Value-based Payment (and Value-based Care Reform) has ranked among HCEG’s Top 10 list of challenges, issues, and opportunities each of the last 10 years that HCEG’s Top 10 list has been published; a clear indication healthcare leaders realize that the move to payment for outcomes (value) vs. volume (FFS) is inevitable. It’s clear that value-based relationships & reimbursement is important to health plans, health systems and provider organizations. But year after year, shared-risk, value-based healthcare appears to be just around the corner. Why so slow? How can healthcare leaders championing the transformation of America’s healthcare system finally begin to realize the value of value-based payment?
In fact, the majority of respondents to the 2019 Industry Pulse Research Survey indicate that value-based relationships including both upside and downside shared risk still appears to be three to five years off.
If what’s apparently widely thought, then why is the move by health plans, health systems, and healthcare providers to value-based reimbursement perpetually stuck at being three to five years away from adopting shared-risk value-based contracts?
Speeding the Move to Value-Based Relationships & Reimbursement
On Wednesday, September 11th, the HealthCare Executive Group is presenting a special Executive Leadership Roundtable as part of their 31st Annual Forum. This interactive roundtable event open to everyone who’s in Boston on September 11th – there’s no charge to join other healthcare leaders from across the country to learn about value-based care and meet others facing similar challenges. To be clear, this special ELR event is open to everyone.
Participants of this special ELR will benefit from:
Interactive discussion between attendees and speakers on what the movement to value means
Learning about the top challenges and opportunities in transitioning from payment for volume
Why healthcare organizations are hesitant to provide value-based care and thoughts on overcoming them
Understanding realistic next steps healthcare leaders can take to make real progress in the move to value
Recent successes in new payment models and lessons-learned
A look at cross-industry partnerships in the movement to value-based care reimbursement
This will be a rare opportunity for Healthcare Champions who gather in Boston on September 11th to learn more about value-based payment and care opportunities and to interact with speakers and other participants on a meaningful basis.
The $64,000 Question (Or the $64B+ Question?) – Always 3 to 5 Years Away
Why is the move by health plans, health systems, and healthcare providers to value-based reimbursement perpetually stuck at being three to five years away from adopting shared-risk value-based contracts?
To learn how to advance value-based care, join us at the Hotel Commonwealth for our September Executive Leadership Roundtable event -Value-Based Relationships & Reimbursement: How can Industry Collaborate to Speed the Move to Value? -and learn from the following session leaders and ELR participants:
Panelists Sharing Insight on Value-Based Relationships & Reimbursement
Join Others to Learn About Value-based Care in Boston on September 11, 2019
Be a part of this unique, no-cost learning and networking opportunity on the last day of the HealthCare Executive Group’s 31st Annual Forum. Breakfast is included and registration is required.
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.
Since the late 1990’s, the reimbursement landscape in healthcare has been changing. Capitation models paved the way for a change from traditional fee-for-service (FFS) payment models to a focus on helping physician partners establish effective, cost-efficient practice models. And now value-based payments are the latest and greatest models for reimbursement of care. In fact, value-based payments were ranked by HealthCare Executive Group members as #3 on the 2018 HCEG Top 10 list.
While uncertainty surrounding healthcare reform in the United States continues and the industry waits for more definitive reimbursement policy from the federal government, one thing is certain—the trend for value-based payments (VBP) continues. Health plans and providers really have no choice but to transition from the traditional fee-for-service model in order to drive down soaring costs and positively impact patient outcomes.
“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 Health and Human Services, March 5, 2018 at the Federation of American Hospitals’ conference
Obstacles in the Path to Value-based Payments
There are many obstacles that must be addressed to successfully implement value-based payments models that reward providers for positive performance and encourage poor performers to improve. In order to achieve the expected outcomes and performance required by VBP, health plans must have the flexibility to develop, implement and administer value-based contracts with providers responsible for care delivery, care management, and care coordination across the medical neighborhood.
How to get there from here…Value-based Payments
On Thursday, March 22, 2018 at 2:00PM ET, Harry Merkin of HealthEdge and Dave Mika of Independent Health will share their insight and real world experience on how to get from here to there with value-based payment. Some of the information they will share includes:
Essential elements of a transition from traditional Fee For Service to Value-based Payment
Independent Health’s story of how important technology-driven strategies are to their adoption of value-based payments
How models being driven by CMS are also impacting commercial contracts
How some health plans are responding to the value-based payment movement including findings from a study of value-based care payments by Humana
The importance of primary care physicians as critical to transforming the way health care is delivered
The type of technology support needed by health plans and providers
The move to value-based reimbursement is inevitable, and only those health plans that adapt will be successful in the future. And developing the capabilities to effectively respond to change doesn’t happen overnight.
Reserve your seat today and learn how to get there from here…
Thurs, March 22, 2018 | 11:00am PT / 2:00pm ET
Learn About Value-Based Payments from Industry Thought Leaders
Presenter – Harry Merkin
Vice President of Marketing, HealthEdge
Harry Merkin has worked with both payers and providers through many dynamic changes in healthcare for a number of years. He is currently responsible for Marketing at HealthEdge, including product marketing, demand generation and thought leadership. He previously had similar responsibilities at Evariant and NaviNet and has collaborated with many transformative entities across the healthcare landscape. Harry has helped introduce and promote innovative enterprise software solutions that enable payers to improve their competitive effectiveness, as well as perform valuable communications between payers and providers, and allow providers to effectively collaborate with patients and consumers as well as with each other
Co-Presenter – Dave Mika
Vice President, Enterprise Core System Operations, Independent Health
Dave Mika plays an integral role in leading the operations unit at Independent Health, located in Buffalo, NY. He is responsible for the coordination of activities across the organization to more effectively manage workloads and partner closely with individual business unit owners to achieve operational excellence. A former Army Reserve combat medic and Licensed Practical Nurse with more than 30 years of experience in the health insurance industry, Mika has also held management positions in member appeals, provider relations, project management and product development and implementation.
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.
Last week we kicked off the first entry in the Health Care Executive Group’s 2018 Webinar Series: The 2018 HCEG Top 10 – Healthcare Opportunities, Challenges & Issues. The new board chair of HCEG, Kim Sinclair, CIO at Boston Medical Center Health Plan, moderated the webinar and was joined by Ferris Taylor, HCEG’s Executive Director and Consultant to Arches Health Plan and David Gallegos, Sr VP of Consulting Services at Change Healthcare, one of HCEG’s long-time sponsor partners.
This blog post provides an overview of webinar highlights of the discussion between Kim, Ferris and David, their responses to attendee questions and some additional information to be shared in a future blog post. The webinar presentation materials and a recording of webinar can be found here.
Note: Verbatim responses are included in quotations and paraphrased responses are not quoted.
Topic #1: Most Interesting Items on 2018 HCEG Top 10 List
Kim asked David and Ferris which three items on the 2018 HCEG Top Ten list three areas were of most interest?
David:
“Of course, they’re all very interesting to me. It’s been a very much a part of my life for the past few years being involved in Healthcare Executive Group and obviously being part of the industry. But really, I think the top three on the list are the top three for a reason. I look at these as the three pillars of value-based care.”
“Any value-based program needs to ensure that it’s that it’s a win-win-win for the payer, for the provider and for the member, in order for it to be sustainable. So, in order for it to be a win-win-win, you really need these three pillars. You need alignment and financial incentives. You need to have strong payer provider integration, or cooperation really, to create a true partnership between the caregiver and the payer. But you also need to have the provider and the payer partner on fundamentally changing the way care is delivered.”
Ferris:
“I don’t think we should minimize the topic of costs in healthcare and that probably shows up in the Top Ten most significantly around Cost Transparency (Item #4). A lot of that discussion in the recent months has been around Addressing Pharmacy Costs (item #9) but it’s not exclusive to that.”
“But here in the HCEG Top Ten is also cyber security (Item #6) and it’s interesting to me that it – like the clinical data and analytics (Item #1) you mentioned David – cuts across almost all of the issues. If we can’t assure the consumer of some sort of privacy around their data and some security, then we have an issue. Cybersecurity was not on the HCEG Top Ten list for many years going back. Three or four years ago it came up to the top of the list.
My top three would also have to include that bigger bucket of consumerism. It’s on the list as Total Consumer Health (Item #5) and Harnessing Mobile Health Technologies (Item #8). And also, The Engaged Digital Health Consumer (Item #10).
“We are in a major transformation of healthcare from the consumer to the buyer being the employer to the consumer. So, I would add those three Kim to the list that David has pointed out.
Keeping Track of David’s & Ferris’s Top 3 Top 10 Picks?
David Gallego’s Top 3 Picks
Ferris Taylor’s Top 3 Picks
#1 – Clinical and Data Analytics
#5 – Total Consumer Health
#2 – Population Health Services Organizations
#8 – Harnessing Mobile Health Technology
#3 – Value-Based Payments
#10 – The Engaged Digital Consumer
Topic #2: Healthcare Consumerism
Kim asked Ferris and David to give their perspective on consumerism and what they’re seeing in the industry absolutely?
David:
“So fundamentally, I think consumerism is about giving people what they want. So, at a high level that means affordable, accessible high-quality care that improves their overall quality of life. That’s simplistic in some ways but I think everyone could agree that’s what people want of health care. You must look at a more granular level as to what consumers want and need as they can vary significantly. And then, so from that perspective, consumerism really needs to be about customization.”
Customized care means the right service and/or right content is delivered at the right time, at the right place and by the right caregiver.
It’s about 24-hour access to care.
It’s about multi-channel access to information and services.
It’s about providing relevant content to current or predicted life events.
It’s about customized care plans to take individual patient specific conditions, genomic, social determinants all into consideration.
It’s about empowering and enabling the consumers so they have the right amount of information to make the right decisions for their health, cost, and quality etc.
Ferris:
“There’s a lot of dimensions of the cost equation, of the price equations that our health care consumers, our members, and our patients just don’t understand. It isn’t consistent with what they experience in the other aspects of their life and I think that takes me to the consumer discussion. And that’s clearly one of my top three.”
“But we are in a major transformation of healthcare from the employer being the buyer to the consumer being the buyer. In December, the American Health Insurance Plans (AHIP) association had an entire three-day conference on consumer experience and digital health. In a nutshell, it really stuck in my mind that as health plans, providers and technology vendors really need to stop thinking like health plans, providers and technology vendors; and start thinking like consumers. People don’t look at healthcare as the only thing in their lives.”
“It’s our responsibility as healthcare stakeholders to find a way that our healthcare messages and our healthcare initiatives can fit into the life flow of our members and our patients; and that of their families, their work, their community and what we need to weave into our initiatives the day to day things that we know, if consumers did them.”
Analogy About Healthcare Spending by David Gallegos
David shared an interesting, very accurate and rather amusing analogy about healthcare spending. “$16 Worth of Groceries for $10!”
Topics Addressed in Next Post: Cybersecurity & Rising Pharmacy Costs
The above represents just a small portion of what Kim, Ferris and David discussed in the first half of the webinar. For more insight on any particular area of interest, you can watch the webinar recording and/or read the transcript here.
In a following post, highlights from the second half will be shared. These include responses to the following two topics posed by Kim Sinclair to Ferris Taylor and David Gallegos:
How are you seeing cyber security and cyber threats impact healthcare organizations beyond the tactical day-to-day front prevention activities?
What are your thoughts about what we as healthcare leaders can do about rising pharmacy costs?
On the 2018 HCEG Top 10 list, Clinical and Data Analytics, Value-based Payments and The Engaged Digital Consumer were ranked #1, #3 and #10 respectively by health plan, health system and healthcare provider executives who participated in identifying and ranking the 2018 HCEG Top 10. It seems fair to say that these three topics are front and center on the mind of executives and thought leaders in the healthcare industry.
Leverage Your AHIP Event & Nashville Connection
If you’re attending AHIP’s 2017 Consumer Experience & Digital Health Forum in Nashville or if you’re a healthcare leader in Nashville the afternoon of Thursday, December 7th, consider joining other healthcare executives and thought leaders at our Executive Leadership Roundtable. A panel of prominent healthcare leaders will meet at Nashville’s Center for Medical Interoperability at 1:00pm CT to accelerate the seamless exchange of information to improve healthcare for all by exploring emerging and high-priority healthcare opportunities at the intersection of population health, value based care, and the engaged digital consumer.
Join Healthcare Leaders & Forum Attendees in a Boardroom-like Setting
HCEG Executive Leadership Roundtable events are held in an intimate, informal and free-flowing setting where the free exchange of ideas, questions and comments are encouraged. This roundtable event will be moderated by Dr. David Diloreto with three distinguished panelists sharing their unique perspective and insight:
Dr. David Diloreto
Ben Leedle
Ferris Taylor
David Gallegos
Senior VP of Healthcare-Population Health at General Electric
President & CEO at Blue Zones and former President & CEO of Healthways
HCEG Board Chair and COO/Consultant at Arches Health Plan
Senior VP of Consulting Services at Change Healthcare
Timely Topics for Healthcare Leaders
A timely and valuable set of topics – with a special focus on Social Determinants and Clinical Data Impacting Population Health – are planned for panelists and attendees:
Innovative strategies health plans, health systems and provider organizations are using to reduce downstream spending while improving overall health outcomes by addressing social determinants of health.
How state-of-the-art data and technologies and opening new opportunities to move consumer health forward.
Opportunities to work with community leaders to identify the factors having the most influence on individual health and quality of life.
Considerations for tailoring specific approaches and investment to address the needs of health plan members and healthcare patients in their communities.
How ground-level community stakeholders can guide health plans and health systems to where funding creates the most effective SDOH improvements.
Extend the Value of Your AHIP Consumer Experience & Digital Health Forum Attendance
In addition to the value described above, this Executive Leadership Roundtable event will include a tour of the Center for Medical Interoperability, lunch and the opportunity for professional networking with roundtable panelists and participants. The Center for Medical Interoperability is a ten-minute ride from the AHIP Consumer Experience & Digital Health Forum being held at the Music City Center in Nashville, TN.
Reserve Your Seat Today!
Attendance at the roundtable is free for current and former HCEG members, attendees of the AHIP Consumer Experience & Digital Health Forum and local healthcare executives. If you have any questions, please contact us.
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.
Payer/Provider Memberships: Candidates are organizations that provide direct insurance benefits (policies, financial, administrative services and other risk-bearing and ASO services) and/or direct health services (medical, dental, vision, etc.) to groups or individuals, either as stand-alone entities or as a subsidiary under a commercial entity.
Individual Membership: Candidates are executives from Payer/Provider Membership eligible organizations.
Alumni Membership: Past HCEG members who are unaffiliated with vendor organizations. Vendors provide products and services to HCEG member candidate organizations to better serve individuals.
For information on becoming an HCEG sponsor partner, see this information and/or contact us.
Speeding the Move to Value-Based Relationships & Reimbursement
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%)
The behemoth of all healthcare conferences started today: the 
