Optum mines insurance claims and clinical data to try to reorient its healthcare operations and stem chronic diseases. The pharmacy benefit management, analytics and care-delivery division of UnitedHealth Group aims to leverage artificial intelligence and machine learning to determine who may develop atrial fibrillation, a hard-to-predict heart rhythm condition. This required a more proactive approach to healthcare, said Patty Horoho, CEO of OptumServe.
“Getting the data into the hands of clinicians so they can proactively reach out to the patients allows us to change the equation of when a disease is going to occur, to if a disease is going to occur,” she said at Project Japan’s Leadership Symposium.
Harnessing the power of an ever-increasing amount of new data will shape healthcare organizations, panelists said. Crunching numbers as part of an accountable care organization helped Cleveland-based University Hospitals reveal snags in patient workflow, CEO Thomas Zenty said. Fixing those bottlenecks can guide more patients to primary-care settings rather than the emergency department, for example, he said.
When Children’s Health in Dallas implemented primary-care services, it treated around 50,000 kids per year and lost $20 million annually, CEO Chris Durovich said. Now, it partners with a primary-care provider and gained access to four times more patients, he said.
Technology and consumer demand is causing more care to move toward ambulatory facilities and homes. Hospitals must learn how to deal with being paid less as care moves to lower-cost settings, Carilion Clinic CEO Nancy Howell Agee said.
When Agee found that there was a breakdown in communication and processes every time a patient moved throughout the system, Roanoke, Va.-based Carilion doubled down on its workforce training, she said.
“It empowered our leaders to look through the lens of the patient at the point of care,” Agee said.
The evolving healthcare landscape requires a new level of transparency and governance, panelists said. Mentorship needs to happen at every level of the organization, which will inform succession planning, UCLA Health President Johnese Spisso said.
“Succession planning is present in our organization now more than it has ever been before,” Agee said.
Dr. J. Stephen Jones, CEO of Washington, D.C.-based Inova, spoke extensively about leveraging the power of colleagues. “Never underestimate the value of informal leaders in your organization,” Jones said.
Good leadership requires difficult discussions, Spisso said. A new muscular dystrophy drug developed at the academic medical center costs up to $1 million per year. There needs to be an ethical discussion about impact versus cost, she said.
“We have to have that conversation,” Spisso added.