“Specialty Networks and Risk Sharing at Scale” – A Session at HCEG’s Annual Forum

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“Specialty Networks and Risk Sharing at Scale” – Monday, September 18th at 3:15PM – 4:30PM

At this year’s 29th Annual Forum in Nashville, TN, Dr. Richard Popiel, EVP & Chief Medical Officer at Cambia Health Solutions, moderates a panel presenting and discussing the current needs, opportunities, and challenges associated with improving the appropriateness, outcomes and affordability of specialty care services; specifically the clinical decision support mechanisms and other solutions that risk-sharing, value-based environments need to simplify, encode and utilize complex clinical content into a standardized, repeatable, evidence-based system for making decisions supporting an organization’s clinical programs.

Dr. Popiel and other healthcare industry experts will present how we as a healthcare system can improve healthcare outcomes and reduce costs by shifting to value and risk sharing arrangements. Insight into how disruptive analytics and analytical approaches to cost trend monitoring and containment will be shared and interactive opportunities to engage will be available.

Healthcare Thought Leaders Share Valuable Insight at HCEG Annual Forum

Panel Moderator – Richard Popiel MD MBA 

Dr. Richard Popiel, Cambia Health Solutions

Richard Popiel, M.D., MBA, Executive Vice President, Healthcare Services & Chief Medical Officer, Cambia Health Solutions & Regence Health Insurance Company

Dr. Richard Popiel leads medical strategy for Regence health insurance plans and provides executive leadership on care initiatives and cost management activities across the corporation. He came to Regence from Horizon Healthcare Innovations, where he was president and chief operating officer. Dr. Popiel earned a B.S. in biology and his M.D. at The George Washington University in Washington, D.C. He also holds an M.B.A. from Northwestern University Kellogg School of Management. He is board-certified in internal medicine.

Panelists include: (Additional panelists are pending confirmation)

Brandon Cady

Brandon Cady – President/CEO at AIM Specialty Health

Brandon Cady is the President and Chief Executive Officer of AIM Specialty Health® (AIM). Brandon joined AIM in 2002 and executed top line growth initiatives that expanded the business into one of the largest and most successful specialty benefits management companies in the United States.

Brandon has held a variety of leadership positions within hospital systems, health plans, and emerging technology companies. Brandon earned his master’s degree in Health Services Administration from the University of Michigan in Ann Arbor and a Bachelor of Business Management from the University of Iowa.

Dunston Almeida

Dunston Almeida – Executive VP of M&A Strategy and Business Development at Evicore

Dunston Almeida serves as an Executive Vice President of M&A Strategy and Business Development at eviCore healthcare, LLC. Dunston focuses on new strategic initiatives and partnerships, driving inorganic growth via mergers and acquisitions (M&A) and working with the Board and Executive Team on the company’s Strategy Council. He also supports the formulation of eviCore’s public policy and regulatory efforts. He has more than 20 years of experience in technology.

 

The 2017 HCEG Annual Forum

The HCEG Annual Forum provides the setting and platform for senior level executives from across the healthcare spectrum to come together for 2-3 days each year to discuss the continuous innovation, evolution and transformation of the industry. Attendees are granted direct access to approximately 100 peers, thought-leaders and solutions providers from around the country; all facing similar obstacles and providing opportunities, while engaging in real, relevant and productive dialog.

This year’s 29th Annual Forum takes place in Nashville, TN on September 18th -20th. For more information on this years annual forum, see this page.

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.

How Total Consumer Health is Impacted by Technology and the Human Touch

By | 2-Total Consumer Health, 5-Transparency, Member Posts, Top 10, Value-Based Care | No Comments

healthcare executive group hceg medica healthedge total consumer health MACRA MIPS APM social determinants of health“Total Consumer Health” means improving ones overall medical, social, financial, and environmental well-being and was identified by HCEG members as the second item on the 2017 HCEG Top 10 list of priorities, challenges and opportunities facing healthcare executives.

Leveraging Medical, Social and Other Data

As value-based care continues to impact the provision of key healthcare services, health plans and providers are seeing an urgent need for improved collaboration centering on the individual member. Total consumer health increasingly relies on innovative technology systems to incorporate data based on life issues and social determinants of health. Providers and care givers must assess, capture and integrate key information that goes beyond mere observation.

By leveraging a mix of actionable data insights and on-the-ground support, health plans are in position to integrate critical technology with a high touch and hyper local approach to care coordination. Total consumer health outcomes are improved when key social determinants are combined with important medical information.

Learn more on Wednesday, April 19th at 2:00pm EDT

 

Join Dr. Alan Spiro, MD, MBA, Chief Medical Officer at Medica, and Harry Merkin, Vice President of Marketing at HealthEdge to learn:value based care total consumer health social determinants of health

  • The appropriate balance between high and low tech options for care coordination
  • How to incorporate innovative tools and methods to address social determinants of health and other factors
  • Real-world examples of innovative collaborative arrangements that are making a positive impact on outcomes

Presenters

Dr. Alan Spiro, MD, MBA – Chief Medical Officer, Medica

As Chief Medical Officer, Dr. Spiro has overall responsibility for the work of Medica’s Health Management segment. This includes working with Medica’s provider partners to develop new models of collaboration aimed at improving quality, patient experience and value. It also includes working with Health Management staff and leaders from other Medica segments to build on the work currently underway to improve the quality and cost of health care.  Follow Medica on Twitter.

Harry Merkin – Vice President, Marketing, HealthEdge

Harry Merkin is a senior marketing executive and is responsible for the company’s demand generation programs, strategic partnerships, product marketing and thought leadership initiatives. He also frequently represents HealthEdge as a speaker at industry conferences and events. Harry has collaborated with many transformative entities across the healthcare landscape including both payers and providers. Follow HealthEdge on Twitter.

Advancing Together: Healthcare Innovation in Wine Country

By | Healthcare Reform, The Industry Pulse, Top 10, Value-Based Care | No Comments

Healthcare innovation forum unitedag hceg hcexecgroup napa ca topics value-based-care

Note: This post was first published by Ferris Taylor on LinkedIn

It could have been the combination of a beautiful day in California’s Wine Country or just the extraordinary and varied perspectives of healthcare executives representing a true cross-section of American healthcare – payers, providers, vendors, purchasers and UnitedAg partners – that elicited deep discussion about value-based relationships and made the jointly sponsored Healthcare Executive Group (HCEG)-UnitedAG Health Innovation Forum such a successful event.  But whatever it was, the forum’s theme – Advancing Together – was clearly a spot-on phrase used to describe an informative and inspiring event.

UnitedAG’s hospitality and the diverse cross-section of attendees at UnitedAg’s Annual Meeting and Conference could not have set a more congenial and thought-provoking setting. Led by Kirti Mutatkar, UnitedAg CEO, Mike DeMore, Superior TPA’s Managing Director and Christopher McDonald, UnitedAg’s Director of Underwriting, the Health Innovation Forum kicked off an open dialogue of the critical issues and opportunities facing healthcare in 2017 and beyond.

The Healthcare Industry Pulse

After 30+ participants introduced themselves to each other, Ferris Taylor, HCEG Office of the Chair and Change Healthcare consultants, Chris Link and David Gallegos, presented highlights from the 7th Annual Industry Pulse Research survey. As is commonly said, a picture is worth 1000 words and Eris Weaver, a graphic recorder meeting facilitator captured many key points throughout the fast moving discussions.

Key research insights among the participants were shared on the impacts that clinical and data analytics can have on stakeholder interactions, workflows and especially on population health.  The transitions from more traditional risk management (disease and care management) to more 21st century tools and technologies were explored. Measures of success for the transition to value-based relationships were considered, especially those that will best serve consumers, healthcare providers and payers.  The Industry Pulse research also highlighted the roles that both cost and quality transparency will play in the future of healthcare.

Alignment of Incentives is Key

As revealed in the excellent graphics created by Eris Weaver as the discussions unfolded, “trust” was a key word arising multiple times.  Dr.  David DiLoreto, SVP at GE Healthcare and HCEG member, facilitated dialogue on the importance of more detailed innovations that value-based relationships demand. Dr. DiLoreto shared some insight experienced in Scandinavia and Denmark versus here in the U.S.

Population Health & Value-based Care

Dr. Arjun Chanmugam, Vice Chair of Johns Hopkins’ Integration and Health Care Transformation, Dr. David Nace, Chief Medical Officer at HCEG sponsor partner MarkLogic and Dr. Craig Brandman, CEO of StepOne Health, contributed their unique insights about the challenges and secrets of value-based health care.

More on Wednesday, March 29th, 2017

The morning of discussion in Wine Country was just the start of innovative thinking around value-based relationships.  Those discussions and more details from the Industry Pulse Research Survey will be shared via a webinar presented by HCEG and Change Healthcare on Wednesday, March 29th at 2:00 PM Eastern.

Free registration is available here.