In this health supplier segment, Saeed Aminzadeh, founder and CEO of Decision Point Healthcare Solutions, discusses the Decision Point Opus Engagement Platform that empowers health plans to understand and predict every facet of a member’s health experience, enabling effective targeting and impactful, holistic interventions.
Saeed founded Decision Point with the mission of improving health plan clinical, financial and operational performance through informed, data-driven predictions on strategic decisions. He has more than 25 years of health information technology experience, with a track record of building high-performing organizations designed to solve complex business problems. He has held key senior management positions at Eliza Corporation, Ingenix (currently Optum), IHCIS and ProVentive, where he built and managed successful sales organizations focused on revenue growth and expansion of client relationships. Saeed’s multi-faceted experience in healthcare information technology began in healthcare analytics, where he helped build the foundational analytical systems to develop HMO and PPO networks for a major insurer, and continued at HPR (currently McKesson) and Solucient (currently Truven Health), where he was responsible for the development, operations, and management of key product lines.
-TRANSCRIPT OF INTERVIEW-
Neal Howard: Welcome to Health Professional Radio for this health suppliers segment. I’m your host, Neal Howard. Thank you for joining us. Our guest is Mr. Saeed Aminzadeh. He’s joining us today as Founder and CEO of Decision Point and I’ll let him give us a little bit of background about himself and thank you for joining us on the program today, Saeed.
Saeed Aminzadeh: Yes, I appreciate you having me. So we found Decision Point back in 2013 and our focus then and still is on trying to help health plans improve their performance. So we try to do is try to disrupt undesirable member behavior. Undesirable means trying to reduce avoidable admissions and readmissions, trying to get members to get their preventive screenings, trying to get members to be able to more adherent with their medications, kind of get them better access and what we do is we take a data approach. We’re trying to predict how people are going to behave. We’re trying to predict what their barriers are, what their engagement, their challenges are going to be. So in theory, if you can predict how someone is behaved, you can zero in on the people that are going to be highest risk and try to change that risk trajectory over time. So we’ve had some successes working with plans over the years, improving access, lowering avoidable admissions, improving preventive care, improving adherence and we’ve shown that this stuff works but it works best really, it only works if we’re working in partnership with our clients. So reviewing the information, they’re taking action on the information we provide them and we’re helping them gauge success and changing their approach and just becoming better over time.
N: What are some of the incentives for physicians to better manage their practices for these outcomes?
S: Well, that’s a good question. Physicians more and more are kind of try to share the risk with the health plan. So meaning that a health plan might be at risk for Medicare Star Rating. So they get reimbursed more if they do well in their Star Rating. So if they do well in their preventive care, they do well in adherence, they do well in access if they do in avoiding utilization, so what they do is try to share that risk with their physician. Meaning that the physician is also paid at risk but this time instead of by the federal government or by the state, they’re paid by the insurance company. So the incentive one is obviously greater payments by the insurance company but instead of, I think also physicians try to do a good job and if as a vendor and as a partner of health plan are providing them with the right tools to do that, it just makes their job easier.
N: Why do you think that it is the government didn’t do some of the same things that the insurance companies are doing seeing as how the insurance companies are going to save money thereby being able to give more money? It seemed I guess it was many years in the making but why didn’t the government come up with it first since they were paying the doctors in the first place?
S: Well, the government … as with everything in life, right? You got to follow the month and what the government does and in fact, the government – it’s odd in our industry in health care, the government is a change agent and it’s very different from other industries and so the government because they are paying for Medicare, paying at least partially for Medicaid, funding other types of health care, they have a vested interest in lowering the payment while also trying to keep quality high. And so they have joined into risk arrangements with health plans – people that they reimburse. These health plans then get into at-risk arrangements with other organizations that they end up paying. So the government is, like it or not, playing a large part in really trying to change the landscape of care. One of the things they’ve done is in the Medicare Star Rating. So basically saying, “I’m going to pay you more or less depending on how you perform across a lot of different measures.” One obviously got to do a good job of providing care to the members. What’s the percentage of your members getting a mammography screen or getting the diabetes testing done? What’s the percentage of members that are adherent to their meds? So they kind of judge these plans based on those metrics and on the other hand, the plans are also under pressure to keep costs low because they’re reimbursed on a member basis, not on a fee-for-service. So it’s interesting. There’s a pressure on both sides. One is to keep costs low on the other hand they need to spend money in order to be able to improve performance across some of those key metrics.
N: How much patient input is taken into consideration?
S: There is quite a bit of patient input and it’s probably a source of concern for plans in my opinion. So a lot of these measures that the plan is at risk for is, some of them are not based on patient opinions, but based on things that happened – “Did you go to the hospital? Did you get your screening stuff?” But some of them like access to care is based on a patient survey, the health outcome survey. That’s another survey. So there is a survey and plans reimbursement is directly linked to what actually patients are saying about the plan but also about their doctor which the plan is also helpful – “Did you get the care you needed? Did you have to wait a long time to get the care? Are you happy with your doctor? Are you happy with your plan? Were they organized when you went to the doctor’s office?” So these are all questions that are asked from patients, from members and are directly then linked to how a plan is performing and how a plan will eventually be reimbursed. So it’s an attempt, like it or not, it’s kind of an attempt at a closed loop to include the patient as well.
N: Very briefly you said you’ve had some successes. Talk about I guess maybe the biggest challenge that you see in implementing these measures in the support of these plans. What’s the biggest challenge?
S: So the biggest challenge is trying to engage the unengaged member, patient, right? So you have a patient that is not going to the doctor. Even though they’re sick, they have a patient that’s not getting the basic preventive care. Sick or not they may not be getting basic preventive care. That plan has a vested interest in doing that. The question comes, “How can you engage someone that really doesn’t want to be engaged?” If you look at the retail industry, they have some advantages, right? You can go to Best Buy and you can walk out with a nice phone or a nice computer or a nice piece of electronics. Here, the plans are trying to sell healthcare, trying to get the person to stay on top of the screenings, do a better job of taking their meds. It’s not sexy and so the biggest challenge is really trying to really focus on that individual and get them to engage better with their doctor, engage better with the plan and get the care that they need. That’s I think the biggest challenge in healthcare in general.
N: Where can we go online and learn more about Decision Point?
S: Yes. Thanks. Please feel free to go to our website. It’s decisionpointhealth.com. That’s one-word decisionpointhealth.com and also you can feel free to follow us on Twitter – @DecisionPointHC. And I look forward to being in touch and I appreciate the interview.
N: Thank you so much for joining us today. You’ve been listening to Health Professional Radio. I’m your host, Neal Howard. Transcripts and audio of this program are available at hpr.fm and healthprofessionalradio.com.au. You can also subscribe to this podcast on iTunes, listen in and download at SoundCloud and be sure and visit our affiliates page at hpr.fm and healthprofessionalradio.com.au.