As both Chief Medical Officer and Chief Innovation Officer for the National Partnership for Healthcare and Hospice Innovation, Dr. Cameron Muir has committed to help guide operators towards a value-based future.

NPHI is a national advocacy organization with more than 100 nonprofit advanced illness care providers, including those offering hospice and palliative care services. Muir joined the organization in 2019 as its chief of clinical innovations.

During his tenure, he has helped to develop and oversee the launch of the NPHI Innovation Lab, which focuses on designing systematic approaches to improve advanced illness care by examining trends in population health, claims analytics and practice optimization.

Muir recently sat down with Hospice News to talk about the ways medicine and health care innovation intersect, as well as the need to focus on quality to prepare for the industry’s value-based future.

What are your top priorities as you come in as CMO?

Number one is quality, always. There’s a real focus on measurement of quality, care model quality, that ultimately then translates down the line to value, which is where everyone has to be by 2030 — in an accountable relationship. That accountability is quality over cost. 

Then we’ve been doing quite a bit of work around what care models should look like and how to support the second thing, which would be the continuum. NPHI is really working hard on integrating hospice into health care. It’s got to be part of a larger continuum of care, more beneficiary focused, as opposed to reimbursement focused, if you will.

That means, for example, that a lot of our members have multiple other service lines to try to meet the seriously ill or advanced ill patient population, including, home health, medical practices like palliative care, home-based primary care and PACE. A good bunch have an [Accountable Care Organization (ACO)], either an [ACO Realizing Equity, Access and Community Health (ACO REACH)] high-needs or Medicare Shared Savings. 

We’re also really recognizing the challenges, both in terms of late referrals and then audit challenges around fraud and abuse. These have made the hospice environment very, very challenging for providers.

The third is then thinking from a policy perspective, so really thinking about, as we’re moving towards value, or as we’re living in value, how we integrate all these things and think about the policy implications.

Are there differences in the role of a CMO in an advocacy organization like NPHI and a provider company?

The biggest thing is, within a provider organization, you’re actually operationalizing and on the hook for implementing, managing, recruiting and compensation, productivity and performance, at the human level. I just think of the CMO at the provider level as being just much more into the devils in the details and serving the patients.

One of my colleagues said that there’s really only two job descriptions in an organization, the people taking care of the people, and the people taking care of the people who are taking care of the people. A good CMO is very, very focused on taking care of the people that are taking care of the people. That’s across the gamut, and making sure it’s sustainable and integrated.

At a national organization level, it’s much more consultative, facilitative and standard-setting. One of the biggest things that I’ve been really learning is how you actually help people to do better when they don’t have to do what you say. How do you influence organizations? How do you take hundreds of organizations, hundreds of medical leaders, hundreds of clinical leaders, hundreds of quality leaders, hundreds of CEOs, CFOs and CMOs, and help them to, first of all, see why change is coming, why it’s necessary, why it’s important and help them to make it as simple as possible.

You’re also NPHI’s chief innovation officer. Are there symmetries between those two positions? What’s it like to wear both hats?

Innovation, to me, is broader. I think the chief medical part is all that we discussed earlier, which is generally focused on the medical quality, implementation, execution, management, etc. The innovations role is broader in the sense that our population health work has been really broad in its base of constituents across the membership.

So for example, in some of our clinical population health guides, it’s been nurse case managers who’ve really been doing complex care management that have been some of the gurus of population health. We’ve gotten into claims analytics in a pretty big way over the past year or two in the innovations role, because that’s a relatively easy way to measure downstream impact on keeping people safe and comfortable at home or not, and then subsequently, if not, hospitalization rates, total spend, etc. That’s a little bit more typically into the finance realm, but it overlaps with quality.

The innovations role is both broader and ends up really trying to think organizationally, how to position organizations to be ready for value-based work and to be the highest quality that they can be.

What are some of the ways in which you as CMO will work with NPHI members?

A couple of different ways, one more deeply in the forums that focus on medical service delivery. So we have two different forums where all of the medical leaders from across NPHI come together on a regular basis. So that’s one.

Two, more time in the payment and policy work, specifically thinking about, for example, eligibility requirements for hospice billing regulations for complex care management and principal care management. Those are things that are going to really integrate across all the different member programs, and I will help deal with those issues and supporting coaching. 

Education is a huge part of all of this — education on the population health standards that we’ve produced, education on how to implement them, and specifically to help the physician leaders to be able to know not only their medical issues, but also the care models that we’re talking about, and be thinking about the policy and regulatory issues. 

You’ve spoken quite a bit about quality and quality measurement. In this context, do you mean things like the Hospice Item Set, the forthcoming HOPE tool metrics, or is this more expansive, going beyond the publicly reported metrics?

The hospice quality metrics that are publicly reported are critical, because they’re how the consumer looks at and assesses a hospice. Payers are often looking at star ratings and which hospice should they be pulling in as a preferred provider in their networks.

But the downstream measures that will probably become more mainstream later are things like disruptive transitions, type one and type two. Those are discharges that result in hospitalization with either readmission to hospice shortly thereafter, or death in the hospital. All of those to me, and the disruptive transitions, are around an opposite category, which is days in the home, in someone’s, for example, last year of life.

How are we working through not just clinical and medical means, but also social determinant means, like food, transportation, safe housing? How do we put those pieces all together to support someone and their loved ones so that they can feel safe and comfortable at home? The quality measure would be days in the home, as opposed to the disruptive transition, which is an unplanned or unnecessary hospitalization.

Then the last piece, from some of the other work we’ve been doing, is addressing social isolation and loneliness and domestic abuse, domestic violence and elder abuse.