As we anticipate the typically slower winter holiday season, many of us at Azara are looking forward to catching our breath after an unbelievably busy fall. Collectively, Azara staff attended 20 conferences in September and October, after what was also an unusually packed summer schedule. It seems that while last spring was still tenuous from a COVID perspective, by the time August rolled around people were ready for in-person events and excited to see faces in real life.
After visiting 19 states during the flurry of fall activity, I asked our teams who travelled to these events to share the major topics and themes they saw represented at Primary Care Association Annual Conferences, user groups, quality and learning summits, and various industry gatherings. Following are the standout themes we observed, which proved remarkably consistent across events, providing valuable insight into where we need to focus in the years to come to best support our clients’ priorities.
A prominent topic we heard about at every event was health equity. Whether this was represented through JEDI (Justice, Equity, Diversity, and Inclusion), social determinants of health collection and utilization, or finding and addressing disparities in care, discussions around health equity dominated the agenda everywhere we went.
This is good news – equity has been added as the fifth element in the Quintuple Aim, and people are, at minimum, acknowledging its importance in any discussion about healthcare improvement, including organizations like Trabian Shorters whose Asset-Framed research is currently being used in the Biden Administration’s initiatives to reduce the racial wealth gap in America. The bad news is there is no silver bullet, and as one presenter at the NCQA Health Innovation Summit I attended said, it cannot be all on healthcare facilities and teams to solve deeply rooted issues of racism and economic inequality. Doctors, nurses, administrators, etc. do not have the power to change housing landscapes or enforce fair hiring practices – it takes a village of partnerships, and I heard again and again about how we need to collaborate, coordinate, cooperate.
Yet it still feels like a piece of the puzzle is missing. We have a disjointed method for delivering care in the United States, both from a provider and technology perspective, and it can feel like the fundamental realities of our healthcare system prevent us from joining forces in a productive way. But, people from diverse backgrounds and organizations are still managing to work together, including payers and practices, and attending these events where examples of partnerships can shine is one way I stay optimistic about improving equity in healthcare going forward.
On a somewhat related note, value-based care was also hot topic. One quote I heard at the NCQA conference from Aneesh Chopra, President of CareJourney, is that for a very long time, fee-for-service has been the “apex predator” of the American healthcare system’s payment structure; however, value-based care models may finally be getting big enough to dominate the market. Many in the industry applaud this move (or have at least resigned themselves to it), but there is also legitimate skepticism.
The concept of value-based care makes logical sense, and fits nicely with our ideas about equitable, patient-centered care: better services and long-term outcomes for less money. But the fact that we keep talking about how to succeed in contracts, rather than how well the model works (the data on the success of VBC is inconsistent at best) points to the reality that there are still many challenges to implementing value-based care at a national, or even a specific population, level. What I do see as hopeful in this scenario is that players from plans and federal agencies (HRSA, CMS, etc.) are participating in this change, helping to grow value-based care so it can become the new T-Rex (if we stick with Aneesh Chopra’s metaphor).
As a part of this change, we see plans funding more care management services, HCCNs supporting population health and alternative payment models, and CMS adjusting the physician fee schedule and other rules like telehealth regulations to accommodate more types of workers. Slow going sometimes, but the conversation has shifted, which I see as positive for the future.
I could not get through this blog without mentioning the burning (pun intended) topic of FHIR. The number of times I heard it mentioned over the past few months left me wondering, with the breadth of people using the term, who actually understands what FHIR does or even stands for (Fast Healthcare Interoperability Resources)? But there sure is a lot of excitement around it.
Everyone who has ever worked with any kind of healthcare data knows the struggle of the many-systems approach, and FHIR is one way to try to ease some of that pain. Will it be the magic wand it is presented as? Probably not, but in conjunction with some of the updates the ONC (Office of the National Coordinator) has made, like expanding USCDI (United States Core Data for Interoperability) and tightening interoperability requirements, there is reason to be optimistic about improved data exchange in the future. How soon in the future is hard to say, and if we continue to proliferate our sources of data (hello, SDOH) that may undermine this effort. But, increasing standardization in data is always something we here at Azara encourage and celebrate, so I am excited to see what’s to come.
Staffing Shortages and Burnout
I want to end with a topic that came up just as frequently as health equity and I believe is one of the most pressing: staffing shortages and healthcare worker burnout. No client of ours, and it seems no healthcare entity, has escaped the brutal toll COVID has had on frontline workers. We must acknowledge how difficult turnover has been, how grueling healthcare work can be, and that this was true before COVID, but a global pandemic has a way of exacerbating simmering issues.
From the Azara perspective, we are always here to help our customers use our tools to help ease some of the burden, though we know technology can only do so much. There is no denying we are in a rough patch for healthcare workers, and to all the frontline and administrative staff reading this, we are humbled by your efforts and are amazed at the work you have accomplished, even in such trying times.
While the travel schedule can be grueling, it is always wonderful to meet people in person – having an impromptu chat at the Azara booth or in the lobby of a hotel for 15 minutes can often accomplish more than hours on Zoom, and we never get tired of seeing our clients’ work highlighted and celebrated. Special thanks to Sam Bar, Carrie Taylor, Leah Dafoulas, LuAnn Kimker, and Amanda Hinderliter for sending me their observations. We are all looking forward to a break this holiday, but as always will be ready to jump back in as we kick off 2023!