Dr. Molly Joel Coye Discusses the Emerging Collaboration Between Payers and Providers

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Health Technology Center

What is likely to emerge is more collaboration between health plans and certainproviders that are willing to provide data about the results of the use of newtechnologies so that we might see more channeled introductions of technologies.

Health Care Technology: You are the CEO of San Francisco’s Health Technology Center. Please tell us about your work.

Molly Joel Coye: HealthTech (the Health Technology Center) forecasts emerging technologies in biotech, pharma, IT, and medical devices; that includes the timing of market entry, the nature of the products and services that will be offered, and the potential impact and consideration in strategic planning for hospital-based delivery systems and health plans and federal agencies like CMS (Center for Medicare and Medicaid Services).

HCT: Many people say that the payer side and provider side of health care are like oil and water. What’s your view on that?

MJC: I think that certainly has been true in that the role of health plans in many cases has been to try to put the brakes on the adoption of new technology and to hold the technologies at bay for as long as possible. I think that is changing for a number of reasons. First of all, it’s clear that some technologies actually improve quality and reduce costs. Secondly, the consumer interest in technology paired with growing direct-to-consumer advertising for devices and biotech, as well as pharmaceuticals, means that it will be increasingly difficult for health plans to resist the pressure to adopt new technologies. What is likely to emerge is more collaboration between health plans and certain providers that are willing to provide data about the results of the use of new technologies so that we might see more channeled introductions of technologies.

HCT: Where do you think the senior-level decision makers on the payer and provider sides can go to get the tools they need to make decisions on implementing technologies?

MJC: There is a broad array of organizations that have traditionally done tech assessment, including Hayes and ECRI. These organizations have a great deal to offer in understanding the currently available technologies and technologies about to enter the market in the next 12 to 18 months. HealthTech was the first organization developed to provide the two- to five-year and five- to 10-year time frames on the emergence of developing technologies (or technologies under development). Since we were founded in 2000, two other for-profit competitors have emerged in the field. We are pleased, on the one hand, to see the evidence that this is a field of growing importance and that there is a lot of interest on the part of delivery systems and health plans. On the other hand, you would always like to remain the sole source provider for these kinds of services.

HCT: How many Americans die every year because of preventable medical errors?

MJC: That number is slightly less than 100,000 a year – roughly 98,000 persons a year. That was part of the Institute of Medicine’s study that came out a few years ago for which I was one of the authors. The report is called “To Err Is Human,” and it underscored the fact that more Americans die from medical errors each year than from many other common causes of death like breast cancer and HIV.

HCT: You have also said that it takes 17 years for new research to be adopted as standard practice. Is that changing? And if it isn’t, what can be done to expedite things?

MJC: As a general pattern this isn’t changing yet. We certainly can see individual cases like drug-eluting stents where there is a very short pathway from the research that demonstrates the benefits of a technology to its adoption. But unfortunately, those tend to be cases where there is a perfect alignment of economic incentives, quality results, and the ease of adaptability of a technology. Because basically clinicians were already used to placing drugeluting stents, so there was not a sharp learning curve involved in the adoption of the technology. If you look at some other technologies that have similar beneficial impact on the management of disease, you can see a much slower rate of adoption. I’ll give two examples: One is the use of the remote patient monitoring devices for chronic disease management, which have a marked effect on emergency department visits and hospital admissions; the other is eICU, a solution that allows hospitals to create a systemwide critical care program, which reduces mortality in intensive care units and hospitals as a whole while decreasing length of stay and cost.

HCT: Back to the issue of payer and provider collaboration; what do you think is the major obstacle that has been slowing down the understanding of how to get these two important groups together to make the system function in the best interests of the patient?

MJC: Unfortunately, I think it is a pretty fundamental factor, and that is that plans make money when patients don’t use doctors and hospitals. And in its best sense, that can occur because the patient is kept healthy and does not need medical care as frequently. In the worst of cases, of course, it can mean trying to limit patient access to necessary care. But the fact that providers and physicians are pitted against plans for the same bucket of money is the underlying cause of a lot of the problems.

HCT: Down the road, do you see a system where the insurance companies work with providers to integrate new kinds of technology with the final result of improving patient quality?

MJC: Yes, actually there are very good examples. One might be that companies that are offering structured messaging – a more elegant email system for physicians and health plans – are paying for this service for patients with their physicians. It appears that the physicians like this and it helps them economically. There are cases where you can get an economic alignment between the interests of either health plans and physicians or both. In the adoption of a new technology, it takes very careful analysis and some good documentation to set up.

HCT:Can you tell us about some more important new technologies on the horizon for health care?

MJC: Similar to my last example, which was Relay Health, the email system, it is the technologies that potentially will drive down costs; and the question is the degree of alignment with providers. There are other technologies on the horizon that will clearly increase costs significantly; things like hepatic dialysis or the use of stents in peripheral lesions. Those are cases that will be much more challenging for health plans to support and to determine under what conditions or with what applications they support the technologies.

HCT: Typically CIOs and CTOs at major provider sites do not like to be first adopters; they like to be careful in their choices. What would you like to say to the senior executive who is trying to decide whether he should be a first adopter?

MJC: I think that’s a very specific decision to make with information about the technology itself and about your local clinical community and the position that you want your health system to adopt. I don’t believe there’s any health system that wants to be an early adopter across the board for all technologies. But by the same token, I think there are many technologies where it would be prudent to actually begin preparing for a relatively early adoption stance. The eICU is a good example of that because it’s turning out to be something which is both clinically very important and also economically quite important for the organizations that have adopted it.