Annual Conference Day 4: Geeta Nayyar discusses information gaps and the promise and perils of technology

Applications of technology and the purveyance of information are key issues impacting the efficacy of the healthcare system, author and healthcare technology expert Geeta Nayyar, MD, MBA, explained during Thursday’s keynote session in Las Vegas.

In a sit-down discussion with HFMA President and CEO Ann Jordan, Nayyar described working at the intersection of medicine and technology, trying to help find the sweet spot where technology is deployed to the benefit of patients and clinicians.

“We’re living in a world where consumers and physicians are only going to be more tech-forward,” said Nayyar, whose résumé includes stints as chief medical officer (CMO) at Salesforce and AT&T. “That’s why you see so many new entrants and nontraditional new kids on the block. They see the [industry] dysfunction and they see the dollar bills.”

Although high-profile efforts such as Haven and IBM Watson Health have faltered, they at least brought a creative spark to the industry, Nayyar said.

“The key thing is they’re thinking differently,” Nayyar said. “The biggest miss in those partnerships is they don’t know what you guys know. They don’t have the understanding of the complexity of healthcare, on the clinical side, on the reimbursement side, on the regulatory side.”

Keeping an open mind to possibilities can allow traditional stakeholders and outside entities to work together. Nayyar referred to a partnership between Atrium Health and Best Buy to enhance remote patient monitoring by deploying Best Buy’s renowned Geek Squad to help with patients’ home-health IT needs.

“That’s the kind of stuff that we just haven’t done historically,” Nayyar said.

Finding ways to reach consumers

For healthcare organizations, consumer marketing represents another area in need of new approaches. Nayyar has written about marketing-industry principles that determine whether a consumer is willing to pay for a service (e.g., a healthcare service). Three keys are:

• Familiarity
• Likability and relatability
• Trust

“If you look at healthcare, we literally fall down on all three,” Nayyar said.

“For some reason we’ve always thought of marketing as an after-the-fact,” she added. “[The thinking is] the supply is there, you don’t really have to market, patients come, don’t worry about it.

“But marketing is now patient education. Marketing is now brand loyalty. And you’re not necessarily competing with the hospital or doctor down the street. You’re now competing with social media influencers who may not even have a license in anything, and you’re competing with retailers and you’re competing with virtual clinics.

“The competition has actually fundamentally changed. And so, marketing has now become really key to patient acquisition, brand loyalty.”

It’s not enough to have a website listing the organization’s sites and services, she noted. Hospitals and health systems should capitalize on social media sites that generate buzz.

“Doubling down on your presence and your brand and how you’re going to elevate that and [showcasing] the doctors that want to be showcased and are OK with social media, that’s going to drive new revenues you never had before,” Nayyar said.

Promoting facts and truth

Marketing strategies also tie into efforts to combat misinformation and disinformation by providing a forum to reach patients and potential patients with reliable messaging.

Although misinformation and disinformation are nothing new, “because of the technology, because of the era we’re in where people are hungry and thirsty [for information] and everything’s at their fingertips or on their wrists, it’s traveling much faster,” Nayyar said. “And patients come in too late, and we have a burnt-out clinician team that is saying, ‘Hey, man, they don’t even need me anymore,’ or, ‘They won’t listen to me.’

“We can’t accept that anymore.”

Consumers also have wearables and outlets such as TikTok through which to find health information. Nayyar said 59 million Americans report using social media for answers about their health.

“We’ve left this huge gap open,” she said.

Coming together on initiatives

As organizations consider how to incorporate technology to better serve patients and help clinicians, collaborative approaches become essential.

CFOs should work with CMOs and chief medical information officers on issues such as how technology projects will affect staff workflows or engender patient trust, Nayyar said.

She’s excited for the continued arrival of generative AI but said implementation should be managed closely because the technology will compound bad habits as well as good ones.

“We have to be mindful that if we are coding and the [doctor’s] notes are terrible … now you’re going to code on that,” Nayyar said. “We have to be mindful of how we learn what the technology can actually do, how we teach it and then how we have to keep the human factor and maintain that humanity piece even on the back end.”

CMMI’s Elizabeth Fowler describes the latest value-based care strategies

The mission of the Center for Medicare & Medicaid Innovation (CCMI) remains paramount 14 years after it was created as part of the Affordable Care Act, Elizabeth Fowler, JD, PhD, director of the center and deputy administrator for CMS, told Annual Conference attendees Thursday.

In the U.S., “We’re not getting what we pay for in terms of the outcomes, access, quality and satisfaction that we should,” she said.

Fowler gave remarks after receiving the 2024 Richard L. Clarke Board of Directors Award, which HFMA presents annually to an industry stakeholder who has made significant positive contributions to the profession of healthcare finance or to the financing of healthcare services.

In her efforts leading CMMI (a.k.a. the Innovation Center), Fowler helps to design and disseminate value-based payment (VBP) models that aim to support financial sustainability across the healthcare industry. The award recognizes her “accessibility and willingness to engage with a broad spectrum of health industry leaders and her commitment to advancing value-based care and payment models to support financial sustainability,” according to a news release.

Learning from ‘spaghetti’

CMMI launched its first VBP model in 2012 and has not slowed down since.

“After a decade of testing more than 50 payment and care delivery models, throwing a lot of spaghetti against the wall to see what sticks, we remain bullish on value-based care, and we continue to believe that moving from a volume-based system to one that rewards value is the right path,” Fowler said.

In a strategic plan published in 2021, CMMI set a goal of ensuring every Medicare beneficiary and most Medicaid beneficiaries would be in an accountable care relationship — either an advanced primary care model or an accountable care organization (ACO) — by 2030.

Recently incorporated models and initiatives are designed to further that goal by expanding primary care and ACOs and integrating primary care and specialty care, Fowler said.

With respect to primary care, CMMI has drawn lessons from past models such as Comprehensive Primary Care and in preparation for upcoming models such as Making Care Primary.

“We’ve learned interest among primary care practitioners in joining value-based care remains high, but many of them need assistance with infrastructure, building health IT systems, data and analytics, all of the tools that they need to be successful,” Fowler said.

CMMI’s ACO programs have evolved over the years to the latest iterations, ACO REACH and ACO Primary Care Flex. Principles of contemporary models include alignment with the Medicare Shared Savings Program (MSSP), an ACO program that is not a CMMI pilot but rather a permanent part of Medicare.

The aligned approach includes incorporating the Advanced Investment Payments program in the MSSP. The AIP program is an expanded version of the former ACO Investment Model, giving participants the tools and resources they need to take on risk.

Bringing specialists into the fold

CMMI also has intensified its focus on specialty care.

“Delivering person-centered care requires addressing the full range of patients’ needs from primary and preventive care services to managing chronic conditions longitudinally and episode care needs acutely, much of which is provided by specialty physicians,” Fowler said. “And our continued progress towards our 2030 accountable care goal requires better integration of specialty care and primary care.”

The specialty-care strategy has four components, she said:

• Enhancing performance data transparency to inform referral decisions in models such as the MSSP, ACO REACH and Making Care Primary
• Maintaining momentum on acute-episode bundled payment models, including a recently proposed mandatory model
• Driving better communication and coordination between primary care physicians and specialists on behalf of their shared patients
• Creating financial incentives for specialists to affiliate with ACOs and move toward value-based care

Going to the next level

With many promising models over the years, the question remains how to scale them.

“We know that providers and model participants are now looking for more certainty, more predictability, and where something is working, they’re looking for more permanence,” Fowler said.

Of 50 previously tested models, only four met the statutory criteria to be extended or expanded, meaning actuaries attest there’s a 95% certainty that the model will generate net savings for Medicare.

“It’s a high bar and a very narrow definition of success, particularly if you consider aspects of our health system that have been historically underfunded like primary care, rural health, health-related social needs,” Fowler said. “Moreover, the models that have been expanded are not the ones that have been most transformational” (examples include models for home health value-based purchasing and nonurgent ambulance services).

“On the other hand, models that have been transformational have not met the bar for certification,” she said, citing the Oncology Care Model and Accountable Health Communities Model.

CMMI has incorporated a new quality pathway that could allow models to be expanded based on quality instead of cost savings, Fowler said.

An important contribution

Noting that Medicare and Medicaid spending in 2019 was 17% lower than projected in 2010, Fowler believes CMMI deserves some of the credit. Some of the savings may stem from what she describes as “spillover effects,” meaning providers furnish enhanced care delivery services even after reaching the end of a model or dropping out.

“We’re examining the notion of this spillover effect more closely,” she said.

She also saluted HFMA and its members for being part of the effort: “For all you do to promote value-based care, and for your partnership along this shared journey.”

Mark your calendars

Fowler’s talk brought an end to Annual Conference 2024. The countdown is on to HFMA’s 2025 event, which takes place June 22-25 at the Colorado Convention Center in Denver.