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

By | HCEG Top 10, Executive Leadership Roundtable, Webinar Series, Pharmacy, Privacy & Security | One Comment

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

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

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

Cybersecurity – 2018 HCEG Top Ten Item #6

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

HCEG Healthcare Executive Group Webinar-Top-10 Trends Cybersecurity

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

Real World Impact of Medical Identity Theft

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

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

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

Addressing Pharmacy Costs – 2018 HCEG Top Ten Item #9

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

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

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

Free-Market Economy and Governance

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

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

pharmacy costs increases hceg healthcare executive group

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

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

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

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

Previous Webinar: Strategies to Address Rising Pharmacy Costs

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

Check out the Webinar Recording for More

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

An Executive Leadership Forum at GuideWell Innovation Center

By | Executive Leadership Roundtable, Data & Analytics, Privacy & Security | No Comments

Executive Leadership Forum at GuideWell Innovation Center hcldr hitsm innovationOur Executive Leadership Forum held at the GuideWell Innovation Center on Monday, May 8th was attended by 21 healthcare executives and solution provider thought leaders. The three-hour event – titled Operationalizing Before Analyzing: Healthcare’s Modern Journey Powered by Data – focused on some of the underlying challenges and issues regarding how healthcare data and analytics technologies impact consumers, providers and health plans.

The forum included lively discussion on real world use cases for healthcare data and analytics, a demonstration of live 3D interaction possibilities and a tour of the GuideWell Innovation Center. The forum was capped off by a happy hour for participants to network with each other and forum sponsors: MarkLogic and Intel.

In this post, highlights of the discussion between forum participants and key takeaways will be presented. In future posts, an overview of the 3D interaction demo and tour of the GuideWell Innovation Center will be shared.

HCEG Board Chair Ferris Taylor shared some information on the tour of the GuideWell Innovation Center and Live 3D Collaboration in this post on LinkedIn.

Demand for Real-time Data and Transactions

A lot discussion during the forum centered around current complexities and how demand for real-time data and transactions—across clinical, administrative and financial operations–is increasing exponentially every day and putting significant demands on service model / operations and legacy infrastructure, which are mostly batch / file transfer oriented.  Several issues were identified as current concerns:

  1. Many underlying data challenges
  2. Lack of agility in quickly responding to opportunities
  3. Inadequate data governance/provenance with ETL approaches in the legacy data pipeline

All audience members agreed they wanted faster time to market and better ability to respond to clients / market / regulations and be more agile when it comes to data. There was broad agreement that “data integration” is a journey that should follow a new data integration pathway instead of the legacy Extract-Transform-Load (ETL) approach:

Real World Use Cases

Over the course of the discussion there were a number of data capture and analytics use cases shared between forum participants. One use case described enrollment data submitted to the IRS on the 1095-B Health Coverage forms sent to individuals noting their qualified health coverage during each month in the year.

One participant described how the IRS had reported back to the health plan that 40% of the records submitted by the health plan to the IRS had errors in name, social security number and/or dependent status; basic required enrollment data elements that the plan was not able to validate or authenticate during the initial enrollment process and remained that way throughout the entire year. Garbage-In-Garbage-Out.

This “1095-B use case” elicited feedback from one forum participant having recent experience at the Census Bureau with the participant describing how government agencies often don’t have complete, accurate data. Just because CMS might have data of one quality level, they don’t always share that data with related agencies so the IRS or the SSA or state Medicaid administrators likely have different data.

Leverage All Data Types & 3rd Parties

Forum participants shared unique perspectives and a Q&A ensued on the example of how the Census Bureau uses associated data to significantly improve the timelines, accuracy and overall value of census data by editing it against 3rd party sources.  This Census Bureau use case and another use case described by forum participants of a BCBS plan emphasized that 3rd party data sources and unstructured data are very important to service improvement, member/patient experience, innovation and growth-oriented project investments.

Primary Investment Areas: Data Improvement & Integration Projects

Forum members identified the following investment areas for data improvement and integration projects that healthcare executives may implement over the next 12-18 months to modernize healthcare data and applications:

healthcare-data-integration-investment-areas-ELF-Blues-MarkLogicThought Leader Presentations

This Executive Leadership Forum was co-sponsored by MarkLogic and Intel. The information shared by these two sponsors are made available here:

    “Healthcare ‘Next Gen’ Data Projects”Bill Gaynor, U.S. Healthcare Director – MarkLogic, Inc.

    “Intel Healthcare Security Readiness Program Overview”Joan Hankin – Global Director of Marketing & Business Development – Healthcare & Life Sciences at Intel Corporation

In addition to information shared by MarkLogic and Intel, Constance Sjoquist, former Research Director at Gartner, also participated:

    “Disrupting the Status Quo in Healthcare” – By Constance Sjoquist, Chief Content Officer – HLTH, LLC.

Three Basic Tenets Unanimously Agreed

At the end of the forum, participants unanimously agree on three basic tenets:

  1. Complete and accurate data – especially basic demographic and social determinants – MUST begin with the first member/consumer/patient-provider interactions at the point of service
  2. Data needs to be authenticated, validated, verified and ENRICHED against other sources – then normalized across other supportive partners and their ‘systems of record’
  3. Today’s technology can support the capture, validation and use of healthcare data on a relatively inexpensive basis.

Join Other Healthcare Leaders

For more information on the Healthcare Executive Group and how you can become more ‘in the know’ and effective as a healthcare executive or thought leader, check out this information about becoming a member. You can also follow us on Twitter, friend us on FaceBook and follow us on LinkedIn.

Why is Healthcare Security Now More Critical?

By | Privacy & Security

2015.06.07 - SecurityI’m not a security expert. I’m a strategy officer for a health plan. My job is to connect the dots on factors that could impact our strategic future. I have to say the dots related to privacy and security are threatening. Like many of you, I received emails from Marriott and American Express after the Epsilon breach years ago saying my credentials had been stolen. More recently, I’ve had similar messages from Sony, Target, Home Depot and others.
2015.06.07 - Security Webinar PromoThis year these dots directly impacted healthcare. My daughter, business colleagues and neighbors, along with 90 million other people, received Anthem and Premera letters giving them credit tracking and fraud insurance. CareFirst just had a 1.1 million member breach. And the OIG claims to have warned one of them that their information was at risk. This problem is not new. It has been on the MCEG/HCEG Top 10 issues 3 of the last 6 years, but keeps getting bumped by other priorities, such as ICD-10, the ACA and others. I’ve just finished the day at AHIP’s pre-conference forum on Cybersecurity, Technology and Infrastructure. It was excellent but disturbing as to where we are at in cybersecurity as an industry.

Why is healthcare security now more critical The financial world doesn’t have a security system they have a remuneration system. Money goes missing from my account and they put the dollars back no harm, no foul, I’m secure, right It is different in healthcare. Unconscious in an ER after an accident, if my blood type or medications comes up in an EMR because someone used my identity for a fraudulent procedure, it just might cost me my life. No one can put that back in the account. Finding out I’ve exceeded my dental plan deductible because someone already had a root canal and crown using my stolen Dental Plan ID makes me acutely aware that my personal information is not secure.

Attempting to connect these dots reminds me of Whack-a-Mole at the circus. We have a mallet in both hands and are pounding down the goffers (cybercriminals, in this case) just as fast as we can. The problem is that there are a lot more dedicated and financially rewarded cybercriminals (as banks just keep reimbursing their fraudulent transactions) than we have mallets. Risk management versus risk avoidance continues to feed the beast. RSA’s President, Amit Yoran, said recently the threat landscape has changed and we have to constantly challenge the existing thinking to get ahead of our adversaries. RSA should know as they had their own significant security breach a few years ago affecting dozens of governments around the world and almost every major defense contractor.

This is a serious trend in healthcare with serious implications. And, it is a battle we are obviously losing. I suggest that we need to do more than challenge our existing thinking we need a whole new way of thinking! Without a whole new approach and focus on security, the credibility and future of healthcare could be in serious jeopardy. The HealthCare Executive Group is accelerating the dialogue on critical issues like security with the launch of the HCEG Webinar Series. Join in the open discussion on June 17th by registering at ww.hceg.org/webinars. We will pick this discussion back up then.