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Notes from the 10th Annual Population Health and Disease Management Colloquium

Richard Scott

Dr. Thomas Wilson, founder of the Population Health Impact Institute, also spoke during the morning session. His presentation focused on transitions of care and, like Dr. Wender’s exploration of the medical home model, Dr. Wilson explored the areas of health reform that, despite the proceedings on Capitol Hill, can be addressed without formal legislation.

He also addressed the need for transparency in wellness and population health programs, and the PHI Institute will host a free Webinar on March 11 at 1:00 p.m. to explore this issue. The Webinar, “The Value of Transparency for the Evaluation of Wellness and other Population Health Programs,” will be moderated by Ford’s corporate medical officer, Dr. Walter Talamonti.

Most of the initiatives being sculpted and the areas being addressed in Washington focus on the “demand” side of the health care equation. That is, they revolve around the patient, the patient’s needs, and the organizations and systems that a patient “uses.” Transitions of care, however, sit on the “supply” side of health care; they are part of—and can be addressed by—the various providers of care. Dr. Wilson, who refers to transitions as the “white space” that drifts unacknowledged by any health care provider, stresses the importance of accountability and attribution when it comes to transitions—of both people and information.

“At each point in the transition, there should be an identifiable provider who is accountable,” says Wilson, who works with the National Transitions of Care Coalition, an organization that seeks to address the white space in patient care.

Dr. Wilson’s work also touches on the important area of transparency within health care wellness programs. After his morning session, he spoke with Case In Point Weekly on this topic. The interview is below.

Richard Scott: Regarding health and wellness programs, you talk about the need for transparency. What does transparency mean in this context?

Thomas Wilson: "Transparency" is a hot term these days and can refer to many different things—openness in government, transparency of health care prices, transparency of outcomes, etc. The transparency in the title refers to transparency of methodology used to generate outcomes in wellness and other population health programs.

RS: And why is this notion of transparency so important?

TW: Outcomes by themselves are not meaningful; they exist within a context and that context must be transparent. Different methods can produce different outcomes using even the same data. The methods use must also be transparent—the devil, as they say, is in the details. Same with this.

There is an old George Carlin routine that may illustrate my point. "And here are the baseball scores: 10, 7, 0, 1, 5…" The audience laughs. These scores are not meaningful without the names of the teams associated with each score. By the way, the rules (i.e., the methods) of baseball are transparent; when a team wins we know they and their opponent played by the same rules.

I should say that this is a very limited form of transparency. It only refers to the methods used to make a claim of success. It does not refer to the business processes of the intervention itself. Washing machines, for example, may be constructed via a lot of trade secrets that were used to make them better washing machines. We do not propose transparency of washing machines. However, if we want to know how two different machines compare, we need to use a method that is clear to all. Shirts that are similarly dirty are verified using a generally accepted measurement tool: wash them in each machine, compare dirtiness using the same tool as before, report before-after results, and then compare the effectiveness of each machine.

To put is simply, just like my third grade math teacher: "Show your work."

RS: How does transparency apply to the realm of comparative effectiveness?

TW: Totally. In fact, the generally accepted evaluation principles upon which the rules of transparency are based are based on comparing methods and results in program on to either standard or care, or another program. Just like baseball ... it is essential that the rules used in the comparison are transparent, at least to the two teams playing.

The transparency standards developed by the PHII were compiled in a year long process by a balanced group of stakeholders assembled by the Institute using generally accepted evaluation principles as a guide: The foundation of this is comparison.

RS: Can you talk about your certification and accreditation programs? Whom and what are they for?

TW: The certification program—called the Methods Evaluation Process or MEP™—is for individuals to learn about generally accepted evaluation principles, the transparency checklist, and to apply them to case studies. The course is offered online and in person and is followed by a test.

The accreditation program—called the Healthcare Transparency Accreditation Program or H-TAP™—is for programs within organizations. A program manager follows the transparency standards, in four parts, for their program. Organizational commitment, set-up (defining metrics and the referent/comparator for example), baseline (filling in values for metrics before the program starts), follow-up (filling in program metrics after the program has been implemented).

RS: What else do you and your presenters plan to cover in the March 11 Webinar?

TW: They will talk about the many methodologies used in the market today and the need for a uniform set of principles for which to evaluate those methods. Of course, one cannot evaluate a method unless the basic elements of it are disclosed. In addition, the value of this approach to nonexpert evaluators and the use of the lingo of the transparency standards to help bridge the gap between these two groups will be discussed.

Finally, PHII—as a 501c3 non-profit—has a public service mission to advocate for transparency of methods. Along with four other organizations, last spring the Institute presented a public comment to the federal government on the need to transparency and timely peer-review in federally funded research.

The most important thing that all speakers will focus on is this: PHII has defined transparency, in this narrow realm. The speakers will encourage others to do the same in their area of expertise.

Speaker are Dr. Joe Chimera (the first person to get MEP certified), and Garry Carneal who chaired PHII's standards committee and sits on the Board of Directors.

We look forward to a good discussion lead by the Corporate Medical Director of Ford Motor Company, Dr. Talamonti.