Dr. Lonny Reisman is the founder and former CEO of HealthReveal. He previously served as Aetna's Chief Medical Officer for six years. Lonny is a recognized leader in health information technology, patient safety and evidence-based medicine and has published numerous clinical, peer-reviewed articles. Prior to his CMO position, Lonny was CEO of ActiveHealth Management. Lonny was also an attending physician at New York Hospital and St. Luke's-Roosevelt Hospital Center, and was a cardiology fellow at the University of Chicago.
I think there's an overlap in terms of what we're trying to achieve relative to clinical outcomes and how to place the patient at the center for a better healthcare experience - whether you're a healthcare provider, leader, or system. Part of the ambiguity in understanding what we want technology to achieve comes from the fact that we haven't defined what we're looking for in terms of performance or outcomes. How are we measuring success? Is it through Net Promoter Scores (NPS), clinical outcomes, patient satisfaction, or physiological improvements? The question really comes down to what do we care about? Cost, affordability, adherence, satisfaction, NPS scores, equity? Unfortunately, the answer is confusing and constantly changing.
"We are so enamored with technology that we have lost sight of what we expect it to do. If our patients are using technologies that reflect nonadherence with meds or lifestyle changes, that information is of great value to practitioners. However, we need to ask ourselves what unmet need the technology is addressing. Is it providing insight into the patient's current disease status or adherence, or is it offering guidance regarding barriers to care optimization? If it's behavior change we are seeking in our patients, then we need to consider if a digital tool has the ability to deliver on that expectation."
Founder and former CEO of HealthReveal;
Former CMO of Aetna
At my core, I believe clinical rigor needs to be our foundation. The criteria for clinical excellence are well established with data from clinical trials, practice guidelines, and statements from specialty societies. It is well documented that our level of adherence to those standards is terrible.
Then, surrounding clinical rigor is the variable of patient experience. We have healthcare systems, technologies, and great practitioners committed to excellence. Unfortunately, the patient's ability to access can be blocked by several barriers. So far, the focus has generally been towards a more consumer or retail experience. But I see this as tangential to the core issue of clinical excellence and rigor because I think that's the best way to achieve the outcomes we’re all striving for.
One issue is we're not adequately collecting data. And there are issues around policy and privacy constraints as well as economical and commercial constraints. But there's a bigger issue related to analytics.
If data are simply ingredients for a recipe, you need to translate the sugar, flour, eggs, etc. into a cake. From a provider perspective, there's the problem with how to translate this deluge of data, like weight, diet, hemodynamics, etc., into something meaningful. As the doctor, you have limited time with the patient, and if you were given all this data and expected to figure it out – analyze the data, distill it into the next best action, and then deploy that action given all sorts of constraints – in the moment, that would be an impossible task. Further, with constraints like affordability, it can seem like a pyrrhic victory to say someone needs a certain drug or device when they have a huge deductible that needs to be met and they can't possibly begin to pay for it.
No. I think the biggest barrier is that people manage what's measured and we're not measuring what matters. For example, let's look at 30-day readmission rates. Why are we looking at a utilization metric instead of something like mortality? Well, we know why, it's because of the initiation of the Hospital Readmissions Reduction Programs (HRRP) in 2012. And from that, we did not see reductions in readmissions, but this shouldn't be our primary metric of success since it's been well documented that the reduction was associated with increasing mortality.
It brings me back to the question of what's our focus? Because ultimately, if we're not focused on clinical excellence, the outcomes we're all mutually trying to acheive aren't going to happen.
I think it can be tremendously helpful, but there must be incentives in place aligned with utilization of the tools as well as adherence with the insights generated by the tools. If digital tool data generation doesn't translate into insight and deployment of that insight, followed by determining if the desired outcome is achieved, there's not going to be meaningful improvement in the health of society. There's just going to be more fragmented data.
There has always been skepticism about the reliability of consumer-generated data and if tools like wearables are accurately tracking health points. Despite these challenges, we must overcome this skepticism by collaborating with the patient to ensure that the data generated are accurate and can be personalized in a broad clinical context that considers other data sources.
As for the reason doctors don't want to implement these tools, they have enough data and and admin stuff to do; electronic medical records, billing, signing, and now we're adding more data to review. Again, a large part of it comes down to this deluge of data and the need for analytics to distill it into the next best action
of patients surveyed:
Were interested in continuing to use telemedicine and wearable health trackers
of physicians surveyed:
Use digital solutions that monitor disease and automatically send them information following a procedure
I don’t think we have a chance of being successful without technologies that support that. It can be as simple as using a calendar app to let patients view your availability and set appointments rather than them sitting on a phone call for hours listening to a robot. But technology is also essential to informing and educating patients. I believe distilling patient data into customized and personalized insights will lead to better patient comprehension and as a result, the adoption of recommended actions.
I don't think it's simple, but I do think technology is essential. I don't know my patient's total cost of care, adherence, hospitalizations, etc. If I'm going to switch from being paid for volume to being paid when a person isn't hospitalized, I need to know all this information. An adequate tech stack is critical, but so is having the right performance measurements and incentives. Technology will be foundational to nuanced excellent clinical care that will translate to better outcomes. If value-based contracting is going to work, those outcomes must be adequately measured, and the rewards must be commensurate with the benefit conferred by doing the right thing for the patient.
Our entire economy is based on incentives and rewards – it’s capitalism. I’d like to think that we’re all altruistic, but the reality is people want to get paid. We must acknowledge that there’s a real commercial element here, and people react to incentives.
People want to get paid for their work, and we’re seeing physician frustration manifest as burnout. The electronic medical record may have all the data points, but it doesn’t guide specific outcomes. You can think of the healthcare system right now as a beautiful restaurant. The service is great, the place is beautiful, but the food stinks. In healthcare, we’ve lost sight of the real goal which is societal health and equity. At the end of the day, the things we’re measuring won’t matter if “the food stinks”.