Having served in various technology leadership roles for 25 years in healthcare, Dave Cheli keeps a close & insightful watch on Healthcare IT trends. We bring to you some expert views from an open ended conversation with Dave, where he gets candid about the future role of clearing houses, interoperability for value based care and challenges ahead for Population Health Management.

Dave has served as the Vice President of Technology for Lumeris, Chief Technical Architect and CIO for TriZetto Provider Solutions, Director of Software Development and EDI for WellPoint. Currently he is serving as the CTO of FocusScript.

In conversation with Dave Cheli…

How BIG is technology’s role in simplifying the rapidly changing healthcare landscape?

Dave: Certainly, technology plays a big role in shaping the direction of healthcare. There are many different categories within healthcare requiring different technologies, whether it’s analytics for population health management or precision medicine, mobile apps that facilitate better patient to doctor communications, improved interfaces for systems, etc. An area that I am particularly interested in and one which threads through many of these is data interoperability that is the ability to integrate all the necessary data feeds into useful, action based information. This is a big challenge in today’s healthcare sector and one that still needs a lot more work.

How crucial is interoperability in realizing value based care? What can providers and vendors do to achieve true interoperability?

Dave: As I mentioned above, data interoperability remains a big challenge and certainly is in the value based world. Value based care ideally brings together clinical, financial, pharmacy and consumer behavioral data. The data is then used for purposes such an identifying high-risk patients, gaps in care, adherence, access to healthcare, etc. These data feeds come in various formats, such as X12, NCPDP, HL7, unstructured, etc. and from a variety of systems which interpret data elements and identifiers differently. The reality is that there are many nuanced differences amongst the standard and systems that allow for interpretation, not to mention the lack of broad adoption of various medical vocabularies to communicate information, such as say lab orders; LOINC vs. Free-form text descriptions. Additionally, many of the data that we work with carries years of data “debt”, meaning that we are using data for purposes, other than what it was originally used for, for example using claim billing codes for clinical purposes.

Between providers and payers, who according to you would be more impacted by value based care and why?

Dave: There are impacts to both parties. Both involve changing established practices, which are born out of a decades old volume-based reimbursement world where providers (reimbursements) and payers (premiums) compete for dollars to value -based reimbursement model where keeping patients healthy is a goal and the system wins when costs are low and quality is high. This world is still evolving, with many variations; in how value-based programs should be implemented and measured, creating confusion and sometime conflicting actions. Additionally, and ideally, higher quality data is required to truly measure value, which is not available for a variety of reason and contributing to slow progress.

With value based care relying more on outcomes than claims, what role do you foresee for clearinghouses in the future?

Dave: Clearinghouses do have a role in value-based care in that they can become more of a data integrator than just a data aggregator – particularly in provider-oriented value based arrangements such as bundled payments. In this role, they would need to take on new transaction types other than just handling financial transactions. This could include clinical transactions, pharmacy, and possibly consumer-oriented data. Of course, this moves the traditional clearinghouse into places where they have been before and needed to develop or adopt other business models.

What are the challenges in population health management? How can we effectively address them?

Dave: As I stated previously, I view data integration as a big challenge particularly since population health is a data driven domain. This not only includes handing different data streams, but “marrying” them together with various technologies such as say a Master Patient Index, vocabulary normalization, etc. What I’d love to see are clearinghouses, pharmacy switches, HIE’s and some of the upcoming API integration vendors start to collaborate more around this topic rather than continue working in silos.

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