Healthcare Policy ACA Focus Area Roundtable. Medicare/Medicaid beneficiaries. Health Insurance Marketplace. HealthCare Executive Group HCEG. Softheon. American Rescue Plan (ARP). Expanded APTC Eligibility and Subsidy Amounts May Drive Individual Market Growth. real-time prior authorization requirements.

Healthcare Leaders Focus on Healthcare Policy & ACA

By | Focus Area Roundtable, HCEG Content, Research | 4 Comments

Early indicators of healthcare policies’ prioritization, implementation, and/or likelihood of success can provide a head start to healthcare organizations – particularly those serving Medicare/Medicaid beneficiaries and those operating in the Health Insurance Marketplace or looking to join the Marketplace in 2022. It is in that spirit that the HealthCare Executive Group (HCEG) has created Focus Area Roundtables to promote dialogue among HCEG members on important 2021 HCEG Top 10+ priorities. This post shares highlights of the initial online discussion about Healthcare Policy & ACA and presents additional information regarding future Focus Area Roundtable discussions.

See below for Additional Focus Area Roundtables Currently Being Assembled

Healthcare Leaders Discuss Healthcare Policy & ACA

On March 11th, executives from mid-sized health plans (MSH), an integrated delivery system (IDS), a national specialty care provider (NSP), and a not-for-profit consortium focused on advancing healthcare data and technology transformation (EDC) participated in the roundtable. In a roundtable fashion, these leaders shared their thoughts, ideas, and concerns on Healthcare Policy & ACA and forecasts for how the Biden administration may reshape the American healthcare ecosystem for the years to come.

The session was moderated by HCEG Executive Director Ferris Taylor and supported by Kevin Deutsch, General Manager and SVP of Health Plan Cloud at Softheon, the 2021 Focus Area Partner for Healthcare Policy & ACA.

What are your healthcare policy & ACA-related priorities, thoughts, and concerns?

Dealing with volume and uncertainty of healthcare policy and regulations amid rapidly changing and often unstructured government programs: ACA enrollment/subsidies, single payer, public option, Medicare/Medicaid buy-in, block grants, CMS Interoperability and Patient Access, etc.It was noted that no one has a crystal ball and none of the participants were “inside” of the administration, so discussions of this type help to develop the ability to respond to the many uncertainties.  The needed speed of learning and agility to respond to changes in healthcare policy is the “new normal.”  Specific perspectives were exchanged among the roundtable participants.

MSH: Expressed concern on how to keep premium costs down for members who are largely low-income.

NSP: With $2 billion at risk in value-based programs and whose patients are mostly Medicare beneficiaries with multiple comorbidities, healthcare policy needs to:

  • Facilitate cost-effective access to coverage for Medicare and other beneficiaries.
  • Establish reasonable value-based programs and not just push out a bunch of voluntary risk-sharing programs long on objectives but short on details.
  • Support coverage and payment for virtual care, particularly remote monitoring.

EDC: Shared that consortium members have noted that recently passed rules on Interoperability and Information Blocking are top of mind. These two areas of regulation and the advent of technology standards like FHIR and code sets such as LOINC, SNOMED, and others are helping to establish a common language and ‘gauge’ to help providers to speak the same language – particularly with payers.

What components of the recently passed American Rescue Plan (ARP) are most promising to you?

MSH: As a health plan, we struggle to address premium affordability and overall cost to the member and aim to keep increases to premiums at inflation or lower. Additional costs beyond the member premium often prevent members from accessing needed care. While the pandemic did not materially impact our overall member count, it did impact the composition of members as the number of commercial members decreased while Medicaid members increased.

NSP: Mentioned the need for providers and supply-side organizations to better understand the true cost of the services and products and services they provide. And another participant noted experience with a wide variety of costs and outcomes for services provided to seemingly similar patients.

FACT SHEET: American Rescue Plan and the Marketplace

What are ARP’s Immediate, Mid-Term, & Long-Term Benefits?

Healthcare Policy ACA Focus Area Roundtable. Medicare/Medicaid beneficiaries. Health Insurance Marketplace. HealthCare Executive Group HCEG. Softheon. American Rescue Plan (ARP). Expanded APTC Eligibility and Subsidy Amounts May Drive Individual Market Growth. real-time prior authorization requirements.All participants agreed there is a large and immediate benefit associated with ARP funding for vaccine-related availability, administration, and tracking.

NSP: Increased funding of COBRA premiums at 100% through September 2021 and increases to Medicaid funding seem to be a positive, as more unemployed people will be less likely to forgo or delay needed care.

Longer-term benefits from the funding and attention drawn to mental health services by the ARP were also noted. One participant called out how historically low funding and the stigma associated with mental and behavioral health services has led to a large, undiagnosed population. The need to invest more in mental health now is needed to save more serious issues later.

EDC: Consortium members have noted the importance of funding and policy related to community health centers and the need for policy and standards related to the collection and use of Social Determinants of Health (SDoH) – particularly for Dual-Eligibles.

Softheon’s Kevin Deutsch noted that changes to ACA subsidy thresholds and payment amounts brought about by the ARP will further complicate reconciliation and payment challenges. And that additional changes to subsidies and cost-sharing reductions by the Biden Administration will likely happen, further complicating these already non-trivial plan administration and payment reconciliation challenges.

RELATED: Expanded APTC Eligibility and Subsidy Amounts May Drive Individual Market Growth

Topics for Next Healthcare Policy & ACA Focus Area Roundtable

Healthcare Policy ACA Focus Area Roundtable. Medicare/Medicaid beneficiaries. Health Insurance Marketplace. HealthCare Executive Group HCEG. Softheon. American Rescue Plan (ARP). Expanded APTC Eligibility and Subsidy Amounts May Drive Individual Market Growth. real-time prior authorization requirements.As the allocated time for the roundtable flew by, Ferris moved to close the inaugural Focus Area Roundtable by asking participants what was top-of-mind in regard to Healthcare Policy & ACA and what participants thought would be the most important topics for the next roundtable. Topics raised by participants as having potential value to other HCEG members, that might be addressed in future roundtables, and would benefit from Softheon’s experience and views across their customers include:

  • Addressing policy/regulations in regard to controlling costs – particularly for high-need, high-cost members/patients.
  • Challenges, issues, and opportunities related to direct provider contracting and value-based payment arrangements.
  • Understanding and addressing costs related to internal operations and process modifications.
  • Sharing lessons learned as to what other healthcare stakeholders are doing, and not doing, in response to rapidly changing Healthcare Policy & ACA.
  • Preparing for the many regulatory deadlines (and the frequent adjustments to timelines) such as the 1/1/2022 real-time prior authorization requirements.

Additional Focus Area Roundtables Currently Being Assembled

HCEG is currently assembling roundtable discussions on Costs & Transparency and Interoperability – two other HCEG Top 10+ focus areas closely related to and impacted by Healthcare Policy & ACA.  Additional focus areas will be added in the coming months.

If you’re an executive of a health plan, health system, or healthcare provider organization who’d like to join one of these informal, small group discussions, please reach out to us here or share your contact information via this tool. And consider joining our newsletter to receive information of potential value to healthcare executives including recaps of future Focus Area Roundtables.oin HCEG and/or participate in our Focus Area Roundtables

RELATED: Healthcare Policy, ACA 2.0, Enrollment Period Lessons, & The Journey to the Exchange

Insight from Healthcare Leaders & Change Makers – 2020 Industry Pulse. HCEG HealthCare Executive Group. Top 10. Digital Health. Health Tech. 2020 Industry Pulse Report Consumer-centric strategy. Sdoh. Value-based-care. In-Network vs. Out-of-Network Providers.

Insight from Healthcare Leaders & Change Makers – The 2020 Industry Pulse Report

By | HCEG Content, Research | No Comments

We’re pleased to announce the release of the 2020 Industry Pulse Report! This annual survey commissioned by the HealthCare Executive Group and Change Healthcare takes the pulse of a broad spectrum of healthcare industry leaders representing payers, providers (hospitals, doctors offices, & integrated delivery networks) and other industry participants from across the nation.

The 2020 Industry Pulse Report is based on the 2020 HCEG Top 10 list of challenges, issues, and opportunities facing healthcare executives and change-makers. In its 10th year of production, the survey drew a record number of respondents (445), 80% of who held titles of director level or above shared their responses and comments on survey questions, 25% of those participants were from the C-Suite.

Results of the initial analysis of survey data were announced earlier this month and can be accessed here.  Look for the release of additional insight based on the 2020 Industry Pulse Report and the 2020 HCEG Top 10 including webinars, podcasts, conference presentations and additional article posts over the coming weeks and months leading up to HCEG’s Annual Forum in September.HCEG HealthCare Executive Group. Top 10. Digital Health. Health Tech. 2020 Industry Pulse Report

RELATED: 2020 HCEG Top 10 List – Preliminary Insight & Overview of What’s to Come

Consumer Experience + Value-Based Care = Consumer Centricity

The 2020 Industry Pulse Report provides deeper insight into the topics of healthcare cost and outcomes transparency, the healthcare consumer experience, and adopting next-generation payment models like value-based care. The information and analysis contained in the report help to understand current progress being made by providers and payers on the topics identified as most important by healthcare leaders. The survey was designed to elicit and share information on some of the methods being used, priorities, and areas of alignment and disagreement between the primary survey respondents: providers and payers.

See ‘Additional Areas of Insight’ below for other HCEG Top 10-related items addressed in the 2020 Industry Pulse Report.

Consumer-Centric Strategy Varies Between Payers & Providers

In terms of existence and maturity of a Consumer-Centric Strategy, there were areas of alignment – and disagreement – between the largest two groups of survey participants: providers and payers. These data are presented across a 4-point continuum of Consumer-Centric Strategy:HCEG HealthCare Executive Group. Top 10. Digital Health. Health Tech. 2020 Industry Pulse Report Consumer-centric strategy. Sdoh. Value-based-care.

  1. No Consumer-Centric Strategy
  2. Nascent Consumer-Centric Strategy:  single-point solutions, but no unifying organization-wide approach
  3. Intermediate Consumer-Centric Strategy: a consumer-centric approach, actively investing in technologies but no company-wide impact
  4. Full Consumer-Centric Strategy: fully implemented tools and technologies to achieve consumer-centric outcomes and able to effectively measure improvements

Areas of alignment – and disagreement – between the survey’s two largest respondent groups Providers (hospitals, doctors offices, & integrated delivery networks) and Payers (health plans) presented overall responses from these core survey participant groups across a 4-point continuum of Consumer-Centric Strategy.

Disagreement on Current State of Healthcare Consumer Centricity

It’s no surprise there’s disagreement regarding the responsibility, readiness, and challenges facing providers and payers in their transformation to address consumer-centricity. The report reveals both providers and payers are split in the area of value-based care – perhaps the most common Next Generation Payment Model:

  • Payers are much more likely to have robust consumer-centric strategies and providers are much more likely to have no consumer-centric strategy at all.
  • Payers and providers disagree on who’s best positioned to provide cost and quality data to consumers.
  • Payers are much more likely to have migrated to value-based care models while providers are still predominantly offering fee-for-service models.

RELATED: 2020 Industry Pulse Report: Alignments and AsymmetriesPhysicians Practice

Who’s Best Positioned to Support Consumer Healthcare Journey?

Regardless of role, most respondents think payers (31%) are best positioned to provide cost and quality data to healthcare consumers.  Some survey respondents noted others: “Health Information Networks”, “Insurance Agents”, and “Government Agencies.”

However, most respondents favor providers nearly 3 to 1 as being best positioned to support the consumer on their healthcare journey. Some respondents shared that “Retailers and innovators,” “Case Managers,” and “Friends and Family” are best positioned to support individuals on their healthcare journey.

Financial Improvements to Positively Impact Consumer Satisfaction

Survey participants ranked a series of financial or billing improvements based on how they perceived those improvements as improving customer satisfaction. Turns out, addressing the basics that consumers have come to expect are perceived as driving the most value.Surprise billing. HCEG HealthCare Executive Group. Top 10. Digital Health. Health Tech. 2020 Industry Pulse Report Consumer-centric strategy. Sdoh. Value-based-care. In-Network vs. Out-of-Network Providers.

  • Clear Identification of In-Network vs. Out-of-Network Providers
  • Consolidated Billing from Multiple Providers
  • Elimination of Surprise Billing
  • Online Payment Capabilities
  • Plain-Language EOBs and Simplified Invoicing
  • Real-Time Point-of-Service Billing
  • Simplified Benefit Explanations/Navigation
  • Simplified/Flexible Payment Options

Participants were also asked to rank other non-clinical improvements based on their potential to positively impact consumer satisfaction.

Additional Areas of Insight – 2020 Industry Pulse Report

Beyond the topics noted above, the 2020 Industry Pulse Report includes insight into the following challenges, issues, and opportunities facing healthcare organizations.

  • Barriers to Adopting Value-Based Care
    • Payers cite lack of or limited IT infrastructure as an impediment to value-based care while providers cite unclear or conflicting performance measures and regulatory changes/political uncertainty
  • How They’re Addressing Social Determinants of Health (SDOH)
    • Payers and providers differ on the type of sdoh-related data they are capturing
  • Effectiveness of Artificial Intelligence and Machine Learning
    • Providers are significantly more likely than payers to state Health System Efficiency has been positively impacted by AI and machine-learning
    • Payers are significantly more likely to say Reducing Costs has been positively impacted.
  • Drivers of Demand for Interoperability
    • Payers view Regulatory Changes as driving interoperability while Providers rank Physician-Driven Initiatives as a driver of the demand for interoperability
  • Top Reasons for Continued Cybersecurity Breaches
    • Across all C-Suite respondents, nearly 25% believe that Cybersecurity is not Recognized as a Priority at the Executive/Board Level.

Information on methods used, areas of alignment, respective priority, and disagreement between various supply-side stakeholders on the above areas can be of unique value to payers, hospitals, doctors’ offices, and integrated delivery networks.

Get Your Copy of the 2020 Industry Pulse Report

Download the 2020 Industry Pulse Report for more details on the above and other insights collected by the 2020 Industry Pulse Report. And look for more analysis and commentary on the Industry Pulse survey from HCEG, our sponsor partners and media covering the healthcare industry.

If you have any questions you have about the 2020 Industry Pulse Report, the 2020 HCEG Top 10, or the HealthCare Executive Group, please feel free to email us.

WEBINAR: “Industry Pulse Check: How Providers and Payers See 2020 Healthcare Trends

More Insight for Healthcare Leaders and Change Makers

The 2020 Industry Pulse Report and the HCEG Top 10 list of challenges, issues, and opportunities demand change and innovation from all stakeholders – particularly within the ongoing uncertainty of U. S. healthcare reform and an election year. Consider the following if you’d like to dive deeper into these topics and connect with other healthcare leaders and change-makers.

Please consider sharing your insight, experiences, and opinion as your perspective will help define the issues facing healthcare and reveal how key industry participants are acting to transform the healthcare delivery system.

Recent 3rd-Party Analysis and Coverage of the 2020 Industry Pulse Report

10th Annual Industry Pulse. HCEG Top 10. HealthCare Executive Group.

Announcing the 10th Annual Industry Pulse Survey of Healthcare Leaders

By | HCEG Top 10, Research, Sponsor | One Comment

The 10th Annual Industry Pulse research survey opens today!

And healthcare industry leaders are encouraged to share their take on the challenges, issues, and opportunities they’re facing in 2020 and beyond. Based on the 2020 HCEG Top 10 list and conducted jointly by the HealthCare Executive Group and Change Healthcare, the survey is intended to flesh out and explore what leaders of healthcare organizations may be facing in the immediate future. Everyone reading this post are encouraged to complete the survey and share it with their co-workers and associates. Just taking this survey will provide respondents with thought-provoking questions and offer ideas they may otherwise not be aware of.

2020 HCEG Top 10 as Basis for 10th Annual Industry Pulse Survey

This 10th annual instance of the Industry Pulse collects additional insight, experiences, and opinions on specific items of the 2020 HCEG Top 10 list developed in September 2019 at HCEG’s 31st Annual Forum. The questions, possible responses, and results of the Industry Pulse can provide valuable, relevant data-driven advice and end-to-end industry insights to help healthcare leaders navigate the complexities of our rapidly evolving healthcare system.

Share your Insight Today!

HCEG and Change Healthcare would like to invite healthcare leaders from across the nation to participate in this year’s Industry Pulse research survey and to compare and contrast their own perspectives against the 2020 HCEG Top 10.Please consider sharing your insight, experiences, and opinion as your perspective will help define the issues facing healthcare, and reveal how the industry is responding.  Everyone who completes the 10th Annual Industry Pulse Survey will be among the first to receive survey results as well as exclusive access to future webinars, content, and events that will be delivered over the new year; expounding on survey results and providing additional insight and value to all healthcare constituents.

RELATED: The 9th Annual Industry Pulse Survey