Q&A WITH SANJAY DODDAMANI, MD, MBA

Doctivity Health had the opportunity recently to talk with Dr. Sanjay Doddamani, a c-suite physician executive with expertise in value-based care and clinically integrated networks, about current and future challenges in healthcare and how the use of actionable data is key to operational success and the provision of quality health services.

Dr. Doddamani is co-founder and former chief executive officer at UpStream Healthcare where he led the transformation of a sizable global risk organization with a unique model of integrated team-based care, clinical and dispensing pharmacy programs, and two-sided risk bearing capabilities for primary care physicians to be successful in value-based care. Over a two-year period, the company grew rapidly and expanded across three states with over 1,000 primary care physicians supporting approximately 160,000 seniors in full-risk arrangements.

Prior to joining UpStream, he was executive vice president, chief physician executive, and chief operating officer at Southwestern Health Resources accountable care network, where he oversaw the strategy and implementation of operations, quality, clinical programs, and population health for over 700,000 patients including 200,000 seniors.

In 2019, he served in the federal government as a senior physician advisor at the Center for Medicare and Medicaid Innovation (CMMI) within the Centers for Medicare and Medicaid Services (CMS) – working across model teams on alternate payment models that test and measure value-based payment innovation.

Prior to joining CMMI, Dr. Doddamani was chief medical officer at Geisinger At-Home, a home-based care model for medically complex patients, and concurrently, he led the Keystone Accountable Care Organization. He continues to focus on accelerating the transition to value-based care, improving patient outcomes, and harnessing big data and artificial intelligence to empower clinicians to provide better care. Dr. Doddamani is a clinical cardiologist board certified in internal medicine and cardiology. He continues to serve on several panels and advisory committees that address many of the healthcare challenges facing our nation.

ONE

DH – What are the biggest challenges in healthcare today?

SD – People accessing healthcare services continue to be challenged by tremendous fragmentation, inefficiencies, waste, and unsustainable costs. Employers and families continue to struggle and as a country we cannot remain competitive when almost one-fifth of our GDP (gross domestic product) is spent on healthcare. Clearly, there is a need to improve the overall patient experience, address the way we provide and pay for quality care, and focus on the social determinants of health (SDOH) and health equity.

We are seeing large retail giants entering into all kinds of health services arrangements across the healthcare industry. We are also seeing a growing shift to value-based care and a more direct role for “Payviders,” where payers are more directly connected to the delivery of care. Our future is in value-based care, but the reality is that it will continue to coexist with fee-for-service until majority of reimbursement is tied to health outcomes and total costs. So, we need to be transparent about who leads and directs patient care and how that care is financed based on the value provided.

TWO

DH – Please share your thoughts on the importance of data analysis for healthcare organizations to set strategies and make decisions to meet these challenges.

SD – It is shocking how largely blind everyone is flying as care is delivered across the continuum. We are lagging behind as an industry in this regard and must improve data sharing and the use of data analytics at a regional level to enhance quality and patient experience. Effective and timely data analysis is imperative for hospitals and health systems to more effectively partner with clinical providers. Presently, as an industry we utilize insufficient or outdated data, and we fail to realize its importance for physicians to achieve productivity standards and greater effectiveness in referral targeting. There is currently a total lack of understanding of the competitor landscape, and how to assess opportunities to create the right collaborative frameworks with aligned incentives to meet patient needs. Our emphasis as we move toward increased value-based care requires a more robust review and analysis of data.

THREE

DH – There is a sea of available data that can overwhelm you. Please comment on having the right data and analytics at the provider level – and also the healthcare segments where you see Doctivity making a difference.

SD – So, we need an optimal market solution to effectively analyze utilization trends and referral patterns to improve in-network care. Doctivity addresses actionable data analysis across payer mix, case mix, product lines, and patient demographics. I am most impressed with how Doctivity utilizes timely data to drive strategies to meet business needs, and where this is otherwise done piecemeal, Doctivity’s advanced data analytics are quickly available on a single platform.

The incredible depth and real-world expertise of Doctivity’s leaders sets them apart in many ways – recognizing the need for geo-clinical mapping at the MSA level to better inform the health system on the provider landscape to assess referral outmigration trends; while appropriately managing referral volumes; creating an excellent data dashboard to channel referrals to higher impact providers. When you have the key performance indicators – KPIs – related to physician performance you are able to target providers appropriately. You can better serve your patients and community to keep care local where possible, manage referral trends, patient volumes, types of procedures, and clinical needs in a given market, and identify where specific specialty services should be enhanced.

Doctivity can be applied to a spectrum of healthcare segments and clinical specialties, and I see its effectiveness especially in joint, chronic back pain and spine care, pediatrics, cardiology, and nephrology to name a few.

FOUR

DH – Please comment on the gap between identifying organizational growth opportunities and delivering quality patient care – and how a software platform like Doctivity fills the gap by driving analytical behavioral change for healthcare organizations.

SD – Doctors who are on the front lines don’t have the data to appreciate differences between specialists, for example, the number of surgeries that have to be redone or appropriate use of post-acute providers and rehab solutions. Data analytics can be utilized to make choosing better quality providers more effective based on objective data. Understanding who the higher performing specialty physicians are is so important, especially for physicians in value-based payment models looking at total cost of care. Doctivity includes actionable data not just as it relates to primary care, but also physician specialists and post-acute care – which enables appropriate, targeted, and effective measurements of performance like network referrals, utilization, and cost-trends. Ultimately, patients must be satisfied with the value of the care provided. Attaining a high level of satisfaction is much more challenging without the use of data to set strategies and make decisions on the healthcare services provided.

FIVE

DH – Where do you see healthcare going from here? What do you see happening in the industry in the coming years?

SD – The federal government has set a 2030 deadline for all providers to be in a value-based model, so we will continue to see this trend upward at the primary care level in ACO arrangements. Specialists need to be included – kidney care, cancer and cardiology are moving more quickly into value-based arrangements. Big retail will continue to disrupt the healthcare industry and there is no doubt that AI and a variety of machine learning models will be used to predict events, improve clinical decision making, develop new solutions, and improve care. Organizational Change Management will be prevalent as we continue with new processes, technologies, and organizational restructuring. The pivot from sick care to maintaining and enhancing health and well-being will be a dominant theme. There will be an increased emphasis on establishing more partnerships to improve coordination and eliminate inefficiencies – the value-based enabler partnerships. Everyone is concerned about skyrocketing costs and there will be a far greater voice heard from employers and consumers. Through it all, the importance and absolute need for effective actionable data will be at the center of everything.

For more information on Doctivity can put its analytic data software solution to work for you, visit www.doctivityhealthcom.