Talking Build vs. Buy and AI in Value-Based Care with Daniel Guerra of ChenMed

This is part of our weekly executive insights series where Elion CEO Bobby Guelich speaks with healthcare leaders about their tech priorities and learnings. For more, become a member and sign up for our email here.

Name: Daniel Guerra

Role: CMIO

Organization: ChenMed

I understand ChenMed historically has a bias toward building solutions over buying. Can you tell me more about that?

Our emphasis on PCP-led care is fundamental to our approach at ChenMed. This philosophy influences everything we do, including the development of our EHR. Maintaining a low patient panel for our doctors, around 400-450 patients per doctor, with monthly appointments, allows us to foster strong doctor-patient relationships and focus on purpose-driven care. This approach necessitates tools that empower our PCPs, which is why we’ve chosen to build our EHR in-house. By doing so, we can ensure that our technology aligns perfectly with our care model and supports the delivery of high-quality, personalized care.

For example, we think that the digital scribe category is a little overhyped, at least on the value-based care side of things. Our notes are different. We’re not building for coding and trying to capture an increasing level of services. We want to make sure that our notes are simple and, at the end of the day, improve clinical outcomes. What we’ve seen is that digital scribes will take as much work to review the output as actually creating the content with our small patient panel and frequent visits.

It’s interesting to me that you actually find it takes as much work to review the output of these solutions.

With our homegrown system, we have built a lot into the physician workflow. We’re accountable for the clinical outcomes of the patient, so our behavioral nudges have to make sure that we emphasize making it easier to do the right thing and harder to do the wrong thing for our patients. With the digital scribes, you tend to lose a lot of those behavioral nudges that we have incorporated within the workflow.

Any specific lessons learned from building in-house?

Two big ones: One lesson is not neglecting the user experience. As a provider, when it comes to these nudges overlaid on the EHR, it’s hard when you have a whole bunch of noise and you don’t know what the signal is. When you have many overlays on the EHR, you tend to lose physician engagement and trust.

Within ChenMed, we have a PCP tech group of physicians at the point of care that give us continuous feedback. They’re accountable for the end-to-end care, so they’re always telling me, “Hey, this is what I need to make it easier for me to take care of my patients.” So getting them engaged and getting that feedback loop is probably the most important thing for us.

The second biggest learning from building a homegrown system is the importance of getting alignment, especially across teams in the organization. Between finance, product development, analytics, and clinical, we need to make sure we’re all aligned on making the right improvements to physician workflows. If we just focus on the tech, we will make a bad workflow faster. So we have to work hard to make sure we’re working on the right solutions, and not just throwing tech behind everything as a silver bullet.

What are some of your key tech-related priorities for the rest of 2024 and then 2025?

For the provider side, it’s really standardizing our care. We’ve grown fast over the last couple of years. We’re focused on tools that will ensure all our patients have individualized care plans while enhancing the provider experience.

Is that something you’re potentially looking at from an AI or generative AI perspective?

Yes, specifically looking at patients’ old referral history, looking at their localization history, and helping us understand their risk profile.

Are there any areas where you’re explicitly looking at external solutions?

Patient access. We take care of the old, the poor, and the sick, so we want to make sure that we simplify their access to care as much as possible. There are many existing solutions out there to help with doing that effectively.