Healthcare Price Transparency Price Transparency Regulations & Compliance, Policies, Programs, & Tools, Data Standards & Operational Considerations

Healthcare Price Transparency – Leaders Share Insight – Part 1

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Healthcare price transparency has a lot of attention and focus right now, especially in the mandate-driven space. But addressing price transparency via compliance with regulations is just a portion of what health plans and healthcare provider organizations should be focusing on to help make healthcare better and more cost-effective for their members and patients.

In our first Focus Area Roundtable on Costs & Transparency held April 5, 2021, a group of HCEG members working for health plans, healthcare providers, and healthcare-related technology/service organizations gathered to discuss some of the challenges, issues, and opportunities associated with addressing price transparency.

Challenges, Issues, & Opportunities Beyond Price Transparency Regulations

Andy Hoffman and Matt Parker, two thought leaders with our Focus Area Partner HealthSparq, shared a timeline overview of the Transparency in Coverage Mandate and the No Surprises Act and facilitated the following questions:

  • How are you thinking about price transparency within a rather heavily regulated space?
  • What do you see as key issues and risks in the price transparency space? What’s the role of the 80/20 rule?Healthcare Price Transparency Regulations & Compliance, Policies, Programs, & Tools, Data Standards & Operational Considerations
  • How can we really focus on what health plan members and provider patients need to make good health care decisions, knowing that members and patients often have to navigate in antagonistic payer-provider environments?
  • How can we balance supporting patient needs and operate as an ongoing business while also informing people what things are going to cost before they have to spend unlimited amounts of money?
  • What unique challenges or strategies are you thinking about with respect to price transparency? And what opportunities are you looking to take advantage of regarding price transparency?

This post shares insight and information shared by roundtable participants on the above questions pertaining to the following categories:

  1. Regulations and compliance including their importance and value to various stakeholders
  2. Price transparency policies, programs, and tools
  3. Data standards and operational considerations to advance price transparency

A second post highlighting participant responses pertaining to the following categories will be shared shortly:

  1. Increasing adoption and the importance of end-user education and support
  2. Payer-provider relationships to support access to price transparency information
  3. Advancing healthcare price transparency and next steps

RELATED: Healthcare Leaders Focus on Healthcare Policy & ACA

Thoughts on Price Transparency Regulations & Compliance

As a payer and provider, I can look at other hospitals across the state and they’re not even using our latest pricing. They’re just putting something out there to meet the requirement. So, if there’s not consistency in the data, it doesn’t actually help anybody. It just creates profound confusion. (Health Plan/Provider)

Some of the things that I hear my peers talk about is: Are we just solving certain regulatory requirements or are we solving something members think they want but won’t actually be able to use in an effective way?  Or are we on a road to something that will be of value to all the parties involved? (Health Plan)

So, what are the different things people are putting out there? How do we then know this is the best? This is what we should be doing versus this is what we are doing. Because I think everybody is just trying to meet the intent of the law or the letter of the law, but a lot of people don’t know how. And so, I think that’s one of the things that we’ve got to [consider] if there’s anything we can do. (Technology/Service Provider)

These are people who are sick and injured and hurt and need health care. And we’ve got to do our part to help them out and we can do that in a way that drives our overall business priorities. This sets the floor. We talk about these mandates being a floor and you build an experience on top of that that supports your member needs and supports your patient’s needs. (Technology/Service Provider)

So, I think it’s a good thing that the conversation has started. But I think that the end product is going to be significantly different from what it is that we’re looking at this point. (Health Plan)

I feel like the price transparency is just a way to get our prices out there – for the most part as individuals [procedures]. Unless it’s very comparative in descriptions, information is really hard to compare apples to apples between hospitals. (Provider)

Healthcare Price Transparency Policies, Programs & Tools

Whenever I used to roll out tools and or guidance, probably two decades ago and in more than one state, you have to understand the nature of what it is that your end goal is. And sort of work backward from that. But just sort of putting some things out there, you end up getting exactly what you put into it. (Health Plan/Provider)

For a lot of these hospitals, putting out their prices shows major vulnerabilities for them when it comes to inappropriate pricing, when it comes to the contracts that they’re having. It does highlight the contracts that they have with their different vendors. (Technology/Service Provider)

I think some plans are in sort of this game of chicken to some extent because the No Surprises Act isn’t finalized yet. (Technology/Service Provider)

And how can we give voice to that as part of the overall conversation with the administration because I think they’re trying but they’re sort of missing the point. So, I think it’s incumbent upon us as an industry to start to respond back on all of those fronts as to how best to rethink how to do that since it started out previously and it’s been through lots of different iterations. But that lack of standards or consistency is just…(Health Plan)

Price Transparency Data Standards & Operational Considerations

From the payer or provider perspective, without somewhat more explicit data structure guidance across the board, it’s [price transparency mandate] not helpful. (Health Plan/Provider)

We need a standardization so that everybody can follow that. (Provider)

I don’t think you can do comparisons. It’s not the latest data. It’s not even the same from hospital to hospital. It’s kind of all over the place. (Health Plan/Provider)

So as an industry, I think whether that’s vendor-specific or provider, payer, or even consumer, I think I’d like to see a conversation around how do we drive to those data standards? (Health Plan/Provider)

I would agree that the majority of people and hospitals are doing that [trying to comply in good faith.] They don’t collect the data internally in ways that’s terribly helpful. So, to publish it [price transparency information] requires an infrastructure that frankly many of them don’t have in a way that makes it useful as say maybe a payer would. (Health Plan/Provider)

Healthcare is local, that’s very much true. So that’ll impact the dynamics and the impact of what price transparency brings to the table. (Thought Leader)

There are operational challenges that we have to address and plan to address to be compliant with the new regulations that the question becomes: How will this look and feel to the consumer because pricing can vary so significantly? (Health Plan)

One of the challenges that we see when we engage with plans is: Who are the folks and entities within the organization that are trying to solve this problem? We’ve got to get fee schedules from your contracting folks, and you need member eligibility and claims verification. You had to pull all these different systems together and that’s been one of the things we’ve seen as a big challenge – especially with bigger payers, these big vast entities that have to solve these problems with groups that really hardly ever talk to each other. (Technology/Service Provider)

Join a Focus Area Roundtable – Connect with Healthcare Peers

Additional Focus Area Roundtables on Costs & Transparency – and other 2021 HCEG Top 10+ focus areas such as Healthcare Policy & ACA, Interoperability, and M & A /Joint Ventures, among others – will take place throughout 2021. If you are interested in participating, reach out to us via email or complete this short form to indicate your interests.

To receive recaps of our Focus Area Roundtables and other information of potential use for leaders of health plans, health systems, and healthcare provider organizations, join our newsletter.

Healthcare Policy ACA Focus Area Roundtable. Medicare/Medicaid beneficiaries. Health Insurance Marketplace. HealthCare Executive Group HCEG. Softheon. American Rescue Plan (ARP). Expanded APTC Eligibility and Subsidy Amounts May Drive Individual Market Growth. real-time prior authorization requirements.

Healthcare Leaders Focus on Healthcare Policy & ACA

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Early indicators of healthcare policies’ prioritization, implementation, and/or likelihood of success can provide a head start to healthcare organizations – particularly those serving Medicare/Medicaid beneficiaries and those operating in the Health Insurance Marketplace or looking to join the Marketplace in 2022. It is in that spirit that the HealthCare Executive Group (HCEG) has created Focus Area Roundtables to promote dialogue among HCEG members on important 2021 HCEG Top 10+ priorities. This post shares highlights of the initial online discussion about Healthcare Policy & ACA and presents additional information regarding future Focus Area Roundtable discussions.

See below for Additional Focus Area Roundtables Currently Being Assembled

Healthcare Leaders Discuss Healthcare Policy & ACA

On March 11th, executives from mid-sized health plans (MSH), an integrated delivery system (IDS), a national specialty care provider (NSP), and a not-for-profit consortium focused on advancing healthcare data and technology transformation (EDC) participated in the roundtable. In a roundtable fashion, these leaders shared their thoughts, ideas, and concerns on Healthcare Policy & ACA and forecasts for how the Biden administration may reshape the American healthcare ecosystem for the years to come.

The session was moderated by HCEG Executive Director Ferris Taylor and supported by Kevin Deutsch, General Manager and SVP of Health Plan Cloud at Softheon, the 2021 Focus Area Partner for Healthcare Policy & ACA.

What are your healthcare policy & ACA-related priorities, thoughts, and concerns?

Dealing with volume and uncertainty of healthcare policy and regulations amid rapidly changing and often unstructured government programs: ACA enrollment/subsidies, single payer, public option, Medicare/Medicaid buy-in, block grants, CMS Interoperability and Patient Access, etc.It was noted that no one has a crystal ball and none of the participants were “inside” of the administration, so discussions of this type help to develop the ability to respond to the many uncertainties.  The needed speed of learning and agility to respond to changes in healthcare policy is the “new normal.”  Specific perspectives were exchanged among the roundtable participants.

MSH: Expressed concern on how to keep premium costs down for members who are largely low-income.

NSP: With $2 billion at risk in value-based programs and whose patients are mostly Medicare beneficiaries with multiple comorbidities, healthcare policy needs to:

  • Facilitate cost-effective access to coverage for Medicare and other beneficiaries.
  • Establish reasonable value-based programs and not just push out a bunch of voluntary risk-sharing programs long on objectives but short on details.
  • Support coverage and payment for virtual care, particularly remote monitoring.

EDC: Shared that consortium members have noted that recently passed rules on Interoperability and Information Blocking are top of mind. These two areas of regulation and the advent of technology standards like FHIR and code sets such as LOINC, SNOMED, and others are helping to establish a common language and ‘gauge’ to help providers to speak the same language – particularly with payers.

What components of the recently passed American Rescue Plan (ARP) are most promising to you?

MSH: As a health plan, we struggle to address premium affordability and overall cost to the member and aim to keep increases to premiums at inflation or lower. Additional costs beyond the member premium often prevent members from accessing needed care. While the pandemic did not materially impact our overall member count, it did impact the composition of members as the number of commercial members decreased while Medicaid members increased.

NSP: Mentioned the need for providers and supply-side organizations to better understand the true cost of the services and products and services they provide. And another participant noted experience with a wide variety of costs and outcomes for services provided to seemingly similar patients.

FACT SHEET: American Rescue Plan and the Marketplace

What are ARP’s Immediate, Mid-Term, & Long-Term Benefits?

Healthcare Policy ACA Focus Area Roundtable. Medicare/Medicaid beneficiaries. Health Insurance Marketplace. HealthCare Executive Group HCEG. Softheon. American Rescue Plan (ARP). Expanded APTC Eligibility and Subsidy Amounts May Drive Individual Market Growth. real-time prior authorization requirements.All participants agreed there is a large and immediate benefit associated with ARP funding for vaccine-related availability, administration, and tracking.

NSP: Increased funding of COBRA premiums at 100% through September 2021 and increases to Medicaid funding seem to be a positive, as more unemployed people will be less likely to forgo or delay needed care.

Longer-term benefits from the funding and attention drawn to mental health services by the ARP were also noted. One participant called out how historically low funding and the stigma associated with mental and behavioral health services has led to a large, undiagnosed population. The need to invest more in mental health now is needed to save more serious issues later.

EDC: Consortium members have noted the importance of funding and policy related to community health centers and the need for policy and standards related to the collection and use of Social Determinants of Health (SDoH) – particularly for Dual-Eligibles.

Softheon’s Kevin Deutsch noted that changes to ACA subsidy thresholds and payment amounts brought about by the ARP will further complicate reconciliation and payment challenges. And that additional changes to subsidies and cost-sharing reductions by the Biden Administration will likely happen, further complicating these already non-trivial plan administration and payment reconciliation challenges.

RELATED: Expanded APTC Eligibility and Subsidy Amounts May Drive Individual Market Growth

Topics for Next Healthcare Policy & ACA Focus Area Roundtable

Healthcare Policy ACA Focus Area Roundtable. Medicare/Medicaid beneficiaries. Health Insurance Marketplace. HealthCare Executive Group HCEG. Softheon. American Rescue Plan (ARP). Expanded APTC Eligibility and Subsidy Amounts May Drive Individual Market Growth. real-time prior authorization requirements.As the allocated time for the roundtable flew by, Ferris moved to close the inaugural Focus Area Roundtable by asking participants what was top-of-mind in regard to Healthcare Policy & ACA and what participants thought would be the most important topics for the next roundtable. Topics raised by participants as having potential value to other HCEG members, that might be addressed in future roundtables, and would benefit from Softheon’s experience and views across their customers include:

  • Addressing policy/regulations in regard to controlling costs – particularly for high-need, high-cost members/patients.
  • Challenges, issues, and opportunities related to direct provider contracting and value-based payment arrangements.
  • Understanding and addressing costs related to internal operations and process modifications.
  • Sharing lessons learned as to what other healthcare stakeholders are doing, and not doing, in response to rapidly changing Healthcare Policy & ACA.
  • Preparing for the many regulatory deadlines (and the frequent adjustments to timelines) such as the 1/1/2022 real-time prior authorization requirements.

Additional Focus Area Roundtables Currently Being Assembled

HCEG is currently assembling roundtable discussions on Costs & Transparency and Interoperability – two other HCEG Top 10+ focus areas closely related to and impacted by Healthcare Policy & ACA.  Additional focus areas will be added in the coming months.

If you’re an executive of a health plan, health system, or healthcare provider organization who’d like to join one of these informal, small group discussions, please reach out to us here or share your contact information via this tool. And consider joining our newsletter to receive information of potential value to healthcare executives including recaps of future Focus Area Roundtables.oin HCEG and/or participate in our Focus Area Roundtables

RELATED: Healthcare Policy, ACA 2.0, Enrollment Period Lessons, & The Journey to the Exchange

Healthcare Policy, ACA 2.0, ACA Enrollment Period Lessons Learned, The Journey to the Exchange. Open Enrollment Period. Special Open Enrollment Period. Federally-Facilitated Marketplace (FFM). State-based Exchanges (SBE) Softheon. 2021 HCEG Top 10+. Expanded APTC Eligibility. Subsidy. Subsidies.

Healthcare Policy, ACA 2.0, Enrollment Period Lessons, & The Journey to the Exchange

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The real and potential impact of Biden administration healthcare policy, the next iteration of the ACA, the Open Enrollment Period that closed in December 2020, the Special Open Enrollment Period that began February 15th, 2021, and opportunities for leveraging the Federally-Facilitated Marketplace (FFM) and State-based Exchanges (SBE) are all current healthcare policy topics that are top of mind for leaders of many healthcare organizations.

Earlier last week our Executive Director Ferris Taylor and Kevin Deutsch, General Manager & Senior Vice President, Health Plan Cloud of HCEG technology sponsor Softheon met to discuss these and related topics. The goal was to identify and create a framework for additional discussion and exchange over the next few months. This post shares an overview of the call, shares a small portion of the discussion, describes content and presentations to be shared over the next few months, and offers an opportunity to engage with other healthcare leaders on the Healthcare Policy/ACA focus area of the 2021 HCEG Top 10+ list.

See the end of this post for information on upcoming events on Healthcare Policy/ACA 2.0 and an opportunity to participate in our Focus Area Workgroups.

The ACA Revolution – Healthcare Policy from ObamaCare to TrumpCare to BidenCare

Ferris kicked off the discussion by noting that the elephant in the middle of the table is that everything seems to have changed with respect to the ACA and healthcare policy. There have been a few different iterations of the ACA at this point. If the ACA focus of the Obama administration was to ‘Pass & Implement’ and the Trump administration mantra was ‘Repeal & Replace,’ Kevin suggests that the goal of the Biden administration is to ‘Advance & Grow’ the ACA.

Kevin shared that a number of health plans that left the marketplace after participating the first couple of years, as well as plans that hesitated to join due to political and other uncertainties, are now rejoining the Exchange or planning to join for the 2022 plan year.

RELATED: “Considerations for Health Plans as we approach ACA 2.0 and Bidencare”

Expanded APTC Eligibility and Subsidy Amounts May Drive Individual Market Growth

The likely expansion of eligibility for Advance Payment Tax Credits (APTC) and increased amounts

Expanded APTC Eligibility and Subsidy Amounts May Drive Individual Market Growth

of APTC subsidies by the Biden administration will create the opportunity for millions of new consumers to enter the individual market.

This is a key consideration – the impact of near-term changes to subsidy levels and APTC eligibility. From the discussion, it appears that retroactive subsidy changes could happen in the next couple of months and undergo additional change over the next couple of years. Kevin shared experience as to how data exchange/interoperability with CMS and having the right controls in place surrounding subsidy determination and reconciliation are critical to sustaining plan performance and scaling enrollment processes.

2021 Open Enrollment and Special Enrollment Period: Lessons Learned & to Be Learned

Perspectives on what health plans and technology providers could (or should) learn from the 2021 Open Enrollment Period that closed in December 2020 were exchanged. Kevin also shared some considerations on the Special Enrollment Period (SEP) recently opened on February 15, 2021 and what we might learn.

See lessons learned from the 2021 Open Enrollment Period in this recent blog post and the recent press release about how Softheon Simplifies Operations and Reduces Administrative Burdens for Health Plans During Special Enrollment Period and Beyond.

RELATED: Bidencare & the Latest on the Special Enrollment Period

New Marketplace Entrants – Partnering to Advance & Grow

In addition to traditional health plans, Kevin shared that Softheon is seeing technology companies focused on personalized care delivery models AND large, established technology firms, becoming an issuer offering plans on the exchange and/or developing products focused on helping others establish a presence on the ACA marketplace.

While some of those technology companies may have the technical expertise, they don’t necessarily have the depth of understanding as it relates to the marketplace requirements and being a Qualified Health Plan on the exchange. They are quickly learning that nuances within the exchange workings and platform – like EDI enrollment processing, billing and payment, integration with claims platforms, and enrollment/subsidy reconciliation – are good areas in which to partner.

Related: Google to establish Minnesota office as projects with Mayo Clinic expand and mature

2022 Enhanced Direct Enrollment – Facilitating Preparations

Ferris mentioned a January 2021 CMS report “Impact of Enhanced Direct Enrollment During the Open Enrollment Period for 2021 Coverage” that noted how the successful full-scale implementation of Enhanced Direct Enrollment (EDE) over the past two years has yielded outstanding results for the Federally-Facilitated Marketplace.

Since Softheon is one of only a few CMS-approved providers of EDE Phase 3 technology, Kevin shared his understanding of the challenges, issues, and opportunities that companies looking to get on the exchange, or improve their existing FFM exchange operations, should be aware of, including:

  • Keeping consumers on your own health plan branded platform throughout the entire enrollment process.
  • Improving member experience by providing customer service staff and insurance brokers with tools to assist with not only the initial enrollment process but also with additional life event-related transactions throughout the plan year.
  • Planning for increased traffic volumes and the exchange of more personal information between systems, companies, and individuals requires a robust identity management strategy and threat detection measures.
  • Meeting significant security, compliance, and other technical requirements, on top of business-related audits and reporting.

The Issuer Journey to the Marketplace Exchange

There are a lot of decisions, steps, shortcuts, and possible detours along the journey to a presence on the healthcare exchange. Beyond plan definition, market positioning, pricing, and CMS submittal efforts currently underway, many organizations wanting to offer plans on the exchange in 2022 are in the early stages of adopting new technology platforms and figuring out how those platforms need to integrate with their existing ecosystem.

Kevin shared that while requirements for a sustainable presence on the exchange are generally consistent across all issuers, the individual steps and specific pathways through the roadmap to get on the exchange may vary. Given the scope of this topic, additional information will be shared in future posts and a special podcast planned after this SEP closes as noted below.

HCEG, Softheon and the Healthcare Policy/ACA Focus Area

In addition to more details on each of the above issues, the exchange between Ferris and Kevin covered a lot of other topics including the following:

  • Trend toward moving from FFM to state-based exchanges.
  • What happens when the state that you’re in, or you’re planning to get into, converts from the FFM into a state-based exchange a year from now?
  • Unique challenges and opportunities in getting on state-based exchanges.
  • Special considerations for State/CMS-qualified Medicaid programs
  • Timelines and steps to be on the exchange in 2022
  • Growing alignment between consumers and their health plans, especially with COVID
  • Increasing retention of plan members across enrollment periods

Upcoming Opportunities for More Information, Insight, & Ideas

Between now and the end of May, HCEG will be working with members, other healthcare executives, industry thought leaders, and sponsor partners to create, curate, and present additional information and insight on various focus areas of the 2021 HCEG Top 10+.

The following Healthcare Policy and related topics are scheduled to be presented with Softheon, the focus area thought leader for Healthcare Policy:

Week of Information/Event
Now HCEG Focus Area Workgroups

HCEG members are encouraged to join small roundtable workgroups on the Healthcare Policy/ACA topic. Click here to join the Focus Area Group discussions.

3/15/21 The Issuer Journey to the Marketplace Exchange

A podcast presenting a roadmap addressing key challenges, issues, and opportunities to establish a presence on the exchange including maximizing plan distribution channels.

3/29/21 Top Questions on Building Your Exchange-related Technology Infrastructure

A digital presentation of technical and technology-related approaches and considerations related to the exchange.

4/12/21 Key Success Factors for Your 2022 Exchange Operations

A blog post presenting learnings gathered from the 2021 Open Enrollment Period, recent exchange implementations, HCEG members, and industry experts.

5/3/21 Topics and Questions to Be Addressed in Upcoming Webinar Series Event

An ongoing, digitally interactive Q & A process collecting and addressing questions from the HCEG network and other industry leaders and participants on current healthcare policy developments, ACA 2.0, and lessons learned from Open Enrollment & Special Enrollment Periods

5/17/21 Webinar: Healthcare Policy Developments, ACA 2.0, and Recapping Open Enrollment & Special Enrollment Periods

A webinar presenting a summary of all the information, insight, and ideas collected in the above events.

June 2021 Summary/Whitepaper on Lessons learned in preparing for the ACA Revolution/Revitalization

To receive announcements and information on all of the above and other information of potential value to healthcare executives and leaders, subscribe to our newsletter today. And reach out to us here if you have any questions and/or would like to share information and/or your insight on these and other HCEG Top 10+ topics.

Interim 2021 HCEG Top 10 List Healthcare Leader Priorities

Identifying COVID-19 Impact on Healthcare Leader Priorities

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The healthcare industry has faced tremendous change and uncertainty for decades. Each year over the last decade, the challenges, issues, and opportunities facing HCEG members have been used to create the HCEG Top 10 list – a list of challenges, issues, and opportunities. Although most healthcare executives were likely comfortable about their priorities at the start of 2020, those healthcare leader priorities were certainly and quickly turned upside down by the emerging coronavirus pandemic. The best-laid plans demanded quick review, understanding, and revision as 2020 progressed.

COVID-19 Impact to Healthcare Leader Priorities

Accordingly, HCEG and our sponsor Change Healthcare performed a ‘flash survey’ of 228 healthcare leaders through June and July of last year to assess how COVID-19 impacted the priorities identified in the 10th Annual Industry Pulse research report – a research survey based on the 2020 HCEG Top 10 list.

The results of this COVID-19 flash survey update to the 2020 Industry Pulse were released in September of 2020. Since COVID-19 prevented the HealthCare Executive Group from hosting its 2020 Annual Forum that same month of September, a formal 2021 HCEG Top 10 list was not created but rather an Interim 2021 HCEG Top 10+ list was assembled using findings from the flash survey and discussion among HCEG’s network of healthcare executives and industry leaders.

Updating Healthcare Leader Priorities as 2021 Unfolds

As 2020 ended and 2021 began, HCEG has been collecting additional information and insight into how the coronavirus pandemic and the 2020 presidential election have impacted the priorities of new and existing HCEG members and our network of partners and associates. We are also reviewing a list of 2021 healthcare predictions and trends shared by industry leaders.

Over the last few weeks, HCEG contacted the 120+ new members who joined HCEG since early December to collect feedback on their current priorities.

HCEG Healthcare Executive Group Annual Forum Healthcare leader priorities

New HCEG Members Share Their Top Priorities

While we are still collecting additional feedback from our members and performing a comparative analysis of information collected from our members to 2021 predictions and trends shared by industry leaders, it’s clear that the pandemic has resulted in new and changed priorities for health plans, health systems, and healthcare providers. Some initial findings based on the feedback provided by new HCEG members include:

  • Consumer Experience” (#1) and “Costs & Transparency” (#2) were the most frequently noted priorities of new members.
  • Data & Analytics” (#5) was the 3rd most referenced top priority. We’re reaching out to our members to gather more specifics about this foundational priority – among other priorities that were shared.
  • Next Generation Payment Models” (#9) was the 4th most frequently noted priority.
  • COVID-19 & Pandemic Preparedness” (#11) was frequently referenced with some new members adding “Patient & Healthcare Worker Safety” as a priority.
  • Holistic Individual Health” (#7) was referenced by only two new members – both healthcare providers.
  • Reimbursement Issues,” “Addressing Underfunding of Primary Care” and “Administrative Expense” – perhaps all considered a subset of “Next Generation Payment Models” – were listed as ‘new priorities’ – mostly by members associated with health systems and healthcare providers.

RELATED: Physician Perspectives on COVID-19 Impact on the Fall Season

How has COVID-19 Impacted YOUR Priorities as a Healthcare Leader?

To help us further refine our Interim 2021 HCEG Top 10+ list, please consider sharing your priorities for 2021 via this simple, one-page survey. We’ll use your responses to create a more complete 2021 HCEG Top 10+ list and to help guide and create additional content as 2021 continues. You may also email us at [email protected].

Connect with the HealthCare Executive Group

Consider joining our newsletter to receive additional information, ideas, and insight for healthcare executives and change-makers.

Please reach out to us at [email protected] if you have any questions or comments. If you are an executive of a health plan, health system, or healthcare provider organization, reach out to us at [email protected] for information on a special membership offer available through the end of January.

Healthcare System Interoperability – The Key To The Care We All Strive For

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What does it feel like to be a patient, provider, pharmacist, and payer in a world where interoperability is not always a reality? What improvements can be expected by healthcare stakeholders in a world where interoperability is vast?

In our October Webinar Series event – The Care We All Strive For: The Impact of Interoperability – our sponsor Surescripts helped to address the two above questions via a short two-act skit. Four fictional healthcare stakeholders – a patient, a provider, a pharmacist, and a health plan executive – each shared their experiences with how interoperability helps to address the Quadruple Aim: enriching the patient experience, improving outcomes, addressing costs, and maintaining provider well-being.Surescripts. The Care We All Strive For – Navigating an Interoperable Healthcare System. HCEG Webinar Series October 2020. Specialty Pharmacy. Interoperability. Prior Authorizations. Quadruple Aim Triple Aim.This blog post recaps a portion of this two-act skit and presents some highlights.

Access the entire recording here.

Two-Acts: Healthcare System Interoperability – Before & After

In Act I of the skit, each of the actors shared their experience in a world where interoperability is not a widespread reality – a world that most healthcare stakeholders experience today. In Act II, they shared how enhanced interoperability can improve the experience and well-being of not only patients and but also providers while reducing administrative and financial burdens and enhancing clinical outcomes – the four goals of the Quadruple Aim.

Highlights of Act I – Navigating Today’s Processes (Before)

Each stakeholder shared their experience living and working in a healthcare environment where interoperability is lacking:

Patient Carlos Garcia expressed his experience and concerns about alternative medication availability and cost:

  1. Need to repeat medical and medication history with each new provider
  2. Difficulty obtaining info on more cost-effective medication alternatives
  3. Lapses in medication adherence due to cost and/or delays at the pharmacySurescripts. The Care We All Strive For – Navigating an Interoperable Healthcare System. HCEG Webinar Series October 2020. Specialty Pharmacy. Interoperability. Prior Authorizations. Quadruple Aim Triple Aim.

Physician Dr. Natalie Pinter, Carlos Garcia’s PCP, noted difficult prior authorization processes and lack of access to benefits information:

  1. Administrative processes take time away from patient interaction
  2. Lack of benefits information makes identifying cheaper therapeutic alternatives more difficult
  3. Cumbersome prior authorization processes – particularly for specialty medications

Pharmacist Keisha Wright also expressed concerns about over-reliance on faxes and administrative burdens:

  1. Challenges with incomplete patient information
  2. Delays in filling prescriptions – particularly specialty medications – due to unwieldy prior authorization processes

VP of Pharmacy at Carlos’s health plan, Oscar Gustafsson, noted impacts his health plan pharmacy operations:

  1. Involve a heavy, over-reliance on faxes to communicate with physicians and pharmacists
  2. Challenges assisting with member medication adherence and addressing gaps
  3. Difficulty assisting members with optimizing the use of their health plan benefits

Navigating Today’s Healthcare Process is a Challenge for Everyone

After Act I, the emcee of the performance – Melissa Warnke, Director PBM-Pharmacy, Health Plan Segment Marketing of Surescripts – shared some recent statistics supporting how insufficient interoperability impacts patients, providers, pharmacists, and health plan payers.Surescripts. The Care We All Strive For – Navigating an Interoperable Healthcare System. HCEG Webinar Series October 2020. Specialty Pharmacy. Interoperability. Prior Authorizations. Quadruple Aim Triple Aim.

Access the entire recording here.

Highlights of Act II – The Care We All Strive For (After)

In the 2nd act, the healthcare stakeholders shared how broad healthcare system interoperability would change stakeholder experience:

Health plan VP of Pharmacy Oscar noted improvements and efficiencies gained in health plan operations:

  1. Allows for timely delivery of medication adherence gaps directly into the workflow of physicians
  2. Ability to share member-specific benefit information to physicians at the point of care
  3. Faster, “faxless” processing and turnaround of prior authorizations

Patient Carlos noted positive impacts on his physician office visit, cost of his medications, and obtaining his medications:

  1. Ability to provide patient medical and medication history to new physicians and pharmacists
  2. Faster, less administratively intense prescriptions – particularly specialty medications – and refills of existing prescriptions
  3. Opportunity to save money with therapeutic alternatives

Physician Dr. Natalie revealed improved ability patient information, reduced administrative work, & more time with her patient:

  1. Patient medical info, medication history, and adherence gaps available electronically in advance of a patient encounter
  2. Electronically accessible benefit plan information facilitates identification and prescription of more cost-effective medication and treatment alternatives
  3. Submitting prior authorizations electronically without faxing
  4. Submitting prescriptions for specialty medications electronically to the pharmacy

Pharmacist Keisha Wright noted reduced patient data collection and streamlined medication processing:

  1. Complete patient and prior authorization info received electronically
  2. More timely processing – especially with specialty medications – allows for more time counseling patients

The Care We All Strive For – The Vast Reality of Improved Healthcare System Interoperability

At the conclusion of Act II, Surescripts Melissa Warnke shared an overview of the vast impact that improved interoperability can have on increasing the transactions that help address the Quadruple Aim. Melissa also shared some additional statistics showing the growing pervasiveness of interoperability. Click images to expand.

Surescripts. The Care We All Strive For – Navigating an Interoperable Healthcare System. HCEG Webinar Series October 2020. Specialty Pharmacy. Interoperability. Prior Authorizations. Quadruple Aim Triple Aim. Surescripts. The Care We All Strive For – Navigating an Interoperable Healthcare System. HCEG Webinar Series October 2020. Specialty Pharmacy. Interoperability is a Reality. Prior Authorizations. Quadruple Aim Triple Aim.

A Faxless Future: Dare We Dream?

After Melissa recapped Act II, a short, light-hearted video was played showing how fax machines might be re-purposed for a useful life after they retire from their long-running service to the healthcare industry. The following are a few examples of how fax machines might serve a new role.  See the short video “A Faxless Future: Dare We Dream.”

Surescripts. The Faxless Future. Artifax. The Care We All Strive For – Navigating an Interoperable Healthcare System. Specialty Pharmacy. Interoperability is a Reality. Surescripts. The Faxless Future. Artifax. The Care We All Strive For – Navigating an Interoperable Healthcare System. Specialty Pharmacy. Interoperability is a Reality. Surescripts. The Faxless Future. Artifax. The Care We All Strive For – Navigating an Interoperable Healthcare System. Specialty Pharmacy. Interoperability is a Reality.

Questions from the Audience on Healthcare System Interoperability

After the video was played, emcee Melissa Warnke fielded some questions submitted by attendees. Here are a few of the questions and their responses:

  1. What have you seen as the best practices for driving the kind of behavior change from providers, pharmacists, and others that obtaining maximum value from increased interoperability takes?

Answer: 32:03 to 34:50

  1. Without a sales pitch, what are the new tools that the provider and pharmacist actors are alluding to that to speed the implementation and adoption of interoperability?

Answer: 37:08 to 40:07

  1. How has COVID-19 impacted the transaction counts (real-time benefit inquiries, medication history transmittals, clinical direct messages) you presented after Act II?

Answer: 41:45 to 45:16

  1. Can pharmacists see the same real-time prescription benefit info as providers?

Answer: 45:39 to 47:33

Connect & Interact w/ Our Sponsor Surescripts & HealthCare Executive Group

Our Webinar Series events are one example of how the HealthCare Executive Group helps to share information and promote collaboration between healthcare leaders, change-makers, and other stakeholders serving the healthcare industry.

For more information on the topics presented by Surescripts in our October Webinar Series:

Learn more about the HealthCare Executive Group and to stay abreast of challenges, issues, and opportunities facing the healthcare industry in 2021 and beyond:

Physician Perspectives on COVID-19 Impact on the Fall Season. HCEG HealthCare Executive Group. Lessons Learned. Experiences from Southern Hemisphere – Seasonal Viruses at All-Time Lows. Value of Encouraging Use of Masks. ‘Long Haulers’ – The Unknown, Long-Term Impact of COVID-19. Financial Impact on Providers, Employer Groups, & Payers. New Reimbursement Models

Physician Perspectives on COVID-19 Impact on the Fall Season (Part 3)

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This is the final post of a 3-part series sharing physician perspectives on COVID-19 impact on the fall season. The information, insight, and ideas presented in this series originated from an informal discussion Ferris Taylor of the HealthCare Executive Group had with three physician executives:

HCEG board member Dr. David Diloreto, MD, a board-certified ophthalmologist, ophthalmic plastic surgeon, a principal at Vizient/Sg2 and prior senior vice-president at GE Healthcare Camden was joined by:

Dr. Johanna Vidal-Phelan, MD, Senior Medical Director in Pediatrics at the University of Pittsburgh Medical Center Health Plan and a practicing pediatrician at Hamilton Health Center, an FQHC in Harrisburg, PA and

Dr. Jason Woo, MD a practicing board-certified obstetrician/gynecologist, a veteran with 31 years in the Commissioned Corps of the U.S. Public Health Service and a consultant at the Arbinger Institute.

COVID-19 Impact to Healthcare: Topics Discussed in This Series

The trio of physician executives discussed the following topics in the first and second posts of the series:

Part 1 Topics

Part 2 Topics

– Impact Factors Affecting Utilization of Services
– Balancing Treatment to Avoid Ongoing Destruction of Demand for Non-COVID Services
– Returning to School & Addressing Disadvantaged Populations
– A Pediatric Physician on Sending Kids – Including Her Own – Back to School
– Impacts on Minorities & Underserved Populations
– Uncertainty in Testing and Understanding Prevalence
– How Long Will We Be Dealing with COVID-19?
– COVID-10 Vaccines & Importance of Fall Flu Shots
– Avoiding Other Illnesses or a Different Pandemic – Maintain Immunizations
– Vaccinations for Underserved Populations – Messaging is Key
– The Change to Telehealth: New Opportunities for Providers to Connect with Patients
– Rethinking the Healthcare Supply-Chain – PPE as a Matter of Trust

Listen to the entire recording here

Be sure to subscribe to our newsletter for more information of potential value to healthcare leaders and change-makers.

Live, Interactive Chat and Q&A – October 13th, 2020

On Tuesday, October 13, 2020, at 11:00 am PT/2:00 pm ET, Doctors DiLoreto, Vidal-Phelan, and Woo will present additional details and current insight on what can be expected for the coming fall season under COVID-19.

Join us for a live, interactive discussion and Q&A. Questions and requests for additional information shared by registrants prior to and/or during the live chat will be fielded by the panelists. Reserve your seat and submit your questions and comments today!

Lessons Learned and Lessons to Be Learned

Lessons learned during the coronavirus pandemic can help to drive innovation that transforms preparedness, care delivery, quality, safety, efficiency, and patient experience over the coming months and years. The discussion continued with the physicians sharing some lessons learned and lessons to be learned.

Experiences from Southern Hemisphere – Seasonal Viruses at All-Time Lows

Dr. David:

COVID-19 Experiences from Southern Hemisphere – Seasonal Viruses at All-Time Lows“We’re also working with folks in the southern hemisphere right now. It’s very interesting they’re in the depths of winter in the southern hemisphere. The pandemic is certainly spreading and hitting places very hard; whether it’s Melbourne Australia, Santiago Chile, Johannesburg South Africa.

What’s interesting is that the incidence of other seasonal viruses is at an all-time low – historic lows. And it’s across a long spectrum so influenza, RSV, pneumococcus remains extraordinarily low suggesting that, obviously, measures such as social distancing, mask-wearing, hand washing are going to be more important than ever. And obviously vaccinating against flu and pneumococcus for older patients is going to be important.

Hopefully in North America, as we enter into winter, we’ll get similar effects that will suppress – like we did in the spring – some of the seasonal virus activity.”

Value of Encouraging Use of Masks

Dr. Johanna:

“And I think one important point about this is mask-wearing. And so, for example, places like Australia you just mentioned. In Chile, people are being compliant with using masks. So this is a message that we really need to also share with our community and the population that wearing your mask is important not only for COVID-19 but it does prevent the exposure to other viruses and illnesses.

And that I tell my pediatric patients wearing your masses showing your love is caring and so they do it, they do it very well.”

RELATED: Surviving Coronavirus Pandemic & Thriving on the Other Side: Rapid Innovation & Telehealth

‘Long Haulers’ – The Unknown, Long-Term Impact of COVID-19

Dr. David Diloreto:

“I’d like to get your insights into are some of the issues we’re seeing with long haulers – folks who actually are continuing to demonstrate symptoms, troubling symptoms, for many weeks or months and potentially for some of them it could be long term.‘Long Haulers’ – The Unknown, Long-Term Impact of COVID-19

We’re seeing widespread neurologic complications, cardiovascular complications – obviously there are aspects of this disease we don’t quite fully understand.”

Dr. David prompted fellow panelists to share a little bit about their concerns in younger individuals who may have had minimal symptomatology but have persistent symptoms going forward that don’t seem to be resolving.

Dr. Jason responded:

“One of the challenges is that when folks say “oh, this is a hoax or this is not real,” I think part of it is just recognizing what they’re seeing right and then what’s relevant to them. The challenge is when we have all this uncertainty when we have so many different messages, and there are all these aspects about the COVID-19 virus and its pathology in the body.

We are only beginning to get a sense that folks aren’t dying from pneumonia, they’re dying from micro infarctions throughout their lungs where it’s overwhelming the immune response. That’s killing them not the typical virus reproduction. And then the neurologic symptoms and the muscle symptoms where the virus is infecting whole body systems.

COVID-19 and Its Uncertain Pathology

We just have no knowledge of that. So, when folks see things it’s recognizing there’s still a lot of uncertainty about this. What’s right for you is what is going to be right for you. But do you want to do that in a vacuum or do you want to do that with better information? So how do we help better inform you about what those risks are because we know that the data is constantly evolving?

And how do we help you be alive for that so that we’re working together to figure it out because one person going back to work by themselves is not going to fix the economy? It’s how do we do this together and how do we address all the different concerns that people are going to be having – be it their economic ones or if they’re elder parents there are long-term consequences for the individual. How do we be alive to the things that are the highest priority for them in terms of what’s the information that they need to make a better decision?”

RELATED: COVID-19 Resources for Health Plans, Health Systems, & Medical Service Providers

Financial Impact on Providers, Employer Groups, & Payers

The coronavirus pandemic has had a significant negative impact to the financial status of hospitals, physicians in private practice, and physicians employed by health systems. With patient volumes cut 60% or worse and with so many healthcare providers paid based on volume, many physicians have taken unprecedented hits to their revenue, and many organizations have furloughed or laid-off employees.

Dr. David shared how the coronavirus pandemic has likely forced all stakeholders – providers, employer groups, and payers including federal and state healthcare programs like Medicaid – into pursuing new value-based reimbursement models.

Employers Forced into New Reimbursement Models

Financial Impact on Providers, Employer Groups, & Payers Employers Forced into New Reimbursement Models“And employers who are really not that interested in thinking about value-based care – they just wanted to make sure their employees were happy with health insurance – now are looking at all kinds of – and these are small and medium-sized employers – anything they can do to eliminate costs now.

They’re much more interested in episode of care bundles and basically looking at structural reimbursement models that deliver their risk going forward. So our projections are that we (as individuals) and obviously state governments have been shielded to some degree from the economic impact by federal subsidies.

But if the economy is shut down in certain states and the tax base erodes, they’re going to have to look at their Medicaid programs in about 18 months totally differently. So there’s going to be much more cost reduction in that space.”

RELATED: Modifying the Focus of Medicaid Value-Based Payment in the Context of COVID-19

Delayed Demand for Non-COVID Services

“So the folks that are also interesting to me are payers. If you look at what’s happened in 2020, many of them obviously – with the demand destruction – now are actually looking at significant surpluses on their financials for 2020. And they’re trying to really look at certain reserving capabilities including a reserve I never knew that existed called the premium discount reserve.

But it’s a way, in this instance, of being able to move these positive income statement effects off your books and onto your balance sheet and release it in future periods. But anyway, that’s probably not for this group.”

COVID-19 Forcing Physicians to Reevaluate Reimbursement

Dr. Jason Woo asked Dr. David Diloreto how the shift in the reimbursement payment system is going to affect our ability to be able to be more comprehensive in our coverage of the population?

Dr. David Diloreto responded:

“This is one of the most interesting aspects that for almost all of my clinical career, which is 30 years now, physicians generally viewed the least risky way to get paid was on a service basis. What’s really interesting is right now in large physician groups and in single-specialty groups and health system employee groups many specialists are thinking differently. They’ve been in situations now that seen demand from elective procedures (drop significantly) and they’re worried about the future.

If you can imagine being a bariatric surgeon with a large mortgage and trying to save money for college education, the world change doesn’t look like the world is going to come back that way. So they’re having grown-up discussions about changing the reimbursement models more to deliver that risk by going to employment; to going to safer ways of getting paid including fixed fees.”

Supporting & Caring for Front-Line Providers

In addition to financial impacts which were discussed later in the session, the physician panelists shared how the coronavirus pandemic has placed a huge physical and emotional burden on many frontline providers. Ferris prompted the physician panelists to share their thoughts on this quadrant of the Quadruple Aim:

What would be effective measures to decrease the burnout rate of physicians and everyone else fighting the coronavirus pandemic?

Dr. Jason:HCEG COVID-19 Supporting Caring for Front-Line Providers

“I think that in a lot of ways it’s going to be very healthy for health care providers to be able to connect to their patient’s. I think on the other side, those frontline providers that are still stuck with trying to take care of the folks that are coming through the ER or into the ICU is where there’s still not a lot of good information. And the struggle that they’re going to go through of trying to do the best that they can with all the uncertainty in the limitations that we have. I think for those folks we have to be really mindful that there’s a great burden that our traditional thought about what the role of the provider is. We have to help see beyond right and get into that.

What’s the best that you can do? What is not the best outcome that you’re going to be able to get, wish for every patient, but what’s the best that you can do within your circumstances. And being more for more mindful of the limitations that your role is going to be, that it is going to have. I think it’s hard because be it the lack of the supply chain, the lack of PPE, the challenges of what tests are available, or not available. Until that gets standardized, until there’s been able to get some trust in the data that they have and the testing methods that they, and the treatments available it’s just going to be hard to be a frontline provider.”

Dr. David added

“I think what we do need to get is the impact on providers, front line providers, who have been through the ringer. If you just think about what they’ve had to do throughout the spring into the summer – even in outpatient practices. Now all the PPE requirements on and off; all the changes in your practice; this is really taking a toll on providers right now.”

Get Your COVID-19 Questions Answered on October 13th

The discussion ended with a general agreement that the discussion could go on for hours. Accordingly, the three physicians agreed to make themselves available for a live, interactive follow-on chat with a Q & A opportunity on October 13, 2020 at 11:00 am PT / 2:00 pm ET.

Reserve your seat and submit your questions and comments today!

Be sure to take advantage of this unique opportunity to learn more about what’s presented in this post – and please share it with your associates. And if you are not a subscriber to our newsletter, consider joining 5000+ other healthcare leaders, change-makers, and industry participants and subscribe today!

Webinar: The Care We All Strive For: The Impact of Interoperability

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Has 2020 given you webinar fatigue? The seemingly endless run of virtual events and webinars would certainly justify it. And while moving everything to the digital world has its challenges, society is embracing technology and making the most of the situation. Healthcare is no exception. With the expanded use of technology, healthcare has been reminded of the importance of being able to communicate with each other quickly, efficiently, and easily.

In our October Webinar Series event, The Care We All Strive For: The Impact of Interoperability, we will help fight that webinar fatigue by taking a break from the traditional webinar structure and take time to revisit our shared purpose – to make healthcare run better for everyone.

Please join us on Wednesday, October 28th at 11:00 am PT / 2:00 pm ET to hear the story of what it feels like to be a patient, provider, pharmacist, and payer in a world where interoperability is a reality.

Our sponsor Surescripts will be joined by four healthcare stakeholders who will share their take on the difference interoperability makes on the experience of a patient, provider, pharmacist, and payer. The panelists will examine how sharing information across stakeholders can reduce administrative burden and improve member experience.*:

Carlos Garcia Dr. Natalie Pinter Keisha Wright, RPh Oscar Gustafsson
Patient with Rheumatoid Arthritis & Hypertension Provider Pharmacist, Specialty Pharmacy Vice President of Pharmacy, Payer

Over the next four weeks leading up to the live webinar on October 28th, we’ll be sharing more information on how patients, providers, pharmacists, and payers all benefit from enhanced interoperability of data and systems. In the meantime, learn more about how Surescripts addresses healthcare interoperability challenges here.

* These are imaginary personas whose role in this webinar will be performed by employees of our sponsor Surescripts.

Physician Perspectives on COVID-19 Impact to Fall Season (Part 2)

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Late last month, the HealthCare Executive Group hosted an informal discussion with three physician executives on their observations, experiences, and insight about how COVID-19 has impacted healthcare and healthcare stakeholders. The theme of the discussion was: “What’s changed, what’s remained the same, and what can we expect in the coming fall season?”

HCEG board member Dr. David Diloreto, MD, a board-certified ophthalmologist, ophthalmic plastic surgeon, a principal at Vizient/Sg2 and prior senior vice-president at GE Healthcare Camden was joined by:

Dr. Johanna Vidal-Phelan, MD, Senior Medical Director in Pediatrics at the University of Pittsburgh Medical Center Health Plan and a practicing pediatrician at Hamilton Health Center, an FQHC in Harrisburg, PA and Dr. Jason Woo, MD a practicing board-certified obstetrician/gynecologist, a veteran with 31 years in the Commissioned Corps of the U.S. Public Health Service and a consultant at the Arbinger Institute.

HCEG’s Executive Director Ferris Taylor helped to facilitate the discussion and provided an HCEG perspective.

This is the second post of a three-part series sharing highlights of that conversation. See the first part here and consider subscribing to our newsletter to receive the final post and other information of value to healthcare leaders and change-makers.

Topics Discussed in Part 1

The trio of physician executives discussed the following topics in the first post of this series:

  • Impact Factors Affecting Utilization of Services
  • Balancing Treatment to Avoid Ongoing Destruction of Demand for Non-COVID Services
  • Returning to School & Addressing Disadvantaged Populations
  • A Pediatric Physician on Sending Kids – Including Her Own – Back to School
  • Impacts on Minorities & Underserved Populations
  • Uncertainty in Testing and Understanding Prevalence
  • How Long Will We Be Dealing with COVID-19?

Listen to the entire recording here

Live, Interactive Follow-On Chat and Q&A – October 13th

For more detailed information on the topics presented in this series of posts and for a chance to interact with and ask questions of these physician leaders, join us on October 13, 2020 at 11:00am PT/2:00 pm ET for a live, interactive chat. The physician panelists will provide additional insight on what’s changed, what’s remained, and what can be expected for the coming fall and winter season under COVID-19.

Questions and requests for additional information shared by registrants prior to and/or during the live chat will be fielded by the panelists. Reserve your seat and submit your questions and comments today!Be sure to take advantage of this unique opportunity to learn more about what’s presented in this post – and please share it with your associates.

COVID-19 Vaccines & Fall Flu Shots

A significant part of the discussion continued on the development of a COVID vaccine and the importance of getting a seasonal flu shot to avoid undue burden to services and potential mis-diagnoses of the seasonal flu as COVID-19. Dr. Johanna shared:

Importance of Flu Shots – Minimize Avoidable Impacts

“We saw a decline of seasonal viruses during the spring and early beginning of the summer. I think right now you have to think about the monumental impact of children returning to school even if it’s for two days. Our children (Dr. Johanna’s children) have been with us since March 13th at 4 p.m. when the school released them and said ‘They’re not coming back. We don’t know when.’

 And so our children haven’t really been exposed to a lot of other people, so we do know that children are going to be exposed not only to COVID-19 but all the other normal viruses that we see; or bacteria like strep throat. I think one of the important messages that I’ve been sharing with my family since day one is the importance of the flu vaccine. And there is a lot of misinformation and misunderstanding about the flu vaccine. People still believe that you get sick from the flu vaccine. That you are going to develop the flu from the flu vaccine. A lot of families, almost not even 50 % of the population in the United States, do not get the flu vaccine every year. “

Is Herd Immunity a Potential Solution?

Dr. Johanna continued:Avoiding Other Illnesses or a Different Pandemic - Maintain Immunizations Vaccinations for Underserved Populations – Messaging is Key

“And so if we want to have a good herd immunity, it is important and I explained to the parents, that providing the flu vaccine to your child and your family is a way to combat a coronavirus. And they look at me like ‘Why? It’s a different virus.’

 And I said: ‘because when your child gets sick with the flu, because you didn’t want to get the flu shot, we are going to have a very hard time differentiating between COVID-19 or the flu. So we have to test your child for both viruses and then there’s going to create a level of anxiety regarding school, quarantine and care that your child is going to need because we don’t know if it’s the flu.’”

Avoiding Other Illnesses or a Different Pandemic – Maintain Immunizations

“Now you can get the flu after getting the flu vaccine but you’re going to be protected from some of the major complications that we see when you have a natural illness and the duration of the illness is much shorter instead of being two to three weeks with the natural illness, it may be two to three days.

So I explained to the parents the importance of getting all the children’s immunizations on time. And believe it or not, there’s a critical important piece of information I need families to understand: Even though throughout most of COVID-19 pediatricians are open and family doctors are seeing children too, the importance of the well-child visit to be up-to-date and your teenagers, and the shots is critical – because we don’t want to change this pandemic for a measles epidemic or whooping cough so we have vaccines to prevent illnesses so let’s use them, let’s get them.”Avoiding Other Illnesses or a Different Pandemic - Maintain Immunizations Vaccinations for Underserved Populations – Messaging is Key

Vaccinations for Underserved Populations – Messaging is Key

Dr. Jason shared the importance of reaching out to underserved populations is a trustful manner:

“I think there’s a communication point that has to be addressed- particularly for the underprivileged populations – is that getting vaccinations has to come from people who sound and look like them. It cannot come from the systems. And that’s where engaging your community outreach folks is going to be so critical to be able to get those. And it may not be having them coming to the hospital. It may be having the local pharmacy or having folks who are able to engage them there.

Because just as you point out Johanna, there’s so much mistrust and particularly folks are just when you can put the message through a medium that they’re more comfortable with that’s just going to be that’s so critical to address some of the social determinants that inhibit a lot of our understanding.”

Dr. David added:

“And that’s encouraging because it’s going to be needed coming forward. CVS for instance has 1800 testing sites right now around the United States that they’re expanding and they’re in negotiations to become vaccination centers. So just to your point that the neighborhood drug store being actually now a health hub where you can get vaccinated.”

RELATED: Surviving Coronavirus Pandemic & Thriving on the Other Side: Rapid Innovation & Telehealth

The Change to Telehealth

One of the clear changes instigated by the coronavirus pandemic is the rapid adoption of telehealth. Stay-at-home and physical-distancing directives forced providers to rapidly adopt telehealth services or expand existing telehealth capabilities. Long hampered by reimbursement and physician adoption challenges, telehealth use exploded at the end of the 1st quarter of 2022 and has now become table-stakes.

Ferris prompted the panelists to share their take on telehealth and Dr. Johanna began:

Physicians Warming to Telehealth

“So I definitely also want to emphasize the importance of innovation and technology. I would talk to peers six months ago if somebody was telling me that I was going to do a tele-visit. I would have left. I was like: ‘I cannot see a pediatric patient by computer or phone.’

And now is I love it. And definitely it has pushed innovation into healthcare. It was slowly happening but to go from March to April and to see the dramatic jump into utilization of telemedicine is really important because it’s being used as a tool to connect with families; to engage patients; to continue allowing providers and physicians to continue providing the services that they (patients) need, and that is part of value-based care.”

Dr. Johanna urged physicians to answer the question:

Physicians Warming to Telehealth Telehealth - New Opportunities for Providers to Connect with Patients

“How can you think outside of the box in order to reach the population that is yours in order to prove it provides the best outcome for your patients?

And offered a reminder:

“And so the traditional model is one-to-one, in the office, with the physician. And we’re moving away from that model to having health care done in the home environment, remote monitoring, telemedicine, community health workers, other alternative sites of care – in order to complement what we call traditional medicine.”

Telehealth – New Opportunities for Providers to Connect with Patients

Dr. Jason on opportunities for telehealth: elective vs. non-elective procedures

“I think there are two different populations of providers that we need to think about:

1. Elective Procedures – Non-Emergent

Avoiding Other Illnesses or a Different Pandemic - Maintain Immunizations Vaccinations for Underserved Populations – Messaging is Key

“One is the folks who perform more of the elective stuff who are not the frontline workers now. In the sense that David was talking about, the folks who traditionally may have been doing elective surgeries or other sub-specialty care where there is an opportunity to transform the way they’re delivering care. In a way, I think that’s going to be more effective because of the opportunity to accept a lot of the modalities that telehealth has pushed forward.

I’ve been trying to do telehealth 20 years ago. I was trying to push telehealth in. I saw the radiologists, the mental health, and the psychiatrist, they loved it because there’s just so much more opportunity available to them when they’re not one-on-one in a fixed location anymore. And for those folks, I think there’s an opportunity to get back to actually better outcomes; to connect with your patients in a way that you hadn’t before.

It’s kind of like Zoom. We do a lot of training and I love the chat feature because there’s this ability to interact with folks that I hadn’t thought of before. And when you’re open to that I think that, in a lot of ways, it’s going to be very healthy for healthcare providers to be able to connect to the patients.”

RELATED: Should You Go to the Doctor’s Office During Covid-19?

2. Non-Elective Procedures – Emergent

“I think on the other side though is those frontline providers that are still stuck with trying to take care of the folks that are coming through the ER or into their ICU’S; where there’s still not a lot of good information. And the struggle that they’re going to go through of trying to do the best that they can with all the uncertainty and the limitations that we have.

I think for those folks we have to be really mindful that there’s a great burden that our traditional thought about what the role of the provider is that we as a physician, I think, we have to help (our patients) see beyond and get into ‘What’s the best that you can do?’”

Healthcare Supply-Chain – Rethinking COVID-19 Impacts

The ready availability of PPE, medical equipment like ventilators, and certain pharmaceuticals was clearly called into question by the coronavirus pandemic. The lack of a $3.00 mask hampered providers’ ability to serve patients. And $30,000 ventilators are not just easily stocked without serious consideration.

Availability of Personal Protective Equipment – A Matter of Trust

Dr. Johanna shared her personal perspective from previous pandemics:

“I remember H1N1 and it was not like this. There is an element of trust as a provider, and also as a person working in the United States, that I should have not had to worry about where is my PPE coming from. It never crossed my mind in 2009 that I would not have enough PPE to protect myself against H1N1.

 And if you recall, pregnant women were high risk for H1N1. And I was pregnant, caring for pediatric patients, with my second child and I never had to think about it twice. And so now, it’s the anxiety that providers have to know that they’re having the correct equipment in order to provide the care.

 And also knowing so many of our peers are impacted by this disease and have died. It’s something that you need to pause and think about: What are we doing?”

Physician’s New Understanding & Appreciation for Supply Chains

Dr. David on physicians and their supply-chain relationship:

“The other interesting difference is that most physicians in December of last year (2019) probably couldn’t really describe a supply chain and certainly couldn’t talk to you about the strategic value of a supply chain.

Well, after they went through the PPE shortages and pharmacy shortages, they’re now really interested in working with their healthcare stakeholders and hospital stakeholders on how to optimize supply chain activities.

And so there’s a lot of work around nationalizing and onshoring. One of the shortages in the supply chain is the fact that countries nationalize these products, they’re not coming to North America. We’re having to work through that and that’s a big change. So with respect to payment models, we’re already seeing employers – remember there’s going to be some significant economic issues for companies/employers who are not interested in or thinking about value-based care.”

RELATED: With Excess National Supply, Exchanges Will Allow U.S. Hospitals to Continue Meeting Ventilator Demand

Part 3 Coming Soon – More COVID-19 Insight from Physician Executives

In the final post of this three-part series, highlights and details on the following topics from the informal discussion with Dr. Diloreto, Dr. Johanna Vidal-Phelan, and Dr. Jason Woo will be shared:

  • Lessons Learned and Lessons to Be Learned
  • Experiences from Southern Hemisphere – Seasonal Viruses at All-Time Lows
  • Value of Encouraging Use of Masks
  • ‘Long Haulers’ – The Unknown, Long-Term Impact of COVID-19
  • Financial Impact on Providers, Employer Groups, & Payers
  • Employers Forced into New Reimbursement Models
  • Delayed Demand for Non-COVID Services

Live, Interactive Follow-On Chat and Q & A – October 13th

For more detailed information on the topics raised in this series of posts and for a chance to interact with and ask questions of these physician executives, join us on October 13, 2020, at 11:00 am PT/2:00 pm ET for a live, interactive follow-on chat and Q & A opportunity.

The physician panelists will provide additional insight into what’s changed, what’s remained the same, and what may be expected this fall and going into 2021. Questions and requests for additional information shared by registrants prior to and/or during the live chat will be fielded by the panelists.

Reserve your seat and submit your questions and comments today!Be sure to take advantage of this unique opportunity to learn more about what’s presented in this post – and please share it with your associates. And if you are not a subscriber to our newsletter, consider joining 5000+ other healthcare leaders, change-makers, and industry participants and subscribe today!

HCEG HealthCare Executive Group 2021 Top 10Step-1-Selection-Feature-1.jpg

Healthcare Challenges, Issues, & Opportunities – The 2021 HCEG Top 10

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The HCEG Top 10 list of challenges, issues, and opportunities facing healthcare leaders have been a focus of the HealthCare Executive Group for over a decade. Planned for development by participants at our 2020 Annual Forum, the 2021 HCEG Top 10 list of challenges, issues, and opportunities facing healthcare executives guides our content and programming throughout the coming year. It also serves as the basis for the Industry Pulse research that HCEG and our sponsor partner Change Healthcare have provided over the last decade.

Given the sea change forced by the coronavirus pandemic, the upcoming presidential elections, not hosting our in-person Annual Forum this year, and feedback received about providing more detailed information – a new approach will be used to develop the HCEG Top 10 list for 2021. Four main objectives guide the development of the 2021 HCEG Top 10 list:

Address Impacts from Coronavirus Pandemic & Upcoming Elections

The COVID-19 crisis has clearly altered healthcare priorities and the outcome of the November elections will most certainly do the same. It’s important for the 2021 HCEG Top 10 list to reflect these changed priorities and likely impact from election results.

Deeper Dive into Topics of Interest to Healthcare Executives

In an effort to provide more detailed input and insight into the challenges, issues, and opportunities facing all healthcare stakeholders, candidates for the 2021 HCEG Top 10 list include over 40 ‘sub-topics’ grouped into thirteen ‘themes.” These additional details are expected to provide more value based on the type of healthcare stakeholder: health plan/payer, provider, and risk-bearing provider.

All Virtual Identification, Selection & Ranking Process

Given the absence of our in-person 2020 Annual Forum that was scheduled for this month – and keeping with HCEG’s goal of providing more granular information – the process for identifying, selecting, and ranking core items on the HCEG Top 10 will take place virtually this year.

Open to All Healthcare Industry Participants

Historically, HCEG’s Top 10 process has been limited to HCEG members and attendees of our Annual Forum. Since HCEG is not hosting a physical annual forum this year, and in an effort to collect a wider perspective from a greater number of healthcare industry participants, we’re opening the 2021 HCEG Top 10 process to everyone who cares to participate.

Overview of 2021 HCEG Top 10 Development Process

The following is the high-level process for developing the new HCEG Top 10 list:

  1. Identify “Initial List of 2021 HCEG Top 10 Themes & Sub-Topics” (COMPLETED)
  2. Solicit Feedback on Initial List from Industry at Large (9/16/20 through 11/4/20)
  3. Collect rankings of the Top 10 Sub-Topics identified in Step #2 (11/15/20 through 11/30/20)
  4. Announce 2021 HCEG Top 10 List (12/14/20)

Help Select Candidates for the 2021 HCEG Top 10

The following are the major thematic categories proposed for the 2021 HCEG Top 10. A list of the sub-topics associated with each theme can be found here.
Take Step 1 of the 2-Step 2021 HCEG Top 10 development process today.  This survey should take less than 5 minutes to complete.  If you are unable to complete the entire survey, we urge you to complete as many of the sections as possible that you consider important.

Thank you in advance for sharing your insight. Please contact us at [email protected] if you have any questions or comments. And join our newsletter to receive information, ideas, and insight for healthcare executives and change-makers: bit.ly/hcegnewsltr

Recapping: Towards Next-Generation Care: The Digital Musculoskeletal (MSK) Clinic

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Currently, people with back and joint pain experience a fragmented approach to care. Whether it’s an acute injury, chronic pain, or surgery, members must contend with multiple providers and handoffs between those involved with providing a ‘whole person approach’ to care. From the individuals’ perspective, it feels like no one is looking at their health holistically or acting as their healthcare champion. And with many people increasingly working from home due to the coronavirus pandemic, challenges related to musculoskeletal conditions – increasing back pain and joint pain – are likely to increase.

Our September Webinar Series event was presented by Hinge Health’s CEO Dan Perez and addressed the following:

  • Key MSK Challenges & Trends in 2020 and Beyond
  • Fractured State of MSK Care
  • Towards Next-Generation Care
  • World’s Largest Digital MSK Cohort Clinical Study

This post is a recap of the webinar. Contact Hinge Health for access to the webinar recording

For more information on how a digital musculoskeletal clinic – covering the full continuum of care from prevention to post-surgery – can provide a one-stop-shop for health plans, employer groups, and provider organizations, reach out to Hinge Health.

Highlights from Towards Next-Generation Care: The Digital Musculoskeletal (MSK) Clinic

HCEG’s Executive Director Ferris Taylor kicked off the webinar noting how Hinge Health addresses 4 of the 2020 HCEG Top 10 list of challenges, issues, and opportunities facing healthcare leaders.HInge Health MSK Issues Musculoskeletal conditions

Dan Perez provided an overview of how musculoskeletal conditions continue to be the top health care cost driver and how MSK care will have the highest growth rate of any virtual care services over the next few years – and likely beyond. Dan went on to provide an overview of The Hinge Health Digital MSK Clinic, details on the four distinct Digital Care Pathways across the care continuum, and shared information on evidence-based care guidelines from the CDC and American College of Physicians.

RELATED: Spotlight on Musculoskeletal (MSK) Programs – Hinge Health

Chronic MSK Pain is Both Physical & Mental

Dan shared information, statistics, and Hinge Health insight on the Gold Standard for Addressing Chronic MSK Pain: a biopsychosocial approach that addresses three key components:

Biological Influence

How exercise therapy can help reduce chronic pain by up to 60%

Psychological Influence

How a belief in oneself often leads to lower pain levels – even 1 to 2 years after the initial intervention

Social Influence

How education and 3rd-party support can empower people to overcome chronic pain

Clinical Care Model Surrounding an Individual

The presentation continued with Dan sharing an overview of the clinical care model upon which Hinge Health’s care model is based. He shared a 1-minute video with webinar participants offering a real-world application of the Hinge Health solution.

The World’s Largest Digital MSK Cohort Study

Details on clinical outcomes from a study of 10,264 participants – validated by researchers at Stanford, Vanderbilt, and top consultants addressing key business questions – were shared:

  • 4 out of 5 participants had meaningful improvement in pain reduction
  • More exercise therapy and coaching resulted in more pain reduction
  • 58% Reduction in depression and anxiety scores
  • More than 2 out of 3 surgeries avoided in Year-1

The presentation concluded with key takeaways on how health plans, employer groups, provider organizations, and other healthcare stakeholders can help their members and patients.

Learn How Hinge Health Can Help Address Costly MSK Issues

To access the webinar recording and for more information on how a digital musculoskeletal clinic – covering the full continuum of care from prevention to post-surgery – can provide a one-stop-shop for members and health plans reach out to Hinge Health.

Our Webinar Series events are one example of how the HealthCare Executive Group helps to share information and promote collaboration between healthcare leaders, change-makers, and stakeholders. Consider joining our newsletter to stay abreast of challenges, issues, and opportunities of importance.