Many of the companies in the health-care system are rethinking business strategies, and Inova Health System, the Northern Virginia hospital giant, is no exception.
Last June, Inova announced a venture with insurance titan Aetna — one of the first such partnerships in the country between entities usually economically at odds — to deliver care more affordably.
Teaming up with an insurance business brings challenges for a traditional hospital system: Rather than just caring for sick patients, the company sees itself as managing people’s overall health and dealing with all the complications of that task.
To help chart its path, Inova is hiring a director of health-care economics to build a team of financial analysts that can translate patient data into optimized use of resources.
The Washington Post spoke with Glenn Lohrmann, Inova’s chief financial officer for population health services, about where the industry is headed. The interview was edited for brevity.
A. There is so much pressure on health-care organizations these days because we’re supposed to provide the best care possible but do it in an efficient manner.
That means there has to be much more of a focus on prevention and wellness. That’s the transition that’s been in place for 30 years, and it’s picked up steam with the Affordable Care Act.
For this position, we need someone who is strong with their data manipulation abilities — the data sets we are dealing with are just huge — but we also need someone who understands health-care claims, including how they are coded as presented from providers. They don’t need to know everything the way a doctor would, but they do need to be able to intelligently converse with the people who are processing claims.
And it’s also important to have somebody who is naturally inquisitive about things. We hope to find someone with a curiosity to drill into the data and help us find opportunities to improve the quality of care and at the same time deliver it in an efficient manner.
We need this person to help us identify people who provide high-quality care and also cost-effective care. In many cases, the same providers fall into both camps if they’re able to diagnose quickly and be really attuned to the patient.
This person will also help with risk-optimization: go into the data and identify who the really sick people are and who are the not-so-sick people. That allows you to assign risk, which in turn could drive the reimbursement that person receives from the state. If you have a sicker member in your group, they’ll want to pay you more. So that allows you to match revenues with expenses.
In the Medicaid side of our business, the state works to identify how well hospitals are treating their Medicaid populations. So the state will look at historical treatment patterns so they can predict utilization patterns. . . . This is tremendously data-intensive work.