Six Takeaways from a Council Luncheon with Dr. Brent James

In front of an intimate group of senior health care executives last week, U.S. Senator Bill Frist, M.D. sat down with Brent James, M.D., a former surgeon and current Chief Quality Officer for Intermountain Healthcare, a 22-hospital system based in Salt Lake City. Here are six takeaways from their discussion:

• Stricter clinical guidelines may save health care. According to James, the industry (and general public) often operates under a misconception that inefficient processes created the American health system’s disproportionate spending. In fact, he argues, only 5 percent of wasteful spending can be fixed with better efficiency. Instead, leaders should be focus on eliminating variation from their medical providers by implementing evidence-based clinical guidelines – which, he claims, could lower waste by 50 percent.
• Like everyone else, electronic medical records are struggling to shift to value. “Epic’s whole model is built for fee-for-service,” James said. “Give it five years. I think the market’s going to prod them pretty hard.” After in-depth discussions with both Epic and Cerner, Intermountain Healthcare ultimately signed on with Cerner three years ago. As systems grow in complexity, James says, the partnership between physicians and EMRs must grow deeper.
• Quality ratings: Everyone’s great – or not. Citing a Paul Keckley survey, James reported that 30 percent of the nation’s hospitals (more than 1,400 facilities) can claim they are on a “top 100 hospitals” list. “So, we have thirty percent of hospitals in the top ten percent of performance,” he said. “When I drive around Utah, every hospital I pass has a sign saying ‘We’re number one!’” The issue he says, is basing these rankings on the right data sets.
• Systems have to stop spending money on data they don’t need. James continued to lament the quality rankings system used by the federal government, because “the measures that we’re generating are not useful for management to improve care.” Relating a personal story from within a hospital, he described discovering that approximately half of the data his team was capturing had virtually no use. Meanwhile, 30 to 50 percent of the critical data needed to manage and improve care was missing. “You just can’t spend money on things that have no utility.”
  
• The heart of population health management: patient behavior. James asked attendees to consider the following: 40 percent of a person’s health is determined by his or her behaviors – tobacco, alcohol, obesity, etc. About 30 percent can be chalked up to genetics; 20 percent depends on a person’s physical social environment. And a mere 10 percent – at best – can be attributed to caregiving. For health systems to live up to their missions – Intermountain Healthcare’s is “Helping people live the healthiest lives possible” – he said reaching patients in their daily lives is imperative.
• “The solution sits in this room – not in the hallways of Washington.” Talking to the room of Nashville-based CEOs and C-suite executives, James said that game-changing innovation – the kind that’s based on evidence and not just good ideas – would have to come from leaders within the health care industry. “I don’t think you can solve this problem at the Washington level, at a policy level. Can it drive us in the right direction? Yes. But it can’t solve it.”