Highlights from Day 1 of 2017 AHIP National Health Policy Conference

By | AHIP, Healthcare Reform, Healthcare Revolution, payer, Risk-Sharing, Value-Based Care | No Comments

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.

‘Next Gen’ Data Strategy, Architecture and Technology to Achieve Innovation & Growth

By | AHIP, analytics, Sponsor | No Comments

marklogic ahip institute Operationalize Before You Analyze: Innovation and Growth Powered by DataMany of our sponsor partners participated in the 2017 AHIP Institute & Exhibition in Austin, Texas earlier this month – sharing info on their healthcare products and services; and sharing information via informal and formal presentation sessions.

Bill Fox, VP of Healthcare and Life Sciences of our sponsor MarkLogic, moderated a panel titled “Operationalize Before You Analyze: Innovation and Growth Powered by Data.” The panel of business and technical leaders discussed how they have used “next gen” data strategy, architecture and technology to achieve innovation, growth and modernization results.  Panel members included:

Sunil Godbole, Senior Director, Application Development at Aetna Inc.

Glen Schuster, Consultant, former CTO at Centene Corp

Shahran Haider, Managing Director of Enterprise Data Strategy and Analytics at L.A. Care

Analyzing Data and Operationalizing Data Are Not the Same Thing

Bill Fox began the panel discussion by offering that analyzing data and operationalizing data are not the same thing and that many health care organizations have focused their innovation and growth investment on the “shiny ball” of analytics — the end stage of the data journey — instead of first improving the agility and speed at the beginning “operational” stages of the data journey.

Save Time on Operations – More Time for Innovation

Glen Schuster: “When companies try to do operations and analytics at same time, it’s operations that almost always ‘wins’”

Sharan Haider: “Now is the time to innovate. And to do that, organizations have to free up time and iterate through faster execution cycles that add more value to operations while improving member and consumer experience.”

Sharan Haider: “If we shorten the amount of time needed to get data together, we can innovate and do analytics better and faster.”

Flexible, Secure, Multi-Model Database Systems are Key

Bill Fox: “Next generation systems must be able to provide users with what they want, how they want it, and when they want it. Data can’t be siloed across numerous legacy systems but must be virtualized in a multi-model database capable of supporting multiple data models against a single, integrated back end where structured and unstructured data in multiple formats are all supported by a flexible and secure infrastructure.”

Glen Schuster: “Value-based reimbursement and managing risk demand that healthcare firms deal with their legacy architecture and employ the resources necessary to facilitate change. Data is classically under reported. A company that can gather data and improve its quality will be in a better position to manage its risk and gain a significant competitive advantage.”multi-model database data models integrated backend structured unstructured marklogic hceg ahip institute

Rapid Implementation with Proven Business Case

Glen Schuster: “It’s easier now to create a hard dollar business case for operationalizing data. Do you know where your data is? How difficult is it to collect, combine and operationalize your data? Over-analyzing cost vs. worth can be an unproductive conversation.”

Sharan Haider: “I know I have a problem. I come to conferences and get excited at what I see. But I’m also a realist. I need to be able to implement solutions from my point of view. To be able to collect, merge and manage my data better and faster.”

Sharan Haider: “We are working to develop a 360 view of our provider customer service, appeals and grievances data in 4-6 weeks. What was a long-term pain and seemed unsolvable was suddenly doable.”

Centers of Excellence and Scaled Agile Framework

Sunil Godbole: “We had an impossible data problem and started our journey 2 ½ ago. We strive to make whatever we build with reusable assets. We established a Center of Excellence (COE) and got the best resources available on market. Our COE performs governance, builds frameworks (ex. Logging, alerts, ingest and egress methods, etc.) that we can extend to all lines of business, affiliates, and other data centers.”

Sunil Godbole: “Code quality has to be present. We employ a Scaled Agile Framework (SAFe) and consistently enforce its use. We do brown bags with scrum teams, new developers and business stakeholders to maintain and grow our skills based and data agility-focused culture.”

Learn More About Healthcare Innovation & Transformation

For more insight and ideas on digitally transforming your healthcare operations and analytics, check out our sponsor partners and consider following the Healthcare Executive Group and our sponsors on social media.

Change Healthcare –> @Change_HC
Cumberland Consulting Group –> @CumberlandCG
GuideWell Connect –> @_GWConnect
HealthEdge –> @HealthEdge
MarkLogic –> @MarkLogic
McKesson –> @McKesson
Softheon –> @Softheon
Virtual Health –> @VirtualHealth_

Part 2 of Health System & Health Plan Innovation, Change & Growth During Uncertain Times

By | AHIP, Health Literacy, Healthcare Reform, payer, Waste & Abuse | No Comments

health systems health plans focus for 2017 health reform outcome literacy members consumers #HITsmIn Part 1 of this series of posts, we shared some insight, ideas and opinions on the first of six topics shared in last week’s Health Information Technology Social Media (#HITsm) tweetchat Health System & Health Plan Innovation, Change & Growth During Uncertain Times.” A total of 72 participants tweeted over 650 times in the chat co-hosted by the Healthcare Executive Group, @_GWConnect and @_GuideWell.

In this second post, select insight, ideas, comments and opinions on Topic #2: What must health systems & health plans focus on over next 8 to 18 months regardless of health reform outcome? are shared. The remaining topics will be addressed in future posts.

Insight, Ideas and Opinions on Topic #2

Connect with Members, Consumers & Patients

  1. Create a connection with the patient that goes beyond the office visit.
  2. Identify, understand & work with ‘impactable members’ to help them make good, cost-effective decisions about their healthcare.
  3. Health systems & plans need to engage w/ patients & members on a more meaningful & regular basis. Not just via EOB’s.
  4. Find out what’s going on in patients’ homes and determine the services they need to keep them healthy.
  5. Include the patient in everything – from the patient’s own care to the growth of the health plan/system. Act on what they hear.
  6. This’s the ‘Hatched, Matched & Dispatched’ cycle. Health plans only ‘engage’ at enrollment, w/ claim EOB’s & at termination.

Address Waste & Abuse

  1. At #AHIPInstitute, Eric Topol said ‘75% of top 10 high cost drugs are prescribed to non-responding patients.” STOP the waste!
  2. Waste and overtreatment, heard from @DocLazris #ErikRifkin are on a mission against it. Video here: https://t.co/OvfS9zjFAW
  3. IMHO it’s important to educate people about how to use their insurance effectively to control their costs. Price Transparency too

Help Consumers Become Better Patients

  1. Focus must be on enable patients to take control of their own care and to be more involved through easy integration of tech.
  2. Universal language – like, “Do you accept my health plan?” Simple question but so often answered wrong.
  3. When these languages are translated into HIT, all those stakeholders interpret associated rules & allowances differently
  4. If you adopt universal languages, IMHO, you will see some of these issues disappear or at least some clarity enter
  5. Smaller, more often, more meaningful. I have to write stuff that’s specific, timely, and actionable – why does H/C bury me in dross?
  6. Anthem has a monthly health plan summary to members that contains ‘personalized and actionable’ health & wellness insights.
  7. “Self-Care Shows Promise In Keeping Individuals w/ Behavioral Health Needs Out of the ER” – Video here: https://t.co/y4As4wkwkY

Don’t Ignore the Masses – Invest in Preventive Services

  1. Insurance! Invest now to save later is a motto that not many want to hear but need to have more faith in.
  2. Need to focus on treating the largely ignored ‘healthy people’ to prevent them from becoming the 5% of patients consuming 22%
  3. I am going 2 go there. Inclusion. No high risk pools. The One-Plan Plan. With a focus on prevention and wellness to mitigate risk
  4. We need to start providing preventive treatments to the masses vs. spending lion’s share of resources on the few sick.
  5. Such a good question. I think prevention costs are minimal compared to the other side of heart surgeries or chemo…
  6. I know a plan that’s feeding care gaps to physicians, so they can stay ahead of the gaps. Also helps scheduling.

Focus on Core Mission & Quality

  1. Shedding/outsourcing operations not core to their mission – like moving data centers to the cloud are long overdue.
  2. All #healthcare needs to focus on quality of care, especially since value-based care and payments look like they will stay

Smartphones – Everyone Has One – Leverage Them!

  1. IMO, health systems & plans must enable consumers and patients to use those things they’re always staring at: Smartphones.
  2. Our President Dr Rene Lerer suggests smartphones will be the “most important part of your body” for health

Interoperability

  1. No matter the #ACA result, plans and providers must get along, and have systems/infrastructure to enable real-time data exchange.
  2. Also interoperability among healthcare tech platforms to provide better utilization of collected patient data

More on the Remaining Four Topics Coming Soon

Check back later this coming week to learn what chat participants shared on the remaining four topics:
      T3: Who’s most likely to disrupt healthcare: insiders or outsiders? And what barriers do each face – right now or in near future?
      T4: What technologies will do the most to move healthcare supply-side toward improving outcomes, lowering costs & enhancing equity?
      T5: Incentives drive innovation. How can they be aligned to meaningfully support innovation that improves outcomes & lowers costs?
      Bonus: What are examples of innovative healthcare programs, processes, people and organizations – U.S.-based or elsewhere?

One More Time!

Thanks again to our co-hosts @_GWConnect and @_GuideWell, John Lynn (aka. @TechGuy) of Healthcare Scene and to all those who participated in the chat.  A complete transcript of the chat can be found here.

For more about opportunities, challenges, and issues impacting healthcare plans, health systems and payers, consider following @HCExecGroup on Twitter and join us on LinkedIn and Facebook too.

Health System & Health Plan Innovation, Change & Growth During Uncertain Times – Part 1

By | 2-Total Consumer Health, AHIP, Healthcare Reform, payer, quality measures | No Comments

Healthcare-innovation-change-growth-executives-HCEG

Last week’s Health Information Technology Social Media (#HITsm) tweetchat was co-hosted by the Healthcare Executive Group, GuideWell and GuideWell Connect from the 2017 AHIP Institute & Exhibition in Austin, TX.

The theme of the chat was “Health System & Health Plan Innovation, Change & Growth During Uncertain Times” and following six topics were discussed:

T1: What specific ‘areas of opportunity’ must health plans/systems address to improve health outcomes, lower costs & improve equity?
T2: What must health systems & health plans focus on over next 8 to 18 months regardless of health reform outcome?
T3: Who’s most likely to disrupt healthcare: insiders or outsiders? And what barriers do each face – right now or in near future?
T4: What technologies will do the most to move healthcare supply-side toward improving outcomes, lowering costs & enhancing equity?
T5: Incentives drive innovation. How can they be aligned to meaningfully support innovation that improves outcomes & lowers costs?
Bonus: What are examples of innovative healthcare programs, processes, people and organizations – U.S.-based or elsewhere?

Thanks to Hosts & Participants!

Special thanks to John Lynn (@TechGuy) of Healthcare Scene, our co-hosts @_GWConnect and @_GuideWell and all the 70+ who participated in the chat.  A complete transcript of the chat can be found here.

Insight, Ideas and Opinions on Topic #1

This post shares insight, ideas and opinions shared by #HITsm chat participants on Topic #1. We’ll share more on the other topics in future blog posts.

Precision Medicine – aka. Personalized Medicine

  1. Precision medicine (aka ‘personalized medicine) was a hot topic at this week’s #AHIPInstitute in Austin.
  2. Patients with complex needs require a custom approach. Personalized medicine promises to improve outcomes at lower cost.
  3. Be excited when we get to the point where #AI effective for health plans. We’re still collectively digging for gold in claims data.
  4. Implementing positive changes in the healthcare industry that give clinicians the opportunity to view #PatientCare in a new light
  5. We definitely need this for #UX — the difference b/t changing your bank profile and your payer profile is enormous

Patients, Consumers & Health Plan Members

  1. It wasn’t that long ago that HC plan leaders were saying “HC plan members aren’t consumers,” LOL
  2. Addressing the healthcare needs of the #aging population of the country will need to take a seat in the front row
  3. Taking advantage of the data we are given to visualize the patient condition and identify at-risk patients earlier
  4. Getting members engaged and empowered in understanding, maintaining, and improving their own health journey
  5. Consumerism has been making inroads into healthcare, patients are acting like consumers about their healthcare options
  6. Until patients “get it” health outcomes can only improve so much

Importance of Basic Health Education, Literacy & Preventive Care

  1. Improving basic health education & literacy through active & coordinated outreach to members & patients is a big opportunity
  2. Improving education & literacy can be as simple as adopting universal languages so plan members aren’t constantly confused
  3. More focus to prevention & wellness. Reach patients before they get ill or have a major medical event.
  4. We need to focus more on prevention – spending too much on too few people – and often late in life.

Customer Relationship Management

  1. Customer service is an area of opportunity, healthcare needs to accept the change and adapt accordingly
  2. Before the healthcare industry dives into AI – they should incorporate basic CRM functions into #EHR systems. Huge communication disconnect!
  3. Addressing the need for clinical decision support and getting the right information available at the right time

Data is Critical to Healthcare

  1. Challenge w/ personalized medicine starts w/ lack of ability to accurately identify correct patient some crazy % of time…
  2. And, of course, standardizing data (#interoperability) to encourage cooperation between all #healthcare entities
  3. Systems that can use unstructured data to inform decisions. AI and machine learning?
  4. Real-time data sharing, especially clinical data, with providers and especially patients
  5. Absolutely! RTI approach needs to be incorporated from data driven perspective
  6. Systems need 2 embrace outcome-driven & SDOH/BDOH-driven ops to lower costs & affect outcomes. Walk the walk; we’ve heard the talk

The Importance of Home & Social Determinants of Health

  1. Health data taken from the home of the patient using this technology can be shown to doctors for perhaps better, tailored care
  2. Another area to take advantage of is using technology to bring healthcare to the home of patients.
  3. It is the space between heart beats where we live – IE not an “area” but care coordination between areas and with patients

Quality Measures & Measuring Outcomes

  1. How about better assessment & collection of what matters to members/patients? Instead of fancy analytics from quants?
  2. How do we measure feelings and happiness? Or are outcomes more quantifiable?
  3. System wide outcome driven treatment and outcome measures to tailor individual client centered care. Educate for prevention
  4. Analytics allows for effective clinical assessments by providing better patient outcomes
  5. We’re trying to do this now, in way, with HCAHPS/CAHPS, right? Don’t believe currently effective, but CAN be quantified.
  6. Do you see a worthwhile set of quality measures worth aligning to?
  7. Great idea: patient-centric measures. What outcomes do patients/members want to achieve, and what data do we need to drive them?
  8. We do this in OT for quality of life/ perceived ‘happiness’ with what is most valuable. All valid reliable and evidence based measure

Look for More on the Other Topics in Following Posts

Check back for more insight, ideas and opinions from the #HITsm chat. Thanks again to John Lynn and our co-hosts @_GWConnect and @_GuideWell and all those who participated in the chat.  A complete transcript of the chat can be found here. You can also follow @HCExecGroup to learn more about opportunities, challenges, and issues impacting healthcare plans, health systems and payers.