Feature: Microsoft exec speaks about transforming healthcare into a better business

Bill Crounse, MD, senior director of Microsoft healthcare division

Bill Crounse, MD, has been a physician, a broadcaster, the cofounder of a tech startup and is currently the senior director of Microsoft’s healthcare division. He will be speaking this weekend at the annual Harvard Business School Healthcare Conference in Boston, but he stopped by CMIO first to give a preview of his keynote speech.

Health IT has come a long way over the past decade and it has the power to transform the healthcare system to be more efficient, but for that to happen Crounse says that hospitals, providers, payors, vendors and patients need to rethink the way they do business.

Approximately 10 years ago, Crounse started a business that attempted to connect patients with providers via the internet, allowing individuals to see and speak with their physicians without leaving the comfort of their own home.

“Wouldn’t it be great if people were able to sit at their desk, book an appointment with their doctor and see their doctor without ever having to leave their chair?” Crounse asked.

Crounse still believes it was a good idea, but he said that he and his partners were about a decade too early, that the available technology was unable to turn this vision into a reality. That’s changed, Crounse said, pointing to Skype as an example of an effective, easy-to-use video conferencing tool.

“It’s still not perfect, but barriers to the implementation of health IT are no longer about the technology,” he said. “The technology has caught up and is able to meet the needs of the healthcare community. The barriers now are the business models.”

One problem, according to Crounse, is that healthcare systems are too often designed to meet the needs of providers and not the needs of patients. “Hospitals’ customers are really physicians,” he said. “They generate revenue for the hospital and patients are somewhere else down the line.”

Volume-based and pay-per-service reimbursement models, have resulted in a number of inefficiencies within healthcare organizations that other businesses don’t experience, Crounse said. By better aligning the incentives of all healthcare stakeholders, he believes that those inefficiencies will begin to fade and that health IT can be used as a foundation for new, more efficient business models.

Crounse pointed to patient-centered, managed care facilities that incorporate health plans, hospitals, pharmacies and primary care providers as healthcare organizations that have successfully aligned the incentives of stakeholders.

“As a provider in a managed care facility, if I am able to meet my patient’s need with an email, a video visit or a phone call, then I still get paid,” he said. “Patients love it because they’re not taking time off of work, waiting around and doing all the other things we ask them to do.”

“A lot of what we do in healthcare does not need to be done one-on-one in an exam room,” he continued. “There will always be a need for that, but a lot of the transactions can take place outside of that realm.”

Abiding by this model, some organizations have been able to shift up to 40 percent of demand for their services to the virtual world, according to Crounse, and if an organization is able to do that that, then its executive decision-makers can reconsider some costly expenses, such as labor and the maintenance of physical facilities.

While Crounse believes that the healthcare system and healthcare organizations are oriented too much to fit the needs of providers, he also believes that providers need to be involved in health IT development or else it won’t be effective.

“When a healthcare organization is considering any changes that will affect clinical workflow or patient engagement, it really requires a clinical perspective, even if that perspective doesn’t drive the conversation,” he said. “Clinicians aren’t always the best business people, but it’s important to engage them early on because they can make an important contribution. They still hold the keys to the healthcare system.”

Additionally, Crounse warned that healthcare organizations shouldn’t expect health IT on its own to produce drastic improvements in efficiency, saying that he’s spoken with countless healthcare executives who believe they can implement a new health IT and continue about business as usual.

“They’re failing to appreciate that we’re just digitizing information,” he said. “It’s what you do next that counts. The transformation of healthcare will be decided by how health IT is used and we should not think for a minute that once we implement an EHR system that we’re done because that’s not where the value comes from.”

Having worked on health IT implementation in other nations, Crounse is concerned by how far behind the American health system is in terms of health IT, but he is pleased with the federal government’s recent efforts to invest in health IT and he believes that the silver lining is becoming more apparent.

“The good news is that the market is changing,” he said. “We realize that the rising costs, the aging population and the burden of chronic disease–we all know that we have to do something about this.”