Ed McCallister, SVP & CIO, UPMC, Chapter 1

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.

Chapter 1

• About UPMC
• Growing trend of consumerism
• “We’re attempting to break down barriers and have a smooth consumer experience.”
• 3 areas of patient engagement
• Applying advanced analytics to leverage data
• “Consumer education is where it all starts.”
• Pittsburgh Health Data Alliance

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Bold Statements

We obviously have to do the mechanics around what it takes for patient care and some of the more traditional Legacy clinical systems, but a big focus has been on how do we have the experience of a person that’s coming through the UPMC environment and have it be a very consistent, very personal experience.

It’s trying to meet the person where they are and guide them through process through the use of transparency tools, quality comparisons, condition management in the portals, and wellness tools.

We’re able to use that data as we collect it to have a more targeted experience for that consumer, whether it be outreach in way of a text message saying, ‘don’t forget to do X,’ or reminder of an appointment, or just a congratulatory text.

We’ve accelerated the education process for the consumer in healthcare over the past five years like no other industry has. We’ve done for healthcare what TripAdvisor did for the hotel industry in putting the side-by-side comparisons out there and arming people with more information to make smart decisions.

Gamble:  Hi Ed, thank you so much for taking the time to speak with us today.

McCallister:  Sure. Thank you, Kate.

Gamble:  I’m sure that most of our readers and listeners are familiar with UPMC, but if you could just give a little bit of information, just what you have in terms of number of hospitals and clinical locations, things like that.

McCallister:  UPMC is a $12 billion organization comprised of 20-plus hospitals, about 3,500 employed physicians. We also have an insurance services subsidiary; we have probably over 100 hospitals and 12,000 physicians in the health plan network, along with 2 million members in multiple employer groups across a Medicare, Medicaid, and commercial population.

We also have an international division as well that does business outside of the domestic US. And we also have just embarked on a UPMC enterprises division within UPMC, which is the innovation arm of what we’re doing. So while we’re focused on world-class patient care, we have an innovation arm that we’ve just embarked upon.

Gamble:  That’s something we’ll definitely want to get into. It’s such a big topic now.  Now in terms of your role as CIO, if you could just talk a little bit about the key facets of your role and then the size of the team you’re looking at.

McCallister:  I’m senior VP and CIO for UPMC as an enterprise. The IT organization is comprised of somewhere in the vicinity of 1,400 employees spread across the departments that I outlined earlier. The key areas within UPMC are obviously the insurance services division, which I mentioned, the health services division which is comprised of our hospital and physician population, and then we have corporate services, as well as the international side. So the IT organization is spread across those areas, along with the UPMC enterprises in support of the enterprise initiatives.

Gamble:  In terms of the clinical application environment, what is the picture in the hospitals right now? Is there a few different systems that are live?

McCallister:  Where we’re headed — and I think all of healthcare is headed — is toward consumerism. It sounds like a very generic term, but UPMC, as I outlined who we are and what we do, we are actually, I think, uniquely positioned to meet the consumerism trend that’s happening and actually define what it could be, whether it’s across hospitals, physicians, payers, etc. I’ll give you an example. I actually spent the first number of years here at UPMC as CIO of the insurance services division — probably the first 14 years that I was here, and the last couple being in this extended role. But I see the difference between how a person is viewed as a consumer from a payer perspective versus when they enter the clinical environment. And I think here at UPMC, we’re attempting to break down the barriers and the walls between each and have just a very smooth person consumer experience.

So when we talk about systems, I think we obviously have to do the mechanics around what it takes for patient care and some of the more traditional legacy clinical systems, but a big focus has been on how do we have the experience of a person that’s coming through the UPMC environment and have it be a very consistent, very personal experience, whether it be patient member or employee.

Gamble:  That’s really an interesting perspective you bring, having that experience on the insurance side. We’re seeing so much of this blend or trying to get to that blend where you talk about the consumer from the payer point of view and the clinical, and those two worlds merging together. I would think that having those 14 years on that insurance side gives you a pretty unique perspective there.

McCallister:  Absolutely. Much like other sectors, what consumers want is the highest quality at the lowest cost — an exceptional customer experience. Instead of us trying to figure out what the consumer wants, we engage the consumer. So it’s more of an outside-in approach than inside-out and trying to guess what the consumer experience should be.

As you can imagine, we have a lot of data on an individual. So as Ed McAllister, I come in as a health plan member, and there’s a certain level of data, whether it be claims data, HRA self-report data. And then from a clinical side, my medical record has information. What we try to do is create a federated experience across all of the UPMC environments so that it becomes a very personal experience for an individual such as myself, who is a member of the UPMC health plan and also a patient of a UPMC physician — I’ve had exposure to UPMC hospitals as well. Creating that federated experience — that continuous experience so that we know the person, is, I think, the holy grail of what we’re trying to reach.

Gamble:  Now along those lines of creating that experience, a lot of work needs to be done to integrate all this data. Can you talk about what are you doing in terms of patient engagement and patient portals — what’s your strategy there?

McCallister:  There are three key areas. This is a UPMC strategy more so than a specific payer strategy or provider strategy, but it’s really three key areas, which are guidance, motivation, and convenience.

In the area of guidance, we create the cost transparency tools and quality comparisons, because the cost quality is what it comes down to at the end of the day. When you talk about member portals and wellness tools, we try to meet the consumer where the consumer wants to be met. So it’s not necessarily a one-size-fits-all where we say, we have a transparency tool and a portal. We know that mHealth and the use of mobile devices is becoming more and more prominent out in the marketplace, so that’s where our focus is as well. So it’s trying to meet the person where they are and guide them through process through the use of transparency tools, quality comparisons, condition management in the portals, and wellness tools.

The second piece on the motivation side is we have a Motivate Me program, which encompasses the weight-race type activities, digital device connectors, etc. Everybody has a wearable device. I don’t think you can walk into a store or a restaurant and not see somebody without a FitBit or some type of device tracking their activity. So as opposed to starting with the technology, we’re focused on this is pretty much the commodity piece, so how do we tie that into the experience and reach out to the consumer and motivate them through what they’re already doing?

The last piece is convenience. I mentioned the mobility — I think we’re all headed toward that iPhone mobile device activity. I’ll give you an example. My daughter is a college student, and I can tell you her PCP is Google. If you ask her who her primary care is, she does a lot of self-diagnosis, and so her mobile device is actually her primary care provider at the beginning. She’ll diagnose something and say, ‘I may need an appointment. Hey, Dad and Mom, what do you think?’ So I think the convenience of how the consumer wants their healthcare experience to be is critical.

Gamble:  Absolutely. As far as what you said about wearables, it’s something that’s just becoming so huge. The numbers are staggering. So I guess the big question is how do you leverage that information? When patients are taking so much time to enter this information into devices, how do you leverage that?

McCallister:  Through the analytics engine. So the data is one piece, and data alone is not very interesting. But when you apply advanced analytics around the data, and again, when I talk about UPMC being uniquely positioned, you think about the data sources we have and the ability we have to do what is becoming more and more obvious, which is healthcare analytics in a person-centered world, more so than just analytics in a more general way. We’re able to use that data as we collect it in the various forms to have a more targeted experience for that consumer, whether it be outreach in way of a text message saying, ‘don’t forget to do X,’ or reminder of an appointment, or just a congratulatory text to say ‘hey, you’re doing a great job. You’ve actually accomplished your 10,000 steps over the past 3 weeks every day. Congratulations.’

So there’s some motivation. As I mentioned, the three areas of guidance, motivation, and convenience are, I think, intertwined amongst the entire consumer experience. Some of it could be guidance to say you need to take action in a certain way based on the data that we’re collecting, or motivation to say hey, you are doing a great job, and by the way, we’re going to do it in the most convenient way to you. And if that means a text message or just a portal that you actually utilize on a regular basis, then that’s the way that we’ll engage you.

Gamble:  Right. Are you finding that there is a willingness among patients to share their personal data?

McCallister:  I think more and more so. Consumer education is where it all starts. If you even rewind five or 10 years ago, when first-dollar coverage was not out of your own pocket, you weren’t as interested. I think that exchanges have actually piqued the interest of consumers in healthcare because they put a side-by-side comparison to the different options that you have, whether it be your insurance plan which covers certain benefits, or what the network looks like — is it a narrow network, etc.

So I think we’ve actually accelerated the education process for the consumer in healthcare over the past five years like no other industry has. We’ve done for healthcare what TripAdvisor did for the hotel industry in putting the side-by-side comparisons out there and arming people with more information to make smart decisions that are smart for them personally and not necessarily more general decisions.

Gamble:  It does seem like it’s been a bit of an untapped market, and we’re seeing that change.

McCallister:  Yeah.

Gamble:  Now as far as just having this incredibly vast amount of data, can you talk a little bit about your strategy just as far as data management, and then leveraging these analytics, even outside of your organization.

McCallister:  Sure. One of the challenges with the abundance of data that we have is actually the whole overused adage of data to information, information to knowledge, knowledge to wisdom. The challenge that comes around it are the security challenges and how you secure the data. Fundamentally, we do that in a different way than we did five or 10 years ago, with cloud-based storage and outside vendors and clinicians and patients that want access to data on mobile devices. So we’ve invested heavily in the security model to secure that data, and how we’re using it in a federated way. The security around what we’re doing with data becomes at the forefront of our attention.

Gamble:  Okay. Looking even beyond UPMC, I had seen the recent announcement about working with Carnegie Mellon and University of Pittsburgh. Is this more of the same idea of working toward the greater goal of being able to really use data to improve care on a larger scale?

McCallister:  Right. It’s very exciting supporting the Pittsburgh Health Data Alliance and partnering with great universities such as CMU and University of Pittsburgh, with the purpose of transforming the explosion of big data in healthcare. It’s happening. We have clinical, financial, genomic data, and are applying new technologies around and products and services that will absolutely change the way diseases are treated and prevented.

Just as an example, imagine a smart phone app that could tell you what single dietary change could most improve your health based on your genetic makeup. I think we’ve scratched the surface. If you break it out into the various phases, we’ve done the data aggregation piece over the X number of years. And with technology, if you go back 10 years, technology many times was the barrier in being able to do something, and that has been a huge paradigm shift where technology is an enabler in so many ways. I think we’re trying to catch up on the clinical side and on the business side on how do we use this data in the most meaningful way.

So I think that alliance will allow us to absolutely jettison how we use data in that patient-centered care, and more surgical, if you will, in how we treat the patient—and I mean surgical in an exact way more so than a clinical surgical way.  But just be so much more exact and so much more predictive in how we do patient care.

Chapter 2