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

By | Healthcare Revolution

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

By | Healthcare Revolution

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

By | Healthcare Revolution

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.

A Snapshot of the HealthCare Executive Group

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Ferris Taylor has been around healthcare for a long time – for almost 30 years now. Over these 30 years, Ferris has seen the ebb and flow of healthcare from multiple angles.  He’s been on the inside of healthcare working for health plans and providers and on the outside working for vendors and consulting firms that serve health plans and providers.

For most of his 30 years in healthcare, Ferris has been involved with the Health Care Executive Group; a 26 year old organization of health care executives having a desire to share information, ideas and challenges that impact the regional, state-wide and area-wide HP’s and provider groups of which its executives are associated.

Ferris was recently interviewed by IntrepidNow where he shared his perspective on healthcare over the last three decades, the sea change that began in healthcare about five years ago, and three specific benefits the Health Care Executive Group provides to its members. Introducing the Healthcare Executive Group Podcast

Benefits of the Health Care Executive Group

  1. Exposure and access to a broad spectrum on industry participants: payers, providers, pharmacy, medical device and other companies that serve the healthcare industry.
  1. A select, non-competitive network of executives that HCEG members can interact with on a day-to-day basis to help address immediate issues and and look to the future to explore what the healthcare industry could be facing the following year and years beyond.
  1. A vetted group of vendor sponsors that take off their sales hat and participate with the HCEG members as thought leaders who share their perspective rather than pitching their solutions.

2016 HCEG Annual Forum

Ferris also shared some information about HCEG’s upcoming 2016 Annual Forum including details on its three areas of focus, what attendees can expect from their participation at the forum and what sets the HCEG Annual Forum apart from other healthcare conferences.

Listen to this podcast to hear what Ferris has to say and check out this page for more information on the 2016 HCEG Annual Forum held September 12-14 at the Renaissance New York Midtown Hotel in New York City. You can learn more about the Health Care Executive group on the Web and follow them on Twitter, Facebook and LinkedIn!

Payment Reform and MACRA: The World is Speeding Up

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Payment reform is much talked about, often written about and now becoming real in today’s world. The move to value-based reimbursements and other new business models is an inevitable reality that is dramatically reshaping the US healthcare system. In the Fee for Service model, providers were typically compensated for the volume: the number of patients seen and tests conducted; in the new world of value-based reimbursements they will increasingly be paid for successful outcomes, promoting healthy behaviors and the prevention of expensive episodes of care. As Richard Migliori, MD, Chief Medical Officer of United HealthGroup recently stated at an industry conference, In a Fee for Service world, the typical physician used to worry about who was in the waiting room. Now in the value-based world they have to worry about who is NOT in the waiting room. He went on to share that of United’s $100 billion in reimbursements, 43% have some tie to value today.

Now CMS is taking a leading role in the transformation, with the recently released MACRA (Medicare Access and CHIP Reauthorization Act of 2015) rule, designed to push quality measures tied to reimbursement incentives for Medicare providers. With the fastest growing segment of health insurance members belonging to government sponsored programs, including Medicare, Medicaid and Duals, CMS has publicly stated it is targeting 30% of all of its reimbursements to be value-based by 2019, with 50% by 2021 and 75% by 2023. The initial MACRA quality measures will start on January 1, 2017, with payments beginning in 2019. And the MACRA rule is written with specific intent of moving the model beyond Medicare into Medicaid, and ultimately into the commercial market over time.

Health plans are compelled to prepare for the change to value-based contracting and quality-based outcomes that MACRA will bring with it. Payors, particularly those with Medicare Lines of Business, must be ready to capture data related to the new quality and performance measures, beginning on January 1, 2017. Payors must have the ability to adjust the way services delivered are reimbursed under Medicare, and embrace the value-based models that MACRA is introducing and reinforcing. And to do so, payors need to leverage a technology infrastructure with the agility to move quickly in order to adjust their benefit and payment models.

Industry experts have been weighing in on MACRA through the recent comments period and in other public forums. A few examples are:

Deloitte: MACRA is poised to drive payment and delivery reform across the payer mix for the foreseeable future.

American Medical Association President Steven Stack: “Our initial review suggests that CMS has been listening to physicians’ concerns,” adding, “In particular, it appears that CMS has made significant improvements by recasting the EHR Meaningful Use program and by reducing quality reporting burdens.”

PwC: In many ways, MACRA genuinely reflects Medicare and Medicaid’s drive towards payments that are based on the quality of care physicians deliver rather than the quantity of procedures they perform.

Senator Debbie Stabenow, Democrat from Michigan: MACRA is a truly historic piece of legislation.

 

In June, a select group of health plan executives and other healthcare leaders gathered for an industry roundtable, sponsored by HealthEdge and Deloitte, for a discussion and to share their perspectives on MACRA.

Executives attending the roundtable considered many aspects of the anticipated changes, including:

  • How quickly the government’s push for pay for performance could truly extend beyond Medicare, into Medicaid and commercial plans and the resulting changes to payer-provider networks and contracts
  • The need for process changes and improved efficiency in how a population is identified and treated, particularly those in at-risk categories.
  • The urgency for health plan IT organizations to have a detailed understanding of the agility and flexibility required to handle changes to provider payments based on performance. Participants stressed that this is a key ingredient for system success that will translate to the financial health of the plan.
  • The ability for a health plan to consider members strategically and with a long-term view, particularly by establishing quality results for younger members and those with lower risk, to create a membership base with high loyalty for the future.
  • The potential impact the law will have on smaller and rural practices. Virtual groups of providers will be facilitated by CMS, along with $20 million of funding, all designed to aid providers of all sizes to participate in the Advanced Payment Model program
  • How the inclination for health plans to narrow provider networks to work with highly rated physicians must be balanced with proper access to healthcare services.
  • The consensus that much of healthcare is local and community based, and MACRA could encourage opportunities to strengthen those relationships in places where the linkage is already strong.
  • The realization that those providers and provider entities that are in denial (I.e. some IDNs) are in for a shock.

With the January 1, 2017 start of the first quality measurement period fast approaching, MACRA promises to be a significant force in how payment reform is accelerated, beginning with Medicare and expanding to all forms of health insurance in the future.

 

About the Author

3bf5dd8Harry Merkin, Vice President, Product Marketing, HealthEdge

Harry Merkin has worked with both payers and providers through many dynamic changes in healthcare for a number of years. He is currently responsible for Product Marketing at HealthEdge and previously had similar responsibilities at Evariant and NaviNet. Merkin has collaborated with many transformative entities across the healthcare landscape. He has helped introduce and promote enterprise software solutions that enable payers to improve their competitive effectiveness, as well as perform valuable communications between payers and providers, and allow providers to effectively collaborate with patients and consumers as well as with each other. Merkin is the parent of two Millennials and is a long-time New England Patriots season ticket holder.