CODE speaking with Dr. Ingrid Vasiliu-Feltes, MD, MBA, FACHE at the 4th Interdisciplinary Conference on Orthopedic Value Based Care 2020

Session Topics:

    • ASC Based Orthopedic Practice – Contracting outpatient joint surgery panel
    • Optimal Characteristics of an Anesthesia Group in a Value Based Ecosystem

Interviewee: 
Dr. Ingrid Vasiliu-Feltes, MD, MBA, FACHE
Chief Quality and Innovation Officer
MEDNAX

Dr. Brian Cunningham:
Okay, we’re here at Value Based Healthcare Conference 2020 OVBC. I’m here with Ingrid and you just gave a really fascinating talk kind of focusing on payer relations and some of the aspects of ASCs, but you have a ton of expertise in almost everything.

Dr. Ingrid:
Folio companies, Surgical Directions, and I just wanted to highlight the great work they’re doing in the perioperative space. They work with a lot of hospital partners to improve perioperative efficiency and in this value based environment, I believe that all organizations that aim to lower costs, improve outcomes and have a sustainable model should take a look at what the great work Surgical Directions is doing.

Dr. Brian Cunningham:
That’s fantastic, Surgical Directions. Tell us a little bit more about the kind of where you see the vision for Value Based Care going. You have a unique perspective, you’ve been across the clinical care portfolio, you’ve been in business, you’ve been in strategy. Yeah. I think you have a direction that I think we could all benefit from hearing a little bit about what your vision is.

Dr. Ingrid:
Yeah. I think my vision actually aligns with what some of our panelists also mentioned. I was happy to hear that just having a race towards cutting costs is not going to be the sustainable model and we have to be creative in terms of designing alternative payment models. We have to be creative in having a larger population health approach as opposed to just having individual metrics in silos that fit a contract, a need, and we have to break the silos of just thinking that annual contractual agreements quickly signed will help us develop a long term value based ecosystem.

So I strongly recommend everybody to have, cost containment should be an expectation that should be strategy number one, and then try to differentiate yourself in the market by improving quality, improving outcomes, having a global population health approach and trying to break these silos. One of our panelists also mentioned that disruption is coming our way from employers and a new entrance into the system. And if we don’t start to think like that, unfortunately, a lot of organizations that are not ready will have a hard time.

Dr. Brian Cunningham:
That’s right. That’s right. We talk a little bit sometimes about the straddle kind of transitioning from fee for service to Value Based Care. People are aligning on both sides trying to figure out how to make that transition. You know earlier Scott Levin mentioned in his panel session the advantage of technology and what that brings to Value Based Care. You have a tremendous understanding of technology from Blockchain to genomics to innovation. Tell us a little bit about your thoughts on technology and the influence it can have on Value Based Care.

Dr. Ingrid:
I actually believe that the strategic considerations that healthcare organizations are facing right now are deeply, deeply, deeply tied to digital acumen and I actually believe that organizations that do not understand how digital technology is deeply infused in every single aspect of whatever they’re going to decide, they’re going to have a hard time and they’re going to fail. So specifically cybersecurity, digital integration of claims. I don’t know if you are familiar, but several payers have formed a consortium to put all their claims on Blockchain.

Most people don’t even know about Blockchain yet in healthcare, but the payers for two years have been working diligently on putting all their claims on Blockchain. And then there are several other consortiums who work on provider credentialing to be put on a Blockchain as well. Not to mention, I don’t know if you saw the news, the FDA just a few days ago announced that they’re going to use a Blockchain to track all the pharmaceutical industry.

And I think that’s a big step. So once you have FDA, payers, provider credentialing, you start to see kind of like a puzzle coming together and that’s just one. But I think also AI has been the new kid on the block this year. If you open your LinkedIn newsfeed, you’re going to see AI almost every third article. Something with it, either the risks of AI or the opportunities of AI. So I do believe for healthcare and specifically for Value Based Care, there are a few of these novel technologies that are going to probably make a big disruptive move this year or if not next year.

Quantum computing is another one that can have a big impact in Value Based Care. So if you asked me to pick, Blockchain definitely one, AI, so applying AI for Value Based Care. That can really break the whole market. And then the third one quantum and edge computing, and people don’t know yet what it really means, but the speed, the technology that would allow us to process all the things that now take us 18 months to reconcile. One of the panelists mentioned that there’s a complete misalignment between how the contracts are being designed and how the payments are supposed to happen.

All those elements I mentioned from a digital technology perspective can solve all that and they can be instant. The same way as we have in banking. When you want your bank account to have the money. If I transfer your money right now, do you want to wait 18 months?

Dr. Brian Cunningham:
No way.

Dr. Ingrid:
No. Don’t you want to see it right now in your mobile app? So same expectations in healthcare in terms of Value Based Care. If we would want to have complete transparency, instant processing of claims so that a payer, provider, patient or hospital partner would instantly see what happened with the dollars in this system. That’s where we should aim to be.

Dr. Brian Cunningham:
Fascinating.

Dr. Ingrid:
That’s it. As simple as that,

Dr. Brian Cunningham:
If you take that and build off it a little bit and say, if I’m a big group of physicians or a big group of surgeons and I say to myself, “Oh my gosh, I have to either figure out AI, Blockchain or quantum computing, I’m going to have a stroke.” What do you think from the perspective of a clinician or a surgical group or a medical group, what are some maybe smaller bite-size pieces or steps along the way in that journey that would be beneficial?

Dr. Ingrid:
You’re absolutely right. Most people have a false impression that having a digital strategy means going to buy an iPhone or a Mac and plug it in. That doesn’t work like that. You need to understand what your pain points are and where the ROI is for you as an organization or a provider group. No matter if you are a payer, hospital, or provider group, you need to know where do I need to deploy the right technology so that it addresses my pain point and it fits into my other strategic goals, right? You can’t just deploy an AI to deploy AI.

You need to have that specific AI tool that will help you in your strategy that you set out to achieve. And what do you want to differentiate yourself with? We talked about that also on the panel. Differentiating yourself in this market, in this value based environment is crucial because everybody’s going to master cutting costs, sooner or later because you either die or your master cutting costs.

Dr. Brian Cunningham:
That’s right?

Dr. Ingrid:
If you don’t want to cut costs, you need to come up with some very, very beautiful, innovative, transformative things to offer so that people want to pay a premium. And I think that’s where these unique digital technologies can come in. But you should not say, “Oh, I need a little bit of quantum. I need a little bit of AI. I need a little bit of Blockchain.” No. As a matter of fact, if you can provide excellent value without any of these, awesome because it’s cheaper, but you should know that others are deploying them and you should be aware of them. So I always call for a balance and a very mindful approach as opposed to just going shopping for digital tools.

Dr. Brian Cunningham:
That’s right. You don’t want to just checkboxes to say you’ve done something. I think one of the things that you touched on which really resonated with me was understanding as a group or an organization where your pain points are. So kind of a self-reflective approach initially and then a cohesive strategy.

Dr. Brian Cunningham:
Differentiation specifically, one of the things I think a lot about is outcomes. It’s vaguely described as a lot of things, but one thing specifically as a surgeon I think about patient-important outcomes, collecting those, leveraging those. How do you see that fitting in specifically in kind of a digital or an analytics strategy moving forward?

Dr. Ingrid:
Well, I think that’s when I mentioned on the panel that we have some missed opportunities it’s exactly what you just referenced. I think for the longest time when you look at all the 3,500 metrics we have in healthcare, how many patient-reported outcomes do you see? Maybe 20.

Dr. Brian Cunningham:
Maybe.

Dr. Ingrid:
And when you look at the standardization of those, they are terrible, and they’re still collected on paper or if you’re lucky on an iPad. So I think, yes, there are some of the novel technologies like natural language processing, some of the technologies like Alexa, some of the technologies that we have now in terms of AI, or chatbots could really help with some of these patient-reported outcomes and really change the paradigm.

Dr. Ingrid:
But I think it’s been completely missed everywhere. So I think, yes, deploying some of these novel tools, and there are some hospital systems that have made the leap and they’re showing very promising results, so I think that’s going to be the future.

Dr. Brian Cunningham:
Fantastic. Well, we could talk all day. I’m going to let you get back to the conference and the panel. And thank you so much for spending a little bit of time with us.

Dr. Ingrid:
No, thank you. I appreciate the opportunity.

Dr. Brian Cunningham:
Okay.

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