If analytics is the machine powering your digital transformation initiatives, then data is the power making that digital transformation machine run. The importance of data and analytics has been identified by our members in each of the last ten years HCEG’s Top 10 list of challenges, issues, and opportunities have been created. For 2019, “Data & Analytics” is ranked #1 on the HCEG Top 10. It’s clear that healthcare leaders believe that data is a catalyst to accelerate meaningful change. And that the use of analytics – particularly prescriptive analytics – is a fundamental strategy for succeeding in a new era of healthcare.
Mountains of Data Waiting to Power Your Healthcare Analytics Machine
Good analytics begins with good data and healthcare organizations are sitting on a mountain of data. According to America’s Health Insurance Plans (AHIP), the typical regional payer processes $8 billion in claims each year with each claim providing its own set of unique data points – largely financial and administrative. But healthcare payers are increasingly collecting, matching, and using clinical data to provide richer, more comprehensive insight on their members.
Given the proliferation of Electronic Health Records (EHR) incented by CMS’s Meaningful Use program, it’s no surprise that more and more data is being pulled from EHR’s. And risk-sharing agreements between payers and providers has resulted in health plans sharing more claims data with their provider partners. In fact, the current Industry Pulse report indicates that EHR data is one of the top two primary sources of clinical data with 30% of health plans reporting they utilize EHR data.
Other sources of clinical data that organizations are using to complement their claims data include ancillary data such as pharmacy, lab, and imaging (17%) and real-time admission, discharge, and transfer notifications (10%)
These enhanced data sources are becoming more and more useful due to the power of artificial intelligence (AI) and machine learning.
New research from Dimensional Insight identifies care quality measures and finance as two top use cases for healthcare organization usage of analytics today. Additional use cases for leveraging data by analytics include
Addressing Social Determinants of Health (#3 on the 2019 HCEG Top 10)
Value-based Care and Alternative Payment Models (#4 on the 2019 HCEG Top 10)
Improving Patient Engagement and Satisfaction
Patient Outcomes Improvement
Analytics Budgets are Increasing for Healthcare Organizations
Additionally, the report finds that 89% of healthcare executives plan to use predictive analytics over the next five years. It’s clear that healthcare payers and health systems have a keen focus on leveraging the massive amounts of data they possess. These data serve to reveal trends, patterns, and insights to help ensure their success going forward.
Solving the Rubik’s Cube of Payer Data
i.e. Lining Up All Your Data to Rapidly and Accurately Gain Unique Insights
For insight into how your healthcare organization’s data can be used to improve health outcomes and reduce costs, join our next Webinar Series Event on June 6th at 2:00 PM EDT / 11:00 AM PDT. Our sponsor partner eQHealth Solutions presents “Solving the Rubik’s Cube of Payer Data.”In this complimentary webinar, you will learn how to aggregate and parse provider data, how you can use data captured outside of your own system, and other practical solutions to use your data to create knowledge for actionable use and outcomes. Attendees will have a chance to ask questions and all registrants will receive a copy of the presentation afterward.
The following is a verbatim transcript of that interview – with a few links and supporting information added in for clarity. You can watch the actual recording here and sign up to receive our eNewsletter here.
Talking About the 2019 HCEG Top 10 List at World Health Care Congress
Mabel Jong: And welcome back. I’m Mabel Jong and you’re watching live coverage of the World Health Care Congress on WHCCTV. Thank you so much for joining us.
We’re going to learn a little bit about the HealthCare Executive Group. Their executive director Ferris Taylor is here.
Ferris Taylor: Well thank you Mabel, it’s good to be with you.
I understand you’re from Boston where the HealthCare Executive Group started in 1988 in Maynard, Massachusetts when a mini computer manufacturer disbanded their healthcare user’s group. That group of users said: “Forget about Digital Equipment, we find value in networking, being able to share the challenges and the opportunities of healthcare” To have somebody around the country that I can pick up the phone and call and say: “Hey, I’m having this problem.”
And if my colleague in Minneapolis says: “I’m not having that problem,” then maybe there’s something wrong with me. Or maybe, we have something to talk about. Or if we both have that problem, then how are we solving that?
So, it’s a small network 100 members or so, primarily technology leaders in their organizations, payers, and providers that find personal, professional and organizational value in sharing ideas about how to address the challenges in healthcare. And as you know, we have lots of lots of them.
Mabel: Lots of them. And in terms of sharing ideas, you also have done a lot of research on coming up with a top 10 list. Not David Letterman’s top 10 list but…
Ferris: It started out that way.
Mabel: Okay. Share with me what this list is about and who makes it.
Ferris: And it’s fascinating because from the very beginning there was always a conversation about the challenges in healthcare. And 10 or 15 years ago the CIO at Health Partners,
Alan Abramson said: “You know, when I go home from our meetings, my executives asked me what we’d been talking about and I tell them.”
But there would be value if we actually went through a process and shared with the industry what our members see as the challenges in the foreseeable future in health care.
So about 15 years ago we started publishing, and at the time it really was (based on) the David Letterman (Top 10 list). We keyed on that – ‘here’s our top ten list.’ And it’s evolved from that. Our members at the end of the year actually vote from a list of 30 or 40 issues that we talked about in the year – what their top 10 issues are. And then we go through a process of ranking them and it (HCEG’s Top 10 list) becomes the benchmark that our members use.
And I recommend that other companies, other healthcare stakeholders around the industry use the Top 10 list to ask themselves: “Am I addressing these issues? Are they on my priority list? What’s my action plan with respect to those issues?”
Mabel: Okay. So, does it go from most important to…
Ferris: We do rank them.
Mabel: Okay. So, number one, you have Data and Analytics all the way to number 10 cybersecurity.
Ferris: That’s a big range.
Mabel: That is a big range. So, people are saying these are the issues that we’re currently facing and that we’re concerned about.
Something Old, And Something New on the 2019 HCEG Top 10 List
Ferris: Exactly. And another dimension of this that you don’t see but is very important is that I can look back over time and see how those issues have moved around. Up until 2015, cybersecurity wasn’t on our list. And then you have two major health plans – 80-million-member record breach, 20-million-member record reach. So a 100 million members records have been lost to the dark side.
Mabel: So, it made the list.
Ferris: Right. And the fact that it’s number 10 doesn’t mean that it’s not important but other things have become more important. Number four is Value-Based Reimbursement. And World Healthcare Congress this week has talked a lot about value and clinical appropriateness of price and those issues.
Three years ago, value-based reimbursement was number one on our list. You could say: “Well it’s dropped in importance.” But in fact, if I look back over our conversations – and we have monthly webinars and do a lot of blogging and then we have quarterly executive roundtables where we take these issues and discuss them in our annual meeting, we spend a hold three days on the program. The discussion was: we can’t get to value-based payments until we have a better handle on data, and in particular, clinical data. We’ve got a lot of claims data but we need the clinical data and we need agreement on the majors and the outcomes and the data we’re going to track before we can get to value-based reimbursement.
Of Course, Social Determinants of Health Are On the List
Ferris: We need to bring the consumer in. Number two is Total Consumer Health. Number three is labeled Population Health Services. We call it social determinants of health but it’s really the barriers to medical health that are non-medical. And we’ve narrowly defined healthcare as medical and it isn’t.
Mabel: Well also, at number nine is Opioid Management.
Ferris: And that’s a new one this year.
Mabel: Yes. I can imagine it would be.
Mabel: But it’s a crisis and your executives are very concerned about this.
Ferris: They are. And on all of these issues. They’re corporate issues. In our discussions, many times they’ve evolved to: What are the systems? What are the data flows? What is the information? What is it that we’re trying to track that will help us, help our executive team address or better handle a crisis like opioid management?
Using the 2019 HCEG Top 10 List to Define and Frame Problems
And you know, from a technology point of view, you could say: “Well that’s a medical issue, it’s not a technology issue.” But, in fact, in our data for a number of years, there were indicators that this was becoming a problem and we didn’t analyze it.
Mabel: I see. Okay. So now that executives have outlined these as their concerns, what does your group do about that?
Ferris: Well, we’re very action-oriented. But to get to action you’ve got to be very sure you define the problem correctly and have the components of the solution in place before you take action. And so, a lot of what we’re focused on are, as a group, here’s what I’m doing from a system and a technology point of view to address each one of these issues.
And their colleague in another part of the country, somebody that they don’t compete against. So they can be very open and sharing are saying: “Well you know, in addition to that I’m doing this.” And the colleague may respond: “Oh, I hadn’t thought about that. I need to bring that to the table as well.” And then they can go to their management team in a very organized and comfortable way saying: “This isn’t just my idea. This is what a group of our colleagues that are similar to us is doing.”
A Common Frame of Reference For Healthcare Leadership
And it gets better acceptance. It allows these things to become priorities within each company’s competitive marketplace because everybody’s different with their resources with the focus that they have on health care.
If you’re a Medicaid plan you have a different focus than if you’re a Medicare, commercial or a dual-eligible plan. So, it’s the networking that leads to the actions that can take place here.
Our closing session yesterday here at World Health Care Congress was two of our board members. Board chair Kim Sinclair from Boston Children’s Medical Center and Alan Abramson from Health Partners sharing with everybody here at World Healthcare Congress what they see out of these as their priority. And going into specifics: these are the things that we are doing to address the challenges that we’ve already acknowledged.
Mabel: All right. Ferris, thank you so much for sharing your experience with HCEG. We appreciate it.
Ferris: It’s a lot of fun all right.
Mabel: Thank you for joining us stay tuned we’re rounding out our last interview very shortly.
Join Other Healthcare Leaders to Digitally Transform Your Organization
For more information, insight, and ideas about the challenges, issues, and opportunities facing healthcare leadership during these uncertain times, consider these opportunities:
Last week a lot of planning, coordination and content development by the HealthCare Executive Group came together at the 16th Annual World Health Care Congress in Washington, DC. For this year’s congress, HCEG partnered with World Congress Events to present the CIO & CTO Strategy Track. This post recaps a few highlights of the 2019 World Health Care Congress, shares some insight from the healthcare leaders and champions presenting at the event and in our the CIO & CTO Strategy Track, and provides some select presentation materials, recordings and other content from the event.
HCEG Top 10-Related Highlights From 2019 World Health Care Congress
As expected, many of the sessions and keynotes at the WHCC event addressed items on the 2019 HCEG Top 10 list with “social determinants of health” (#3 on the 2019 HCEG Top 10) and “value-based payment” (#4 on the 2019 HCEG Top 10) being pervasive themes throughout the keynotes, sessions and exhibit hall.
Value-Based Care – It’s More Than Just Adding An Alternative Payment Model
One of the sessions in the Provider Transformation track, ‘Do Medicare Changes Enhance or Hinder Clinical and Payment Transformation‘ emphasized the role of the primary care doctor in the shift from the dominant fee-for-service reimbursement model to new value-based-payment methods. Panelists also called out that to truly transform our health care system, change must not just focus on payment models but also deliver scalable clinical and operational methods. And HCEG members acknowledge this as “Operational Effectiveness” is ranked #8 on the 2019 HCEG Top 10 list.
Defining, Measuring, and Communicating Quality Measures are Key for Leveraging Social Determinants of Health
Another session titled “SDoH Business Strategy: Quantify and Communicate the ROI and VOI of SDoH Initiatives” shared the following key points and considerations for healthcare organizations looking to address social determinants of health as barriers to care:
Quality measures that incorporate social determinants of health must be developed and understood BEFORE starting programs and initiatives.
Readily available public data is not granular enough to capture SDoH factors needed appropriate quality measures.
Conducting clinical trials on proposed quality measures can help to understand and quantify the benefits of SDoH initiatives.
Incorporate patient/member personalization into a standardized, common infrastructure that enables economies of scale.
Predictive analytics – a perennially high-ranking item on HCEG’s Top 10 lists – is THE critical component of SDoH programs.
Combining clinical data from EHR’s with claims and other administrative/demographic data records allows health plans/health systems opportunities never before easily attainable.
Health plans, health systems, and providers must clearly understand and communicate the benefit that addressing social determinants of health can have for their members and patients.
Organizations should strive to assign a financial measure assigned to each quality measure.
CIO & CTO Strategy Track at World Health Care Congress
Alan Abramson shared four areas of focus for HealthPartners:
Formally chartering projects to deploy technology-based approaches to largely manual processes
Carving out and focusing on efforts to improve patient experience
Address inefficiencies in technology ecosystems, business policy, and processes
Establishing R & D projects to assess opportunities and benefits of new, emerging technologies
Increasing Operational Effectiveness in Health Plans & Health Systems
Alan went on to share that the #1 initiative his healthcare organization has been focusing on last year, in 2019 and will continue to focus on in 2020, is increasing Operational Effectiveness (#8 on the 2019 HCEG Top 10). Alan provided some examples as to how HealthPartners is achieving greater operational effectiveness including:
Utilizing Lawson Financials to consolidate multiple disparate functions
Rehosting and re-platforming administration systems such as employer group setup, utilization management reporting, new member enrollment, and patient admission, discharge and transfer.
Positioning systems, policies, and procedures to accommodate increases in individual health plan coverage
Consolidating four different laboratory systems into one system
Using Robotic Process Automation (RPA) to automate user administration and security
Using AI-powered bots to automate 27,000 software QA tests that took three weeks to complete and that now take 17 hours.
Alan noted that achieving success via ‘standardization’ in one area often leads to end users demanding improvement via standardization in other areas.
Payer-Provider Data Sharing and Interoperability Critical in Risk-Sharing Relationships
Kim Sinclair’s healthcare organization serves approximately 400,000 members and patients via its health plan, hospital, and medical centers – 80% of whom are Medicaid beneficiaries and represent 15% of the state’s Medicaid population.
Like other integrated healthcare delivery systems – especially those entering the nascent world of ‘accountable care,’ Kim noted that investments in provider network management and payer-provider interoperability have often lagged that of other initiatives. Moreover, a competitive market with many small medical practices lacking sufficient IT systems and a tendency to ‘throw bodies at a problem’ has increased the challenges her organization faces.
Kim also shared some examples of how her organization is addressing their challenges, issues, and opportunities:
Integrating various systems with a focus on creating an industry-leading accountable care organization (ACO).
Formal projects to identify and stratify members and patients with complex care management needs.
Revising policies, procedures, teams, and systems to effect a truly integrated system.
Reducing pended claims and time to pay – particularly important where both payer and provider are sharing risk.
Focusing on change management and investing in payer-provider interoperability and support.
Cybersecurity – Think Beyond Enterprise and Employee Training
In this CIO & CTO Strategy Track session, panelists discussed cybersecurity at the end-user level. They emphasized the importance of leadership having a strong grasp on the ‘foundational’ components of cybersecurity (patch management, identity/access management, perimeter security, etc.) And also encouraged the audience to pay attention to data assets outside their own four walls. For instance, the use of Software as a Services (SaaS) and 3rd parties they contract with (outsourced vendors) who possess their organization’s sensitive data.
HCEG board member Eric Decker and SVP of IT & CIO at Independent Health spoke about how his mid-sized health plan has evolved beyond the core technical cybersecurity team as the ‘first line of defense’ by chartering a Risk Office responsible for creating and testing their cybersecurity framework. His organization also has an Internal Audit team that regularly audits core controls as well as the cybersecurity framework.
Think holistically – consider the psychology of cybersecurity and how to optimize your workforce against threats.
Tim Thull, SVP of IT & CIO at Medica Health Plan spoke about how it is important to have strong oversight, governance, and controls framework around information risk management from your board of directors to individual staff. Medica has implemented HITRUST as common security framework with an information risk program which provides sound technology solutions and controls. Robust training and awareness remain a critical component in ensuring everyone is an active participant in strong cybersecurity defenses.
Optimize Information Sharing to Generate Real Value from Data
Latecia spoke about the importance of viewing data as a strategic asset, explained that “the ‘Why’ we share information matters” and offered some lessons learned during the Opioid Symposium and Code-a-Thon sponsored by HHS.
Data are in silos
Data sharing is inefficient
Analytics capacity is uneven
Data sharing is costly
Video Interviews by Mabel Jong at 2019 World Health Care Congress
One of the interesting and informative parts of the WHCC event was their WHCC TV feature where Mabel Jong – professional on-camera interviewer and panel moderator specializing in healthcare – does short interviews with keynote speakers, session panelists, and other healthcare leaders and champions participating in the Congress.
Mabel interviewed Ferris Taylor, recent Chief Operating Officer of Arches Health Plan and HCEG’s executive director. More about this interview will be shared as the recordings are released. In the meantime, you can find many of the interviews performed by Mabel Jong on the World Congress Events YouTube Channel.
HCEG Member Feedback on 16th Annual World Health Care Congress
HCEG Board members Cate McConnell, Healthcare Payer Industry Practice Lead at Appian Corporation and Eric J. Decker, SVP of IT & CIO at Independent Health shared their insight on the 16th Annual World Health Care Congress:
What was unique about the WHCC event?
Eric:The keynotes went right to the heart of the issues impacting our industry today (transparency, value-based payments, social barriers, member engagement, and affordability). Likewise, the breakout sessions were plentiful and offered a diverse array of topics to choose from.
Cate:WHCC, being in Washington DC, includes policymakers in greater numbers than most conferences. It was good to hear some of the interesting ideas shared by the policymakers. I would have liked to have more people from the current HHS/CMS administration who are shaping healthcare policy speak at WHCC.
How did WHCC’s event differ from what HCEG presents with its Annual Forum?
Eric:Many healthcare conferences – WHCC included – include limited time for questions and answers, not only in the keynotes but also the breakout sessions. The event had nowhere near the time that HCEG’s forum includes for questions (and even debate).
Cate:WHCC is much bigger than HCEG’s annual forum which leads to fewer and less intense opportunities for networking and discussion. The large exhibit hall/show floor can sometimes be a distraction.
What didn’t you see or what could have been better about WHCC?
Cate:Pricing transparency is ‘critical’ in healthcare – in terms of procedures, tests, and drugs – but there weren’t any discussions of how to do this, and what this means to provider compensation. The free market disruptors will likely force this on the industry, which appears unwilling/unready to address it themselves. A speaker made the point that of the two industries that don’t have price transparency – college education and healthcare – prices increase many times greater than inflation because there are no incentives to become more efficient.
What were some things you felt were ‘most important’ for WHCC attendees to absorb?
Cate:Many speakers acknowledged that disruption is coming and that Amazon, Google, and Apple are the prime disruptors. Yet most executives shrugged off this threat with “they will learn healthcare is complex.” This seems to be an “innovator’s dilemma” situation where current industry players are unable to disrupt themselves due to entrenched business models. But what will happen to healthcare if Amazon drives sweeping disruption as it did in retail? Are we ready for widespread bankruptcies?
“External Market Disruption” is ranked #7 on the 2019 HCEG Top 10 list.
Other Recaps & Insight from 2019 World Health Care Congress
Here’s a bit about what others are sharing from the 2019 HCEG Top 10 list at the 16th Annual World Health Care Congress:
A Unique Opportunity for Healthcare Executives, Leaders & Champions
The 16th Annual World Health Care Congress was a great opportunity for those working to transform the healthcare industry during these uncertain times. And the HealthCare Executive Group was honored to have partnered with World Congress Events to host the new CIO & CTO Strategy Track.
For another opportunity to learn about new strategies and approaches to addressing the challenges, issues, and opportunities facing healthcare leaders – and to establish new relationships to facilitate your organization’s digital transformation – consider joining other healthcare executives, leaders, and champions at our 2019 Annual Forum in Boston on September 9th through the 11th. The year’s agenda is centered around the following major themes supported by the 2019 HCEG Top 10:
Technology & Its Role in Transformational Industry Change
Digital Health: Consumer & Organizational
Pharmacy Costs and Opioid Management
In addition, all participants in our 31st Annual Forum will be treated to a special networking event between the Boston Red Sox and the New York Yankees at Fenway Park on September 9th – at no additional charge.
Health plan members and health system patients have become more vocal in their demands for clarity and measurable value from their healthcare services. Members see ever-increasing costs and continued transfer of those costs from employers to their employees. New direct to consumer entrants are changing the interaction paradigm. All of these factors are driving healthcare payers toward new ways of engaging with their members and providers.
HIMSS President and CEO Hal Wolf states, “Consumer pressure is driving a disruptive technology-enabled shift in healthcare today.” Accordingly, healthcare organizations and the companies supporting them are looking for ways to deliver their promise of value. This requires a better understanding of individual consumer preferences, better care coordinating, and better delivery across a broad health ecosystem.
New Generations of Healthcare Consumers are Demanding New Healthcare Services & Delivery Channels
In addition, digital generations—Millennials and Gen Z —are increasingly unsatisfied with how they obtain their healthcare services. Recent Accenture research1 found that one-third of millennials and almost half of Gen Z say they don’t have a primary care physician—compared to just 16% of baby boomers. Millennials are shifting the historical relationship between physician and patient to virtual, retail clinics and digital self-service.
Enabling Total Consumer Health and Improving Operational Effectiveness
The HealthCare Executive Group Top 10 list of challenges, issues, and opportunities facing healthcare leaders in 2019 and beyond reflects the importance of engaging health plan members and health system patients. Total consumer health—defined as improving members’ overall medical, social, financial, and environmental well-being—was ranked second on HCEG’s 2019 Top 10 list. And operational effectiveness—implementing lean quality programs, process efficiency, robotics automation, revenue cycle management, real-time/near-time point of sales transactions, and beyond—was ranked eighth.
It’s clear that healthcare organizations must rapidly develop services and products that engage healthcare consumers and help their organizations stay one step ahead of these major shifts in healthcare consumer preferences.
Address Changing Needs with Low-Code Application Development Platforms
Leadership charged with delivering healthcare products and services must address the changing needs of healthcare consumers in an agile, cost-effective way. Forward-thinking healthcare organizations are using low-code development platforms to digitally transform their organizations and efficiently respond to patient engagement opportunities.
What is a Low-Code Development Platform?
A low-code development platform2 allows you to build enterprise software applications using graphical user interfaces, drag and drop assembly and configuration. With low-code tools, you don’t write the application in traditional software code—you draw it like a flow chart. This greatly accelerates application development by orders of magnitude for both professional programmers and non-technical “citizen developers.”
Low-Code Platforms Enable Innovation, Accelerate Delivery and Improve Agility
Low-code platforms can help build applications that consolidate data, automate key processes, and enable mobile innovation. Instead of changing business operations to match the way commercial off-the-shelf (COTS) software works, companies can use to align their software systems with their business needs.
Low-Code Platforms Offer a Range of Benefits
Usability beyond software developers, easing the burden on IT
Extended existing applications and data across new channels and devices
Reduced IT sprawl, minimizing maintenance and related expenses
Flexibility to build new solutions using technology already owned
A fast and simple way to create powerful software
Key Features of High-Quality Low-Code Tools
While considering how your healthcare organization might speed up its digital transformation initiatives, keep in mind the key features of high-quality low-code tools include:
A single interface that ties together disparate systems so you can work no matter where data is stored
Enhanced security through a HIPAA compliant cloud
An API to allow drag-and-drop design to build your app once, then easily deploy to any device
Easy automation across people, robots, and machines
Areas Where Low-Code Platforms Can Quickly Add Value
No single commercial-off-the-shelf (COTS) software system can address all the member- and patient-related engagement opportunities that healthcare organizations face—at least not without high expenses and potentially long wait times for vendors to add functionality to their product. In addition, many COTS systems don’t integrate with other COTS and the myriad custom-developed systems healthcare organizations typically have installed.
Low-code development platforms can address many member- and patient-related business and functional needs. Capabilities include:
Integrating clinical data from providers with financial data from payers
Maintaining accurate and complete provider directories
Aggregating data to better coordinate patient services
Creating member- and patient-facing apps for scheduling services and accessing financial and clinical records
Providing real-time support for admissions and discharges
Handling complaints, appeals, and grievances automation
Managing simple, automated utilization and prior authorizations to ensure members understand what’s covered under their plans
Understanding out-of-pocket costs prior to obtaining services to help increase member satisfaction
More About Leveraging Low-Code Development Platforms
There are a number of good resources and references on low-code development platforms:
Transform Member & Patient Engagement Using Low-Code Application Development Platforms
The future of healthcare depends upon the ability to quickly adapt and provide quality and convenience for providers, payers, and most importantly, health plan members and health system patients. It takes speed and power to deliver transformational healthcare solutions. Low-code application development platforms provide both – enabling organizations to build web and mobile apps faster, run them on a HIPAA-compliant cloud, and manage complex processes, end-to-end, without limitations.
The HealthCare Executive Group (HCEG) is a professional association chartered to convene and support executive leaders of health plans, health systems, and provider organizations. Since the HealthCare Executive Group’sinception over 30 years ago, HCEG has offered membership to organizations providing direct insurance benefits and/or direct health services to groups or individuals, either as stand-alone entities or as subsidiaries under a commercial entity. Anoffid starting today, we’re announcing two new individual membership options for healthcare executives and leaders: Individual Membership and Alumni Membership. HCEG is retaining the existing Organizational Membership option for healthcare organizations preferring that option.
New Membership Options in HealthCare Executive Group
These two new membership options provide a pathway for more people to become part of the HealthCare Executive Group on a cost-efficient basis.
Candidates are executives from Payer/Provider Membership eligible organizations.
Past HCEG members who are unaffiliated with vendor organizations. Vendors provide products and services to HCEG member candidate organizations to better serve individuals.
For a very reasonable investment, healthcare executives and others leading the transformation of the healthcare industry can obtain benefits that can provide outsized returns on that small investment – only $99 dollars for a limited time!
Why Healthcare Leaders Should Join the HealthCare Executive Group
Individual Membership and Alumni Membership offer a variety of benefits all year round: Professional Networking & Relationships, In-Person/Live Events, Professional Development Opportunities, Resources, Research & News, and discounts to popular healthcare conferences.
Throughout the year, members can leverage HCEG’s platform, content, events, professional development, and networking opportunities to help them optimize their time, stay up to date on industry issues, enhance leadership skills, and obtain valuable resources to share with their staff and help transform their healthcare organization.
Professional Networking & Relationships for Healthcare Executives
Our members have unparalleled, year-round networking opportunities centered upon a calendar of events and content identified and defined by HCEG members and updated throughout the year via input and research from members and sponsor partners. Our mission and focus are to provide the platform, channels, content and on-going support for convening and connecting our members with their peers, industry thought leaders, and other resources critical to the transformation of the healthcare industry.
In-Person/Live Events for Healthcare Leaders Transforming Healthcare
HCEG offers its members various opportunities to connect with peers and other industry leaders in live, face-to-face venues throughout the year. These events are typically free to HCEG members or are discounted based on HCEG membership.
Executive Leadership Roundtables
Our quarterly Executive Leadership Roundtables(ELR) are bundled with popular healthcare conferences like the AHIP Institute and HLTH Forum. These ELR’s are intimate, participatory opportunities to learn from prominent industry thought-leaders, share ideas and obtain advice and real-world experience from others.
HCEG Annual Forum
As an Individual Member or Alumni Member, you’ll receive discounted registration to our Annual Forum held in September of each year. Our Annual Forum is our marquee event and includes not only prominent keynote speakers but also unique extracurricular networking opportunities. Check out thisrecap of the 2018 Annual Forumcelebrating HCEG’s 30-Year Anniversary.
Individual & Alumni Member Discount to 2019 Annual Forum
After registering as an Individual Member or an Alumni Member and paying the membership fee, new members receive a discount code (via pop-up window and email) to HCEG’s 2019 Annual Forum. This code can be used immediately or at a future date.
Also, and you’re hearing this for the first time here, HCEG members attending our 2019 Annual Forum in Boston, MA on September 9th through 11th will enjoy a very unique, uncommon extracurricular networking event. For more information on what this event includes, contact us.
Thought-Leadership & Professional Development Opportunities for Healthcare Executives
In addition to quarterly ELR’s, our Annual Forum, and partner events, HCEG also offers our members various opportunities for participating in webinars, research surveys, blog posts, and other knowledge sharing channels.
Webinars & Online Discussion Group Opportunities for Healthcare Executives
In addition to attending HCEG’s monthly Webinar-Series events, HCEG members have the opportunity to help define webinars and serve as panelists. In addition, HCEG hosts period online discussions and encourages member participation as an important way for members to demonstrate their thought leadership and grow their network.
Research Surveys for Healthcare Executives & Thought-Leaders
The Industry Pulse research survey is based on the HCEG Top 10 and administered in a partnership between HCEG and sponsor partner Change Healthcare. The 9th Annual Industry Pulse was just released last week and promises to be a source of many reviews, discussion, and elaboration over the coming months and year.
Knowledge Creation, Content Sharing & Promotion for Healthcare Executives
Our members enjoy the opportunity to share information, insight, and ideas with each other and the industry at large via various HCEG channels including our blog, bi-weekly eNewsletter, and social channels. In addition, HCEG promotes certain member insight and content to amplify member content on best practices, new ideas, breaking news, and key advancements.
Become a HealthCare Executive Group Member Today
As uncertainty continues its grip on healthcare in the United States and new digital technologies advance digital transformation opportunities, it’s more important than ever for healthcare leaders to stay abreast of important industry trends, challenges, and opportunities.
Value Well Beyond Conferences, Webinars, & Content
Individual membership in the HealthCare Executive Group is a very cost-effective way for healthcare leaders to reduce uncertainty, stay up to date on changes within their field, and help to transform their organizations.
Special Discount on HCEG Individual Membership
As an additional incentive to join HCEG as an individual, we’re offering a $50 discount off the regular $149 per year rate for a limited time. Use KickoffPromo to expand your knowledge and grow your professional network for only $99!
The HealthCare Executive Group (HCEG) has been convening and supporting leaders of health plans, health systems, and provider organizations for over three decades. Similarly, and for nearly two decades, the World Health Care Congress has been connecting leaders from all parts of the health care ecosystem to catalyze and support relationships that ultimately transform the delivery, affordability, and quality of health care. And next month starting April 28th, the 16th Annual World Health Care Congress (WHCC) convenes in Washington, DC with over 1,500 of the industry’s best and brightest minds gathering to learn from peers, form new relationships, share insights and strategies, and discuss policy, innovation, and disruption impacting individual organizations and the healthcare industry as a whole.
Special discount to 16th Annual World Health Care Congress when registering with HCEG2019
HCEG Partners with WHCC on CIO & CTO Strategy Track
In this year’s 2019 World Health Care Congress, the HealthCare Executive Group is pleased to partner with WHCC to provide and moderate the CIO & CTO Strategy Track – a series of sessions designed to bring together policymakers, technology leaders, and health plan and health system professionals supporting enterprise decisions around information technology. The sessions presented in this track will be based on select items on the 2019 HCEG Top 10 list of challenges, issues, and opportunities facing healthcare leaders.
This post provides some insight into CIO & CTO Strategy Track sessions, the healthcare champions who will be presenting and participating in the various sessions, and presents a unique discount offer for HCEG members and associates considering attending this high-profile healthcare event.
Digital Technology – The Foundation of Healthcare Innovation and Disruption
While most of the sessions at the WHCC are focused on strategy, leadership, business transformation, and policy, the sessions in the CIO & CTO Strategy track will share insight, ideas, and actionable information on digital technology-related topics identified by HCEG members and associates in the 2019 HCEG Top 10 list – specifically:
Data Analytics (Top 10 Item #1)
Importance of Useable Technology (Top 10 Item #5)
Pharmacy Costs and Transparency (Top 10 Item #6)
External Market Disruptors (Top 10 Item #7)
Cybersecurity (Top 10 Item #10)
In addition, HCEG’s board chair Kim Sinclair, executive director Ferris Taylor, and board member Alan Abramson will share insights on the 2019 HCEG Top 10 list of primary challenges, issues, and opportunities.
Technology-Focused Sessions Supporting Healthcare Innovation and Disruption
There are eighteen different tracks at the 16th Annual World Health Care Congress – something for everyone that can be mixed and matched to meet specific areas of interest and need. Use HCEG2019 when you register here to receive a discount not generally available to everyone.
Here are the sessions in the CIO & CTo Strategy Track that HCEG has partnered with the World Health Care Congress to present:
Optimize Information Sharing to Generate Real Value from Data (HCEG Top 10 Item #1)
Insight and examples of why using technology for technology’s sake simply do not work will be shared along with a discussion of machine language and artificial intelligence’s promise in flagging fraudulent activity more quickly; alleviating waste and abuse.
Cybersecurity – Think Beyond Enterprise and Employee Training (HCEG Top 10 Item #10)
Mon, April 29th at 2:30 pm
Jothi Dugar, Chief Information Security Officer in the Office of the Director at the NIH Center for Information Technology will join HCEG board member Eric Decker, Sr VP of IT & CIO at Independent Health, and HCEG Secretary Tim Thull, Sr VP & CIO at Medica to discussion cybersecurity – ranked #10 on the 2019 HCEG Top 10.
Discussion topics include:
Addressing cybersecurity at the end-user level by considering the psychology of cybersecurity and how to optimize your workforce against threats
What’s holding health care back from sophisticated approaches to providing private, secure PHI
Healthcare Innovation and Disruption Highlighted in HCEG Top 10 List & Industry Pulse
On Tuesday, April 30th at 2:25 pm, HCEG board chair Kim Sinclair, CIO at BMC HealthNet Plan, executive director Ferris Taylor, and board member Alan Abramson, Sr VP of IT & CIO at HealthPartners and Co-Chair of the Minnesota eHealth Advisory Committee will present ‘The HCEG Reveal: What CIOs and CTOs Care about Most in 2019 (and Why You Should Too).’ In this session, an overview and their insight on the 2019 HCEG Top 10 list of challenges, issues, and opportunities facing healthcare executives in 2019 will be shared including an overview of the impact the HCEG Top 10 can have on members, patients, providers, and others in our increasingly digital world.
The 9th Annual Industry Pulse Survey – Perspectives on Healthcare Innovation and Disruption
Attendees of ‘The HCEG Reveal’ session will also enjoy insight and commentary on the 2019 Industry Pulse research survey – an annual survey based on the 2019 HCEG Top 10 and scheduled for release in the weeks before the World Health Care Congress event. This 9th instance of the Industry Pulse looks not only at the marketplace challenges, trends, opportunities, and investments reported by industry leaders but also compares and contrasts those findings with what was uncovered in past Industry Pulse surveys.
More Details on 16th Annual World Health Care Congress and CIO & CTO Strategy Track
Here’s additional information on the 16th Annual World Health Care Congress. Feel free to reach out to us or contact WHCC if you have any questions regarding registration for this world-class healthcare event.
HCEG is pleased to offer its members and associates a special discount to this year’s 16th Annual World Health Care Congress. Use HCEG2019 when you register here to receive a discount not generally available to everyone.
Connect w/ HealthCare Innovators and Disruptors at 16th Annual World Health Care Congress
As uncertainty retains its grip on the healthcare sector, healthcare leaders now – more than ever – need to stay on top of the policies, regulations, technologies, and trends shaping the market. Consider joining your peers at the 16th Annual World Health Care Congress on April 28th in Washington, DC and register today!
Stay Connected with HealthCare Innovators and Disruptors
Healthcare leaders and those championing the transformation of healthcare can subscribe to our eNewsletter to stay abreast of information, events, and networking opportunities in 2019 and beyond.
The 2019 HIMSS Global Conference & Exhibition adjourned on Friday, February 15th with 45,000+ professionals from 90+ countries, 1300+ exhibitors, 300+ education sessions spanning 24 topics and 100’s of special programs and networking events taking place over the nearly weeklong event. And HealthCare Executive Group (HCEG) members, sponsor partners, and other Champions of Health were in attendance.
HCEG Executive Director Ferris Taylor – A Champion of Health
This post presents a few highlights and resources from the conference including:
Dr. Karen DeSalvo – Former Office of the National Coordinator for Health Information Technology (ONC)
Aneesh Chopra – First Chief Technology Officer of the United States
All of these Champions of Health discussed what was expected to be major HIMSS conference themes: Data Interoperability, Information Blocking and open API’s based on the Fast Healthcare Interoperability Resources (FHIR) standard. All of which got a boost on the opening day of the HIMSS conference with the CMS and ONC release of new rules intended to make data more accessible.
Champions of Health Discuss Interoperability and Value-Based Care Delivery
On Wednesday evening, another Champion of Health, CMS’s Deputy Administrator and Director of the Center for Medicare and Medicaid Innovation (CMMI) Adam Boehler joined John Doerr, Chairman of Venture capital firm Kleiner Perkins and Aneesh Chopra for an interesting and occasionally provocative discussion on The Intersection Between Interoperability and Value-Based Care Delivery.
As the session title indicates, the discussion centered around the topics of liberating healthcare data and addressing incentives to change payment from fee-for-service to value-based payments. This was an interesting discussion in that none of these three individuals are clinicians but rather brought what was clearly a business focus to the discussion.
Four Key Considerations for Revising Healthcare Incentives
Adam Boehler noted four key considerations for healthcare leaders to address in their quest to revise incentives and effect true change in the healthcare ecosystem
Treat patients as consumers
Help providers become more accountable for outcomes
Adjust incentives to reward more preventive services
Improve how payment policies are aligned to outcomes
Interesting Comments from Champions of Health at 2019 HIMSS Conference
A few interesting comments were made during the chat.
Aneesh Chopra, John Doerr, & Adam Boehler (R)
From John Doerr:
“There is not currently any business case for a large health system to replace their installed EHR system”
“What I believe is missing is a platform to make value-based care more successful and accelerated. We need to blow up fee-for-service to make these platforms happen”
“Artificial intelligence has been overhyped and is now underappreciated”
“On the current trajectory, the United States won’t win the artificial intelligence race”
From Adam Boehler:
“CMMI is a real treasure trove of information [regarding payment model innovations and programs] that is not being taken advantage as much as it should be by healthcare industry participants“
North Carolina as a Hotbed for Healthcare Innovation
Additionally, the group discussed some of the organizations, programs and individuals working on innovative and other potentially transformational changes in various areas around the country. In particular, North Carolina was noted by all as leading the way in the area of value-based care, reimbursement, and improving outcomes.
Seemingly every speaker positively acknowledged that North Carolina is a hotbed of healthcare innovation with John Doerr stating “If what’s happening in North Carolina won’t work, we’re hosed.”
More About Value-Based Care & Delivery – 2019 HCEG Top 10 Item #4
The discussion between Adam Boehler, Aneesh Chopra, and John Doerr in the Orange County Convention Centers Chapin Theater was an insightful, entertaining, comfortable, and welcome break at the end of the 3rd day of the HIMSS conference. Sitting in those comfortable seats at the end of three days of walking, standing and talking made the information, opinion and occasional levity shared among these three healthcare leaders all the more enjoyable.
For every year since the HCEG Top 10 list of challenges, issues, and opportunities have been created by HCEG members, value-based payments have been included on the list. In 2018, value-based payment was ranked as #3 on the list – this year it’s ranked #4. One of HCEG’s members will be writing a guest post covering more of the discussion that ensued during The Intersection Between Interoperability and Value-Based Care Delivery.
Subscribe to our eNewsletter for more on this specific session and other topics of interest to healthcare executives and thought leaders.
Inspirational Stories from Champions of Health at 2019 HIMSS Conference
Not everything in Orlando was just about technology, policy and the business of transforming healthcare. There were sessions featuring inspiring, true-life stories of courage in dealing with the clinical, administrative and financial aspects of the American healthcare system.
Cris Ross, CIO of the Mayo Clinic, shared about his personal struggle with dealing with the very healthcare ecosystem in which he had a role in creating. See this account of some of the challenges Cris Ross faced.
Above the scene view of HIMSS TV crew – Monday, 2/11/19
Whether you attended the HIMSS conference or not, you can access many of the presentation decks shared in the 300+ educational sessions. For information on how to access presentations from HIMSS sessions, see this easy 3-step process here.
What are Others Saying About the 2019 HIMSS Conference?
Thankfully, there’s no shortage of recaps, summaries, post-conference analyses and opinion pieces that can serve to help cut through a lot of the hype and chaff that’s unavoidable in a large conference like the annual HIMSS conference. Here are a few summary recaps that may be of interest.
In addition, our sponsor partners shared via HIMSS formal, live-streamed sessions, hosted luncheon session for attendees to share their experiences with blockchain technologies, offered complimentary smoothies throughout each day, and in general helped attendees to get the most out of their HIMSS conference experience.
More Opportunities for Champions of Health to Convene, Share, & Network
Events like the 2019 HIMSS Global Conference & Exhibition are great opportunities to get a feel for and gain a better appreciation for what’s going on across the entire healthcare ecosystem. There are so many challenges, issues, opportunities, and uncertainties that must be triaged on a daily basis. To many people, meeting and interacting with other individuals, communities, groups, vendor companies and other organizations in a meaningful – however brief – moment is what these conferences are all about.
To continue our mission of convening and supporting Champions of Health, the HealthCare Executive Group offers the following opportunities to healthcare executives and other leaders:
16th Annual World Healthcare Congress – Washington, DC – April 28 – May 1, 2019
Use HCEG2019 for a special HCEG-only discount to this important annual event. Feel free to contact us for more information.
Our 2019 Annual Forum – Boston, MA – Sep 9-11, 2019
HCEG’s 2019 Annual Forum takes place in Boston, Massachusetts on September 9 – 11, 2019. Our planning of the agenda, speakers and special networking events continues and we are close to opening up registration. To learn a bit about last year’s annual forum and see some pictures, check out this recap. And click here to be added to a list to receive the latest information on our 2019 Annual Forum as it becomes available.
The 2019 HIMSS Global Conference & Exhibition kicks off this coming Sunday in Orlando, FL and runs through Friday, February 15th. 45,000+ professionals from 90+ countries, 1300+ exhibitors, 300+ education sessions spanning 24 topics and 100’s of special programs and networking events will converge to offer comprehensive insight into the current state of the healthcare industry. In addition to many of our members and sponsor partners in attendance, board members of the HealthCare Executive Group (HCEG) and a couple support staff will be gathering content of interest to share, networking and supporting our sponsor partners.
Items on the 2019 HCEG’s Top 10 List Dominate
Not long after last year’s HIMSS Conference came to an end, industry thought leaders, prominent analysts, and media outfits covering the digital healthcare space started predicting the major themes and top trends expected to dominate this year’s HIMSS conference. These themes and trends include…
HCEG Members & Sponsor Partners at the 2019 HIMSS Conference
If you’re at the HIMSS Conference, be sure to check out our sponsor partners exhibits, sessions and the special events they’re hosting. Here are those we know about at this time.
Visit Booth 6543 to learn about Appian’s leading platform for low-code enterprise development. Appian will be providing live demos of their platform on Tuesday, February 12th at 11:30 am – addressing topics such as Clinical Trials Intake, Clinician Onboarding and Credentialing, Home Health Manager, Provider Payment Reconciliation, Utilization Management, and more!
Be sure to Refresh and Rejuvenate Yourself – and your phone – as Appian will be offering complimentary healthy smoothies throughout booth hours each day, along with a relaxing device charging station area for you to take a break. And while you’re at the Appian booth, be sure to have your badge scanned for a chance to win a Vitamix to create your own smoothies at home or an Apple Watch Nike Plus Series 4 to track your healthy habits.
For more information and to schedule a meeting with Appian at HIMSS, contact Appian
Visit Booth 6158 to learn about the offerings of our newest sponsor partner Surescripts. Surescripts will also be sharing information on their products and services in Booth’s 9100-44 and VHQ8659
Other HCEG Sponsors & Partners at 2019 HIMSS Conference
In addition to the above, our other sponsors and partners will be represented at the 2019 HIMSS Conference & Exhibition in some capacity. Check out their leading healthcare products/services and reach out to them for more information.
Resources to Help Conquer the 2019 HIMSS Conference & Exhibition
This year, HIMSS will be live-streaming a number of sessions. Whether you’re attending or not, consider checking out these live-streamed sessions.
Learn more about the companies exhibiting at the conference here. Also, HIMSS has a comprehensive list of all the vendor/exhibitor categories and subcategories to help you refine your list of must-see vendors and exhibitors.
Popular Hashtags at the 2019 HIMSS Conference & Exhibition
Whether you’re attending the 2019 HIMSS Conference or not, you can stay connected with the popular themes and topics – and general HIMSS19 subject by using the following hashtags:
#HIMSS19 = The official hashtag for the 2019 HIMSS Conference
Keep your eyes peeled for more information, insight, and ideas that HCEG members, sponsor partners, and advisors will be gathering from Orlando this coming week. A special ‘HIMSS19-edition’ eNewsletter will be shared later next week including major takeaways, insights from conference thought leaders and some pictures capturing HCEG member and sponsor partners experiences at the conference. If you aren’t already a subscriber to our newsletter, you can sign up here.
Save the Date – 2019 HCEG Annual Forum – Boston, MA
HCEG’s 2019 Annual Forum takes place in Boston, Massachusetts on September 9 – 11, 2019. We’re working on developing an interesting agenda and lining up some great speakers. To learn a bit about last year’s annual forum and see some pictures, check out this recap. And click here to be added to a list to receive the latest information on our 2019 Annual Forum as it becomes available.
As January nears to a close and nearly all of us have already abandoned our New Year’s resolutions, we want to share what’s been going on in the last month or so with the HealthCare Executive Group (HCEG); and share about what’s in-store for HCEG members and associates over the next month.
Read on for more about the following:
Recap of Our Executive Leadership Roundtable at AHIP’s CX & Digital Health Forum
2019 HCEG Top 10 List in the News
The 9th Annual Industry Pulse Research Survey
Executive MindXchange – The Payor & Provider Ecosystem Evolution
2019 Annual Form of American Association of Payers, Administrators and Networks
2019 HIMSS Conference & Exhibition
Recap of Our Executive Leadership Roundtable at AHIP’s CX & Digital Health Forum
In December, we hosted an Executive Leadership Roundtable (ELR), Immediately after AHIP’s 2018 Consumer Experience & Digital Health Forum (AHIP CDF) adjourned in Nashville, TN. Brian Lobley, President, Commercial and Consumer Markets at Independence Blue Cross and Stuart Hanson, Managing Director, Head of Healthcare Payments at JPMorgan Chase & Co chaired the ELR with HCEG’s Executive Director Ferris Taylor moderating.
The roundtable leaders and about 30 participants shared insight on Consumer Experience & Digital Health – the theme of AHIP’s forum – on an intimate basis over the course of 2+ hours.
By the way, you can access additional information about HCEG’s 2018 Annual Forum including session materials, participant roster, and more here.
The 9th Annual Industry Pulse Research Survey
The results of the 9th Annual Industry Pulse – a research survey co-sponsored by HCEG and our sponsor partner Change Healthcare – will be released in the next month or so. This important healthcare industry survey is based on the 2019 HCEG Top 10 List and offers a deeper dive into the top challenges, issues, and opportunities facing healthcare leadership. Here’s last year’s 2018 Industry Pulse report.
Be sure to review the results of this in-depth research survey to stay abreast of industry trends, current leadership insight and the what others think are the opportunities, issues and challenges facing leaders in the American healthcare industry. Share your email here and we’ll be sure to send you a copy.
Executive MindXchange – Explore the Payor & Provider Ecosystem Evolution
Starting Sunday, January 27th, payers, providers and healthcare technology executives will collaborate for three days in San Diego, CA to discuss and advance a shared vision of the changing world within the healthcare ecosystem. Check out this page for more information and save $250 by using the “HCEG” discount code when you register.
2019 Annual Form of American Association of Payers, Administrators and Networks
At the same time as healthcare leaders are ‘Exploring the Payor & Provider Ecosystem Evolution’ in San Diego, the American Association of Payers, Administrators and Networks (AAPAN) 2019 Annual Forum is similarly bringing together leaders from health plans, provider networks, 3rd party administrators and care management organizations to collaborate on ideas that surely won’t stay in Vegas long.
2019 HIMSS Conference & Exhibition
Many HCEG members, sponsors, partners, and associates will be attending the granddaddy of all healthcare conferences – the 2019 HIMSS Conference & Exhibition – in Orlando, FL next month. We’ll be sharing information in an upcoming blog post including a list of who’s attending, speaking and exhibiting.
Whether you’ve already abandoned our New Year’s resolutions or not, don’t abandon the opportunity to connect with, share and learn about the challenges, issues, and opportunities facing healthcare leadership in 2019 and beyond. As the article on resolutions listed, don’t let Procrastination, not having a game plan, and/or ‘doing it alone’ prevent you from being ‘in the know’ during these uncertain times in healthcare.
It’s no surprise to anyone working in healthcare that healthcare consumerism and digitally enabled organizations that support healthcare consumers and patients are top of mind for today’s healthcare executive leadership. Indeed, Total Consumer Health and The Digital Healthcare Organization are ranked #2 and #5 respectively on the 2019 HCEG Top 10 list of challenges, issues, and opportunities facing healthcare executives.
Topics Discussed at HCEG’s Recent Executive Leadership Roundtable in Nashville, TN
As is the approach with all ELR’s hosted by the HealthCare Executive Group, the theme presented and the topics were aligned with and built upon the theme of the anchor event: Consumer Experience & Digital Health:
Catalysts for Healthcare Consumerism
Turning Passive Health Plan Members and Patients into Active Consumers
How Value-Based Relationships Change How Healthcare Stakeholders Engage with Their Members and Patients
Independence Blue Cross and JP Morgan Chase Perspectives on Member Engagement
Impact of New Competition and Innovations on “Healthcare Consumerism”
This is the first post of a two-part series recapping the information, insight, and ideas shared during the nearly three-hour long executive leadership roundtable event held on December 13th, 2018.
Helping Simplify Healthcare Decisions
One theme throughout the 2018 AHIP CDF was that most compelling opportunities to improve healthcare lie in making the complex simple. In healthcare, there are simply too many transactions that add friction and create misery for the very people who can ill-afford to experience them. These transactions must be imbued with both humanity & simplicity.
Ferris Taylor kicked off the discussion by asking panelists:
What is being done now or can be done soon to help people understand their healthcare options?
Brian Lobley noted the importance and value of healthcare consumers working with and through their PCP or other physician(s) primarily responsible for providing their care. He noted that many primary care physicians will only work within their own healthcare system and will often not suggest any services from other providers outside that healthcare system – even if it were in the patient’s best interest clinically and/or financially. Brian went on to state that until consumers bear more of the cost there will not likely be any appreciable change
Discussion ensued that short benefit periods preclude most health plans or other risk-bearing organizations from investing in people’s health. Everyone seemed to agree that longer benefit periods or some way of sharing individual healthcare costs over a period of multiple years and perhaps across multiple payers would go a long way toward improving individual outcomes and lowering overall costs.
Integrating Services into Physician Workflow and Patient Life Flow
Roundtable participates agreed that in order to maximize consumer and patient benefit and to minimize physician burnout, diagnostic and therapeutic procedures must be intelligently integrated into physician/clinician workflow and the patient’s life-flow.
Physicians and patients simply don’t want to be told what to do but rather provide and obtain needed services as conveniently as possible and as part of their individual, respective day to day workflow and life-flow. As Ferris stated: ‘Make the right thing the easy thing to do!’
Democratizing Healthcare Decision-Making and Control to Consumers and Patients
“Until healthcare is democratized, it’s going to be very hard for consumers to really take control. Right now, healthcare consumers really don’t have much choice because it’s the employers who choose the health plan and the employers who make all the contracting and payment decisions. Until consumers have more choice and can make more of the primary decisions, there won’t be any major improvement.”
Tipping Points to a Truly Consumer Driven Healthcare Industry
One roundtable participant asked:
“What are your predictions on what the tipping points are that would get us to the truly consumer-driven industry much like retail or other things?”
JP Morgan’s Stuart Hanson stated that consumers and employer groups are fed up and taking action on their own and not waiting for the government or health insurance plans to address high costs and inconsistent outcomes:
“I think we are there now with the current member populations of most health plans. Consumers are fed up. They’re asking their physicians harder questions. They’re challenging how their health plans adjudicate claims. They’re actually reading their EOB’s and trying to understand them. And now employer groups are demanding change.”
“But the industry has not adapted to employer and member demands so that’s why there are employer-driven initiatives like the Comcast-IBX initiative and the Amazon Berkshire Chase consortium that are driving employer-based change.”
Stuart and Brian went on to share information and insight on two nascent employer group consortiums they are each involved with:
The 50/50 joint venture between the parent company of Brian Lobley’s Independence Blue Cross, Independence Health Group, and Comcast.
Healthcare – Particularly Pharmacy – is a Huge and Growing Expense
One participant stated loudly: ‘Drug prices and their outcomes must be addressed!’
Stuart shared that, after salary and facilities (rent), healthcare is the 3rd largest expense for most employers. And that pharmacy is the largest and fastest growing part of overall healthcare expenditures. Brian noted that big pharma, and specialty drugs in particular, will eventually sink U.S. healthcare if pharmacy costs are not addressed soon.
The idea that a single payer or ‘Medicare For All’ movement can solve America’s healthcare crises was floated. Brian noted that many people fail to realize that these approaches are still based on a combined government-private solution and that many of today’s cost and outcomes challenges will not necessarily be fixed.
Increase in Home-based Care – Opening Opportunities for Non-Traditional Providers
As the home becomes more accessible physically and virtually via new technologies like voice, home-based medical and non-medical services provided in the home will help accelerate the tipping point. Brian pointed to the recent purchase of GreatCall by Best Buy and his own company’s partnership with Comcast. There was general agreement that the access that Best Buy’s Geek Squad and Comcast’s CATV installers have to the residential market offer great potential to engage with and influence healthcare consumer behavior.
Questions from Healthcare Leaders Participating in HCEG’s Executive Leadership Roundtable
Our roundtable events are free-flowing discussions and the eventual direction of each roundtable event is often dictated by where attendee interaction takes us. And participants at our ELR did ask questions and participate without being prodded:
Who do you think is the next Kodak in the Healthcare Industry?
ELR participant Dr. Kyra Bobinet, MD asked panelists: ‘Who do you think the next Kodak will be in the healthcare space?’
Stuart responded: “Health plans” and noted how there used to be 100+ BCBS health plans and now there are less than 40.
And Brian added: “Hospitals” and noted that there are way too many beds available and hospital facilities and real estate holdings are huge expenses. And the movement of more home-based care is only exacerbating this shift in care settings.
Where do you see benefit design going to actually support true prevention?
Participant Kristen Valdes, CEO of b.well, raised the topic of more and more employer groups wanting to offer preventive and other services that are not often available in many health plan benefit packages. Kristen shared:
‘We are seeing employers in our market wanting to pay for true prevention and we’re having to create programs. Employers are willing to pay (for preventive services) outside of their medical benefit.’
Kristen also noted that more healthcare organizations are offering their members and patients the opportunity to undergo genetic testing as part of a routine primary care visit. Increasingly, analytics are able to interpret these test results in terms of identifying the total cost of an individual based on providing care or not providing care.
The vision is that these services will provide physicians with relevant information to inform personalized treatment decisions for their patients, such as offering preventive steps to patients at risk for hereditary conditions.
Brian Lobley shared his opinion that the healthcare industry is a ways away from more widespread use of genomic and related testing because many individuals are afraid to use these tests based on a fear that the results may be used against them. Several participants shared that they find it hard to believe that someone will allow themselves to be exposed in terms of what their genomic testing reveals about their potential cost of care.
Why Have Health Plans, Physicians and Provider Organizations Not Partnered to Go Against Big Food?
Cate McConnell, Healthcare Change Leader at Appian, questioned why traditional healthcare constituents have not organized to lobby and make attempts to change the negative effect that many of the foods consumed in America have on an individual’s healthcare.
While no one offered an explanation, one participant did reference a recent article claiming that ‘gut health’ can be more important than ‘heart health.’ And Dr. Kyra Bobinet shared that nutrition and proper food choices are her passion and that anyone interested in learning more could reach out to her for more information.
Your Disease Does Not Define Who You Are
To illustrate the importance of how most people view their healthcare status and need, Ferris Taylor shared a description of one’s healthcare state does not define them:
“My wife has diabetes but she isn’t a diabetic. She’s a mother. She’s a grandmother. She sings in a choir. She has a life. She’s in the community. She wants to deal with that one element of her life but get on with all the rest of her life.”
The Four Constituents of Well-Being
In response to Ferris’s share that the state of our health does not define who we are as individuals, Dr. Kyra Bobinet shared that scientific studies have shown that four primary constituents rooted in neural circuits have a significant influence on our well-being:
Resilience: the rapidity with which we recover from adversity; some people recover slowly and other people recover more quickly.
Outlook: the ability to see the positive in others, the ability to savor positive experiences, the ability to see another human being as a human being who has innate basic goodness.
Attention: the ability to voluntarily bring back a wandering attention over and over again is the very root of judgment, character, and will.
Generosity: altruistic behavior activates circuits in the brain that are key to fostering well-being.
Kyra shared that practicing these four skills can provide the substrate for enduring change, which can help to promote higher levels of well-being in our lives. Turns out, well-being is a skill that can be practiced and strengthened.
More About Healthcare Consumerism & Digitally Enabled Organizations
In the second post recapping our Executive Leadership Roundtable, we’ll share insight and ideas on the following topics that were presented and discussed:
How social determinants of health are becoming a driver of consumer health business objectives
Three steps for jump starting digital transformation
What was not addressed at the AHIP CDF that participants thought should have been addressed
ELR participant responses to certain statements and claims during the AHIP CDF