Part 2 – Healthcare cannot be High Performance without quality-based physician-patient matching

So how do we get to true quality transparency that takes into account access, equity, patient experience and patient safety? It’s Quadruple Aim - the hard way. It may not be in my lifetime when we will wrangle real quality data out of providers, but keep in mind that the audience for this data must understand risk adjustment, facility characteristics and the fact that medicine is messy by nature and bad things happen to the best doctors. Fortunately, CMS is penalizing hospitals for readmissions and you don’t see as many mishaps in the operating room after Atul Gawande’s Checklist Manifesto became infused into common practice for surgery. But quality needs to be recognized as paramount when matching patients with physicians.

All doctors know a really good one if they could see their resume on paper, including education, certifications, appointments, published research, practice patterns, patient experience, lack of sanctions and other quality measures. Most accomplished physician CVs are a dozen or more pages long. Who has access to these or has time to read them? That notwithstanding, a human’s assessment is still subjective without a 360° view of data for a physician, including consumer reviews de-objectified through sentiment analysis, and a machine objectively helping to make the recommendation. Today, we can determine that level of quality with big data and data science – but it requires a lot of heavy lifting in defining a taxonomy that covers nearly the entire universe of medical codes and terms and mapping them to consumer terms.

But what everyone seems to be missing in the High-Performance Healthcare conversation is matching high quality doctors’ clinical focus to a patient’s condition. There are 11 sub-specialties in Ophthalmology! You don’t want to get that Ophthalmologist recommendation from your Facebook neighborhood forum and end up going to a cornea specialist when you have a retina problem. Most specialists in that particular situation will refer you to a retinal specialist, but many specialists are actually generalists in their specialty and take all comers.

I compare medicine to law when speaking about matching. You never want to consult a tax attorney about a criminal matter. You never want to go to a corporate tax attorney for a divorce – but you might need to consult a divorce tax attorney for that divorce! Lawyers specialize in tax and sub-specialize in consumer, corporate, divorce, etc. Specialists, and even PCPs, do the same.

Studies have proven (as well as logic) that specialists have better outcomes when they perform relatively high volumes of procedures or deliver high volumes of treatments, addressing specific conditions. That said, performing too many procedures/treatments can also make a doc fall out of the accepted guidelines of quality.

When you start with a logical, objective definition of quality, many of your cost concerns go away because you have good docs working with patients that they should be treating, leading to less complications, medical errors, overtreatment, etc. Maybe you don’t need a COE program, there are excellent doctors in your network – even your narrow network. Your employees simply need help to find them.

Healthcare performance cannot, by definition, be “high” if people aren’t getting to the right doctor. ArmadaHealth solves for this problem by deploying a patent-pending, data science/machine learning (DSML) platform that, with input from evidence-based literature and subject matter experts, defines physician quality at the specialty level, sub-specialty level and their area of clinical focus including the condition-, diagnosis- and/or procedure-level.

When we match physicians with patients, our clinical navigators use our platform to create a pool of physician recommendations that are then vetted for non-clinical matching attributes, such as location, network participation, special needs accommodations, etc. All of this is provided to the patient, guaranteeing 100% accuracy in matching with the best physicians, given the parameters (which might be a geography or include a specific health system).

Employers and consumers of healthcare are going to continue to spend a significant part of their respective disposable budgets for healthcare, regardless of value-based care initiatives, for the foreseeable future. With tools from ArmadaHealth, they can now start to realize comprehensive higher quality physician-patient matching.