An Executive Leadership Forum at GuideWell Innovation Center

By | analytics, Executive Leadership Forum, Security | No Comments

Executive Leadership Forum at GuideWell Innovation Center hcldr hitsm innovationOur Executive Leadership Forum held at the GuideWell Innovation Center on Monday, May 8th was attended by 21 healthcare executives and solution provider thought leaders. The three-hour event – titled Operationalizing Before Analyzing: Healthcare’s Modern Journey Powered by Data – focused on some of the underlying challenges and issues regarding how healthcare data and analytics technologies impact consumers, providers and health plans.

The forum included lively discussion on real world use cases for healthcare data and analytics, a demonstration of live 3D interaction possibilities and a tour of the GuideWell Innovation Center. The forum was capped off by a happy hour for participants to network with each other and forum sponsors: MarkLogic and Intel.

In this post, highlights of the discussion between forum participants and key takeaways will be presented. In future posts, an overview of the 3D interaction demo and tour of the GuideWell Innovation Center will be shared.

Demand for Real-time Data and Transactions

A lot discussion during the forum centered around current complexities and how demand for real-time data and transactions—across clinical, administrative and financial operations–is increasing exponentially every day and putting significant demands on service model / operations and legacy infrastructure, which are mostly batch / file transfer oriented.  Several issues were identified as current concerns:

  1. Many underlying data challenges
  2. Lack of agility in quickly responding to opportunities
  3. Inadequate data governance/provenance with ETL approaches in the legacy data pipeline

All audience members agreed they wanted faster time to market and better ability to respond to clients / market / regulations and be more agile when it comes to data. There was broad agreement that “data integration” is a journey that should follow a new data integration pathway instead of the legacy Extract-Transform-Load (ETL) approach:

Real World Use Cases

Over the course of the discussion there were a number of data capture and analytics use cases shared between forum participants. One use case described enrollment data submitted to the IRS on the 1095-B Health Coverage forms sent to individuals noting their qualified health coverage during each month in the year.

One participant described how the IRS had reported back to the health plan that 40% of the records submitted by the health plan to the IRS had errors in name, social security number and/or dependent status; basic required enrollment data elements that the plan was not able to validate or authenticate during the initial enrollment process and remained that way throughout the entire year. Garbage-In-Garbage-Out.

This “1095-B use case” elicited feedback from one forum participant having recent experience at the Census Bureau with the participant describing how government agencies often don’t have complete, accurate data. Just because CMS might have data of one quality level, they don’t always share that data with related agencies so the IRS or the SSA or state Medicaid administrators likely have different data.

Leverage All Data Types & 3rd Parties

Forum participants shared unique perspectives and a Q&A ensued on the example of how the Census Bureau uses associated data to significantly improve the timelines, accuracy and overall value of census data by editing it against 3rd party sources.  This Census Bureau use case and another use case described by forum participants of a BCBS plan emphasized that 3rd party data sources and unstructured data are very important to service improvement, member/patient experience, innovation and growth-oriented project investments.

Primary Investment Areas: Data Improvement & Integration Projects

Forum members identified the following investment areas for data improvement and integration projects that healthcare executives may implement over the next 12-18 months to modernize healthcare data and applications:

healthcare-data-integration-investment-areas-ELF-Blues-MarkLogicThought Leader Presentations

This Executive Leadership Forum was co-sponsored by MarkLogic and Intel. The information shared by these two sponsors are made available here:

    “Healthcare ‘Next Gen’ Data Projects”Bill Gaynor, U.S. Healthcare Director – MarkLogic, Inc.

    “Intel Healthcare Security Readiness Program Overview”Joan Hankin – Global Director of Marketing & Business Development – Healthcare & Life Sciences at Intel Corporation

In addition to information shared by MarkLogic and Intel, Constance Sjoquist, former Research Director at Gartner, also participated:

    “Disrupting the Status Quo in Healthcare” – By Constance Sjoquist, Chief Content Officer – HLTH, LLC.

Three Basic Tenets Unanimously Agreed

At the end of the forum, participants unanimously agree on three basic tenets:

  1. Complete and accurate data – especially basic demographic and social determinants – MUST begin with the first member/consumer/patient-provider interactions at the point of service
  2. Data needs to be authenticated, validated, verified and ENRICHED against other sources – then normalized across other supportive partners and their ‘systems of record’
  3. Today’s technology can support the capture, validation and use of healthcare data on a relatively inexpensive basis.

Join Other Healthcare Leaders

For more information on the Healthcare Executive Group and how you can become more ‘in the know’ and effective as a healthcare executive or thought leader, check out this information about becoming a member. You can also follow us on Twitter, friend us on FaceBook and follow us on LinkedIn.

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

By | analytics, payer, Top 10 | No Comments

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”