New CMO Shares Keys to Population Health Services Organization Success

Ernesto Vazquez shares his perspectives on value-based contracting, improving quality, controlling costs, and harnessing data analytics.

Ernesto Vazquez, MD, is set to play the top clinical leadership role at MercyOne Population Health Services Organization (PHSO).

MercyOne PHSO was launched in 2012 and has a portfolio of direct-to-employer, commercial, and government value- and risk-based contracts covering more than 300,000 patients of the MercyOne health system. The PHSO's Partnered Provider Network has decreased healthcare spending by more than $150 million, according to the Clive, Iowa-based health system.

Vazquez is taking on the CMO position at MercyOne PHSO following the retirement of David Swieskowski, MD, who played a broad leadership role at the PHSO including CMO responsibilities. Vazquez joined MercyOne in 2011, serving as a physician at MercyOne Clive Family Medicine Clinic and a member of the MercyOne Clinics quality committee.

Before joining MercyOne, Vazquez was a primary care physician at Summit Medical Center in Hermitage, Tennessee, where he served in several leadership roles such as a member of the medical executive committee. He earned his medical degree at the University of Texas Southwestern Medical School in Dallas.

Vazquez recently spoke with HealthLeaders to share his perspectives on PHSO operations. The following is a lightly edited transcript of that conversation.

HL: From a clinical viewpoint, what are the key elements of successful value-based contracting?

One important clinical element is having the right information. Every health system is very complex, and we need to make sure that we have the right information.

Another important aspect of value-based contracting from a clinical perspective is making sure you have the infrastructure to take care of patients from a holistic standpoint. It's not enough to take care of a patient medically. You have to be able to provide needed resources. For example, if there are gaps in housing, you need to have a social support system or social work system to be able to help the patient.

You also need to communicate with the payers to make sure that what we are doing is appropriate and that our services are being considered fairly. Payers need to be able to give feedback on a real-time basis; so that if there are deficiencies, we are given the opportunity to correct them. This feedback not only improves patient care but also allows us to benefit from value-based contracts.

HL: At MercyOne, what are the primary challenges of advancing quality and reducing cost of care?

Vazquez: The primary challenge in improving quality is setting a high standard of care for each patient in each clinical encounter. We can have all the data on the patient and all the gaps that need to be filled; but, ultimately, we are still dealing with a human being, and that can be a challenge. No two people are the same.

In controlling costs, the difficulty is that patient care may not align with cost containment. We need to do what's best for the patient, and sometimes that results in higher costs of care. The cost of care can be more than we projected. The PHSO can look for redundancies and unnecessary costs.

HL: Give an example of unnecessary costs.

Vazquez: One example in the clinical setting for primary care physicians is with complex patients, who require extensive monitoring. These patients see multiple physicians in multiple specialties frequently. Many times, the communication between the providers is delayed. So, the PCP may not know that the patient had a test the day before an office visit and repeats the test. These are repetitive tests that serve no purpose.

HL: How does the PHSO intervene when there are unnecessarily repeated tests?

Vazquez: We have a good infrastructure of data analysis and claims analysis that gets filtered through our health coaches, who are employed by the PHSO and work in clinics. The health coaches help communicate unnecessary tests to the clinicians. We are working on better communication. It takes a team approach. It takes technology. It takes awareness among clinicians.

HL: What aspects of MercyOne PHSO do you find most intriguing?

Vazquez: As a science and number guy, what I find most intriguing is the data analytics capability. As a clinician, it's intriguing to use our data to identify patients who are at higher risk and to prioritize them to get the best care in a timely fashion.

We believe that we are trendsetters. With good information we can not only affect the lives of our patients but also enhance the ability of clinicians to work at their best and take care of the patient.

HL: Give an example of data analytics at the PHSO.

Vazquez: We can analyze how many of our patients have been hospitalized recently. One big goal of Medicare is to minimize rehospitalizations. With the data that we have and the processing we can do, we have algorithms that can identify patients who are at risk for readmission. Then we can get them in to see their doctor to try to prevent a readmission.