HIMSS 2012 – Greenway, Justin Barnes

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Ann Fishman, with EHR TV, interviews Justin Barnes, VP of Marketing, Industry & Government Affairs of Greenway.

Category: HIMSS12, Tradeshows
Date: March 13, 2012
Views:3,190 views

Ann Fishman: I’m Ann Fishman at HIMSS 2012 and I’m with Justin Barnes, vice president of Greenway. Justin, hello!—

Justin Barnes: Hi!

Ann Fishman: Great to see you! And Justin also is very involved in the community, the EHR community. So tell me what other activities you’ve taken on.

Justin Barnes: Sure, as you mentioned, I’m vice president of Greenway, but then also chairman emeritus of the EHR Association, but one of the new ventures that I’m most excited about as a co-chair of the Accountable Care Community of Practice. Really a large, 16 of the global leaders around Accountable Care have come together in partnership with CMS to look for innovations and best practices around accountable care. So it’s going to be a fun 2012. We had a great 2011 starting the community of practice, but a long way to go and a lot to do.

Ann Fishman: Well, Accountable ACOs are very complex and I admire you that you could take this on and I want to discuss that and maybe deconstruct it a little bit. But I think it might be interesting to start with a recent trip you took that I read about with the MGMA to Cuba to evaluate their healthcare. So, why don’t you tell me about that?

Justin Barnes: Sure! A great opportunity was presented to me to go to Cuba with about— I think it was 21 other leaders from within MGMA. We went down in December and we studied the Cuban healthcare system really top to bottom. And what we’re looking for is to understand— they actually do excel in a few areas certainly; infant mortality, they have the lowest rate globally. And so we want to see how can they do that and really what models they have to create the most efficient care and sustain this efficient care.

And so what we really uncovered is best practices that we brought back here to America and we’re going to start to look at and how do we integrate into our health care system. But bottom line is, they have an entire health care system built on preventive medicine, community based medicine.

There’s care providers in every single community. They start off with a practice. A single practice will take care of about a thousand residents in the community and then you start there. So, all care is centralized and is started and managed at the local level. If you need to go beyond that to a specialist, you can go up to a polyclinic, and that’s the next level up. And then if you— if the polyclinic doesn’t have what you need or your care will take more than what you can actually receive at the polyclinic, you get referred up to the hospital. But you don’t just walk into an ER. They don’t, you know, where a lot of costs here in America come from. So they have a whole healthcare system based on the community, based on going to the right care center, for your episode that you need in that care setting, and then moving on up. So I’m very impressed with that type of a model; all of us were and we saw what best practices we can bring back here to America.

Ann Fishman: Very interesting! Since we’re discussing politics, I think it might be related—I saw a headline in that health IT news on Monday, and it was, “If a Republican wins, will healthcare reform be derailed?” So, my question to you is, given that mentality, are we ready to take any lessons from Cuba?

Justin Barnes: I would say yes and I would say I’m actually involved in most of the major campaigns that are happening now just from an advisory standpoint, an assistant standpoint, and obviously, I still work with the current administration. So, even if a Republican gets elected, you’re not going to have too much derailed. I understand that a lot of the Republican campaigns are on repeal and replace type of platforms, but no matter what, Accountable Care is kind of the structure that a lot of us working within now and certainly, Meaningful Use, we don’t see those kinds of models changing at all. There’s tons of support, bipartisan support for Meaningful Use. There’s bipartisan support for Accountable Care.

That actually was a Republican strategy initially. So that was something that a lot of us supported years ago. We finally got into regulation. I don’t see it changing a whole lot even if a Republican becomes president or if any of the chambers in the house tend to shift— will— could shift. So, I think we’re very well positioned. It’s a good talking point and articles will be written on it. I don’t see a lot of change coming in that regard; a lot is bipartisan support.

Ann Fishman: But in your opinion, is healthcare a political issue?

Justin Barnes: Unfortunately, it is, but it also doesn’t need to be. And a lot of us approach this from a bipartisan standpoint. I’m part of the Bipartisan Policy Center and we have both the past majority leaders of the Senate, on the Democrat and Republican side, so— and that’s the way we navigate it. So everything that we produce out of the Bipartisan Policy Center has policies and regulations, suggestions that we all agree to. And I think that’s very important. So we take the politics out of healthcare which we essentially need to do.

Ann Fishman: Okay! If the Affordable Care Act is struck down by the Supreme Court in March, well it will be in June they’re having the arguments in March, will that change anything?

Justin Barnes: Specifically, they’re going to take up the individual mandate in March. Even if they strike it down, I see the tenets of Accountable Care still moving forward, the tenets of Meaningful Use still moving forward. Yeah, insurance exchanges could essentially shift or there could be some policy changes, but again, we’re running 35-45 billion dollar annual deficit in healthcare costs. We have no more money to pull from. We’re draining all of our trust funds. We’ll be— our Medicare trust funds will be empty by 2021 probably. So, even where we’ve stealing from the bank and that, we have no more money to go get. We have to look for more affordable, more accountable care and more responsible care and responsible care models. So, my bottom line is, working every single day to create smarter sustainable healthcare system in America as well as globally, so I don’t see a lot of things changing even if it get struck down.

Ann Fishman: Okay, how do you evaluate our progress in terms of Meaningful Use 1 standards being achieved?

Justin Barnes: That’s an excellent question. Some people had higher hopes from where it would be. I actually think we’ve achieved a lot. I think that people just, you know, they saw 19, 20, 35 billion dollars, whatever the number will end up being that we put in to this program, as there’s going to be, you know, to catch the industry on fire. And while it did ignite a great interest in products— it’s been measured progress. But I think it’s been at a very healthy pace. It hasn’t outpaced where products can deliver and patients— and doctors needed to do all the research. And so it’s going to take time for them to— they weren’t just going to turn around overnight and started buying all these EHRs.

So, I think we’ve achieved the success that we have to so far. $3.1 billion has been paid off so far; 180,000 registrations. I say we’re well on target from what we predicted we would be. I would say you can have anywhere upwards of 300,000 people to 350,000 people achieving Meaningful Use when this program is all said and done and fully implemented. I think we’re well on our way and the goals have been achieved so far.

Ann Fishman: Okay! How about ICD-10? Do you think the American physicians are ready for the transition to ICD-10?

Justin Barnes: I think the debate’s still ongoing around that. I want to say we want to make sure that we’re providing the most advance care possible. And we want to— again as best practices we can learn from other countries. Other countries have already gone to ICD-10. I think that we still have some research to do to make sure that we can keep pace here, that we can implement the right infrastructures inside our healthcare institutions. So, I can’t say— if delaying ICD-10 is a good idea, I still think that’s something that we have more that we have to figure out and more to study there to make sure that we’re doing the right thing. I don’t want to get behind globally though in the quality of care that we provide. And so we need to take a hard look at delaying it. It might be the right thing. It also could be where some leaders, innovators run out in front. And some care providers who want to implement it early certainly can. We’ll see how this matures.

Ann Fishman: So let’s talk about your baby, the ACOs. Can you demystify it a little bit, explain it— define it, explain it and tell me what you are doing?

Justin Barnes: Sure. Certainly a vast topic, and there’s a lot of information out there. I like to start very simply from a standpoint of there’s some simple tenets around Medicare, their shared savings model. But— and it doesn’t mirror a lot to what the private communities is doing and the private community mirrors a lot of what Medicare is doing. So, it’s not as complicated, kind of you look at some of the basic tenets.

You got to have around 5,000 patients. You got to make a multiyear commitment. You got to make sure that health IT is at your infrastructure and your core. You got to make sure that you’re focused around quality measures and metrics and that you’ve got the governing structures. A lot of these initials are going to be physician led. They need to be physician led to be successful long term. You have got to make sure you’ve got— really, it does come down to government structure, operational structure, health IT.

So, there’s some real simple components that you have to really start and understand. Very simply, I tell people to start with your community. What is your community doing? If you’re not sure, investigate. Understand what private plans have ACO type plans available to you. You obviously know the Medicare shared savings plan is available to you. Understand even where quality reporting is going to happen in your community. PQRS, can you participate in that; patients in a medical home, what option do you have today, what options might you work towards for 2013 and 2014. Have a one-year business plan, a three-year business plan and a five-year business plan.

So start up very simple and just basic tenets of business. Understand again what your community is doing, what your employers are doing, what the private payers are doing and what CMS is doing, and then how do you want to play. What is your technology infrastructure? Are you ready to participate in Accountable Care? Are you ready to share data, to create the quality reports necessary to participate in accountable care? So, all of that is very important. Those are just good initial steps to start with. Partnering with the right company and a right set of strategies is critically important as well. We work very hard to partner with a lot of our leading customers so we can navigate them through Accountable Care. We’re going to eventually navigate all of our customers and then some through Accountable care. But we’re starting off with a large subset of our customers that are leaders in their community are used to creating forms or at least we help them create these forms around the country and start these conversations around Accountable Care. So, I think those are some real basic areas to start and basic things to understand.

Ann Fishman: Well, I think it’s going to be a busy year for you. I thank you very much Justin.

Justin Barnes: Yeah!

Ann Fishman: I’m with Justin Barnes, vice president at Greenway, HIMSS 2012. Thank you so much!

Justin Barnes: Thanks for having me.

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