From 3M Health Information Systems
Meet our newest Inside Angle podcast host: Clark Cameron
We are excited to welcome our new podcast host Clark Cameron, director of payer commercialization at 3M Health Information Systems. Read more about Clark’s background and expertise, including what topics he will be covering on the podcast.
What is your history at 3M?
I joined 3M HIS in 2014. Prior to that I spent nearly 20 years working with Optum, UnitedHealth Group and Blue Cross Blue Shield of Alabama. My background is rooted in health care finance and health care software. My good friend and retired 3Mer Kurt Price hired me at 3M to help build out and grow our payer business. I worked with our 3M HIS strategy team for five years, then moved over to Megan Carr’s regulatory and payer solutions team to lead payer strategy and commercialization efforts. For several years, I also published an internal industry news email called the 3M HIS Daily Dose.
Can you give us some background on the history of methodologies at 3M?
The U.S. health care payment transformation story began in 1965 with the creation of Medicare and Medicaid. These entities played a crucial role in shaping the industry’s payment approaches and payment tools. From the mid-1960s to the early 1980s, Medicare and Medicaid reimbursed health care providers a percentage of the charges those providers submitted. Essentially, the more services providers conducted, the more they were paid, creating a perverse incentive structure, which continues to persist.
To counter this trend and the unsustainable health care costs associated with it, Medicare adopted a prospective payment approach called diagnosis related groups (DRGs). A team of health care economists from Yale created the DRGs, which were adopted by Medicare in 1983. Instead of using percentage-based payments, hospitals began receiving a fixed fee for each case or admission. This fee was determined by assigning each patient to a diagnosis-related group of similar patients. Each DRG had an associated price, and hospitals were paid accordingly. Although hospitals might experience loss or gain on a case-by-case basis, the DRG system was designed to balance out, so providers remained financially whole based on the cases they handled.
This prospective payment approach was later extended to outpatient care as well in the form of ambulatory patient classifications (APCs). The DRG and APC methodologies were designed for Medicare populations, or primarily patients over the age of 65. During the 1980s, some of those Yale health care economists led 3M’s effort to dramatically improve the Medicare DRGs and Medicare APCs, accounting for patients of all ages, which is more appropriate for state Medicaid and commercial health plans populations. 3M™ All Patient Refined DRGs (APR DRGs) and 3M™ Enhanced Ambulatory Patient Groupings (EAPGs) are 3M’s answers to Medicare DRGs and APCs, respectively. Today both 3M APR-DRGs and 3M EAPGs enjoy wide adoption among state Medicaid programs, hospital systems and commercial health plans.
Over the past 15 years, the health care industry has been slowly shifting from volume-based (fee-for-service) care to value-based (pay for outcomes) care. During that time, 3M has developed a comprehensive suite of powerful, population health risk adjustment and quality measurement methodologies. I could go on with my response for hours, but the short answer to your question is: 3M has been at the center of health care payment transformation for more than 40 years, and we are well-positioned to be at the center of health care’s value-based future.
What does value-based care mean to 3M HIS?
3M HIS’ primary focus is the inpatient hospital space and physician office space. In short, health care providers. And while providers and health plans once sat on opposite sides of the negotiating table, the advent of value-based care changed that dynamic. Increasingly, health plans are purchasing provider practices and health systems are standing up health plans or entering value-based arrangements like Medicare Advantage, Medicaid Managed Care or accountable care organizations (ACOs). What once were battle lines between providers and payers, are now blurred and often disappearing. 3M is in the unique position of having both a dominant provider client footprint and a tremendous portfolio of health care payment methodologies and services built to assist those who manage health care populations. Government and market forces are driving the value-based care agenda forward and 3M has the goods to assist all participants, whether they be providers or payers. Although fee-for-service health care is a stubborn incumbent, value-based health care is a formidable insurgent. It’s the future of health care.
What should listeners expect from your new podcast series?
I have a lot of opinions on the topic of value-based care, so listeners can look forward to in-depth and dynamic discussions. Regarding my guests, listeners will hear the voices, perspectives and ideas of fascinating industry experts, pioneers and change agents who have built their careers around improving health care and driving toward a value-based future.
Listen to Clark’s debut episode, “Looking back and moving forward: The Medicare Inpatient Prospective Payment System.”
Clark Cameron is director of payer commercialization at 3M Health Information Systems.