Schumacher Clinical Partners (SCP) staffs and operates more than 400 emergency departments and hospital medicine programs throughout the United States, treating some 8 million patients annually. The company, based in Lafayette, Louisiana, manages electronic medical record, coding, billing, and back-end reimbursements on its platform. Like many health care organizations, changing consumer expectations, new regulations, and an influx of patient data has created a perfect storm for SCP to rethink how it leverages digital tools to better serve patients and providers.
MIT Sloan Management Review guest editor Gerald C. Kane spoke with SCP’s chief information officer Chris Cotteleer about how digital transformation through data and analytics makes his organization more efficient, improves patient outcomes, and offers attractive work environments for health care providers.
MIT Sloan Management Review: How do you use data and analytics insight to change the way you make decisions?
Cotteleer: Our goal is to get the right doctor or clinician into the right facility at the right time for the patient to walk through the door and be treated well. We take a very operation-centered approach to information; it’s not unlike a supply chain. We’ve got a supply of patients coming in — an infinite queue with spikes in demand. They need to be served, and we’ve got to get providers on the ground to do that.
To meet patient demand, we spend a lot of time trying to predict what’s going to happen — accounting for changes like surges and seasonality — and for that, having patient chart information is very important, so we can tell that a Triage Acuity 5 [lower level of support needed] takes a little bit of time, or a Triage Acuity 1 [a higher level of support] will take more. Depending on the blend of what’s occurring in that emergency department, we might staff an extra NP/PA [nurse practitioner or physician’s assistant] or an extra doctor, and all of that goes to cost and quality of care.
I read somewhere that you’re working on something called “syndromic surveillance.” Can you tell me a little bit about that?
Cotteleer: We’re on the precipice of that. It’s a real driver for us. Call it “syndromic surveillance” or call it “better operations” — we want to know, for example, if we’re experiencing an uptick in the flu, because that has real implications to our patients. If we see more cases of a condition, we can then shift our staffing levels in near-real time to adjust for that uptick and continue a high level of service. We’re working with academia and others to beat the CDC [Centers for Disease Control and Prevention] in time to deliver information. And I say that with pride, because the CDC is pretty great at what it does, and we want to be thought of in the same breath.
What are the things you’re most excited about coming down the pipeline in the next few years that will influence you or the way you do business?
Cotteleer: Blockchain technology, where I can have an inalienable, parse-able, and additive record. We’re looking at it, and insurers are starting to get into it. If you manage it like a contract — a contract for wellness, if you will — it’s very applicable. Something occurs and I generate the initial blockchain, then I add things and throughout the episode of care, I can always refer back. I have an inalienable chain of evidence where only the people who need to be involved are involved, and it can parse out value to the individuals who deserve it.
MACRA [Medicare Access and CHIP Reauthorization Act of 2015] is the upcoming change in how health care is reimbursed; it’s going to change the industry. Right now what happens is, you break an arm and pay a fee for service. In the future, it’s going to be results based. It’s not whether I fix your broken leg; it’s whether you can walk again. MACRA is going to change it and say, at first you get an incentive to get a good result. But over time, that’s going to change into a penalty when clinicians don’t achieve positive outcomes.
Well, how does one manage that? That’s where blockchain applications come in. In order for us to be able to parse that, first we have to capture it and measure it. And then we have to be able to go back through it and see who participated. What you’re talking about is a value chain. You’re taking an event and you’re capturing all the evidence and participants in that value chain that results in a well patient and a reimbursement. Now we have to be reciprocal with everybody in that value chain to make sure that everybody gets compensated in a way that they can continue to do that. Because if you can’t continue to do it at a profit, or at least break even, you’re going to go out of business, and that doesn’t suit the value chain.
How do you balance trying to keep the trains running and exploring something new at the same time?
Cotteleer: You get very good at segmentation, compartmentalizing, and knowing what your priorities are and sticking to them. Operationally, we have an A and an I Team.
The A Team is responsible for keeping the trains on the tracks, as you said. We have had fires, hurricanes, and flooding in Lafayette, and we have not missed a beat. Knock on wood, we are 99.999% up.
The I Team [which stands for “integration”] is charged with chasing the next big opportunity. My senior vice president is on the integration team with me, along with a couple of vice presidents, and a couple of top managers. They make sure integrations succeed from a technology perspective. Organizationally, we have an integration PMO [Program Management Office] that helps take some of the load and looks upstream to indicate to us what’s coming down, and help us prioritize so we get the right people on the right jobs at the right time. It’s a balancing act. And our executive team here, I’ve got to tell you, is actually pretty good.
Do you have all the talent you need to make this happen? What skills do you look for when hiring IT talent?
Cotteleer: Do we have enough talent? No. Are we looking for more? Yes. Is it hard to find? Really good talent is. What do we look for? Vision isn’t enough; it’s necessary, but not sufficient. You need strategy and execution, and that means a sort of je ne sais quoi. There’s a passion inside that I look for. We have 133 people on staff in IT, and I try to interview everybody who comes through the door. And I look for the same thing: Technology we can teach in a lot of cases, or we can rent. I’m looking for people who can think.
I’ve got people who are very deep in a specific technology, and we need them for specific things. But what I really need is someone who can say, “I understand this problem and how technology can enable a solution.” Or, “I see that opportunity, and here’s the technology to bring to bear.” Because most of the stuff we’re doing today didn’t exist 10 years ago.
Do physicians say, “There’s an advanced digital infrastructure, this is a good place to work?”
Cotteleer: I believe if you talked to our chief medical officer, he would say physicians absolutely come here because they’re attracted to our platforms and technologies, because it allows them to serve their patients well, efficiently. You know what physicians, in my anecdotal experience, don’t like doing? Spending 15 minutes with a patient only to spend an hour on the EMR [electronic medical record]. We work on technologies to streamline their interaction with the computer so they can focus on what they want to do, which is to serve patients. Absolutely, I think they come to us for the technology we can offer.
All of our physicians can log onto a secure portal and check their performance. Every doctor can see how they’re doing with respect to all of their peers at their facility and across the country. We measure that down to the provider level.
Do they appreciate that data-driven feedback?
Cotteleer: They love it. It results in better doctors and happier patients. If a chart needs more information, we can return it to a doctor electronically. They can fix it right away and move on, which has economic and quality benefits to us and the patient.
Can you give us a vignette of what you offer doctors to make their process easier, and to make a better patient experience than another hospital?
Cotteleer: Sure — a doctor comes in. Has the choice between us and one of our competitors. We say to him, “Hey, doctor, you know what? With me you’re always going to know where you stand vis-à-vis your peers, and you always know what you’re going to get paid.” And remember, he’s an ER physician. He didn’t pick the easy route; he picked the toughest 90 seconds of your life every night for the next 25 years of his life. This is, in general, a competitive, highly intelligent individual. Giving them feedback through data like this is enormously attractive to them.
Not only that, if you get a chart deficiency — meaning we require more information — we’ve made it as easy as humanly possible. It’s a one-stop shop. You log in, single sign-on. Everything at your control panel to run your emergency room life is there, from scheduling through compensation. The entire spectrum of their experience here is accessed through consolidated touch points, and that’s very attractive to them.
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