Doral Davis-Jacobsen and I met at a Healthcare Financial Management Association conference, and I have to say she’s as impressive professionally as she is friendly and warm as a person. Here’s a little bit on her background and why we decided to feature her accomplishments and opinion on our blog:
Doral Davis-Jacobsen, MBA, FACMPE is CEO of Prosper Beyond, Inc., a specialized healthcare consulting firm nestled in beautiful Asheville, North Carolina. Doral is a seasoned healthcare consultant with over 20 years of experience serving healthcare providers ranging from solo practitioners to large academic medical centers. She is a popular speaker and author, always looking around the corner to help her clients prepare for 'what's next.' Doral is known for assisting practices with next generation managed care contract negotiations, revenue cycle and payment reform. She is a Fellow in the American College of Medical Practice Executives. Doral graduated from Florida Atlantic University with a bachelor's in health services and obtained her master's in business administration from Webster University in Denver, Colorado. Doral has authored numerous articles on medical practice revenue cycles, managed care contracting, and payment reform. She is also a frequent speaker at national, regional and local healthcare forums.
I hope you enjoy this blog and hearing from Doral.
Amber Winkler, Clarify CEO
Why healthcare? You could have chosen any industry, and you chose one of the most complicated niches, healthcare.
Well, my mom is a nurse and my father a scientist so I guess growing up with those kinds of influences was a primer for me. I didn’t plan to stay in this industry for long. I thought I would try it out for a year or two and move on. As it turns out, I really like a puzzle and the business of healthcare reminds me of an M.C. Escher drawing - sometimes you have to turn it upside down to figure it out. I am passionate about simplifying the complicated, and the healthcare industry serves up those challenges every day.
You have a very interesting and impressive resume. Can you tell us about your career path and how you got to your current position?
I started out answering phones at what is now one of the largest independent medical practices in the country. I remember picking EOBs out of the trash can, working the denials, and watching the claims get paid. It was amazing to experience the unnecessary headaches providers had to go through to be paid. I moved over to the insurance industry to see how those dots connected, and to learn about network development and managed care contract negotiations. From the other side of the fence, it was a lot like looking up while standing under a waterfall. The complexity of processing claims, utilization review, rate loading, legacy systems, products and employers was staggering. I gained an appreciation from that perspective and learned a lot about what really goes on at the payer (and it’s not all evil- tons of talented folks in many ways ‘stuck’ in a broken wheel).
While on the payer side I had the good fortune to work on a large scale international IT project and developed an appreciation for what it takes to build a program - from pulling it out of our ‘business’ brains to application development. I moved across the country from South Florida to Colorado and ran a high risk OB clinic at CU for a short while. In contrast to back end billing (job #1) the front end was an entirely different bucket of worms and I learned a lot about the vast differences in skill sets and competencies necessary to manage a practice - soup to nuts.
I took a financial analyst job with a group of IPAs (which eventually evolved into an Administrator role) after my stint at the practice and spent several years learning all about risk contracting, CINs/IPAs, financial analyses, provider relations and so much more. I met the person who has been one of my most influential mentors at that gig, and her friendship and mentoring has made a profound impact on my career - always offering up the perfect mix advice and support for me. I took a little break when I started my family and began consulting part time for a small regional firm in Asheville, North Carolina. Over time, I consulted with all types of providers: small solo practices, large academic institutions, critical access hospitals, large group practices...you name it. If there was a ‘physician’ in the scope of work, I was involved. I developed a great love for consulting and realized that my many different experiences and propensity for simplifying the complex added quantifiable value for clients. Through the years I developed a huge network of colleagues in the physician consulting space, and we were constantly exchanging ideas as this industry continues to reinvent itself. Today, I am launching a specialty consulting firm: Prosper Beyond, Inc. focused on assisting providers with navigating the business of healthcare (managed care contracting/revenue cycle/MACRA) and I have never been so energized and excited to serve!
How did you get involved in researching MACRA and Alternative Payment Models (APMs)?
While plugging away at writing a book on APMs: ‘Getting from Here to There: Transitioning to Alternative Payment Models’ we (my writing partner Nanci Robertson and I) saw that this subject matter was absolutely connected to payment reform. The evolution of managed care contracting, the ACA, MACRA, APMs, MIPS, HCPLAN all point in a similar direction in terms of framework and drivers. I began a ritual of daily reading, digesting, and synthesizing this information in order to incorporate it into the book and to better serve clients. Frankly, I believe that really good consultants know their stuff and that is exactly who I want to be. The best way to learn is to teach the material, and teaching myself was the catalyst to my MACRA & APM involvement.
What are some of the misconceptions people have about MACRA and APMs?
The most surprising element is how many providers (about 50% according to Modern Healthcare) are not aware that any of this is in play. I’m sure this will continue to shift but the timelines are right in front of us now - frightening.
In terms of MACRA, I continue to hear that folks believe it may not apply to them or that they are sure that they are ‘safe’ in an APM. Essentially, this tipping point for providers has hit the ground. The vast majority of clinicians are in a ‘risk’ contract for traditional Medicare, and the performance period starts in a few months. There is a misconception about APMs being ‘safe.’ The risk has shifted, but the work of transformation still needs to be done and physicians are truly the key in APM performance. APMs will require similar reporting requirements to MIPS, so there is no ‘get out of jail free’ card with APMs. Additionally, not all APMs are considered “Advanced” according to MACRA, and this has many providers confused.
In regards to patient-centered medical home (PCMH), some of my clients believe PCMH Recognition automatically qualifies as an Advanced APM. This is confusing. If certain requirements are met (which are super convoluted) PCMH may qualify in the future but not out of the gate (awaiting final rule clarification). However, if your practice is PCMH you get full points in the clinical practice improvement activities category under MIPS which will be great for scoring (which is also tied to money), and also the pure ‘halo’ effect of the transformational culture of PCMH should help practices do better in MIPS and APMs (advanced and otherwise). One more thing - being PCMH could help you enter Advanced APMs such as CPC+ in certain areas of the country.
Finally, most believe this is just about physicians. It is not and you can read more about the far reaching impact to hospitals, health systems, and more in this article: http://www.hfma.org/MACRAquality/
What is your best advice for healthcare organizations in regards to preparing for APMs?
Do not delay in charting your course. Providers who actively seek to understand how to manage MIPS and carve paths to explore APMs with payers will be advantaged. Also, make sure that you educate your teams regarding the implications of MACRA and understand how it connects to current programs. It behoves practices to take a good look at current performance in the Value Modifier program and at Quality and Resource Use Reports (QRUR). If you are not sure where to start, get some help - it will be worth it in the long run.
We would love your honest opinion on this. Do you believe that MACRA is here to stay or is it just another initiative that will last 3 years or less?
I’m not sure if MACRA is here to stay, but I am sure that healthcare reform is here for the long haul. We can't sustain the misalignment in our system and the fundamental incentives need to change completely. I am excited about what this transformation could mean for our future... let me share a personal story:
When my daughter was two, we noticed that her eyes looked a little crossed. We took her to her pediatrician who quickly dismissed it, but a mother's gut is never wrong. I took her to a pediatric ophthalmologist who told me she had "intermittent extropia strabismus," and the physician announced she would need 4 surgeries over the course of several years to correct the condition. We elected to search for other less invasive treatment possibilities and found that vision therapy might be worth exploring. Long story short, with a string and a ball we worked with her over a period of years, and today at age 16 it is very rare to see evidence that this was ever an issue for her. Guessing the total cost of her care would have been $250k or more, not to mention the discomfort/risk/stress of the surgeries.
I understand why the recommendation for surgery was made and how these levers work. I also understand why the less invasive option was never mentioned and I hope that someday my children's children will be offered the string and the ball first. That is what I hope healthcare reform achieves.
What is something that bothers you about the healthcare industry?
We tend to ‘over complicate’ things in this industry. There are many competing priorities and the love for the ‘simple’ is hard to find.
We see you were awarded the Fellow in the American College of Medical Practice Executives 2013 award. Congratulations! What work led to that award?
I wanted to learn all about value based contracting, so what better way than to write a gigantic paper?! I’m the kind of person that needs to really understand a subject from the inside out and writing this paper helped me accomplish this goal.
What are your favorite things to do when you’re not working?
I love to hang out with my husband and kids (this is #1). I also enjoy, yoga, clogging, adventures with my Girl Scout Troop, and travel (for fun not work - a HUGE difference there).
Pancakes or Waffles?
I go either way really - but I must say I do like a little chicken with my waffles...
I see you have been involved in Girl Scouting for a while - why?
I’m super passionate about mentoring our youngins.’ I believe that it’s important for our kids to have a place to go to talk about issues and explore who they are and who they might become. Girl Scouting is a nice framework to help girls get out of their comfort zone, talk with each other, take risks, and try new things. There have been some unexpected twist and turns though. One time at a meeting a few years ago we made collages of what ‘empowerment’ meant and asked a bunch of questions around the table. We went around asking “do you think a woman could be president?” and of the 10 or so girls there, all but one had a resounding ‘yes, of course’, but one girl said ‘no’ - she did not think this was possible. Flashbulb memory for me, my heart sank and the silence was so loud. A million questions raced through my mind: What messages was she getting about herself from those close to her? What experiences did she have (she was only 12) that would lead her to reach this conclusion? And most importantly, was it possible to help her challenge that idea and begin to fathom the possibilities beyond the ‘gates’ that she saw around herself? While I’m not sure how these girls would answer this question today, there is an indication that this question and the idea of a female president may not be so crazy, right? By the way, I only planned to be a Girl Scout leader for one year. It was definitely not my plan to do this as a long term thing. But I have had the good fortune to continue my relationships with my girls/families for well over a decade now. It’s my hope and it makes me happy to feel that I’ve made a difference in some of their lives.
To get in touch with Doral, you can connect with her on LinkedIn or email her at email@example.com.