If analytics is the machine powering your digital transformation initiatives, then data is the power making that digital transformation machine run. The importance of data and analytics has been identified by our members in each of the last ten years HCEG’s Top 10 list of challenges, issues, and opportunities have been created. For 2019, “Data & Analytics” is ranked #1 on the HCEG Top 10. It’s clear that healthcare leaders believe that data is a catalyst to accelerate meaningful change. And that the use of analytics – particularly prescriptive analytics – is a fundamental strategy for succeeding in a new era of healthcare.
Mountains of Data Waiting to Power Your Healthcare Analytics Machine
Good analytics begins with good data and healthcare organizations are sitting on a mountain of data. According to America’s Health Insurance Plans (AHIP), the typical regional payer processes $8 billion in claims each year with each claim providing its own set of unique data points – largely financial and administrative. But healthcare payers are increasingly collecting, matching, and using clinical data to provide richer, more comprehensive insight on their members.
Given the proliferation of Electronic Health Records (EHR) incented by CMS’s Meaningful Use program, it’s no surprise that more and more data is being pulled from EHR’s. And risk-sharing agreements between payers and providers has resulted in health plans sharing more claims data with their provider partners. In fact, the current Industry Pulse report indicates that EHR data is one of the top two primary sources of clinical data with 30% of health plans reporting they utilize EHR data.
Other sources of clinical data that organizations are using to complement their claims data include ancillary data such as pharmacy, lab, and imaging (17%) and real-time admission, discharge, and transfer notifications (10%)
These enhanced data sources are becoming more and more useful due to the power of artificial intelligence (AI) and machine learning.
New research from Dimensional Insight identifies care quality measures and finance as two top use cases for healthcare organization usage of analytics today. Additional use cases for leveraging data by analytics include
Addressing Social Determinants of Health (#3 on the 2019 HCEG Top 10)
Value-based Care and Alternative Payment Models (#4 on the 2019 HCEG Top 10)
Improving Patient Engagement and Satisfaction
Patient Outcomes Improvement
Analytics Budgets are Increasing for Healthcare Organizations
According to a recent report from the Society of Actuaries, greater than 60 percent of payers and providers are planning to increase their analytics budgets by 15% or more.
Additionally, the report finds that 89% of healthcare executives plan to use predictive analytics over the next five years. It’s clear that healthcare payers and health systems have a keen focus on leveraging the massive amounts of data they possess. These data serve to reveal trends, patterns, and insights to help ensure their success going forward.
Solving the Rubik’s Cube of Payer Data
i.e. Lining Up All Your Data to Rapidly and Accurately Gain Unique Insights
For insight into how your healthcare organization’s data can be used to improve health outcomes and reduce costs, join our next Webinar Series Event on June 6th at 2:00 PM EDT / 11:00 AM PDT. Our sponsor partner eQHealth Solutions presents “Solving the Rubik’s Cube of Payer Data.”In this complimentary webinar, you will learn how to aggregate and parse provider data, how you can use data captured outside of your own system, and other practical solutions to use your data to create knowledge for actionable use and outcomes. Attendees will have a chance to ask questions and all registrants will receive a copy of the presentation afterward.
Last week a lot of planning, coordination and content development by the HealthCare Executive Group came together at the 16th Annual World Health Care Congress in Washington, DC. For this year’s congress, HCEG partnered with World Congress Events to present the CIO & CTO Strategy Track. This post recaps a few highlights of the 2019 World Health Care Congress, shares some insight from the healthcare leaders and champions presenting at the event and in our the CIO & CTO Strategy Track, and provides some select presentation materials, recordings and other content from the event.
HCEG Top 10-Related Highlights From 2019 World Health Care Congress
As expected, many of the sessions and keynotes at the WHCC event addressed items on the 2019 HCEG Top 10 list with “social determinants of health” (#3 on the 2019 HCEG Top 10) and “value-based payment” (#4 on the 2019 HCEG Top 10) being pervasive themes throughout the keynotes, sessions and exhibit hall.
Value-Based Care – It’s More Than Just Adding An Alternative Payment Model
One of the sessions in the Provider Transformation track, ‘Do Medicare Changes Enhance or Hinder Clinical and Payment Transformation‘ emphasized the role of the primary care doctor in the shift from the dominant fee-for-service reimbursement model to new value-based-payment methods. Panelists also called out that to truly transform our health care system, change must not just focus on payment models but also deliver scalable clinical and operational methods. And HCEG members acknowledge this as “Operational Effectiveness” is ranked #8 on the 2019 HCEG Top 10 list.
Defining, Measuring, and Communicating Quality Measures are Key for Leveraging Social Determinants of Health
Another session titled “SDoH Business Strategy: Quantify and Communicate the ROI and VOI of SDoH Initiatives” shared the following key points and considerations for healthcare organizations looking to address social determinants of health as barriers to care:
Quality measures that incorporate social determinants of health must be developed and understood BEFORE starting programs and initiatives.
Readily available public data is not granular enough to capture SDoH factors needed appropriate quality measures.
Conducting clinical trials on proposed quality measures can help to understand and quantify the benefits of SDoH initiatives.
Incorporate patient/member personalization into a standardized, common infrastructure that enables economies of scale.
Predictive analytics – a perennially high-ranking item on HCEG’s Top 10 lists – is THE critical component of SDoH programs.
Combining clinical data from EHR’s with claims and other administrative/demographic data records allows health plans/health systems opportunities never before easily attainable.
Health plans, health systems, and providers must clearly understand and communicate the benefit that addressing social determinants of health can have for their members and patients.
Organizations should strive to assign a financial measure assigned to each quality measure.
CIO & CTO Strategy Track at World Health Care Congress
Alan Abramson shared four areas of focus for HealthPartners:
Formally chartering projects to deploy technology-based approaches to largely manual processes
Carving out and focusing on efforts to improve patient experience
Address inefficiencies in technology ecosystems, business policy, and processes
Establishing R & D projects to assess opportunities and benefits of new, emerging technologies
Increasing Operational Effectiveness in Health Plans & Health Systems
Alan went on to share that the #1 initiative his healthcare organization has been focusing on last year, in 2019 and will continue to focus on in 2020, is increasing Operational Effectiveness (#8 on the 2019 HCEG Top 10). Alan provided some examples as to how HealthPartners is achieving greater operational effectiveness including:
Utilizing Lawson Financials to consolidate multiple disparate functions
Rehosting and re-platforming administration systems such as employer group setup, utilization management reporting, new member enrollment, and patient admission, discharge and transfer.
Positioning systems, policies, and procedures to accommodate increases in individual health plan coverage
Consolidating four different laboratory systems into one system
Using Robotic Process Automation (RPA) to automate user administration and security
Using AI-powered bots to automate 27,000 software QA tests that took three weeks to complete and that now take 17 hours.
Alan noted that achieving success via ‘standardization’ in one area often leads to end users demanding improvement via standardization in other areas.
Payer-Provider Data Sharing and Interoperability Critical in Risk-Sharing Relationships
Kim Sinclair’s healthcare organization serves approximately 400,000 members and patients via its health plan, hospital, and medical centers – 80% of whom are Medicaid beneficiaries and represent 15% of the state’s Medicaid population.
Like other integrated healthcare delivery systems – especially those entering the nascent world of ‘accountable care,’ Kim noted that investments in provider network management and payer-provider interoperability have often lagged that of other initiatives. Moreover, a competitive market with many small medical practices lacking sufficient IT systems and a tendency to ‘throw bodies at a problem’ has increased the challenges her organization faces.
Kim also shared some examples of how her organization is addressing their challenges, issues, and opportunities:
Integrating various systems with a focus on creating an industry-leading accountable care organization (ACO).
Formal projects to identify and stratify members and patients with complex care management needs.
Revising policies, procedures, teams, and systems to effect a truly integrated system.
Reducing pended claims and time to pay – particularly important where both payer and provider are sharing risk.
Focusing on change management and investing in payer-provider interoperability and support.
Cybersecurity – Think Beyond Enterprise and Employee Training
In this CIO & CTO Strategy Track session, panelists discussed cybersecurity at the end-user level. They emphasized the importance of leadership having a strong grasp on the ‘foundational’ components of cybersecurity (patch management, identity/access management, perimeter security, etc.) And also encouraged the audience to pay attention to data assets outside their own four walls. For instance, the use of Software as a Services (SaaS) and 3rd parties they contract with (outsourced vendors) who possess their organization’s sensitive data.
HCEG board member Eric Decker and SVP of IT & CIO at Independent Health spoke about how his mid-sized health plan has evolved beyond the core technical cybersecurity team as the ‘first line of defense’ by chartering a Risk Office responsible for creating and testing their cybersecurity framework. His organization also has an Internal Audit team that regularly audits core controls as well as the cybersecurity framework.
Jothi Dugar, Chief Information Security Officer in the Office of the Director at the NIH Center for Information Technology shared what seems like an obvious approach to thinking about cybersecurity but may not, in fact, be so common:
Think holistically – consider the psychology of cybersecurity and how to optimize your workforce against threats.
Tim Thull, SVP of IT & CIO at Medica Health Plan spoke about how it is important to have strong oversight, governance, and controls framework around information risk management from your board of directors to individual staff. Medica has implemented HITRUST as common security framework with an information risk program which provides sound technology solutions and controls. Robust training and awareness remain a critical component in ensuring everyone is an active participant in strong cybersecurity defenses.
Optimize Information Sharing to Generate Real Value from Data
Latecia spoke about the importance of viewing data as a strategic asset, explained that “the ‘Why’ we share information matters” and offered some lessons learned during the Opioid Symposium and Code-a-Thon sponsored by HHS.
Data are in silos
Data sharing is inefficient
Analytics capacity is uneven
Data sharing is costly
Video Interviews by Mabel Jong at 2019 World Health Care Congress
One of the interesting and informative parts of the WHCC event was their WHCC TV feature where Mabel Jong – professional on-camera interviewer and panel moderator specializing in healthcare – does short interviews with keynote speakers, session panelists, and other healthcare leaders and champions participating in the Congress.
Mabel interviewed Ferris Taylor, recent Chief Operating Officer of Arches Health Plan and HCEG’s executive director. More about this interview will be shared as the recordings are released. In the meantime, you can find many of the interviews performed by Mabel Jong on the World Congress Events YouTube Channel.
HCEG Member Feedback on 16th Annual World Health Care Congress
HCEG Board members Cate McConnell, Healthcare Payer Industry Practice Lead at Appian Corporation and Eric J. Decker, SVP of IT & CIO at Independent Health shared their insight on the 16th Annual World Health Care Congress:
What was unique about the WHCC event?
Eric:The keynotes went right to the heart of the issues impacting our industry today (transparency, value-based payments, social barriers, member engagement, and affordability). Likewise, the breakout sessions were plentiful and offered a diverse array of topics to choose from.
Cate:WHCC, being in Washington DC, includes policymakers in greater numbers than most conferences. It was good to hear some of the interesting ideas shared by the policymakers. I would have liked to have more people from the current HHS/CMS administration who are shaping healthcare policy speak at WHCC.
How did WHCC’s event differ from what HCEG presents with its Annual Forum?
Eric:Many healthcare conferences – WHCC included – include limited time for questions and answers, not only in the keynotes but also the breakout sessions. The event had nowhere near the time that HCEG’s forum includes for questions (and even debate).
Cate:WHCC is much bigger than HCEG’s annual forum which leads to fewer and less intense opportunities for networking and discussion. The large exhibit hall/show floor can sometimes be a distraction.
What didn’t you see or what could have been better about WHCC?
Cate:Pricing transparency is ‘critical’ in healthcare – in terms of procedures, tests, and drugs – but there weren’t any discussions of how to do this, and what this means to provider compensation. The free market disruptors will likely force this on the industry, which appears unwilling/unready to address it themselves. A speaker made the point that of the two industries that don’t have price transparency – college education and healthcare – prices increase many times greater than inflation because there are no incentives to become more efficient.
What were some things you felt were ‘most important’ for WHCC attendees to absorb?
Cate:Many speakers acknowledged that disruption is coming and that Amazon, Google, and Apple are the prime disruptors. Yet most executives shrugged off this threat with “they will learn healthcare is complex.” This seems to be an “innovator’s dilemma” situation where current industry players are unable to disrupt themselves due to entrenched business models. But what will happen to healthcare if Amazon drives sweeping disruption as it did in retail? Are we ready for widespread bankruptcies?
“External Market Disruption” is ranked #7 on the 2019 HCEG Top 10 list.
Other Recaps & Insight from 2019 World Health Care Congress
Here’s a bit about what others are sharing from the 2019 HCEG Top 10 list at the 16th Annual World Health Care Congress:
A Unique Opportunity for Healthcare Executives, Leaders & Champions
The 16th Annual World Health Care Congress was a great opportunity for those working to transform the healthcare industry during these uncertain times. And the HealthCare Executive Group was honored to have partnered with World Congress Events to host the new CIO & CTO Strategy Track.
For another opportunity to learn about new strategies and approaches to addressing the challenges, issues, and opportunities facing healthcare leaders – and to establish new relationships to facilitate your organization’s digital transformation – consider joining other healthcare executives, leaders, and champions at our 2019 Annual Forum in Boston on September 9th through the 11th. The year’s agenda is centered around the following major themes supported by the 2019 HCEG Top 10:
Technology & Its Role in Transformational Industry Change
Digital Health: Consumer & Organizational
Pharmacy Costs and Opioid Management
In addition, all participants in our 31st Annual Forum will be treated to a special networking event between the Boston Red Sox and the New York Yankees at Fenway Park on September 9th – at no additional charge.
Harry Merkin, VP of Marketing at HealthEdge and Dave Mika VP of Enterprise Core System Operations at Independent Health shared insight and real world experience on how health plans and their provider networks can transition from traditional fee for service (FFS) to value-based payment (VBP).
This blog post recaps highlights of the webinar and provides access to additional information from the webinar. A recording of the webinar can be found here. You can also check out this Twitter Moment summarizing live Tweets from the webinar.
Value-Based Payment Began in the Late 1990’s
In the late 1990’s, capitation models began paving the way for change from traditional FFS payment models to models focused on helping establish effective, cost-efficient practice models. In the last few years, value-based payments have become the latest and greatest models for reimbursement of care. The importance of value-based payments is supported by HealthCare Executive Group members ranking Value-Based Payment as #3 on the 2018 HCEG Top 10 list.
Moreover, recent statements by current and former HHS officials have supported the need for value-based payment:
“There is no turning back to an unsustainable system that pays for procedures rather than value”, and the transition “needs to accelerate dramatically.” – Alex Azar, Secretary of HHS, 3/5/18 at the Federation of American Hospitals’ conference
“I highly encourage health care leaders to listen intently to his full remarks. The transition to value is moving forward; if you aren’t already preparing for it, it is time to get on-board.“ – Michael Levitt, former governor of Utah and former HHS Secretary
Value-Based Payment Can Lower Costs and Improve Outcomes
Harry Merkin shared the results of a November 2017 Humana study showing that VBP programs achieve meaningful gains in cost and quality vs. traditional FFS methods with total healthcare costs associated with VBC plans 15% lower than care costs of FFS plans. And a more recent survey by the Healthcare Financial Management Association revealed that 70% of healthcare organizations participating in VBP programs have achieved positive results.
Value-based Payment Must Address the Quadruple Aim
Independent Health’s Dave Mika shared real-world insight into the experience his organization has witnessed. A key focus raised by Dave is that health plans looking to implement or extend value-based payment programs must address the four pillars of the Quadruple Aim:
Enhancing patient experience
Improving population health
Reducing costs
Improving the work life of health care providers
Questions from Webinar Participants About Value-Based Payment
HCEG webinar series events always include the opportunity for questions from participants and this webinar was no exception. Two of many questions included the following short, paraphrased responses by Dave Mika – and other questions can be obtained from the webinar recording:
What is the key to gaining alignment with PCP’s?
Answer: Actively reaching out to and collaborating with key stakeholders in the local community.
What data has proven to be most useful to the provider network?
Answer: Information on patient gaps in care– ideally provided at the point of care in the physician’s workflow – can be very effective in improving value.
And More on How to Get There from Here…
In addition to the above, the webinar addressed the following considerations for transitioning from traditional FFS programs to VBP programs:
Aligning delivery and reimbursement models with high-performing providers
Tools for members to self-manage and self-navigate the care delivery system
Technology support including web and digital capabilities
The move to value-based reimbursement appears inevitable, and only those health plans and providers that begin to transition and adapt today will be successful in the future. Change doesn’t happen overnight. To learn more about how making the transition from FFS to VBP, check out the webinar recording, consider contacting HealthEdge for more information and keep in touch with the HealthCare Executive Group by connecting with us on Twitter, Facebook, LinkedIn and subscribing to our newsletter.
The behemoth of all healthcare conferences started today: the 2018 HIMSS Conference & Exhibition. Few healthcare conferences garner the attention of healthcare industry executives and professionals as the annual HIMSS Conference and Exhibition. And HealthCare Executive Group (HCEG) members, sponsor partners and advisors are among the approximate 45,000 healthcare professionals descending upon Las Vegas this week to network with others, attend sessions addressing topics of interest, cut through the clutter and and jockey for position among 10’s of 1000’s of others in the cavernous exhibit halls of the HIMSS conference.
How Big is the HIMSS Conference?
To get an idea about the sheer size of the HIMSS Conference & Exhibition, consider the following statistics provided by HIMSS:
Number of Attendees: Approximately 45,000 people – equal to a capacity crowd during a Cubs game at Wrigley Field
Geography: attendees from 40 countries will be represented.
Exhibitors: About 1300+ vendors – most all of them flush with shiny handouts and branded tchotchke battle each other for the attention, contact information and budget of the attendees from around the globe.
Carpet: More than 10 miles of carpet cover the aisles of the exhibit hall
Connectivity: About 18 miles of cabling provide internet connectivity throughout the convention center.
HCEG’s Top 10 Mirror Popular HIMSS Themes
Historically, industry executives, media, thought leaders, speakers, influencers and brands predict major HIMSS conference themes in the months and weeks leading up to the conference. Not surprisingly, this year’s major themes closing align with the opportunities, challenges and issues ranked by HCEG’s members in the 2018 HCEG Top 10. These include the following:
Advanced Analytics (Ranked #1 on HCEG Top 10 List)
Clinical, operational and financial processes supported by ever-improving artificial intelligence, machine learning and natural language processing applications have been identified by many as a primary way to make everyone more proactive to improve outcomes and lower costs. And the importance of non-traditional data sources such as social determinants of health, consumer-generated data and data purchased from 3rd parties provide tangible cost savings, time savings and quality of care improvements.
Value-based Payment & Care (#3)
In spite of recent pullback by CMS on bundled payment initiatives and some delays in implementing certain regulations regarding value-based payment programs, information, products and services aimed at accommodating our aging population and increasing levels of chronic conditions are legion in the sessions, exhibit booths and hallway conversations at HIMSS.
Population Health Programs & Services (#2)
Results from the 8th Annual Industry Pulse report, based on the HCEG Top 10, make it is clear that the industry can’t get to value-based payment (VBP) without significantly enhanced clinical data, analytics and agreed upon measures. And VBP won’t succeed unless there is more focus on bringing communities together to change behaviors and how we think about approaching population health.
Sorting through all the overlapping platforms, data trends, and tools needed to complement the care team and provide patients with optimal outcomes at the lowest cost are no easy feat. Attendees exploring the exhibit hall in search of achieving efficient implementations, streamlined operations, scaled delivery across large markets have their work cut out for themselves this week.
Engaging Healthcare Consumers & Patients (#10)
Whether you agree or not, healthcare services and products are moving from a B2B to a B2C and B2B2C delivery model.
Recent announcements from non-traditional healthcare market participants like the Amazon-Berkshire Hathaway-JP Morgan Chase partnership and the CVS- Aetna merger make it clear that massive change in the traditional healthcare market – lead by the digitization of everything – is imminent. Duplicating the consumer engagement models these new healthcare market entrants have proven in other industries and markets makes it apparent that significant cultural and organizational changes are required to adapt to the digital transformation sweeping the healthcare industry.
Popular Hashtags At the 2018 HIMSS Conference
You can zero in on popular HIMSS-related themes using the following hashtags:
#patientengagement – Being used over 80% more this year in comparison to last year
Check out this eBook from HIMSS on some of the innovation that will be on display at this year’s conference.
HCEG Sponsor Partners at HIMSS
If you’re at the HIMSS Conference, be sure to check out our sponsor partners exhibits, sessions and special events are hosting. Here are those we know about at this time. We’ll share more as they become known.
Instamed
Visit Booth 5062 to get some water, soft pretzels, Tastykakes and learn more about Instamed’s offerings.
Keep your eyes peeled for more information, insight and ideas that HCEG members, sponsor partners and advisors will be gathering from Las Vegas this week. A special ‘HIMSS18-edition’ eNewsletter will be shared later this week including major takeaways, insights from conference thought leaders and some pictures capturing the event. If you aren’t already a subscriber to our newsletter, you can sign up here.
As more Accountable Care Organizations (ACO) are formed and as value-based reimbursement arrangements between payers and providers expand, the need for assessing non-traditional drivers of health outcomes, leveraging payer, provider and community resources and enhancing collaboration between patients, providers and payers are becoming key to improving outcomes and managing costs.
Our Thursday, October 26, 2017, Harry Merkin, VP of Marketing at our sponsor partner HealthEdge teamed up with Barbara Berger, VP of Care Management at First Care Health Plans, to present “Care Redesign: Lowering Costs While Improving Patient Outcomes,” HealthEdge’s entry in this month’s HCEG Webinar Series. The webinar presented innovative, real-world examples of how First Care Health Plans is improving member outcomes and lowering their cost of care via three primary approaches:
Collaborating with providers and health systems
Partnering with community resources
Making critical information available to key stakeholders
Addressing Discontinuances of Care
Barbara shared that, while the high volume, time-sensitive nature of healthcare delivery often leads to a discontinuance of care delivery and management between the silos in which payers and providers often operate, the increased data sharing associated with the emergence of ACO’s and value-based reimbursement and care models are helping to align care provided by providers and health plan payers. Examples of balancing the proper people, processes and technologies were shared.
Population Assessments and Social Determinants of Health
Barbara emphasized the importance of carefully and thoroughly assessing an individual’s health care, behavioral and social needs as part of a periodic, recurring population assessment and how doing so can have a key, beneficial impact to healthcare outcomes. And with “Social Determinants of Health” forming the basis (bottom) of Maslow’s Triangle of Needs, First Care is starting to include an assessment of member’s social determinants of health in their population assessment program. Factors such as the following are included in the population assessment:
Access to Healthcare Services
Access to Food
Access to Local Community Resources
Access to Transportation Options
Public Safety
Financial Status
After Barbara shared her insight on this currently popular topic, Harry Merkin stated: “The phrase ‘social determinants of health’ is no longer a buzzword!”
Addressing Social Determinants of Health
Barbara shared an overview about First Care’s “Expecting the Best Maternity Program” that combines case management and utilization management to complement care provided by physicians while guiding and supporting members – and their family – through member pregnancies; particularly high-risk pregnancies.
Besides services such as assistance with locating medical providers, toll-free 24/7 access to a clinician and a package of select products and services aimed at supporting pregnant women, the program also includes an innovative “Nurse-Family Partnership” where a First Care nurse is paired with an expecting family to help the patient and her immediate family members understand and manage the pregnancy. First Care nurses regularly reach out to ask questions on how the pregnancy is progressing and answer any questions the patient and family may have.
The program has resulted in a significant per decrease in NICU maternity admissions.
The Recording, The Content and More Insight from HealthEdge
The webinar presented three considerations for payer-provider population health programs:
Be methodical about population assessment
Integrate People, Process and Technology with Providers
Use value-based contracts to align vision of member/patient care
You can learn more about how collaborating with providers and health systems, partnering with community resources and making critical information available to key stakeholders can improve outcomes and lower costs by checking out this recording of the webinar and these few slides from the presentation. If you would like more information or if you have any questions on the content of this webinar, please feel free to contact HealthEdge too.
“Specialty Networks and Risk Sharing at Scale” – Monday, September 18th at 3:15PM – 4:30PM
At this year’s 29th Annual Forum in Nashville, TN, Dr. Richard Popiel, EVP & Chief Medical Officer at Cambia Health Solutions, moderates a panel presenting and discussing the current needs, opportunities, and challenges associated with improving the appropriateness, outcomes and affordability of specialty care services; specifically the clinical decision support mechanisms and other solutions that risk-sharing, value-based environments need to simplify, encode and utilize complex clinical content into a standardized, repeatable, evidence-based system for making decisions supporting an organization’s clinical programs.
Dr. Popiel and other healthcare industry experts will present how we as a healthcare system can improve healthcare outcomes and reduce costs by shifting to value and risk sharing arrangements. Insight into how disruptive analytics and analytical approaches to cost trend monitoring and containment will be shared and interactive opportunities to engage will be available.
Healthcare Thought Leaders Share Valuable Insight at HCEG Annual Forum
Panel Moderator – Richard Popiel MD MBA
Dr. Richard Popiel, Cambia Health Solutions
Richard Popiel, M.D., MBA, Executive Vice President, Healthcare Services & Chief Medical Officer, Cambia Health Solutions & Regence Health Insurance Company
Dr. Richard Popiel leads medical strategy for Regence health insurance plans and provides executive leadership on care initiatives and cost management activities across the corporation. He came to Regence from Horizon Healthcare Innovations, where he was president and chief operating officer. Dr. Popiel earned a B.S. in biology and his M.D. at The George Washington University in Washington, D.C. He also holds an M.B.A. from Northwestern University Kellogg School of Management. He is board-certified in internal medicine.
Panelists include: (Additional panelists are pending confirmation)
Brandon Cady
Brandon Cady – President/CEO at AIM Specialty Health
Brandon Cady is the President and Chief Executive Officer of AIM Specialty Health® (AIM). Brandon joined AIM in 2002 and executed top line growth initiatives that expanded the business into one of the largest and most successful specialty benefits management companies in the United States.
Brandon has held a variety of leadership positions within hospital systems, health plans, and emerging technology companies. Brandon earned his master’s degree in Health Services Administration from the University of Michigan in Ann Arbor and a Bachelor of Business Management from the University of Iowa.
Dunston Almeida
Dunston Almeida – Executive VP of M&A Strategy and Business Development at Evicore
Dunston Almeida serves as an Executive Vice President of M&A Strategy and Business Development at eviCore healthcare, LLC. Dunston focuses on new strategic initiatives and partnerships, driving inorganic growth via mergers and acquisitions (M&A) and working with the Board and Executive Team on the company’s Strategy Council. He also supports the formulation of eviCore’s public policy and regulatory efforts. He has more than 20 years of experience in technology.
The 2017 HCEG Annual Forum
The HCEG Annual Forum provides the setting and platform for senior level executives from across the healthcare spectrum to come together for 2-3 days each year to discuss the continuous innovation, evolution and transformation of the industry. Attendees are granted direct access to approximately 100 peers, thought-leaders and solutions providers from around the country; all facing similar obstacles and providing opportunities, while engaging in real, relevant and productive dialog.
This year’s 29th Annual Forum takes place in Nashville, TN on September 18th -20th. For more information on this years annual forum, see this page.
It could have been the combination of a beautiful day in California’s Wine Country or just the extraordinary and varied perspectives of healthcare executives representing a true cross-section of American healthcare – payers, providers, vendors, purchasers and UnitedAg partners – that elicited deep discussion about value-based relationships and made the jointly sponsored Healthcare Executive Group (HCEG)-UnitedAG Health Innovation Forum such a successful event. But whatever it was, the forum’s theme – Advancing Together – was clearly a spot-on phrase used to describe an informative and inspiring event.
UnitedAG’s hospitality and the diverse cross-section of attendees at UnitedAg’s Annual Meeting and Conference could not have set a more congenial and thought-provoking setting. Led by Kirti Mutatkar, UnitedAg CEO, Mike DeMore, Superior TPA’s Managing Director and Christopher McDonald, UnitedAg’s Director of Underwriting, the Health Innovation Forum kicked off an open dialogue of the critical issues and opportunities facing healthcare in 2017 and beyond.
The Healthcare Industry Pulse
After 30+ participants introduced themselves to each other, Ferris Taylor, HCEG Office of the Chair and Change Healthcare consultants, Chris Link and David Gallegos, presented highlights from the 7th Annual Industry Pulse Research survey. As is commonly said, a picture is worth 1000 words and Eris Weaver, a graphic recorder meeting facilitator captured many key points throughout the fast moving discussions.
Key research insights among the participants were shared on the impacts that clinical and data analytics can have on stakeholder interactions, workflows and especially on population health. The transitions from more traditional risk management (disease and care management) to more 21st century tools and technologies were explored. Measures of success for the transition to value-based relationships were considered, especially those that will best serve consumers, healthcare providers and payers. The Industry Pulse research also highlighted the roles that both cost and quality transparency will play in the future of healthcare.
Alignment of Incentives is Key
As revealed in the excellent graphics created by Eris Weaver as the discussions unfolded, “trust” was a key word arising multiple times. Dr. David DiLoreto, SVP at GE Healthcare and HCEG member, facilitated dialogue on the importance of more detailed innovations that value-based relationships demand. Dr. DiLoreto shared some insight experienced in Scandinavia and Denmark versus here in the U.S.
Population Health & Value-based Care
Dr. Arjun Chanmugam, Vice Chair of Johns Hopkins’ Integration and Health Care Transformation, Dr. David Nace, Chief Medical Officer at HCEG sponsor partner MarkLogic and Dr. Craig Brandman, CEO of StepOne Health, contributed their unique insights about the challenges and secrets of value-based health care.
More on Wednesday, March 29th, 2017
The morning of discussion in Wine Country was just the start of innovative thinking around value-based relationships. Those discussions and more details from the Industry Pulse Research Survey will be shared via a webinar presented by HCEG and Change Healthcare on Wednesday, March 29th at 2:00 PM Eastern.
Political, business, and health care leaders from across the nation gathered to dive deeply into our nation’s top policy priorities in an effort to move forward in today’s uncertain healthcare environment.
What a period for healthcare reform in the United States!
In addition to some general comments about healthcare policy and politics, today’s sessions addressed topics such as the following:
Risk-sharing and Cost Control
Value-based Care
Pharmacy Costs
Medicaid Exchanges
Importance of Social Determinants of Health
Social shares from conference attendees
As is happening more and more at many of today’s top healthcare conferences, conference proceedings, insights and other information were shared on Twitter – among other social channels. Here’s a sample of some interesting shares from Day 1 of the 2017 AHIP National Health Policy Conference.
Thanks to all those noted below who took the time to share with those who were unable to attend the conference.
Prescription drug costs pass physician services as biggest slice of health insurance premium
@rpalme01
Keep talking to your local pharmacist and sharing what he tells you.
Medicaid Exchanges, Access & Importance of Social Determinants of Health
Handle
Tweet
@ajmc_journal
Healthcare reform is a question of access vs true availability. The devil is truly in the details, said @AndyGurmanMD
@nancyrwise
Interested in continuing conversations about potential intersection of #Medicaid and Exchange markets in #healthcare #simplicity
@ahipcoverage
From transportation, housing & environmental health, plans are addressing social determinants of health
Keep on Top of More Insight on Healthcare Reform
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The long and winding road That leads to your door Will never disappear I’ve seen that road before It always leads me here Lead me to your door -The Beatles
Teresa DiMarco – Strategic Advisor at Leverage Health
If you?ve been around the health care industry for the last 30+ years, you know that the ACA and HHS? efforts around value based payment, ACOs and the like, are not new ideas. ? They have as their goal the same outcomes we?ve all been striving for over the past five decades: to achieve better health outcomes and patient care experience, cost-effectively.? We didn?t call it the Triple Aim at the time, but it?s the same thing.
The development of HMOs in the 70s and 80s was the mechanism, at the time, to re-organize health care delivery and financing in order to achieve what is now called the Triple Aim.? The initial and, some would argue, the most successful models early on were closed panel staff-model and group-model HMOs, where the providers took on full-risk and were also the payers?responsible for patient care, health outcomes and managing costs under a fixed budget, responsible for adequate patient access and for patient satisfaction, retention and growth.? We then expanded some of the principles of the staff model HMO to broad networks of providers which weren?t integrated clinically or financially, and thus had to use externally imposed controls to manage cost and quality.? We did so under the banner of managed care.
But, managed care hasn?t achieved all that we wanted, and managed care?s geographic and population reach has its limits.? Fee for service is still very alive, but not ?alive AND well? in terms of achieving our objectives.
So, now we are back to the future?or the future is back to the past?trying to figure out how we bring together providers of care, their patients and responsibility for financial and quality outcomes into one organization that is fully accountable and ?at risk?.? Thus, ACOs and value based payment models are introduced.? New names for the same concepts.
Now, CMS is tackling the unmanaged Medicare FFS program, which still represents a significant proportion of all Medicare program expenditures. ? Sylvia Burwell of CMS has announced that its goal is to have 85% of Medicare fee-for-service payments tied to quality or value by 2016, and 90% by 2018.? And, the target is to have 30% of Medicare payments tied to quality or value through alternative payment models by the end of 2016 and 50% by the end of 2018.? Alternative payment models, per CMS, include ACOs and bundled payment arrangements. Beyond CMS, the commercial managed care payers have been expanding their use of value-based payment arrangements for years.? The pace is accelerating.
What Does This Mean for Providers?
What does this mean for providers?? It changes everything–how they think, how they operate on the ground, how they make clinical decisions at the point of care, what information and tools they need, what data they evaluate, what metrics and outcomes they focus on, how they invest their capital, and how they make money or avoid losing money. Providers need to lead the coordination and management of patient care across the continuum of settings and specialties, for entire episodes of care.? They also need to understand the aggregate populations for which they are now accountable and to focus and manage all the health care resources to achieve broad population-based goals for quality and cost.? It is the long and winding road.
With all the focus on ACOs and value-based payments, you?d think that was the lynchpin of change. Yes, it?s a critical and fundamental element.? It is a required catalyst to undo the thinking and unwind the systems of care that were built and optimized under 75 years of FFS payment. But, these elements, while important, won?t get us there by themselves.? They alone won?t change behavior or create the systems of care that produce the outcomes we desire.
The Lynchpin to Change
The biggest tasks ahead, which are required to change the system, are also the most critical ones?changing the care delivery processes, workflows and point of care decision processes inside provider organizations. It?s transformational.? It?s a huge job. It will take significant resources, both human and capital, to execute. These process changes represent a total care re-design and a total change in how providers THINK about patient care, which now must include financial resource management and a long-term view of outcomes.
While this payment evolution is taking place, a challenge for provider organizations will be navigating across two very different financial models?FFS for some patients and value-based payment for others.? Practically speaking, it?s unworkable to manage patient care differently and have clinicians think differently depending on each patient?s payment arrangement.? Providers, at some point, will need to make a commitment to the new care delivery processes consistent with value-based thinking.? Likely, they will experience short-term hits on revenue and profitability on the FFS patients until the new models dominate.? This transition period will be painful, but the sooner providers ready themselves for success in a value-based world, the better positioned they will be to lead in their markets.? Ready-providers can actually help to drive more payer and employer business to the new models sooner, thus reducing the amount of time and business in the uncomfortable transition.
Interdisciplinary Work?Pulling the whole system of care together
Today?s world has providers operating in silos.? Primary care providers don?t coordinate effectively with specialists.? Hospitals don?t coordinate the transitions of care–from acute to post-acute to home care settings to ensure stabilization and recovery.? Behavioral care providers operate independently of primary care, but the two are interdependent for patient well-being.? Pharmacists and dentists operate on islands all to themselves.
What needs to happen in this care redesign for the value-based world is the coming together of clinicians of various disciplines, with experts in patient-service-experience and financial leaders.? Working in teams, the different perspectives will redefine the care protocols and workflows on the ground. ? Collaboration inside the delivery system, and outside the delivery system with new partners in the community, will take time, energy and, most of all, leadership.
Information technology and new analytic systems will play a critical role in supporting care delivery teams with the dashboards, long-term system-wide insights and patient-specific point of care data needed for decision making and care coordination.? Putting the right data in the right hands at the right time will be crucial. ? For example, a nurse case manager who is coordinating patient discharge needs to know what the most appropriate and cost effective SNF or ICF or rehab or home care options make sense for this patient, and have at his/her fingertips the data about which specific providers have the best outcomes and cost so the best choice can be made.? Then, he/she will need to facilitate, manage, educate, coordinate all elements of the execution of that care plan across a multitude of provider entities, partners and community resources.? And have the systems to track it.
Providers need to think and act like payers
Providers don?t need to design the new world order from scratch.? Much of the expertise and way of thinking about care at the macro-economic and system-wide level resides inside the managed care payers today. Population health thinking, care coordination and case management processes, reimbursement design, and other mechanisms for operating in a risk-based world has been the work of managed care/payers for decades. ? The population health information, the metrics, the claims systems, actuarial expertise, business processes, coordination of care tools and IT systems all exist there.
Some providers may think of managed care/payers as their nemesis. It?s understandable.? The payers had to insert themselves in the FFS system, trying to manage their risk from the outside; often, they imposed their management processes too late in the process to be optimal, and it all felt and was intrusive.? But, in an ACO environment, this thinking about value needs to move into where the patient and the provider live, and where care decisions are made.? What payers have, and what payers know, and what processes payers use, can all be brought to bear to help providers succeed in the value-based world.
So, collaboration opportunities exist not just across the health care delivery system of providers, but also with the payer world, in order to accelerate this transition to a value-based system.
The Long and Winding Road
Whether its primary care and PCMH models, Pioneer ACO models, or new BPCI (Bundled Payments for Care Improvement) programs coming soon from CMS for hip and knee replacements?. it?s all moving in the right general direction.? But, at the detail level, it?s still a great experiment.? CMS is trying new structures, algorithms, and payment formulae.? Providers are trying new structures and methods to manage care under the new reimbursement models.? Payers are trying a multitude of collaborative and control oriented models.? It doesn?t always work.? It will continue to evolve and improve.? It will ultimately lead us all to the value-based outcomes we seek.
It?s the long and winding road. We?ve seen that road before. It always leads us to that door [achieving value].
Teresa has 30 years of executive management experience in health insurance, managed care, healthcare IT, and in government-funded health care systems and BPO services (Medicaid, Medicare). ?Over her career, she was CEO of three tech-enabled health care services companies where she led them to market leadership positions and successful exits. ?She also advises companies, private equity, health care start-ups and venture-backed firms on growth strategies and operations. ?Teresa has a B.S. in Nursing and MBA from The Darden School of Business at the University of Virginia.
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Other sources of clinical data that organizations are using to complement their claims data include ancillary data such as pharmacy, lab, and imaging (17%) and real-time admission, discharge, and transfer notifications (10%)
In this complimentary webinar, you will learn how to aggregate and parse provider data, how you can use data captured outside of your own system, and other practical solutions to use your data to create knowledge for actionable use and outcomes. Attendees will have a chance to ask questions and all registrants will receive a copy of the presentation afterward.
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