From Healthcare Innovation:
Some healthcare leaders, driven by the desire to improve the healthcare system, are putting into action the theories and philosophies they believe in. One example is Ezekiel Emanuel, M.D., Ph.D., vice provost for global initiatives at the University of Pennsylvania, and whose office sits inside the Department of Medical Ethics & Health Policy at the university. Dr. Emanuel, who was a key policy adviser to President Barack Obama during the time that he and congressional Democrats were developing what would come to be called the Affordable Care Act (ACA), has for many years been passionate about creating change in the U.S. healthcare delivery system. It is in that context that a little over a year ago, Emanuel, along with colleagues Amol Navathe, M.D, Ph.D., an assistant professor of health policy and medicine at Penn and a Commissioner of the Medicare Payment Advisory Commission (MedPAC), and Simeon Schwartz, M.D., president emeritus of the Westmed Medical Group in Miami, led the creation of Embedded Healthcare, a spinoff created at Penn’s Transformation Institute. Embedded Healthcare is unusual, in that it is not a software company in any traditional sense, though it leverages a software platform; instead, its customers are health plans whose leaders want to influence physicians to change ordering and referral behaviors. Conceptually, it falls somewhere between a consulting firm and a utilization management company.
As Embedded Healthcare’s website explains it, “Embedded Healthcare is a health care platform that makes it easy to engage and motivate providers to make decisions that deliver better care at lower costs. We draw upon cutting-edge behavioral science to help payers set up innovative payment models and deliver targeted nudges and incentives to providers working in an open network. Our turnkey solutions require neither new investments in health IT nor disruption of physician practice, making it easier for providers to give the most effective and efficient care to their patients. Embedded Healthcare strives to engage front-line providers in the success of value-based care because they are vital to a lower cost, higher quality US health care system.”
Then, on August 1, the leaders at Clarify Health, a cloud analytics and value-based payments platform company, announced the launch of Clarify Advance, which came on the heels of Clarify Health’s acquisition of Embedded Healthcare. As the Aug. 1 press release explained it, “Clarify Advance provides payers with an important tool to accelerate the shift from fee-for-service to value by creating the incentive framework and behavioral nudges that drive meaningful change into the daily decisions of providers, regardless of the payment model they are in today.” And the press release quoted Emanuel, speaking in his capacity as a strategic advisor to Clarify Health, in saying that ““We know prices for identical services vary tremendously among providers,” said Dr. Ezekiel Emanuel, Vice Provost for Global Initiatives at the University of Pennsylvania, Co-Director of Healthcare Transformation Institute, and a strategic advisor to Clarify Health. “Providers have no insight into the rates of facilities and the numerous specialists in their network, or which ones provide the best outcomes at the lowest cost. This has contributed to the inefficient and unsustainable process in which we operate, and why the adoption of value-based care has lagged. With behavioral science and micro-targeted incentives, we have a proven approach to accelerate adoption of high-value clinical behavior, which in turn, can lower healthcare costs and improve outcomes.”
Shortly after the announcement of Clarify Health’s acquisition of Embedded Healthcare, Dr. Emanuel spoke with Healthcare Innovation Editor-in-Chief Mark Hagland about the current landscape around value-based care delivery and payment, and where everything is headed. Below are excerpts from that interview.