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Richard Parker on Global Payment Models & His Big Career Transition

richparkerDr. Richard Parker, former Chief Medical Officer at Beth Israel Deaconess Care Organization (BIDCO), is a man of many talents. In addition to working as a physician, medical director and board member at BIDCO, he has also worked as a political consultant.

Now, after working for the Beth Israel Deaconess Care Organization for more than 15 years, Parker is off on a new adventure – one he calls his most exciting yet: starting his own healthcare consulting company, Parker Healthcare Innovations. We recently sat down with him to hear about this career shift.

Q: Tell us about your work at Beth Israel Deaconess.

In 2000, I was asked to be the medical director for the physician organization and I agreed to do it if I could still see patients, so I was medical director 50 percent of the time and seeing patients 50 percent of the time. That was the beginning of a lot of learning about the business of medicine, pay for performance, contracts, how doctors are motivated, information technology, and EMR.

In 2012, we had the opportunity to apply for the Pioneer ACO. In the greater Boston area, there are 5 organizations that are Pioneer ACOs: BIDMC, Mount Auburn, Partners Healthcare, Steward, and Atrius Health. That was a very fast learning curve because previously we were just dealing with the commercial population, which was up to the age of 65; now, we had to add all patients over the age of 65 who were in this Pioneer ACO. It was a different game.

Older patients are not the same as younger patients. There is more illness, more chronic disease, more hospital admission, and so now, instead of thinking about patients one at a time (which is how we learned to care for patients in medical school), we had to think of populations of patients – about systems and public health. I had to think: What can we do to make our systems better so we are improving the quality of care for patients in tangible ways and decrease costs? And this is the irony and the conundrum: it is actually possible to increase quality and decrease cost at the same time.

That allows for the transition from fee for service (FFS) to global payments. In the FFS model, patients come in, we treat them, and we bill them; that compels more treatment, more admissions, more referrals. In the global payment world, we turn that 180 degrees, we say, ‘Okay, doctors – maybe hospitals – you have a budget. If you come in under budget, we’ll share the surplus with you. If you come in over budget, you’re going to write us a check.’ That is an extremely different financial model. So at Beth Israel, I was trying to figure out how to build the systems and then how to translate this message to providers.

Q: What kind of results have you had with the Pioneer ACO?

We’ve seen excellent results. In fact, the BIDCO Pioneer ACO was the leader in the Boston Market and we’re the third most financially successful Pioneer ACO in the country. We’ve seen a lot of success. By the second year, we saw results in terms of quality, cost and patient satisfaction.

Q: So, the big question: What motivated you to make the switch from that work to starting your own company?

Part of my motivation was waking up one day and saying, “I’ve been in the same place for 30 years.” I started as an intern at Beth Israel Deaconess and I’m now going to be 59 years old. I’m fortunate to be healthy and have a great family and if I wanted to do something different, this seemed like the right time to do it. With the success we have had at BIDCO, this would be a great time to use it as a launching pad to do something different.

Q: What is your vision for Parker Healthcare Innovations? What would you like to achieve? 

The first part is assisting doctors, hospitals, and to a lesser extent, health plans, that are trying to make the transition from fee for service medicine to a global payment system. Some of the things I talked about earlier, the challenges, these are things I now know a lot about, through working with Beth Israel Deaconess for 30 years. The challenges exist in the areas of governance, information technology and care management. Though people often think about this as a financial enterprise, really this is an opportunity to improve systems of care and the quality of care.

For example, I started a nurse practitioner home visit program. The sickest now get a nurse practitioner visiting their homes monthly. Now, with the nurse practitioner making a home visit, we’re not seeing them in the hospital as much. Patients are healthier, happier, families are happier. This is a big win. This is a real obvious example of a systems approach to disease management.

There are certain diseases that we need to focus on in order to be successful. In the Medicare population, there are six: heart failure, diabetes, emphysema, chronic kidney disease, behavioral medicine, and palliative or end of life care. I anticipate helping groups of doctors, hospitals, and insurance companies in how to move in this direction because I know how to do it. Every system is different. There’s a lot to figure out and it’s not for the faint of heart to make that transition.

The other thing I’m doing in my company is giving a presentation on the topic of stress. My goal is to give this presentation to companies and to colleges because I feel that chronic stress has become a really enormous problem and I saw this when I was practicing medicine.

Q: What other trends do you see in the future? What else should the healthcare world be preparing for?

One colossal trend will be the demand for more value for money. There will be continued pressure on all of us to stop wasting so much. Healthcare costs are a big drain on the economy and businesses, whether you’re self-employed or you work for a big corporation, everyone is paying this colossal cost. The issue of cost in healthcare hasn’t been adequately addressed; it hasn’t been touched.

On a brighter note, I’m hoping that we’ll see more intelligent self-care, maybe leveraging technology. Technology is fabulous but only if used in a useful way. Hopefully with all this technology we can help people with self-care, around chronic illnesses, like weight management, stress, blood pressure control, diabetes. Hopefully we’ll see some really good things in that space.

I’d also like to see more care at home, less in the hospital setting. I consult to a home IV infusion company, called Soleo Health, and I think doing treatments for patients in the home is better, more comfortable and cost-saving.

Kirti Patel, MD, MHL

Kirti Patel, MD, MHL

    Kirti A. Patel, MD, MHL, is a physician, writer, speaker and advisor. She has a background in scientific research, 14 years of clinical experience, holds a Master's degree in healthcare leadership from Brown University, and is an advisor for an early-stage women's health startup, Confi. Dr. Patel avidly follows scientific and technology innovations, new ventures, and startups in healthcare. She is also a passionate advocate for women's health and leadership. To hear her thoughts on these topics and more, visit kirtipatel.com or follow her on Twitter, @kirtipatelmd.

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