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
The trend toward Healthcare Consumerism & Digital Health products and services is driving what healthcare providers, health systems and health plans are offering – or are planning to offer – individuals participating in the U.S. healthcare market. Whether covered by employer-subsidized insurance, government programs like Medicaid or Medicare, the individual commercial market, any other type of coverage or even not covered and paying for your healthcare with cash, healthcare consumerism and leveraging digital health products and services to decrease costs and improve outcomes are two important movements that can’t be ignored.
‘Indeed, Total Consumer Health and The Digital Healthcare Organization are both ranked in the top five items on the 2019 HCEG Top 10 list of challenges, issues, and opportunities:
#2: Total Consumer Health: Improving members’ overall medical, social, financial, and environmental well-being.
#5: The Digital Healthcare Organization: Health Savings Accounts, member and provider portals, member and patient health literacy, cost transparency, digital payment capabilities, CRM, wearables and other patient-generated data, health monitoring, and omnichannel information distribution and transaction access.
“Healthcare Consumer-centric companies accounted for 60 percent of the funding in Q3 2018, raising $1.9 billion in 111 deals compared to $1.7 billion in 138 deals in Q2 2018”
The HCEG Top 10 Challenges, Issues & Opportunities Over the Years
Over the 10 year period in which the HCEG Top 10 list has been published, ‘Healthcare Consumerism’ or a closely aligned similar category has been ranked on the HCEG Top 10 list a total of eight times. And ‘Digital Health’ has also ranked among the HCEG Top 10 challenges, issues and opportunities eight times. Only ‘Payment Reform’ and ‘Big Data & Analytics’ have been listed on the annual HCEG Top 10 list more frequently.
It should be no surprise to most people that healthcare consumerism has long been a top challenge, issue, or opportunity for healthcare organizations of all types. The rise of several factors have been identified by industry experts and trade media as the primary reasons for the growth if consumerism in the healthcare industry:
High-Deductible Health Plans
Employers Shifting Costs from to Employees
Rapidly Increasing Healthcare Costs
And while traditionally a laggard in the adoption of digital technologies, healthcare organizations are not immune to the need to digitally transform themselves. Ignoring the need to adopt digital health technologies can only result in serious disruption, or even extinction, of healthcare organizations both large and small.
Comments on Healthcare Consumerism & Digital Health from HCEG Top 10 Survey Respondents
The executives and industry thought leaders participating in defining the 2019 HCEG Top 10 list at our recent 2018 Annual Forum in Minneapolis, MN included notes and commentary on the specific challenges, issues, and opportunities listed in the survey worksheet. The following are some of those comments related to healthcare consumerism and digital health:
“Data & Analytics (ranked #1) are table stakes to any consumer-focused products and services. And foundational to all Digital Health initiatives.”
“Population Health (ranked #3) could be considered ‘Total Consumer Health’”
Note: A number of participants expressed opinions that “Population Health” and “Total Consumer Health” could be considered the same thing. After some discussion, everyone agreed that Population Health should be considered as population-centric as opposed to person-centered.
“Social determinants of health have a huge impact on health outcome but as a health system we lack the ability to control/impact these barriers.”
“Connecting with our members on a frequent basis is very challenging. We struggle with identifying and delivering the right message at the right time.”
“Different departments have their own goals and objectives and these often create a disjointed member experience.”
“We must move from deploying largely unconnected tactical approaches to a more holistic, coordinated customer experience strategy.”
“It’s not always clear to us what matters to individual patients and how we can measure those things.”
How to Learn More About Healthcare Consumerism & Digital Health
The HCEG Top 10 list drives the content HCEG creates and delivers to its members and associates via blog posts like this, our Webinar Series Events and our Executive Leadership Forums. Accordingly, we’re pleased to share several complimentary opportunities to learn more about opportunities for healthcare organizations to meet the needs of increasingly educated and proactive healthcare consumers AND how specific digital health products and services are supporting the creation, delivery, and consumption of medical and non-medical services and products that improve health outcomes.
Webinar Series Event: The New Engaged Digital Consumer
What Digital Healthcare Organizations Must Do to Survive and Thrive
On Thursday, November 15th, 2018 at 2:00 pm ET, our sponsor partner HealthEdge will present a webinar that provides information from recent market studies and specific examples illustrating how engaged digital consumers regard the services provided by health insurers.
Attendees will learn:
The top organizational priorities health insurance executives are currently facing
Key challenges and solutions that enable health insurers to address these organizational priorities
The most important expectations that members have of their health insurer
How trust levels between members and health insurance organizations are being addressed by new disruptive entities entering healthcare
If you can’t make it, go ahead and register and we’ll send you the recording and slides after the event!
AHIP-ELR: Total Consumer Health & The Digital Healthcare Organization
On Thursday, December 13th, 2018 at 1:00 pm CT/2:00 pm ET, we’re hosting a special Executive Leadership Roundtable immediately after the 2018 AHIP Consumer Experience & Digital Health Forum convenes at the Music City Center in Nashville, TN. Lunch will be provided at no charge and the following topics will be presented and discussed by several healthcare industry leaders:
How competition from new entrants, cost containment pressures associated with value-based care programs, health/entitlement reforms, and technological innovations may impact ‘healthcare consumerism’
Approaches for turning passive health plan members and health system patients into active healthcare consumers
Catalysts for healthcare consumerism change: employer groups demanding better value and trend of health plan members and individuals directly engaging with plans and providers
How value-based relationships demand that healthcare organizations engage with their members and patients
Which tools and services healthcare organization can use to enhance member/patient engagement
Our executive leadership roundtable event is complimentary but registration is required (so we can make sure everyone gets lunch).
Also, you can receive a discount off registration to the 2018 AHIP Consumer Experience & Digital Health Forum by using “HCEG” when you register here.
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More Insight on the 2019 HCEG Top 10 Items Coming Soon!
As 2018 winds down and 2019 takes off, the HealthCare Executive Group will continue to create, curate and promote content and events addressing each of the items on our 2019 HCEG Top 10 list. We’ll be presenting numerous webinars, hosting Executive Leadership Roundtables in conjunction with popular healthcare conference events, and – of course – holding our popular Annual Forum. The 31st HCEG Annual Forum will take place in Boston, MA in September 2019. Stay tuned for more information!
Consider joining our unique organization of healthcare executives and thought leaders today. See this page for more information and/or reach out to us here.