Improved Savings, Outcomes by Identifying Top-Performing Docs
How do companies know employees are getting the best healthcare available? Until now, they didn't ... but thanks to Embold Health, today's employers can do more than cross their fingers and hope for best outcomes.
The data analytics company is creating a new standard for healthcare quality by combining the largest dataset in healthcare, clinically validated analytics and the expertise of leading physicians and data scientists to shine a light on top-performing doctors, ensuring that people receive better care and that all doctors have the opportunity to improve.
Variations in Care
The Nashville-based company was founded in 2017 by Daniel Stein, MD, MBA, a primary care provider who previously served as chief medical officer of Walmart Care Clinics. Stein also served as an emergency room physician for the Veteran's Healthcare System of the Ozarks and held various policy positions in Washington, D.C., while completing his medical degree at Johns Hopkins School of Medicine in Baltimore.
As a medical student, Stein first noticed a striking contrast in provider performance. "Even while training at Johns Hopkins, which is one of the best schools in the country, there were physicians whose skills hadn't kept up as much, or doctors who were performing tests that the latest science showed weren't necessarily beneficial to patients," he said. "It struck me that from the outside in we all look the same; but from the inside, we're all quite different when it comes to quality of care."
That realization frustrated Stein and followed him throughout his career. Even at Walmart, he realized that the biggest and most sophisticated companies still didn't have sophisticated enough analytics to view performance in a clinically meaningfully way. The absence of a data-driven, scientifically objective way to measure provider care prompted Stein to form a data sharing collaboration with Blue Health Intelligence, the largest and most complete healthcare data set in the country. Stein also pursued collaboration arrangements with top academic researchers to help bring the best science and research to provider performance.
Teaming with Walmart
In 2019 Embold Health publicly announced Walmart as their first partner. "We're very excited for this relationship, since Walmart is a tremendous innovator in pushing the envelope around the importance of quality and innovation," Stein said.
The world's largest retailer rolled out the initiative to approximately 115,000 employees and family members in select markets and is working with Embold to roll out the benefit on a market-by-market and specialty-by-specialty basis.
"Healthcare is local, and the quality of care in one city is different than another and across specialties," Stein explained. "We empower employers and employees, regardless of community, to get in and see those physicians who consistently deliver high quality care. Everyone deserves to know they'll get care based on science, but much of healthcare's existing quality measures like readmission rates and length of stay are a bit of a hodgepodge and often at hospital level. We're looking at care delivered at the physician level."
Key Drivers
Embold uses three key drivers to examine results for physician performance - appropriateness of care, effectiveness of care and total cost of care.
"When we run analyses to share with employers, we show them opportunities to improve quality by helping employees find physicians who consistently perform better," Stein said. That includes identifying those who provide inappropriate or unnecessary care - a problem Stein considers an epidemic in the U.S. For obstetric care, as an example, that means highlighting physicians with lower C-section rates and complications among healthy women with low-risk pregnancies vs. those with higher rates of C-sections and complications.
By directing patients toward providers with better outcomes, employers remove the guesswork while, in the long run, reducing costs.
The Process
Embold provides physician information to employers, who decide how they want to craft their benefits plan. Employers then integrate that information into their health plan and equip employees with Embold's user-friendly provider finder guide. Embold provides full transparency in sharing findings with clients, as well as the medical community, and Stein said providers are grateful for the feedback. That's because most have never seen data about their own performance.
"We're focused on driving improvement through transparency, and we are fully transparent with measures, methodology and physicians," Stein said. "As a PC myself, I know physicians get up wanting to help patients, but in reality the practice of medicine is hard. There are always new practices, treatments and guidelines, and most of us don't get feedback on how care has been delivered, although we want it."
From Embold's physician page, providers in Embold markets can request a report to learn how they perform relative to their peers. Consultations also are available to help empower providers and equip them with tools and data to improve.
"We want to help improve healthcare in this country," Stein said. "We think everyone deserves to go to a physician who delivers high quality care, and every physician should be delivering high quality care based on the latest science. Embold provides information, insights and ability to help empower better quality care for everyone."
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