Healthcare Roundtable

• MARC BABITZ – Utah Department of Health
• Scott Barlow – Revere Health
• GARY BELL – GBS Benefits
• BLAINE BENARD – Holland and Hart
• LINNEA BENTZ – Diversified Insurance Brokers
• RYAN BINGHAM – Spectra Management
• BYRON CLAWSON – IASIS Health
• PATTY CONNER – Avenue H, State of Utah
• ERIC HALVORSEN – UMA Financial Services
• JOHN KEMP – Big-D Construction
• MICHELLE McOMBER – Utah Medical Association
• JIM SHEETS – LDS Hospital
• MATT SLONAKER – Utah Health Policy Project
• DAVID TANNER – Granger Medical Clinic
• Matt Weed – Intermountain Healthcare

We’d like to give a special thank you to Dave Gessel, executive vice president at the Utah Hospital Association, for moderating the event.

The hottest topic in Utah right now in healthcare is the debate over Medicaid expansion. Should we be expanding Medicaid, and if so, how do we accomplish that?

McOMBER: We do agree with Medicaid expansion. We think it’s good for the citizens of Utah, that it benefits all. So we should find a way to pay for it that actually is across the board. We think if you took a general sales tax increase, you could take a very, very, very tiny amount, and you could cover it.

BARLOW: This has been a tough issue because clearly the expansion needs to happen. There’s just too many vulnerable people that don’t have coverage. Now they have penalty taxes as well as not having coverage, which is additionally problematic.

SLONAKER: We’re now stuck in this quagmire of how to fund the Medicaid expansion. And frankly, over the last three years there have been a number of things proposed. A sales tax on food has been a rather late suggestion, but I think it’s an OK suggestion. There are a variety of other ways that they’ve thought about. Maybe it’s a mix of some provider groups paying some portion. Some of the beneficiaries paying some portion. The hospitals have come to the table. A small sales tax on food, something like that.

At the Utah Health Policy Project, we help people sign up for health insurance, as well as work on the policy side of things. And 50 percent of folks that we see come in our doors don’t have an option. They’re in this gap. So we see them front and center. They’re people who are working low-paid jobs, generally speaking, and don’t get offered insurance through their own employer, and they’re also not eligible for the ACA subsidies because they don’t make enough. So there’s a need out there, that’s for sure.

We’ve talked about Utah being open for business, good for business. We’re now facing having a higher uninsured rate than the rest of the country. We’ve always been really good in that category, towards the top. Now we’re lower than average. We’re around Alabama, Mississippi. Colorado’s beat us. They’ve done a Medicaid expansion. So as far as attracting business, it’s one of those big, global metrics that businesses look at. It’s important from that perspective, too.

SHEETS: It needs to happen. We shouldn’t lead the nation in the rate of uninsured, especially in Utah. It’s kind of an interesting dichotomy to have, to be one of the top economies in the country and yet still have that many uninsured. There’s a lot of reasons why we need to expand, not just to get people insured, but people need the care.

Mental health services is something that’s woefully inadequate, and Medicaid expansion was really helpful with that. We see a lot of that at LDS Hospital. We’re the only really inner city hospital for Intermountain, so we see a lot of those patients and deal with them every day.

WEED: Intermountain’s position on this is the same. We deal with the most impoverished, the people who need the coverage. We’ve got to figure out a way to do that.

I think that we, as hospitals, are willing to participate in the subsidy and the funding of this. The issue is the extent. If we’ve got unlimited exposure on this, that’s something that we’re not willing to enter into. On the other hand, if it’s defined, if it’s reasonable, I think that’s a position we’re willing to support.

We’ve seen a wave of the major health insurance companies trying to merge, the national ones, across the country. So let’s talk about what we see as the future of health insurance and how private exchanges are changing the healthcare landscape, and what’s going on with our own state exchange.

BENTZ: Specifically with the mergers going on, the buying power of a lot of our companies and then the employees that work for them is changing the dynamics, it’s changing the access points and how we’re going to be negotiating benefit options. I think we’re going to see a lot more self-funded plans coming back around, especially with a lot of these mergers because we’re going to see fewer competitors in the market than we’ve had in the past. Competition is good in healthcare, specifically here in Utah. So it’s just going to change the dynamics. And I think it’ll steer it more toward more the consumer-driven and the high-deductible plans.

BELL: I agree—there will be fewer options for employers as a result of it. I can’t disagree with the fact that it’s a free market system and if there’s interest in buying and merging, that’s OK. But there are fewer options. Aetna doesn’t probably have a tremendous amount of business here, so to acquire Altius was a little less impactful. We’re waiting to see what it might mean for Regence, though, as a result of the Anthem merger.

TANNER: For providers, the consolidation means we just have less people we have to negotiate with, and maybe some different tactics that the insurance companies are deploying with the shift in healthcare. We see more analytics being applied to the delivery of care. And so perhaps larger organizations, larger insurance companies can put some resources toward that game. But that’s yet to be seen.

McOMBER: From the physician perspective, we’ve had a lot of concern expressed about some of the consolidation that’s happening. We haven’t seen as much in Utah, but we’re starting to see it. But just the wave across the country is concerning to physicians.

What we are seeing in response to some of this is physicians who are looking for other options. Because if you can’t participate in an insurance plan or if there’s consolidation, if you’re blocked out of participating, which is sometimes what we see happening, they’re looking for other options for how they’re going to care for patients.

What we are seeing are some creative ways for them to participate with patients that actually does not include insurance. We’re seeing some concierge services starting up in Utah. We’re seeing telemedicine that does not include insurance. Some of that’s probably good, but some of it may be bad. But they’re looking for other ways to do care.

You get too big, too. Prices actually go up, not necessarily down. When Sutter Healthcare in California merged last year and got bigger, the prices went up 20 percent. You see that in insurance companies, too. We want to be careful when we’re looking at consolidation that we don’t get so big that prices actually go up and we reduce competition.

CONNER: We’re running an exchange that’s really based on having competition and being able to allow small employers to come in and choose from multiple plans. If that ends up being one or two, then there’s really no competitive marketplace in which they can shop to help drive down those prices. So with these mergers, we see they are stopping a lot of that competition and the pricing.

These mergers aren’t like overnight activities. It takes a long time for them to do the mergers. And the consumers and the members of each of those respective plans are stuck in limbo for many years. The local people can’t make decisions because their corporate is holding back on making any future plans on things. That impacts a lot of people’s lives in between.

SLONAKER: The other marketplace we’re dealing with in Utah now is the federal exchange. I just want to report that there are six insurers offering 101 plans. That’s a little bit of growth. So from that perspective, maybe there is a little more choice for consumers. It’s a small glimmer of hope perhaps, that we are seeing more and more insurers want to participate in the federal exchange. And maybe that will provide downward pressure on prices eventually.

One of the things that’s happened in recent years is the growth in accountable care organizations. How do you feel those are going and how will they impact healthcare in the future?

BARLOW: The overall opportunity to affect healthcare is quite positive because it’s causing everyone to think about patient-centric care. How do you engage the patient more? How do you find new delivery vehicles to provide a better product at a lower price?

It’s been a rough journey simply because it’s new. We’re in a schizophrenic world where part of the business is in that side of work and part of it is in the normal fee-for-service environment, which makes it very difficult. But the biggest challenge has been simply getting the massive data sets that come with it figured out. We started with the federal one in 2012, and every few months there’s a surprise of information that comes with that experience. We’ve got five commercial ACOs as well that we’ve been practicing.

The data is absolutely clear that we’re bending the cost curve materially in terms of the populations that are in those vehicles. Every quality index you can track is getting better—some significantly better, some a little bit better. The challenge is delivering in a market that really is quite efficient in its care on a lower-cost delta that’s enough to result in some real successes for the systems that are doing this.

We did renew our federal one this year for three more years. We just felt like it was a worthwhile experiment. I’ve not made any money on it. But we didn’t really go into it thinking we’d make money. It’s more of the experience and the learning opportunities. You’re going to see those concepts and principles that are being learned continue to be perpetuated in the healthcare system.

WEED: The Medicaid ACO has been in now since 2013. All of a sudden, overnight, we had 80,000 Medicaid enrollees. The good thing about it is it begins to align the system. So if you push the risk more to the delivery system and it’s not being held by some third-party administrator, you’ve actually got some incentives in the right place where actual care can be impacted.

TANNER: Granger also started an ACO in 2013. Like most national ACOs, they don’t make any money the first few years because you spend so much time looking at data analytics and trying to figure out how you’re going to manage population health. One of the challenges is getting all the information among the various providers of care. I think some of the new initiatives that CMS is putting out by some of their risk proposals in 2017, 2018 may have a little bit more impact to ACOs in the future.

CLAWSON: A couple years ago we entered into an ACO arrangement with Humana; we have around 35,000 lives that we’re managing. If we were able to track the trend of the benefit of this, the MLR is around 102 percent if you’re not in the ACO and being managed within our system.

You’ve got to share the data, you’ve got to give it back to the doctors, the doctors have got to be on point to manage the population appropriately and carefully to make sure this works. But when they’re managed correctly, we’re able to bend that trend from 102 percent MLR to 79 percent MLR. So it is doable. And we have found some success in a very sick population, the Medicaid population.

McOMBER: Many of our physicians are participating in different ACOs and it is teaching them to manage their patients and manage risk, and teaching them to look at the patients in a different way. In addition to that, it gives them the opportunity to see all of the data. In the past they didn’t have the opportunity to see the data. Now they can see how much a lab costs, how much prescriptions cost, how much their surgeries cost compared to others. And they can make decisions based on data. Where in the past you didn’t make decisions based on data, you just made decisions in a vacuum basically. You made decisions based on what you thought was best for the patient, but you had no other data that you could look at.

When we look at the cost curve, they can see what is happening with their own group, with other groups, with the patients, with things that they affect in the patient’s care, and they can make decisions also based on cost.

We’re now in the fifth/sixth year of the Affordable Care Act. Give some examples of how you think the ACA is positively or negatively impacting Utah employers, especially small businesses. Are more or less businesses providing health insurance to their employees?

BINGHAM: There are definitely certain industries, like hospitality or restaurants, that historically have not offered coverage that are starting to offer that. It’s definitely caused a dramatic shift as far as the number of hours people are working and different things from that aspect.

But I would say, at least from our clientele, they’re not offering benefits because of the Affordable Care Act. A lot of it is the economy. Where the economy has continued to grow and do much better, it’s about competition. So they’re wanting to offer the most benefits, offer a great package to attract good talent. Yes, I’m sure there is some result of the Affordable Care Act, but I would say largely it’s because of that competition that we’re seeing some of these increased numbers.

CONNER: We’re seeing more businesses come in to Avenue H. Our take-up rate has been pretty decent, somewhere around 18 to 20 percent each year. We’re seeing businesses that were not offering coverage before, but we’re also seeing those that had coverage before and are looking for competition and a different way in which to offer those plans to their employees.

There are still some that are doing group busting, breaking up small businesses and putting them in the individual market because they can take advantage of the advanced premium tax credit and cost sharing reduction that way. That helps those people from an affordability standpoint. We do see that in the industries that are high turnover, lower pay—maybe the hospitality industry, low-end manufacturing, seasonal businesses.

This year we’re going to see those rates go up quite a bit in the individual market. So those that have split up those groups in the last couple of years may now be saying, wow, we may want to bring that group back together and take advantage of maybe some lower rates in the small business side, but also the pretax benefits. So they have to weigh that cost of the individual market with the advanced premium tax credit versus the pretax benefits under the group insurance.

BELL: We have over 600 small groups. We haven’t seen a tremendous amount of dissolving the group benefit options with the 50 and below. We see a lot of high increases coming around the corner, and we’re concerned about that. So we might see more dissolving of the groups as we get into that.

BENTZ: I’m seeing a huge increase in small businesses coming in. A lot of it has to do with the competition—how can we attract and retain our employees, because now our competitor is offering a benefit package? They’re having to look at the whole platform now, the investments they’re making.

McOMBER: The Utah Medical Association is a small business, and we have not seen a decrease in the cost of premiums over time. We’ve actually seen just as much of an increase since passage of the ACA. So in terms of controlling costs, we haven’t seen any of that from the side of the small business. In fact, I’ve had to increase the portion that our employees pay for their insurance premiums because we just can’t cover the 20 percent increase. And we have healthy employees. But we’re seeing huge increases in premiums every year.

SLONAKER: We find that small businesses that haven’t been able to offer insurance—and they still aren’t—are able now to have their employees get coverage through the federal insurance marketplace. That leverages the advanced premium tax credit. That’s been a pretty important thing that a lot of small businesses we’ve been working with have realized.

BINGHAM: What we’re seeing is a huge flux in these level-funded or partially self-funded plans for much smaller organizations. But the result is the risky business is getting stuck with the community rates or these certain pools, and then the good risk is pulling out to go do association plans or agency-level plans. Which is great for those, but I worry we’re going to have a negative affect on the community—maybe rates have become more even across the board, but we’ve still seen those 9, 10, 11, 12-percent-plus rate increases. So we’re seeing more competition, but a lot of it’s just more competition in other types of plans that are really reverting back to the rule from previously where you look at health risk.

I just worry that we’re doing this circular thing that’s just going to lead us right back to where we’re at. There’s not a perfect solution that’s going to solve that. It’s great if you get into that healthy pool, but then it’s very bad for those others that are stuck with the status quo.

Utah is always ranked near the lowest as far as physicians per capita in the country. What do you think we can do to continue to attract and hopefully increase the number of physicians practicing in Utah?

BABITZ: The medical school recently increased the number of its students; unfortunately, the medical school doesn’t have a track record of turning out the physicians we need in terms of primary care. And we don’t have enough residency slots in Utah, especially in primary care, to even keep them here if they were able to do that. Is there any possibility of increasing residency slots, particularly in specialties we need? That would include general surgery and some of the subspecialties, but mostly primary care, general internal medicine.

Utah’s a great place to practice medicine. It’s a great place to live. It’s also not an expensive place to live compared to many other states. And our salaries in Utah for physicians reflect a lower cost of living. In other words, we have lower salaries. So when you compare the salary offered in Utah versus the salary in many other places, it’s 20 percent lower. What many don’t realize is the cost of living here is probably going to be 20 to 25 percent lower compared to those places. That is why the revolving payment programs are critical for us to be able to offer something to get people to come and experience Utah, and help them know that they can make up the difference in terms of income to help them pay off debt. Because student loans are another big issue for physicians.

McOMBER: We do have a unique system in terms of insurance here in Utah. So if you are being recruited to come to Utah, one of the things you look at outside of salary is can you get on insurance panels. If you aren’t going to be able to get onto an insurance panel, you know that you can’t survive here in Utah. And we have fewer insurance plans here in Utah than you do in other states. So that actually is something that could be a barrier to recruitment in Utah.

SHEETS: For us, at the hospital, we run into situations where we don’t recruit because we feel there’s an over-supply or there’s enough physicians per capita, especially with some of the specialists. I’m actually under the impression, at least in the Salt Lake area, that there’s more physicians per capita than we have a demand for. Might not be in the rural areas. And that might be not in certain specialties. But at least the data I’ve looked at shows that.

BARLOW: The bigger worry I have is the large portion of the physician population that’s over 55. What I normally see with physicians is the retirement decision is usually a sudden one; they’re just fed up with the hassles of medicine. As we get into these new eras with a lot of unknowns, the bigger worry is creating a negative work environment to the point where a large cadre of that 55 to 65 is going to say, “You know what? I’m done. I’ve had enough of this.”

BABITZ: If I go into a large clinic that’s well covered with insured patients and I say, “Do you need more doctors?" They say, “No. We’re fine. We’re great." Got everything they need.

But I go down to a community health center or the homeless clinic or talk to people who are on Medicaid and say, “Do you have enough doctors? Do you have healthcare?" The answer is absolutely not. And I go to some rural areas. Absolutely not. Where you stand will determine your view of the manpower supply in Utah.

Where I sit in the Department of Health, looking at the whole state, I will say we are horribly short, especially in primary care, general medicine and general internal medicine, and in some subspecialities: general surgery, neurology, cardiology. In Salt Lake, yeah, we’re pretty well served. Get out of Salt Lake and Utah County, boy, you’ve got some problems.

CLAWSON: For primary care physicians, if you’re not with some of the bigger organizations, whether it be Intermountain or Revere or Granger, even with us, Physician Group of Utah, there’s a lot of independents that are trying to find that relationship and align with someone. So we’ve developed an independent practice association with around 750 physicians in it, up and down the Wasatch Front. So there are opportunities to get some of these individuals aligned with their practices in organizations.

What do you see happening in population health initiatives? Are we educating the public enough? Are they engaging enough?

BELL: I think this is an exciting new opportunity. From an employer perspective, we’re asking ourselves: Maybe there’s an undersupply of physicians? But maybe we have over demand for physicians. Maybe we can find ways to be more efficient. Maybe we can utilize physician assistants in a more effective way. Maybe we can install onsite clinics. If there is waste in the system, maybe we can find ways through better partnerships, partnering with the health plans, to help drive out some of that inefficiency.

I had a meeting with the chair of the department of medicine up at the University who said, “Today about 40 to 45 percent of healthcare delivery is waste." And it’s never going to be perfect. It’s an art and a science that needs a whole lot of work for sure. But population health, this is really the exciting part of it for us. I would compliment those of you here in the room who are involved with respect to the health plans and providing data to us on behalf of larger employers. Because with the data and with really good analytics we can help employers improve health, reduce risk and lower costs. And that’s where it starts, with health improvement. How can you improve health if you don’t understand what’s occurring within the population, if you don’t understand or have a feel for the chronic conditions and whether or not people are managing their health, compliant with their medications, avoiding any gaps in care?

There’s a tremendous opportunity with the data to assess an employer’s situation, the risk of the population, and help employers develop strategies that improve the health. I’ve heard that about 75 percent of healthcare costs can be attributed to chronic care conditions. So there’s a huge opportunity, and employers are seeing it. And with the availability of data, we can start working on that.

TANNER: In a fee-for-service world, it really compartmentalizes the delivery of care, the trials and errors that we had in the HMO world of the ’90s, where it was more about controlling utilization than it was about the delivery mechanism. Population health is really an exciting field. Because now, with data, we’re looking at how to keep patients healthier longer and not have the high utilization or the high costs. And really improving the delivery using the total cost of care, using all providers and all information in what is being coordinated for the delivery of that. And it requires that coordination.

BINGHAM: I see it in two different areas. You’ve got the large employer, which has been discussed quite a bit, because potentially there is that data sharing for some of the level funded or partial self-funded plans. But there’s also a concern with the community rated groups, which is we’ve seen a dramatic shift in those employers not wanting to initiate or participate in some of these wellness initiatives because they think, well, what does it matter now? I’m just going to get what everybody else is. So that’s definitely a huge concern. It’s trying to educate that you are part of a bigger pool—you are part of probably the largest pool in that community rated plan. Maybe it’s not going to shift dramatically; you aren’t going to see a 10 percent cost savings next year. But 1 percent is 1 percent each and every year.

One of the things we’ve seen is the stick and the carrot. The stick tends to work a whole lot better for premium reductions and those changes there than just dangling something and hoping people take it. We’re seeing more of a success when people are actually adjusting the premiums as an employer, based within the parameters. We’re going to have to see more of that if we’re going to see more dramatic change or quicker change in some of these programs.

McOMBER: Population health is key, getting patients involved in their healthcare. We know that things people do cause healthcare costs to increase. Obesity causes a lot of healthcare costs. Not controlling your diabetes causes a lot of costs. Not controlling your high blood pressure. So if we can have patients who are participating in their healthcare, who are following instructions, who are doing what they need to do to help increase their health and decrease their costs, we can control healthcare costs a lot better. Population health and having the whole picture, having the provider side of things, but also having the patient participate in that, is the key to really where we want to go in healthcare.

BABITZ: Population health to me means everybody in the state of Utah. I see a lot of folks who aren’t in your systems of care. One of the ambitious, strategic goals of the Department of Health is that we should be the healthiest state in the nation. When you think about it, there’s no reason Utah shouldn’t be the healthiest. We’re at number five, which is pretty good. Why aren’t we the healthiest? It’s because we have about 20 percent of the population who are left out of your systems, and their health is horrible. Their infant mortality, their mortality, their death from cancer, their chronic diseases.

One of the challenges for Utah as a state, which will include all of us in this room, is what can we do to impact the health of our whole population, as well as those in my business, as well as those in my insured group. I don’t have an answer for it, but it’s a challenge.

SLONAKER: What we see on the frontlines are folks that really just don’t understand their insurance. There’s a huge deficit in the comprehension in the basics of how to use the insurance. How do I manage my diabetes? How does my insurance work? So are insurers doing enough to educate their members? I think they do a lot, but from what we can tell, especially with these new insurances, it’s confusing and they really don’t understand some of the basics. And we try to do our best. We have a little packet that we walk through. But time will tell as to whether or not that’s going to work.

That includes empowering consumers so they know the questions they should ask of their doctors. You know, it’s not all based upon how your insurance works or what their physician does, but rather how they interface. So, for example, asking the simple question: Do I really need this hip surgery? What’s the alternative? One of the biggest waste elements is some of these unneeded surgeries.

SHEETS: I was interested in Dr. Babitz’s comment about those that aren’t in our networks. The perspective from the hospital is everyone’s in our network because of our emergency room. People come to my emergency room whether they’re SelectHealth, Medicaid, Medicare or uninsured and we’ve got to treat them. And then they’re in our network.

So population health management is very important and it’s really needed. And from the hospital standpoint, it’s changing. Where in the past we used to think as a hospital, let’s just worry about taking care of the patient when they enter the door and when the leave. Didn’t really think about where we’re discharging them to or what they were doing before they got there. But now, with readmission penalties, possible prior complications that we’re monitoring, repeat visitors and frequent flyers in our emergency rooms, we have really got to consider our population.

Where it really becomes acute is with the mental health population. And that’s before they get to us.

The key, though, with population health is the practical application of the incentives. That’s the challenge. We are in a world where we are one foot in two canoes. And we have the fee-for-service world where it gives completely different incentives, where that’s more volumes, high utilization—it’s per click versus more of the risk sharing. That’s where we’re moving, but we’re not there yet. The sooner we can align those incentives with the community physicians—whether they’re Intermountain Medical Group physicians or Revere Health physicians, as well as with employers and providers and benefit managers—until we get there and can really do that, we’re just going to continue to talk about population health.

Data, for the first time in our industry, seems to be more widely shared, or shared in a way that it’s changing a lot of people’s behavior—providers, insurers, consumers. What are the exciting things you’re seeing with big data or how has it changed how you do your healthcare business?

BARLOW: Physicians are data masters. Their training is to take in subjective and objective information, make life or death decisions on the fly. So it requires a very robust capability of data.

When we looked at what we call gaps in care—anything that’s not been done for a patient that needs to be done or they’ve never been in at all—we find now when we get these data sets from payers that around 67 percent of the care that’s deemed to have not been given actually has been given. It’s just documentation and data transfer issues. And the beauty of that is it gives us a more substantive picture of what we really need to do to make a difference in health versus things that become redundant, repetitive, perhaps not value added, perhaps even harmful to people simply because the data sets say that something is missing when oftentimes it’s not.

The big issue now is patient engagement, the ability to give patients access to their medical record, for it to be portable across providers, systems, and even across state boundaries. That capability is now beginning to be reached.

BENTZ: From the consultant side, absolutely it’s exciting because it’s predictive modeling. It’s being able to take the data we have and look to the future and say, here’s our diabetic population. What can we do to back up and provide additional education or engagement, pharmacy management, those areas, rather than waiting till the claims have occurred? But being able to predict it and put some things in place for outreach programs to be able to lower some of those cost drivers.

BABITZ: We are doing really well in data, but we have a couple more big hurdles to accomplish. Number one is there’s probably 15, 20 different electronic health records being used in Utah right now. They don’t talk to each other. They don’t share data. Second thing, most electronic health records, especially in the ambulatory setting, they’re not made to retrieve data in any useful way.

The third thing is, nationally the average individual changes health insurance plans about every three to four years. Now, if that means they go into a different data system, how do we follow that patient? How do we know what’s really going on with them so we can see if they’ve made changes or if they’re improving?

BENTZ: Marc brings up a good point about the time span a company stays with a carrier or a network. But as you’re seeing more the standalone total health options with the clinics within an employer group or even your standalone wellness program, not necessarily netted into the health plan that you have, that’s where you’re going to see the consultants like us that are collecting that data. So regardless of which carrier you’re with, we’re housing that data. And we’re still able to do that predictive modeling over time regardless of where it is because we are the house that’s collecting those data points.

TANNER: We have a lot of limitations on sharing data. HIPAA really restricts us and it always gets the attorneys in the room with us saying you can’t share. We’re out to protect the patient. But it also creates some real limits on being able to take advantage of many of the data points that Matt spoke about.

We need to find a way to bridge that and be able to share more data in a more useful way. Right now, total claims data gives you what’s the CPT code, what’s the diagnosis code, and what the charge was. But you’ve missed all the other pieces in a medical record that might help to truly follow population health as it should be.

CLAWSON: At some points we feel like we want to retain that information, to protect it, for one reason or another. All of us need to understand that if we don’t allow it to go out and allow the clinicians to do what they need to do—and that is take that information, get on a one-to-one level with their patient, have a relationship—we can have as much data in the world, but if we’re not building that relationship with the consumer, having them believe that we are working in their interests, then we’re not using it correctly.