Health Care and Insurance

Group aims to turn data into better care: Lilly's Larkin joins Health Information Exchange

November 19, 2007

The Indiana Health Information Exchange recently hired Dr. Greg Larkin to be its chief medical officer.

Larkin, who is the longtime head of Eli Lilly and Co.'s employee clinics and health plans, will focus on the exchange's Quality Health First program, which aims to use a local database of doctors' records and insurance claims to help doctors improve their quality of care.

The program includes health insurance plans-such as Anthem, UnitedHealth and Medicare-that cover on average 70 percent of local doctors' patients. The health plans have agreed to pay incentives to doctors who perform best in the program.

Larkin, a former family doctor in Greencastle, will work with smaller physician practices to make use of the Quality Health First information.

He sat down with IBJ's health care reporter, J.K. Wall, to discuss his new job. What follows is an edited version of that interview.

IBJ: Why did you decide to take this job?

LARKIN: It's a national demonstration that's going on here. It is truly a topshelf program. It's one of six in the country. It's probably the only one that's doing things the way we're doing it. The planets have aligned favorably (in Indianapolis) on this particular concept.

IBJ: Quality Health First is essentially a pay-for-performance program, where it promises higher pay for doctors who do the best job of making the right medical calls for their patients. How is Quality Health First different from the numerous performance programs now run by health insurers?

LARKIN: There is pay for performance where you measure performance purely on efficiency. So basically, you're saying, "We'll pay you more if you're a cheaper practice." That has nothing to do with the cost. ... The Quality Health First pay-for-performance is truly paid against improved clinical outcomes, which is really why we all signed up [to be doctors].

IBJ: How far back does your interest go in using computers to make health care more efficient?

LARKIN: I'm not a nerd, but ... I had the first Apple in my practice. In fact, I had the right to program. I mean, it was Basic, [but] you could write something. So I customized it so I could put my office charts on it. ... At Lilly, we've had electronic medical records in our department since '93. You kind of learn this really can bring efficiency to care.

IBJ: It seems like this new job is a continuation of things you've already been doing. Do you think that experience, using computers in your physician practice, will help you as you go around to physicians?

LARKIN: It might. But the success of Quality Health First will not be built on the success of electronic medical records. Even if [physicians] don't have electronic medical records, there'll be ways to expedite the entrance of that [blood pressure] reading. Perhaps he or she can go into a Web site and put in the blood pressure. Or they can put it on a special coded fax and send it in.

IBJ: Describe how you plan to take the information in the Quality Health First database and deliver it to physicians, particularly to those in small practices.

LARKIN: We're creating a team of nurse liaisons who are particularly skilled in helping explain and deliver data and going out to the smaller practices. We take the Quality Health First information to the smaller offices, help interpret what that information means, as well as have some transfer of best practices that would help the [doctors] that aren't performing as well as they can, do so.

IBJ: Do you think you'll have major hurdles to surmount to get doctors to change the way they run their practices?

LARKIN: I was in practice. Once you start chopping wood in a small practice, you hardly take any time to sharpen the ax because you're so darn busy chopping wood. And you really don't want to change unless you really feel the patients' health will really be improved even if you did change.

However, if there are some [doctors] that are clearly doing something better, we want to learn from them and take it to the other practices and say, "If you code your chart with a sticker that says he's diabetic, you're more likely to think about having a retina exam. That's what this doctor did. This is how they got such high margins."

The smaller piece is how to help the small practice. One [thing to do] is to have them understand that this is truly a good program. It's credible, it's independent, it's designed by physicians. The payout is more than a dinner: it could be as much as $10,000 to $20,000 a year, depending on the program, and it's worth understanding.
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