Don McDaniel, Chief Executive Officer, Continuum Health. Continuum Health is a member of the Quality Institute’s Leadership Council.
What is the role of Continuum Health in today’s quickly changing health care landscape?
Continuum Health has a legacy of supporting and working with physician organizations. That’s the reason we get up in the morning. Physicians should be at the center of change. Our job is to enable physicians and help them optimize their practices, their business models, and keep them up to speed with all the regulatory things that are happening in Washington. We’re seeing fundamental change driven principally by reform that pays for performance. It really changes the entire business model for physicians. Are practices ready? At the end of the day what we’re really trying to do is help physicians be participants in high-performing, community-based, clinically integrated networks. We’re the support arm for our physician partners.
NJ has one of the highest rates of small and solo practitioner practices? Is that going to change — and should it change?
A couple of things are happening around the work force. We’ve seen a permanent change from physicians who want to be truly independent to physicians who want employment, no debt, and predictable work hours. All those things are true. For physicians who want to be employed, what are their alternatives? On the employment side, we encourage our physician partners to build physician-led organizations where physician can find employment. For small and solo practices, we’re working very hard to build new business models that allow those practices to stay independent to not just survive but also to thrive. We can do that through clinical integration. Our worldview is that there will be a physician renaissance and physicians have to take the mantle of leadership to drive change. We’re in the business to help them do that.
We have seen that changing payment models changes care models. How important is physician leadership in alternative payment?
It’s absolutely critical. The fee-for-service system set up by Medicare in the 1960s has completely undermined, in my estimation, quality, cost and transparency. All the incentives are now aligned by incentives based on fee-for-service. And so if you think about in the 80 percent part of our lives that are not health related we take so many things for granted economically that are all obstacles in health care. In health care we rarely talk about results.
We talk about process measures. Are you talking to your patients about smoking? Nobody asks, ‘Were you able to help your patients stop smoking?’ We need to move to a results-oriented system. Whether you like McDonald’s or not, you can get on a consistent basis the same French fry experience no matter where you visit in the world. But you can go to Philadelphia and you can have 20 different joint replacement experiences. You will have price variations. Quality variations. We need physician leaders to lead change. We need physician entrepreneurs. I believe that physicians want to do the right thing and want to change the system in a positive way. … We need a system that destroys the trillion-dollar waste that’s medically unnecessary, or waste, fraud and abuse. We feel this is a golden opportunity to change and physicians need to be represented in the battle.
How do you see the role of data in practice transformation?
Data and insights are at the center of our pivot. We have and will make significant investments in data capabilities. Here’s what I’ve learned about physicians. Telling a physician they are doing something wrong you might as well hit your head against the wall. But showing them what they are doing and how that compares with other physicians who are getting better results is golden. This notion of building data-driven environment is very powerful. The capabilities in health care are so archaic. The intelligent engine in a plane generates one terabyte of data on the typical trip between Cleveland and New York. People in financial services, media and electronics … they laugh at us. We’re behind in data driven support at the point of need.
Let’s say you go to your primary care physician and the physician needs to make a referral. The current method is for the physician to refer to someone he or she always refers to, maybe someone they played golf with. Now imagine if that primary care physician had at the point of decision a data pack of information that could inform that referral choice. That changes the game. The primary care physician consumes six percent of total spend. But they control through the pad about 80- percent of total spend. We have to try to make primary care physician more efficient and make primary care more attractive. We have to help primary care physicians think more holistically.
It’s a day off and the sun is shining. Where can we find you?
I have six kids, and our youngest two are in high school. So there are always various sports and activities and I am shepherding my children around. I do a lot of travel for work and so when I am not working I am with my family. We’re close-knit. I love watching sports and I love to read. But mostly my free time surrounds my wife and my children. It’s all about family.