Here’s a vital question, “How do you make sure that the physicians your employees or members are seeing are high quality in a given area of focus?” Getting to the right doctor matters when you consider that something like 70% of back surgeries are unnecessary and medical errors are the third leading cause of death in this country. And also because, as Suzanne DelBanco put it in EP224, if a payer simply cuts out the bottom performing 10% of practices, the returns are outsized from a cost and quality perspective. The challenge is how to actually accomplish this. How to measure quality in a sea of dirty data and noise and whatever the opposite of interoperability and aggregated data sets is. With the confounding factor also that outcomes are rarely if ever included in data sets, especially when you consider that the outcomes that matter to patients are really the outcomes that count.
Today I speak with Suzanne Clough, MD. In a former life, Suzanne was a co-founder of Welldoc, the first FDA-approved digital health platform and also featured on EP102 of this podcast. Now, Suzanne is the chief-medical officer over at ArmadaHealth, a company that aims to become a GPS for health care helping to get patients to the right doctor quicker.
You can learn more at www.armadahealth.com
Dr. Suzanne Sysko Clough, MD, is Chief Medical Officer of ArmadaHealth, a health and data science company that navigates consumers to quality health care providers using big data, AI, and proprietary quality algorithms that together produce 360-degree profiles of physicians. The platform enables precision matching of physicians with patients based on diagnosis/condition and nonclinical attributes. Before ArmadaHealth, Suzanne was a co-Founder and Chief Medical Officer of WellDoc, the first FDA-approved digital health platform. Dr. Clough completed her medical training in internal medicine and a fellowship in endocrinology at the University of Maryland Medical Systems and served as an assistant professor in the Division of Endocrinology as well as Medical Director and as the Founder and Medical Director of the Center for Weight Management and Wellness.
02:10 Why finding the right provider is so important.
03:01 Higher quality health systems or the need for wider specialty coverage?
03:59 “We don’t recognize that there can be a quality...difference among physicians and...among health systems.”
06:08 Quality as the intersection of clinical acumen and the ability to form a relationship.
07:18 Determining what is or isn’t appropriate.
08:11 When it seems appropriate from a physician standpoint but isn’t from a patient standpoint.
11:01 When physicians could use more support.
11:49 Practicing wisely.
14:36 Do payers care about getting patients to the right doctor?
17:00 Center of Excellence model vs insurance policy methods.
23:06 “We’re not empowering people with the right information.”
23:41 How ArmadaHealth’s approach is different.
24:27 Claims data vs clinical data and outcomes data.
27:06 How ArmadaHealth pairs patients with physicians.
31:00 Who ArmadaHealth is deployed by.
31:31 Who ArmadaHealth gets their outcomes data by, and why this is important to assessing patient quality care.