SM: How does the architectural approach change things on the clinical side?
TM: On the clinical side it is exactly the same thing. ONC has put together the quality metrics for meaningful use. The metrics on the list were designed around elements which will improve quality and remove costs from the system. About 85% of the items on that list are about patient behavior rather than clinical decision support.
We have to drive some new architectural thinking. The way we are thinking about doing that is implementing those quality metrics. One example would be tracking the rate at which hypertension patients take their blood pressure medication.
The way it is envisioned now is that in 2011, we are going to certify paying providers for having systems that can report what percentage of their hypertension patients in are taking their blood pressure medication. In 2016, we can start paying doctors based on that.
You do not need a numerator and denominator to make these kinds of quality improvements. All you need to know is a class of patient whose members are not taking their medication. Who cares if it is a specialist or a primary care physician who convinces those patients to finally start taking their medication? The specialists are starting to get more active here, saying that meaningful use does not have anything to do with them. Cardiologists say they have their own quality metrics. That reflects the complexity of what we have to automate. We have been supporting legislation in Congress to implement payments right now to close gaps in care.
SM: There is a physical element to the scenario in which a patient is not taking her medication. How can an information system detect that?
TM: There are a couple of loopholes, but they are not big ones. You know if patients are filling their prescriptions for chronic conditions. The pharmacy data is readily available. It is not hard to identify who has stopped taking their drugs.
SM: Let’s say that all the systems come together so that physicians can take payments at the point of service. How much money would that save the system?
BW: Billions. For every dollar that goes uncollected, a doctor has to pay $4 to collect it. If you have fewer administrative staff, you could use them for other things to improve the patient experience.
SM: Are there not any startups or companies that are doing point-of-sale systems for doctors’ offices that link to health payer systems?
TM: The industry has the old clearinghouse model that drive today’s process. That model cannot support what we are talking about regarding payment reform. We need new models to do that, and there are lots of people working on it.
SM: Could you summarize how you built the company in terms of financing and your ramp?
BW: The company is venture-backed by North Bridge Venture Partners and Atlas Venture, as well by firms such as General Electric. Between 1998 and 2001, we did a total of three rounds. We have been profitable for eight out of our eleven years. The company is now on track to have an extremely good year. We typically sell to one insurance company a year, and this year we have sold to four.
We have just over 200 employees in Cambridge, Massachusetts. We have 40% of the providers in the United States. We are in 50 states and three territories. We now have the ability to add other things onto our rails.
SM: You have a good story. I wish you all the best.