Highlights from Day 1 of 2017 AHIP National Health Policy Conference

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The 2017 AHIP National Health Policy Conference kicked off today in Washington, DC.

Political, business, and health care leaders from across the nation gathered to dive deeply into our nation’s top policy priorities in an effort to move forward in today’s uncertain healthcare environment.

What a period for healthcare reform in the United States!

In addition to some general comments about healthcare policy and politics, today’s sessions addressed topics such as the following:

  • Risk-sharing and Cost Control
  • Value-based Care
  • Pharmacy Costs
  • Medicaid Exchanges
  • Importance of Social Determinants of Health

Social shares from conference attendees

As is happening more and more at many of today’s top healthcare conferences, conference proceedings, insights and other information were shared on Twitter – among other social channels. Here’s a sample of some interesting shares from Day 1 of the 2017 AHIP National Health Policy Conference.

Thanks to all those noted below who took the time to share with those who were unable to attend the conference.

General Stuff

Handle Tweet
@ajmc_journal There’s still a basic misunderstanding of how health insurance works, says @AHIPCoverage’s Tavenner
@rpalme01 @MD_Insurance @al_redmer ACA “status quo is not an option, status quo is not a solution”  #ACA
@nancyrwise Newt Gingrich sure that SOME bill will be passed this session…  but no direction on what it will include.  #AHCA
@nancyrwise T. Nickel, thank you: “Association Health Plans are awesome… until they are not”  @NAIC_News

Cost of Healthcare & Risk-Sharing

Handle Tweet
@ajmc_journal The only cost containment strategy that works is cost sharing but it can be such a burden that it takes care away–@chipkahn
@avercloud Healthcare payers: Make the move from pilot to full-scale bundled payment adoption. Let’s discuss at #AHIPPolicy
@leah_a_brown The discussion a few years ago was about coverage, now healthcare 2.0 is about cost.
@mahphealth Good point by MD Comm. Al Redmer Jr on NAIC panel Can’t do anything on premiums unless moderate cost of delivering #healthcare
@nancyrwise Great quote: “Pay for value = transferring risk to providers.” M. Chernew
@nancyrwise If health orgs are bigger & more integrated, they are better positioned to own market power: unlikely to lower costs. M. Chernew
@suemontgomery2 Cost of premiums is all about the cost of delivering care. – Ted Nickel at #AHIPPolicy

Value-based Care & Reimbursement

Handle Tweet
@ahipcoverage Consumers want affordable coverage & high-quality care – that’s what value-based care delivers.
@avercloud Debate the policy, but value-based healthcare is here to stay. Let’s discuss bundled payment success at upcoming #AHIPPolicy

Pharmacy

Handle Tweet
@springstex Prescription drug costs pass physician services as biggest slice of health insurance premium
@rpalme01 Keep talking to your local pharmacist and sharing what he tells you.

Medicaid Exchanges, Access & Importance of Social Determinants of Health

Handle Tweet
@ajmc_journal Healthcare reform is a question of access vs true availability. The devil is truly in the details, said @AndyGurmanMD
@nancyrwise Interested in continuing conversations about potential intersection of #Medicaid and Exchange markets in #healthcare #simplicity
@ahipcoverage From transportation, housing & environmental health, plans are addressing social determinants of health

Keep on Top of More Insight on Healthcare Reform

Be sure to follow the Healthcare Executive Group on Twitter, Facebook and LinkedIn where we share insight into the challenges, opportunities and issues facing healthcare executives and others in today’s fast-changing healthcare environment.

Recapping the 2017 HIMSS Conference & Exhibition

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The 2017 HIMSS Conference & Exhibition held last week in Orlando, Florida drew an official 42,287 attendees. With almost 500 educational sessions and nearly 1300 vendors of all sorts of technology products and services, it wasn’t hard to feel overwhelmed and leave the conference thinking that you somehow missed something important and of potential value to your organization.

Thankfully, there’s no shortage of recaps, summaries and post-conference analyses and opinion pieces that can serve to fill in any blanks. It’s just a matter of filtering out the thinly veiled marketing pieces and clearly biased opinion posts. And, as is a growing feature of more and more conferences, a large amount of content like slide decks, video and audio recordings are available.

This post provides a cross-section of articles recapping and summarizing the 2017 HIMSS Conference & Exhibition. These articles are from healthcare advisory firms, industry media, individuals and vendors of healthcare IT products and services. Also included are instructions on how to access any presentation materials that may be available from the HIMSS educational sessions.

Major Themes Align w/ HCEG’s Top Ten List

A quick review of the 20 or so “HIMSS conference summaries” listed below reveals that the major themes of the 2017 HIMSS conference are closely aligned with the 2017 HCEG Top Ten list developed by HCEG members. In fact, with the exception of “uncertainty,” the first four items on HCEG’s top 10 list are among the top five themes at the 2017 HIMSS Conference. And, considering that the HCEG Top 10 List was derived in September of last year prior to the U.S. Presidential election, HCEG members are batting 1000 with their assessment of the top challenges facing the healthcare system in the United States.

hceg hcexecgroup healthcare top 10 healtyhit hitsmTop Themes at 2017 HIMSS Conference

  1. Value-based Care & Reimbursement
  2. Artificial intelligence/Analytics/Machine Learning
  3. Cybersecurity
  4. Consumerism & Patient Engagement
  5. Uncertainty

In regards to the ‘uncertainty’ surrounding healthcare in the United States, Rachel Arndt and Joseph Conn of Modern Healthcare have an interesting article titled “Questions and uncertainty cloud normally sunny HIMSS” that offers the idea that current levels of uncertainty aren’t just due to the presidential election but also exacerbated by vagaries in the 21st Century Cures Act and complexities associated with precision medicine, genomics and the demands for interoperability.

HIMSS Conference Summaries & Recaps

Industry Advisory Firms

“HIMSS17: Little Less Hype, More Focus on Value” – Chilmark Research

“Heard at HIMSS 2017” – Oliver Wyman

“Insights from HIMSS 2017” – Greyhealth Group

Industry Media Outlets

“What issues dominated HIMSS17? We asked, you answered” – Becker’s Health IT & CIO Review

“Emerging trends at HIMSS—focusing on practical uses of IT” – Health Data Management

“HIMSS 2017 buzz ranges from patient engagement to AI, machine learning” – Search HealthIT

“HIMSS17: How tech tools can aim for better patient experience” – HealthcareDIVE

“12 top technology trends from HIMSS17” – Health Data Management

“HIMSS 2017: Telehealth, remote monitoring and home care help providers meet patients where they are” – FierceHealthcare

“A look back at HIMSS17: Most impactful insights from thought leaders in Orlando” – Healthcare IT News

Individuals

“Machine learning is the new ‘plastics’ and four more HIMSS17 observations” – Dr. John Halamka

“HIMSS17 Recap: AI Disruption in Patient Experience and Beyond” – Senem Guney

“Things I learned at HIMSS17” – Neil Versel

Vendors (Who aren’t being too ‘salesy’)

“Reflections on HIMSS 2017: Same Same, but Different” – Datica

“The Hottest Topics at HIMSS17” – Spok

“3 Takeaways from HIMSS17” – Dimensional Insight

“HIMSS 2017 Top 10 Themes and Highlights” – Kinvey

Interesting Video & Audio Clips from HIMSS17

Ginni Rometty Keynote at HIMSS 2017 – From IBM

HIMSS17: Full Event Highlights – HIMSS Media

“Episode 12: Bonus – HIMSS 2017 Insights and Recap, Part 1” – HealthBox

Accessing Conference Presentation Materials

If a specific educational session had any handouts available and if the presenter(s) gave permission, then HIMSS has made the handouts available for download – whether you attended the conference or not. To access handouts from a specific session, use this link to search for a specific session. Then click on the title of the session to display details about the session. If any materials are available, click on ‘Download Session Handout.”

HIMSS17 healthit hitsm healthcare technology hceg hcexecgroup session-details

But wait! There’s more!

Two additional interesting and potentially use artifacts associated with the 2017 HIMSS Conference & Exhibition include the following:

“2017 HIMSS Leadership and Workforce Survey”

“684,657,317 Impressions of HIMSS17” – Adam Bazer of HIMSS

Be sure to follow the Healthcare Executive Group on Twitter, FaceBook and LinkedIn where we share healthcare-related information, insight and commentary on a regular basis. For more information about becoming a member of the Healthcare Executive Group, check out HCEG’s 2017 Membership Guide.

The Future of the State Exchanges: Post Election

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Ferris W. Taylor, HealthCare Executive Group Office of the Chair and Past COO, Arches Health Plan presented “The Future of the State Exchanges: Post Election” at a special pre-conference event of the 2017 American Association of Payers, Administrators & Networks (AAPAN) Annual Forum in Tuscon, AZ on January 28th, 2017.

In his presentation – which can be found here – Ferris shared his real-world experience and perspective on state-based health insurance exchanges and how exchanges in particular and the ACA in general may be impacted in the coming months and years. Ferris admitted that he needed to look into his crystal ball for ‘assistance’ on a few of his thoughts. Some highlights from the presentation and ensuing discussions with forum attendees include:

  1. The ‘Affordable Care Act’ could also have been titled the ‘Accessible Care Act’

Access alone is not enough. The Triple Aim dictates that Access, Cost and Quality must be simultaneously addressed in order for true healthcare reform to be achieved.

  1. State-based Exchanges are better positioned than others

States that implemented their own exchanges are better positioned to respond to any reform approach ultimately decided by the Administration and Congress.

  1. Confidence in the Public Exchange has been falling dramatically year over year

Ferris shared some preliminary results from The Industry Pulse, an annual research survey hosted by Change Healthcare that is based on HCEG’s yearly Top 10 list, and pointed out that the three exchange-related items that actually improved year over year were items within control of health plans:

  1. Direct Sales (Web-based)
  2. Single Payer Private Exchanges
  3. Storefront/Retail
  1. Insurance Market Reform Options and Market Support Considerations

Ferris shared two information-packed slides outlining various health care reform options being floated by President Trump, HHS nominee Tom Price, Speaker Paul Ryan and others – including the  ACA Replacement plan proposed by Bill Cassidy (R-LA) and Susan Collins (R-ME) which would largely give individual states the option to continue operating under existing ACA regulations.

Look closely…that’s a turtle under there!

  1. Trigger Points & Timeline – and Things to Watch

Ferris and the attendees had a lively discussion surrounding key ‘trigger points’ related to healthcare reform and some ‘Things to Watch.’ See the presentation here for more information on these two presentation topics.

Additional Info on Potential Impact to ACA and Health Insurance Exchanges

“Healthcare Triage: Fixing the exchanges”The Incidental Economist@IncidentalEcon

“Milliman identifies six key questions arising from the Trump/ACA executive order” – Milliman @millimaninsight

“What’s Next for U.S. Healthcare Under Trump?”LEK @LEK_Consulting

“President Trump and the Affordable Care Act: What Happens Now?” –  Schulte Roth & Zabel – @SRZLawFirm

Check out the following for more information on:

Ferris W. Taylor

Healthcare Executive Group

Benefits of being an HCEG member

Collections of Information on HCEG’s 2017 Top 10 List

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One of the overarching reasons why the Healthcare Executive Group exists is to promote the sharing of information and ideas between its members and the healthcare community at large. Towards that end, we’re pleased to announce the availability of Twitter “Collections” for HCEG’s 2017 Top 10 Priorities, Issues & Challenges.

A Twitter Collection for each of the Top 10 items has been created and each collection contains articles, studies, white papers, commentary and other information pertaining to a specific HCEG Top 10 item.  These collections will be maintained on a go-forward basis so when you are looking for specific information pertaining to one of the HCEG Top 10 items, be sure to check out one of the HCEG Top 10 Collections.

( Click on one of the follow HCEG Top 10 items to access its collection of information)

Value-based Payments: targeting specific medical conditions to manage cost and quality of care Total Consumer Health: improving member’s overall well-being – medical, social, financial, and environmental
Clinical and Data Analytics: leveraging big data with clinical evidence to segment populations, manage health and drive decisions Cybersecurity: protecting the privacy and security of consumer information
Cost Transparency: growing legislation and consumer demand Harnessing Mobile Health Technology: improving disease management, member engagement, and data collection/distribution
Addressing Pharmacy Costs: implementing strategies to address growth of pharma costs versus benefits to quality of care and total medical costs Care Redesign: leveraging team-based care models, focusing on behavioral health and social needs
Accessible Points of Care: telehealth, retail clinics and micro-hospitals vs. large, integrated systems Next Generation ACOs: additional programs in bundled payment, episodes of care-shared savings, and growing participant base

For more information on the priorities, issues and challenges facing healthcare executives in 2017 and beyond, consider checking out HCEG’s social medial channels:

On Twitter – @HCExecGroup

On LinkedIn – healthcare-executive-group

On Facebook – HealthCareExecutiveGroup

How Predictions About Healthcare in 2017 Compare to HCEG Top 10 List

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2017 Healthcare Predictions HCEG

It’s that time of year when everyone is sharing their thoughts on healthcare predictions and trends for 2017. And the Healthcare Executive Group wants to take this opportunity to share what it considered the Top 10 Priorities, Issues and Challenges facing healthcare supply-side constituents: health plans, payers, providers and health systems.

History of HCEG Top 10 List

The HCEG Top 10 list of Healthcare Priorities, Issues and Challenges has been a pillar of the Healthcare Executive Group for the last 12 years. The list is developed each year during HCEG’s annual forum and reflects what HCEG healthcare executive members think will be their primary focus for the following year.

The HCEG Top 10 list for 2017 includes the following items:

  1. Value-based Payments: targeting specific medical conditions to manage cost and quality of care
  2. Total Consumer Health: improving member’s overall well-being – medical, social, financial, and environmental
  3. Clinical and Data Analytics: leveraging big data with clinical evidence to segment populations, manage health and drive decisions
  4. Cybersecurity: protecting the privacy and security of consumer information
  5. Cost Transparency: growing legislation and consumer demand
  6. Harnessing Mobile Health Technology: improving disease management, member engagement, and data collection/distribution
  7. Addressing Pharmacy Costs: implementing strategies to address growth of pharma costs versus benefits to quality of care and total medical costs
  8. Care Redesign: leveraging team-based care models, focusing on behavioral health and social needs
  9. Accessible Points of Care: telehealth, retail clinics and micro-hospitals vs. large, integrated systems
  10. Next Generation ACOs: additional programs in bundled payment, episodes of care-shared savings, and growing participant base

To be sure, the items on the HCEG Top 10 list may not be considered predictions as much as they are ‘important areas for those on healthcare’s supply side to be aware of in 2017.’

“It’s tough to make predictions, especially about the future” – Yogi Berra

And it’s not just HCEG members who compile lists of predictions and trends for the healthcare industry. In the waning weeks of the year, industry professionals, health plan and hospital system CEO’s, leading consulting firms like PWC and Accenture, research firms like Gartner, media reporters, and a host of others all share their take on what they consider to be important trends and predictions for the upcoming year. Here’s a list of some of those sharing their 2017 Healthcare Predictions.

Given the ubiquity of “predictions for healthcare in 2017” and the fact that healthcare was a primary issue in the U.S. presidential election, it seemed that comparing HCEG ‘s Top 10 list to the summarized results of 2017 healthcare predictions made by others would confirm HCEG’s list and/or call out differences. The fact that the HCEG Top 10 list was compiled BEFORE the presidential election and all of the comparison lists were created AFTER the election is envisioned to, at least somewhat, account for any impact the election may have had on people’s interpretation of priority and value.

Collection of Predictions about Healthcare & Healthcare Technology in 2017

To establish a baseline list of predictions and trends for healthcare in 2017, the lists contained in this blog post were reviewed with categorized based on their primary and secondary categories with the results compared to the items on the HCEG Top 10 list. A few facts and observations about this baseline list:

  1. 36 lists containing a total of 179 “predictions” were curated
    HCEG 2017 Predictions - Major Categories

    HCEG 2017 Predictions – Major Categories

  2. Only predictions that were clearly understood and of sufficient granularity were included
  3. Each prediction was coded with one of the following 19 primary categories
  4. Where possible, a secondary category was assigned

Analysis of 2017 Predictions

Most Frequently Referenced Categories

In terms of most frequently referenced predictions (regardless as too rank) found among the 30 lists reviewed, Emerging Technologies, Reform/Regulations, Analytics & Big Data, Value-based Reimbursement, Access, and Consumerism were among the most frequently cited areas of focus in 2017.

Category Count Corresponding HCEG Top 10 Item(s)
Emerging Technologies 29 6-Harnessing Mobile Technology
Reform/Regulations 24 8-Care Redesign (loose correlation)
Analytics & Big Data 19 3-Clinical and Data Analytics
Value-Based Reimbursement 16 1-Value-based Payments

5-Cost Transparency

Access 13 9-Accessible Points of Care
Consumerism 11 2-Total Consumer Health
Interoperability 9
Finance/Reimbursement 9 1-Value-based Payments

5-Cost Transparency

7-Addressing Pharmacy Costs

Cybersecurity 8 4-Cybersecurity
Mobile Health 6 6-Harnessing Mobile Technology
Processing Efficiency 6
Digital Transformation 5 6-Harnessing Mobile Technology
Collaboration 5 10-Next Generation ACOs
Mergers & Acquisitions 4
Health Literacy 4 2-Total Consumer Health

5-Cost Transparency

Pharmacy 3 7-Addressing Pharmacy Costs
Resources 3
Precision Medicine 2 8-Care Redesign
Wearables 2 6-Harnessing Mobile Technology
Patient Experience 1 2-Total Consumer Health

9-Accessible Points of Care

Categories by Top 3 Rankings

In an attempt to present the data in a more generalized fashion, the following table reflects the ranking of the categories based on the sum of the top three rankings for each item.

Category Count Top 3 Count Top 3 % of Count Corresponding HCEG Top 10 Item(s)
Reform/Regulations 24 15 63% 8-Care Redesign (loose correlation)
Emerging Technologies 29 14 48% 6-Harnessing Mobile Technology
Analytics/Big Data 19 12 63% 3-Clinical and Data Analytics
Consumerism 11 8 73% 2-Total Consumer Health

5-Cost Transparency

Access 13 7 54% 9-Accessible Points of Care
Value-based Care 16 7 44% 1-Value-based Payments

5-Cost Transparency

Cybersecurity 8 6 75% 4-Cybersecurity
Finance/Reimbursement 9 6 67% 1-Value-based Payments

5-Cost Transparency

7-Addressing Pharmacy Costs

Mobile Health 6 6 100% 6-Harnessing Mobile Technology
Collaboration 5 5 100% 10-Next Generation ACOs
Digital Transformation 5 5 100% 6-Harnessing Mobile Technology
Interoperability 9 5 56%
Processing Efficiency 6 5 83%
Health Literacy 4 3 75% 2-Total Consumer Health
Mergers & Acquisitions 4 3 75%
Pharmacy 3 3 100% 7-Addressing Pharmacy Costs
Resources 3 3 100%

Insights on How HCEG List Compares to General 2017 Predictions

While certainly subject to some interpretation and discussion, the following four areas listed by many of those sharing their 2017 Predictions were NOT directly matched to any of the items on HCEG’s Top 10 list.

Category Prediction from Article
Interoperability
  • Acceleration of Interoperability
  • EHR access
  • Financially stable, regional IDNs are spending big dollars toward extended connectivity while rest of the pack looks on
  • Integrated systems
  • Integration of medical & social determinants of health
  • Interoperability: Continuing progress
  • More progress and collaboration around interoperability
  • Organizations choosing platforms vs. application silos will only accelerate
Processing Efficiency
  • $1 of innovation will need $7 of core execution
  • Adoption of auto-adjudication will accelerate
  • Auto-adjudication will drive providers to interact with EHRs, revenue cycle management and practice management vendors.
  • Complex claims outsourcing market grows
  • Cost reduction pressures require balance with compliance demands
  • Focus on front end and middle office business office functions & RCM outsourcing intensifies.
M&A
  • Consolidation of activities to Top 7 Digital Giants
  • Continued growth of merger and acquisitions as the reimbursement mechanisms favor organized groups of providers.
  • Many more insurers will drop out of the marketplaces.
  • Maturation of digital health startups and increasing merger and acquisition activity
Resources
  • Human resources shortage
  • Skilled hospital tech staff recruitment is even more challenging.
  • The rise of non-CIO executives in technology decisions: Not quite yet

Note: Items in above table were culled from various articles listing 2017 Predictions. 

Overall Rankings of 2017 Predictions

The following major categories of 2017 Healthcare Predictions are based on the rank assignments as noted by the author of each of the individual articles/posts.

#1 Ranking 36 % of Ttl #4 Ranking 22 % of Ttl
Reform/Regulations 7 19% Value-Based Care 5 23%
Emerging Technologies 4 11% Analytics/Big Data 4 18%
Value-Based Care 4 11% Reform/Regulations 3 14%
Cybersecurity 4 11% Interoperability 2 9%
Finance/Reimbursement 3 8% Access 2 9%
Analytics/Big Data 3 8%
Consumerism 3 8% #5 Ranking 17 % of Ttl
Emerging Technologies 4 24%
#2 Ranking 34 % of Ttl Value-Based Care 2 12%
Analytics/Big Data 6 18% Processing Efficiency 2 12%
Emerging Technologies 5 15%
Reform/Regulations 5 15% #6 Ranking 12 % of Ttl
Digital Transformation 3 9% Access 2 17%
Consumerism 2 6% Emerging Technologies 2 17%
Finance/Reimbursement 2 6% Reform/Regulations 2 17%
Processing Efficiency 2 6%
Mobile Health 2 6% #7 Ranking 11 % of Ttl
Emerging Technologies 3 27%
#3 Ranking 31 % of Ttl Reform/Regulations 2 18%
Emerging Technologies 5 16% Analytics/Big Data 1 9%
Access 5 16%
Mobile Health 3 10% #8 Ranking 6 % of Ttl
Analytics/Big Data 3 10% Emerging Technologies 3 50%
Consumerism 3 10% Resources 1 17%
Reform/Regulations 3 10% Consumerism 1 17%

Note: Some lists didn’t explicitly rank their predictions as #1, #2, #3, etc. In those cases, rank was assigned based on the precedence of the prediction in the article. I.e. if a specific prediction was listed before another prediction , it was assumed that prediction ranked higher.

Other Insights

The Most Frequently Referenced Categories, Categories by Top 3 Rankings and Overall Rankings of 2017 Predictions Results listed above provide a few instances of correlation with and diversion from the 2017 HCEG’s Top 10 list.

Note: The contents of the tables below were were culled from the various articles listing 2017 Predictions. 

Emerging Technologies

On area of divergence between the HCEG Top 10 list and 2017 Healthcare Predictions Baseline is that Emerging Technologies were not clearly identified by HCEG as of primary focus in 2017. In general, “emerging technologies” are identified as things like 3D printing, AI/machine learning, augmented reality, Blockchain, cloud, drones, Internet of Things, medical devices and robotics. One may argue that, given HCEG’s membership is skewed toward health plans/payers, that  these emerging technologies are not part and parcel of a healthplan/payer-based focus. Given their dominance and potential value, perhaps they should be?

Some Predictions on Emerging Technologies

Adoption of technologies within realm of AI, including RPA and machine learning, will move very fast and take over in many different ways.
Blockchain will move from theory to practice, as pilots and production-ready applications become a reality.
Hype around the Cloud quiets down as it becomes the primary way to build enterprise architecture.
60% of healthcare applications will collect real-time location data and clinical IoT device data and embed cognitive capabilities to discover patterns
Gadgets will continue to be commoditized and competition will grow
IoT will save $1 Trillion a year in maintenance, services & consumables
50% increase in the use of robots to deliver medications, supplies, and food throughout the hospital

Health Reform/Regulations

Given the largely unexpected results of the presidential election, it’s not a surprise that the uncertainty of healthcare reform and regulations jumped to the top position for impacts to healthcare in 2017. Elections have consequences. No doubt as one prognosticator stated “The Trump Presidency Will Rock the Healthcare Boat.”

Some Predictions on Health Reform/Regulations

Massive confusion on status of the ACA
President-elect Donald Trump will likely not fulfill his promise to completely repeal the ACA
The Trump Presidency Will Rock the Healthcare Boat
Regulation drives demand for advanced data and analytics capabilities
Movement by employers away from defined benefit plans to defined contribution plans and increased participation in private exchanges. –
Expand the use of health savings accounts for consumers.
Medicaid expansion costs will be incorporated in the Medicaid block grants
Republicans will attempt to “modernize” Medicare through vouchers or tax credits
There will be continued movement to narrow network products in an attempt to hold down costs.
Federal insurance license changes allowing for competition and selling over state lines
Healthcare startups: Make nice with regulators in 2017

Analytics & Big Data

Predictions about the importance of healthcare analytics made by HCEG members was one area that matched the general baseline as ranking #3.

Some Predictions on Analytics & Big Data

AI (artificial intelligence) or machine learning to translate big data into actionable insights
Convo on healthcare becoming one of most interesting “Big Data” petri dishes society has to offer begins.
Evidence-based decision making (expanded use of data and analytics) to eliminate unnecessary utilization and increase patient safety
Contextualization algorithms will advance exponentially
Advancing data governance
Combining structured and unstructured data
Consortiums of data: genomic, social, EMR, complaint and prescription data, emerge that will create insights never before possible
Mastery of unstructured data will deliver customer insight
Moving to metadata
Taking advantage of real-time data
Startups in analytics space begin to challenge  large, incumbent players and healthcare organizations will begin to actively engage with these new players.

Value-based Reimbursement

Value-based care and reimbursement were highly ranked on both the HCEG Top 10 list and the 2017 Healthcare Predictions Baseline. Given the importance of value-based reimbursement and general bi-partisan support for value-based initiatives like MACRA, VBR should largely survive drastic alteration under the new administration.

Some Predictions on Value-based Reimbursement 

Value-based care will drive adoption of tools for chronic disease management
Easing the training wheels off value-based payment
2017 will be a year for learning about the alternative reimbursement methodologies and planning for the compliance program requirements of the future.
Preparing medical students for work in a value-based world
More performance-based measures beyond cost to quality and satisfaction
Renewed and upgraded Enterprise Resource Planning Systems (ERP) swings back into importance, now for Value Based Care Costing.

Access

HCEG members ranked ‘access’ topics lower than the general baseline.

Some Predictions on Access

The rise of decentralized healthcare and the decline of hospitals.
Significant rise in voluntary services/ healthcare for the wealthy
Self-select virtual care – for convenience
Telehealth will no longer be on the outskirts, pushed into the mainstream with expanded reimbursement policies, usage and outreach programs

Additional Insight Can Be Obtained Here

HCEG Top 10 Info

Collection of 2017 Healthcare Predictions

Raw Data – here is the raw data collected from the various articles on 2017 Healthcare Predictions

Following is a List of Articles used for this analysis – See more info here.

# Title
1 “3 Mega Trends for Healthcare Marketers to Leverage in 2017”
2 “5 healthcare technology trends taking center stage in 2017”
3 “7 Bold Predictions for Healthcare in 2017”
4 “Healthcare CFOs weigh in on 2017 challenges, trends in latest surveys”
5 “Healthcare Industry Trends to Watch”
6 “Healthcare Predictions for 2017”
7 “Healthcare Technology Trends for 2017”
8 “How Consolidation Will Impact Hospitals and Health Systems in 2017”
9 “List Top 10 predictions for IT in 2017 and beyond”
10 “5 healthcare technology predictions for 2017 from Connexica” 
11 “Retail Trumps Healthcare in 2017: Health/Care Forecast for the New Year”  
13 “These Trends Could Reshape Healthcare Tech in the Very Near Future”
14 “Top health industry issues of 2017: A year of uncertainty and opportunity”
16 “Upcoming Trends and Innovations in Healthcare IT 2017”
17 “What to Watch: Health Care Trends for 2017”
18 “10 Predictions for How the Healthcare Industry Will Change in 2017”  
19 “2017 Predictions: Big Data, Digital, and Virtual Care Key to Engage Healthcare’s Empowered Consumer”
21 “4 Business Trends to Watch in the Insurance Industry for 2017”
22 “5 Digital Health Predictions for 2017”
23 “5 Healthcare IT Trends to Watch In 2017” 
24 “7 (plus 1) predictions for healthcare IT in 2017” 
25 “8 Health Tech Challenges and Opportunities in 2017” 
26 “9 Healthcare Tech Trends in “The New Year of Uncertainty” 
27 “Coming Soon to Your Hospital: IoT, Cognitive Computing, Robots and More Ransomware”  
28 “Healthcare Predictions 2017: Accelerated Adoption of Alternative Payment Models”   
30 “How market changes will influence data priorities in healthcare”
31 “Post-Election Predictions for the Healthcare Industry”  
32 “7 digital health predictions for 2017” 
33 “Tom Main and Welltok’s Jeff Margolis Make Their 2017 Predictions” 
35 “2017 Healthcare Trends Forecast: Spok Leaders Weigh In” 
36 “2017 Predictions from Healthcare Leaders Across the Country” 
37 “Trends in health IT for 2017: Ransomware, RPA, blockchain predictions”  
38 “8 technologies that will transform healthcare in 2017 and beyond”  
39 “Five Health IT Trends I’m Looking Forward to in 2017” 
40 “The election is over: 3 health care predictions”  
41 “2017 Predictions: Medicare, Drug Costs, Cybersecurity and More” 

 

Using Incentives to Drive Health Care Shopping Behavior – Recap, Recording & Research

By | 5-Transparency, Sponsor, Top 10 | No Comments

On Tuesday, December 13th, HCEG sponsor HealthSparq presented a webinar on “Using Incentives to Drive Healthcare Shopping Behaviors.” Over 100 individuals and companies registered for the webinar presented by John Surie of M Health and were presented with information from a study commissioned by HealthSparq to explore how how incentives can impact health care shopping behavior.  The graphic-laden presentation offered insight into information that could influence how incentives programs are rolled out by health plans, employers and health systems.

Healthcare Cost Quality Transparency Consumer Shopping Behaviors

Research Survey on Use of Incentives to Drive Healthcare Consumer Shopping Behaviors – M Health/HealthSparq

Some Survey Highlights Include

  • Examples of popular “incentives” include lower premiums, reduced co-pays, cash, gift cards, movie tickets, etc.
  • Cash incentives are most effective but smaller amounts are almost as effective as larger amounts
  • Providing an incentive of some sort has a marked increase (20+%) in encouraging the use of telehealth services
  • Incentives have a strong positive impact on encouraging the viewing of healthcare-related videos Increasing the amount of an incentive had strongest effect in driving choice of a surgical center
  • Cash incentives have a stronger influence on choice of lab & imaging than on choice of physician, which entails a more personal decision.
  • Heavy ‘users of incentives’ were not any more likely to achieve positive outcomes vs. light users
  • Strong correlation btw those who use ‘rewards programs’ outside of healthcare (airlines, grocery, etc.) and reward programs in healthcare

The Recording, The Research and More Insight from HealthSparq

In addition to making a recording of the webinar available here on YouTube, HealthSparq created a summary of the webinar via this blog post. Moreover, HealthSparq is willing to provide speaker John Surie’s complete research paper on the topic presented in the webinar. You can request that research paper here.

If you have any questions about using incentives to drive healthcare shopping behaviors or would like to obtain additional information , please reach out to HealthSparq at 855-SPARQ-IT (855-772-7748) or via their web site. You can also follow @HealthSparq on Twitter.

More for HCEG Members

For the 2017 membership year, HCEG has many additional opportunities for learning, sharing and networking with other healthcare industry executives, opinion leaders, and decision makers. If you’re not a HCEG member and would like more information on becoming a member, please see http://hceg.org/membership/ or contact Juliana Ruiz at info@hceg.org.

2017 Top 10 Challenges & Issues Discussed on the #HITsm Tweetchat

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2017 Top 10 Challenges & Issues Discussed on the #HITsm Tweetchat

The #HITsm tweet chat is a popular Twitter chat about healthcare information technology and related topics.  The chat is sponsored by @HealthStandards and is held every Friday at 9:00am PT. This week, the theme of the #HITsm chat will be the Top 10 Challenges for Healthcare Executives and the chat will be moderated by HCEG’s very own Ferris Taylor, COO of Arches Health Plan.

The HCEG Top 10 list is developed by HCEG members each year and forms the basis for examining critical priorities, challenges and issues faced by health plans and healthcare providers in the post-reform era. The #HITsm chat will present five topics intended to support and compliment the 2017 Top 10 Challenges & Issues list.

Topics for the #HITsm Tweetchat

Topic 1: What do you think are the main issues and concerns facing healthcare organizations?
Topic 2: What are some ways to identify and prioritize challenges and issues specific to your healthcare organization?
Topic 3:  How can you establish an environment that communicates the importance of change and welcomes opinions and new ideas?
Topic 4:  What are some ways to inform & engage others – in your firm & broadly across industry – in large transformational initiatives?
Topic 5:  Why do you think healthcare innovation lags that of other industries? And what can be done to ameliorate that?

Background on the HCEG Top 10 List

Based on HCEG member input and sponsor research, the HCEG Top 10 list serves as the basis for continuous and evolving dialog on the main issues and concerns facing healthcare payers, providers and other constituent organizations. The Top 10 list has been published every year for the last decade and you can find more information on this year’s list and previous year’s Top 10 lists here.

What’s Next for the HCEG Top 10 List?

In addition to serving as the basis for a wealth of research, white papers, webinars, blogs, and formal and informal discussion opportunities available throughout the year, the Top 10 list serves as the basis for The Industry Pulse: a research survey project executed via a partnership between HCEG and Change Healthcare.  This survey will be available October 31st and all #HITsm tweet chat attendees are encouraged to take the survey:  IndustryPulse

Reading Material

The following are some additional materials on opportunities, challenges and issues facing the healthcare industry:
Why Health Care Innovation Lags (And What To Do About It)
What are Healthcare Executives Focusing on for 2017
Top 10 healthcare issues to watch in 2016
Disruptive Innovation in Healthcare: What to Expect in 2016
2016 Industry Pulse
Healthcare Innovation and the Four Key Digital Health Trends Expected for 2016 (Part 1)
Healthcare Innovation: How 2016 trends are already evolving (Part 2)

Come Join the #HITsm Tweetchat!

Come join the #HITsm tweet chat this Friday, 10/28 at 9:00am PT to discuss the Top 10 Challenges for Healthcare Executives. And check back here after the chat for a summary of the information shared on the topics discussed. Also, consider following HCEG on Twitter.


The HCEG Top 10 List – Innovating and Transforming the Healthcare Industry

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The HCEG Top 10 List – Innovating and Transforming the Healthcare Industry

Each year for the past 12 years, the Healthcare Executive Group ideates and defines a list of the top 10 challenges, issues and impacts that its healthcare executive members think will be their primary focus for the following year. The HCEG Top 10 list is intended to drive healthcare innovation and transformation throughout the industry by serving as the basis for continuous and evolving dialog on the critical healthcare issues and concerns facing HCEG’s member organizations.

Creating the 2017 HCEG Top 10 List

hceg-blog

David Gallegos SVP of Consulting Services for Change Healthcare helps drive the discussion around the 2017 HCEG Top 10.

Over 100 HCEG members and sponsor partners developed the 2017 Top 10 list during its Annual Forum held on Sep 11th through the 13th in New York City. As Ferris Taylor, HCEG Office of the Chair and COO of Arches Health Plan noted: “This year’s Top 10 list was derived from an initial list of 27 topics, and reflects the incredible transformation taking place (and needing to take place) in customer-centric services provided by health plans. As discussed at our Forum, technology and innovation are moving quickly. Our members see these 10 trends having lasting impact in the way we all become engaged, digital consumers and responsible healthcare stakeholders.”

The Prioritized 2017 HCEG Top 10 List Includes:

  1. Value-based Payments: Targeting specific medical conditions to manage cost and quality of care
  2. Total Consumer Health: Improving member’s overall well-being – medical, social, financial, and environmental
  3. Clinical and Data Analytics: Leveraging big data with clinical evidence to segment populations, manage health and drive decisions
  4. Cybersecurity: Protecting the privacy and security of consumer health information
  5. Cost Transparency: Growing legislation and consumer demand
  6. Harnessing Mobile Health Technology: Improving disease management, member engagement, and data collection and distribution
  7. Addressing Pharmacy Costs: Implementing strategies to address growth of pharma costs versus benefits to quality of care and total medical costs
  8. Care Redesign: Leveraging team-based care models, focusing on behavioral health and social needs
  9. Accessible Points of Care: Telehealth, retail clinics and micro-hospitals vs. large, integrated systems
  10. Next Generation ACOs: Additional programs in bundled payment, episodes of care-shared savings, and growing participant base

What’s Next for the Top 10?

surveyIn addition to serving as the basis for a wealth of research, white papers, webinars, blogs, and formal and informal discussion opportunities available throughout the year, the Top 10 list serves as the basis for The Industry Pulse: a research survey project executed via a partnership between HCEG and Change Healthcare.  The survey will be available October 6th through October 31st to an expanded group of healthcare executives, analysts and industry though leaders. Joint research between the HCEG and Change Healthcare will be conducted to expand on the list and to detail how certain healthcare organizations address the Top 10 items via different trajectories.  This research will enable participants to benchmark how their own organization is tracking against these varying approaches and consider alternative strategies. A white paper containing comprehensive survey results and analysis will be available in early December. Take the survey today.

For more information on the HCEG Top 10 list and the Healthcare Executive Group, check out our website or contact us. You can also follow us on Twitter where we tweet as @HCExecGroup, check us out on Facebook  and/or follow us on LinkedIn.


Designing Digital Commerce Distribution for the Healthcare Revolution

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Last week, HCEG’s marquis sponsor, Softheon, hosted a webinar “Digital Commerce Distribution: Driving Value in the Age of the ‘Digital Payer’.” The hour long webinar, available here as an MP4, was presented by Michael Hendershot, Business Development Director at Softheon and Dana Franke, Director of Operations at Softheon.

As the title implies, the webinar presented information on digital health and how health plans can utilize digital commerce programs to remain competitive in today’s healthcare market. The presenters also offered various ideas and approaches for developing a digital commerce strategy. There was a Q & A session at the end where participants raised some good questions.

The Digital Commerce Distribution Agenda

The agenda for the webinar included the following topics (each starting at the time noted)

  1. How does digital commerce differ from traditional channels? (12:07)
  2. What are the main components of digital commerce distribution? (14:04)
  3. How has digital commerce revolutionized traditional payer approaches? (15:28)
  4. What role does digital commerce play in customer experience strategies? (16:45)
  5. What steps should payers take to design their digital commerce strategy? (19:38)
  6. In what ways can digital commerce provide insight into member behavior and trends? (21:21)
  7. Can digital commerce be optimized to help generate a greater portion of total revenue? (23:25)
  8. How can payers incorporate a greater portion of their business into digital commerce? (25:14)

Additional Insight from the Webinar

The webinar provided a lot of statistics, information and actionable ideas for webinar attendees. The reader is urged to view the webinar where they will be presented with informative slides, information, ideas and comments like the following:

  • “Health plans need not only provide the tools prospects and members need to interact with the health plan but also launch marketing strategies through the digital tools they make available”
  • “Digital tools have revolutionized sales and enrollment, administrative functions like provider searches, premium payment, claims status and other common customer service activities.”
  • “Payers need to be able to provide a balance of customer experience strategies depending on their target market. Medicare members may be more focused on one on one communication and education in an advocate role via traditional channels while digital tools may be the point of first contact for younger families and recent college graduates.”

What must payers understand about digital commerce?

  • “Health plans must understand their member population and how these members prefer to communicate with the health plan. Then the plans must use that information to design an online experience focusing on minimizing the amount of time that customer service interactions take.”
  • “Digital commerce is not just an IT challenge but a company-wide initiative.”
  • “If your core claims administration system can accept 834 transactions, then you are well-positioned to work with technology providers like Softheon”
  • “When you’ve seen one 834 (enrollment transaction), you’ve seen one 834”

Some Questions from the Audience

The following were some of the questions raised during the Q & A. Listen to the recording to hear the responses.

  • “Are some of the newer carriers like Oscar and Harken pushing the older carriers to take more of an active role or movement toward digital commerce?” (33:18)
  • “What are you seeing from your clients as the top challenges in moving to digital commerce?” (34:34)
  • “What is your definition of a payer?” (36:34)

To learn more about Softheon and its cloud-based Exchange solutions, contact John Saunders: pr@softheon.com, (631) 216-7491

The HealthCare Executive Group

The HealthCare Executive Group (HCEG) is a national network of select executives from across the entire healthcare spectrum; coming together to continually learn, grow, share and reshape the healthcare industry. HCEG periodically sponsors webinars. For more information on becoming a HCEG member, see Why Join HCEG? on the HCEG website. You can also follow HCEG on Twitter and like them on Facebook.

 

“ACA: The Road Ahead in Transitioning from “Accessible” Care Act to the true “Affordable Care Act”

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Last week one of HCEG’s sponsor partners, HealthEdge, co-hosted a webinar “Payment Reform: Exploring Technology Implications for Health Insurers” with Medica. The hour long webinar, available here on YouTube, was presented by Andrew Davis – VP & GM of Medica’s Medicare segment  and Harry Merkin, VP of Product Marketing at HealthEdge.  The webinar addressed the move from fee-for-service to value-based reimbursement models; specifically the underlying technology systems health insurers are using or will soon need to use to avoid left behind. The impact of new MACRA legislation was another topic discussed throughout the webinar and during the Q & A period at the end of the webinar.

Value-Based Reimbursement is Big – And Getting Bigger

The move to value-based reimbursement (VBR) and other business models based on quality and value is dramatically reshaping the U.S. healthcare system and is happening faster than anyone could have anticipated even just a couple years ago. Currently, CMS is on track to have 30% of its reimbursements under value-based arrangements this year in 2016. And CMS is targeting 50% of all its reimbursements to be value-based by 2018 and 75% by 2023.

Agility – Efficiency – Transparency

A survey by McKesson – Journey to Value: The State of Value-Based Reimbursement in 2016 – reveals that 61% of payers and 41% of hospitals expect VBR reimbursement to positively impact their organizations.  In order for payers and hospitals to realize positive benefits from VBR, or at least avoid being unduly impacted by new value-based systems in a negative way, these healthcare organizations need to focus on three technology imperatives

Agility – health plans must be able to adapt to new payment models and rollout new benefit designs and lines of business quickly. And they must be willing and able to rapidly share relevant, actionable information with their provider networks.

Efficiency – the increase in administrative and reporting processes demanded by value-based reimbursement dictate that health plans automate key processes to enhance their competitive position.

Transparency health plans must be able to provide a patient-centered, 360 degree view of their members to the entire care team. Member experience and engagement should no longer be nice to haves.

Additional Insight from the Webinar

 The webinar provided a lot of statistics, information and actionable ideas for webinar attendees. The reader is urged to watch the webinar on YouTube where they will be presented with information and ideas like the following:

“MACRA raises a concern about ensuring adoption across all provider types. MACRA is ‘Meaningful Use on steroids’”

“There is widespread concern about conflict and misalignment between quality measures under Medicare FFS and the quality measures proposed MACRA”

“There will be a significant administrative burden managing multiple measure sets needed to comply with existing quality measure reporting programs and MACRA’s new Merit-Based Incentive Payment System (MIPS)  – at least as far as these programs are defined today.”

“Larger provider organizations working w/ ACO’s have a significant advantage under MACRA”

“Medicare Advantage is gold standard for effective risk-based contracting in today’s healthcare marketplace”

healthcare“Providers must treat all Medicare beneficiaries the same regardless as to whether they’re reimbursed via FFS, Medicare Advantage risk or new MACRA reimbursement”

“MACRA brings a bigger set of carrots and sticks that payers can with providers.”

“MACRA will enable Medicare and Medicaid programs to keep providing healthcare for generations to come”

Other Webinars by the HealthCare Executive Group

The HealthCare Executive Group (HCEG) is a national network of select executives from across the entire healthcare spectrum; coming together to continually learn, grow, share and reshape the healthcare industry. HCEG periodically sponsors webinars such as the one described in this post. For more information on becoming a HCEG member, see Why Join HCEG? on the HCEG website.