Leonard D’Avolio has spent his 17-year career in government, the private sector and academia working to improve the quality in the health care system. D’Avolio is the co-founder of Cyft, a firm that uses data and artificial intelligence technology to improve clinical care. He is also an assistant professor at Brigham and Women’s Hospital in Boston and Harvard Medical School.
He previously worked at Ariadne Labs where he worked to improve childbirth care in 70 clinics in India and helped create the infrastructure for the world’s largest genomic medicine cohort and embedded the first clinical trial within an electronic medical record system for the Dept. of Veterans Affairs
D’Avolio recently sat down with Hospice News to talk about his approach to making change, the ways evolving systems of payment, and new technologies are driving innovation and improvement in serious illness and end-of-life care.
Through Cyft, you’re coming to the end-of-life and serious illness care space with an emphasis on technology and the use of data. How do you see those forces changing how health care organizations operate, particularly hospice and palliative care providers?
I think our emphasis on technology and data is a means to an end. Ultimately, we believe everyone should have the highest possible quality, serious illness care. We believe the way to do that is to use technology to help clinicians identify people that are most likely to benefit from different types of services, whether that’s a home visit or a conversation with a family about goals of care, or ultimately, to prepare families to help them decide whether or not hospice is most appropriate for them.
Data and technology are our tools for learning and improving. We believe one of the most important things we can do is help, for example, palliative care, go upstream and offer more via value-based contracts. So the ability to help payers understand the value you bring in terms of improved outcomes and cost savings is critical. If you can use your data to demonstrate the value of your offerings as a serious illness care provider, then you’re more likely to be able to offer more and better care to more people. That’s how we think about the use of data and technology to improve services.
What do you see as your own kind of personal mission in relation to end-of-life and serious illness care?
I believe that data and technology are the foundation for learning and improvement, and for my last 17 years have been dedicated to helping health care providers use their data to learn and improve. Serious illness care is probably the most important area in which we can make this contribution, because It really hasn’t received the attention it deserves, and it hasn’t been reimbursed in ways that allow it to be sustainable and scaled.
How do you think hospice and palliative care providers need to adapt to the changing health care environment?
I think that the writing is on the wall that palliative services will soon be offered as as part of value- based contracts, meaning that, rather than get paid fee-for-service as we’re used to now, per episode, we’re going to see more and more of this care moving into sort of capitated arrangements.
If that is the move, then for the first time these organizations need to be able to use their data to discover who are the right people to care for and what are the most efficient ways to care for them, and how do we measure and demonstrate our value. I think organizations that recognize this can adapt by adopting the appropriate infrastructure and skills that are more likely to thrive in this change.
The way value-based contracts evolve is the federal government introduces pilot programs through the Center for Medicaid and Medicare Innovation (CMMI). Often times these contracts evolve from pilots to become the way that [the U.S. Centers for Medicare & Medicaid Services (CMS)] reimburses. We’re at the start of that cycle with the introduction of the Primary Care First Seriously Ill Population (PCF-SIP) model and the Value-Based Insurance Design model (VBID).
About one-third of reimbursement in the PCF-SIP model will be based on clinical efficiency and cost-effectiveness. VBID is an effort to promote Medicare Advantage to carve in hospice and palliative care, so that that too would be operating under a capitated payment amount. And we’re seeing Direct Contracting, which is probably the most aggressive form of value-based care being offered at the primary care level, place an emphasis on what they call the high-needs populations.
So those are the very specific examples of policies that that would lead me and others to conclude that there is a trend here, moving toward more capitated payment arrangements, more value based arrangement.
Some of the overarching goals in the healthcare system at large involve improving quality, improving care coordination and reducing costs. There’s a lot of effort to address those issues, with payment models that incentivize those improvements. Do you believe payment models are the best mechanisms for achieving those goals? Are there other things that need to be done to move the needle on those and where does technology and data fit into those solutions?
We see not just in health care but in every industry, you get what you incentivize. What gets done is dictated by what is paid for. So I think incentive and payment policy really is first and foremost. I would say it’s a necessary but not sufficient condition, because after you have the incentive, now you need to start changing the culture, changing the infrastructure to support this, really changing behavior.
The role of technology in a fee-for-service model has been to use data to ensure reimbursement for services already delivered. Sometimes it’s about checking boxes related to mandatory quality measurement. Usually data is used to demonstrate that you already did a thing.
If you move toward more value-based structures, where now you are given a fixed amount of money with which to deliver high quality care, it’s less about mandated quality measures. Now you need to use your own data as your competitive advantage to figure out what is the best thing to do, right now, for my patients in light of the resources that I have. That’s a very different mindset.
Of course high quality clinical care supports a healthcare organization’s success as a business. Do you think there’s ways that the business aspects of health care can foster high quality clinical care?
I do. The business on health care should be delivering high quality care, which is why I’m an advocate for more value-based constructs. I think in the past the business of health care was about volume. I think the future of high quality health care will be that delivering good care is good business. We will get paid to deliver high quality care, defined as the right care to the right people at the right time.
And by the way, the patients and their families should have a say as to whether or not the care was right; it shouldn’t simply be checking a box or delivering a certain amount of service. If we can truly align it so that clinicians believe that they are delivering high quality care, patients believe that they are receiving the right quality care, and the business is rewarded accordingly.
I know that there’s a lot of work to do to get us there. But I also believe that it’s possible and candidly, it’s the reason I entered into health care. This window of value-based care is now open. And the faster we can run through it, and the more lucrative we can make the delivery of high quality care, the more likely high quality care is to become the routine.