Q&A: Bradley Hunter, VP Value-Based Care and Core Solutions, KLAS Research

Healthcare Innovation recently sat down with Bradley Hunter, VP value-based care and core solutions at KLAS Research. He shared his perspectives on improving public and population health outcomes, the lessons learned from the pandemic, and what comes next.

Can you give an overview of how electronic health records (EHRs) improve public and population health outcomes?

When it comes to both public and population health outcomes there's a couple of different facets that roll into my mind. One is just, how can we get better outcomes from healthcare because we all want that—let's go with Quadruple Aim and make sure we get better outcomes that are lower cost and it's a better experience for the patient and the physicians.

Then we say, how do we translate that world of population health? Well, we want to make sure that people stay out of the hospital, so let's reduce our readmissions. We want to make sure that people are living healthier lives. In healthcare, we were in sick care, and we have been for the last 50 years. So, we know how to do sick care really well, but how do we get better and be proactive so that we can really help people take care of themselves that come to the hospital system? And how do we incentivize that properly? And then there's the health equity discussion that comes around this as well—how do we get that equitable care so that everyone can get the healthcare that they need, at a price that's affordable for them and also for us as a nation. All of those things were all together in my mind of how do we get better outcomes? The question of how do the EHR specifically help with that? Well, they're a great source of data for this, but it takes more than just the EHR to really drive outcomes for a population.

What are the six pillars of population health?

Back in 2015, if you went to HIMSS that year, you would see population health, population health population health. You might say, “Hey, what's the core of your platform? Document Imaging?” “Well, we do population health.” Well, maybe they did, maybe they didn’t, but they were just going with it. With so much confusion around the words “population health” and technology platforms for population health, we needed a definition. And so that's where the six pillars came from. We held a summit where we brought leading provider organizations, payer organizations, and vendor organizations. We said, “OK, let's agree on a definition here.” And we hammered that out over a couple of days, and we came out with the six pillars.

The six pillars are:

1. Data aggregation
2. Data analysis
3. Care management or care coordination
4. Administrative/financial
5. Patient engagement
6. Clinician engagement

The idea is that a comprehensive platform will have pieces that span all six pillars of population health. It's a way for us to differentiate who has what out there and also to report that back to the industry. The six pillars they've been in place since 2016. We refined them and added services later in 2017. And it's been a wonderful tool ever since.

What are some of the biggest lessons learned from the pandemic in terms of population health?

One of the things that came out of the pandemic was a greater understanding of risk vs. fee-for-service. In a purely fee-for-service world the pandemic was a really hard thing, because your revenue as a hospital system declined drastically, especially at the beginning of pandemic. We were all unsure if we could even go outside, there was that level of fear that we had. And because of that level of fear, elective surgeries were canceled and there were a lot of things that didn't happen, which normally bring in revenue for a hospital system. If you think of Q2 financials from 2020, it was like, “I don't know what this is going to look like, but I know we're going to be in the red and it may be significantly in the red.” During the pandemic, these “provider friends,” could look across the fence at their friends who are deep into downside risk. They’re fully capitated, and they look over the fence and it is business as usual over there. They're not struggling with all the same fee-for-service. So, one of the things that has come because of the pandemic is a stronger move toward taking downside risks specifically, because that's how we move the needle in value-based care and the more revenue you have tied to value based care, the more you can do those activities that help you control your costs and drive down the cost for your organization and provide a better experience for your customers, for the patients.

Are there any big changes on the horizon for population health?

I have had several conversations with providers around this topic of taking on risks and where they are today and where they expect to be in the next three years. And everyone that I talked to has said that they are going to increase the amount of risk that they are taking on as an organization over the next three years. And the only exception was one that said all of their revenue is currently tied to value-based contracts, so they can't increase that but will probably expand their programs. It'll be more revenue, but it's not a greater percentage of revenue. So the trend that's coming out of that is moving toward risk.

There's just a lot of pieces that are pointing toward taking on more risk and once we get to a point where we're taking on a substantial enough amount of risk that's tied to downside contracts, that's where we see there's a significant change for the health system because they think about things differently. You're not thinking about heads and beds—the fee-for-service type mentality—you're thinking about how we can keep people out of the hospital, like what kinds of things can we do so that people live more happy, healthy days at home. That that's what we really want.

How fast do you see organizations moving into value-based care?

It's not going to be rapid. I think we're going to see more of it, especially over the next five years. But I think that it will continue to be slow until organizations hit that critical mass, where they say, “OK, we're going to be all about value-based care.” And then the transition becomes rapid, but along the way, they're putting those pieces in place so that they can have that governance structure. They can have the team of care managers, they can educate their physicians, they change the compensation structure for physicians—so it's not based off if are they [services] used, it's based off of your panel of patients. There's a lot of moving parts that have to happen and then are the commercial payers going keep going down this road that CMS is going down? If so, then great. If not, then that's going to be hard, also.

Any final words of wisdom?

My closing thoughts for provider organizations is make sure you're talking with your peers about this, because you're all at varying levels of risk. Talk with some who are really progressive and doing this and seeing what successes and challenges they're having. Also talk with some who are not as far along on the journey, because you can help pull them along, but also learn what the things they're struggling with are.