Connect with HealthCare Executive Group at the AHIP Institute & Expo

By | AHIP, Annual Forum, Conferences, Executive Leadership Roundtable, HCEG Top 10, HIMSS18, HLTH2018, Sponsor, Webinar Series | No Comments

health care conference, Conference, Health Care, Hospital, Health System, Health Insurance, Health Plan, Benefits, Affordable Care Act, Policy, CMS, Health Care Reform, compliance, pharmaceutical, health IT, network, contracting,health plans,health systems,leadership, medicaid & policy, pophealth analytics, behavioral health,network contracting, employer direct contracting, self-insured, Population Health Analytics, PopHealth, Social Determinants of Health, healthcare, healthcare conference,HealthCare Executive Group convenes and supports healthcare executives and thought leaders by providing a platform supporting the creation, curation and sharing of information and insight on current opportunities, challenges and issues in the healthcare industry.

It’s our 30th Anniversary and the HealthCare Executive Group has been in overdrive during the first half of 2018. We held an Executive Leadership Roundtable at the recent HLTH Future of Healthcare Forum, we worked with our sponsor partners to share insight via our ongoing HCEG Webinar Series, we’ve attended a handful of major healthcare industry conferences in support of our members and sponsor partners, and we continue to leverage our social channels to help address the issues, challenges and opportunities facing today’s healthcare executive leader.

We’ve also been preparing for our 2018 Annual Forum taking place September 12th through the 14th in Minneapolis, MN – recruiting industry thought leaders and fleshing out an agenda that promises to share valuable information, insight and networking opportunities.  Finally, we’re wrapping up the first half of our 30th Anniversary year by attending the 2018 AHIP Institute & Expo where we’ll support our members and sponsor partners – and gather additional insight to make our 2018 Annual Forum all the more valuable.

Major Healthcare Conferences of 2018

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HCEG members and sponsor partners participated in many of the major healthcare conferences taking place in the first part of the year including the:

2018 HIMSS Conference & Exhibition in March

15th Annual World Healthcare Conference in April

Inaugural HLTH Future of Healthcare Forum in May

Check out a recap of our roundtable event held as part of the Association Day at the inaugural HLTH Future of Healthcare Forum here.

WEDI Spring Conference in May

WEDI conference organizers have made complete conference information including sessions handouts available here.

2018 AHIP Institute & Expo next week June 20 – 22

HCEG members and sponsor partners will be participating in more conferences as the year continues, including, our course, hosting the 2018 HCEG Annual Forum celebrating our 30th Year convening and supporting healthcare executives and thought leaders.

Read on for more about HCEG Members and Sponsor Partners at the AHIP Institute.

HCEG’s Executive Leadership Roundtable

In May, we partnered with the International Association of Innovation Professionals, the Center for Healthcare Innovation, and the Workgroup for Electronic Data Interchange and held a unique ELR titled ‘Leadership, Trust & Skills in Overcoming Obstacles to Radical Innovation in Healthcare.’

Check out a recap of the roundtable event held in conjunction with the inaugural HLTH Future of Healthcare Forum here.

The Next Executive Leadership Roundtable – Nashville, TN

We’re planning another Executive Leadership Roundtable to coincide with the AHIP Consumer Experience & Digital Health Forum on December 11 – 13, 2018 in Nashville, TN. Members and sponsors interested in helping shape the theme of this roundtable are urged to contact us at info@hceg.org.

HCEG Webinars Offer an Opportunity to Learn from Sponsor Partners

In the first few months of 2018, HCEG and our sponsor partners produced webinars addressing a variety of topics such as Value-based Payment, Post-Acute Care in Medicare Advantage and a deeper dive into the 2018 HCEG Top 10. For more information on these webinars including a recap and recording, check out the following:

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

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

Recapping Value-Based Payment – Getting from Here to There…

The Financial Impact of Post-Acute Care in Medicare Advantage

The HealthCare Executive Group Webinar Series Continues

In August, “The Four Pillars of a Successful Core-System Replacement Project” will be presented by sponsor partner Change Healthcare on August 2nd, 2018 at 2:00PM ET. Reserve your seat for this webinar today!

HCEG is also working with other sponsor partners on additional webinars planned for the 4th quarter of 2018 after the Annual Forum.

Consider subscribing to our eNewsletter to be kept abreast of these webinars and other information and events of value to healthcare executives and thought leaders.

Preliminary Agenda and Keynote Speakers for HCEG’s 30th Anniversary Annual Forum

We’re pleased to share the preliminary agenda and announce that Andy Slavitt, former Acting CMS Administrator and current leader of Town Hall Ventures, and Dan Buettner, National Geographic Fellow, NY Times bestselling author and principle at the Blue Zones Project will be providing keynote addresses at our 2018 Annual Forum in Minneapolis, MN on September 12 – 14, 2018.

The following represents the current agenda which is being fleshed out and evolving on a weekly basis. We’re also identifying and recruiting more speakers and panelists, and planning enjoyable networking events intended to make our 2018 Annual Forum our best forum ever. If you or someone you know would like to be considered to speak or serve as a panelist at our forum, please use this form.

hceh annual forum healthcare executive group annual forum conference

To learn more and to get an idea about what the HCEG Annual Forum is all about…

… Check out these pictures from last year’s HCEG Annual Forum

… See who’s among the previous attendees of HCEG Annual Forum’s

If you would like to register to attend HCEG’s Annual Forum, you can register here. And if you are unsure as to whether you should attend, check out these Nine Reasons to Attend the 2018 HCEG Annual Forum.

HCEG Members and Sponsor Partners at AHIP Institute & Expo

The 2018 AHIP Institute & Expo takes place next week, June 20th through the 22nd in San Diego, CA and HCEG members and sponsor partners will be participating, speaking and exhibiting.

If you’re attending the AHIP Institute, be sure to meet our sponsor partners. Some of our sponsor partners are exhibiting, some are presenting, and some are attending. ALL of our sponsor partners can help your healthcare organization transform itself in today’s rapidly evolving healthcare environment.

Also not to be missed are sponsor partners CareCentrix and Change Healthcare offering refreshments and a Lunch & Learn session.

Date & Time Sponsor Partner Event
June 20: 8:00am – 11:00am CareCentrix Welcome Refreshments
June 20: 11:00am – 12:15pm Change Healthcare Lunch & Learn

Value-Based Care Market Research: Inside Successful Programs

June 20: 3:45 pm – 4:30 pm CareCentrix The Future of Care at Home: New Strategies for Post-Acute Care
June 21: 9:30 am – 10:15 am CareCentrix Coffee Break in the Exhibit Hall

Stay Connected and Learn More About HealthCare Opportunities, Challenges & Issues

Check out the following for more information about the HealthCare Executive Group:

Becoming a Member of the HealthCare Executive Group

Attending our 2018 Annual Forum

Subscribe to our eNewsletter

Limited Sponsorship Opportunities

The HealthCare Executive Group has limited general sponsorship opportunities available to companies interested in supporting our members on a consultative, partnership basis. For more information, contact Juliana Ruiz.

Leadership, Trust & Skills in Overcoming Obstacles to Radical Innovation in Healthcare

By | Conferences, Executive Leadership Forum, HCEG Top 10, The Industry Pulse | No Comments

The HealthCare Executive Group (HCEG) was honored to co-host a special Executive Leadership Roundtable  May 9th at the recent HLTH Future of Healthcare Forum.  HCEG partnered with the International Association of Innovation Professionals (IAOIP), the Center for Healthcare Innovation (CHI), the Workgroup for Electronic Data Interchange (WEDI) and special guest Dr. Sunnie Giles for the Boardroom-style event. The theme of the roundtable was Leadership, Trust and Skills in Overcoming Obstacles to Radical Innovation in Healthcare. Over a period of 3 hours, Charles Stellar, CEO of WEDI, moderated a panel of innovation and healthcare thought leaders as each shared their respective insight on the following topics:

  • Ferris Taylor, HCEG Executive Director, shared insights on innovation and technology gleaned from the HCEG member organizations, the HCEG Top 10 and 8th Annual Industry Pulse Survey
  • Brett Trusko, CEO of IAOIP, shared an International overview of Innovation Certification programs
  • Lynn Hanessian, Chief Strategist, Edelman Health representing CHI, shared info and highlights from the Edelmen Trust Barometer research, and
  • Dr. Sunnie Giles shared key findings from her research and recent book supporting “The New Science of Radical Innovation”

See also Recapping the 2018 HLTH Future of Healthcare Forum

Insight into Obstacles to Radical Innovation in Healthcare

After each panelist concluded their presentations and key takeaways, an open Q & A period between panelists and attendees took place. This discussion evolved into an intimate engagement among Executive Leadership Roundtable attendees ensuing into a free-flowing, rather ‘un-conference-like’ approach. Interaction was so engaging that many session participants hung around AFTER the official end of the Executive Leadership roundtable to continue the discussion, network with each other and build professional relationships that are destined to accelerate more considerations in the future.

Insights on Radical Innovation in Healthcare – The HCEG Top 10 and 8th Annual Industry Pulse Research

Ferris Taylor connected the development of the annual issues to the common theme of innovation and technology and then shared five highlights of the 8th Annual Industry Pulse report – a survey of 2000 healthcare stakeholders jointly conducted by HCEG and its sponsor partner, Change Healthcare.

  1. Social determinants of health have now transcended buzzword status
  2. High-deductible health plans are not converting passive patients into active healthcare consumers
  3. Mobile/digital health adoption is not just about functionality and interoperability, but is significantly impacted by privacy and security concerns – more about trust than technology
  4. Industry attention is turning to blockchain, artificial intelligence, robotic process automation and other advanced technologies
  5. Healthcare is transitioning from negative to positive incentives to influence consumer behavior faster than most expect

The Edelmen Trust Barometer

After Ferris Taylor set the context for key areas of need and innovation in healthcare, Lynn Hanessian shared a detailed overview of the Edelman Trust Barometer – a measure of people’s trust in business, government, NGOs and media. Lynn opened with a sobering chart showing a historical decline in trust over the period of 2017 to 2018 – with 14 of 15 sectors showing an overall decrease in trust.

Lynn also shared insight from the Edelman report showing the division of opinion as to the impact of Tech to the Cost of Healthcare: 23% of respondents believed that technology will make healthcare MORE expensive over the next 5 years and 16% believe technology will make healthcare LESS expensive.

Overview of International Innovation Certification Programs

Brett Trusko of the IAOIP shared an overview of how the IAOIP is on a mission to professionalize the practice of innovation around the world. Brett shared the following methods that the IAOPI believes will be critical to promote the IAOIP’s mission of advancing innovation:

Brett also shared an overview of the Current Body of Best Practices for Innovation, why ‘professionalization’ of innovation is important, his beliefs as to why Failure to Innovate is NOT an Option, He closed his presentation with What You Can Do Now to advance the professionalization of innovation.

The New Science of Radical innovation

Dr. Sunnie Giles rounded out the initial roundtable presentations by sharing some highlights from her new book “The New Science of Radical Innovation.” Sunnie shared:

  • A Definition of Radical Innovation
  • The Concept of VUCA (especially in healthcare): Volatility, Uncertainty, Complexity & Ambiguity
  • 4 Factors That Make Radical Innovation Challenging for Leaders
  • How to Harness Volatility, Uncertainty, Complexity & Ambiguity to Increase Innovation in Healthcare

Open Discussion About Innovation at HLTH Future of Healthcare Forum

All in all, the Executive Leadership Roundtable at HLTH was an informative and engaging event. Of the 120+ registrants, over half participated in the roundtable with a number of walk-ins and with many of those individuals remaining afterwards to continue the discussion about the opportunities and challenges for innovation in healthcare. Given that the HLTH Association Day was the afternoon of the last day of the 4-day HLTH forum, all participants and presenters considered it a great success!

HCEG appreciates the collaboration with Brett Trusko from the Association of Innovation Professionals, Lynn Hanessian representing the Center for Healthcare Innovation and Dr. Sunnie Giles of the Quantum Leadership Group. HCEG would also like to extend a special thanks to Charles Stellar of WEDI for moderating the panel and representing WEDI’s role in innovation and technology so well.

Connect with Each Other and The HealthCare Executive Group

If you enjoyed the 2018 HLTH Future of Healthcare Forum, or would like to participated in a greatly scaled down yet equally valuable version of the forum, consider being part of the HealthCare Executive Group’s Annual Forum taking place in Minneapolis, MN on September 12 – 14th.  We have a special event planned to celebrate our 30th year anniversary. Moreover, if you’re a healthcare executive who can benefit from collaborating with your C-suite peers, consider becoming a HCEG member.

In the meantime, be sure to follow us on Twitter, Connect with us on LinkedIn and subscribe to our eNewsletter.

Access presentation deck from the Executive Leadership Roundtable here.

Recapping the 2018 HLTH Future of Healthcare Forum

By | Conferences, Executive Leadership Roundtable, HLTH2018 | No Comments

Photo Credit: HLTH.co

The inaugural 2018 HTLH Future of Healthcare forum took place in Las Vegas earlier this month with 3,500+ attendees and 375+ speakers assembled over four days starting May 5th with the HLTH Hackathon. And HealthCare Executive Group (HCEG) members and sponsor partners were there – interpreting and absorbing key takeaways, presenting as speakers and panelists in various sessions and adding their own unique support and participation at this highly touted, new healthcare conference billed by organizers as ‘The Hottest, Newest, Largest and Most Important Healthcare Event.”

HCEG was also honored to co-host a special HCEG Executive Leadership Roundtable – Leadership, Trust and Skills in Overcoming Obstacles to Radical Innovation in Healthcare – in conjunction with the International Association of Innovation Professionals (IAOIP), the Center for Healthcare Innovation (CHI) and the Workgroup for Electronic Data Interchange (WEDI) and special guest, Dr. Sunnie Giles the author of “The New Science of Radical Innovation.” This three-hour roundtable took place on the last day of the forum as part of HLTH’s Association Day.

Un-Common Content with a Few Common Themes

Sessions at HLTH were organized into five tracks that varied each day. So, with 100+ sessions over four days, there were about 4 or 5 sessions covering any particular track – a reasonable and manageable number. HLTH event organizers also assigned all sessions in each track to the same room location; making it easy to navigate between tracks and sessions. There were a few crowded sessions and some rather sparsely populated sessions.

Based on an informal survey of sessions attended by HCEG members and a scan of various recaps of the HLTH Future of HealthCare forum over the past two weeks, a few common threads emerged.

Must Address Multiple Conditions, High-Cost Patients & Care Transition

Many of the sessions at the HLTH event addressed the importance of providing cost-effective services and products to three groups of people:

  • People with multiple chronic conditions – particularly diabetes, hypertension, hyperlipidemia, asthma and depression.
  • Patients who drive a large percentage of total health care costs
  • Patients discharged from the inpatient setting.

Health Happens Outside the Exam Room & Hospital

And many of these same sessions and more than a few of the exhibitors shared information, ideas and approaches aimed at addressing these three populations by focusing on social determinants of health. Quite a few speakers and panelists spoke of the need to extend health services beyond the walls of the treatment room and out into the local community.

As noted in the recent Industry Pulse Research Survey co-authored with HCEG sponsor Change Healthcare, payers are beginning to integrate community programs and resources into their medical practices.  Only 18.9% of responders said they were not currently integrating any social determinants of health, a dramatic change over the last few years.

Payment Innovation in Healthcare is Desperately Needed

Another oft-mentioned topic at the HLTH forum was value-based care and the need for payers and providers to come together on sharing not only upside risk but downside risk as well. While the rise of personalized medicine, targeted therapies, specialty pharmaceuticals and molecular diagnostics offer tremendous opportunity, payers are still growing their sea legs figuring out how to measure outcomes and associated value models – at the same time as providers and the healthcare supply-side are beginning to demonstrate outcome values in risk-based payment contracts.

What’s clear is that rapidly evolving medical technologies must be simultaneously supported by reasonable regulatory frameworks and payment model development. Hopefully, the federal government will serve as the vanguard for innovation in the area of reimbursement.

Engagement: The Most Un-Buzzworthy Word at HLTH?

In one session, the moderator quizzed the panel as to what industry buzzword they disliked most and ‘engagement’ was the clear winner (loser?) among panelists as the most over-used and unclear healthcare buzzword. The CEO of Maestro Health, Rob Butler suggested that people don’t want engagement with a medical condition but rather to be connected to their health system and support networks.

Amanda Natvidad of FitBit noted in her post titled “HLTH Recap: 6 Key Takeaways from The Future of Healthcare Event” that Kimon Angelides, founder and CEO of Vivante Health, suggested, “People with chronic conditions don’t want to be more engaged with their disease – they want to reduce the hassles and be more empowered… and technology can help in this journey.” 

This very idea that People Don’t Want to Be Engaged with their Medical Condition was offered by HCEG Executive Director Ferris Taylor in a recent webinar on the 2018 HCEG Top 10.

HCEG Members & Sponsors at the HLTH Future of Healthcare Forum

More than a few of our HCEG sponsor partners were at the HLTH event – speaking in sessions, as sponsors, participating in 1:1 and small group meetings and exhibiting.

Softheon was active in several ways with sponsoring the HACK/HLTH ‘hackathon’ where participants collaborated and created meaningful solutions in competition for over $80,000 in prizes. Eugene Sayan, Softheon’s CEO also presented ‘Convergence of Health and Non-Health Data’ along with Jeff Margolis, CEO of WellTok.

Not to stop with those two events, Softheon also joined Lyft to sponsor Wyclef Jean at the JEWEL Nightclub on Tuesday. Softheon also was one of the larger exhibitors at the HLTH Future of Healthcare forum. Check out pictures of HLTH’s After-Hours Activities here.

Change in Healthcare at the HLTH Future of Healthcare Forum

Change Healthcare’s President and CEO Neil de Crescenzo keynoted Tuesday’s General Session “The Patient Experience: Making it Easier for Healthcare Providers to Make it Easier” and shared some common-sense solutions to revolutionize patient experiences, utilizing healthcare data in ways which enable providers to orchestrate and improve patient interactions – all while delivering a seamless experience aimed at improving patient loyalty and new patient attraction.

Change Healthcare was also a major sponsor, giving the first 3,000 attendees a high quality hot/cold mug and having a dominant position in the Exhibit Hall.  Change HC also teamed up with Adobe and Microsoft to “Put the ‘Consumer’ in Healthcare Consumer Engagement.”  enable health systems to better engage with patients. The joint solution will use Change Healthcare’s Intelligent Healthcare Network, Adobe’s Experience Cloud, and Microsoft’s Azure offering to improve customers’ healthcare experience. You can learn more about this venture here.

CareCentrix CEO John P. Driscoll was a panelist along with David Muhlestein, Chief Research Officer at Leavitt Partners on a Tuesday session titled ‘Aligning Health Policy to Health Possibility.’ This session addressed the potential for technology to transform the health industry through more innovative – and perhaps disruptive – health policy. There were a few moments of ‘extreme interaction’ between the two panelists.

HealthEdge sponsored one of the few handfuls of ‘Meeting Pods’ at the HLTH event. These small group meeting spaces along the hallways seemed like a good idea and through focused effort, HealthEdge had it pod occupied to clients and prospects during the entire HLTH event.

Announcements at HLTH2018 – Large, Small & Mostly Meaningful

One of the interesting media related events at the HLTH event was the “Make an Announcement” opportunity for all HLTH attendees. All sponsors, exhibitors, speakers or otherwise were able to make an announcement about new products, venture funds being launched, collaborations and other ‘newsworthy events’ at a pre-arranged time in a dedicated media area. Some of the major announcements included:

Former CMS Administrator Andy Slavitt’s new venture firm, Town Hall focusing attention on businesses working to serve the underserved communities across the country. 

David T. Feinberg, M.D., CEO of Geisinger Health announced their commitment to anticipatory medicine and precision medicine initiatives by adding DNA sequencing to routine patient care. 

HCEG’s Executive Director Ferris Taylor also announced HCEG’s 30th Year Anniversary and the opening of registration for HCEG’s Annual Forum on September 12-14th in Minneapolis, MN.

Check out more announcements here.

Interesting Aspects of HLTH’s Future of Healthcare Forum

There were some interesting meeting and networking opportunities at of the HLTH Future of Healthcare event including:

Hosted Buyers Meetings – Rumor was that almost 1000 pre-arranged attendee-exhibitor buyer meetings took place over TBD days at the HLTH forum. https://hlth.co/hosted-buyer-program/

Funding Founders – 6 Minute, Double Opt-In VC ‘speed dating/networking session’ took place about 300 times early in the day for one hour. Based on the early morning start time and lively attendance, the Hosted Buyer and Funding Founders sessions seemed like worthwhile features of the HLTH forum.

Great Meal Service – The HLTH organizers offered a nice selection of good food, well-orchestrated for a conference of this size

Digital Content Delivery, Networking and Logistical Support at the HLTH2018 Forum

In a future post we’ll share some insight and opinion about some of the unique ways in which the HLTH Future of Healthcare Forum organizers differentiated their forum and provided extra value opportunities to attendees.

HLTH 2018 Association Day: Executive Leadership Roundtable – HCEG, CHI, IAIOP and WEDI

As noted above, HCEG was honored to join other associations in an Executive Leadership Roundtable (ELR) as part HLTH’s 2018 Association Day. The theme of the ELR was centered on leadership in healthcare innovation and complimented by author Dr. Sunnie Giles highlighting her just published book on “The New Science of Radical Innovation.” Look for a recap of the roundtable as part of HLTH’s Association Day in a following post.

Ongoing Press Coverage of the 2018 HLTH Future of Healthcare Forum

Given that it’s been a couple weeks since the HLTH Future of Healthcare forum has ended, you can imagine there are a number of other recaps like this one from The HealthCare Executive Group. Here are additional recaps of the HLTH Future of Forum currently available:

Looking back at HLTH 2018

Startup Health chief on investment strategies, getting out of healthcare’s bubble

What the HLTH?

At HLTH, David Feinberg, M.D. Shares Why Geisinger Is Investing in the Full Health of Its Communities

Are Federal Health Officials Fed Up with Providers’ Unwillingness to Take on Downside Risk?

At the HLTH Conference, Former CMMI Director Patrick Conway Looks Back, and Forward

At HLTH, a Candid Discussion of What the Federal Government Can and Should Do to Promote Healthcare Innovation

Digital Health Innovators are Setting their Sights on Medicaid—Can the Private Sector Improve Healthcare?

Walmart’s next healthcare move: Using data to identify bad doctors

Closing Out the First-Ever HLTH Meeting in Las Vegas

HLTH & Healthcare — My tweetstorm on the HLTH conference

HLTH The Future of Healthcare – Convening, Collaborating, and Curating – Or, Do We Really Need Another Conference?

HLTH Recap #1: Kicking It Off

HLTH Recap #2: Making It Real

HLTH Recap #3: Top Picks

Readers Write: HLTH 2018 Recap: A Transformation in Talking about Healthcare Transportation

HLTH Recap: 6 Key Takeaways from The Future of Healthcare Event

Live at HLTH, Trevor and Steve host a Unicorn Panel with Frank Williams, Anne Wojcicki and Jonathan Bush.

DIGITAL HEALTH BRIEFING: HLTH conference roundup

More Insight and Ideas on Events for Healthcare Executives

Check back soon for more on the 2018 HLTH Future of Healthcare Forum. We’ll provide a detailed recap of the Executive Leadership Roundtable event that took place on Wednesday, May 9th.

Before the month is out, the HealthCare Executive Group will be opening up registration for our Annual Forum taking place in Minneapolis, MN on September 12 – 14th.  We have a special event planned to celebrate our 30th year anniversary. If you’re a healthcare executive who can benefit from collaborating with your C-suite peers, consider becoming a HCEG member.

In the meantime, be sure to follow us on Twitter, Connect with us on LinkedIn and subscribe to our eNewsletter.

Recapping Value-Based Payment – Getting from Here to There…

By | HCEG Top 10, HealthEdge, payment, reimbursement, Risk-Sharing, Value-Based Payment, Webinar Series | No Comments

Our sponsor partner HealthEdge hosted HCEG’s Webinar Series event in March: Value-Based Payments – Getting from here to there…

Harry Merkin, VP of Marketing at HealthEdge and Dave Mika VP of Enterprise Core System Operations at Independent Health shared insight and real world experience on how health plans and their provider networks can transition from traditional fee for service (FFS) to value-based payment (VBP).

This blog post recaps highlights of the webinar and provides access to additional information from the webinar. A recording of the webinar can be found here. You can also check out this Twitter Moment summarizing live Tweets from the webinar.

Value-Based Payment Began in the Late 1990’s 

In the late 1990’s, capitation models began paving the way for change from traditional FFS payment models to models focused on helping establish effective, cost-efficient practice models. In the last few years, value-based payments have become the latest and greatest models for reimbursement of care. The importance of value-based payments is supported by HealthCare Executive Group members ranking Value-Based Payment as #3 on the 2018 HCEG Top 10 list.

Moreover, recent statements by current and former HHS officials have supported the need for value-based payment:

“There is no turning back to an unsustainable system that pays for procedures rather than value”, and the transition “needs to accelerate dramatically.” – Alex Azar, Secretary of HHS, 3/5/18 at the Federation of American Hospitals’ conference

“I highly encourage health care leaders to listen intently to his full remarks. The transition to value is moving forward; if you aren’t already preparing for it, it is time to get on-board.“ – Michael Levitt, former governor of Utah and former HHS Secretary

Value-Based Payment Can Lower Costs and Improve Outcomes

Harry Merkin shared the results of a November 2017 Humana study showing that VBP programs achieve meaningful gains in cost and quality vs. traditional FFS methods with total healthcare costs associated with VBC plans 15% lower than care costs of FFS plans. And a more recent survey by the Healthcare Financial Management Association revealed that 70% of healthcare organizations participating in VBP programs have achieved positive results.

Value-based Payment Must Address the Quadruple Aim

Independent Health’s Dave Mika shared real-world insight into the experience his organization has witnessed. A key focus raised by Dave is that health plans looking to implement or extend value-based payment programs must address the four pillars of the Quadruple Aim

  1. Enhancing patient experience
  2. Improving population health
  3. Reducing costs
  4. Improving the work life of health care providers

Questions from Webinar Participants About Value-Based Payment

HCEG webinar series events always include the opportunity for questions from participants and this webinar was no exception. Two of many questions included the following short, paraphrased responses by Dave Mika – and other questions can be obtained from the webinar recording:

What is the key to gaining alignment with PCP’s?

Answer: Actively reaching out to and collaborating with key stakeholders in the local community.

What data has proven to be most useful to the provider network?

Answer: Information on patient gaps in care– ideally provided at the point of care in the physician’s workflow – can be very effective in improving value.

And More on How to Get There from Here…

In addition to the above, the webinar addressed the following considerations for transitioning from traditional FFS programs to VBP programs:

  • Aligning delivery and reimbursement models with high-performing providers
  • Tools for members to self-manage and self-navigate the care delivery system
  • Technology support including web and digital capabilities

The move to value-based reimbursement appears inevitable, and only those health plans and providers that begin to transition and adapt today will be successful in the future. Change doesn’t happen overnight. To learn more about how making the transition from FFS to VBP, check out the webinar recording, consider contacting HealthEdge for more information and keep in touch with the HealthCare Executive Group by connecting with us on Twitter, Facebook, LinkedIn and subscribing to our newsletter.

Value-Based Payments – Getting from here to there…

By | Healthcare Reform, HealthEdge, payment, reimbursement, Value-Based Care, Value-Based Payment | No Comments

 value-based payments (VBP) models. Capitation models traditional fee-for-service (FFS)

Since the late 1990’s, the reimbursement landscape in healthcare has been changing. Capitation models paved the way for a change from traditional fee-for-service (FFS) payment models to a focus on helping physician partners establish effective, cost-efficient practice models. And now value-based payments are the latest and greatest models for reimbursement of care. In fact, value-based payments were ranked by HealthCare Executive Group members as #3 on the 2018 HCEG Top 10 list.

value-based payments (VBP) models. Capitation models traditional fee-for-service (FFS) MACRAWhile uncertainty surrounding healthcare reform in the United States continues and the industry waits for more definitive reimbursement policy from the federal government, one thing is certain—the trend for value-based payments (VBP) continues. Health plans and providers really have no choice but to transition from the traditional fee-for-service model in order to drive down soaring costs and positively impact patient outcomes.

“There is no turning back to an unsustainable system that pays for procedures rather than value” and the transition “needs to accelerate dramatically.”

– Alex Azar, Secretary of Health and Human Services, March 5, 2018 at the Federation of American Hospitals’ conference

Obstacles in the Path to Value-based Payments

There are many obstacles that must be addressed to successfully implement value-based payments models that reward providers for positive performance and encourage poor performers to improve. In order to achieve the expected outcomes and performance required by VBP, health plans must have the flexibility to develop, implement and administer value-based contracts with providers responsible for care delivery, care management, and care coordination across the medical neighborhood.

value-based payments (VBP) models. Capitation models traditional fee-for-service (FFS) MACRA

How to get there from here…Value-based Payments

On Thursday, March 22, 2018 at 2:00PM ET, Harry Merkin of HealthEdge and Dave Mika of Independent Health will share their insight and real world experience on how to get from here to there with value-based payment. Some of the information they will share includes:

  1. Essential elements of a transition from traditional Fee For Service to Value-based Payment
  2. Independent Health’s story of how important technology-driven strategies are to their adoption of value-based payments
  3. How models being driven by CMS are also impacting commercial contracts
  4. How some health plans are responding to the value-based payment movement including findings from a study of value-based care payments by Humana
  5. The importance of primary care physicians as critical to transforming the way health care is delivered
  6. The type of technology support needed by health plans and providers

The move to value-based reimbursement is inevitable, and only those health plans that adapt will be successful in the future. And developing the capabilities to effectively respond to change doesn’t happen overnight.

Reserve your seat today and learn how to get there from here

Thurs, March 22, 2018 | 11:00am PT / 2:00pm ET Healthcare Executive Leadership Forum at Guidewell Innovation Center

Learn About Value-Based Payments from Industry Thought Leaders

Presenter – Harry Merkin

Vice President of Marketing, HealthEdge

Harry Merkin has worked with both payers and providers through many dynamic changes in healthcare for a number of years. He is currently responsible for Marketing at HealthEdge, including product marketing, demand generation and thought leadership. He previously had similar responsibilities at Evariant and NaviNet and has collaborated with many transformative entities across the healthcare landscape. Harry has helped introduce and promote innovative enterprise software solutions that enable payers to improve their competitive effectiveness, as well as perform valuable communications between payers and providers, and allow providers to effectively collaborate with patients and consumers as well as with each other

Co-Presenter – Dave Mika

Vice President, Enterprise Core System Operations, Independent Health

Dave Mika plays an integral role in leading the operations unit at Independent Health, located in Buffalo, NY. He is responsible for the coordination of activities across the organization to more effectively manage workloads and partner closely with individual business unit owners to achieve operational excellence. A former Army Reserve combat medic and Licensed Practical Nurse with more than 30 years of experience in the health insurance industry, Mika has also held management positions in member appeals, provider relations, project management and product development and implementation.

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

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

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

How Big is the HIMSS Conference?

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

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

HCEG’s Top 10 Mirror Popular HIMSS Themes

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

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

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

Value-based Payment & Care (#3)

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

Population Health Programs & Services (#2)

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

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

Engaging Healthcare Consumers & Patients (#10)

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

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

Popular Hashtags At the 2018 HIMSS Conference

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

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

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

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

#Aim2Innovate, #TransformHIT, and #EmpowerHIT

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

HCEG Sponsor Partners at HIMSS

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

Instamed

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

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

Cumberland Consulting Group

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

Change Healthcare

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

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

Special ‘HIMSS18-edition’ eNewsletter

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

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

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

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

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

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

Cybersecurity – 2018 HCEG Top Ten Item #6

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

HCEG Healthcare Executive Group Webinar-Top-10 Trends Cybersecurity

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

Real World Impact of Medical Identity Theft

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

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

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

Addressing Pharmacy Costs – 2018 HCEG Top Ten Item #9

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

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

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

Free-Market Economy and Governance

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

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

pharmacy costs increases hceg healthcare executive group

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

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

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

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

Previous Webinar: Strategies to Address Rising Pharmacy Costs

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

Check out the Webinar Recording for More

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

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

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

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

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

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

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

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

David:

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

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

Ferris:

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

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

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

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

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

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

Topic #2: Healthcare Consumerism

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

David:

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

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

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

Ferris:

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

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

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

Analogy About Healthcare Spending by David Gallegos

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

Topics Addressed in Next Post: Cybersecurity & Rising Pharmacy Costs

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

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

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

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

Connect with the HealthCare Executive Group

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

Rising Pharmacy Costs – Strategies to Address – Webinar Recap

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

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

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

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

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

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

Trends in Rising Pharmacy Costs

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

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

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

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

How Drug Prices are Determined in the United States

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

Specialty Pharmacy Trends & Drivers of Specialty Pharmacy Spend

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

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

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

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

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

The Future – Pharmacy Trends and Government Intervention

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

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

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

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

 

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

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

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

Leverage Your AHIP Event & Nashville Connection

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

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

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

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

Timely Topics for Healthcare Leaders

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

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

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

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

Reserve Your Seat Today!

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

Healthcare Executive Leadership Forum at Guidewell Innovation Center