Wednesday, August 5, 2009

Health Innovators Series: Jim "Woody" Woodburn on the elimination of hospitalizations

Jim Woodburn MD, the newly appointed Vice President and Medical Director for Clinical Initiatives at United Health. shares his perspectives on health, health care, and the key reform elements that can transform our current health system.

As part of the development of the X PRIZE, we have had fascinating conversations with innovators throughout the health industry and health care system. One of the favorite thinkers in this area is James “Woody” Woodburn, MD. Behind his “Aw shucks” exterior lies an extremely intelligent, always thoughtful, and highly intuitive leader with the knack for being right in the middle of the latest health innovations. From his original work at Blue Cross / Blue Shield of Minnesota, to serving as the first Chief Medical Office of Minute Clinic to his role as a entrepreneur in residence at Lemhi Ventures, Woody has been quitely but steadily driving us to a better health delivery system. He recently took a position with United Health as their Medical Director of Clinical Initiatives with a charge to change the delivery and financing of primary care.

His original interview, as well as a subsequent update regarding his new position, can be found below:

Woody, tell us a little about your background?

I began my career in medicine when I started working on a project to create an artificial liver in 1972. This project got me thinking quite a bit about medical devices and the opportunity for technology to impact the way we practice medicine. I later went to medical school and was drawn to Emergency Medicine as a specialty. After practicing in the community for five years, the sheer wave of chronic and preventive challenges I saw on a daily basis created an interest for me to get ahead of the problem. I worked another five or so years in occupational and preventive medicine before moving over into a corporate role at BCBS of Minnesota. In this capacity, I really learned alot about organized medicine, population health, cost drivers, and the myriad problems of access, costs, and quality that we dealt with everyday.

Part of my efforts were directed at bringing together the vast collective experience of all the various physicians who participated in Blues plans to develop a national medical management forum. From this experience I began moving into population health issues and the challenges of disease management. I could see that many of the issues were related to access - where a simpler form of care could potentially treat and manage many of the things that were showing up and contributing to Emergency room overcrowding. As we started evaluating solutions, we took a closer look at the Minute Clinic model that was just emerging in Minnesota. I ultimately ended up leaving BCBS to become the Chief Medical Officer of Minute Clinic. I participated in the rapid growth from 12 clinics to over 250 before the company was ultimately sold to CVS. It was one of those amazing lifetime experiences to be a part of delivering a new model of care to a market so ready to buy.

After Minute Clinic I began working with Lemhi Ventures who were founded by Tony Miller and several other of his ex-Definity Health colleagues. My role was as Entrepreneur in Residence evaluating health transformation concepts, information technology, and general health innovation. It was a great position from which to evaluate the market, see the latest and greatest tools and technologies, and meet some of the great innovators in the health care space. After an 18 month stint there, I was ready for the next challenge which I have accepted in my new role at United.

Can you tell us about this role and what United is trying to accomplish with their Clinical Initiatives Division?

I will be working in the Optum Health division and leading the development and operations for a few new strategic initiatives. The first is United’s new focus on rolling out Telehealth and Telemedicine applications with our Cisco technology infrastructure partnership. We envision Telehealth to be able to improve access in rural and underserved urban areas, drive increased volume to high performing and cost effective specialty care and improve productivity of employees of the companies United supports.

The second and related area is in mobile health clinic and remote ‘brick and mortar’ clinic operation and strategic deployment.

The third is helping with new contracting models of care. I’m very interested in redeploying revenue flow back into primary care in a new, accountable, web-enabled and cross-functional team (aka medical home) in the UHG networks. I think there are significant areas of where we can improve care coordination and incentives to reduce waste while improving outcomes.

What specific opportunities do you see to reduce costs while improving outcomes?
Well you need to begin by being careful how you define “waste” in the healthcare system. Someone’s waste is another persons bread and butter. We can say for sure that there are several points of failure. The hardest one to change is the culture of the physicians. The self-reinforcing “guild” mentality of physicians is not very patient centric and not very collaborative either. As a result, we have silo’d health information that is not interoperable, we have non-existent customer service, and we don't have meaningful or transparent reporting of outcomes.

We have not as yet developed or tested a completely enabled care system. Those data systems haven’t come close to becoming integrated as of yet. Everyone has these high hopes that we will be able to reduce wast,e but how can we unless we create financial accountability and measure outcomes as the drivers to improve physician behavior and ultimately patient health? This then begs the whole measurement question - do we aggregate scores? how do we provide public access? how is the information best synthesized and presented to the stakeholders? We have seen some powerful effects of even surfacing this data, let alone injecting it into the clinical workflows to help both the provider and the patient understand what the data says when they are at a point of decision. We currently aren’t using the full set of measurement tools that could be helping us move to a new system.

Any particular measures you would like to see implemented?

The more I think about it, hospitalization in and of itself should be considered a system failure. No one should be going to the hospital. In saying this, I realize that there are many cases where hospitalization is appropriate and required, but for a broad majority of situations the hospital is not where these issues should be treated. What if you could achieve a community that had no hospitalization? Many of the large integrated systems have dramatically reduced hospitalizations because it does not impact their bottom line negatively, in fact, they are rewarded for reducing hospitalizations. Is there a way to create a community wherein all the organizations were working together to wipe out preventable hospitalizations? That should be the aim of the Healthcare X PRIZE.

How could a community organize to achieve this?

Well this begins to strike at a core principle of population health, most of health (~70%) is not related to health care - issues like drinking water, air quality, education are bigger determinants of health than anything that the provider community is doing. An activated community, dedicated to reducing hospitalizations by 50%, might be able to marshal the resources, influence the culture, and engage people in a way that can actually achieve this goal. It would require chipping away at the goal one person at a time and bringing a myriad of pieces together to help it happen. That could really be powerful - entire communities focusing all their resources on a targeted goal like reducing hospitalizations 50%.

What care delivery models do you believe hold the most promise to achieve something like this?

Clearly I am a fan of the Medical Home concept, although I think it needs to be deepened and broadened and supported by tools that actually make the promise a reality. I believe that creating an accountable, capitated primary care system that is incented to holistically care for the patient will allow us to get to the type of care we all hope for. This team care will include the community, educators, primary care providers, practitioners, and others who will contribute to a focused factories managing a populations health. I am convinced that this cannot and will not happen with established players, but rather disruptive innovators who will completely change the paradigm and reset expectations of physicians, patients, and payers.

I also see great opportunities for new entrants who can reduce hospitalizations and dramatically improve the end of life. Look, no one who promotes reducing hospitalizations as part of their model is going to do well with the hospital crowd - reducing admissions reduces revenues which reduces employment for the largest employer in the community. This creates some serious political challenges to programs with this focus. The end of life also has some interesting political and ethical issues but the entire conversation should be reframed. No one wants to die in a hospital, or use resources in a futile situation particualrly when those resources mean that someone else goes without care. Instead, having a “system” frame of reference allows us to understand that quality of life, dying surrounded by family at home, and other end of life transitions can be a dramatic improvement for everyone over current practices.

What opportunities would the Venture Community see in the X PRIZE?

I think the VC Community is always looking for ways, particularly in health care, for winners and losers to more rapidly declare themselves. Healthcare has traditionally had a very slow experimentation process in the actual delivery and financing of care. This makes the entire health services sector somewhat of a challenge for the VC’s to get interested in given their traditional 4-6 year time horizons.

With that being said, if the X PRIZE can create a model where lightweight teams can be allowed to be creative, have rapid implementation opportunities, and measured results than I think we can create much more interest. I am thinking about the whole “Care Package” concept pioneered by groups like which lend themselves very well to focused factories. I also think Web-Enabled coaching, and some of the new models of online interaction will be have an impact. Not to mention the entire health education / literacy space that goes way beyond any of the online content that we see today.

I think there are alot of value and opportunity inherent in the X PRIZE brand; the fact that it is being applied to health care should create new possibilities within the Venture Community.

Will we see Optum Health participating in the Healthcare X PRIZE?

It is far too early to tell. I will have my plate really full over the next several months. I certainly will be cheering for the X PRIZE as it officially launches and by that time should be able to provide greater clarity on how we might be able to leverage some of Optum’s considerable assets for the project. Lets touch base then.

Who are the other health innovators we should be speaking to?

A lot of what I’ve learned comes from radiologists, the ambulatory surgical space, and related high volume areas wherein they are interested in greater efficiencies, economies of scale, and a better patient experience. In these settings they are constantly looking for ways to reduce time, pain, promote healing, and optimize for experience. These particular specialty areas are often overlooked when gather lessons learned or establishing best practices.
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