Nicole Fetter is a Director in the Healthcare Services practice. She trained as an Orthopedic Surgeon and has experience in population health, physician alignment, value-based care models, orthopedic surgery, OR operations improvement, and health system strategic growth. Nicole has worked with a wide variety of healthcare providers including academic medical centers, community hospitals, large for-profit health systems and not-for-profit health systems. She has worked with health systems to assess, build and implement capabilities to support value-based care.
What were some of the reasons that influenced your move from clinical care as a surgeon to the consulting side of healthcare?
My decision to leave practice and enter consulting was based on two primary factors. The first was that I saw the entire healthcare landscape starting to change. The ACA had just been passed and there was a lot of discussion about how healthcare could be improved across the industry; the more I learned about potential changes, the more interested I became in helping shape that change beyond my day-to-day practice. At the same time, as a practicing physician, I experienced the challenges encountered in a clinical setting and the mounting “asks” being placed on physicians. It often felt that there was a wide gap in understanding between administration and physicians. In consulting, I see the opportunity to help bridge the gap between practice and change. I understand what frustrates clinicians but can also understand how certain changes can influence how healthcare is delivered. I love that my current work allows me to help facilitate that communication in order to establish better alignment.
What is the biggest change you’ve seen in healthcare throughout your career?
The movement of care outside of the hospital – which is taking multiple forms. Many surgical cases are being done outpatient now that never would have been considered for outpatient 10 years ago (ex: total hips, PCI). With the shift to value, there is also increased focus on keeping patients with chronic conditions out of the ER and hospital. We see a transitioning of hospital-based services, such as infusions, to the outpatient space as well. The hospital used to be the focus of health services and delivery, but that is rapidly changing and from this change we are seeing hospital systems attempt to build out / accommodate those changes in an effort to stay relevant.
What are some lessons you’ve seen working with clients from all industries in healthcare?
I would have to say the three biggest lessons are: Change takes time, you have to start somewhere, and communicate “smartly.”
Change takes time – transitioning from fee-for-service (FFS) to fee-for-value (FFV) is a significant change. It means changing how clinicians support patients, how hospitals view their role in treatment of acutely ill patients and discharge planning, how hospitals have to start taking on roles traditionally held by payers, how payers reimburse providers, and how pharma and medical device companies interact with their customers. You can’t “flip the switch” and expect people to change their processes and points of view overnight. It’s important for organizations to set reasonable expectations. They should see meaningful impact on very focused KPIs in a short time if pilots are appropriately structured, however, establishing a strategic timeline and when impact is anticipated is an important exercise that many organizations do not under go.
This leads to the 2nd lesson: You have to start somewhere. Many organizations get paralyzed in data analysis or wanting a plan to be perfect before they begin. You’ll never get anywhere meaningful with that approach. It’s important to be data-driven, but once you’ve validated your assumptions, it’s important to launch a plan. It will NEVER be perfect – but you won’t learn lessons and figure out what you need to do differently until you start.
In general, I think you can’t overcommunicate about change or transitioning from FFS to FFV. Stakeholders are often at different stages of education and understanding. However, I also think organizations have a tendency to communicate to physicians in the same method that they communicate to other stakeholders; I think it is more effective to meet physicians where they are at. If several critical physicians don’t come to department meetings, then meet them in their office or in the OR between cases. Ensure that written communication is brief and clearly states the key takeaways and asks up front. Provide additional detail at the end or as attachments for those who are interested but don’t bury the main points within a long email – as I guarantee the doctors will not read far enough in to find them!
Data to measure outcomes, costs, and value, seem to be central to the value-based care equation. What are the biggest challenges in the use of data in VBC?
Data is the lynchpin of work in healthcare, yet continues to be our biggest challenge. There isn’t a lack of data — there’s generally too much data — but very rarely is it actionable or meaningful. The issue becomes: How do you pull data from many different and often siloed sources and create a single source of truth that clearly outlines actionable opportunities? Outcomes measures are challenged by the timeframe to show impact combined with a lack of standardized measures such that different payers, providers, and other stakeholders do not always align on a small set of measures that are meaningful and easily measured. Cost accounting systems used by hospitals make it incredibly difficult to truly define the cost of a given test, procedure, or admission. Hospitals may not know how to ingest post-adjudicated payors’ claims data and even if they do, many payors won’t release full claims data due to concerns about inadvertently providing competitor pricing information. In addition, the definitions of costs vary drastically across healthcare depending on the stakeholder: hospital, physician, payor, patient, employer. Blockchain data presents some interesting possibilities to create a truly comprehensive, longitudinal medical record for patients and their providers, however, it is in the early stages. I think we are better than where we were previously but there is still a significant path left to unlock the full potential related to using data to help optimize care in VBC.
Why is Medical Alley the place to solve the value-based care problem?
Medical Alley represents a distinctive environment which includes a vast array of healthcare stakeholders including pharmaceutical companies, medical device companies, health insurers, and healthcare providers. Therefore, this group is uniquely positioned to innovate around problems facing the healthcare industry as a whole – each bringing their individual perspectives and strengths to the table, which has the potential to result in creative, out-of-the-box ingenuity that could transform healthcare.
What is one thing, other than time or money, you wish you had more of?
Pasta – and the metabolism to allow me to eat it all.