Thought Leaders in Healthcare IT: CareJourney CEO and President Obama’s CTO Aneesh Chopra (Part 5)

Sramana Mitra: In this use case that you mentioned, what are they doing with that information?

Aneesh Chopra: Establishing contracts. Physicians negotiate contracts with insurance companies on a fee-for-service basis. If I see a patient, will you pay me $100? In parallel, there is a related network function to say, “I’m not as interested in what your unit price will be when I see a patient. What I’d rather do is take responsibility for the full expected spend on that patient for the year or three years.”

If I could reallocate what we do within that budget to proactively communicate to the patient and engage them, my bet is that it’ll only cost me $9,300 to care for someone who would otherwise cost $10,000. That difference of $700, I’ll take that as my reward for having built a better system.

Those organizations negotiating value-based contracts are our most common member as they use this information to help recruit doctors who have predisposition to caring for people in a better way and to coach organizations on where their physicians can improve to beat that benchmark. That’s our most common use case.

Sramana Mitra: How common is this kind of value-based care and preventative-oriented care in the medical system today?

Aneesh Chopra: It’s about 10% of the activity. CMS has set the goal for Medicare patients to be 100% enrolled in these models by 2030. CMS is probably in the 25% to 30% range. That number is growing and is expected to grow faster over the next several years. The private sector is catching up. Perhaps the area with the greatest room for improvement remains our employer population where they’re used to paying the annual spend.

They haven’t quite figured out what it would mean to forecast what that spend would be, prepay some of that expenditure, and then manage some of those risks. I’m pretty bullish. That will follow rapidly as we scale the public sector insurance programs.

Sramana Mitra: Do you have any large employer as your partner in this mode?

Aneesh Chopra: We do have large employer networks that have used the data to double-check or, in some cases, assist in the referrals. Even if they’re still paid fee-for-service, they would like to see a list of the high-value surgeons so it’s not just word-of-mouth but there is some rigor on the data side. We’ve got a growing number of employer populations eager to move to high-value networks even if the patient can go anywhere.

Sramana Mitra: If you were to assess timeline-wise, what is the sales cycle? How long will it take you to convince major employers to get into this value-based care mode?

Aneesh Chopra: Thankfully, CareJourney isn’t leading the cause. There are organizations thinking about value-based care options for employers today. Our sales cycle is to support those organizations with the information they need. We’re a wholesaler and not a retailer of that. There’s a lot more growth for CareJourney to keep going on the Medicare fee-for-service and the Medicare Advantage book, and shortly thereafter, the Medicaid book.

We will work to unlock the commercial population over time, in part because the commercial data remains hidden from public use. What we would be doing today is referencing the public data as the proxy for what high-value care looks like. It may be not hold in the employer population. That’s an area where we have constant debate. For now, the Medicare risk market is large enough and has room for growth.

Sramana Mitra: From your company strategy point of view, that makes perfect sense. From a bigger picture point of view, the employers have such a large percentage of the population. They also need to get on board.

Aneesh Chopra: They represent almost 100% of the net profits to nearly all the healthcare delivery organizations. There is already an important role they play.

This segment is part 5 in the series : Thought Leaders in Healthcare IT: CareJourney CEO and President Obama's CTO Aneesh Chopra
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