HIStalk Practice Interviews Dave Spalding, COO, TMA PracticeEdge

Dave Spalding is COO of TMA PracticeEdge.

Tell me about yourself and the company.
TMA PracticeEdge, LLC, is a new services company developed by the Texas Medical Association to bring physicians the technology and expertise they need to take advantage of new healthcare payment models. It provides Texas physicians real options to design their own future. Today, we offer physicians a complete tool kit to help them form clinically integrated networks, manage population health, and operate value-based care models. We also provide consulting services in support of practice transformation. We will be seeking to expand our service solution set very quickly.

I am a healthcare executive with experience starting up new, high-growth healthcare services companies. Some of the recent companies I have helped get off the ground successfully include a new management services organization, a no-fee Health Savings Account bank and a five-star Medicare Part D Administrator.

Why did TMA decide the time was right to introduce PracticeEdge? What were you hearing from TMA members that led to its development?
Faced with the rapidly evolving healthcare environment and growing concern from the membership, the TMA leadership and board established a physician-led task force to research the concept of creating a physician services organization. After about two years of design and development work, the company was formally launched in February 2015.

Have any other state medical associations launched similar ventures? If so, did you reach out to them as PracticeEdge was coming together?
My understanding is TMA is the first medical association to launch a venture of this kind.

Why did TMA decide to partner with BCBS in this venture?
BCBSTX shares the TMA PracticeEdge goal of supporting and growing physician-led ACOs in our communities throughout Texas. When they initially expressed an interest in working together jointly on that goal, we welcomed their input and ideas. Ultimately, we were able to develop a mutually beneficial joint venture structure with BCBSTX bringing to the table innovative ideas, strategic capital, and flexible value-based contracting models for physicians.

Are PracticeEdge services only available to TMA members? How does your business model work?
Our services are targeted to our membership base, which is natural given the strength of our brand with independent physicians. We had a strong desire to get to market as rapidly as possible; therefore, we are utilizing a service provider to help us deliver our services. The firm we chose was Innovista Health Solutions, a leading physician-centric provider of population health, network development, and care management. Innovista already has over 120,000 lives under management in ACOs in Texas and Illinois. They bring competency and expertise to our clients, and they are very complementary to our trusted brand.

How many clients do you currently have? Are you seeing a particular type of physician practice express the most interest?
We have already landed three new ACOs for January 2016, and our pipeline is expanding as the word gets out about our services. Interestingly, we are working in a large urban setting, a middle market, and a rural market. We could not be more pleased with the reception we have received from physician leaders.

How do you envision helping them your clients better utilize healthcare IT as part of their overall ACO strategy?
Probably the biggest single IT-driven advantage we can bring to an ACO is access to best-in-class population health management technology. That access comes at a scalable cost, and it levels the playing field for independent physicians looking to compete against larger healthcare provider systems.

What types of ACO models will PracticeEdge steer its clients towards? Pioneer, Next-Generation, eventually commercial?
Every client is different, and we consult with them to assess their specific needs; however, it is safe to say we see real interest already in commercial ACOs as well as Medicare Advantage. Also in Texas, physician ACOs have been successful in working with the CMS Medicare Shared Savings Program ACO model.

Will you eventually offer your services outside of Texas, competing with companies like Aledade?
Our affiliation with our medical association makes us unique in some regards. We plan to grow our business around our membership and that strong historical connection. There is a lot of competition already in our space, and we think that is great for physicians, as competition drives market innovation.

Given that reimbursement models for telemedicine are shifting, do you anticipate your clients incorporating telemedicine services into their practices at a faster rate than previously?
We don’t see anything on the horizon that indicates telemedicine is going to expand in our region. Healthcare is local, and so far, retail telemedicine has not seen great uptake here.

Where are the majority of your clients with Meaningful Use? Are they feeling burdened or empowered by the criteria? How are you helping them to clear any IT hurdles they may be facing?
Physicians are feeling extremely burdened by the Meaningful Use criteria and are dropping out of the program. The unintended consequence is that it will further impact access for Medicare patients as the Medicare penalties increase. The program in its current form is unsustainable. As for helping them clear IT hurdles, the main approach we are taking is to work closely with a couple of EHR vendors that have been vetted by TMA physicians. Once these relationships are finalized, TMA PracticeEdge can help these practices optimize use of their EHRs, not only for Meaningful Use, but for other value-based programs as well.

Do you have any final thoughts?
We are really encouraged by what we are seeing in Texas and nationally with physician-led ACOs. Our estimate is that about 70 percent of the shared savings generated under the CMS MSSP ACOs has been delivered by physician-led ACOs versus a hospital-based ACO. We know from experience that when physicians step up and lead the charge into value-based care and population health, they can produce sustainable results including higher quality healthcare delivery at a lower cost.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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DOCtalk with Dr. Gregg 6/1/15

The Bastardization of HIT

A friend who travels the globe, and who works in the land of health information technology, recently mentioned how much better the potential was for HIT companies in countries beyond the U.S. He went on to say, and I quote:

“Wish I could say the same for the U.S. HIT***kthedocsbehemothpophealthbigdatastickittotheproviders companies.” (Asterisks added, to protect the eyes of the innocent.)

To be clear, my friend isn’t a healthcare provider. Still, he does have a genuine concern for us healthcare trench grunts. He also happens to have perhaps the most impressive overview of the world of health IT that I’ve ever beheld. While my vocabulary doesn’t include words of such magnitude, I certainly got his point. Thus, his long-lettered, contrived adjective gave me cause to pause, and to consider just where we are in U.S. HIT, and compare it with from whence we came.

After some goodly contemplation, I’ve a simple conclusion: My friend was correct – we’ve been bastardized.

According to Merriam-Webster, the definitions of “bastardize” include:

• To produce a poor copy or version (of something);
• To reduce from a higher to a lower state or condition;
• To modify especially by introducing discordant or disparate elements.

I think we might be hitting on all of the bastardization cylinders there.

First, let me say that I truly believe the vast majority of men and women in U.S. healthcare and health IT chose their careers based upon a desire to “do good.” Providers typically start with a desire to help people get and/or stay well. HIT folks often start with a desire to build a better HIT “mousetrap.” Each wants to help. Each has good goals. Most also have good values. How, then, did we go from such a higher plane to the bastardized level to which we have now sunk?

It may be entirely too trite to try and condense this down into a simple “here’s why,” but I’ll risk it. It seems to me that the ultimate evils in both the worlds of healthcare and healthcare IT can be summed up in two words – ego and greed.

Hollywood and professional sports aside, I can’t think of any industries that have as much ego as do healthcare and IT. Docs are notorious for their “God complex.” But, I swear, sometimes I think IT folks are striving to outdo docs for the top spot on “Mount Ego.”

So many think that they have the best ideas, that they have the “real” solutions, that they “know” the truly right answers and solutions better than anyone else. (For example, every EHR on the planet is “industry leading,” is “intuitive,” and “thinks like you do.” Huh. Really? Can they all actually think like me … and like you …and like every other provider out there?) How many times do vendors start off with a great idea or product, only to become subsumed by their own ego believing that because they did this first thing well, they’ll do everything well. A product or service that started superbly becomes bastardized with less functional and far-from-best-of-breed iterations or add-ons. (Producing a “poor copy or version.”)

Bring into this mix insurance company regulations – including the intentional obfuscation of payment and process clarity – and then add in some well-intended, but going-off-track-with-increasing-complexity-and-loss-of-focus government regulations and you further increase bastardization. (Introducing “discordant or disparate elements.”)

(To be fair and balanced, many of us HIT bloggers are no less guilty. Good initial intentions become derailed with egocentric bluster and a feeling that “we are somebody” just because we know how to type using reasonably accurate grammar. We become swayed by our own notoriety – even as relatively limited as it is – and start believing that we somehow know more than the rest of HIT-dom.)

On the greed side of things, that lovely little seductress has probably knocked more of us off of our initial high-minded pedestals than anything (in both healthcare and HIT). Initial grand ideas and success succumb to enhanced lifestyles, and enhanced bills. The need to pay those higher bills starts to drive decisions more and more. Lifestyle improvements often bring a sense of entitlement. Once we have more, we start to believe we deserve more. This seems to happen for both individuals as well as corporations.

What this then leads to is big payrolls, enormous new offices and facilities, large budgets, expensive marketing and promos, and more – all taking more money to support. As the need for more money to continue the ongoing expansion of such grows, decisions become less about the best product or service and more about the economies. Behind closed doors, HIT execs – whether industry or governmental – have often been heard to say, “When it comes down to it, it’s all about the money.” (Reducing “from a higher to a lower state or condition.”)

And, yes, just so I’m not accused of favoritism, this same effect occurs with some HIT bloggers. Big time.

All of this takes away – in focus and in dollars – from our supposed real purpose – healthcare.

There are some truly phenomenal healthcare information technologies in the U.S. There are some truly phenomenal U.S.-based HIT companies. There are some truly phenomenal HIT folks, and HIT bloggers. But, when taken as a whole, when you read all the gripes and complaints about the state of HIT in the U.S. today, from providers or patients or vendors or regulators, it’s really hard not to sense a significant bastardization of what we might be, of what we started out to be.

Of course, nothing this immense can be reduced to one or two causative factors. And, I know that this perspective will likely tick some people off. Others will dismiss these ideas as those of an unimportant little independent doc/blogger. (Which I am!) Still others might think I’m anti-American or anti-Capitalism. (Which I’m not!) But if anyone can step back and look at the state of health IT here in the U.S., from a total gestalt-type view, and not see one big bastardized version of what we could/should be … well … show me, and I’ll buy a round for the whole HIT house.

From the trenches…

PS – Does my little opinion really matter? Naw. Just throwing it out there into the mix with those of all the other grumps.

“America’s health care system is neither healthy, caring, nor a system.” – Walter Cronkite

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 6/1/15

Top News

CMS releases its latest round of Medicare Part A and B hospital and physician payment data. The new 2013 dataset has information for nearly 1 million healthcare providers who collectively received $90 billion in Medicare payments. The updated data has already prompted a few media outlets to highlight the highest-paid physicians, many of whom are facing legal troubles as a result. I applaud the agency’s attempts to be transparent, but wish they could offer it in a more user-friendly format. 

HIStalk Practice Announcements and Requests

Many local providers were on hand during a weekend Relay for Life event in Chattanooga, TN. The Erlanger Health System booth caught my eye because of the system’s decision last week to sign a $91 million contract with Epic, which will also require $97 million in maintenance costs over the next 10 years.

Watching: iSteve. Mr.H’s mention of the woman who unwittingly dropped off an extremely rare Apple 1 computer to a Bay Area recycling firm puts me in the mood to watch (again) this parody biopic of Steve Jobs featuring Justin Long. The garage scenes featuring the construction of the Apple 1 are priceless.

Webinars

June 9 (Tuesday) 11:30 ET. “Successful HIEs DO Exist: Best Practices for Care Coordination.” Sponsored by Medicity. Presenters: Dan Paoletti, CEO, Ohio Health Information Partnership; Brian Ahier, director of standards and government affairs, Medicity. Not all HIEs are dead – some, like Ohio’s CliniSync HIE, are evolving and forging a new path to successful care coordination. Brian Ahier will explain how HIEs can help providers move to value-based care models, emphasizing Meaningful Use Stage 3 and FHIR. Dan Paoletti will provide best practices in describing CliniSync’s journey to success in serving 6,000 primary care physicians, 141 hospitals, and and 290 long-term and post-acute care facilities. Attendees will learn how to use a phased approach, establish client champions, help providers meet MU Stage 2, create a provider email directory, deliver care coordination tools, and drive continued ROI.

Tweet Chat

Crohn’s patient and advocate Carly Medosch (@CarlyRM) will host the next #HIStalking tweet chat Thursday, June 11 at 1pm ET. You can brush up on her background here. Stay tuned for chat topics.

Announcements and Implementations

IPatientCare adds new pediatric specialty templates and workflows to its EHR, PM, and patient portal tools.

Toronto-based CognisantMD adds the Ocean eRequests patient self-service tool to its Ocean communication platform.

The Behavioral Health Division of Northwestern Counseling & Support Services (VT) trades its fax machine for the VITLAccess portal from Vermont Information Technology Leaders, which operates the Vermont HIE.

Athenahealth offers athenaCommunicator Enterprise to new customers who participate in an ACO for a flat 10 percent of their MSSP shared savings payouts.

Government and Politics

ONC announces the U.S. and U.K. Obesity Data Challenge during Health Datapalooza in Washington, D.C. The Health Data Consortium, HHS, and the de Beaumont Foundation are looking for Stateside solutions that enable public and private providers to help patients address the obesity epidemic at a community and personal level. Submissions are due July 13, with $40,000 in prize money up for grabs.

Telemedicine

The VA Office of Rural Health will use a two-year, $2 million rural health grant to deploy a mobile telemedicine clinic equipped with ViaSat technology for veterans in the town of Ark-La-Tex, LA. The Rural Vets Health Outreach van will initially focus on mental health services, and then branch out into primary care.

The local paper highlights the success East Tennessee community clinics have had with telemedicine, including the use of remote ultrasounds during prenatal care, and school-based services. 

Online USA Doctors launches direct-to-consumer eVisits as part of its Web-based healthcare platform.

A judge approves an injunction requested by Dallas-based telemedicine provider Teladoc against the Texas Medical Board for its new rule that requires doctors to conduct a face-to-face patient visit before issuing a prescription. Lt. Dan provides a deeper dive into the news here.

Telecommunications company Orange will sponsor the 2015 mHealth Grand Tour, a 10-day cycling tour from Brussels to Geneva in early September. Open to Type 1 and 2 diabetics, the tour will serve as testing ground for new telemonitoring and medical coaching services for riders. Healthcare data gathered during the ride will be used to evaluate the impact such technologies have on diabetic athletes.

People

Cory Bendixen (Act-On Software) joins eVisit as director of sales.

Tim Theriault, global CIO of Walgreens Boots Alliance, resigns for personal reasons. He will be replaced by Anthony Roberts, SVP/international CIO.

Jeremy Delinsky, chief product officer at Athenahealth, resigns after five months in the position to take a CTO position with an online furniture company. His interim replacement will be VP Kyle Armbrester.

Research and Innovation

University of Notre Dame researchers win funding from the NFL and GE’s Head Health initiative for their Contect app, which uses speech-pattern data gathered from athletes to detect head injuries. The app guides athletes through a one minute, forty-second test that asks them to read words and phrases on screen into a microphone. Athletes hit hard during a season perform the test again to determine if further testing for head injury is necessary.

New data from Athenhealth’s ACAView shows  that physician practices are in for further financial struggle – possibly to the tune of $18 billion – thanks to an increasing number of Medicaid patients as a result of ACA-induced expansion. Scott Gottlieb, MD suggests physicians are making up for the lack of higher-paying, privately insured patients by expanding patient volumes, increasing the number of reimbursed tests and procedures they perform, and raising out-of-pocket fees for privately-insured patients.

Sponsor Updates

• Medicity posts “ICD-10: Are We There Yet?”
• Versus Technology will exhibit at AAMI 2015 June 5-8 in Denver.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

More news: HIStalk, HIStalk Connect.

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Population Health Management Weekly Wrap Up 5/29/15

Top News

The Bipartisan Policy Center highlights the need for deeper collaboration between clinicians and community organizations in a new report. It’s Prevention Task Force recommends that CMS integrate at least two population healthcare quality measures into the next iteration of ACOs, and invest in developing and evaluating demonstrations of an accountable health community model. I couldn’t agree more with the observation of task force member William Dietz, MD, who pointed out that, “Building supportive community systems and integrating them with clinical interventions is essential, because where people live, work, learn, and play has a greater influence on Americans’ health than what goes on in the doctor’s office.”

Webinars

June 9 (Tuesday) 11:30 ET. “Successful HIEs DO Exist: Best Practices for Care Coordination.” Sponsored by Medicity. Presenters: Dan Paoletti, CEO, Ohio Health Information Partnership; Brian Ahier, director of standards and government affairs, Medicity. Not all HIEs are dead – some, like Ohio’s CliniSync HIE, are evolving and forging a new path to successful care coordination. Brian Ahier will explain how HIEs can help providers move to value-based care models, emphasizing Meaningful Use Stage 3 and FHIR. Dan Paoletti will provide best practices in describing CliniSync’s journey to success in serving 6,000 primary care physicians, 141 hospitals, and and 290 long-term and post-acute care facilities. Attendees will learn how to use a phased approach, establish client champions, help providers meet MU Stage 2, create a provider email directory, deliver care coordination tools, and drive continued ROI.

Announcements and Implementations

The Illinois Gastroenterology Group implements SonarMD’s new population health management platform to patients with Chrohn’s Disease. IGG Managing Partner and SonarMD President Lawrence Kosinski, MD developed the platform, which uses electronic health assessments to monitor a patient’s care and alert physicians to downward trends.

Acquisitions, Funding, Business, and Stock

Healthcare analytics software startup EagleDream Health acquires Focused Medical Analytics for an undisclosed sum. FMA’s employees will be retained, bringing the newly combined company’s total staff to 20. EagleDream will continue with its plans to raise an additional $1 million to $2 million in Series A funding this summer, and hopes to employ up to 150 employees within the next five years.

Digital health self-management business DPS Health rebrands as Canary Health to better reflect its focus on population health management services for emergent-risk populations.

New Zealand-based Orion Health files its first financial update following its November IPO on the NZX, reporting a one-year loss of $44 million despite a 7 percent increase in revenue. The company’s North America business dragged down its numbers, which CEO Ian McCrae attributed in part to continued volatility as the market continues to adopt population health management solutions. The company’s move to a recurring, subscription-based revenue model likely also didn’t help.

People

Prabhjot Singh, MD (Columbia University) joins New York-based Mount Sinai’s Samuel Bronfman Department of Medicine as vice chair of population health. He will also take on the role of director of the Arnhold Global Health Institute at Mount Sinai’s Icahn School of Medicine.

Research and Innovation

A HIMSS Analytics study finds that many healthcare organizations over the last two years have increasingly changed their focus from accountable care to population health, as evidenced by a rise in data analytics utilization.

University of Rochester researchers receive a $130,000 National Science Foundation grant to further develop an app that will track the spread of Ebola and other infectious diseases. The Android-friendly Node app monitors user’s location patterns, walking and sleeping habits, and their need for resources. It can also help them find care, better understand disease prevention, and improve disease monitoring. A pilot study of the app will take place in Nigeria this summer.

Other

The National Academy of Medicine (formerly the Institute of Medicine) identifies in a new book 15 core measures that healthcare stakeholders can use to benchmark and improve outcomes, costs, and access.

Academic medical center executives pen a commentary calling on their colleagues to embrace the transition to population health management or run the risk of becoming obsolete. “To survive, AMCs will need to become an integral part of a system in which enhancement of population health is the explicit mission,” writes Temple University Health System COO Verdi DiSesa, MD who is also on staff at Temple University School of Medicine. “This transformation presumably must be accomplished while the AMCs still fulfill their traditional missions of advanced patient care, teaching and research. It’s likely that some AMCs will need to redefine their mission and not try to be everything for everyone.”

Sponsor Updates

• Nordic posts a video of its Community Giveback Day activities on May 22. Check out the 1:00 mark when the guy recording Nordic employees working on a Habitat for Humanity house asks one of them, “What do you think your KLAS rankings for hammering upside down would be?”
• Intelligent Medical Objects will exhibit at the e-Health Conference May 31-June 3 in Toronto.
• Healthwise will exhibit at the AHIP Institute 2015 June 3-5 in Nashville.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

More news: HIStalk, HIStalk Connect.

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News 5/28/15

Top News

Patient advocate Susannah Fox (Pew Research Center) is named CTO of HHS. She replaces Bryan Sivak, who stepped down last month.

Webinars

June 9 (Tuesday) 11:30 ET. “Successful HIEs DO Exist: Best Practices for Care Coordination.” Sponsored by Medicity. Presenters: Dan Paoletti, CEO, Ohio Health Information Partnership; Brian Ahier, director of standards and government affairs, Medicity. Not all HIEs are dead – some, like Ohio’s CliniSync HIE, are evolving and forging a new path to successful care coordination. Brian Ahier will explain how HIEs can help providers move to value-based care models, emphasizing Meaningful Use Stage 3 and FHIR. Dan Paoletti will provide best practices in describing CliniSync’s journey to success in serving 6,000 primary care physicians, 141 hospitals, and and 290 long-term and post-acute care facilities. Attendees will learn how to use a phased approach, establish client champions, help providers meet MU Stage 2, create a provider email directory, deliver care coordination tools, and drive continued ROI.

Acquisitions, Funding, Business, and Stock

House-call app startup DrNow seeks Houston-area physicians interested in joining the ranks of its Trusted Practitioner Program, which prepares participants to become part of its provider network.

After “rebalancing” its workforce by laying off 250 employees, Allscripts announces plans to consolidate its Raleigh, N.C. workforce into a new 12-story office building. The company will occupy close to 250,000 square feet in the new Midtown Plaza building, scheduled to open in spring 2017.

Remote monitoring startup ToSense receives FDA clearance for its CoVa monitoring system, which includes a wearable sensor for at-home patients with chronic illnesses. The necklace monitors heart rate, fluid buildup, respiration, stroke volume, and cardiac output. Scripps Health Chief Academic Officer Eric Topol, MD has been a fan of the device, touting its ability on CBS This Morning to potentially prevent hospital readmissions.

Announcements and Implementations

Chicago Cardiology Institute implements Tiger Text secure messaging across its two facilities.

Communications and consulting firm Health Connexions partners with ICDNavigator to offer physicians ICD-10 transition assistance, compliance, and conversion services.

JDL HealthTech launches HIPAA Security Essentials, a HIPAA-compliance service tailored to practices with one to three physicians.

Government and Politics

CMS releases annual updates for the 2014 electronic clinical quality measures, including 64 updated eCQMs for EPs.

American Academy of Family Practice Board Chair Reid Blackwelder, M.D. responds to proposed Meaningful Use Stage 1 and 2 modifications by CMS, expressing support for the decision to shorten the reporting period to 90 days and to lower patient engagement thresholds. He also expressed concern over the burden of MU audits: “If the government believes that a strong primary care foundation is the key to an improved and sustainable health care system, then we urge you to … provide immediate and increased relief to those who have acted responsibly and legally and had no intent to defraud or deceive by participating in the Meaningful Use program.”

People

Steven Strongwater (Geisinger Health) joins Atrius Health (MA) as president and CEO.

Research and Innovation

Swiss researchers create a six-sensor chip that can be implanted under the skin to monitor blood levels, the results of which can be sent to a smartphone via Bluetooth. The device has already been used to measure glucose and paracetamol levels in mice. Preparations for human trials are in the works.

Other

This article profiles the impetus for ICD-10 Charts, a set of free ICD-10 templates for practices and hospitals developed by Parth Desai and computer programmer Will Pattiz. Desai, who grew up working at his father’s internal medicine practice in Columbus, GA, developed the resource to help his dad make the transition to ICD-10. The Physicians Foundation has stepped in to further fund the project, which will soon include free coding training and additional resources.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

More news: HIStalk, HIStalk Connect.

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