Health Evolution | January 19, 2021
Kevin Hutchinson joined Apervita as CEO after the company acquired Qcentive in 2019. Prior to Apervita, Hutchinson served as chief executive at several startups and stalwarts alike, including the founding CEO at Surescripts.
He also spent time working at IBM, Oracle, Medscape and MedicaLogic, which was sold to GE and ultimately became Centricity. And he is a board member or advisor to multiple technology companies.
Health Evolution interviewed Hutchinson about what attracted him to Apervita, the holy grail of activating patients to adopt digital health tools, the company’s value-centric collaboration platform, and more.
You joined Apervita in 2019 as CEO after the merger with Qcentive and you also have a long history of leading health care innovators. What attracted you to Apervita?
Hutchinson: Apervita built a technology platform that focuses on how to innovate digital measurement and with the acquisition of Qcentive’s value-based care tools that are driven by quality measures, the combination was a perfect segue into where health care was moving. So, what attracted me to Apervita is that the company is perfectly timed — and the pandemic only pushed it further ahead — for digital quality measures, value-based care and clinical pathways.
An argument has emerged in 2020 that because organizations that are heavily reliant on fee-for-service have struggled, revenue-wise, CEOs that have not already pursued value-based care should reconsider. From your perspective, is now the time for value-based care?
Hutchinson: Without question, the COVID pandemic certainly exposed the weaknesses of the traditional fee-for-service reimbursement model. Also, the tools needed to support value- based contracts for both payers and providers are available now. In the past, it was tech-driven with analytics databases and people manually trying to apply those to contract terms and payments. In the past, it could take as long as a year for payers and providers to reach settlement at the end of a contract because of all the back and forth and the quality of the algorithms doing the measurements. With years of experience in the technology market of helping both providers and payers manage value-based contracts, that makes it seem more possible than ever.
One of the big factors of value-based contracts is how to efficiently manage patient populations, and the growth of telehealth during the pandemic has opened providers’ eyes because patients are using these tools. That’s the holy grail — to get patients to adopt digital tools. Health plans, including CMS, are paying for telehealth, and now there’s an open door to managing populations through more effective means without incurring the cost of office visits.
Telehealth usage rates spiked early in the pandemic and those have since settled down, yet they remain higher than pre-pandemic levels. What are you expecting of telehealth use late in 2021 and the future?
Hutchinson: If I had that crystal ball, I would focus solely on being an investor. But I do believe telehealth will expand. Historically, the thing that gets patients to use technology is appointment scheduling. We’ve seen that over the last ten years as companies have focused on automating the appointment process. The next evolution of telehealth is integrating into EHRs, then moving into disease management or prescription compliance. So, telehealth underwent a heavy growth curve at first and we’ll see steady growth as patients get more used to these tools, scheduling appointments, participating in virtual visits and ultimately managing their health. Ultimately telehealth apps will replace the need for patient portals, or we’ll see these worlds merge together.
Circling back to Apervita’s value-centric collaboration, what should CEOs understand about that?
Hutchinson: There are three things Apervita is doing to enable the Learning Health System. The concept has been around since about 2005 or 2006 and entities such as AHRQ and IOM have been talking about it for a while. Ultimately, a Learning Health System aims to deliver better patient care via digital infrastructure. Value-based contracting is akin to the roof on the house because it’s about payment, measuring risk, getting reimbursed. But before you get to a contract, you have to digitize quality measures. We’re seeing The Joint Commission, CMS and NCQA push toward digital measures and the core of Apervita is a central engine and platform for digital measures. The Joint Commission deployed the Apervita platform to over 3,000 hospitals for quality measure reporting.
The second is clinical intelligence, which is really about pathways and this is all part clinical practice guidelines, delivering information to the point of care when physicians are making decisions. Measure performance impact those pathways and pathways impact measures. That intersection is what the Learning Health System is all about — measuring the quality of care to improve the pathway and vice versa.
The third is value-based care itself and managing value-based contracts. Being able to utilize digital measures for quality reporting in real time allows payers and providers to focus on the best performance risk terms to put into a value-based care contract.
If you think of the Learning Health System as building a house, you start with the foundation. The foundation of Apervita’s approach to supporting the Learning Health System consists of digital measures, then the walls are clinical pathways to influence decisions that drive care, and value-based payments are, again, the roof on the house.
Kevin Hutchinson, Apervita
What should existing and prospective clients expect from Apervita in the coming 18-24 months?
Hutchinson: During the next 18-24 months, we will be placing a lot of emphasis on relationships to accelerate the transition from paper-based measures to digital measures with our clinical quality language (CQL) engine so they’re more accurate, transparent and accessible. Users will be able to look at measurements in a real time environment either monthly, weekly or daily.
You’ll see us undertake a lot of work in partnerships where Apervita’s platform will enable EHR vendors to provide digital quality measures within their applications. Measure building organizations will build, test, and execute their digital quality measures using our platform and CQL engines creating a library of quality measures for the industry to use. For example, The Joint Commission utilizes Apervita’s platform, which allows 3,000+ hospitals to digitally process their required measures for accreditation. This provides exponential efficiencies for both the hospitals and The Joint Commission.
Also, over the next 18-24 months, from the merger with Qcentive, in addition to payers using our solution today to measure provider performance for value-based contracts, providers will be able to manage value-based performance across multiple health plans and multiple contracts instead of a single view of each. Most of those today are delivered by payers to providers via PDFs. We released a solution that provides the ability for payers and providers to see the same data, so the next step is broadening provider capability for managing value-based contracts.
Additionally, we’re continuing to develop our stateful engine for clinical pathways. So, it won’t just be ‘Yes, no-based inputs for a pathway execution.’ Instead, the stateful engine will assess the patient in a more clinical level. For example: The ability to include a current diagnosis, past history, co-morbidities or active medications, to enable individualized pathways for an individual patient — and that’s very different than managing a population based on generic clinical pathways that may or may not be the right path for a particular patient.
And what about three to five years into the future?
Hutchinson: Moving into machine learning and AI capabilities. If I’m measuring the performance of a provider organization and see areas for improvement for a quality measure or element of a value-based care contract, I can, without human intervention, deliver the improved pathway so physicians can make higher-quality decisions at the point of care based on clinical performance. Imagine if a COVID pathway could have been altered in real-time across the entire health care industry as providers learned what treatments were working for the various and unique patient profiles.
For value-based care we will enable “what if” analysis so that providers and payers can see optimal contract terms based on real world and current clinical data. Today, that takes a lot of human involvement but in 3-5 years AI and ML should be able to do that.
What is the hardest challenge you have overcome as a CEO and entrepreneur?
Hutchinson: Timing the market, and in health care that’s twice as hard. I’ve been on the innovation side of health care technology for quite a while, having the privilege of leading teams who bring cutting-edge solutions to the market for real-world problems. Like one of the first EMRs, MedicaLogic, which we sold to GE and became Centricity or with building Surescripts, the first national health information network in the industry. It’s always about making sure you have the timing right on where the market is going because if you are too far ahead or too far behind it just won’t work.
And what career accomplishment are you most proud of?
Hutchinson: I’m always most proud of my teams. I stay in touch with everyone on my teams all the way back to my IBM days when I first got out of school. I love developing people to reach their potential. We did that at Surescripts, MedicaLogic, Medscape and now we’re doing it with Apervita where we have an experienced high-quality team. Another point of pride is that many past team members are senior leaders in other companies. We were all in health care when digital health was not cool, everyone was saying “we’re not going to use EHRs, we use faxes to share patient data” and “why write a prescription in a computer when paper is faster?” It’s been great to see those people evolve and make a real impact in improving health care.
What advice would you offer other CEOs and innovators?
Hutchinson: In health care especially, network like crazy because there’s a lot to learn. Sometimes people think what they are doing is unique, but you can learn a lot from all the innovations happening. In the 2010’s it felt difficult to keep up and it’s much more difficult to stay on top of all the innovation happening today. CEOs looking down the road need to stay tightly connected to the industry by networking with other companies. Become involved as an advisor or board member to other enterprises because that really helps in terms of keeping track of what’s happening throughout the market today.
2020 was obviously a tumultuous year. What predictions would you make for 2021?
Hutchinson: Vaccines. We’re all happy that vaccines are happening, and will maybe even be fully-deployed by the summer for the U.S. From a prediction standpoint, I think we will see a strong movement to digital measures for improving and reducing the number of quality measures that are out there. There’s a lot of work being done by smart people to focus on “measures that matter” as we like to say. Only about 35 percent of all measures, and maybe not even that high, are being used so there’s a lot of work to synthesize down to measures that matter. And I think we’ll see huge growth in the number of members (patients) and providers that are participating in full-risk value-based care contracts.