HCEG Members and Sponsor Partners at the HIMSS Conference in Las Vegas!

By | HCEG Top 10, HIMSS18, Population Health, Social Determinants of Health, Value-Based Payment | No Comments

The behemoth of all healthcare conferences started today: the 2018 HIMSS Conference & Exhibition.  Few healthcare conferences garner the attention of healthcare industry executives and professionals as the annual HIMSS Conference and Exhibition. And HealthCare Executive Group (HCEG) members, sponsor partners and advisors are among the approximate 45,000 healthcare professionals descending upon Las Vegas this week to network with others, attend sessions addressing topics of interest, cut through the clutter and and jockey for position among 10’s of 1000’s of others in the cavernous exhibit halls of the HIMSS conference.

How Big is the HIMSS Conference?

To get an idea about the sheer size of the HIMSS Conference & Exhibition, consider the following statistics provided by HIMSS:

  • Number of Attendees: Approximately 45,000 people – equal to a capacity crowd during a Cubs game at Wrigley Field
  • Geography: attendees from 40 countries will be represented.
  • Exhibitors: About 1300+ vendors – most all of them flush with shiny handouts and branded tchotchke battle each other for the attention, contact information and budget of the attendees from around the globe.
  • Carpet: More than 10 miles of carpet cover the aisles of the exhibit hall
  • Connectivity: About 18 miles of cabling provide internet connectivity throughout the convention center.

HCEG’s Top 10 Mirror Popular HIMSS Themes

Historically, industry executives, media, thought leaders, speakers, influencers and brands predict major HIMSS conference themes in the months and weeks leading up to the conference. Not surprisingly, this year’s major themes closing align with the opportunities, challenges and issues ranked by HCEG’s members in the 2018 HCEG Top 10. These include the following:

Advanced Analytics (Ranked #1 on HCEG Top 10 List)

Clinical, operational and financial processes supported by ever-improving artificial intelligence, machine learning and natural language processing applications have been identified by many as a primary way to make everyone more proactive to improve outcomes and lower costs. And the importance of non-traditional data sources such as social determinants of health, consumer-generated data and data purchased from 3rd parties provide tangible cost savings, time savings and quality of care improvements.

Value-based Payment & Care (#3)

In spite of recent pullback by CMS on bundled payment initiatives and some delays in implementing certain regulations regarding value-based payment programs, information, products and services aimed at accommodating our aging population and increasing levels of chronic conditions are legion in the sessions, exhibit booths and hallway conversations at HIMSS.

Population Health Programs & Services (#2)

Results from the 8th Annual Industry Pulse report, based on the HCEG Top 10, make it is clear that the industry can’t get to value-based payment (VBP) without significantly enhanced clinical data, analytics and agreed upon measures.  And VBP won’t succeed unless there is more focus on bringing communities together to change behaviors and how we think about approaching population health.

Sorting through all the overlapping platforms, data trends, and tools needed to complement the care team and provide patients with optimal outcomes at the lowest cost are no easy feat. Attendees exploring the exhibit hall in search of achieving efficient implementations, streamlined operations, scaled delivery across large markets have their work cut out for themselves this week.

Engaging Healthcare Consumers & Patients (#10)

Whether you agree or not, healthcare services and products are moving from a B2B to a B2C and B2B2C delivery model.

Recent announcements from non-traditional healthcare market participants like the Amazon-Berkshire Hathaway-JP Morgan Chase partnership and the CVS- Aetna merger make it clear that massive change in the traditional healthcare market – lead by the digitization of everything – is imminent. Duplicating the consumer engagement models these new healthcare market entrants have proven in other industries and markets makes it apparent that significant cultural and organizational changes are required to adapt to the digital transformation sweeping the healthcare industry.

Popular Hashtags At the 2018 HIMSS Conference

You can zero in on popular HIMSS-related themes using the following hashtags:

#patientengagement – Being used over 80% more this year in comparison to last year

#AI and its variants #artificialintelligence, #machinelearning and #bigdata

#VR, #AR and #IoT are trending upwards of 100-200% over last years conference

#Aim2Innovate, #TransformHIT, and #EmpowerHIT

Check out this eBook from HIMSS on some of the innovation that will be on display at this year’s conference.

HCEG Sponsor Partners at HIMSS

If you’re at the HIMSS Conference, be sure to check out our sponsor partners exhibits, sessions and special events are hosting. Here are those we know about at this time. We’ll share more as they become known.


Visit Booth 5062 to get some water, soft pretzels, Tastykakes and learn more about Instamed’s offerings.

Also, on Tuesday, March 6, 2018 at 7:30pm, InstaMed is also hosting a reception at TAO in The Grand Canal Shoppes of the Venetian Hotel & Casino. See here for more info.

Cumberland Consulting Group

Cumberland Consulting Group is hosting a happy hour on Wednesday, March 7 at 4:00-7:00pm at the Public House in Grand Canal Shoppes at the Venetian. For more information, contact Brigid Turrittin.

Change Healthcare

Visit booth 4202 to meet with Change Healthcare – a HIMSS featured exhibitor.

On Tuesday, March 6th at 9:30, Change Healthcare, Intel and other vendor will present “Blockchain Reset – Seeing Through the Hype and Starting Down the Path.” Location is Sands Hall G Booth 11955ET.

Special ‘HIMSS18-edition’ eNewsletter

Keep your eyes peeled for more information, insight and ideas that HCEG members, sponsor partners and advisors will be gathering from Las Vegas this week. A special ‘HIMSS18-edition’ eNewsletter will be shared later this week including major takeaways, insights from conference thought leaders and some pictures capturing the event. If you aren’t already a subscriber to our newsletter, you can sign up here.

Part 2: Recapping ‘The 2018 HCEG Top 10 Healthcare Opportunities, Challenges & Issues’ Webinar

By | Cybersecurity, Executive Leadership Roundtable, HCEG Top 10, Pharmacy, Webinar Series | No Comments

The theme of last month’s HCEG Webinar Series event was The 2018 HCEG Top 10 – Healthcare Opportunities, Challenges & Issues. In a previous post, highlights of the following two topics that were discussed by moderator Kim Sinclair, HCEG board chair and CIO at Boston Medical Center Health Plan, and panelists Ferris Taylor, HCEG’s Executive Director and Consultant to Arches Health Plan and David Gallegos, Sr VP of Consulting Services at Change Healthcare, were reviewed:

  • Which three items on the 2018 HCEG Top Ten list three areas were of most interest?
  • What’s the state of healthcare consumerism and what’s being seen in the industry?

This second post recaps highlights from the second half of the webinar where the topics of Cybersecurity (Ranked #6 on the 2018 HCEG Top 10) and Addressing Pharmacy Costs (Ranked #9) were discussed. The webinar presentation materials and a recording of webinar can be found here.

Cybersecurity – 2018 HCEG Top Ten Item #6

Topic #3: How are you seeing cyber security and cyber threats impact healthcare organizations beyond the tactical day-to-day prevention activities?

HCEG Healthcare Executive Group Webinar-Top-10 Trends Cybersecurity

Ferris Taylor: “I think it’s (cybersecurity) fundamental that we need to innovate and improve cybersecurity in all of our healthcare processes. That really means giving people a confidence that their personal information won’t be used in ways that a person doesn’t want it to be used. So, it ties back to consumerism.

Real World Impact of Medical Identity Theft

“Here in Utah, about three years ago, there was a baby born in the hospital that was heroin addicted. And of course, the Department of Social Services immediately went to the home and removed the three other children from that home. The fundamental problem was that the mother of that heroin baby was not the mother in that home. And it took that mother three months to get her children back. It was a case of medical identity theft where the baby was born. The real mother checked out.  We can understand the personal impact that that lack of security around medical information caused for that family.”

David Gallegos: “The world has gotten a lot smaller and technology a lot more complex over the past decade. And clearly cyber terrorism is a big part and a growing concern that every organization needs to take seriously. But you need to keep in mind that the safest computer is one that’s turned off and unplugged. And clearly that’s not very useful.

“We need to balance both security and usability and the sharing of clinical information. It’s going to be critical to our care model redesigns and our clinical collaboration. This data is also going to be important for us to leverage artificial intelligence and, to help us determine optimal courses of treatment. In some cases, this information is even going to be needed to help really define how whole populations are treated.”

Addressing Pharmacy Costs – 2018 HCEG Top Ten Item #9

Kim Sinclair shared that pharmacy costs continue to rise and is a topic constantly in the news, noting that non-profit hospitals have stated intent of joining together to form their own pharmacy organizations.

Topic #4: What are your thoughts about what healthcare leaders can do about rising pharmacy costs?

Ferris Taylor: “I saw some statistics on pharmacy costs that struck me to the heart. It was from the Health Care Cost Institute over the last four years. It was actually 2012 to 2016 and the cost of prescriptions in the marketplace had gone up by 25%. But the utilization of prescriptions had only gone up by 1.8%. And it wasn’t just pharmacy costs. Emergency Room prices have gone up by 30% and visits went up by 2%.”

Free-Market Economy and Governance

“So, I think, once again, we haven’t transitioned from the buyer being the employer to the consumer becoming more and more important in that purchasing decision. As we discuss pharmacy costs, the other thing that I think we need to recognize is that we have a free-market economy. But industries have responsibilities to govern themselves. And I know some of the bad players in the pharmacy industry are outside of the Pharmacy Association. So, it’s hard to regulate them. But I use those key issues as the things to help us start to address the pharmacy costs”

David Gallegos on the State We’re in with Pharmacy Costs

pharmacy costs increases hceg healthcare executive group

“What I look at the state we’re in with pharmacy costs. To me it’s entirely self-made. We’ve created these regulations that allow schemes like pay to delay, or evergreening – that’s really pushed generics out further in terms of their development. We create, in a sense, quasi monopolies.”

“We criminalize the ability to negotiate for larger population blocks. I mean it seems ridiculous to me, actually, that drugs that were invented and manufactured here in the United States can often be purchased cheaper outside of our country.”

“Clearly drugs are very important. They reduce admissions that would use other high cost care. And some of them are miracles. They can literally cure diseases – cure the incurable. So, I understand this is not a simple problem. But if a drug cost a million dollars and the person can’t afford it, is it really a miracle?”

“And in any other market, if there was a product that nobody could afford, the supplier would price it differently. And that’s what we have in our market.”

Previous Webinar: Strategies to Address Rising Pharmacy Costs

For more about pharmacy costs, see this recap of last December’s webinar titled “Strategies to Address Rising Pharmacy Costs” presented by our sponsor partner Cumberland Consulting Group.

Check out the Webinar Recording for More

For more insight on 2018 HCEG Top 10 and the perspective of healthcare executives, check the webinar recording and subscribe to our eNewsletter where we’ll be sharing more information, insight, opinions and ideas of value to healthcare executives and thought leaders. Our newsletter will also share information on future webinars and events like our Executive Leadership Roundtable in Las Vegas this coming May 9th.

Recapping ‘The 2018 HCEG Top 10 Healthcare Opportunities, Challenges & Issues’ Webinar – Part 1

By | Top 10, Value-Based Care, Value-Based Payment, Webinar Series | No Comments

Last week we kicked off the first entry in the Health Care Executive Group’s 2018 Webinar Series: The 2018 HCEG Top 10 – Healthcare Opportunities, Challenges & Issues. The new board chair of HCEG, Kim Sinclair, CIO at Boston Medical Center Health Plan, moderated the webinar and was joined by Ferris Taylor, HCEG’s Executive Director and Consultant to Arches Health Plan and David Gallegos, Sr VP of Consulting Services at Change Healthcare,  one of HCEG’s long-time sponsor partners.

This blog post provides an overview of webinar highlights of the discussion between Kim, Ferris and David, their responses to attendee questions and some additional information to be shared in a future blog post. The webinar presentation materials and a recording of webinar can be found here.

Note: Verbatim responses are included in quotations and paraphrased responses are not quoted.

Topic #1: Most Interesting Items on 2018 HCEG Top 10 List

Kim asked David and Ferris which three items on the 2018 HCEG Top Ten list three areas were of most interest?


“Of course, they’re all very interesting to me. It’s been a very much a part of my life for the past few years being involved in Healthcare Executive Group and obviously being part of the industry. But really, I think the top three on the list are the top three for a reason. I look at these as the three pillars of value-based care.”

“Any value-based program needs to ensure that it’s that it’s a win-win-win for the payer, for the provider and for the member, in order for it to be sustainable. So, in order for it to be a win-win-win, you really need these three pillars. You need alignment and financial incentives. You need to have strong payer provider integration, or cooperation really, to create a true partnership between the caregiver and the payer. But you also need to have the provider and the payer partner on fundamentally changing the way care is delivered.”


“I don’t think we should minimize the topic of costs in healthcare and that probably shows up in the Top Ten most significantly around Cost Transparency (Item #4). A lot of that discussion in the recent months has been around Addressing Pharmacy Costs (item #9) but it’s not exclusive to that.”

“But here in the HCEG Top Ten is also cyber security (Item #6) and it’s interesting to me that it – like the clinical data and analytics (Item #1) you mentioned David – cuts across almost all of the issues. If we can’t assure the consumer of some sort of privacy around their data and some security, then we have an issue. Cybersecurity was not on the HCEG Top Ten list for many years going back. Three or four years ago it came up to the top of the list.

My top three would also have to include that bigger bucket of consumerism. It’s on the list as Total Consumer Health (Item #5) and Harnessing Mobile Health Technologies (Item #8). And also, The Engaged Digital Health Consumer (Item #10).

“We are in a major transformation of healthcare from the consumer to the buyer being the employer to the consumer. So, I would add those three Kim to the list that David has pointed out.

Keeping Track of David’s & Ferris’s Top 3 Top 10 Picks?

David Gallego’s Top 3 Picks Ferris Taylor’s Top 3 Picks
#1 – Clinical and Data Analytics #5 – Total Consumer Health
#2 – Population Health Services Organizations #8 – Harnessing Mobile Health Technology
#3 – Value-Based Payments #10 – The Engaged Digital Consumer

Topic #2: Healthcare Consumerism

Kim asked Ferris and David to give their perspective on consumerism and what they’re seeing in the industry absolutely?


“So fundamentally, I think consumerism is about giving people what they want. So, at a high level that means affordable, accessible high-quality care that improves their overall quality of life. That’s simplistic in some ways but I think everyone could agree that’s what people want of health care. You must look at a more granular level as to what consumers want and need as they can vary significantly. And then, so from that perspective, consumerism really needs to be about customization.”

Customized care means the right service and/or right content is delivered at the right time, at the right place and by the right caregiver.

  1. It’s about 24-hour access to care.
  2. It’s about multi-channel access to information and services.
  3. It’s about providing relevant content to current or predicted life events.
  4. It’s about customized care plans to take individual patient specific conditions, genomic, social determinants all into consideration.
  5. It’s about empowering and enabling the consumers so they have the right amount of information to make the right decisions for their health, cost, and quality etc.


“There’s a lot of dimensions of the cost equation, of the price equations that our health care consumers, our members, and our patients just don’t understand. It isn’t consistent with what they experience in the other aspects of their life and I think that takes me to the consumer discussion. And that’s clearly one of my top three.”

“But we are in a major transformation of healthcare from the employer being the buyer to the consumer being the buyer. In December, the American Health Insurance Plans (AHIP) association had an entire three-day conference on consumer experience and digital health. In a nutshell, it really stuck in my mind that as health plans, providers and technology vendors really need to stop thinking like health plans, providers and technology vendors; and start thinking like consumers. People don’t look at healthcare as the only thing in their lives.”

“It’s our responsibility as healthcare stakeholders to find a way that our healthcare messages and our healthcare initiatives can fit into the life flow of our members and our patients; and that of their families, their work, their community and what we need to weave into our initiatives the day to day things that we know, if consumers did them.”

Analogy About Healthcare Spending by David Gallegos

David shared an interesting, very accurate and rather amusing analogy about healthcare spending. “$16 Worth of Groceries for $10!”

Topics Addressed in Next Post: Cybersecurity & Rising Pharmacy Costs

The above represents just a small portion of what Kim, Ferris and David discussed in the first half of the webinar. For more insight on any particular area of interest, you can watch the webinar recording and/or read the transcript here.

In a following post, highlights from the second half will be shared. These include responses to the following two topics posed by Kim Sinclair to Ferris Taylor and David Gallegos:

How are you seeing cyber security and cyber threats impact healthcare organizations beyond the tactical day-to-day front prevention activities?

What are your thoughts about what we as healthcare leaders can do about rising pharmacy costs?

Connect with the HealthCare Executive Group

If you want to learn more about healthcare in the United States and connect with like minded thought-leaders, consider subscribing to our eNewsletter, follow us on Twitter, and connect with us on LinkedIn and Facebook. Better yet, join our unique organization of healthcare executives and thought leaders.

Rising Pharmacy Costs – Strategies to Address – Webinar Recap

By | HCEG Top 10, Pharmacy, Sponsor, Webinar Series | No Comments

It’s no secret that rising pharmacy costs are a serious challenge for the health plans, health systems, sponsors and individuals on the hook for paying for them. Our healthcare executive members ranked “Addressing Pharmacy Costs” as #9 on the 2018 HCEG Top 10 list.

How Can Health Plans and Health Systems Address Rising Pharmacy Costs?

On Wednesday, November 13, 2017, Pete Biagioni, Managing Partner at Cumberland Consulting Group, and Marcia Lambert, Partner at Cumberland Consulting Group presented “Strategies to Address Rising Pharmacy Costs,” Cumberland Consulting Group’s entry in this month’s HCEG Webinar Series. 

The webinar provided attendees with a lot of great insight and information on the following:

  1. An overview of trends in growth of pharmacy costs
  2. Pharmaceutical Distribution Channels
  3. Drivers of specialty pharmacy spend
  4. Drug cost management strategies
  5. What strategies health plans and health systems can implement to address rising pharmacy costs

Trends in Rising Pharmacy Costs

Rising pharmacy costs trends Specialty Pharmaceuticals Management Strategies Distribution Reimbursement System Provider Administered, Outpatient Prescription Drugs

Specialty Pharmaceuticals – a 95% increase in just two years!

Pete Biagioni kicked off the presentation by highlighting that prescription drug spending is now the largest category in healthcare benefit spending – outpacing specialty care, inpatient and outpatient costs. Pete added that not only is prescription drug spending the largest healthcare expense but it’s also the fastest-growing category of benefit spending!

Largest contributor to increases in rising pharmacy costs are Specialty Drugs – with a 95% increase* in just two years!

How Drug Prices are Determined in the United States

One interesting part of the presentation was Marcia Lambert’s overview of the Pharmacy Distribution and Reimbursement System for Patient-Administered vs. Provider Administered, Outpatient Prescription Drugs in the U.S.  Several very detailed and informative slides were shared.  These slides identified the product flow, contractual arrangements and financial payments between the myriad of entities involved with pharmacy distribution in the U.S.

Specialty Pharmacy Trends & Drivers of Specialty Pharmacy Spend

A good part of the presentation covered specialty pharmaceuticals, which are growing at a CAGR of 17% as more products are being developed to treat orphan diseases and provide newer therapies. Some specialty pharmacy trends include:

  • As more specialty drugs are dispensed, a shift away from the buy-and-bill system (reimbursement through medical benefit) to the pharmacy (reimbursement through prescription drug benefit) can be expected.
  • As SPs gain more revenue and market share, they’ll come under more scrutiny and attempts at cost containments from payers.
  • The healthcare system’s grudging acceptance of high-priced orphan disease drugs has given manufacturers more incentive to develop low-volume SP drugs.
  • The high cost of SP’s will demand more Value-Based/Outcomes-Based evidence

Pharmacy Cost Management StrategiesRising pharmacy costs trends specialty pharmacy Management Strategies Distribution Reimbursement System Provider Administered, Outpatient Prescription Drugs

The Cumberland presenters provided an overview of traditional Strategies to Manage Rising Pharmacy Costs and then dived into a LOT of detailed information on the pros and cons of newer, novel strategies for managing pharmacy costs including:

  • Comprehensive Medication Review / Medication Therapy Management
  • Specialty Pharmacy Coordination & Management
  • Outcomes-based Contracting
  • ‘DIR’ Fees – Direct and Indirect Reimbursement

The Future – Pharmacy Trends and Government Intervention

This rapid paced presentation moved toward its conclusion with Pete Biagioni sharing a few slides listing some ways that government intervention might impact prescription drug prices. And the webinar completed with a short listing of future trends for prescription drugs in the U.S. The entry of Amazon and mega deals like CVS buying Aetna being two likely major impacts.

The Recording, The Content and More Insight from Cumberland Consulting Group

The above is just a portion of the information presented by our sponsor partner Cumberland Consulting Group. You can learn more about “Strategies to Address Rising Pharmacy Costs” by reviewing the entire recording of the webinar available here.  If you’d like more information or if you have any questions on the content of this webinar, please feel free to contact Cumberland Consulting Group. You may also want to follow Cumberland on Twitter.

*Per CMS 2014  fact sheet: https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html


Population Health, Value-Based Care, & The Engaged Digital Consumer – An Executive Leadership RoundTable

By | AHIP, analytics, Executive Leadership Roundtable, HCEG Top 10, Nashville, Population Health, Social Determinants of Health, Value-Based Care, Value-Based Payment | No Comments

On the 2018 HCEG Top 10 list, Clinical and Data Analytics, Value-based Payments and The Engaged Digital Consumer were ranked #1, #3 and #10 respectively by health plan, health system and healthcare provider executives who participated in identifying and ranking the 2018 HCEG Top 10. It seems fair to say that these three topics are front and center on the mind of executives and thought leaders in the healthcare industry.

Leverage Your AHIP Event & Nashville Connection

If you’re attending AHIP’s 2017 Consumer Experience & Digital Health Forum in Nashville or if you’re a healthcare leader in Nashville the afternoon of Thursday, December 7th, consider joining other healthcare executives and thought leaders at our Executive Leadership Roundtable. A panel of prominent healthcare leaders will meet at Nashville’s Center for Medical Interoperability at 1:00pm CT to accelerate the seamless exchange of information to improve healthcare for all by exploring emerging and high-priority healthcare opportunities at the intersection of population health, value based care, and the engaged digital consumer.

Join Healthcare Leaders & Forum Attendees in a Boardroom-like Setting

HCEG Executive Leadership Roundtable events are held in an intimate, informal and free-flowing setting where the free exchange of ideas, questions and comments are encouraged. This roundtable event will be moderated by Dr. David Diloreto with three distinguished panelists sharing their unique perspective and insight:

Dr. David Diloreto Ben Leedle Ferris Taylor David Gallegos
Senior VP of Healthcare-Population Health at General Electric President & CEO at Blue Zones and former President & CEO of Healthways HCEG Board Chair and COO/Consultant at Arches Health Plan Senior VP of Consulting Services at Change Healthcare

Timely Topics for Healthcare Leaders

A timely and valuable set of topics – with a special focus on Social Determinants and Clinical Data Impacting Population Health – are planned for panelists and attendees:

  • Innovative strategies health plans, health systems and provider organizations are using to reduce downstream spending while improving overall health outcomes by addressing social determinants of health.
  • How state-of-the-art data and technologies and opening new opportunities to move consumer health forward.
  • Opportunities to work with community leaders to identify the factors having the most influence on individual health and quality of life.
  • Considerations for tailoring specific approaches and investment to address the needs of health plan members and healthcare patients in their communities.
  • How ground-level community stakeholders can guide health plans and health systems to where funding creates the most effective SDOH improvements.

Extend the Value of Your AHIP Consumer Experience & Digital Health Forum Attendance

In addition to the value described above, this Executive Leadership Roundtable event will include a tour of the Center for Medical Interoperability, lunch and the opportunity for professional networking with roundtable panelists and participants. The Center for Medical Interoperability is a ten-minute ride from the AHIP Consumer Experience & Digital Health Forum being held at the Music City Center in Nashville, TN.

Reserve Your Seat Today!

Attendance at the roundtable is free for current and former HCEG members, attendees of the AHIP Consumer Experience & Digital Health Forum and local healthcare executives.  If you have any questions, please contact us.

Healthcare Executive Leadership Forum at Guidewell Innovation Center

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.

Announcing the 2018 Industry Pulse Research Survey

By | Annual Forum, HCEG Top 10, Healthcare Reform, The Industry Pulse | No Comments

HealthCare Executive Group Announces 2018 Top 10 Industry Issues List Industry PulseMany people familiar with the HealthCare Executive Group (HCEG) know that the HCEG Top 10 list has been a keystone of the HealthCare Executive Group for over a decade – 13 years to be exact. The HCEG Top 10 identifies the current opportunities, challenges and issues that HCEG members and their healthcare organizations face during this era of healthcare reform and transformation. The items on the yearly HCEG Top 10 serve to encourage continuous and evolving dialog and drives HCEG’s programming, webinars, blogs, whitepapers, research and discussion throughout the coming year.

HCEG Top 10 as Basis for the Industry Pulse

The HCEG Top 10 also serves as the framework for the Industry Pulse – an annual research survey conducted jointly by HCEG and Change Healthcare. The Industry Pulse research survey collects additional insight, experiences and opinion on specific items of the HCEG Top 10 list. Healthcare executives, thought leaders and other industry participants serving all areas of healthcare may participate. The results of the Industry Pulse can provide valuable, relevant data-driven advice and end-to-end industry insights to help healthcare leaders navigate the complexities of our rapidly evolving healthcare system.

Share your Insight Today!

HCEG and Change Healthcare would like to invite healthcare leaders from across the nation to participate in the 2018 Industry Pulse research survey and to backdrop and contrast their own perspectives against the 2018 HCEG Top 10.Please consider sharing your insight, experiences and opinion as your perspective will help define the issues facing healthcare, and reveal how the industry is responding.

Everyone who completes the 8th Annual Industry Pulse Survey will be among the first to receive survey results as well as exclusive access to future webinars, content and events that will be delivered over the new year; expounding on survey results and providing additional insight and value to all healthcare constituents.

Healthcare Executive Group Supports National Health IT Week – October 2-6, 2017

By | Annual Forum, HCEG Top 10, Healthcare Reform | No Comments

NHITWeek National Health IT Week HealthIT healthtech HIMSS HCEGToday marks the start of National Health IT Week (#NHITWeek,) a collaborative and partner-driven event whose purpose is to promote the awareness and demonstrate the use of information technology in:

  • Supporting Healthcare Transformation: The many ways in which health IT is driving transformation in healthcare delivery including improvements in quality and safety, interoperability, advances in innovation, and patient and consumer activation and engagement.
  • Expanding Access to High Quality Healthcare: Use of innovative technologies including telehealth and remote patient monitoring to improve healthcare access, coordination and outcomes.
  • Increasing Economic Opportunity: Highlighting the importance of a robust, diverse health IT workforce and health IT’s role in supporting economic growth.
  • Making Communities Healthier: The fundamental role health IT plays in supporting population and public health

As a group of executives, thought leaders and advisory partners serving health plans, health systems and provider organizations throughout the United States, the Healthcare Executive Group (HCEG) is proud to partner with and to support National Health IT Week and the above points of engagement – this week of October 2 – 6, 2017 and throughout the year. You can learn more about #NHITWeek and related events here.

The 2018 HCEG Top 10

To kick of National Health IT Week, the Healthcare Executive Group is pleased to announce the formal release of the 2018 HCEG Top 10 list of opportunities, challenges and issues facing executives of health plans, health systems and provider organizations in the United States.

The HCEG Top 10 has been a keystone of the Healthcare Executive Group for over 13 years and provides insight into the most current, pressing priorities facing their industry. Based on HCEG member input and sponsor partner research, the HCEG Top 10 serves as a framework for continuous and evolving dialog among healthcare executive members on the critical opportunities, challenges and issues facing their organizations. Educational programming including periodic Executive Leadership Round Tables, research initiatives, monthly webinars, whitepapers, blog posts and ongoing member discussion are all driven by the HCEG Top 10.

For more information on the 2018 HCEG Top 10, see today’s press release and visit our web site.

Help Spread the Word About National Health IT Week

Never before has the digital transformation of healthcare been so pervasive and rapid. Health information technology is key to advancing the imperative points of engagement emphasized during National Health IT Week. Please join the conversation on social media by using the #NHITWeek hash tag. Share how you and/or your organization is using health information technology to transform points of healthcare and health outcomes.

HCEG will be participating in NHIT Week by sharing content via its social channels, member LinkedIn pages, and via this blog. For more information, insight, ideas and commentary about National Health IT Week, healthcare, healthcare information technology and the digital transformation of healthcare, consider following us on Twitter, LinkedIn and Facebook – and subscribe to our eNewsletter.

Healthcare Executive Group’s 2017 Annual Forum – Social Media Highlights

By | Annual Forum, Executive Leadership Forum, HCEG Top 10, Healthcare Reform, The Industry Pulse | No Comments

healthcare executive group hceg digital transformation annual forumThe 29th Annual Forum of the Healthcare Executive Group held in Nashville last week included nine sessions lead by healthcare industry leaders. These industry veterans and thought leading panel members provided forum participants with a wealth of information and insight into key areas of healthcare reform, innovation and digital transformation.  As might be expected, insight, ideas, opinions and concerns surrounding the areas of Consumer Engagement, Transparency, Population Health, Health Plan-Provider Data Exchange, and Merger & Acquisition activity within the digital healthcare space were common across nearly each of the nine sessions presented at the forum.

As noted in this previous post, content from these sessions will be shared over the coming days and weeks.  In this post, highlights from each of the above referenced areas shared by forum participants via social media are presented. Special thanks to all those who shared via their social channels. To receive other information shared during our 2017 Annual Forum, consider subscribing to our newsletter and following us on our social channels: Twitter, LinkedIn and Facebook.

Consumer & Patient Engagement

“Doctors working at the ‘Top of their license’ will address most of the provider shortage.” – Mark Stryker @themarkstryker of @Leverage_Health quoting Dr. Karen DeSalvo @KBDesalvo

“We’re working w/ our retail pharmacy partners to help them to better help consumers.” – Jim Sheninger of @GoodRx

“Engagement starts w/ developing culturally sensitive trust of providers treating patients.” – Hugh Lytle @equalityceo of @EqualityHealth1

“Need time to develop trust w/ others; it typically takes 30 days of near daily engagement.” – Rich Rakowski of Medically Home

“Coins term ‘Co-vider’ where healthcare consumer serves as 1st provider identifying (diagnosing?) medical condition.” – Steve Sisko @ShimCode quoting David Vinson of @DHXGroup

“We’re trying to put the pharmacist in front of the counter – to more easily interact with consumers.” – William Resnick of  EmpiRx Health

“Many health plans have lost sight that they’re essentially a community of people that must be regularly engaged.” – Torben Nielsen @TorbenSNielsen of Premera

“Near unanimous consensus by participants that technology is not the problem; rather policy, inertia & politics.” – Steve Sisko

Population Health

“What’s your one ‘dashboardable metric?” Rich Rakowski: “A 30-50% savings for the payer for patient condition.” – Ben Leedle of Blue Zones, LLC asking  “What was Missed in Two Decades of Population Health – Today’s Opportunities for Disruptive Innovation” panel

“Cognitive behavioral therapy is becoming first line treatment for insomnia; not drugs.” – Joe Jennings, CEO at BeHealth Solutions @behealthsolns

HCEG Annual forum healthcare executive group healthtechSocial Determinants of Health

“Katrina lesson: sensitive extreme collaboration. Social determinants become real.” – Chuck Martel @cmartel on Dr. Karen DeSalvo keynote

“Our zip code affects our health more than our genetic code.” – Richard Lungen @rlungen of @Leverage_Health quoting Dr. Karen DeSalvo

“Healthcare spend and trend is crowding out other essential social investments. Agree?” – Mark Stryker on Dr. Karen DeSalvo keynote

Accountable Care Organizations

“First step to ACO success: providers and payers agree to ‘put down their weapons’ with data.” – Chuck Martel quoting John Poelman @JHPoelman of Leavitt Partners @leavittpartners

“Panelists note there is no clear correlation between #ACO financial results and quality measurement outcomes.” – Steve Sisko quoting panelist in “Value-Based Reimbursement/Relationships” session

Digital Health

“Data is the single most important element we’re just beginning to exploit.” – Chuck Martel quoting Torben Nielsen in “Healthcare & Consumers Going Digital – Is HIT a Disruption or Opportunity?” session

“The unabated proliferation of healthcare apps is “Appageddon.’” – Steve Sisko quoting David Vinson

“I work in healthcare during the day. And then I go home to the 21st century.” – Torben Nielsen

“Technology and Technology companies’ are re-creating what health looks like.” – Mark Stryker paraphrasing Dr. Karen DeSalvo keynote

Transparency of Price & Quality

“Need to differentiate between price transparency & transparency of clinical efficacy & potential interactions.” – Blake Slansky of Walgreens

“Are we going to try to compete w/ Amazon on cost? Or quality of service? How will we protect our position?” – Forum Attendee asks panel addressing “Pharmacy Costs / PBM and Rx Transparency”

“Only two countries allow Direct to Consumer marketing of prescription drugs: United States & New Zealand.” – Nichole (Nikki) White of Medica

Mergers & Acquisitions in Healthcare

“What are some of the things that are going well or not so well in healthcare M&A?” – Justin Roth of Triple Tree Investments @TripleTreeLLC asks “Technology Innovation and M&A Market Trends” panel

“Need to move cultural due diligence upstream in the M&A process.” – Tom McEnery of Change Healthcare @Change_HC

“Having a designated liaison for each functional area. And be sensitive to culture of each area.” – Paul Wallace of Heritage Group USA

hceg annual forum digital health annual forumPlan Provider Data Mgmt

“Providers view data updates as a misplaced burden & something that disrupts patient care.” – Charlie Falcone of Aperture Credentialing during “Payer Provider Operations – CMS Mandates & Provider Data Management Initiatives” panel

“The proliferation of networks – especially ACO’s – has exacerbated provider directory data accuracy issues.” – Ian Gordon of Regence/Cambia Health Solutions @Cambia

“Working w/ data originators to co-develop data exchange processes vs. dictating requirements can improve data.” – Ian Gordon

“Differing state regulations & mandates hamper ability to develop shared plan-provider data mgmt processes.” – Steve Sisko paraphrases Charlie Falcone

“Provider data management is not a strategic act but an ongoing tactical & operational activity.” – Russ Thomas of @Availity

“Plan-provider data management is not a technology problem; it’s an engagement challenge.” – Ian Gordon

“Health plans generally don’t view provider data management as an area where they need to compete.” – Russ Thomas

“Panel members all agree that #ACA should have mandated plan-provider data requirements, standards & update processes.” – Steve Sisko paraphrases “Payer Provider Operations – CMS Mandates & Provider Data Management Initiatives” panelists


“Innovation without integration will not yield sustainable results.” – Donato Tramuto @DonatoTramuto of Tivity Health @TivityHealth

“Fail to succeed…glean something from every mishap and mistake.” – Donato Tramuto (Via @Tivityhealth)

“Core competencies are transferrable. Don’t confuse what people do with what they are good at.” -Tom McEnery

There’s More Coming!

We’re just getting started with sharing content from last week’s 29th Annual Forum of the Healthcare Executive Group. We’ll be sharing recaps from individual sessions, participant interviews, pictures from the forum and more.  So stay connected and in the loop by subscribing to our newsletter and following us on our social channels. Better yet, consider becoming a member today!

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.