Improving the Effective Integration of Technology with Care Delivery

Written by Mark Golombek

The decision of which direction to take at a crossroad will inevitably alter the course and destiny of the journey. Health information tech start-up Clinovations arrived at its own major crossroad recently…
After further investment in order to grow, the decision was made to be acquired by the Advisory Board Company: a global research, technology and consulting firm partnering with more than 230,000 leaders in more than 5,000 organizations across health care and higher education. It has proven to be the best decision that this young company has made thus far. The decision has furthered Clinovations’ mandate to provide strategic, clinical and health IT advisory and management consulting to improve the efficiency, effectiveness and quality of healthcare. Business in Focus spoke with Clinovations CEO and Co-founder Trenor Williams, MD, to learn more.

The company began, in 2007, as a collaboration between chief medical officers, chief medical information officers and other specialists, both federal and commercial, in the Baltimore-Washington metropolitan area. The meeting included the chief medical information officer from the Navy and personnel from the Department of Veterans Affairs, regional health systems and the National Quality Forum. They got together to share experiences and spoke of the challenges and opportunities inherent in what they do.

Trenor was a family doctor who practiced in California and served as a lieutenant in the Navy reserves. The meeting spurred him into action. After leaving Deloitte Consulting in 2008, he formed Clinovations together with Anita Samarth.

“At that time, there were just two of us, and we worked with some of the regional health systems in the DC-Baltimore metro area and started to grow the company little by little. It took two years to get us to five employees, and things started to grow more rapidly from there.”

The goal of Clinovations was to create a clinically-focused consulting firm. It is now a leading healthcare consulting firm with services designed to improve the effectiveness of healthcare. The company offers innovative advisory and management consulting services for health IT. Its strength comes from a diverse selection of clinicians, doctors, nurses, pharmacists, management consultants and IT experts.

Organizations invest hundreds of millions of dollars in technology in an effort to streamline health care and provide information to physicians and caregivers that ideally helps them to make better decisions about patient care. As an organization chooses an electronic heath record, Clinovations can take over by helping during the design process.

“We work as translators and navigators in that space, to help organizations design, implement and optimize that technology in an effort to allow them to deliver better care.”

There are many variables at play, not the least of which are finding the right people and getting the right stakeholders involved in the process. Next comes building a vision of what change is going to look like, making good decisions about how best to use the technologies and integrate them with other strategic initiatives.

“The implementation is like pregnancy. It’s a defined period of time with key milestones, but it has a start and end date. Turning on a switch with an electric health record is like delivery, you need a lot of resources there to make sure that it goes well. After it is on, and you start to optimize, it’s like raising a child, and you do that for a lifetime.”

Clinovations helps organizations through that ongoing journey of utilizing resources, people and technologies and continuing to improve through that process.

Return on investment is not just about the money, but also clinical, financial and operational return. Clinical outcomes, operational performance and efficiency are all affected by the acceleration and use of technology. Up to now, very few had actually optimized clinical workflow or the delegation of responsibilities.

A doctor can feel like a data entry clerk some of the time. What Clinovations has done to mitigate this is to use the new technologies to delegate responsibilities for a broader care team and improve the productivity while allowing people to do what they do best.

For hiring, Clinovations is fortunate to have a dedicated team to rely on, and with the acquisition by the Advisory Board, resources have been further expanded. It is an unusual model in the industry as half of Clinovations’ employees and contractors are physicians.

“It is a combination of us identifying and finding people around the country with specific population, health, analytics or electronic health record expertise. We also get a lot of incoming referrals from friends, health systems that we work with, vendors and partners that have identified positions they think might be a good fit.”

On the management consulting side, it possesses some unbelievable young talent right out of top tier colleges or masters level programs that it trains to become part of the team. It also attracts experienced consultants from the top consulting firms around the country.

“We’ve given them an opportunity to spread their wings and take on broader responsibilities with clients. That’s one of the advantages of a growing smaller company compared to some of the multinationals.”

Trenor recognizes that growth has to be managed well. The most important thing is to grow and maintain excellence in service for the health systems and life science companies with which it works. Optimization is the key here.

In 2008, only five percent of U.S. hospitals had physicians placing orders electronically and that number crested the 70 percent mark by the first quarter of 2015, a massive and unprecedented jump as many organizations have invested time and resources to get the system installed.

“We have partnered with electronic health record and analytic vendors to provide these ongoing services. Now that the system is in they need to know how to redesign the workflow, the governance and how decisions are made in alignment with strategic initiatives.”

Clinovations has developed some products to support reimbursement for services such as annual wellness exams. In 2014, less than 15 percent of the U.S. Medicare population currently gets this exam. “With the Affordable Care Act, there is great opportunity.”

The Centers for Medicare and Medicaid Services want Medicare patients to have access to a yearly wellness exam. Clinovations’ technologically optimized solution changes the workload and delegates responsibilities to a broader care team, creating an organizational vision. It is allowing organizations to increase services from less than 10 percent to close to 80 percent of Medicare patients. That drives clinical value, better outcomes and a more positive patient engagement and experience.

An unforeseen outcome of this work is that it allows the health system to create capabilities for population health in a fee-for-service world. Clinovations has had a great response from health systems around the country with solutions like this. Therefore it is expanding its footprint pretty significantly in that area.

Clinovations is also working in the area of life sciences. Healthcare technology has created new opportunities for the life science companies to think about how to explore partnerships in the system. “I think one of the things that we’ve done, still on the theme of being a translator and navigator, is to support leading life science companies and leading health systems around non-branded, but quality, improvement projects for specific patient populations.”

One of its current projects focuses on patients who have irregular heartbeats. It is known that from an evidence-based standpoint these patients should have their blood thinned to reduce the chance of stroke. Clinovations is working to create the tools inside a health system’s electronic health record to capture that patient population and then redesign the clinical decision support for health providers. This will be done at the point of care to allow them to use evidence-based and standardized risk space scoring for those patients so they can make better, more informed clinical decisions. Reporting will then be tracked to improve the capabilities for the entire organization.

Another project involves the healthcare safety net system in the U.S. It is in the midst of an electronic health record implementation and Clinovations is getting the chance to partner by placing several interim leaders on the project for the next fifteen months to help support the organization and their mission.

When Trenor thinks back to about a year ago, his company was thinking about investment and not acquisition. It was fortunate to be only a mile away from the Advisory Board. “We actually have some friends there and former Advisory Board team members that are on our team. We transitioned from a conversation with them about investments to acquisition. Being in the service industry, we don’t have a technology and we don’t sell widgets. We are a people company, so the most important thing was the cultural fit. We were fortunate that it was the easiest box for us to check.”

Clinovations wanted to go to an organization that could have impact, and the Advisory Board is that. Trenor is really proud of the work his company has done and wanted to make sure that it could fit in and complements what the Advisory Board does.

Another advantage to the acquisition was in gaining access to health system leaders around the country. “There is nobody better that partners with more than 75 percent of the hospitals in the U.S… Almost five months in and it is such a reality! We have more opportunities to have higher level conversations with the CEOs and COOs and Chief Strategy Officers for some of the leading health systems around the country than ever before. It’s been a great opportunity to share the work that we do – the value that we bring – and it has worked out even better than I would have thought and I had pretty high expectations coming in!”



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