By skyforbes 
Earlier this year, Tincture spoke with Acting Administrator at Centers for Medicare and Medicaid Services (CMS), Andy Slavitt. Below is the first transcribed portion of the conversation between Andy and Dr. Jordan Shlain, Tincture’s founder and editor-in-chief. It has been edited for clarity. (This is the final part of a series —see here for part one and part two.)
Jordan Shlain: I’m out here in Silicon Valley. And there are hundreds of startups all over the place — all these entrepreneurs trying to land pilot programs at hospitals and clinics. And now, a few years into the Affordable Care Act and Meaningful Use, there’s all of a sudden this entirely new program for physicians to react to.
There’s something called the ‘Valley of Death’ for startups; I wonder if, given the timeline and scale of the program, will MACRA make the ‘Valley of Death’ into the ‘Grand Canyon of Death?’ How should a young company be thinking about building things for this unknown world?
Andy Slavitt: Absolutely not. This should be the beginning of a much-needed cycle of innovation. The only way true innovation happens is for the innovators to get a crisp understanding of users, and what kinds of problems there are to solve. I think where we have been actually, is that most of the tech and software firms have had to design products to meet the regulatory needs of things like Meaningful Use. You may have as an entrepreneur or software company — put so much time into your roadmap to meet these regulatory requirements that you’ve had very little time left to innovate.
I think the single most important thing we can do to spur innovation is the opening of APIs and the elimination of data barriers. We need to allow new companies to offer technology that eliminates what you call “desktop lock.” Physicians have had to make decisions about their electronic medical records — which is a record keeping system, not really a workflow system. And that decision, and because there was no requirement for an open API layer, it left physicians locked in, saying, “Well, this is the technology that I have — if the vendor’s not going to innovate for me, I can’t move data in and out of other applications. So there is an enormous opportunity to do that.
The other things that will spur this change is that we will have so much more flexibility in the types of programs and types of measures that physicians select. This will give clues to innovative companies on what the market’s real needs are. For example, if a physician selects to be in a certain type of medical home model, it’ll be very clear that care coordination and patient outreach are going to be vital to their success. This should have the effect of creating new markets for innovators.
Jordan: We keep on talking about the patient, and there’s also been a lot of talk about the consumer. You said a while back “we need to make healthcare more like a retail experience.” Retail always involves the consumer. But the retail world wants to make the experience great so you buy something. And I’ve never seen a consumer in the ICU. I’ve never seen the consumer in the hospital. These are patients — I appreciate you calling them patients in this context.
Andy: Yeah, well the “consumer” context for me is when they’re buying insurance. That’s when I want them to be the most empowered consumers they can be. But when they walk through a physician’s door, they’re very different people than who they were when they’re pulling up in the parking lot.
Jordan: That’s right — I think they’re much more anxious. I think of the patient as an anxiety model, where anxiety underpins their logic; whereas the consumer has an excitement model, where they have free choice, free will — as a patient, you don’t have a lot of choices, and you have tethered will.
Jordan: I have a question for you about your use of social media, if I may. Given that we’re entering this new realm of communication, I think it’s a breath of fresh air that you’re tweeting so much. And you are genuinely tweeting yourself, tweeting your own thoughts. It puts a face to this big impersonal institution called “CMS.” I wonder how your colleagues in the beltway, physicians and patients, and the community at large — how they react to your embrace of social media.
Andy: Well, let’s look at what we’re trying to do. What we’re trying to do is move rapidly away from a model where people feel like there is a black box that is disconnected from the realities of day-to-day patient care. The fears and the vulnerability that people feel when they’re a part of the healthcare system, and quite frankly, the frustration that you feel when you feel like someone far away is deciding the rules of how you operate or the test you’re trying to teach to.
Now the reality is: The work gets done at our agency — at 10 regions around the country. In the course of rolling out the quality payment program, we have quite literally had tens of thousands of interactions with physicians through webinars, through learning sessions, through other means. We’ve created all kinds of dynamic feedback loops — white boards, online presentations, conference calls, seeking a massive amount of inputs. In many respects, what you see me doing in social media, we should be seeing others do on social media: Putting up the aperture so that we can be better at listening, and that people can see that we’re listening.
There are times as a leader when you want to motivate your team with inspiration and vision. There are other times when the best motivation they can get is to hear their critics as directly and loudly and clearly as possible. I think that’s a vital part of where we want to be. Social media can help. I also just got back from visiting in person with a number of smaller practices and large practices around the country — as many of my colleagues have done as well. Whether you like CMS or not, and many do not — we’re a vital partner in helping patients and physicians get to where they need to get.
Jordan: This is so important — I wish more people would take your cue and get active on social media. Today’s it’s like having a relationship with a black box — how we make it transparent?
Andy: That’s why this conversation really does help. We want to expand access for people through more means to engage and ultimately to participate. When you put together and implement a law or a regulation, you can’t possibly think of every consequence — intended or unintended — that comes out of the work that you’re doing. The only way you can get higher levels of assurance, optimize the levels of comfort for physicians while minimizing the negative consequences — is with feedback, with interaction. So it’s very important to us that physicians, clinicians, patients, innovators, others, give us comments and feedback.