2019 Industry Pulse Survey value-based payment Value-Based Relationships & Reimbursement:

Value-Based Relationships & Reimbursement: How can Industry Collaborate to Speed the Move to Value?

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Value-based Payment (and Value-based Care Reform) has ranked among HCEG’s Top 10 list of challenges, issues, and opportunities each of the last 10 years that HCEG’s Top 10 list has been published; a clear indication healthcare leaders realize that the move to payment for outcomes (value) vs. volume (FFS) is inevitable. It’s clear that value-based relationships & reimbursement is important to health plans, health systems and provider organizations. But year after year, shared-risk, value-based healthcare appears to be just around the corner. Why so slow? How can healthcare leaders championing the transformation of America’s healthcare system finally begin to realize the value of value-based payment?

In fact, the majority of respondents to the 2019 Industry Pulse Research Survey indicate that value-based relationships including both upside and downside shared risk still appears to be three to five years off.2019 Industry Pulse Survey value-based payment

If what’s apparently widely thought, then why is the move by health plans, health systems, and healthcare providers to value-based reimbursement perpetually stuck at being three to five years away from adopting shared-risk value-based contracts?

Join Us at Hotel Commonwealth for our Complimentary Executive Leadership Roundtable – Breakfast is Included

Healthcare Innovation and Disruption, HealthCare Executive Group, HCEG, 16th Annual World Health Care Congress (WHCC), CIO & CTO Strategy Track, innovation, disruption. healthcare champions, Data Analytics, Pharmacy Costs and Transparency, Importance of Useable Technology, Cybersecurity, HCEG Top 10, Center for Healthcare Innovation (CHI), International Association of Innovation Professionals,Speeding the Move to Value-Based Relationships & Reimbursement

On Wednesday, September 11th, the HealthCare Executive Group is presenting a special Executive Leadership Roundtable as part of their 31st Annual Forum. This interactive roundtable event open to everyone who’s in Boston on September 11th – there’s no charge to join other healthcare leaders from across the country to learn about value-based care and meet others facing similar challenges. To be clear, this special ELR event is open to everyone.

Participants of this special ELR will benefit from:

  • Interactive discussion between attendees and speakers on what the movement to value means
  • Learning about the top challenges and opportunities in transitioning from payment for volume
  • Why healthcare organizations are hesitant to provide value-based care and thoughts on overcoming them
  • Understanding realistic next steps healthcare leaders can take to make real progress in the move to value
  • Recent successes in new payment models and lessons-learned
  • A look at cross-industry partnerships in the movement to value-based care reimbursement

This will be a rare opportunity for Healthcare Champions who gather in Boston on September 11th to learn more about value-based payment and care opportunities and to interact with speakers and other participants on a meaningful basis.

The $64,000 Question (Or the $64B+ Question?) – Always 3 to 5 Years Away

Why is the move by health plans, health systems, and healthcare providers to value-based reimbursement perpetually stuck at being three to five years away from adopting shared-risk value-based contracts?

To learn how to advance value-based care, join us at the Hotel Commonwealth for our September Executive Leadership Roundtable event -Value-Based Relationships & Reimbursement: How can Industry Collaborate to Speed the Move to Value? -and learn from the following session leaders and ELR participants:

Panelists Sharing Insight on Value-Based Relationships & Reimbursement

Moderator: David Di Loreto, MD – Principle – Sg2

Panelists:

Join Others to Learn About Value-based Care in Boston on September 11, 2019

Be a part of this unique, no-cost learning and networking opportunity on the last day of the HealthCare Executive Group’s 31st Annual Forum. Breakfast is included and registration is required.

Healthcare Innovation and Disruption, HealthCare Executive Group, HCEG, 16th Annual World Health Care Congress (WHCC), CIO & CTO Strategy Track, innovation, disruption. healthcare champions, Data Analytics, Pharmacy Costs and Transparency, Importance of Useable Technology, Cybersecurity, HCEG Top 10, Center for Healthcare Innovation (CHI), International Association of Innovation Professionals,

2018 HCEG Annual Forum

Networking, Collaboration, And Learning Opportunities for Healthcare Executives

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Ongoing uncertainty, the need to digitally transform operations, and external disruption are three of many challenges, issues, and opportunities facing today’s healthcare leaders. So how can healthcare executives find the information, collaboration, and networking opportunities, both in-person and virtual, to stay on top of things? Indeed, professional associations, many healthcare conferences and digital channels such as LinkedIn, newsletters, blog posts, and Twitter can be an effective way for healthcare leadership to quickly and cost-effectively advance their initiatives and programs.

The HealthCare Executive Group (HCEG) has existed over 30 years to help those championing the transformation of healthcare better understand the challenges, issues, and opportunities facing they face and to facilitate connections with others facing similar concerns. This post shares insight from a long-term member of the HealthCare Executive Group on how HCEG has differentiated itself from the noise, vendor sales pressure and overbearing crowds so common in today’s conferences and digital channels.

How the HealthCare Executive Group Supports Healthcare Champions

Can you tell us a little bit about yourself and your association with the HealthCare Executive Group?Eric Decker, CIO, Independent Health

I am Eric Decker, Chief Information Officer at Independent Health, a regional payer headquartered outside of Buffalo, NY.  I have been a member of HCEG since 2015 and became a board member of HCEG in 2018.

Why did you join the HealthCare Executive Group?

I was promoted to CIO in early 2015, and being a ‘first-time’ CIO, I was looking for associations where I could meet and network with other healthcare executives at organizations similar to Independent Health. HCEG had been recommended to me by another CIO, and I was really happy with the networking opportunities and content provided at their annual forum.

What do you think makes the HealthCare Executive Group different than other healthcare associations and leadership organizations like HIMSS, CHIME, FACHE, etc?

The relatively small setting of the annual forum distinguishes HCEG from larger associations’ events.  There is only one concurrent track, and the break times allow me to reconnect with peers who I had met at previous forum events, as well as make new connections.

How does HCEG solicit input from its members as to what content, events, and services they’d like HCEG to provide to them?

Well, HCEG’s annual Top 10 list of challenges, issues, and opportunities is certainly the prime example of how it solicits specific information from its members. Not too many organizations drive all of their event planning and content development based on the sole input of its members.

What unique networking opportunities and experiences does the HealthCare Executive Group offer?

HCEG offers more than the usual networking mixers. The extracurricular activities at the Annual Forum and the Executive Leadership Roundtables are very conducive to getting to know other healthcare professionals in a relaxed environment. Too many times the crowds, noise and commercial distractions get in the way of truly forming a meaningful relationship that lasts beyond the networking event itself.

RELATED: A Conference for Healthcare Executives Unlike Any Other

What about the HealthCare Executive Group makes it different than other associations and organizations supporting healthcare leaders?

HCEG’s Annual Forum and Executive Leadership Roundtable events are a ‘safe space’ for healthcare executives to learn, discuss and inform – free from the distractions of large events and without vendors pushing sales pitches. I’m better able to gain perspective on challenges, issues, and potential opportunities.

HCEG events are very informal yet supportive. The friendliness and flexibility of their event and administrative staff was impressive. HCEG helps its members forge meaningful relationships that last long after any single event ends. Industry media that may share comments out of context are not allowed.

Nowadays, there are lots of ways to stay connected and communicate with peers and other business associates. How does HCEG support member connections and information exchange?

A single conference event over two or three days once or twice a year is not enough to keep up with challenges, issues, and opportunities in today’s fast-paced, uncertain healthcare environment.

HCEG provides a nice mix of in-person, physical gatherings throughout the year and also well-coordinated of virtual, digital channels to help stay informed and connected. And offers its members events, opportunities and support to share and acquire information and expertise outside of a single, transactional event.

HCEG’s develops its yearly Top 10 list during their Annual Forum. What can you share about the Annual Forum and the HCEG Top 10 list?

HCEG’s Annual Forum reinforced the information that I know and filled in some of the blanks I was not completely aware of. It has a good mix of sessions that presented a variety of perspectives. I was somewhat surprised by the candor and willingness to the panelists to engage with the audience.

The HCEG Top 10 provides a good overview of what’s happening in the industry. It helped me get a sense of what others are thinking and helped validate – and invalidate – some of my thoughts and assumptions.

RELATED: How Healthcare Leaders Leverage the 2019 HCEG Top 10 List

Meet Eric and Other Healthcare Champions at HCEG’s 31st Annual Forum

The 31st Annual Forum of the HealthCare Executive Group takes place September 9th – 11th in Boston. Come join Eric Decker and other champions focusing on the healthcare and digital innovation necessary to transform the healthcare system in the United States. Interact with your healthcare peers, learn more about how others are addressing similar challenges, issues, and opportunities, and create new relationships to advance your company-focused and personal missions.Healthcare Innovation and Disruption, HealthCare Executive Group, HCEG, 16th Annual World Health Care Congress (WHCC), CIO & CTO Strategy Track, innovation, disruption. healthcare champions, Data Analytics, Pharmacy Costs and Transparency, Importance of Useable Technology, Cybersecurity, HCEG Top 10, Center for Healthcare Innovation (CHI), International Association of Innovation Professionals,

2018 HealthCare Executive Group Annual Forum. 30th-anniversary. Hewing Hotel Minneapolis, MN. Healthcare Industry Executive Leaders

Healthcare Leaders Share Insight in Boston on September 9th

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The 31st Annual Forum of the HealthCare Executive Group begins on Monday, September 9th – long considered a hotbed of healthcare and digital innovation. Champions focusing on the healthcare and digital innovation necessary to transform the healthcare system in the United States will be gathering at the Hotel Commonwealth in Boston, Massachusetts at our 31st Annual Forum. They’ll interact with their healthcare peers, learn more about how others are addressing similar challenges, issues, and opportunities, and create new relationships to advance their company-focused and personal missions.

In previous posts, we’ve shared the following details on how this year’s Annual Forum provides meaningful value to the leaders transforming their healthcare organization:

A Conference for Healthcare Executives Unlike Any Other

Healthcare Executives Address Industry Challenges, Issues, & Opportunities in Boston on September 9th

In this post, we’ll share more complete details about the topics, speakers, and events of our 31st Annual Forum taking place in Boston, MA on September 9th – 11th.

Healthcare Executives Address Industry Challenges, Issues, & Opportunities2019 Annual Forum of the HealthCare Executive Group (HCEG). Ideas, 'Best Practices' and lessons learned. Intimate venue insight, ideas, and actionable information. 2020 HCEG Top 10 list.

Topics of Importance to Healthcare Leaders

Here are the sessions that will be presented at the HCEG Annual Forum. To appreciate the information, value, and industry connections our Annual Forum offers healthcare leaders be sure to check out this recap of last year’s 30th Annual Forum of the HealthCare Executive Group – Agenda, Speakers, Pictures, and More

Monday, September 9, 2019

Tour of the IBM Watson Immersion Center

Small group tours of the IBM Watson Immersion Center for a discussion of artificial intelligence technologies

Welcome to Boston

Enjoy lunch while meeting fellow forum attendees and enjoying a compelling, fun, and interactive Quizzify orchestrated by Al Lewis, Quizzify President. Learn just how much you do not know about healthy behavior.

The DC Landscape: Policy Poised to Impact Health Plans in the Near Term

Matt Eyles, President and CEO of AHIP, helps forum attendees understand which conversations in DC are most essential as they form their business strategies for future years.

Changing the Story: The Myths and Missed Opportunities for Connected Care

Ann Mond-Johnson of the American Telehealth Association shares insight on the barriers to broader adoption and future opportunities to take advantage of connected care technologies in improving care and reducing inefficiencies across the health care system.

Peer-to-Peer Networking and Entertainment

Forum attendees gather at the Left Field Deck at Fenway Park for a two-hour dinner and networking event followed by a Boston Red Sox/Yankee game.

RELATED: Recap Materials from Last Year’s 30th Anniversary of the HealthCare Executive Group Annual Forum

Tuesday, September 10, 2019

Knowledge is Power: Cost Transparency as a Shared Strength and Responsibility

In this breakfast keynote address: panelists Niall Brennan, President & CEO of the Health Care Cost Institute and Dr. Michael Sherman, SVP & Chief Medical Officer of the Harvard Pilgrim Health Care and Lecturer at Harvard Medical School share how health plans may collaborate to enable best-in-class data sets and provide greater value to both the business and member through transparency.

Logistics & Transportation Panel Discussion: Promote Health Equity and Remove Transportation as a Barrier to Care

Megan Callahan, Vice President of Healthcare at Lyft and other panelists examine the role of transportation in ensuring access to critical health services, with an emphasis on improving care and experience for under-served Medicaid and Medicare populations.

Digital Transformation: How Novel Technologies are Making a Tangible Impact

In this panel discussion, Mariya Filipova, VP of Innovation at Anthem, Ray Constantini, MD, CEO and Co-Founder of Bright.MD and Oron Afek, CEO and Co-Founder of VIM discuss use cases for disruptive innovation in digital health including short- and long-term impacts on their business, relationships with other stakeholders, members, and patients.

Beyond the Trend: Follow the Money to Identify Technologies Defining the Future of Healthcare

Panelists Ricardo Johnson of Healthworx at CareFirst Blue Cross Blue Shield, Ryan Stewart, Managing Director of Healthcare Technology Investment Banking at Leerink Partners, and Tuoyo Louis, Founder and Managing Partner of Bambu Global Healthcare Advisors discuss the current M & A landscape with a focus on technology investment. Gain insight into which advancements investors are betting on and why.

2020 HCEG Top 10 & Industry Pulse Roundtables: Voting and Ranking

HCEG board, HCEG members, sponsor partners, and forum participants interact with each other to identify the 2020 Top 10 challenges, issues and opportunities for their organizations. Join your peers and be part of shaping the 2020 HCEG Top 10 list of challenges, issues, and opportunities facing healthcare leaders during these continued uncertain times.

Unleash Value and Innovation in Your Organization:  Understanding the Problem You Don’t See

Jason Woo, MD, MPH, FACOG, Medical Officer at U.S. Public Health Service helps forum participants identify the foundational challenges healthcare organizations we often fail to see that inhibits their own success.

Develop a Collaborative Approach to Address the Opioid Crisis

Gregory Marotta, CEO of Clean Slate Opioid Clinics and Dave Henderson, CEO of Thrivee explore how organizations are today in dealing with the opioid epidemic and collaborative strategies to move forward.

Sustaining Outcomes and Savings through Lifestyle & Behavioral Modification

Eric Hamborg, co-founder and chief commercial officer at MOBE will be joined by other prominent panelists. They’ll discuss how services with sustainable cost-saving models can be designed and delivered to address the challenges of a growing hidden population of members with complex health profiles.

Closing Keynote: Massachusetts Healthcare and Political Landscape

A well-known thought leader from New England on the leading edge – sometimes the bleeding edge – of healthcare reform and transformation will close out the second day of our Annual Forum.  Their presentation centers around what has happened and might happen in the future with New England healthcare – a vanguard of healthcare transformation in the United States.

Wednesday, September 11, 2019

Special Executive Leadership Roundtable at Our Annual Forum

A special Executive Leadership Roundtable event – Value-based Relationships and Reimbursement: Why is the Transformation Taking So Long? – is open to everyone!

Value-Based Relationships and Reimbursement: Why is the Transformation Taking So Long?

Jeff Micklos, Executive Director of Health Care Transformation Task Force (HCTTF) and colleague Clare Pierce-Wrobel will be joined by HCEG sponsor partners Harry Merkin of HealthEdge and Mayer Yermaneni of EQHealth.

They’ll share insight on how payments to physicians and other practitioners are not patient-centered nor value-based. And how our healthcare industry is still primarily “fee-centered” with few providers incentivized to provide value-based care. Register for this special Executive Leadership Roundtable event taking place on Friday, September 11th here.Healthcare Innovation and Disruption, HealthCare Executive Group, HCEG, 16th Annual World Health Care Congress (WHCC), CIO & CTO Strategy Track, innovation, disruption. healthcare champions, Data Analytics, Pharmacy Costs and Transparency, Importance of Useable Technology, Cybersecurity, HCEG Top 10, Center for Healthcare Innovation (CHI), International Association of Innovation Professionals,Note: This ELR event is open to everyone and registration at the 2019 HCEG Annual Forum is not required.

Healthcare Leaders Sharing in a Trusted Environment

Come join other healthcare executives and industry leaders in Boston on September 9th-11th and be a part of a manageable, information-packed event. In addition to the uncommon speakers identified above, we’ve got some additional sessions and uncommon healthcare conference surprises in store.  Contact Juliana Ruiz if you require any assistance.

Healthcare Executives Address Industry Challenges, Issues, & Opportunities2019 Annual Forum of the HealthCare Executive Group (HCEG). Ideas, 'Best Practices' and lessons learned. Intimate venue insight, ideas, and actionable information. 2020 HCEG Top 10 list.

RELATED: Announcing Individual Membership in HealthCare Executive Group

Healthcare Industry Leaders. HealthCare Executive Group. HCEG. Annual Forum. National Associations. Health Plans. Non-Traditional/Emerging Providers. Research/Consultancies. Venture Capital. Government. Challenges, Issues, And Opportunities. HCEG Top 10.

Healthcare Leaders Present at HCEG’s 2019 Annual Forum

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The HealthCare Executive Group is built around two core values: that healthcare leaders trust their peers more than any other source when facing industry challenges; and that, because those challenges evolve every year and impact similar organizations in different ways, meaningful interaction between industry leaders must be supported by the environment, agenda, and background of speakers and others presenting their knowledge, experiences, and ideas.

For over 30 years, the Annual Forum of the HealthCare Executive Group has endeavored to pursue these core values in our events, content and other support for our members and the healthcare industry at large. In the month’s leading up to HCEG’s Annual Forum, a team of trusted healthcare executives supported by event planning professionals gets to work. The agenda is developed based on the current HCEG Top 10 list. Qualified leaders in the healthcare industry leaders are identified and engaged. A supportive venue, fare fitting a queen and special networking events are contracted. The result is an event supporting the exchange of timely, useful information exchange and open dialogue and interaction between speakers and attendees.

Diverse Mix of Healthcare Industry Knowledge

While originally comprised of leadership from mid-market health plans, the HealthCare Executive Group has evolved over the years to include senior leaders from national healthcare associations, health systems, provider organizations, public health servants, research organizations, and more recently, leaders of organizations that partner to share risk. Given the uncertain and rapidly changing healthcare environment, it’s important that Annual Forum speakers represent a diverse mix of perspectives on how to improve healthcare outcomes and lower costs. And the disruption of traditional roles by new market entrants and the creative partnerships being made demand a new mix to insight shared.

For the 2019 Annual Forum, the following individuals have been confirmed to be sharing their knowledge, insight, and opinions with forum participants. Another dozen individuals are pending formal agreements.

National Associations

  • Matt Eyles, President & CEO, America’s Health Insurance Plans (AHIP)
  • Ann Mond-Johnson, CEO, American Telemedicine Association (ATA)
  • Charles Stellar, President & CEO, Workgroup for Electronic Data Interchange (WEDI)

Health Plans

  • Mariya Filipova, Vice President of Innovation, Anthem Inc.
  • Gregory LeGrow, Sr Director Technology Engagement Solutions, BCBS of MA

Non-Traditional/Emerging Providers

Research/Consultancies

Venture Capital

Government Healthcare Leaders

Other Healthcare Leaders

  • Al Lewis, President, Quizzify
  • Eric Hamborg, Chief Commercial Officer, MOBE
  • For information on the specific topics and sessions that each of the above individuals will be presenting, check out the agenda for the 2019 Annual Forum.

RELATED: Healthcare Executives Address Industry Challenges, Issues, & Opportunities in Boston on September 9th

Healthcare Leaders Sharing in a Trusted EnvironmentHealthcare Executives Address Industry Challenges, Issues, & Opportunities 2019 Annual Forum of the HealthCare Executive Group (HCEG). Ideas, 'Best Practices' and lessons learned. Intimate venue insight, ideas, and actionable information. 2020 HCEG Top 10 list.

Perhaps the most unique aspect of HCEG’s Annual Forum – and our Executive Leadership Roundtable events – is the manageable number of attendees, the supportive, intimate environment and the lack of vendor and media participation that too many other healthcare conferences entail. Our goal is to foster the level of trust necessary for attendees to feel comfortable about their participation. To share difficult experiences and inside tips, as well as to pose questions participants might not otherwise feel comfortable asking in the more populated, public setting of most healthcare conferences.

We believe that the agenda and setting of our events attract the best and brightest leaders in healthcare – both speakers AND attendees.

RELATED: A Conference for Healthcare Executives Unlike Any Other

Join Other Healthcare Leaders in Boston on September 9th

Come join other healthcare executives and industry leaders in Boston on September 9th-11th and be a part of a manageable, information-packed event. In addition to the uncommon speakers identified above, we’ve got some additional sessions and uncommon healthcare conference surprises in store.  Contact Juliana Ruiz if you require any assistance.

Healthcare Executives Address Industry Challenges, Issues, & Opportunities2019 Annual Forum of the HealthCare Executive Group (HCEG). Ideas, 'Best Practices' and lessons learned. Intimate venue insight, ideas, and actionable information. 2020 HCEG Top 10 list.

RELATED: Announcing Individual Membership in HealthCare Executive Group

Healthcare Executives Address Industry Challenges, Issues, & Opportunities 2019 Annual Forum of the HealthCare Executive Group (HCEG). Ideas, 'Best Practices' and lessons learned. Intimate venue insight, ideas, and actionable information. 2020 HCEG Top 10 list.

A Conference for Healthcare Executives Unlike Any Other

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Over the 30+ years that the HealthCare Executive Group (HCEG) was created to support healthcare executives, many of the popular conferences, forums, and events attended by healthcare industry participants have grown and morphed into spectacles hard to imagine back in the late 80’s.

  • Crowds numbering in the 1000’s and 10’s of 1000’s are packed into mammoth venues.
  • 100’s of sessions – sometimes spread over 15 to 20 ‘tracks’ – cover nearly every topic under the sun.
  • Big-name keynote speakers are touted as ready to share insight to transform lives, inspire action and grow companies.
  • Super-star speakers receive top billing and surely a huge portion of the increasingly costly registration fees – but often fall short and disappoint.
  • Over the top vendor exhibits staffed with dozens of salespeople vie for attendees attention.
  • Box lunches, if you’re lucky. Or standing in line for a sandwich from a kiosk.

In short, many of today’s healthcare conferences provide too much of the wrong stuff and not enough of the good stuff. And the Annual Forum presented by the HealthCare Executive Group is specifically designed and developed to provide what other healthcare conference events don’t.

Healthcare Executives Address Industry Challenges, Issues, & Opportunities 2019 Annual Forum of the HealthCare Executive Group (HCEG). Ideas, 'Best Practices' and lessons learned. Intimate venue insight, ideas, and actionable information. 2020 HCEG Top 10 list.Healthcare Executives Address Industry Challenges, Issues, & Opportunities 2019 Annual Forum of the HealthCare Executive Group (HCEG). Ideas, 'Best Practices' and lessons learned. Intimate venue insight, ideas, and actionable information. 2020 HCEG Top 10 list.

Timely Topics Presented in a Cohesive Fashion for Healthcare Executives

The keynotes and sessions at HCEG’s Annual Forum’s are presented and moderated by executives and others actively working in the healthcare industry. Executives that recognize the value of collaborating with like-minded individuals to solve challenges, deal with similar issues, and leverage opportunities together. Accordingly, session themes and topics are based on the current challenges, issues, and opportunities identified by health plan, health system, and healthcare providers – not the exhibitors and others aiming to sell products and services.

For a sample of the type of information presented at HCEG’s Annual Forums, see this recent post: Healthcare Executives Address Industry Challenges, Issues, & Opportunities in Boston. You can also check out the agenda and program guide from last years Annual Forum.

Healthcare Industry Leaders Addressing Today’s Challenges vs. Coin-Operated Speakers

Speakers at our annual forum are well-established, well-known leaders currently working in the healthcare industry. They won’t be selling anything except great insight on the challenges, issues, and opportunities facing today’s healthcare leadership. In today’s uncertain and increasingly volatile healthcare industry it’s critical to get unbiased insight.

    • Some of the Speakers at HealthCare Executive Group’s 2018 and 2017 Annual Forums:
      • David Shulkin, former Secretary of the Veterans Administration and Chief Innovation Officer of Sanford Health
      • Karen DeSalvo, Assistant Secretary for Health at U.S. Department of Health and Human Services
      • Andy Slavitt, former Acting CMS Administrator and current leader of Townhall Ventures
      • Craig E. Samitt, MD, MBA, President & CEO of BCBS of Minnesota
      • Brandon Cady, President & CEO of Anthem/AIM Specialty Health
      • Kyle Rolfing, Co-Founder & President of Bright Health
      • Tony Miller, Co-Founder & CEO of Bind on Demand Health
      • Donato Tramuto, CEO at Tivity Health
      • Dan Buettner, National Geographic Fellow, NY Times Best Selling Author

Intimate, Manageable Environment Supporting Quality Information ExchangeHealthCare Executive Group HCEG Annual Forum

Unlike many conferences, HCEG’s Annual Forum takes place in a venue selected for maximizing attendees comfort, access, and interaction. Seating arrangements, ingress, and egress are thoughtfully laid out in an intimate and accessible manner. Crowded and impersonal are two words NOT associated with HCEG’s Annual Forum’s.

Healthcare Leaders vs. Every Other Role Under the Sun

HCEG limits participation in its Annual Forum to healthcare executives and leadership serving health plans, health systems, and provider organizations. The majority of attendees reside in the C-suite and all registrations are screened. Media, vendors of any sort, and ‘all-comers’ willing to pay the registration fee are not allowed.

Sales Free Environment vs. Vendor Exhibits & Booth Barkers

You won’t find any vendor exhibits and salespeople at HCEG’s Annual Forum. And while some HCEG sponsor partners may participate in the forum, they do so in a passive, consultative fashion. Sales pitches and vendor marketing materials are not allowed.

Exceptional Food & Drink vs. Box Lunches & Waiting in Line for Coffee

Great content and insightful speakers alone do not make a conference worthwhile. Accordingly, HCEG places a lot of thought and effort into providing breakfast, lunch, dinner, and refreshments throughout the day. Exceptional food and drink combined with a comfortable environment go a long way in supporting the exchange of information and ideas

RELATED: Recapping the 2018 Annual Forum of the HealthCare Executive Group

Networking Events at 2019 HealthCare Executive Group Annual Forum

All of the above aspects of HCEG’s Annual Forum are intended to support new introductions and grow existing relationships between forum attendees. Keynotes from industry leaders help set the context. Then informative sessions help flesh out – and flush out – the challenges, issues, and opportunities, facing healthcare executives. And informal, entertaining – yet structured – opportunities to interact are provided.

For this year’s forum, participants will enjoy two unique events:

Red Sox vs. Yankees Baseball Game at Fenway Park

Forum attendees are invited to a private reception on the Coca-Cola Field Deck at Fenway Park – widely known as some of the Best Seats for Partying and Socializing at Fenway Park.  Immediately following this private networking reception, all Annual Forum attendees will enjoy the Red Sox vs. Yankees Game.

Note: This special networking event is located directly across the street from the annual forum venue and is included with 2019 Annual Forum registration at no additional cost on a first-come, first-served basis.

IBM Watson Experience Center

Another unique event at this year’s annual forum is small group tours of the IBM Watson Experience Center. The tour includes an open discussion of technology applications in healthcare. Transportation to and from the forum venue and the IBM Watson Experience Center will be provided.

RELATED: See pictures, program guide and more from last year’s 2018 Annual Forum 

Join Other Healthcare Leaders in Boston on September 9th

Come join other healthcare executives and industry leaders in Boston on September 9th-11th and be a part of a manageable, information-packed event. In addition to the keynotes, sessions, Top 10 ranking, and special networking events noted above, we’ve got some additional sessions and uncommon healthcare conference surprises in store.  Contact Juliana Ruiz if you have any questions.

Healthcare Executives Address Industry Challenges, Issues, & Opportunities2019 Annual Forum of the HealthCare Executive Group (HCEG). Ideas, 'Best Practices' and lessons learned. Intimate venue insight, ideas, and actionable information. 2020 HCEG Top 10 list.

RELATED: Announcing Individual Membership in HealthCare Executive Group

Healthcare Executives Address Industry Challenges, Issues, & Opportunities2019 Annual Forum of the HealthCare Executive Group (HCEG). Ideas, 'Best Practices' and lessons learned. Intimate venue insight, ideas, and actionable information. 2020 HCEG Top 10 list.

Healthcare Executives Address Industry Challenges, Issues, & Opportunities in Boston on September 9th

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The 2019 Annual Forum of the HealthCare Executive Group (HCEG) takes place in HCEG’s birthplace – Boston, Massachusetts – on September 9th.  Just over 30 years ago, a group of healthcare executives created the Managed Care Executive Group (MCEG), a ‘user group’ to share their ideas, ‘Best Practices’ and lessons learned. These healthcare leaders recognized the value of collaborating with like-minded individuals to solve challenges, deal with similar issues, and leverage opportunities together. Fast forward about 20 years and the Managed Care Executive Group became the HealthCare Executive Group. And in less than two months, the HealthCare Executive Group returns to its birthplace in Boston for its 31st Annual Forum!

Our annual forum planning team is pleased to share that the 2019 Annual Forum is shaping up to be one of our best forums ever. Three keynotes from prominent healthcare industry leaders with interactive sessions set in an intimate venue provide insight, ideas, and actionable information. The development of the 2020 HCEG Top 10 list enables all forum participants to have a role in identifying and ranking the challenges, issues, and opportunities they’re facing in today’s uncertain and rapidly transforming healthcare industry. And two unique networking events offer the opportunity for attendees to grow and expand their professional and personal networks.Healthcare Executives Address Industry Challenges, Issues, & Opportunities2019 Annual Forum of the HealthCare Executive Group (HCEG). Ideas, 'Best Practices' and lessons learned. Intimate venue insight, ideas, and actionable information. 2020 HCEG Top 10 list.

Keynotes by Healthcare Industry Leaders

The DC Landscape: Policy Poised to Impact Health Plans in the Near Term

Matt Eyles, President & CEO of America’s Health Insurance Plans (AHIP), will open the forum with an overview of the legislative and political landscape in Washington, D.C. Attendees will gain insights to help them:

  • Cut through the noise in the upcoming election year
  • Learn which policies may directly impact healthcare businesses and members in the next year
  • Explore top-of-mind issues including the future of Medicare and the ACA, as well as bipartisan agreements to reduce the price of prescription drugs
  • Consider new ways to keep costs down and simplify the healthcare system for members

Knowledge is Power: Cost Transparency as a Shared Strength and Responsibility

Niall Brennan, former Chief Data Officer at the Centers for Medicare & Medicaid Services (CMS) and current President & CEO of Health Care Cost Institute (HCCI), shares insight into how healthcare organizations collaborate to enable best-in-class data sets to provide greater value through transparency. Niall will share how:

  • to understand cost and utilization trends in the commercially insured population
  • to delve into the issue of cost variation in the US market and how it impacts the transparency movement at the regulatory level
  • HCCI and health plans work together to share de-identified cost and outcome data, help their members navigate cost more easily and drive improvement in quality and value with robust analytics
  • healthcare plans, health systems, provider organizations AND members, patients, and consumers can both benefit from and help fuel the transparency mission

The Changing Landscape and the Politics of Healthcare

While unable to share confirmed details about the keynote speaker, HCEG is working with two Massachusetts healthcare industry leaders with the expectation one or both of them will share their valued perspective on the changing landscape and political uncertainties impacting the healthcare industry. This keynote address will take place over dinner on the second day of the 2019 Annual Forum. We’re hopeful the schedule of the speaker we’re working with supports their ability to share their insight unique and ideas with the healthcare executive attendees of our 2019 Annual Forum.

Interactive Sessions

This year’s Annual Forum includes eight presentations/panelist sessions addressing challenges, issues, and opportunities facing today’s healthcare leaders. HCEG sessions aim to enable significant interaction opportunities for our annual speakers, panelists, attendees, and all others involved to be able to network and share their respective thoughts and needs.  A few of the sessions we’re developing to promote information exchange and networking opportunities include:

Digital Transformation: How Novel Technologies are Making a Tangible Impact

Healthcare Executives Address Industry Challenges, Issues, & Opportunities 2019 Annual Forum of the HealthCare Executive Group (HCEG). Ideas, 'Best Practices' and lessons learned. Intimate venue insight, ideas, and actionable information. 2020 HCEG Top 10 list.

Panelists will present and discuss use cases of disruptive digital health innovation and attendees will…

  • Hear first-hand examples of how technology successfully integrates into organizational workflow
  • Learn of short and long-term impacts on their business, relationships with other stakeholders, and consumers.
  • Better understand which technologies foster engagement between health care stakeholders
  • Be able to assess the impact of disruptive digital health innovation on consumers, patients, outcomes, and costs

Beyond the Trend: Follow the Money to Identify Technologies Defining the Future of Healthcare

This panel of experts discusses the merger and acquisitions (M&A) landscape with a focus on technology investment.  Attendees will…

  • Gain insight into which advancements investors are betting on and why
  • What’s driving the investment community toward M&A, and how the right technology factors into the decision to invest in a business or not
  • Learn about top technologies poised to meaningfully support healthcare payment and delivery transformation in the next 3 years

Developing a Collaborative Approach to Address the Opioid Crisis

In this panel, experts discuss the current state of the opioid crisis and explore collaborative strategies for better managing the current opioid crisis:

  • Strategies in play today that aim to prevent and treat opioid abuse including progress to-date and lessons learned during their implementation
  • Next steps to move the needle in a positive direction including which efforts are making the most impact
  • How healthcare organizations can collaborate to mitigate the opioid epidemic on a local and national level

Quizzify: So, You Think You Know Healthcare?

An interactive, fun, and compelling ‘Quizzify session’ led by Al Lewis, President of Quizzify, will help forum participants learn just how much they DO NOT KNOW about healthy behavior. This live quiz simulates an approach many employers are using to teach employees how to make healthier decisions and spend healthcare dollars more wisely. We think this will be an enlightening session.

2020 HCEG Top 10: Voting and Ranking

Over the last decade, a highlight of the HealthCare Executive Group’s annual forum is the development of the HCEG Top 10 list of challenges, issues, and opportunities currently faced by healthcare executives. Starting with a list of 25-30 items identified by HCEG members and sponsor partners, forum participants interact with each other to identify the top 10 challenges, issues and opportunities facing their organizations. After interactive discussion in roundtable format over lunch, forum participants rank the items to create the 2020 HCEG Top 10 list.HCEG Top 10. Industry Pulse Survey. Challenges, issues, opportunities healthcare industry. Data & Analytics, Total Consumer Health, Population Health Services, Value-based Payments, The Digital Healthcare Organization, Rising Pharmacy Costs, External Market Disruption, Operational Effectiveness, Opioid Management

RELATED: How Healthcare Leaders Leverage the 2019 HCEG Top 10 List

Networking Events at 2019 HealthCare Executive Group Annual Forum

Beyond the content presented at HCEG’s Annual Forum, our event aims to support new introductions and grow existing relationships between healthcare executives. Keynotes from industry leaders help set the context. Then informative sessions help flesh out – and flush out – the challenges, issues, and opportunities, facing healthcare executives. Some fun and structured opportunity to interact can go a long way.

And participants of the HealthCare Executive Group’s 2019 Annual Forum will enjoy two events providing support for meeting new people, sharing your knowledge, expanding your network, and perhaps rekindling stale relationships. Indeed you’ll meet new people, learn a lot, eat well, and experience new entertainment.

Red Sox vs. Yankees Baseball Game at Fenway Park

Forum attendees are invited to a private reception on the Coca-Cola Field Deck at Fenway Park – widely known as some of the Best Seats for Partying and Socializing at Fenway Park.  Immediately following this private networking reception, all Annual Forum attendees will enjoy the Red Sox vs. Yankees Game.

Note: This special networking event is located directly across the street from the annual forum venue and is included with 2019 Annual Forum registration at no additional cost on a first-come, first-served basis.

IBM Watson Experience Center

Another unique event at this year’s annual forum is small group tours of the IBM Watson Experience Center. The tour includes an open discussion of technology applications in healthcare. Transportation to and from the forum venue and the IBM Watson Experience Center will be provided.

RELATED: See pictures, program guide and more from last year’s 2018 Annual Forum 

Exceptional Meals, Venue, C-Suite Participants, & Networking Opportunities

The HealthCare Executive Group’s Annual Forum is unlike any other healthcare conference event. In fact, our annual forum is pretty much the opposite of other healthcare events:

Intimate and Accessible vs. Impersonal and CrowdedHealthCare Executive Group HCEG Annual Forum

The venue, sessions, and seating are all designed for maximum attendee comfort and interaction.  Moreover, HCEG’s annual forum includes unique networking events so forum participants can expand their network and create meaningful relationships.

Participating in our Annual Forum can truly advance attendees professional and personal goals.

Healthcare Industry Leaders Addressing Today’s Challenges vs. Coin-Operated Speakers

Speakers at our annual forum are well-established, well-known healthcare industry leaders. They won’t be selling anything except great insight on the challenges, issues, and opportunities facing today’s healthcare leadership. In today’s uncertain and increasingly volatile healthcare industry it’s critical to get unbiased insight.

Some of the Speakers at HealthCare Executive Group’s 2018 and 2017 Annual Forums:

      • David Shulkin, former Secretary of the Veterans Administration and Chief Innovation Officer of Sanford Health
      • Karen DeSalvo, Assistant Secretary for Health at U.S. Department of Health and Human Services
      • Andy Slavitt, former Acting CMS Administrator and current leader of Townhall Ventures
      • Craig E. Samitt, MD, MBA, President & CEO of BCBS of Minnesota
      • Brandon Cady, President & CEO of Anthem/AIM Specialty Health
      • Kyle Rolfing, Co-Founder & President of Bright Health
      • Tony Miller, Co-Founder & CEO of Bind on Demand Health
      • Donato Tramuto, CEO at Tivity Health
      • Dan Buettner, National Geographic Fellow, NY Times Best Selling Author

Healthcare Executives & Leaders vs. Every Other Role Under the Sun

Participation in HCEG’s Annual Forum is limited to healthcare executives and leadership serving health plans, health systems, and provider organizations. The majority of attendees reside in the C-suite and all registrations are screened. Media, unscreened vendors of any sort, and ‘all-comers’ willing to pay the small registration fee are not allowed.

No 3rd Party Pitches vs. Vendor Salespeople and Booth Barkers

You won’t find any vendor exhibits at HCEG’s Annual Forum. And HCEG sponsor partners participate in the forum in a passive, consultative fashion. No sales pitches or vendor marketing materials are allowed.

Relaxing Venue with Great Food & Drink vs. Box Lunches and Waiting in Line for Coffee

Great content and insightful speakers alone do not make a conference worthwhile. Accordingly, HCEG places a lot of thought and effort into selecting an accessible venue. Our annual forum offers a comfortable environment supporting the exchange of information and ideas. Excellent food, drink, and refreshment is always available to forum participants.

Join Other Healthcare Leaders in Boston on September 9th

Come join other healthcare executives and industry leaders in Boston on September 9th-11th and be a part of a manageable, information-packed event. In addition to the keynotes, sessions, Top 10 ranking, and special networking events noted above, we’ve got some additional sessions and uncommon healthcare conference surprises in store.  Contact Juliana Ruiz if you require any assistance.

Healthcare Executives Address Industry Challenges, Issues, & Opportunities2019 Annual Forum of the HealthCare Executive Group (HCEG). Ideas, 'Best Practices' and lessons learned. Intimate venue insight, ideas, and actionable information. 2020 HCEG Top 10 list.

RELATED: Announcing Individual Membership in HealthCare Executive Group

HCEG Webinar Series. Art & Science of Aligning People, Process, & Technology to Grow Your Healthcare Organization. The Golden Triangle. Operational efficiency. 2019 HCEG Top 10 list. HealthEdge. business transformation initiatives. Sal Gentile, Friday Health Plans.

The Art & Science of Aligning People, Process, & Technology to Grow Your Healthcare Organization

By | HCEG Top 10, HealthEdge, Operational Effectiveness, Webinar Series | No Comments

People, process, and technology are at the core of every business. And how these three critical components are used to create and deliver a healthcare organization’s products and services ultimately result in company profitability and growth. Indeed, the critical challenges healthcare organizations are facing during these uncertain times involve humans, the processes they must follow, and the mix of entrenched, emerging – and as yet- often unknown technologies supporting an organizations mission and growth.

Transforming your healthcare organization requires an explicit focus on effectively aligning the Golden Triangle of People, Process, & Technology.

The Golden Triangle: People, Process, & Technology

HCEG Webinar Series. Art & Science of Aligning People, Process, & Technology to Grow Your Healthcare Organization. The Golden Triangle. Operational efficiency. 2019 HCEG Top 10 list. HealthEdge. business transformation initiatives. Sal Gentile, Friday Health Plans.

Delivering operational efficiency, a key aspect of transforming today’s healthcare organizations requires an approach that optimizes the relationships between people, process & technology; hence the Golden Triangle. Each part of the Golden Triangle is its own science. And each needs to be mastered to effect true transformation and business growth. Ignore the relationship between people, process, and technology at your own risk.

And know that the art, where real value and efficiency are found, is at the intersection of people, process & technology. Like a three-legged stool, each part of the Golden Triangle must be sufficiently developed and aligned as integral components of successful transformation initiatives. Too often, healthcare organizations give short shrift to the people point of the triangle.

RELATED: Operational Efficiency Ranked #7 on 2019 HCEG Top 10 List

Successful Transformation Initiatives: Keys to Success & Challenges

In a study by IBM titled “Making change work…while the work keeps changing,” 1400 participants identified the keys to successful change initiatives and the major challenges to change that organizations must consider as they plan and strategize their business transformation initiatives.

Keys to Successful Change Initiatives at Healthcare Organizations

People Factors

    • Employee Involvement
    • Honest and Timely Communication
    • Change Agents to Engage Other Employees
    • Change Supported by Culture
    • Efficient Training Programs
    • Monetary and Non-Monetary Incentives

Process Factors

    • Adjustment of Performance Measures
    • An Efficient Organizational Structure
    • Top Management Sponsorship

Challenges to Change Initiatives at Healthcare Organizations

People Factors

    • Changing Mindsets and Attitudes
    • Corporate Culture
    • Shortage of Resources
    • Lack of Commitment by higher management
    • Insufficient Change Know-How
    • Little to no Transparency

Technology Factors

    • Impact on Existing Process
    • User Experience
    • Flexibility and Interoperability of Technology Systems

See this article for more about the keys to successful change initiatives and the major challenges to change that organizations must consider as they transform their organization.

People are Key to Aligning People, Process, & Technology

Famed IBM founder Thomas J Watson shared the following on the importance of NOT ignoring the people component of organizational change initiatives.

“Teach your associates to teach themselves and in a way that you will strengthen the entire organization” – Thomas J Watson (1947)

Additional Insight & Ideas on Leveraging People, Process, & Technology

In today’s uncertain and rapidly changing healthcare environment, healthcare leaders are seeking to enter new geographies, start new lines of business, or even radically transform their traditional way of doing business. To position your healthcare organization for successful growth by optimizing the intersection of people, process, and technology, join us on July 25th for our Webinar Series event: Using People, Process & Technology to Grow Your Business.

Sal Gentile, CEO of Friday Health Plans and our sponsor partner HealthEdge will share how they leveraged the art and science of people, process and technology to successfully grow their respective healthcare organizations both from the ground up as well as within an established organization.Healthcare Innovation and Disruption, HealthCare Executive Group, HCEG, 16th Annual World Health Care Congress (WHCC), CIO & CTO Strategy Track, innovation, disruption. healthcare champions, Data Analytics, Pharmacy Costs and Transparency, Importance of Useable Technology, Cybersecurity, HCEG Top 10, Center for Healthcare Innovation (CHI), International Association of Innovation Professionals,

If you’re not sure whether you can attend this HCEG Webinar Series event, go ahead and register and we’ll send you the recording/recap.

If you have any questions about this blog post or want to learn more about the HealthCare Executive Group, please reach out to us at [email protected]. Also, consider following @HCExecGroup on Twitter and LinkedIn.

2019 AHIP Institute & Expo. HCEG. Healthcare Executive Group. Nashville, TN. David Cordani, Cigna Healthcare. Health Care Cost Institute (HCCI) Niall Brennan. CMS. National All Payer Claims Database (APCD) Public Data, Interactive Tools Related to Health Care Cost Utilization

Insight & Observations from the 2019 AHIP Institute & Expo

By | AHIP, Conferences, HCEG Top 10, Nashville, Social Determinants of Health | No Comments

The 2019 AHIP Institute & Expo took place in Nashville, TN earlier this month and our Executive Director Ferris Taylor was in attendance – along with many of our members and sponsor partners. This post shares just a bit of what Ferris observed. Also included are some recaps of the event shared by industry media and analysts.

Cigna CEO on Importance of Access, Affordability, and Eliminating Surprises

Wednesday’s afternoon keynote, A Blueprint for a More Sustainable Health Care System, was presented by David Cordani, President & CEO of Cigna Corporation. David’s introductory message emphasized the importance of access, affordability, and eliminating surprises. During his 45-minute session, David shared the following thoughts and ideas – among others:

Healthcare organizations – and the companies that support healthcare organizations – need to understand the needs of the people and companies they want to do business with and then earn the “right” to meet those needs.

In the quest for the digital transformation of their healthcare organizations, healthcare leaders should consider and address the “transactional going to transitional going to transformational”

Treat the whole person and be sure to do your best to connect individuals (plan members and patients) with providers. Drive this change through innovation

Some statistics shared by David Cordani

  • The United States is the only place in the world you want to be if you have a critical medical conditional.
  • In 1992, the healthcare industry resisted
  • In 2008, the healthcare industry collaborated
  • In 2020, will the healthcare industry choose to lead?

What is the Health Care Cost Institute (HCCI) and Why Should You Care?

2019 AHIP Institute & Expo. HCEG. Healthcare Executive Group. Nashville, TN. David Cordani, Cigna Healthcare. Health Care Cost Institute (HCCI) Niall Brennan. CMS. National All Payer Claims Database (APCD) Public Data, Interactive Tools Related to Health Care Cost Utilization

Ferris Taylor (left) & Niall Brennan

Niall Brennan, former Chief Data Officer at CMS and current president & CEO of HCCI, joined Melinda Buntin, PhD, Chair of the Department of Health Policy at Vanderbilt and Robert Town, PhD, HCCI board chair and professor of economics at University of Texas-Austin to share an overview of the Health Care Cost Institute.

For those who may not know, the Health Care Cost Institute (HCCI) is the first qualified entity recognized by CMS for quality, efficiency, and use of resources. The speakers shared an overview of the benefits of collaborating and sharing data with HCCI and how HCCI members have access to the following types of Healthcare Market Intelligence:

  • benchmarking enrollment, utilization, and payments
  • provider profiling (understanding and tiering networks)
  • care management (patient identified data)
  • custom analysis (utilization of care, alternative payment methods, Rx, etc.)
Niall Brennan will be presenting the breakfast keynote at HCEG’s 2019 Annual Forum on Tuesday, September 10, 2019. For more information about our Annual Forum, click here.

Niall also shared some information on the National All Payer Claims Database (APCD) and emphasized that without data, states without APCD’s are flying blind with little or no ability to assess cost or quality. The group urged all attendees with the power to do so, to submit their data to HCCI and then focus on using the information and data HCCI generates in return to for quality and improvement programs.

Additionally, a general consensus among the speakers was their surprise that employers are not outraged over the variation in healthcare prices and even more with the fact that, while demand for some services is declining, in many cases prices are still going up.

For more information about HCCI including how to become a partner, click here.

RELATED: HCCI Research, Public Data, and Interactive Tools Related to Health Care Cost and Utilization

AHIP President & CEO Matt Eyles – Speaker at HCEG’s 2019 Annual Forum

At the AHIP event, Matt Eyles, AHIP’s CEO & President, shared his take on “What the Industry needs to do to address Health Care’s Challenges.” Matt will also be speaking at HCEG’s 2019 Annual Forum on Tuesday, September 10, 2019. For more information about our Annual Forum, click here.

Social Determinants of Health at AHIP Institute & Expo

Unsurprisingly, social determinants of health – ranked #3 on the 2019 HCEG Top 10 list – was a popular topic at the AHIP Institute & Expo. Check out these articles and resources on this hot topic impacting health plans, health systems, and provider organizations.SDOH. Social Determinants of Health. Total Population Health. HCEGTop10. HCEG. Healthcare Executive Group. Population Health Services: Operationalizing community-based health strategy, chronic care management, driving clinical integration, and addressing barriers to health such as social determinants.

AHIP Launches Project Link to Address Social Determinants

AHIP Institute Takeaways

At AHIP 2019, Health Plan Leaders Parse the Challenges and Opportunities of SDOH

Insurers to work together on social barriers to health

At the AHIP 2019 Conference, Former Surgeon General Murthy Speaks of Social Isolation and Its Impact

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“Healthcare Organizations Focus on Data & Analytics for Digital Transformation”

“Release of the 9th Annual Industry Pulse Survey Results”

Artificial Intelligence. Predictive Analytics. Bigdata. Machine Learning. HealthCare Executive Group. Benefits Costs. Patient Outcomes. Quality Standards. STAR ratings. Profit Margins. Improving Efficiencies. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.

Insight on Solving the Rubik’s Cube of Payer Data

By | analytics, HCEG Top 10, payer, Sponsor, Webinar Series | No Comments

Healthcare payers are sitting on a lot of data, from eligibility data, to claims data, to data obtained from 3rd parties, to data derived from analytics. It’s no surprise that over the last decade “Data & Analytics” has been a consistent entry on the HealthCare Executive Group’s Top 10 list of challenges, issues, and opportunities facing healthcare executives. And currently ranked #1 on the 2019 HCEG Top 10 list. To help share insight, ideas, and actionable information supporting data and analytics, our sponsor partner EQ Health Solutions presented our June Webinar Series event: Solving the Rubik’s Cube of Payer Data.

Chief Strategy & Growth Officer Mayur Yermaneni and Marina Brown, RN BSN, Vice President of Clinical Programs, from eQHealth Solutions shared information and insight on the following four topics:

  • The current state of the payer market and future considerations
  • The Rubik’s Cube of Payer Data – the Present Debacle
  • What tools and technologies will lead to continued payer success?
  • Top six things to consider when evaluating your healthcare analytics vendor

Highlights from Solving the Rubik’s Cube of Payer Data

This blog post presents some highlights from the webinar and provides access to additional information from the webinar. You can also check out this Twitter Moment summarizing live Tweets from the webinar.  The complete recording of the webinar can be found here. To jump to the specific place in the recording, click on the timestamp range [HH:MM] that accompanies each transcripted section below.

HealthCare Executive Group Top 10 list. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.

For more information on how EQ Health Solutions can advance your organization’s data and analytics initiatives and programs, contact EQ Health Solutions.

Current State of the Payer Market and Future Considerations

Mayur Yermaneni shared some insight into current data and analytics capabilities of healthcare payers: [7:16]

Some payers are firmly in an average spectrum of recognizing current trends and some and some payers are still in the infancy stages of recognizing the impact of these trends. So, I’m trying to generalize some of these themes so that everybody can actually benefit from it.

Margins are Decreasing

So, across the board, one of the key things, and I guess this is not unique to the payer market itself, is that margins are decreasing. With new regulations coming on board there are more and more cost burden associated with the payer market. Some payers are becoming a financial institution from that standpoint [of increasing regulatory burden.]

Mega Mergers

You see this a lot more in the bigger payer, payers like Aetna’s acquisitions, United’s acquisitions, WellCare and all these acquisitions that are happening is [intended] to counter their decrease in margins by creating economies of scale that they could benefit by actually saying: “If I can actually acquire another of these entities, then I can create a cross burden rate across these common units and hopefully benefit from the margins play game.”

Data Security

Nobody wants to show up and in tomorrow’s Wall Street Journal. In the current day and age, there’s an entire team dedicated just so that that payer’s name doesn’t show up on tomorrow’s newspaper. Primarily because with the PHI (Protected Health Information), the abundance of PHI information from all different sources. It’s extremely important to say: “Well how do we protect our data?” Payers have a lot more data than anybody else outside of providers.

And there are two different spectrums of the data set – and both are equally critical from the standpoint of ensuring that data security is a key aspect in your space because today, a 100 record, 500 records, or anything above that threshold you’re going to have to report it. So, data security becomes actual strategy nowadays. How do you make sure that your data security is actually playing to your advantage? And your customers have to be able to trust that and that Trust is what’s going to actually give you – even though that has nothing to do with the actual health plan itself, or the benefits members are receiving, or the card that they are receiving. But they still have to be able to trust that their data is secure. 

Showing Value Vital in Provider/Hospital Negotiations [10:17]

Finally, when it comes to providing the value of data, the data set that payers are actually having to wrestle with: how are we showing the value that we are providing to the hospital segment, the provider segment, and the member segment? 

But if you look at it, you still have to deal with all the other aspects before you get to the value component: administrative setup, data security, operating margins, and everything.Contract negotiations. HealthCare Executive Group. Benefits Costs. Patient Outcomes. Quality Standards. STAR ratings. Profit Margins. Improving Efficiencies. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.Well, how is that actually happening? Big data. Well, I’m not going to bore everybody with the definition of what big data is but, in a nutshell, in today’s world of Instagram, Facebook and Snapchat it’s all about the volume and speed and the frequency of the data that you’re receiving. And in the payer market, it’s a lot of data. It used to be a monthly fee [to obtain/access data]. Now it’s an API call to an HL7 message which is instantaneous. And the amount of frequency that you’re having to deal with is a lot more than what you had before. And the number of types of data that the payer market is actually having to deal with is a lot more. And even in there, the data can be segregated into a couple of different ways: 

  • The data that’s the primary data sources
  • The derived data sources that you’re generating as a result of your operation or as a result of some of the analysis that you’re doing on top of it. 

So now that’s another big trend that the payer market is having to actually wrestle with.

Social Determinants of Health Data are Increasingly Important

Ferris Taylor [HCEG’s Executive Director] indicated that this [Data & Analytics] was the top topic and social determinants of health were one of the key aspects to it. And that hasn’t changed. What has changed is how that’s being viewed. Instead of being a peripheral data source to actually being a central component to how your operations need to be done from social terms of health standpoint.

Marina Brown, EQHealth’s Vice President of Clinical Programs added:

I was just going to say that I do think that this is really a big one for the industry. Social determinants of health are definitely going to help change the way that we deliver health care. And that’s a very important distinguishment. It’s not going to change the way that we do health care because we treat a diabetic the same but it will change the way that we deliver care simply by helping to better guide the interventions that we’re utilizing to create more meaningful behavior change over time.

Tools and Technologies to Solve the Rubik’s Cube of Payer Data

Marina and Mayur shared an overview of the tools and technologies that healthcare payers are using to identify trends, root causes of patient and population-level issues, and transforming healthcare payer’s data and analytics infrastructure.

Another key aspect is artificial intelligence. Now again I don’t want to get into the definitions of artificial intelligence, but the key aspect is, with the advent of big data with the advent of the amount of data you’re having to deal with. It’s not humanly possible for a supervisor or a manager or a management team to be able to simulate all the data and actually say: What am I making use of this data? And how am I going to make use of this data? And what decisions am I making?

So artificial intelligence – or machine learning – and they’re not necessarily synonymous but in some in some aspect they’re synonymous in terms of combining the wealth of data that you’re getting and actually seeing what insights can be derived based on all those data sets; at a much more faster pace and a more timely manner compared to what we would have had to do if we were doing it manually. And there is an element of: how do we use the machine learning algorithms or artificial intelligence approaches to say: Can I do a better prognosis?

Everybody’s aware of [IBM] Watson’s cancer cure approaches to it and Watson has evolved a lot of other stuff. But predominantly in the mainstream the payer market, this hasn’t yet taken off into a full-fledged problem because we’re dealing with not necessarily a literature research but more in the realm of operational research and operational analytics.

Hear more from Mayur and Marina about tools and technologies at [13:09] and [24:53] in the recording.Artificial Intelligence. Predictive Analytics. Bigdata. Machine Learning. HealthCare Executive Group. Benefits Costs. Patient Outcomes. Quality Standards. STAR ratings. Profit Margins. Improving Efficiencies. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data.

How can we employ artificial intelligence or machine learning concepts into the operational realm of the payer operation? [14:40]

There are some positive trends. There’s a huge growth of Medicare Advantage (MA) plans. Their margins continue to increase because it’s a catch-22 situation for MA plans because of the risks. And now MA plans are able to accurately reflect their risk scores. And as a result, their premiums are being reflected the right way – which actually helped them from their margin standpoint because their operations were still on the same aspects of it because in the previous era they were not reporting their risk the right way because they didn’t have all the data gathering up opportunities. But now that they’re able to gather their [data analysis] opportunities, they can predict their risk a lot more accurately, so their premiums are going up. As a result, the margins are getting better and also the operations have stayed the same.

Government Plans Off-Loading Operational Functions to Health Plans

And in the Medicaid managed care space what you’re seeing is a lot more growth in that space for, predominantly, what we could say s for one single reason: most of the state administrative entities are actually trying to off-load the burden onto the plans so that risk is being passed on to the managed care plans and the state entities become the administrative agency. Of course, with that, they’re also holding performance measures as an accountability which is not just about the financial side of it but also the quality side of it because they don’t want to sacrifice the quality of care being rendered to their beneficiaries. But as a result, you’re seeing a lot of growth in the managed care space Medicaid managed care well

What does this mean to me or my organization as a payer? [16:29]

If I actually eliminate all the big terminology, fundamentally there are two simple concepts:

  1. Is our plan performing better than what it was before from a cost standpoint? And with the qualifier added, is the plan performing to a level where the plan can afford too? Because one of which you’re collecting to your risk is what you’re paying out. That’s one of the key foundations. That’s a simple question that you’re going to answer.

And the second aspect of it is:

  1. Are we improving the quality of our plan? And quality can be defined in multiple ways. I think the STAR rating, the HEDIS measures, and all that stuff. But at the end of the day it’s really are you improving quality in terms of outcomes for the members?

And the second point is actually impacting the first point from a long-term standpoint. So, if you’re impacting the quality aspects of it, then you’re able to impact the cost aspect of it as well. But it doesn’t happen every year, it happens over as a strategic view. You have to put that as a strategic view long term view so that on the short run your cost structure might have variances but over a long run, you’re actually improving the trends of that one.Rubik’s Cube of Payer Data. Artificial Intelligence. Predictive Analytics. Bigdata. Machine Learning. HealthCare Executive Group. Benefits Costs. Patient Outcomes. Quality Standards. STAR ratings. Profit Margins. Improving Efficiencies. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.

Operational Simplicity and the Health of Your Health Plan [17:54]

But what does that mean in terms of a payer when you think about how you have to think about it?

It comes down to two things: operational efficiency and health of your health plan. How do we make a difference in looking at all the data that we have and actually answer these two business questions; and then tie them back to the simple questions of ‘Am I performing better in terms of cost?’ And ‘Am I improving the cost?’

Marina added: [18:38]

I think that operationally looking at the data is really going to, as a program administrator, is going to give me insight into things like the following:

  • What care management programs or medical management programs are most needed for my population?
  • What programs that I’m currently utilizing are really the most effective ones?

Taking that a step farther as you look into those specific programs that are most effective, you’ll also then be able to look at things like: What are the interventions that are most effective in this population. From a utilization review perspective?

Is my UR working only as a gatekeeper for my health plan or are we actually effectively managing acute episodes and beyond that acute episodes? And then really helping us determine all of this ultimately helps us determine what care intervention strategies do we need to tweak? Which ones do we need to add to our programs to create that meaningful behavior change that increases the health of our membership, increases the quality of the care that’s being provided to that membership, and ultimately reduces the cost?

The Rubik’s Cube of Payer Data – the Present Debacle

Mayur shared some insight into the struggle that many payers have regarding reporting and analytics: [20:03]

In a lot of ways, payers are struggling between: Am I doing reporting or am I doing an analysis? And how am I looking at it? Am I doing the analysis for the sake of reporting or am I doing analysis for the sake of improving or answering the two questions that we started out with?

  1. Is our plan performing better than what it was before from a cost standpoint?
  2. Are we improving the quality of our plan?

HealthCare Executive Group. Benefits Costs. Patient Outcomes. Quality Standards. STAR ratings. Profit Margins. Improving Efficiencies. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.And those could be the patient member outcomes, quality standards, STAR ratings, keeping benefits cost down, maintaining the profit margin, improving efficiencies. All of these are questions that every payer is asking.

And the list goes on and on and you guys are actually dealing with a lot more in today’s world. I’m sure every organization has a ton more questions to add to it but, fundamentally, why and how to do it is where the biggest question comes into play because often everybody goes down the path of: ‘Okay, I need to solve this reporting problem so I need to have this kind of technology in place. I need to solve my data analysis problem from a predictive modeling standpoint, so I need to have this technology base.

And as a result, you’re creating more and more silos within the analytic space and not necessarily taking advantage of the full spectrum of the data that you have or creating in its entirety in a holistic view. Because at the end of the day, if the technology analytics is being used for the reporting purposes then you only solve 30% of your problems because the majority of your problems are deriving insights from your data and actually saying how can we make a difference in our operations? How can we make a difference in our outcomes?

Payers have multiple data sources and everything is often viewed as a silo. [23:30]

Healthcare organizations are maturing but fundamentally they’re still struggling with the aspects of:

  • Am I doing quality analysis?
  • Am I doing financial analysis?
  • Am I doing operational analysis?
  • Or am I doing just reporting for the regulatory agencies?

Payers need to design their operational strategy to leverage all quadrants of dimensions: Quality, Financials, Operations, and Predictive Analytics.

Marrying Clinical Expertise with Data Analytic Capabilities [25:04]

HealthCare Executive Group Top 10 list. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.

I want to talk briefly about the key components that are going to make a difference. Often what happens is an analyst is asked a question and they actually come back and that data set is then presented to clinical leadership. And then clinical leadership asks a follow-up question and then makes some decisions on top of it. But in reality, what if you change that and involve that clinician up front during the analysis itself, along with the data scientist? So, what we view in the industry is that there’s a lot more benefit if you actually pair the clinicians and the data scientists together up front in the design and analysis phase.

So that 1) you can cut down your cycle crime and 2) you’re asking the questions up front and how to think about your operations. And that’s going to help frame your reporting and analytics problem in a way where you’re getting to a solution much faster.

Marina added:

I think that’s a really important point that you’re making. I think bringing these two teams of people together helps to bring about that important balance and maximize your outputs because your data scientists are experts at identifying the trends and the data. And when that information is presented to the clinicians, they can then help interpret those trends. That’s going to ultimately formulate your adjustments to your operations, your program design, etc. I think that’s a great point.

Pairing Clinicians with Data Scientists Frees Up Time for Patient Engagement

Mayur continued:

And another aspect to it is, when you’re thinking for clinicians, you’re actually taking away their valuable time working with a member. If you’re asking them to understand what’s happening with the data and go into the exercise and then making the decision to it. But if you pair them up front, you’ve solved the problem and then you’re giving them time to have their team’s focus more on the members then they are focusing on the data itself.

Marina added:

Right. Care teams are so busy trying to make that outreach to the members that having that technology available to them, to be able to guide them to identify trends or issues with that particular member, is going to save time. And it ensures too that all of the important or pertinent trends for that particular member, for that particular population, are being identified. Because at the end of the day, clinicians are just that, clinicians. They’re not data analysts.

Developing a Multi-Dimensional, 360-Degree View of Your Data

Marina and Mayur presented some insight and ideas on how to create a decision-making framework providing a multi-dimensional, 360-degree view for your clinical, operational, administrative, and financial teams.

See [28:15] for more information, insight, and ideas on creating a multi-dimensional, 360-degree view of your clinical, operational, administrative, and financial data.

Top Six Things to Consider When Evaluating Healthcare Analytics Vendors

Here are top six things that you should consider when you think about analytics or in the majority of organization’s how you want to get there.

  1. Data Security
  2. In-House Experts
  3. Intuitive Easy-To-Use Platform
  4. Actionable Real-Time Data Visualization
  5. Data Accuracy
  6. Acceptance of Data in Any Format

For details on the importance of each of the above considerations for evaluating healthcare analytics vendors, listen in starting at [36:04].

Questions from Webinar Series Attendees

Our organization currently executes minimal analytical formalities, processes, etc and we are at an immature analytical state. Would investing and working with an analytics vendor refute all [our efforts] at this stage in our organization? [44:37]

Mayur: No. You can view it from the standpoint of: if you’re in the early stages of maturity then that would be the perfect time to assess how you want to design your system and what kind of systems you want to have in place. And you may not have to go through the same evolution steps that the entities started out early on. You may actually leapfrog by taking in all that stuff up front itself. So absolutely, even if you don’t have all the data organized in a unified view that’s fine too because you do have data sets. The first steps very well could be how do you get them into the unified view. So I wouldn’t hesitate working with and investing in analytics if you’re in the early stages of maturity because this very well could be an opportunity where you don’t have to redo the some of the things that you might have done if you’re already in further stages.Artificial Intelligence. Predictive Analytics. Bigdata. Machine Learning. HealthCare Executive Group. Benefits Costs. Patient Outcomes. Quality Standards. STAR ratings. Profit Margins. Improving Efficiencies. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.

Our organization prides itself on taking the best care of our patients. Can you give us examples of how using an analytics vendor can improve our patient outcomes vs. just us monitoring it internally? [46:03]

Marina responded to this question with an interesting story about how EQ health identified and assisted high-utilization, low literacy, diabetic patients in the Mississippi Delta.  Listen at [46:22] as to how EQHealth made life easier for patients and improved their health, all while reducing emergency room visits and inpatient admissions.

My team is discussing the decision to build an analytics platform internally or buy and outsource it with a vendor. Do you have any insight into what is more successful and pros and cons? [50:50]

Mayur: I don’t think there is a right answer or wrong answer. It really centers on your strategy. Are you trying to make that as your core competency or are you wanting to retain your core competency to manage plan operations but want to have the benefit of the analytics and the analytics platform; then at that point you should outsource. But if you’re wanting to make analytics your core competency, then you need to have that in-house. But when you do decide to make it in-house, you still need to… hear the rest of Mayur’s answer at [51:08]

Listen to more questions and answers from Solving the Rubik’s Cube of Payer Data here.

More Insight for Healthcare Leaders

Our Webinar Series events are one example of how the HealthCare Executive Group helps to share information and promote collaboration between our members, associates and sponsor partners. Our next Webinar Series event will be ‘Using People, Process & Technology to Grow Your Business’ and will be presented by our sponsor partner HealthEdge on July 25th, 2019 at 2:00 pm ET.HCEG. HealthCare Executive Group Webinar Series: ‘Using People, Process & Technology to Grow Your Business’ HealthEdge.

HCEG’s 2019 Annual Forum

Save The Date HCEG Annual Forum

In addition to connecting with us on Twitter and LinkedIn and subscribing to our eNewsletter, consider joining other healthcare executives and industry thought leaders at our 2019 Annual Forum in Boston, MA on September 9-11, 2019. In addition to the always insightful, information-packed sessions and networking opportunities our annual forum offers, we’re including two special networking events on Monday, September 9th:

  • Tour of the IBM Watson Research Facility in the morning
  • Red Sox vs. Yankees Baseball Game at Fenway Park in the evening

For more information, click here and/or contact us at [email protected].

HCEG Webinar Series Event. “Solving the Rubik’s Cube of Payer Data” Digital transformation. HCEG’s Top 10 Data & Healthcare Analytics. Artificial Intelligence, Machine Learning. Electronic Health Records. EHR. Claims Data. EqHealth Solutions. CMS’s Meaningful Use program. Industry Pulse Social Determinants of Health. Value-based Care. Alternative Payment Models

Healthcare Organizations Focus on Data & Analytics for Digital Transformation

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If analytics is the machine powering your digital transformation initiatives, then data is the power making that digital transformation machine run. The importance of data and analytics has been identified by our members in each of the last ten years HCEG’s Top 10 list of challenges, issues, and opportunities have been created. For 2019, “Data & Analytics” is ranked #1 on the HCEG Top 10. It’s clear that healthcare leaders believe that data is a catalyst to accelerate meaningful change. And that the use of analytics – particularly prescriptive analytics – is a fundamental strategy for succeeding in a new era of healthcare.

Mountains of Data Waiting to Power Your Healthcare Analytics Machine

Good analytics begins with good data and healthcare organizations are sitting on a mountain of data. According to America’s Health Insurance Plans (AHIP), the typical regional payer processes $8 billion in claims each year with each claim providing its own set of unique data points – largely financial and administrative. But healthcare payers are increasingly collecting, matching, and using clinical data to provide richer, more comprehensive insight on their members.

Given the proliferation of Electronic Health Records (EHR) incented by CMS’s Meaningful Use program, it’s no surprise that more and more data is being pulled from EHR’s. And risk-sharing agreements between payers and providers has resulted in health plans sharing more claims data with their provider partners. In fact, the current Industry Pulse report indicates that EHR data is one of the top two primary sources of clinical data with 30% of health plans reporting they utilize EHR data.

digital transformation. HCEG’s Top 10 Data & Analytics. Artificial Intelligence, Machine Learning. Electronic Health Records. EHR. Claims Data. EqHealth Solutions. CMS’s Meaningful Use program. Industry Pulse Social Determinants of Health. Value-based Care. Alternative Payment ModelsOther sources of clinical data that organizations are using to complement their claims data include ancillary data such as pharmacy, lab, and imaging (17%) and real-time admission, discharge, and transfer notifications (10%)

RELATED: 9th Annual Industry Pulse Research Survey Results

Popular Use Cases for Healthcare Analytics

These enhanced data sources are becoming more and more useful due to the power of artificial intelligence (AI) and machine learning.

New research from Dimensional Insight identifies care quality measures and finance as two top use cases for healthcare organization usage of analytics today. Additional use cases for leveraging data by analytics include

  • Addressing Social Determinants of Health (#3 on the 2019 HCEG Top 10)
  • Value-based Care and Alternative Payment Models (#4 on the 2019 HCEG Top 10)
  • Improving Patient Engagement and Satisfaction
  • Patient Outcomes Improvement

Analytics Budgets are Increasing for Healthcare Organizations

According to a recent report from the Society of Actuaries, greater than 60 percent of payers and providers are planning to increase their analytics budgets by 15% or more.

Additionally, the report finds that 89% of healthcare executives plan to use predictive analytics over the next five years. It’s clear that healthcare payers and health systems have a keen focus on leveraging the massive amounts of data they possess. These data serve to reveal trends, patterns, and insights to help ensure their success going forward.

Solving the Rubik’s Cube of Payer Data

i.e. Lining Up All Your Data to Rapidly and Accurately Gain Unique Insights

For insight into how your healthcare organization’s data can be used to improve health outcomes and reduce costs, join our next Webinar Series Event on June 6th at 2:00 PM EDT / 11:00 AM PDT. Our sponsor partner eQHealth Solutions presents “Solving the Rubik’s Cube of Payer Data.”In this complimentary webinar, you will learn how to aggregate and parse provider data, how you can use data captured outside of your own system, and other practical solutions to use your data to create knowledge for actionable use and outcomes. Attendees will have a chance to ask questions and all registrants will receive a copy of the presentation afterward.HCEG Webinar Series Event. “Solving the Rubik’s Cube of Payer Data” Digital transformation. HCEG’s Top 10 Data & Healthcare Analytics. Artificial Intelligence, Machine Learning. Electronic Health Records. EHR. Claims Data. EqHealth Solutions. CMS’s Meaningful Use program. Industry Pulse Social Determinants of Health. Value-based Care. Alternative Payment Models