When Pat Blake, President of McKesson Technology Solutions, introduced a panel discussion his company sponsored on Tuesday at HIMSS, he succinctly stated the challenge facing physicians, payors and the industry that supports them:

“Providers and payors are focused on cost, quality and outcomes,” said Blake. “But it is incredibly complex and challenging to materially move the needle related to performance.”

The panel, which consisted of five experts with different backgrounds, shared their insight on everything from their support for value-based payments to a longing to return joy to the practice of medicine.

Moderator Mary Grealy, president, Health Leadership Council (HLC), a coalition composed of chief executive officers within all disciplines of the American health care system, led the discussion, entitled “Establishing Stability in a Climate of Uncertainty.”

The panel consisted of:

Dr. James Barr, a family medicine specialist and vice president of Clinical Intelligence, Atlantic Health System
Lili Brillstein, MPH, director Marketplace Innovations, Horizon Blue Cross Blue Shields, New Jersey
Mark McAdoo, vice president, McKesson Health Solutions, and former CEO of HealthQX
Dr. Zak Ramadan-Jradi, MBA, executive director and vice president of Accountable Care, MultiCare Connected Care

Grealy asked the panel several questions and responses are paraphrased below.

“What is the single biggest barrier to moving the current system and where we should be going?”

Ramadan-Jradi – We need to understand and agree on why we’re moving to a value-based model first, and not so much how. We need to take the message to the employers because they’re not sure what it means in regard to delivering quality and outcomes. How do you get the employer to move from a PPO model to an ACO model? I’m seeing us trying to move, but we’re still running a traditional system. This is quite expensive. How long until we make the leap of faith to move to a value-based system?

Barr – We need to move from the bottom up. Interoperability is a problem. We have 93 EMRS, trying to aggregate data and extract information is not easy. Return on investment is very challenging, we need to make models impact 20 percent of revenue to make a business case – five or 10 percent (at risk) is not enough.

Brillstein – I see it around the country, we’re making the transition too fast, no one knows what to do yet (with at-risk models). I like a no-risk model because it is more collaborative.


“Are we going to see an eventual “flipping of the switch”? Where are we on a timeline to seeing a conversion to value-based payments? What role should the government serve?

McAdoo – Medicare has started with bundled payments [value-based for an episode of care] for total joint replacements. The commercial payers have adopted this model very quickly. Technology plays a critical role in such a model.

Brillstein - Value-based [episodes of care] is not going to be perfect in the beginning. We just have to do it and be open to change. We have to be respectful of the clinicians (physicians) and develop models that make sense for them. Our analytics partners have done amazing things with the data, it helps our physicians make the data clinically actionable.



Barr – We have an issue with physician burnout, where physicians are starting to question if they made the right decision going into medicine. One of the keys is we need to bring back the joy of practicing by using data and information systems to make them more efficient so we can look up and see the patient again. So we need a model where the data helps the physician be a better doctor. I don’t know any physician who doesn’t want to be a better doctor.

Ramadan-Jradi – To truly move a value-based system, payers have to make a big investment; the commercial side is lagging behind. I don’t think we’re ready to do that. I see a lot of tweaks and finessing, but I think a value-based system is still down the road. The uncertainty in Washington is keeping a lot of people unsure.

"If you had five minutes to spend with Tom Price, M.D., the new Secretary of Health and Human Resources, what would you tell him?"

Ramadan-Jradi – Encourage Secretary Price not to politicize the process. He is a physician and he understands how health care needs to be delivered in practices. We need tort reform. If we’re going to use best clinical practices related to utilization, we don’t want to get sued for doing so.

Barr – We need to make sure that patients are also getting the information they need from the system – they are the true consumers. Also that health care is local, what works in one place won’t work in another. Transparency of data has to get better. Agendas will be hitting him left and right. We’ve got to re-establish the culture of health care – we’ve lost our way. We’ve got to care better – where care is a verb, not a noun. We need for culture to take us down the right path.