Over 30 years ago, C-suite leaders of healthcare organizations came together to form the Managed Care Executive Group (MCEG) – a peer-to-peer mentoring concept used to help its members solve their problems with input and advice from other group members. And 60 years before MCEG was born, Napoleon Hill – author of the popular book Think and Grow Rich – shared the idea of Mastermind Group. In 2014, the Managed Care Executive Group rebranded as the HealthCare Executive Group (HCEG) and continued its mission as a Mastermind Group for healthcare executives.
More Than a Conference Organizer, Media Outlet, or Online Networking Group
In its essence, the HealthCare Executive Group is a Mastermind group comprised of senior healthcare executives and industry leaders focused on transforming the healthcare system. HCEG is not purely a conference organizer, a media/content producer, or promoter of online events but rather an organization chartered to convene and support executive leaders of health plans, health systems, and provider organizations – throughout the year – in their mission to affect true change in our failing healthcare system.
The majority of HealthCare Executive Group members are senior executives associated with health plans, health systems, and risk-bearing provider groups. Memberships at the individual and company levels are available each providing various levels of benefits including discounted to complimentary access to our Annual Forum, events, thought-leadership, and personal development opportunities.
Partnering to Enhance Collaboration, Content and Networking Opportunities
HCEG has established both formal and informal partnerships with complementary organizations that also serve our members and other healthcare industry participants associates. These partnerships extend and complement the content, networking opportunities, and value offered by HCEG and its partners. For 2020, these partnerships include:
“The conference is a great conference for the level of executives and people that you have in the room talking about issues. There’s not a lot of primers at this conference which is nice. You’ve got people who are ready to dig deep on issues and can have executive-level conversations pretty quickly. And yesterday, I identified three or four potential partnerships between our organizations and how we can work to solve some of these issues together.” – Ricardo Johnson, Senior Director Healthworx at CareFirst BlueCross BlueShield
“I think they nailed the 2020 Top 10 list (of challenges, issues, and opportunities facing healthcare leadership.) I mean it, really every item on there would have been in the top of my list as well. I think that this group of people has really identified the top issues in the industry and gathered folks who are uniquely qualified to speak to them.” – Sara Stevens, VP of Healthcare Economics & Analytics Ops at Capital District Physicians’ Health Plan
“I think the word is it’s (HCEG’s Annual Forum) still intimate by design. We like to keep it roughly a hundred or so people. The last thing we wanted to be is a giant circus of people who don’t have the chance to share information and have an intimate discussion – so that’s by design.” – Richard Lungen, Managing Member at Leverage Health
A limited number of healthcare industry product and service vendors serve as sponsor partners to underwrite and assist with HCEG’s events, programming, and content. HCEG’s sponsor partners play a role unlike many vendors who sponsor other healthcare events. Rather than dominating speaker positions, exhibiting products in a booth, or littering HCEG’s physical and digital channels with sales messages, HCEG requires its sponsor partners to serve in a supportive, consultative role on a year-round basis.
Sponsor Partners of HCEG contribute to ongoing educational initiatives and benefit from increased visibility through our year-round thought leadership opportunities via:
Last year was a very busy year for the HealthCare Executive Group (HCEG.) In addition to hosting our 31st Annual Forum in our birthplace of Boston, Massachusetts, HCEG hosted two Executive Leadership Roundtables, presented the CIO & CTO Strategy Track at the 16th Annual World Health Care Congress, delivered seven webinars in conjunction with our sponsor partners, published 35 blog posts addressing challenges, issues, and opportunities facing healthcare leadership, and presented at several of our partner’s conferences and events.
Moreover, in 2019 HCEG became an Educational Partner with America’s Health Insurance Plans (AHIP) and a Collaboration Partner with the Health Information Management Systems Society (HIMSS.) For 2020, we have an equally insightful and interesting agenda of live, in-person and virtual events and content in store.
Looking Back at HCEG Events – Live, In-Person & Virtual Healthcare Innovation & Transformation
31st HCEG Annual Forum
Our 2019 Annual Forum marking our 31st annual event since HCEG was founded in 1988 took place in Boston, Massachusetts – the birthplace of the HealthCare Executive Group. Check out this page for the agenda, photos, and some proceedings from the forum. You can also view video interviews of various speakers and attendees here.
In addition, HCEG presented the CIO & CTO Strategy Track at the 16th Annual World Health Care Congress. This track consisted of six separate sessions over two days. See the recap of the WHCC event and the CIO & CTO Strategy track presented by HCEG here.
2020 HCEG Top 10 List & 10th Annual Industry Pulse Survey
The 2020 HCEG Top 10 list of challenges, issues, and opportunities facing healthcare industry leaders, innovators, and change-makers was created by participants of our 31st Annual Forum. This list was then used as the basis for the Industry Pulse research survey sponsored by HCEG and sponsor partner Change Healthcare.
Webinars & Blog Posts Advancing Healthcare Innovation & Transformation
One of the ways we share healthcare information, insight, & ideas is via our Webinar Series Events and blog posts. Our blog posts share insight, information and ideas on items in the HCEG Top 10 list, recaps of webinars and HCEG hosted events, and other information of interest to healthcare industry leaders, innovators, and change-makers.
Check out this blog post for information, insight, & ideas presented in our webinars and blog posts in 2019.
Looking Forward to HCEG Events & Content in 2020
For 2020, the HealthCare Executive Group has a full schedule of live, in-person and virtual events and a full calendar of content throughout the year. In addition to releasing the results of the 10th Annual Industry Pulse research survey conducted in partnership with Change Healthcare next month, we’ll be creating the 2021 HCEG Top 10 list at our 32nd Annual Forum this coming September.
We’re also looking forward to our new Educational Partnership with America’s Health Insurance Plans (AHIP) and acceptance a Collaboration Partner with the Health Information Management Systems Society (HIMSS.)
32nd HCEG Annual Forum
Our 32nd Annual Forum will be held in Boston, MA on September 21-23, 2020. We’re planning our best forum ever and have some interesting speakers, special events and new information-sharing opportunities planned. Sign up here to receive Annual Forum updates and registration details.
In addition to our Annual Forum, we’re planning to host several Executive Leadership Roundtables at major healthcare industry conferences:
The results of the 10th Annual Industry Pulse survey will be released next month. This important industry survey is based on the 2020 HCEG Top 10 List and offers a deeper dive into the top challenges, issues, and opportunities facing healthcare leadership. Here’s last year’s Industry Pulse report.
Every year, HCEG events – including live, in-person events and virtual events like webinars and blog posts – are driven by items on the current HCEG Top 10 list. In addition, HCEG hosts and presents a Webinar Series Event nearly every month on the 3rd Thursday of the month. And publishes blog posts on a bi-weekly basis. In addition to topics centered on specific events and HCEG Top 10 items, content created and curated by HCEG will be focused on the following themes in each month of 2020:
2019 Recap & 2020 Preview
2020 HCEG Top 10 List
2020 HIMSS Conference
10th Annual Industry Pulse Results
2020 World Health Care Congress
32nd HCEG Annual Forum Agenda
AHIP Institute & Expo 2020
HCEG Top 10 Mid-Year Review
32nd HCEG Annual Forum
2020 HLTH Forum
2021 HCEG Top 10
11th Annual Industry Pulse Survey Opens
2020 HCEG End of Year Recap
Connect with Healthcare Industry Executives, Leaders, Innovators & Change-Makers
The HealthCare Executive Group (HCEG) offers value to the healthcare industry aimed squarely at its health plan roots – and to forward-thinking, still emerging health systems and ‘value-based providers’ transitioning to ‘risk-bearing providers.’ One of the ways we share healthcare information, insight, & ideas is via our Webinar Series Events and blog posts.
Webinars for Healthcare Industry Executives, Leaders, Innovators & Change-Makers
In 2019, the HealthCare Executive Group hosted and presented the following webinars:
Social Determinants of Health: A Payer’s Strategic Advantage
Kim Ingram and Harry Merkin of HealthEdge joined healthcare industry veteran Constance Sjoquist to share examples of Social Determinants of Health (SDoH) in practice and provide guidance on how healthcare organizations can get started addressing and overcoming challenges organizations face with regards to SDoH. Watch the recording here.
We Can Stop Diseases, But Can We Stop The Fax?
Jeff Sponaugle, CTO of Surescripts was joined by associates Ashley Fifield and Melissa Warnke to review technologies that enhance prescribing and inform care decisions, to get patients the right prescription at the right cost, the first time. View the recording here and access the presentation deck here.
The Doctor Can’t See You Now: New Ways to Speed Up and Improve Provider On-Boarding
Appian, a leading vendor of low-code application development platforms, shared best practices and tools to automate and standardize provider onboarding while minimizing risk to the revenue cycle and operations. View the recording here and access the presentation deck here.
Using People, Process & Technology to Grow Your Business
Sal Gentile, CEO of Friday Health Plans, and Dannette Coleman of HealthEdge shared insight on the art and science of people, process and technology to successfully grow their respective health insurance businesses both from the ground up as well as within an established organization. View the recording here.
Solving the Rubik’s Cube of Payer Data
Mayur Yermaneni and Marina Brown of eQHealth Solutions discussed why it isn’t the volume of payer data that makes it so valuable – it’s the unique view that payer data offers into member/patient health. View the recording here.
The Pulse of the Healthcare Industry for 2019
HCEG Executive Director Ferris Taylor and David Gallegos of Change Healthcare reviewed the analysis of the latest Industry Pulse survey and offered insights into the thoughts and opinions of surveyed healthcare leaders exploring how healthcare leaders are preparing for the future. View the recording here and access the presentation deck here.
HCEG’s 2019 Top 10 List & 9th Annual Industry Pulse Report
HCEG’s Executive Director Ferris Taylor and Digital Strategist Steve Sisko share an overview of the 2019 HCEG Top 10 list and how the 9th Annual Industry Pulse Research Survey builds upon specific items of the HCEG Top 10 list. View the recording here.
Popular Blog Posts for Healthcare Industry Executives, Leaders, Innovators & Change-Makers
In 2019, the HealthCare Executive Group published 35 blogs posts that can be accessed here. The following are some of the more popular blog posts:
As America celebrates Thanksgiving, the HealthCare Executive Group (HCEG) is honored to have the support of our sponsor partners and acknowledge the contribution these leading healthcare companies have provided and continue to provide to our healthcare executive members, industry advisors, and associates throughout the year. Through the support of the companies highlighted below, HCEG is able to provide a comprehensive package of information, events, and networking opportunities throughout the year.
The HealthCare Executive Group offers our sincere thanks to these leading vendors of products and services that help improve health outcomes and lower costs.
HealthCare Executive Group – Gold Sponsors
Appian provides a low-code development platform that accelerates the creation of high-impact business applications. Many of the world’s largest organizations use Appian applications to improve customer experience, achieve operational excellence, and simplify global risk management and compliance. For more information, visit www.appian.com.
For 30 years, eQHealth Solutions has been improving healthcare quality and reducing costs through innovative technology, population health management solutions and medical management services. Our expansive offerings include eQSuite®, a cloud-based, SaaS technology coupled with eQCare®, a community-based services portfolio. This combination of technology (high-tech) and community-based services (high-touch) covers all your population health management, care coordination, and utilization management needs.
Softheon delivers cloud-based solutions that create a retail-like, user-friendly experience and provide personalized communication and real-time support to boost member engagement. Cost effective, and configurable software that supports health plans and states with enrollment, member billing, and reporting for over 3.2M Americans.
Care management belongs at the center of healthcare, powering every element in its ecosystem. HELIOS is the first solution capable of seamlessly connecting all data points in the care continuum, and leveraging the workflows and analytics to make a significant impact. HELIOS provides the digital connective tissue between payers, providers, and members.
Built to Transform Interactions between Clinicians, Pharmacists, and Patients
The Surescripts Network Alliance unites virtually all electronic health records (EHR) vendors, pharmacy benefit managers (PBMs), pharmacies and clinicians, plus an increasing number of health plans, long-term and post-acute care organizations, specialty hubs and specialty pharmacy organizations.
Solera connects patients, payers, and physicians to a network of partners who are preventing and managing chronic disease.
Working with Solera, health plans and other payers securely and efficiently leverage a network of community-based and digital health solutions.
Solera helps employers identify and engage those in their workforce with the greatest opportunity for obesity-related chronic disease prevention.
The First and Only Consumer Experience Platform Built Specifically for Health Insurance
Zipari is the only consumer experience technology company to exclusively specialize in health insurance and offer native understanding of the industry, which means we instinctively understand our clients’ goals.
Change Healthcare consulting is a catalyst for your value-based healthcare system. Change Healthcare is a healthcare technology company that offers software, analytics, network solutions, and technology-enabled services to help create a stronger, more collaborative healthcare system. Change Healthcare helps deliver measurable value not only at the point of care, but also before, after, and in between care episodes.
InstaMed powers a better healthcare payments experience on one platform that connects consumers, providers, and payers for every healthcare payment transaction. InstaMed’s patented, private cloud-based technology securely transforms healthcare payments by driving electronic transactions, moving money and healthcare data seamlessly and improving consumer satisfaction.
Health insurers must act quickly to launch new offerings targeted at member populations in specific market segments. Whether a government program, commercial or individual product, or dental or TPA offering, HealthEdge works with transformative health plans to create and maintain a competitive advantage.
Health plans and providers have historically been at odds with each other but are now starting to enter various types of formal and informal partnerships. Healthcare vendors who’ve fiercely protected their intellectual property and data for decades are just starting to open up their products and services via API’s and shared processes. And the individuals at the center of the healthcare industry – plan members and patients – have a growing multitude of digital health technologies from which to pick and choose from to improve their health at the lowest possible cost – and with the greatest protection for their privacy and security. All of these actions – essential to truly transforming the healthcare system – require building trust.
Building Trust is the First Step to Meaningful Outcomes
Trust, is defined by Merriam-Webster as: the assured reliance on the character, ability, strength, or truth of someone or something, was a common theme and topic of discussion at the 2019 HLTH Conference taking place in Las Vegas this week.
Importance of Trust in Unlocking Voice Tech’s Power
In “Unlocking Voice Tech’s Power,” a session held on Tuesday, October 29th, trust was identified as a key consideration to address the privacy, accuracy & relevancy of voice-enabled patient services and care delivery. Moderator Daniel Kraft, MD, Founder of Exponential Medicine and panelists Missy Krasner of Amazon, Rasu Shrestha, MD, MBA of Atrium Health, and Jennifer Schneider, M.D., M.S. of Livongo all shared comments about the importance of building trust with the patient to advance digital health adoption.
“Think about trust as perhaps the most valuable currency that exists in healthcare and trust is really difficult to build and to nurture and grow but it’s really easy to break”
“How do we make sure that we use technological capabilities like Amazon Alexa skill sets to build trust, to nurture trust, and to grow trust? And in doing so to really start a revolution”
“How do we up the trust element? How do we make sure that we’re able to contextualize some of the interactions to me the person when I might have several other members in my family also in that household that use the same Alexa device?
“How do I make sure that I’m able to get those right nudges to move my behavior towards where I need to start moving towards so that I can lead the best life possible?”
In addition to insight from other panelists on how to address the public’s declining trust in US health care system, Lynn Hanessian, Chief Strategist at Edelman and Board Member of the Center for Healthcare Innovation will present select findings from the 2019 Edelman Trust Barometer – a research study on the levels and impact of trust among today’s consumers.
On September 9th through the 11th, healthcare executives and champions of transforming the healthcare system met in Boston, MA for the 31st Annual Forum of the HealthCare Executive Group. As has been the case for over a decade, forum participants discussed and defined the challenges, issues, and opportunities facing their organization. These items were then ranked by participants to create the 2020 HCEG Top 10 list as noted in this press release.
Preliminary Insight on the 2020 HCEG Top 10 List
In this post, we’ll share an overview of the items on the 2020 HCEG Top 10. Some insight on new entrants on the list, items rising or falling in perceived importance – or falling off the list. And information on what many forum participants feel are foundational or ‘table stakes’ items for today’s healthcare organizations.
New Entrants – And the Marriage of Previous Entrants
As Ferris Taylor, HCEG’s executive director shared with Jacqueline LaPointe of xtelligent Healthcare Media in this recent article on the 2020 HCEG Top 10: “The Top 10 list recognizes that we’re starting to merge or to recognize that some of these top ten priorities are actually very intertwined. They connect with each other.”
Accordingly, this year’s Item #3 “Delivery System Transformation” was discussed as a combination of last year’s Item #3 “Population Health Services” and Item #7 “External Disruption.” Participants felt that meaningful transformation will not just come from external entities but also through scalable partnerships that address both medical and non-medical services.
Similarly, Item #7 “Holistic Individual Health” was considered a subset of last year’s Item #2 “Total Consumer Heath.”
Previous Entries Rising or Falling in Importance
“Value-based Payments” – ranked #4 on last year’s list was replaced with Item #7 “Next Generation Payment Models” and dropped a few spots to #7. Participants felt that the label ‘value-based’ was too narrow and becoming an insufficiently defined, worn-out phrase.
Last year’s Item #9 “Opioid Management” did not explicitly rank on this year’s 2020 HCEG Top 10. While clearly a major issue and challenge for healthcare organizations, substance use disorders were considered to be addressed in Item #6 “Holistic Individual Health.”
Table-Stakes/Foundational Functionality on the 2020 HCEG Top 10 List
Participants in developing the 2020 HCEG Top 10 list felt that several items from previous years should really be considered as foundational to addressing all their challenges, issues, and opportunities. These include the following:
Data & Analytics – Previously Ranked #1 on the 2019 & 2018 HCEG Top 10 lists
As Ferris Taylor, HCEG’s executive director shared with Jacqueline LaPointe in the above-referenced article :
“We’re seeing a much larger focus on digital technologies and taking advantage of the analytics, data, and the technology that is out there. Those have changed quite dramatically in the last five years or so. Data is much more readily available and it’s broader than just administrative data. We now have clinical data, lab data, social, economic, and demographic data. The analytical tools also are much more sophisticated.”
Privacy & Security – Ranked as #10 in 2020 and 2019
This item received a lot of discussion with many participants feeling it should be ranked #1. Like “Data & Analytics,” the majority of participants felt that addressing privacy and security are table stakes for today’s healthcare organizations.
The 2020 HCEG Top 10 list drives the physical and digital events and content produced by HCEG throughout the year. This includes our Executive Leadership Roundtables, webinars, conference presentations, blog posts, and other content. Stay tuned to this blog and consider subscribing to our eNewsletter for more information on the challenges, issues, and opportunities facing today’s healthcare leaders and champions.
10th Annual Industry Pulse Research Survey
Perhaps the most noteworthy use of the HCEG Top 10 is that it serves as the basis for a research survey – The Industry Pulse – produced in conjunction with Change Healthcare – one of HCEG’s long-time sponsor partners. The results of the Industry Pulse can provide valuable, relevant data-driven advice and end-to-end industry insights. Healthcare leaders can use the list to identify opportunities to navigate our rapidly evolving healthcare system.
This research survey is currently being developed and will be available to industry champions next month. See last year’s Industry Pulse survey here and stay tuned for more.
Session at 2019 AHIP Consumer Experience & Digital Health Forum
HCEG members will be presenting a session at the upcoming AHIP Consumer Experience & Digital Health Forum in Chicago on December 10-11, 2019, at the Swissotel. The session titled “Top 10 Challenges, Issues, and Opportunities as Identified by Healthcare Executives” will expound on the 2020 HCEG Top 10 and provide the following audience takeaways:
Additional insight on what a group of health plan leaders considers to be their top challenges, issues, and opportunities for 2020 and beyond.
Understand how challenges facing health plan leaders have evolved over the last ten years.
An overview of some of the ways other health plan leaders are transforming and innovating their organizations.
An understanding of challenges, issues, and opportunities health plan leaders may be facing but are not aware of
Many healthcare organizations struggle with credentialing and onboarding healthcare providers quickly. Delays can have a negative ripple effect for patients and physicians alike. Increased wait times lead to canceled appointments, reduced clinician revenue, and customer dissatisfaction. Inaccuracies can result in denied claims and fines. Right now, healthcare organizations need tools for automating and standardizing provider onboarding processes —while minimizing risk to the revenue cycle and operations.
From application processing to new-hire paperwork and credentialing verification, streamlining these tasks, and using robotic process automation and AI to get there, is the future for streamlining provider onboarding processes.
So, unless your provider onboarding processes are effective and efficient, patients may not hear the most sought after phrase at the doctor’s office: “The doctor will see you now!”
The Doctor Can’t See You Now: New Ways to Speed Up and Improve Provider Onboarding Processes
Also in this webinar, Ryan VanDePutte from Bits In Glass and Kirsten Prucha from Luxoft will share best practices and their experience in the healthcare field, as well as how to improve operational effectiveness for other healthcare processes.
You’ll also hear first hand how webinar panelists have worked with healthcare organizations to improve their provider onboarding processes and how these processes helped improve patient and member outcomes. Discover how enhancing your provider onboarding processes can be a key step in the journey toward digitally transforming your enterprise using robotic process automation and AI.
Attendees will have an opportunity to ask questions and all webinar registrants will receive a recording of the webinar regardless as to whether they can attend or not. Learn more about the webinar and sign up here.
Appian provides a low-code development platform that accelerates the creation of high-impact business applications. Many of the world’s largest organizations use Appian applications to improve customer experience, achieve operational excellence, and simplify global risk management and compliance. For more information, visit www.appian.com.
Ongoing uncertainty, the need to digitally transform operations, and external disruption are three of many challenges, issues, and opportunities facing today’s healthcare leaders. So how can healthcare executives find the information, collaboration, and networking opportunities, both in-person and virtual, to stay on top of things? Indeed, professional associations, many healthcare conferences and digital channels such as LinkedIn, newsletters, blog posts, and Twitter can be an effective way for healthcare leadership to quickly and cost-effectively advance their initiatives and programs.
The HealthCare Executive Group (HCEG) has existed over 30 years to help those championing the transformation of healthcare better understand the challenges, issues, and opportunities facing they face and to facilitate connections with others facing similar concerns. This post shares insight from a long-term member of the HealthCare Executive Group on how HCEG has differentiated itself from the noise, vendor sales pressure and overbearing crowds so common in today’s conferences and digital channels.
How the HealthCare Executive Group Supports Healthcare Champions
Can you tell us a little bit about yourself and your association with the HealthCare Executive Group?
I am Eric Decker, Chief Information Officer at Independent Health, a regional payer headquartered outside of Buffalo, NY. I have been a member of HCEG since 2015 and became a board member of HCEG in 2018.
Why did you join the HealthCare Executive Group?
I was promoted to CIO in early 2015, and being a ‘first-time’ CIO, I was looking for associations where I could meet and network with other healthcare executives at organizations similar to Independent Health. HCEG had been recommended to me by another CIO, and I was really happy with the networking opportunities and content provided at their annual forum.
What do you think makes the HealthCare Executive Group different than other healthcare associations and leadership organizations like HIMSS, CHIME, FACHE, etc?
The relatively small setting of the annual forum distinguishes HCEG from larger associations’ events. There is only one concurrent track, and the break times allow me to reconnect with peers who I had met at previous forum events, as well as make new connections.
How does HCEG solicit input from its members as to what content, events, and services they’d like HCEG to provide to them?
What unique networking opportunities and experiences does the HealthCare Executive Group offer?
HCEG offers more than the usual networking mixers. The extracurricular activities at the Annual Forum and the Executive Leadership Roundtables are very conducive to getting to know other healthcare professionals in a relaxed environment. Too many times the crowds, noise and commercial distractions get in the way of truly forming a meaningful relationship that lasts beyond the networking event itself.
What about the HealthCare Executive Group makes it different than other associations and organizations supporting healthcare leaders?
HCEG’s Annual Forum and Executive Leadership Roundtable events are a ‘safe space’ for healthcare executives to learn, discuss and inform – free from the distractions of large events and without vendors pushing sales pitches. I’m better able to gain perspective on challenges, issues, and potential opportunities.
HCEG events are very informal yet supportive. The friendliness and flexibility of their event and administrative staff was impressive. HCEG helps its members forge meaningful relationships that last long after any single event ends. Industry media that may share comments out of context are not allowed.
Nowadays, there are lots of ways to stay connected and communicate with peers and other business associates. How does HCEG support member connections and information exchange?
A single conference event over two or three days once or twice a year is not enough to keep up with challenges, issues, and opportunities in today’s fast-paced, uncertain healthcare environment.
HCEG provides a nice mix of in-person, physical gatherings throughout the year and also well-coordinated of virtual, digital channels to help stay informed and connected. And offers its members events, opportunities and support to share and acquire information and expertise outside of a single, transactional event.
HCEG’s develops its yearly Top 10 list during their Annual Forum. What can you share about the Annual Forum and the HCEG Top 10 list?
HCEG’s Annual Forum reinforced the information that I know and filled in some of the blanks I was not completely aware of. It has a good mix of sessions that presented a variety of perspectives. I was somewhat surprised by the candor and willingness to the panelists to engage with the audience.
The HCEG Top 10 provides a good overview of what’s happening in the industry. It helped me get a sense of what others are thinking and helped validate – and invalidate – some of my thoughts and assumptions.
Meet Eric and Other Healthcare Champions at HCEG’s 31st Annual Forum
The 31st Annual Forum of the HealthCare Executive Group takes place September 9th – 11th in Boston. Come join Eric Decker and other champions focusing on the healthcare and digital innovation necessary to transform the healthcare system in the United States. Interact with your healthcare peers, learn more about how others are addressing similar challenges, issues, and opportunities, and create new relationships to advance your company-focused and personal missions.
People, process, and technology are at the core of every business. And how these three critical components are used to create and deliver a healthcare organization’s products and services ultimately result in company profitability and growth. Indeed, the critical challenges healthcare organizations are facing during these uncertain times involve humans, the processes they must follow, and the mix of entrenched, emerging – and as yet- often unknown technologies supporting an organizations mission and growth.
The Golden Triangle: People, Process, & Technology
Delivering operational efficiency, a key aspect of transforming today’s healthcare organizations requires an approach that optimizes the relationships between people, process & technology; hence the Golden Triangle. Each part of the Golden Triangle is its own science. And each needs to be mastered to effect true transformation and business growth. Ignore the relationship between people, process, and technology at your own risk.
And know that the art, where real value and efficiency are found, is at the intersection of people, process & technology. Like a three-legged stool, each part of the Golden Triangle must be sufficiently developed and aligned as integral components of successful transformation initiatives. Too often, healthcare organizations give short shrift to the people point of the triangle.
Successful Transformation Initiatives: Keys to Success & Challenges
In a study by IBM titled “Making change work…while the work keeps changing,” 1400 participants identified the keys to successful change initiatives and the major challenges to change that organizations must consider as they plan and strategize their business transformation initiatives.
Keys to Successful Change Initiatives at Healthcare Organizations
Honest and Timely Communication
Change Agents to Engage Other Employees
Change Supported by Culture
Efficient Training Programs
Monetary and Non-Monetary Incentives
Adjustment of Performance Measures
An Efficient Organizational Structure
Top Management Sponsorship
Challenges to Change Initiatives at Healthcare Organizations
Changing Mindsets and Attitudes
Shortage of Resources
Lack of Commitment by higher management
Insufficient Change Know-How
Little to no Transparency
Impact on Existing Process
Flexibility and Interoperability of Technology Systems
See this article for more about the keys to successful change initiatives and the major challenges to change that organizations must consider as they transform their organization.
People are Key to Aligning People, Process, & Technology
Famed IBM founder Thomas J Watson shared the following on the importance of NOT ignoring the people component of organizational change initiatives.
“Teach your associates to teach themselves and in a way that you will strengthen the entire organization” – Thomas J Watson (1947)
Additional Insight & Ideas on Leveraging People, Process, & Technology
In today’s uncertain and rapidly changing healthcare environment, healthcare leaders are seeking to enter new geographies, start new lines of business, or even radically transform their traditional way of doing business. To position your healthcare organization for successful growth by optimizing the intersection of people, process, and technology, join us on July 25th for our Webinar Series event: Using People, Process & Technology to Grow Your Business.
Sal Gentile, CEO of Friday Health Plans and our sponsor partner HealthEdge will share how they leveraged the art and science of people, process and technology to successfully grow their respective healthcare organizations both from the ground up as well as within an established organization.
If you’re not sure whether you can attend this HCEG Webinar Series event, go ahead and register and we’ll send you the recording/recap.
If you have any questions about this blog post or want to learn more about the HealthCare Executive Group, please reach out to us at [email protected]. Also, consider following @HCExecGroup on Twitter and LinkedIn.
Healthcare payers are sitting on a lot of data, from eligibility data, to claims data, to data obtained from 3rd parties, to data derived from analytics. It’s no surprise that over the last decade “Data & Analytics” has been a consistent entry on the HealthCare Executive Group’s Top 10 list of challenges, issues, and opportunities facing healthcare executives. And currently ranked #1 on the 2019 HCEG Top 10 list. To help share insight, ideas, and actionable information supporting data and analytics, our sponsor partner EQ Health Solutions presented our June Webinar Series event: Solving the Rubik’s Cube of Payer Data.
Chief Strategy & Growth Officer Mayur Yermaneni and Marina Brown, RN BSN, Vice President of Clinical Programs, from eQHealth Solutions shared information and insight on the following four topics:
The current state of the payer market and future considerations
The Rubik’s Cube of Payer Data – the Present Debacle
What tools and technologies will lead to continued payer success?
Top six things to consider when evaluating your healthcare analytics vendor
Highlights from Solving the Rubik’s Cube of Payer Data
This blog post presents some highlights from the webinar and provides access to additional information from the webinar. You can also check out this Twitter Moment summarizing live Tweets from the webinar. The complete recording of the webinar can be found here. To jump to the specific place in the recording, click on the timestamp range [HH:MM] that accompanies each transcripted section below.
For more information on how EQ Health Solutions can advance your organization’s data and analytics initiatives and programs, contact EQ Health Solutions.
Current State of the Payer Market and Future Considerations
Mayur Yermaneni shared some insight into current data and analytics capabilities of healthcare payers: [7:16]
Some payers are firmly in an average spectrum of recognizing current trends and some and some payers are still in the infancy stages of recognizing the impact of these trends. So, I’m trying to generalize some of these themes so that everybody can actually benefit from it.
Margins are Decreasing
So, across the board, one of the key things, and I guess this is not unique to the payer market itself, is that margins are decreasing. With new regulations coming on board there are more and more cost burden associated with the payer market. Some payers are becoming a financial institution from that standpoint [of increasing regulatory burden.]
You see this a lot more in the bigger payer, payers like Aetna’s acquisitions, United’s acquisitions, WellCare and all these acquisitions that are happening is [intended] to counter their decrease in margins by creating economies of scale that they could benefit by actually saying: “If I can actually acquire another of these entities, then I can create a cross burden rate across these common units and hopefully benefit from the margins play game.”
Nobody wants to show up and in tomorrow’s Wall Street Journal. In the current day and age, there’s an entire team dedicated just so that that payer’s name doesn’t show up on tomorrow’s newspaper. Primarily because with the PHI (Protected Health Information), the abundance of PHI information from all different sources. It’s extremely important to say: “Well how do we protect our data?” Payers have a lot more data than anybody else outside of providers.
And there are two different spectrums of the data set – and both are equally critical from the standpoint of ensuring that data security is a key aspect in your space because today, a 100 record, 500 records, or anything above that threshold you’re going to have to report it. So, data security becomes actual strategy nowadays. How do you make sure that your data security is actually playing to your advantage? And your customers have to be able to trust that and that Trust is what’s going to actually give you – even though that has nothing to do with the actual health plan itself, or the benefits members are receiving, or the card that they are receiving. But they still have to be able to trust that their data is secure.
Showing Value Vital in Provider/Hospital Negotiations [10:17]
Finally, when it comes to providing the value of data, the data set that payers are actually having to wrestle with: how are we showing the value that we are providing to the hospital segment, the provider segment, and the member segment?
But if you look at it, you still have to deal with all the other aspects before you get to the value component: administrative setup, data security, operating margins, and everything.Well, how is that actually happening? Big data. Well, I’m not going to bore everybody with the definition of what big data is but, in a nutshell, in today’s world of Instagram, Facebook and Snapchat it’s all about the volume and speed and the frequency of the data that you’re receiving. And in the payer market, it’s a lot of data. It used to be a monthly fee [to obtain/access data]. Now it’s an API call to an HL7 message which is instantaneous. And the amount of frequency that you’re having to deal with is a lot more than what you had before. And the number of types of data that the payer market is actually having to deal with is a lot more. And even in there, the data can be segregated into a couple of different ways:
The data that’s the primary data sources
The derived data sources that you’re generating as a result of your operation or as a result of some of the analysis that you’re doing on top of it.
So now that’s another big trend that the payer market is having to actually wrestle with.
Social Determinants of Health Data are Increasingly Important
Ferris Taylor [HCEG’s Executive Director] indicated that this [Data & Analytics] was the top topic and social determinants of health were one of the key aspects to it. And that hasn’t changed. What has changed is how that’s being viewed. Instead of being a peripheral data source to actually being a central component to how your operations need to be done from social terms of health standpoint.
Marina Brown, EQHealth’s Vice President of Clinical Programs added:
I was just going to say that I do think that this is really a big one for the industry. Social determinants of health are definitely going to help change the way that we deliver health care. And that’s a very important distinguishment. It’s not going to change the way that we do health care because we treat a diabetic the same but it will change the way that we deliver care simply by helping to better guide the interventions that we’re utilizing to create more meaningful behavior change over time.
Tools and Technologies to Solve the Rubik’s Cube of Payer Data
Marina and Mayur shared an overview of the tools and technologies that healthcare payers are using to identify trends, root causes of patient and population-level issues, and transforming healthcare payer’s data and analytics infrastructure.
Another key aspect is artificial intelligence. Now again I don’t want to get into the definitions of artificial intelligence, but the key aspect is, with the advent of big data with the advent of the amount of data you’re having to deal with. It’s not humanly possible for a supervisor or a manager or a management team to be able to simulate all the data and actually say: What am I making use of this data? And how am I going to make use of this data? And what decisions am I making?
So artificial intelligence – or machine learning – and they’re not necessarily synonymous but in some in some aspect they’re synonymous in terms of combining the wealth of data that you’re getting and actually seeing what insights can be derived based on all those data sets; at a much more faster pace and a more timely manner compared to what we would have had to do if we were doing it manually. And there is an element of: how do we use the machine learning algorithms or artificial intelligence approaches to say: Can I do a better prognosis?
Everybody’s aware of [IBM] Watson’s cancer cure approaches to it and Watson has evolved a lot of other stuff. But predominantly in the mainstream the payer market, this hasn’t yet taken off into a full-fledged problem because we’re dealing with not necessarily a literature research but more in the realm of operational research and operational analytics.
Hear more from Mayur and Marina about tools and technologies at [13:09] and [24:53] in the recording.
How can we employ artificial intelligence or machine learning concepts into the operational realm of the payer operation? [14:40]
There are some positive trends. There’s a huge growth of Medicare Advantage (MA) plans. Their margins continue to increase because it’s a catch-22 situation for MA plans because of the risks. And now MA plans are able to accurately reflect their risk scores. And as a result, their premiums are being reflected the right way – which actually helped them from their margin standpoint because their operations were still on the same aspects of it because in the previous era they were not reporting their risk the right way because they didn’t have all the data gathering up opportunities. But now that they’re able to gather their [data analysis] opportunities, they can predict their risk a lot more accurately, so their premiums are going up. As a result, the margins are getting better and also the operations have stayed the same.
Government Plans Off-Loading Operational Functions to Health Plans
And in the Medicaid managed care space what you’re seeing is a lot more growth in that space for, predominantly, what we could say s for one single reason: most of the state administrative entities are actually trying to off-load the burden onto the plans so that risk is being passed on to the managed care plans and the state entities become the administrative agency. Of course, with that, they’re also holding performance measures as an accountability which is not just about the financial side of it but also the quality side of it because they don’t want to sacrifice the quality of care being rendered to their beneficiaries. But as a result, you’re seeing a lot of growth in the managed care space Medicaid managed care well
What does this mean to me or my organization as a payer? [16:29]
If I actually eliminate all the big terminology, fundamentally there are two simple concepts:
Is our plan performing better than what it was before from a cost standpoint? And with the qualifier added, is the plan performing to a level where the plan can afford too? Because one of which you’re collecting to your risk is what you’re paying out. That’s one of the key foundations. That’s a simple question that you’re going to answer.
And the second aspect of it is:
Are we improving the quality of our plan? And quality can be defined in multiple ways. I think the STAR rating, the HEDIS measures, and all that stuff. But at the end of the day it’s really are you improving quality in terms of outcomes for the members?
And the second point is actually impacting the first point from a long-term standpoint. So, if you’re impacting the quality aspects of it, then you’re able to impact the cost aspect of it as well. But it doesn’t happen every year, it happens over as a strategic view. You have to put that as a strategic view long term view so that on the short run your cost structure might have variances but over a long run, you’re actually improving the trends of that one.
Operational Simplicity and the Health of Your Health Plan[17:54]
But what does that mean in terms of a payer when you think about how you have to think about it?
It comes down to two things: operational efficiency and health of your health plan. How do we make a difference in looking at all the data that we have and actually answer these two business questions; and then tie them back to the simple questions of ‘Am I performing better in terms of cost?’ And ‘Am I improving the cost?’
I think that operationally looking at the data is really going to, as a program administrator, is going to give me insight into things like the following:
What care management programs or medical management programs are most needed for my population?
What programs that I’m currently utilizing are really the most effective ones?
Taking that a step farther as you look into those specific programs that are most effective, you’ll also then be able to look at things like: What are the interventions that are most effective in this population. From a utilization review perspective?
Is my UR working only as a gatekeeper for my health plan or are we actually effectively managing acute episodes and beyond that acute episodes? And then really helping us determine all of this ultimately helps us determine what care intervention strategies do we need to tweak? Which ones do we need to add to our programs to create that meaningful behavior change that increases the health of our membership, increases the quality of the care that’s being provided to that membership, and ultimately reduces the cost?
The Rubik’s Cube of Payer Data – the Present Debacle
Mayur shared some insight into the struggle that many payers have regarding reporting and analytics:[20:03]
In a lot of ways, payers are struggling between: Am I doing reporting or am I doing an analysis? And how am I looking at it? Am I doing the analysis for the sake of reporting or am I doing analysis for the sake of improving or answering the two questions that we started out with?
Is our plan performing better than what it was before from a cost standpoint?
Are we improving the quality of our plan?
And those could be the patient member outcomes, quality standards, STAR ratings, keeping benefits cost down, maintaining the profit margin, improving efficiencies. All of these are questions that every payer is asking.
And the list goes on and on and you guys are actually dealing with a lot more in today’s world. I’m sure every organization has a ton more questions to add to it but, fundamentally, why and how to do it is where the biggest question comes into play because often everybody goes down the path of: ‘Okay, I need to solve this reporting problem so I need to have this kind of technology in place. I need to solve my data analysis problem from a predictive modeling standpoint, so I need to have this technology base.
And as a result, you’re creating more and more silos within the analytic space and not necessarily taking advantage of the full spectrum of the data that you have or creating in its entirety in a holistic view. Because at the end of the day, if the technology analytics is being used for the reporting purposes then you only solve 30% of your problems because the majority of your problems are deriving insights from your data and actually saying how can we make a difference in our operations? How can we make a difference in our outcomes?
Payers have multiple data sources and everything is often viewed as a silo.[23:30]
Healthcare organizations are maturing but fundamentally they’re still struggling with the aspects of:
Am I doing quality analysis?
Am I doing financial analysis?
Am I doing operational analysis?
Or am I doing just reporting for the regulatory agencies?
Payers need to design their operational strategy to leverage all quadrants of dimensions: Quality, Financials, Operations, and Predictive Analytics.
Marrying Clinical Expertise with Data Analytic Capabilities [25:04]
I want to talk briefly about the key components that are going to make a difference. Often what happens is an analyst is asked a question and they actually come back and that data set is then presented to clinical leadership. And then clinical leadership asks a follow-up question and then makes some decisions on top of it. But in reality, what if you change that and involve that clinician up front during the analysis itself, along with the data scientist? So, what we view in the industry is that there’s a lot more benefit if you actually pair the clinicians and the data scientists together up front in the design and analysis phase.
So that 1) you can cut down your cycle crime and 2) you’re asking the questions up front and how to think about your operations. And that’s going to help frame your reporting and analytics problem in a way where you’re getting to a solution much faster.
I think that’s a really important point that you’re making. I think bringing these two teams of people together helps to bring about that important balance and maximize your outputs because your data scientists are experts at identifying the trends and the data. And when that information is presented to the clinicians, they can then help interpret those trends. That’s going to ultimately formulate your adjustments to your operations, your program design, etc. I think that’s a great point.
Pairing Clinicians with Data Scientists Frees Up Time for Patient Engagement
And another aspect to it is, when you’re thinking for clinicians, you’re actually taking away their valuable time working with a member. If you’re asking them to understand what’s happening with the data and go into the exercise and then making the decision to it. But if you pair them up front, you’ve solved the problem and then you’re giving them time to have their team’s focus more on the members then they are focusing on the data itself.
Right. Care teams are so busy trying to make that outreach to the members that having that technology available to them, to be able to guide them to identify trends or issues with that particular member, is going to save time. And it ensures too that all of the important or pertinent trends for that particular member, for that particular population, are being identified. Because at the end of the day, clinicians are just that, clinicians. They’re not data analysts.
Developing a Multi-Dimensional, 360-Degree View of Your Data
Marina and Mayur presented some insight and ideas on how to create a decision-making framework providing a multi-dimensional, 360-degree view for your clinical, operational, administrative, and financial teams.
See [28:15] for more information, insight, and ideas on creating a multi-dimensional, 360-degree view of your clinical, operational, administrative, and financial data.
Top Six Things to Consider When Evaluating Healthcare Analytics Vendors
Here are top six things that you should consider when you think about analytics or in the majority of organization’s how you want to get there.
Intuitive Easy-To-Use Platform
Actionable Real-Time Data Visualization
Acceptance of Data in Any Format
For details on the importance of each of the above considerations for evaluating healthcare analytics vendors, listen in starting at [36:04].
Questions from Webinar Series Attendees
Our organization currently executes minimal analytical formalities, processes, etc and we are at an immature analytical state. Would investing and working with an analytics vendor refute all [our efforts] at this stage in our organization? [44:37]
Mayur: No. You can view it from the standpoint of: if you’re in the early stages of maturity then that would be the perfect time to assess how you want to design your system and what kind of systems you want to have in place. And you may not have to go through the same evolution steps that the entities started out early on. You may actually leapfrog by taking in all that stuff up front itself. So absolutely, even if you don’t have all the data organized in a unified view that’s fine too because you do have data sets. The first steps very well could be how do you get them into the unified view. So I wouldn’t hesitate working with and investing in analytics if you’re in the early stages of maturity because this very well could be an opportunity where you don’t have to redo the some of the things that you might have done if you’re already in further stages.
Our organization prides itself on taking the best care of our patients. Can you give us examples of how using an analytics vendor can improve our patient outcomes vs. just us monitoring it internally?[46:03]
Marina responded to this question with an interesting story about how EQ health identified and assisted high-utilization, low literacy, diabetic patients in the Mississippi Delta. Listen at [46:22] as to how EQHealth made life easier for patients and improved their health, all while reducing emergency room visits and inpatient admissions.
My team is discussing the decision to build an analytics platform internally or buy and outsource it with a vendor. Do you have any insight into what is more successful and pros and cons? [50:50]
Mayur: I don’t think there is a right answer or wrong answer. It really centers on your strategy. Are you trying to make that as your core competency or are you wanting to retain your core competency to manage plan operations but want to have the benefit of the analytics and the analytics platform; then at that point you should outsource. But if you’re wanting to make analytics your core competency, then you need to have that in-house. But when you do decide to make it in-house, you still need to… hear the rest of Mayur’s answer at[51:08]
Listen to more questions and answers from Solving the Rubik’s Cube of Payer Data here.
In addition to connecting with us on Twitter and LinkedIn and subscribing to our eNewsletter, consider joining other healthcare executives and industry thought leaders at our 2019 Annual Forum in Boston, MA on September 9-11, 2019. In addition to the always insightful, information-packed sessions and networking opportunities our annual forum offers, we’re including two special networking events on Monday, September 9th:
Tour of the IBM Watson Research Facility in the morning
Red Sox vs. Yankees Baseball Game at Fenway Park in the evening