NOVO Live: The Podcast

Episode 5: Can Data Improve Your Health?

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About Dr. Tim Bartholow

Dr. Tim Bartholow is the VP and first Chief Medical Officer at NeuGen LLC. Before joining WEA Trust, Dr. Bartholow served as the Wisconsin Medical Society’s Chief Medical Officer for five years. In this role, he focused on physician and community engagement to promote change in the delivery and payment of health care. Prior to joining the Society staff in November 2008, Dr. Bartholow spent 16 years caring for patients at the Prairie Clinic in Sauk City, Wis., where he was one of 12 clinical owners and an EMR since 2003. In the late 1990s, he served as medical director for Community Physicians Network, an independent practice association with more than 400 primary care providers. Learn more:

The Transcript

Curt Kubiak: Let’s talk a little bit about access to data. And, again, a large number of our listenership is our employers. Right? And they’re wondering where it is they can get access to their data so that they can make better decisions. What advice would you give them? On that topic? Specifically, how do I get my data?

Dr. Tim Bartholow: Yeah, so the, the employer has the ability, right, they’re paying claims. And if somebody can aggregate that information, it can be very helpful to them. There’s actually on a statewide basis, however, if each employer doesn’t want to do that for their individual, you know, 50 or 2,000 people. On a statewide basis, there are many of the insurers of the state put their claims into a central database called WHIO – Wisconsin Health Information Organization. And in that block of information, you can actually see, well, how many potatoes, carrots or rutabaga does it take to make my stew? Right? Let’s be tangible. How many resources does it take in order to to make an angioplasty, for instance. And it may be shocking to some of the listenership to hear, and me as an employer – frankly, and as an independent primary caregiver – there was a lot of variation between what was necessary to produce an angioplasty by one person as compared to another by, let’s say, between 40 and 100% more to actually produce the same quality event.

Curt Kubiak: So it’s a huge variation, right? So if I’m an employer, typically, my interaction with these employees is, they let me know that they’re going to be leaving for a medical event, they leave for that medical event, they come back, and hopefully good results, right, they come back and they’re back on the line. I get two employees, same procedure, they go to two different locations, they’re both back on the line, but I look at my costs of having to manage those things. They could be you know, as much as 60% different?

Dr. Tim Bartholow: Yeah. 60, 80, 100 percent different actually. And the question, I think, if I’m an employer is okay, so who’s making that decision with the patient, right with the employee? I don’t want to be involved in that decision as an employer, right? I don’t want to be prescriptive about what my employee does. But what I do want for them is I want really good primary care advice. Right? So I want that primary caregiver as best possible to be empowered with “Well, I can get a hip or knee done, you know, here at, you know, one resource use of high quality or I could get it done over here, same quality, and maybe, you know, 70% more.” Why would I do that? Right? And I would say again, Curt, the the more resource used in order to achieve the same quality outcome is just greater opportunity for more things, radiation and a drug or a needle stick in an environment where there are superbugs. It’s, it’s not innocuous, right? It’s not just money.

Curt Kubiak: Yeah, so we, we as employers have to make sure that we are educating ourselves on some of these details, because we pay the bill without really understanding all of the implications that you’ve just discussed. So if we’re not taking action to get access to our data, or to get access to some semblance of our data, so that we can educate our employees, so that we can set up a benefit plan design that encourages them to purchase health care differently, so that we can have conversations with local primary care physicians that can guide them to better health decisions, then we’re leaving money on the table.

Dr. Tim Bartholow: Yeah. And it’s, quality, it’s cash and that cash translates to, you know, a business is an opportunity right to, to hire the next person. So communities have got to care about this, right? If If businesses aren’t as strong as they could be, because healthcare is more expensive than it needs to be, then it’s going to be the community who doesn’t have the extra job, right, or the extra tax base or ultimately, the world competitiveness, right, that the valley is completely not only capable of but shown, right? World leadership. How do we preserve that right, and how do we frankly, strengthen that and so we’re looking for these health care partners, right to make sure that the input costs of healthcare, right are not expanding faster than wages. Today about 6 percent health care costs expansion as compared to two percent trend on wages, right? We’re really looking for folks who can say we can help make sure that healthcare costs aren’t growing as fast as they have been. And there’s, there’s no need to sacrifice any quality. And in fact, when we do this investigation about what the cost of healthcare is, frankly, as you all have shown, at NOVO Health, that the careful assessment of what each of these costs, each of these steps and care costs, leads to a better overall experience. It’s just better quality.

Curt Kubiak: So we really do have to make sure as employers that we ourselves are getting educated, that we’re educating our HR managers, we’re interacting with our employees, and ultimately finding ways to educate our employees. Right? Because this is an assault a problem that clinicians and advisors can resolve on our own, we really do need those employers who are paying the bill, to take an active role in participation, and making sure that they understand the information, making sure that their employees understand it so they can act differently.

Dr. Tim Bartholow: Yeah, I absolutely agree. And look, we don’t, you don’t go to an employer school, you don’t go to health care class, right. Most of us build a widget, we’ve learned how to do that well, we didn’t have a lot of health care background. But, you know, the question of why is pretty powerful. Right? Yeah. Why would it cost this much here? And that much there, right? Or why doesn’t the primary caregiver that I’m, you know, working with? How do they make this decision? Right? And if they don’t have any additional information about the cost of care, why not? Right? I just think it’s, it’s completely okay for the employer, trying to make a world competitive business, to say, I don’t understand this completely, but let me engage in a conversation about educate me, right about how we make these choices. They do this with every other input costs, right? Yeah, that we have.

Curt Kubiak: So an employer should be asking their broker for the for the cost data. If for some reason they can’t get their information through their broker, they could certainly use the state resource at the Wisconsin Health Information Organization – WHIO – find them online. But there’s things that they can do.

Dr. Tim Bartholow: Yeah, yeah, no, I think there’s lots of ways to, we have good assets in the state, and we need to use them, we need to use them better. Honestly, if we’re going to, if we’re going to make ourselves as world competitive as we we want to.

Curt Kubiak: Excellent, yeah, I appreciate you, even at the start of your career taking an interest in data, right. So every other industry, when they’re trying to solve problems relies on the data so that they can, you know, kind of fine tune their next moves and make sure that they’re doing something that’s going to be impactful right to their consumer. And so with health care, and WHIO, talk to me a little bit about this information, right, so this information has been available. But how has it been utilized, maybe underutilized? How can we think differently about that information that’s out there?

Dr. Tim Bartholow: So important question, right. We all have been interested in what claims data can tell us. Claims data, the doctors will say, don’t always describe every nuance of quality. And I agree with that. However, we can see where large blocks of investment are occurring. So for instance, in the course of building an angioplasty, how many dollars go into the institutional costs? And, how many dollars go into, for instance, the decision making in the skill of delivering the service? Turns out to be the physician pieces of that turned out to be pretty small. And, and understandably, institutional pieces are pretty expensive. We want really great care, right. But the, the, in our state, we have an all payer claims database, all payer claims database is actually $60 billion of charges. That amount of cash turns out to be against a $347 billion annual GDP for the state of Wisconsin, turns out to be about one dollar in seven, right? So this state has this opportunity, right to have an investigation into what does getting a hip or a knee or an angioplasty or taking care of the rheumatology patient or having a delivery look like at one institution versus another? One of the challenges we’ve had is trying to get our physicians the feedback about when I deliver a baby, how many resources does it take in order for me to do that and how does that compare to my partner? And how does that compare to others across the state? Why should that matter? Well, if for instance in delivering a baby and outcome is you know, healthy mom, healthy baby in our state, we will have people do that for sort of 8,000 resource dollars. And other folks will do it for 14,000. But the employers have to pay for that right? Or in the case of Medicaid or Medicare, then right and Medicaid, and specifically Medicaid is paying for that delivery. And we don’t you know, Medicaid is paid for by taxpayer dollars, we want the taxpayer right to have the best value for their, you know, their confidence and investment and choosing that doctor, right.

Curt Kubiak: Yeah. So let me just make sure that I’m following your comments here, because it’s very important for our listeners to be able to track. So the payers claim database effectively, these are insurance companies giving us their information about what they’ve paid different healthcare entities or groups in order to deliver care. Right? So this is claims paid, these are the actual dollars that have been spent by organizations for healthcare. So you can use that information to compare different geographies, different specialties, different positions within a specialty, that’s what I’m hearing you say is that

Dr. Tim Bartholow: Yeah, even physicians within a practice, it’s interesting that if you take a large practice of cardiologists, right, there’ll be variation between them. And we haven’t done a good job, honestly, of in sort of the general system of giving these physicians feedback about how many resources they’re using. And in fact, I think sometimes we haven’t, we haven’t known that it was important to achieve high quality, but at the least resource use possible.

Curt Kubiak: So my manufacturing background, I like to talk about these types of things, because there’s more than one way to get to an end. But when you design the solution with cost as one of the elements, right, you start to think very differently, don’t you? Right? So it’s not just how do I get this, this mom and her baby, you know, a good outcome with regard to delivery. But what’s the shortest timeframe that I can have that happen? What is the least resource consumed possible? So in order to get to that healthy outcome, right, because I don’t think we want anything more than that. But we certainly don’t want anything less than that. This isn’t this isn’t about cutting corners on quality, to reduce cost. But this is about removing variation that wouldn’t be value added. Right?

Dr. Tim Bartholow: I mean, you can get a high quality event. And with sort of, you know, one amount of resource use. But in the state, you can also get a high quality event, literally no difference in quality that we can perceive, at double the resource use. Why? Why would we, right? Why would we want that when we’re spending so much money on health care? It’s more so than that, actually. Right? It’s not just that we’re taking our community treasure, and we’re spending more on an individual outcome that, you know, maybe we wouldn’t have to. You tell me if we have a mom or a baby in the hospital? How much, how much more radiology, radiation, right? How much more drug? How much more? How many more days in a hospital where there might be superbugs do you really want that mom and that baby to be exposed to, right? So it’s not and in healthcare, we’re using sophisticated tools, right? And every time we use that sophisticated tool, it should help and and we know that there’s a small risk of, for instance, if you take an X ray, little bit of radiation. So, when somebody is using double the amount of resources, it’s not just the money, there may be a small amount of additional risk that we’re tolerating that we shouldn’t be doing. Right? So you’re paying more and having, frankly, a lower quality, overall quality outcome.

Curt Kubiak: Yeah, so healthcare acts a little bit differently than some people might think. Right. So typically, what I feel like I’m paying more for something, I’m getting a higher quality service or product. In healthcare, we could actually save dollars, not do additional diagnostic test, not administer the additional narcotic and actually save the patient money and make them healthier.

Dr. Tim Bartholow: Yeah, no, I think this is actually we’ve had certain states have shown us this. Some of your listeners may be familiar with Maryland Bartlett’s work in in Montana. The state budget was running a little bit short and the public workers needed health care insurance. But there’s a several million-dollar shortfall. So, Maryland was brought in –  she’s an accountant –  but said, “look, we’re witnessing variation in the amounts that we’re paying our various institutions across Montana,” and she also noticed that when some of the institutions were paid more quality actually was less. Why? well because folks when they’re operating at tighter margins like your former life and like where I’ve grown up professionally, if you don’t watch how many dollars you spend, you actually end up with, with a process, right, that isn’t as careful about the increments of choice that you make. So where we’re paying attention to cost, we frankly get a better result.

Curt Kubiak: Yeah, so the example that you’re giving with regard to the state of Montana, they’re a huge employers. So they’ve got large numbers of people that are working for the state and they make changes these things can have a huge financial impact.

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