t P4P programs work?
it’s not about the money
OK, it is about the money
it has to involve my entire practice

49. documentation

50. MYTH MY OFFICE NOTES ARE FOR HELPING YOU
#4 WITH YOUR BLAH BLAH BLAH

51. lay enthusiasts have have imbued routine
office notes with more value than they
actually have
Clement McDonald, MD
Director, Lister Hill National Center for Biomedical Communications
National Library of Medicine

52. CMS began making Medicare EHR
incentive payments in May 2011 and, as
of September 2012, had paid about
$4 billion to 82,535 professionals and
1,474 hospitals
Daniel Levinson
November 2012 report, “Early assessment finds that CMS faces obstacles in
overseeing the Medicare EHR incentive program”
Office of the Inspector General

53. CMS anticipates spending an estimated
$6.6 billion in incentive payments
between 2011 and 2016
Daniel Levinson
November 2012 report, “Early assessment finds that CMS faces obstacles in
overseeing the Medicare EHR incentive program”
Office of the Inspector General

54. so what did we get for our $6.6 billion?

55. we converted our
paper siloes to
electronic siloes

56. Patient

57. has

58. a

59. history

60. of
no

61. one

62. paying
attention

63. to

64. her
history.
See

65. EMR
for

66. details...

67. what’s the solution?

68. what’s the solution?
have a system that identifies new HCCs
use NPs for documentation
EHRs may be helpful but they have
to be interoperable

69. the real solution is to rethink medical education
to teach core behaviors, not core knowledge
to be thorough, accountable, reliable, 100%
Larry Weed, MD
Father of the Problem-Oriented Medical Record

70. engage

71. MYTH YOU CAN ENGAGE PHYSICIANS WITH JUST THE
#5 RIGHT PROGRAM AND BONUS MONEY

75. from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)

76. from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)

77. from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)

78. from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)

79. 1
drawtheBIGpicture

80. 2
showme
theDATA

81. gowiththeFLOW
3

82. make the new way of doing things,
feel just like the old way of doing things
to get faster adoption, quicker results
behavior change that will lead to a
change in attitude

84. to build trust

85. to act as teammates

86. toincludethepatient

87. patientascostdriver

88. it’s
not
just
about
data

89. it’s
also
about
whom
your
DATA
serving
data to

90. savvy
consumers

91. not current
error prone
MPASTEE
no comparator

92. unadulterated

93. nonjudgemental

95. There are no
shortcuts to
anywhere
worth going
Publilis Syrus

97. cultural
revolution

98. THIS IS ABOUT
BEHAVIORAL
CHANGE
SHOW ME THE DATA
TRY SOMETHING DIFFERENT

100. YES
WE CAN!
WAR PRODUCTION CO-ORDINATING COMMITTEE

101. qa

102. THRASYS
thankyou
contactinfo
wayne.pan@thrasys.com
@waynepan
linkedin.com/in/waynepan
slideshare.net/bonedoc97