There’s a lot of talk about innovation in healthcare IT, but when Ed McCallister says it’s in the DNA of his organization, it’s not just talk. In addition to more than 20 hospitals, 500 outpatient sites and a health plan, UPMC comprises an innovation arm that has launched several products and companies, including an ACO initiative. It’s no wonder McCallister says innovation is a verb — not a noun. In this interview, he talks about the growing trend in consumerism and how his team is leveraging data to transform the patient experience; the partnership that he believes will transform the way care is delivered; and what it really means to be an integrated delivery system. He also shares his thoughts on where the industry is headed, and what he learned from being on the payer side.
- Creating a PCMH
- Leveraging analytics to arm docs with “more precise info”
- From payer CIO to system-wide CIO
- Having a “total 100 percent vision of what’s happening”
- Trends in M&A
- Evolent Health initiative
- “We have a lot of opportunity ahead of us & we’re in a good place to make the change happen.”
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It doesn’t start with the technology; it starts with what the patient-centered medical home and creating the care team, whether it be a virtual care team or a physical care team around that particular member.
We have more willing participants in the healthcare consumer today than we had 5 years ago, so I think that you’re going to see an acceleration in the advanced analytics world and what that could mean as far as patient care.
I’ve always felt that I had the ability to cross boundaries and create a true and integrated experience for myself, but most importantly for a person that’s within the UPMC environment — as a patient, as a member, as an employee, as an employer group.
If you start with that piece, it allows you to actually extend your abilities and your efforts in a way that’s different than if you were just trying to create a product. We’re not a product creator. We’re a company that cares deeply about our patients.
I think the blurring of lines between payer and provider is either going to happen through people trying to create what UPMC is as an integrated delivery system, or creating that insurance capability from within the provider organization.
Gamble: With everything being focused on patient-centered, person-centered health, what kind of outreach do you do to stay on top of what patients want and where they are willing to share information? What is your approach as far as really understanding the patients’ needs?
McCallister: When we talk about patient-centered medical homes, that’s really what you’re describing. It’s the doc and the hospital and the payer and everybody working together as a care team for the member. So when you’re talking about the outreach, that’s speaks to my role in the field of technology and how does that person want to be engaged. Some people are fine with a phone call. For others, it’s a text message. It doesn’t start with the technology; it starts with what you described as that patient-centered medical home and creating the care team, whether it be a virtual care team or a physical care team around that particular member.
When I say we’re uniquely positioned, we are, because everything I’ve mentioned, we are involved with that particular person in some fashion many times. And where we’re not, we have many UPMC patients who are not health plan members. So in that case, we would engage the member using the same model, but you can plug in other payers perhaps. It’s maybe not as seamless; maybe not all the information is there, but nevertheless it is.
It’s the same angle from the health plan; the health plan has 2 million members, and because there are 20 hospitals within UPMC and the plan’s network is over 100 hospitals and 10,000 additional docs, it’s a different dynamic. But I think the model works that we’ve created within UPMC and the different components. It’s kind of a plug and play component when you have that patient-centered medical home and you’re able to do what’s best for the patient.
Gamble: So obviously there are so many different things you’re focused on, so I guess the big question is what’s next, or what do you really see as the next big thing you’re looking at?
McCallister: We touched on some of the initiatives. Obviously big data is here to stay, along with what we do in the advanced analytics world — the great clinical minds and creation of clinical pathways that lead to the best experience for a patient are at the forefront of what we’re doing in the analytics world. I would say that 95 percent of what we’re doing, in some fashion, ties back to the world of analytics, because that’s really the engine. The technology is good, but without analytics, it’s not as interesting. A tool that’s not used could be a very cool technology, but I think personalizing the experience for the consumer is what’s going to make the difference, and that’s going to be done through advanced analytics. I think that we have more willing participants in the healthcare consumer today than we had 5 years ago, so I think that you’re going to see an acceleration in the advanced analytics world and what that could mean as far as patient care and as far as member experience. I think it kind of crosses the gamut of all areas of healthcare. I do think big-time analytics is at the forefront of what we’re doing in the Pittsburgh Health Data Alliance partnership. It’s an advanced version of the future of where we’re headed with healthcare, and the potential within that partnership is enormous.
Gamble: It seems like what you’re talking about with patient engagement, you’re hoping for that snowball effect, where the more people see the results, the more engaged they will be if they see the difference it’s making.
McCallister: You’re absolutely right. I mentioned the consumer piece as a cost comparison. We’re using tools are similar to an ‘Ask the Doc’ type of thing, but it’s really doctors’ experiences and clinical experiences like, wearing a splint actually could help you not have surgery for carpal tunnel if you take certain precautions or certain steps.’ So I think it’s more prescriptive in using the data and using voices that are trusted voices. It’s not necessarily your insurance company telling you what to do, but rather the doctor-patient relationship that becomes critical, and arming the doc with more precise information and more prescriptive as opposed to just that office visit is going to be critical over the years as well in the very immediate future.
Gamble: Now you’ve been in your current role almost a year?
Gamble: And you spent about 14 years on the insurance side.
McCallister: I was here in the beginning days of the health plan so it’s probably been about 15 years, and then the past year in my current role.
Gamble: How did that progression go for you? I mean, you were a CIO before, but this is obviously a different type of CIO.
McCallister: I’m a real CIO now. Titles aside, UPMC is an environment where you work across the boundaries. Although I was CIO of the insurance services division, I was very tightly engrained with what was happening across the entire system. It wasn’t a siloed position. The new position isn’t necessarily that shocking for me because I’ve in this world for the past 15 years, just in a different role with a different lens. The leadership here is a very collaborative group and we’re able to work across boundaries. When we talk integrated delivery system, I know that I’ve experienced some other integrated delivery systems across the country that didn’t necessarily behave as an integrated delivery system. They had the different functions, but they didn’t necessarily behave in a similar way. I’ve always felt that I had the ability to cross boundaries and create a true and integrated experience for myself, but most importantly for a person that’s within the UPMC environment — as a patient, as a member, as an employee, as an employer group. So it’s been very good.
Gamble: I’m sure. You were already part of the organization, so it may have been a different transition if you weren’t, but that wasn’t the case. That’s helped a lot, I’m sure.
McCallister: Absolutely. And again, just the collaborative nature of the senior team here at UPMC makes it a very transparent transition — not only for myself, but for the organization.
Gamble: That aside, have there been some times where you have definitely realized that it is an adjustment; that it is a different animal?
McCallister: It absolutely has, and in a good way, because I think I’m able to better understand and I’m able to share from a different perspective the view of why we want to take a certain direction, and I’m also able to learn from the experiences on the provider side, which I was probably less experienced with on a day-to-day basis. So I’m able to understand better why certain things were the way they were. And again, when I talked earlier about the opportunity center, it creates great opportunity when you pull back the curtains and are able to have a total 100 percent vision of what’s happening across the company versus 50, 70, 80 percent.
Gamble: I can imagine that from the time you started there, it’s been really interesting to see how the organization has grown, and I’m sure ‘grown’ is putting it mildly.
McCallister: And continues to grow. I think we’re very well positioned for the future, and again, it comes from the vision from the top of seeing three or four moves ahead of where this is headed. I’ve always heard the analogy that if the exercise is to create a product, we’ll create that product and we’ll the best at it, but if the game changes, we have to be ready. Many times we’re driven by what’s happening through the government regulations such as the Medicare reimbursement rules that changed recently or some of the different benefits that drive it, but we’ve always been, I think, positioned to be very nimble and able to adjust to whatever the future may hold.
Gamble: Right, and from what I’ve seen in reading and doing research, it seems that UPMC has taken on a role of helping to really grow the area and create jobs in the area. That’s something that I think can only help the organization to make this not about just UPMC, but about Pittsburgh and the entire area.
McCallister: Right, and at the end of the day, the UPMC mission is excellent patient care. It really is. When you asked me earlier about the change from my previous role to this role, just the passion for which people engage in their profession is just mindboggling. Others that have been here for a while in the clinical environment probably aren’t surprised. But just how focused on the patient people are here and how passionate they are about patient care — if you start with that piece, it allows you to actually extend your abilities and your efforts in a way that’s different than if you were just trying to create a product. We’re not a product creator. We’re a company that cares deeply about our patients and the patient experience, and I think the growth that’s borne out of that is what we do as we try to extend, outside of the walls of UPMC, the ability for others to do that. That’s where a lot of our commercial ventures are targeted to say hey, this works very well for us; because we are very patient-focused, let’s create a product or let’s create services that allow others to meet those same goals that I’m sure that they have.
Gamble: The last thing I wanted to touch on a little bit is one of the big trends we’re seeing in this industry, which is lot of merging and consolidation. Do you think we’re going to see more organizations that are modeled maybe after UPMC and becoming that integrated delivery system and going toward that direction?
McCallister: I think it’s a very tough environment for some of the smaller community hospitals. The economics of healthcare are difficult at times. I point back to the example of Evolent Health. UPMC, along with the advisory board, created Evolent Health, which comes into health systems and actually helps create what you just described. It’s been a very successful company where providers are at the forefront where they should be in patient care and person engagement. They create almost an integrated delivery system and create the payer arm of what the system looks like. I’m not sure as far as mergers amongst various healthcare organizations, but I think the blurring of lines between payer and provider is either going to happen through people trying to create what UPMC is as an integrated delivery system, or creating that insurance capability from within the provider organization. I guess that’s a long answer to your question. But yes, I think that you’ll see some consolidation. I think you’ll see some Evolent Health-like activities happening across the country as well.
Gamble: Like we had said at the beginning of our conversation, it is an extremely interesting time to be either in the industry or doing my role, which is kind of on the outside looking in.
McCallister: It’s fascinating. It really is. Spending the last 25 years of my career in healthcare, the sea change of what’s happening in this industry is amazing. And more amazing is the speed at which it’s happening. Personally, I think we as a company are very well positioned. I’m unbelievably in a great position as CIO of an organization such as this. As an industry, I think, the good news is we have a lot of opportunity ahead of us. Again, through big data analytics and some of the things we’re talking about and some of the initiatives we’re undertaking, I think we’re in a good place to make the change happen.
Gamble: Yeah, absolutely. Well, we’ve definitely touched on a lot. I really appreciate your taking the time. I know you have a couple of things on your plate.
McCallister: Yeah, one or two.
Gamble: I think that our readers and listeners are definitely going to benefit from hearing your perspectives. So thank you so much.
McCallister: Thank you. I appreciate the time.
Gamble: I hope to catch up with you again some time down the line.
McCallister: Absolutely, let’s plan on it. Thank you, Kate.
Gamble: Thank you.