Recap of Webinar: ‘Care Redesign: Lowering Costs While Improving Patient Outcomes’

By | HealthEdge, Sponsor, Value-Based Care, Webinar Series | No Comments

As more Accountable Care Organizations (ACO) are formed and as value-based reimbursement arrangements between payers and providers expand, the need for assessing non-traditional drivers of health outcomes, leveraging payer, provider and community resources and enhancing collaboration between patients, providers and payers are becoming key to improving outcomes and managing costs.

Our Thursday, October 26, 2017, Harry Merkin, VP of Marketing at our sponsor partner HealthEdge teamed up with Barbara Berger, VP of Care Management at First Care Health Plans, to present “Care Redesign: Lowering Costs While Improving Patient Outcomes,” HealthEdge’s entry in this month’s HCEG Webinar Series.  The webinar presented innovative, real-world examples of how First Care Health Plans is improving member outcomes and lowering their cost of care via three primary approaches:

  1. Collaborating with providers and health systems
  2. Partnering with community resources
  3. Making critical information available to key stakeholders

Addressing Discontinuances of Care

Barbara shared that, while the high volume, time-sensitive nature of healthcare delivery often leads to a discontinuance of care delivery and management between the silos in which payers and providers often operate, the increased data sharing associated with the emergence of ACO’s and value-based reimbursement and care models are helping to align care provided by providers and health plan payers. Examples of balancing the proper people, processes and technologies were shared.

Population Assessments and Social Determinants of Health

Barbara emphasized the importance of carefully and thoroughly assessing an individual’s health care, behavioral and social needs as part of a periodic, recurring population assessment and how doing so can have a key, beneficial impact to healthcare outcomes.  And with “Social Determinants of Health” forming the basis (bottom) of Maslow’s Triangle of Needs, First Care is starting to include an assessment of member’s social determinants of health in their population assessment program. Factors such as the following are included in the population assessment:

  1. Access to Healthcare Services
  2. Access to Food
  3. Access to Local Community Resources
  4. Access to Transportation Options
  5. Public Safety
  6. Financial Status

After Barbara shared her insight on this currently popular topic, Harry Merkin stated: “The phrase ‘social determinants of health’ is no longer a buzzword!”

Addressing Social Determinants of Health

Barbara shared an overview about First Care’s “Expecting the Best Maternity Program” that combines case management and utilization management to complement care provided by physicians while guiding and supporting members – and their family – through member pregnancies; particularly high-risk pregnancies.

Besides services such as assistance with locating medical providers, toll-free 24/7 access to a clinician and a package of select products and services aimed at supporting pregnant women, the program also includes an innovative “Nurse-Family Partnership” where a First Care nurse is paired with an expecting family to help the patient and her immediate family members understand and manage the pregnancy. First Care nurses regularly reach out to ask questions on how the pregnancy is progressing and answer any questions the patient and family may have.

The program has resulted in a significant per decrease in NICU maternity admissions.

The Recording, The Content and More Insight from HealthEdge

The webinar presented three considerations for payer-provider population health programs:

  1. Be methodical about population assessment
  2. Integrate People, Process and Technology with Providers
  3. Use value-based contracts to align vision of member/patient care

You can learn more about how collaborating with providers and health systems, partnering with community resources and making critical information available to key stakeholders can improve outcomes and lower costs by checking out this recording of the webinar and these few slides from the presentation. If you would like more information or if you have any questions on the content of this webinar, please feel free to contact HealthEdge too.

More Information

HealthEdge Website

HealthEdge on Twitter

First Care Website

First Care on Twitter

If you’re not a HCEG member and would like more information on becoming a member, please see this page or email Juliana Ruiz.

A Unique Event and Exclusive Group for Healthcare Executives

By | Annual Forum, Executive Leadership Forum, Member Benefits, Sponsor, The Industry Pulse, Top 10 | No Comments

Our 2017 Annual Forum came to a close at noon this past Wednesday. Over 110 healthcare executives, nationally known healthcare speakers and industry thought leaders gathered in Nashville, TN – Music City and the Healthcare Capital of the United States – to share their insight, ideas and concerns about healthcare reform and digital transformation during these rapidly evolving, uncertain times in healthcare.

The 29th Annual Forum featured three keynote speakers, nine sessions covering the latest topics of interest to executives leading health plans and health systems and three nighttime events structured to support networking between forum participants. All in all, the two and half days of our 2017 Annual Forum added up to one incredible opportunity for those leading the digital transformation of healthcare reform in the United States to come together on an intimate basis , to share and learn with each other collaboratively.

The 2018 HCEG Top 10 List

As has taken place during each of the last seven HCEG Annual Forum events, participants selected and voted on the Top 10 Opportunities, Challenges and Issues facing health plan and health system executives over the coming months and year. This new 2018 HCEG Top 10 list will drive the focus of Executive Leadership Round Tables, webinars, content development and other collaborative opportunities throughout the remainder of 2017 and the coming new year.

What We’ll Be Sharing From Our 2017 Annual Forum

Over the next few weeks, insight, ideas, opinions and concerns generated during the forum will be shared with members and the public at large. We’ll recap forum speaker and participant insight and opinion into how healthcare in the United States will be impacted by healthcare policy reform, digital transformation initiatives and both national and state-level actions. Readers of this blog, our friends on social media, attendees of our webinars and round tables and subscribers to our newsletter can look forward to how speakers, panelists and participants at our 2017 Annual Forum shared insight on the following:

  • How Clinical and Data Analytics leverage clinical evidence to segment populations, manage health and drive decisions
  • How the emergence of Population Health Services Organizations are operationalizing population health strategy, chronic care management, driving clinical integration, and integrating social determinants of health
  • How Value-Based Payments are being used to target specific medical conditions to manage cost and quality of care
  • How Cost Transparency is inevitable due to growing legislation and consumer demand
  • And more certain topics that can help healthcare leaders address transformation during these uncertain healthcare times

How We’ll Share

The Healthcare Executive Group will share the following via its web site, blog, social channels – including Twitter, LinkedIn an Facebook, and via other channels including member LinkedIn accounts, sponsor partner media and healthcare industry media. Look for the following:

  • Quotes from Keynote Speakers & Panelists
  • Session recaps including Presentation Materials
  • Thoughts from Forum Participants including social media shares
  • Audio Soundbites
  • Pictures and more

How to Stay Connected

To have this valuable information pushed to you, subscribe to our newsletter, follow the Healthcare Executive Group on LinkedIn, Twitter and Facebook; and consider becoming a member of our unique organization of Healthcare Executives. Learn more about the Healthcare Executive Group here.

2017 HCEG Annual Forum Speaker & Agenda Information

By | Annual Forum, Member Posts, Sponsor, Top 10 | No Comments

Thompson Hotel Nashville (Image Thompson Hotels)

To succeed in today’s uncertain and tumultuous healthcare environment, health plans, health systems and provider organizations must develop a clear strategic identity supported by a distinctive portfolio of platforms, products, and services that transform their chosen strategy into a winning business model. Change, Innovation and Growth are imperative to survive in today’s healthcare environment.

This September 18th though the 20th, the 29th Annual Forum Healthcare Executive Forum takes place in Nashville, TN at the Thompson Hotel Nashville. Leading experts in health care policy, operations, reimbursement and digital health will examine the opportunities, challenges and issues healthcare executives must face in 2017 and beyond. This blog post provides some details on the speakers and presenters, more detail on the opportunities, challenges and issues that will be discussed, and more on what participants in our 2017 Annual Forum can expect to enjoy.

Keynote Speakers at 2017 Annual Forum

Karen DeSalvo Opening with Interactive Q & A

A great line-up of keynote speakers, moderators and panelists are on tap for the Annual Forum.  On Monday the 18th, Karen DeSalvo, Assistant Secretary for Health at U.S. Department of Health and Human Services, will provide the opening keynote address which will be immediately followed by an interactive Q & A session as lunch is served. The interactive Q & A format offers forum participants a unique opportunity to interact among themselves and with a leading healthcare policy executive.

Open discussion on important topics with a diverse set of peers all actively working to address healthcare outcomes and costs in the United States is a distinctive feature of all HCEG events – particularly the Annual Forum.

Donato Tramato, CEO of Tivity Health, Life’s Bulldozer Moments

During breakfast on Tuesday, Donato Tramato, CEO of Tivity Health (formerly Healthways), will provide a motivational keynote address: “Life’s Bulldozer Moments:”How Adversity Leads to Success in Life and Business.” Donato will recount business and life lessons learned and show that adversity can lead to success – how anyone bulldozed by life can pull themselves out of the rubble, dust themselves off and find meaning and purpose.

Later on Tuesday, another Nationally and Internationally recognized healthcare executive speaker will address forum participants as dinner is served.

As with all HCEG forums and executive leadership events, participants will be able to interact with speakers and other forum participants – asking questions and sharing viewpoints, with the objective to develop actionable strategies to each of their organizations.

Unparalleled Mix of Moderators & Panelists

In addition to the keynote speakers, a select group of healthcare industry leaders which includes some HCEG members will serve as moderators and panelists sharing their unique insight and perspective on a number of carefully selected topics.  Some of these individuals include:

A complete list of these moderators and panelists can be found here.

Certain Strategies for Uncertain Healthcare Times

The following are a sample of the sessions planned for the Annual Forum:

Payer Provider Operations – CMS Mandates & Provider Data Management Initiatives

Recent CMS call letters, proposed mandates and new state and federal level regulations regarding provider networks underscores the value and importance of addressing data quality via effective communication and collaboration between health plan payers and providers. Hear from panel members on approaches for ensuring network adequacy, complying with real-time provider directory updates and related impact of No Surprise Bill legislation sweeping the country.

Leading Edge Technology / Disease Management / Population Health

Disease management and Population Health has struggled in the past and now is giving way from identifying and matching people living longer with multiple chronic conditions to providing cost-effective, scalable mitigation and support services/products needed by this rapidly changing population. Panelists will discuss opportunities, challenges, and issues for improving clinical and costs via services and technologies addressing access to care, supporting interaction among constituents, and reducing costs via analytics, artificial intelligence and alternative/virtual reality services.

Pharmacy Costs / PBM and Rx Transparency

Prescription drugs are a fast-growing part of most large employers’ total medical spend and the increasing prevalence of high-deductible health plans have put on spotlight on the importance of Rx price transparency, benefit design and pharmacy benefit management practices. This panel will examine opportunities for managing the financial and non-financial/clinical aspects of prescription drugs, working in revolutionary ways with PBM’s, while ensuring optimal outcomes and member/patient satisfaction.

Specialty Networks and Risk Sharing at Scale

Value-based care programs and risk-sharing in accountable care organizations are core components for delivering and paying for care more effectively and efficiently. This panel will discuss and explore how opportunities and issues with specialty networks and support for risk-sharing at scale.

Precision Medicine and Behavioral Health Aspects of Substance Abuse/Opioids

As the use and abuse of opioids skyrockets, precision medicine technology that successfully stratifies patient risk by analyzing genetic and non-genetic (environmental & lifestyle) risk factors to accurately predict prescription opioid abuse show promise of helping physicians choose more effective treatments and reduce addiction risk while lowering cost. This panel will explore how health plans and providers can utilize precision medicine to achieve a new standard in healthcare delivery based on evidence-based insights and predictive analytics.

Digital Health & Consumer Engagement

Certain digital health technologies are rapidly becoming an integral way of connecting to and engaging with the healthcare consumer. Though still being decided, this panel will explore the digital technologies most likely to gain consumer acceptance, engagement and lead to real improvements in overall well-being, outcomes and cost-reductions.

Technology Innovation and Healthcare M & A Market Trends

Achieving scale via M & A deals and through dedicated ‘innovation programs” have been a popular way for health plans and health systems to create “quick-win” value.  And health plan/health system leaders must employ a smarter, more sophisticated scale equation to derive the most value from these approaches. This panel will review current trends in healthcare innovation and M & A activity and discuss risks and benefits of various value creation strategies.

Additional Forum Events and Opportunities

In addition to a knowledgeable group of healthcare visionaries and thought-leaders exchanging information, ideas and opinions with forum participants, participants at the 29th Annual Forum will enjoy other critical networking and perspective sharing events and opportunities including:

  • Meet and Greet at Thompson Hotel – Sunday night
  • Off-Site Reception with great Nashville music on Monday the 18th
  • Catered breakfasts, lunches and dinners each day of the forum
  • Nashville Late Night Party – Tuesday the 19th
  • Participate in identifying and selecting the 2017 HCEG Top 10*
  • Networking and open discussion with all speakers, moderators, panelists and forum attendees

For more information on the 2017 Annual Forum of the Healthcare Executive Group including registration, visit this page.

‘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_

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.