HCEG. HealthCare Executive Group. Annual Forum, events, thought-leadership, personal development opportunities. HIMSS 2020 Collaboration Partner. AHIP Educational Partner

The HealthCare Executive Group: Supporting & Convening Leaders & Change Makers in 2020 & Beyond

By | Annual Forum, Executive Leadership Roundtable, Conferences, HIMSS, Sponsor, Member Benefits | One Comment

Over 30 years ago, C-suite leaders of healthcare organizations came together to form the Managed Care Executive Group (MCEG) – a peer-to-peer mentoring concept used to help its members solve their problems with input and advice from other group members. And 60 years before MCEG was born, Napoleon Hill – author of the popular book Think and Grow Rich – shared the idea of Mastermind Group. In 2014, the Managed Care Executive Group rebranded as the HealthCare Executive Group (HCEG) and continued its mission as a Mastermind Group for healthcare executives.

More Than a Conference Organizer, Media Outlet, or Online Networking Group

In its essence, the HealthCare Executive Group is a Mastermind group comprised of senior healthcare executives and industry leaders focused on transforming the healthcare system. HCEG is not purely a conference organizer, a media/content producer, or promoter of online events but rather an organization chartered to convene and support executive leaders of health plans, health systems, and provider organizations – throughout the year – in their mission to affect true change in our failing healthcare system.

The majority of HealthCare Executive Group members are senior executives associated with health plans, health systems, and risk-bearing provider groups. Memberships at the individual and company levels are available each providing various levels of benefits including discounted to complimentary access to our Annual Forum, events, thought-leadership, and personal development opportunities.

RELATED: A Conference for Healthcare Executives Unlike Any Other

Partnering to Enhance Collaboration, Content and Networking Opportunities

HCEG has established both formal and informal partnerships with complementary organizations that also serve our members and other healthcare industry participants associates. These partnerships extend and complement the content, networking opportunities, and value offered by HCEG and its partners. For 2020, these partnerships include:

HIMSS 2020 Collaboration Partner

HCEG is a Collaboration Partner with the Health Information Management Systems Society (HIMSS) at their 2020 HIMSS Global Health Conference & Exhibition on March 9–13, 2020 in Orlando, FL. We’ll be hosting a “Breakfast Meet and Greet” on Wednesday, March 11th at 7:15 am.

AHIP Educational Partner

Last year, HCEG became an Educational Partner of America’s Health Insurance Plans (AHIP). HCEG members Ian K. Gordon and Ferris Taylor joined Dr. Esteban Lopez in presenting “What Should Be Keeping Health Care Executives up at Night?” For 2020, the HealthCare Executive Group will be hosting an Executive Leadership Roundtable at AHIP’s Institute & Expo 2020 in Miami, FL this coming June.

Other Partnerships for Healthcare Executives & Change Makers

As in previous years, HCEG has partnered with other organizations to present information, insight, and ideas for healthcare delivery system transformation.  These partnerships are outlined in this post titled “Healthcare Innovation & Transformation – Looking Back at 2019 & Forward Through 2020.HCEG. HealthCare Executive Group. Annual Forum, events, thought-leadership, personal development opportunities. HIMSS 2020 Collaboration Partner. AHIP Educational Partner

Testimonies from HCEG Members

 “The conference is a great conference for the level of executives and people that you have in the room talking about issues. There’s not a lot of primers at this conference which is nice. You’ve got people who are ready to dig deep on issues and can have executive-level conversations pretty quickly. And yesterday, I identified three or four potential partnerships between our organizations and how we can work to solve some of these issues together.”  – Ricardo Johnson, Senior Director Healthworx at CareFirst BlueCross BlueShield

“I think they nailed the 2020 Top 10 list (of challenges, issues, and opportunities facing healthcare leadership.) I mean it, really every item on there would have been in the top of my list as well. I think that this group of people has really identified the top issues in the industry and gathered folks who are uniquely qualified to speak to them.” – Sara Stevens, VP of Healthcare Economics & Analytics Ops at Capital District Physicians’ Health Plan

“I think the word is it’s (HCEG’s Annual Forum) still intimate by design. We like to keep it roughly a hundred or so people. The last thing we wanted to be is a giant circus of people who don’t have the chance to share information and have an intimate discussion – so that’s by design.” – Richard Lungen, Managing Member at Leverage Health

RELATED: Networking, Collaboration, And Learning Opportunities for Healthcare Executives

Supportive, Consultative Sponsor Partners

A limited number of healthcare industry product and service vendors serve as sponsor partners to underwrite and assist with HCEG’s events, programming, and content. HCEG’s sponsor partners play a role unlike many vendors who sponsor other healthcare events. Rather than dominating speaker positions, exhibiting products in a booth, or littering HCEG’s physical and digital channels with sales messages, HCEG requires its sponsor partners to serve in a supportive, consultative role on a year-round basis.

Sponsor Partners of HCEG contribute to ongoing educational initiatives and benefit from increased visibility through our year-round thought leadership opportunities via:

  • Development of the HCEG Top 10
  • The HCEG Webinar Series
  • HCEG Executive Leadership Roundtables
  • Regional Networking Events
  • Online Discussions and Virtual Panels
  • HCEG Annual Forum
  • HCEG Original Content
  • HCEG Committees and Board of Directors

See this overview of HCEG sponsor partners and sponsorship of the HealthCare Executive Group.

RELATED: Healthcare Information, Insight, & Ideas – 2019 Webinars & Blog Posts

Connect with Healthcare Industry Executives, Leaders, Innovators & Change-Makers

Stay connected healthcare industry leaders, innovators, and change-makers in 2020 by subscribing to our eNewsletter. And consider becoming a member of the HealthCare Executive Group.

HCEG Healthcare Executive group Thanksgiving

Special Thanks to HealthCare Executive Group’s 2019 Sponsor Partners

By | Sponsor, Partners, Trust | No Comments

As America celebrates Thanksgiving, the HealthCare Executive Group (HCEG) is honored to have the support of our sponsor partners and acknowledge the contribution these leading healthcare companies have provided and continue to provide to our healthcare executive members, industry advisors, and associates throughout the year. Through the support of the companies highlighted below, HCEG is able to provide a comprehensive package of information, events, and networking opportunities throughout the year.

The HealthCare Executive Group offers our sincere thanks to these leading vendors of products and services that help improve health outcomes and lower costs.

HealthCare Executive Group – Gold Sponsors

HCEG Healthcare Executive Group. Appian. Enterprise low-code. industry-leading intelligent automation. Digital Transformation Patient, member, and provider data. healthcare payers and providers innovation, consumers, healthEQ Health Solutions HCEG Healthcare Executive GroupHCEG Healthcare Executive Group. Softheon. cloud-based solutions. retail-like, user-friendly experience. personalized communication. Real-time support member engagement. enrollment, member billing, ACA. Direct Enrollment
Appian provides a low-code development platform that accelerates the creation of high-impact business applications. Many of the world’s largest organizations use Appian applications to improve customer experience, achieve operational excellence, and simplify global risk management and compliance. For more information, visit www.appian.com.For 30 years, eQHealth Solutions has been improving healthcare quality and reducing costs through innovative technology, population health management solutions and medical management services. Our expansive offerings include eQSuite®, a cloud-based, SaaS technology coupled with eQCare®, a community-based services portfolio. This combination of technology (high-tech) and community-based services (high-touch) covers all your population health management, care coordination, and utilization management needs.Softheon delivers cloud-based solutions that create a retail-like, user-friendly experience and provide personalized communication and real-time support to boost member engagement. Cost effective, and configurable software that supports health plans and states with enrollment, member billing, and reporting for over 3.2M Americans.
WebsiteWebsiteWebsite
BlogBlogBlog
LinkedInLinkedInLinkedIn
Twitter – @AppianTwitter – @eQHealthTwitter – @Softheon
FacebookContactFacebook
ContactContact
Virtual Health HCEG Healthcare Executive Groupsurescripts CHEG sponsor healthcare executive groupHCEG Healthcare Executive Group. Network partners preventing and managing chronic disease. Health plans, payers securely efficiently network of community-based digital health solutions.
Care management belongs at the center of healthcare, powering every element in its ecosystem. HELIOS is the first solution capable of seamlessly connecting all data points in the care continuum, and leveraging the workflows and analytics to make a significant impact. HELIOS provides the digital connective tissue between payers, providers, and members.Built to Transform Interactions between Clinicians, Pharmacists, and Patients

 

The Surescripts Network Alliance unites virtually all electronic health records (EHR) vendors, pharmacy benefit managers (PBMs), pharmacies and clinicians, plus an increasing number of health plans, long-term and post-acute care organizations, specialty hubs and specialty pharmacy organizations.

Solera connects patients, payers, and physicians to a network of partners who are preventing and managing chronic disease.

Working with Solera, health plans and other payers securely and efficiently leverage a network of community-based and digital health solutions.

Solera helps employers identify and engage those in their workforce with the greatest opportunity for obesity-related chronic disease prevention.

WebsiteWebsiteWebsite
BlogBlog
LinkedInLinkedInLinkedIn
Twitter – @virtualhealth_Twitter – @surescriptsTwitter – @soleranetwork
FacebookFacebookContact
ContactContact
zipari hceg healthcare executive group
The First and Only Consumer Experience Platform Built Specifically for Health Insurance

Zipari is the only consumer experience technology company to exclusively specialize in health insurance and offer native understanding of the industry, which means we instinctively understand our clients’ goals.

Website
Blog
LinkedIn
Twitter – @ziparico
Facebook
Contact

HealthCare Executive Group – Silver Sponsors

HCEG Healthcare Executive Group. Change Healthcare consulting. value-based healthcare system. healthcare technology company. software, analytics, network solutions, and technology-enabled services.HCEG Healthcare Executive Group. InstaMed healthcare payments experience. Consumers, providers and payers. payment transaction. private cloud-based technology electronic transactionsHCEG Healthcare Executive Group Health insurers, new offerings. member populations. government program, commercial or individual product, or dental or TPA offering,
Change Healthcare consulting is a catalyst for your value-based healthcare system. Change Healthcare is a healthcare technology company that offers software, analytics, network solutions, and technology-enabled services to help create a stronger, more collaborative healthcare system. Change Healthcare helps deliver measurable value not only at the point of care, but also before, after, and in between care episodes.InstaMed powers a better healthcare payments experience on one platform that connects consumers, providers, and payers for every healthcare payment transaction. InstaMed’s patented, private cloud-based technology securely transforms healthcare payments by driving electronic transactions, moving money and healthcare data seamlessly and improving consumer satisfaction.Health insurers must act quickly to launch new offerings targeted at member populations in specific market segments. Whether a government program, commercial or individual product, or dental or TPA offering, HealthEdge works with transformative health plans to create and maintain a competitive advantage.
WebsiteWebsiteWebsite
BlogBlogBlog
LinkedInLinkedInLinkedIn
Twitter – @Change_HCTwitter – @InstaMedTwitter – @HealthEdge
FacebookFacebookFacebook
ContactContactContact
HCEG Healthcare Executive Group. RedCard health plans TPAs secure data communication members providers.
RedCard helps health plans and TPAs use the power of secure data to build stronger, more effective communication with your members and providers.
Website
Contact
For more information on the benefits of becoming an HCEG Sponsor in 2020, check out our Sponsorship Prospectus.  

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

Announcing the 10th Annual Industry Pulse Survey of Healthcare Leaders

By | Research, HCEG Top 10, 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

HCEG Webinar Series. Art & Science of Aligning People, Process, & Technology to Grow Your Healthcare Organization. The Golden Triangle. Operational efficiency. 2019 HCEG Top 10 list. HealthEdge. business transformation initiatives. Sal Gentile, Friday Health Plans.

The Art & Science of Aligning People, Process, & Technology to Grow Your Healthcare Organization

By | HealthEdge, HCEG Top 10, Webinar Series, Operational Efficiency | No Comments

People, process, and technology are at the core of every business. And how these three critical components are used to create and deliver a healthcare organization’s products and services ultimately result in company profitability and growth. Indeed, the critical challenges healthcare organizations are facing during these uncertain times involve humans, the processes they must follow, and the mix of entrenched, emerging – and as yet- often unknown technologies supporting an organizations mission and growth.

Transforming your healthcare organization requires an explicit focus on effectively aligning the Golden Triangle of People, Process, & Technology.

The Golden Triangle: People, Process, & Technology

HCEG Webinar Series. Art & Science of Aligning People, Process, & Technology to Grow Your Healthcare Organization. The Golden Triangle. Operational efficiency. 2019 HCEG Top 10 list. HealthEdge. business transformation initiatives. Sal Gentile, Friday Health Plans.

Delivering operational efficiency, a key aspect of transforming today’s healthcare organizations requires an approach that optimizes the relationships between people, process & technology; hence the Golden Triangle. Each part of the Golden Triangle is its own science. And each needs to be mastered to effect true transformation and business growth. Ignore the relationship between people, process, and technology at your own risk.

And know that the art, where real value and efficiency are found, is at the intersection of people, process & technology. Like a three-legged stool, each part of the Golden Triangle must be sufficiently developed and aligned as integral components of successful transformation initiatives. Too often, healthcare organizations give short shrift to the people point of the triangle.

RELATED: Operational Efficiency Ranked #7 on 2019 HCEG Top 10 List

Successful Transformation Initiatives: Keys to Success & Challenges

In a study by IBM titled “Making change work…while the work keeps changing,” 1400 participants identified the keys to successful change initiatives and the major challenges to change that organizations must consider as they plan and strategize their business transformation initiatives.

Keys to Successful Change Initiatives at Healthcare Organizations

People Factors

    • Employee Involvement
    • Honest and Timely Communication
    • Change Agents to Engage Other Employees
    • Change Supported by Culture
    • Efficient Training Programs
    • Monetary and Non-Monetary Incentives

Process Factors

    • Adjustment of Performance Measures
    • An Efficient Organizational Structure
    • Top Management Sponsorship

Challenges to Change Initiatives at Healthcare Organizations

People Factors

    • Changing Mindsets and Attitudes
    • Corporate Culture
    • Shortage of Resources
    • Lack of Commitment by higher management
    • Insufficient Change Know-How
    • Little to no Transparency

Technology Factors

    • Impact on Existing Process
    • User Experience
    • Flexibility and Interoperability of Technology Systems

See this article for more about the keys to successful change initiatives and the major challenges to change that organizations must consider as they transform their organization.

People are Key to Aligning People, Process, & Technology

Famed IBM founder Thomas J Watson shared the following on the importance of NOT ignoring the people component of organizational change initiatives.

“Teach your associates to teach themselves and in a way that you will strengthen the entire organization” – Thomas J Watson (1947)

Additional Insight & Ideas on Leveraging People, Process, & Technology

In today’s uncertain and rapidly changing healthcare environment, healthcare leaders are seeking to enter new geographies, start new lines of business, or even radically transform their traditional way of doing business. To position your healthcare organization for successful growth by optimizing the intersection of people, process, and technology, join us on July 25th for our Webinar Series event: Using People, Process & Technology to Grow Your Business.

Sal Gentile, CEO of Friday Health Plans and our sponsor partner HealthEdge will share how they leveraged the art and science of people, process and technology to successfully grow their respective healthcare organizations both from the ground up as well as within an established organization.Healthcare Innovation and Disruption, HealthCare Executive Group, HCEG, 16th Annual World Health Care Congress (WHCC), CIO & CTO Strategy Track, innovation, disruption. healthcare champions, Data Analytics, Pharmacy Costs and Transparency, Importance of Useable Technology, Cybersecurity, HCEG Top 10, Center for Healthcare Innovation (CHI), International Association of Innovation Professionals,

If you’re not sure whether you can attend this HCEG Webinar Series event, go ahead and register and we’ll send you the recording/recap.

If you have any questions about this blog post or want to learn more about the HealthCare Executive Group, please reach out to us at [email protected]. Also, consider following @HCExecGroup on Twitter and LinkedIn.

Artificial Intelligence. Predictive Analytics. Bigdata. Machine Learning. HealthCare Executive Group. Benefits Costs. Patient Outcomes. Quality Standards. STAR ratings. Profit Margins. Improving Efficiencies. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.

Insight on Solving the Rubik’s Cube of Payer Data

By | Payers, HCEG Top 10, Sponsor, Data & Analytics, Webinar Series | No Comments

Healthcare payers are sitting on a lot of data, from eligibility data, to claims data, to data obtained from 3rd parties, to data derived from analytics. It’s no surprise that over the last decade “Data & Analytics” has been a consistent entry on the HealthCare Executive Group’s Top 10 list of challenges, issues, and opportunities facing healthcare executives. And currently ranked #1 on the 2019 HCEG Top 10 list. To help share insight, ideas, and actionable information supporting data and analytics, our sponsor partner EQ Health Solutions presented our June Webinar Series event: Solving the Rubik’s Cube of Payer Data.

Chief Strategy & Growth Officer Mayur Yermaneni and Marina Brown, RN BSN, Vice President of Clinical Programs, from eQHealth Solutions shared information and insight on the following four topics:

  • The current state of the payer market and future considerations
  • The Rubik’s Cube of Payer Data – the Present Debacle
  • What tools and technologies will lead to continued payer success?
  • Top six things to consider when evaluating your healthcare analytics vendor

Highlights from Solving the Rubik’s Cube of Payer Data

This blog post presents some highlights from the webinar and provides access to additional information from the webinar. You can also check out this Twitter Moment summarizing live Tweets from the webinar.  The complete recording of the webinar can be found here. To jump to the specific place in the recording, click on the timestamp range [HH:MM] that accompanies each transcripted section below.

HealthCare Executive Group Top 10 list. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.

For more information on how EQ Health Solutions can advance your organization’s data and analytics initiatives and programs, contact EQ Health Solutions.

Current State of the Payer Market and Future Considerations

Mayur Yermaneni shared some insight into current data and analytics capabilities of healthcare payers: [7:16]

Some payers are firmly in an average spectrum of recognizing current trends and some and some payers are still in the infancy stages of recognizing the impact of these trends. So, I’m trying to generalize some of these themes so that everybody can actually benefit from it.

Margins are Decreasing

So, across the board, one of the key things, and I guess this is not unique to the payer market itself, is that margins are decreasing. With new regulations coming on board there are more and more cost burden associated with the payer market. Some payers are becoming a financial institution from that standpoint [of increasing regulatory burden.]

Mega Mergers

You see this a lot more in the bigger payer, payers like Aetna’s acquisitions, United’s acquisitions, WellCare and all these acquisitions that are happening is [intended] to counter their decrease in margins by creating economies of scale that they could benefit by actually saying: “If I can actually acquire another of these entities, then I can create a cross burden rate across these common units and hopefully benefit from the margins play game.”

Data Security

Nobody wants to show up and in tomorrow’s Wall Street Journal. In the current day and age, there’s an entire team dedicated just so that that payer’s name doesn’t show up on tomorrow’s newspaper. Primarily because with the PHI (Protected Health Information), the abundance of PHI information from all different sources. It’s extremely important to say: “Well how do we protect our data?” Payers have a lot more data than anybody else outside of providers.

And there are two different spectrums of the data set – and both are equally critical from the standpoint of ensuring that data security is a key aspect in your space because today, a 100 record, 500 records, or anything above that threshold you’re going to have to report it. So, data security becomes actual strategy nowadays. How do you make sure that your data security is actually playing to your advantage? And your customers have to be able to trust that and that Trust is what’s going to actually give you – even though that has nothing to do with the actual health plan itself, or the benefits members are receiving, or the card that they are receiving. But they still have to be able to trust that their data is secure. 

Showing Value Vital in Provider/Hospital Negotiations [10:17]

Finally, when it comes to providing the value of data, the data set that payers are actually having to wrestle with: how are we showing the value that we are providing to the hospital segment, the provider segment, and the member segment? 

But if you look at it, you still have to deal with all the other aspects before you get to the value component: administrative setup, data security, operating margins, and everything.Contract negotiations. HealthCare Executive Group. Benefits Costs. Patient Outcomes. Quality Standards. STAR ratings. Profit Margins. Improving Efficiencies. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.Well, how is that actually happening? Big data. Well, I’m not going to bore everybody with the definition of what big data is but, in a nutshell, in today’s world of Instagram, Facebook and Snapchat it’s all about the volume and speed and the frequency of the data that you’re receiving. And in the payer market, it’s a lot of data. It used to be a monthly fee [to obtain/access data]. Now it’s an API call to an HL7 message which is instantaneous. And the amount of frequency that you’re having to deal with is a lot more than what you had before. And the number of types of data that the payer market is actually having to deal with is a lot more. And even in there, the data can be segregated into a couple of different ways: 

  • The data that’s the primary data sources
  • The derived data sources that you’re generating as a result of your operation or as a result of some of the analysis that you’re doing on top of it. 

So now that’s another big trend that the payer market is having to actually wrestle with.

Social Determinants of Health Data are Increasingly Important

Ferris Taylor [HCEG’s Executive Director] indicated that this [Data & Analytics] was the top topic and social determinants of health were one of the key aspects to it. And that hasn’t changed. What has changed is how that’s being viewed. Instead of being a peripheral data source to actually being a central component to how your operations need to be done from social terms of health standpoint.

Marina Brown, EQHealth’s Vice President of Clinical Programs added:

I was just going to say that I do think that this is really a big one for the industry. Social determinants of health are definitely going to help change the way that we deliver health care. And that’s a very important distinguishment. It’s not going to change the way that we do health care because we treat a diabetic the same but it will change the way that we deliver care simply by helping to better guide the interventions that we’re utilizing to create more meaningful behavior change over time.

Tools and Technologies to Solve the Rubik’s Cube of Payer Data

Marina and Mayur shared an overview of the tools and technologies that healthcare payers are using to identify trends, root causes of patient and population-level issues, and transforming healthcare payer’s data and analytics infrastructure.

Another key aspect is artificial intelligence. Now again I don’t want to get into the definitions of artificial intelligence, but the key aspect is, with the advent of big data with the advent of the amount of data you’re having to deal with. It’s not humanly possible for a supervisor or a manager or a management team to be able to simulate all the data and actually say: What am I making use of this data? And how am I going to make use of this data? And what decisions am I making?

So artificial intelligence – or machine learning – and they’re not necessarily synonymous but in some in some aspect they’re synonymous in terms of combining the wealth of data that you’re getting and actually seeing what insights can be derived based on all those data sets; at a much more faster pace and a more timely manner compared to what we would have had to do if we were doing it manually. And there is an element of: how do we use the machine learning algorithms or artificial intelligence approaches to say: Can I do a better prognosis?

Everybody’s aware of [IBM] Watson’s cancer cure approaches to it and Watson has evolved a lot of other stuff. But predominantly in the mainstream the payer market, this hasn’t yet taken off into a full-fledged problem because we’re dealing with not necessarily a literature research but more in the realm of operational research and operational analytics.

Hear more from Mayur and Marina about tools and technologies at [13:09] and [24:53] in the recording.Artificial Intelligence. Predictive Analytics. Bigdata. Machine Learning. HealthCare Executive Group. Benefits Costs. Patient Outcomes. Quality Standards. STAR ratings. Profit Margins. Improving Efficiencies. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data.

How can we employ artificial intelligence or machine learning concepts into the operational realm of the payer operation? [14:40]

There are some positive trends. There’s a huge growth of Medicare Advantage (MA) plans. Their margins continue to increase because it’s a catch-22 situation for MA plans because of the risks. And now MA plans are able to accurately reflect their risk scores. And as a result, their premiums are being reflected the right way – which actually helped them from their margin standpoint because their operations were still on the same aspects of it because in the previous era they were not reporting their risk the right way because they didn’t have all the data gathering up opportunities. But now that they’re able to gather their [data analysis] opportunities, they can predict their risk a lot more accurately, so their premiums are going up. As a result, the margins are getting better and also the operations have stayed the same.

Government Plans Off-Loading Operational Functions to Health Plans

And in the Medicaid managed care space what you’re seeing is a lot more growth in that space for, predominantly, what we could say s for one single reason: most of the state administrative entities are actually trying to off-load the burden onto the plans so that risk is being passed on to the managed care plans and the state entities become the administrative agency. Of course, with that, they’re also holding performance measures as an accountability which is not just about the financial side of it but also the quality side of it because they don’t want to sacrifice the quality of care being rendered to their beneficiaries. But as a result, you’re seeing a lot of growth in the managed care space Medicaid managed care well

What does this mean to me or my organization as a payer? [16:29]

If I actually eliminate all the big terminology, fundamentally there are two simple concepts:

  1. Is our plan performing better than what it was before from a cost standpoint? And with the qualifier added, is the plan performing to a level where the plan can afford too? Because one of which you’re collecting to your risk is what you’re paying out. That’s one of the key foundations. That’s a simple question that you’re going to answer.

And the second aspect of it is:

  1. Are we improving the quality of our plan? And quality can be defined in multiple ways. I think the STAR rating, the HEDIS measures, and all that stuff. But at the end of the day it’s really are you improving quality in terms of outcomes for the members?

And the second point is actually impacting the first point from a long-term standpoint. So, if you’re impacting the quality aspects of it, then you’re able to impact the cost aspect of it as well. But it doesn’t happen every year, it happens over as a strategic view. You have to put that as a strategic view long term view so that on the short run your cost structure might have variances but over a long run, you’re actually improving the trends of that one.Rubik’s Cube of Payer Data. Artificial Intelligence. Predictive Analytics. Bigdata. Machine Learning. HealthCare Executive Group. Benefits Costs. Patient Outcomes. Quality Standards. STAR ratings. Profit Margins. Improving Efficiencies. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.

Operational Simplicity and the Health of Your Health Plan [17:54]

But what does that mean in terms of a payer when you think about how you have to think about it?

It comes down to two things: operational efficiency and health of your health plan. How do we make a difference in looking at all the data that we have and actually answer these two business questions; and then tie them back to the simple questions of ‘Am I performing better in terms of cost?’ And ‘Am I improving the cost?’

Marina added: [18:38]

I think that operationally looking at the data is really going to, as a program administrator, is going to give me insight into things like the following:

  • What care management programs or medical management programs are most needed for my population?
  • What programs that I’m currently utilizing are really the most effective ones?

Taking that a step farther as you look into those specific programs that are most effective, you’ll also then be able to look at things like: What are the interventions that are most effective in this population. From a utilization review perspective?

Is my UR working only as a gatekeeper for my health plan or are we actually effectively managing acute episodes and beyond that acute episodes? And then really helping us determine all of this ultimately helps us determine what care intervention strategies do we need to tweak? Which ones do we need to add to our programs to create that meaningful behavior change that increases the health of our membership, increases the quality of the care that’s being provided to that membership, and ultimately reduces the cost?

The Rubik’s Cube of Payer Data – the Present Debacle

Mayur shared some insight into the struggle that many payers have regarding reporting and analytics: [20:03]

In a lot of ways, payers are struggling between: Am I doing reporting or am I doing an analysis? And how am I looking at it? Am I doing the analysis for the sake of reporting or am I doing analysis for the sake of improving or answering the two questions that we started out with?

  1. Is our plan performing better than what it was before from a cost standpoint?
  2. Are we improving the quality of our plan?

HealthCare Executive Group. Benefits Costs. Patient Outcomes. Quality Standards. STAR ratings. Profit Margins. Improving Efficiencies. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.And those could be the patient member outcomes, quality standards, STAR ratings, keeping benefits cost down, maintaining the profit margin, improving efficiencies. All of these are questions that every payer is asking.

And the list goes on and on and you guys are actually dealing with a lot more in today’s world. I’m sure every organization has a ton more questions to add to it but, fundamentally, why and how to do it is where the biggest question comes into play because often everybody goes down the path of: ‘Okay, I need to solve this reporting problem so I need to have this kind of technology in place. I need to solve my data analysis problem from a predictive modeling standpoint, so I need to have this technology base.

And as a result, you’re creating more and more silos within the analytic space and not necessarily taking advantage of the full spectrum of the data that you have or creating in its entirety in a holistic view. Because at the end of the day, if the technology analytics is being used for the reporting purposes then you only solve 30% of your problems because the majority of your problems are deriving insights from your data and actually saying how can we make a difference in our operations? How can we make a difference in our outcomes?

Payers have multiple data sources and everything is often viewed as a silo. [23:30]

Healthcare organizations are maturing but fundamentally they’re still struggling with the aspects of:

  • Am I doing quality analysis?
  • Am I doing financial analysis?
  • Am I doing operational analysis?
  • Or am I doing just reporting for the regulatory agencies?

Payers need to design their operational strategy to leverage all quadrants of dimensions: Quality, Financials, Operations, and Predictive Analytics.

Marrying Clinical Expertise with Data Analytic Capabilities [25:04]

HealthCare Executive Group Top 10 list. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.

I want to talk briefly about the key components that are going to make a difference. Often what happens is an analyst is asked a question and they actually come back and that data set is then presented to clinical leadership. And then clinical leadership asks a follow-up question and then makes some decisions on top of it. But in reality, what if you change that and involve that clinician up front during the analysis itself, along with the data scientist? So, what we view in the industry is that there’s a lot more benefit if you actually pair the clinicians and the data scientists together up front in the design and analysis phase.

So that 1) you can cut down your cycle crime and 2) you’re asking the questions up front and how to think about your operations. And that’s going to help frame your reporting and analytics problem in a way where you’re getting to a solution much faster.

Marina added:

I think that’s a really important point that you’re making. I think bringing these two teams of people together helps to bring about that important balance and maximize your outputs because your data scientists are experts at identifying the trends and the data. And when that information is presented to the clinicians, they can then help interpret those trends. That’s going to ultimately formulate your adjustments to your operations, your program design, etc. I think that’s a great point.

Pairing Clinicians with Data Scientists Frees Up Time for Patient Engagement

Mayur continued:

And another aspect to it is, when you’re thinking for clinicians, you’re actually taking away their valuable time working with a member. If you’re asking them to understand what’s happening with the data and go into the exercise and then making the decision to it. But if you pair them up front, you’ve solved the problem and then you’re giving them time to have their team’s focus more on the members then they are focusing on the data itself.

Marina added:

Right. Care teams are so busy trying to make that outreach to the members that having that technology available to them, to be able to guide them to identify trends or issues with that particular member, is going to save time. And it ensures too that all of the important or pertinent trends for that particular member, for that particular population, are being identified. Because at the end of the day, clinicians are just that, clinicians. They’re not data analysts.

Developing a Multi-Dimensional, 360-Degree View of Your Data

Marina and Mayur presented some insight and ideas on how to create a decision-making framework providing a multi-dimensional, 360-degree view for your clinical, operational, administrative, and financial teams.

See [28:15] for more information, insight, and ideas on creating a multi-dimensional, 360-degree view of your clinical, operational, administrative, and financial data.

Top Six Things to Consider When Evaluating Healthcare Analytics Vendors

Here are top six things that you should consider when you think about analytics or in the majority of organization’s how you want to get there.

  1. Data Security
  2. In-House Experts
  3. Intuitive Easy-To-Use Platform
  4. Actionable Real-Time Data Visualization
  5. Data Accuracy
  6. Acceptance of Data in Any Format

For details on the importance of each of the above considerations for evaluating healthcare analytics vendors, listen in starting at [36:04].

Questions from Webinar Series Attendees

Our organization currently executes minimal analytical formalities, processes, etc and we are at an immature analytical state. Would investing and working with an analytics vendor refute all [our efforts] at this stage in our organization? [44:37]

Mayur: No. You can view it from the standpoint of: if you’re in the early stages of maturity then that would be the perfect time to assess how you want to design your system and what kind of systems you want to have in place. And you may not have to go through the same evolution steps that the entities started out early on. You may actually leapfrog by taking in all that stuff up front itself. So absolutely, even if you don’t have all the data organized in a unified view that’s fine too because you do have data sets. The first steps very well could be how do you get them into the unified view. So I wouldn’t hesitate working with and investing in analytics if you’re in the early stages of maturity because this very well could be an opportunity where you don’t have to redo the some of the things that you might have done if you’re already in further stages.Artificial Intelligence. Predictive Analytics. Bigdata. Machine Learning. HealthCare Executive Group. Benefits Costs. Patient Outcomes. Quality Standards. STAR ratings. Profit Margins. Improving Efficiencies. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.

Our organization prides itself on taking the best care of our patients. Can you give us examples of how using an analytics vendor can improve our patient outcomes vs. just us monitoring it internally? [46:03]

Marina responded to this question with an interesting story about how EQ health identified and assisted high-utilization, low literacy, diabetic patients in the Mississippi Delta.  Listen at [46:22] as to how EQHealth made life easier for patients and improved their health, all while reducing emergency room visits and inpatient admissions.

My team is discussing the decision to build an analytics platform internally or buy and outsource it with a vendor. Do you have any insight into what is more successful and pros and cons? [50:50]

Mayur: I don’t think there is a right answer or wrong answer. It really centers on your strategy. Are you trying to make that as your core competency or are you wanting to retain your core competency to manage plan operations but want to have the benefit of the analytics and the analytics platform; then at that point you should outsource. But if you’re wanting to make analytics your core competency, then you need to have that in-house. But when you do decide to make it in-house, you still need to… hear the rest of Mayur’s answer at [51:08]

Listen to more questions and answers from Solving the Rubik’s Cube of Payer Data here.

More Insight for Healthcare Leaders

Our Webinar Series events are one example of how the HealthCare Executive Group helps to share information and promote collaboration between our members, associates and sponsor partners. Our next Webinar Series event will be ‘Using People, Process & Technology to Grow Your Business’ and will be presented by our sponsor partner HealthEdge on July 25th, 2019 at 2:00 pm ET.HCEG. HealthCare Executive Group Webinar Series: ‘Using People, Process & Technology to Grow Your Business’ HealthEdge.

HCEG’s 2019 Annual Forum

Save The Date HCEG Annual Forum

In addition to connecting with us on Twitter and LinkedIn and subscribing to our eNewsletter, consider joining other healthcare executives and industry thought leaders at our 2019 Annual Forum in Boston, MA on September 9-11, 2019. In addition to the always insightful, information-packed sessions and networking opportunities our annual forum offers, we’re including two special networking events on Monday, September 9th:

  • Tour of the IBM Watson Research Facility in the morning
  • Red Sox vs. Yankees Baseball Game at Fenway Park in the evening

For more information, click here and/or contact us at [email protected].

HCEG Webinar Series Event. “Solving the Rubik’s Cube of Payer Data” Digital transformation. HCEG’s Top 10 Data & Healthcare Analytics. Artificial Intelligence, Machine Learning. Electronic Health Records. EHR. Claims Data. EqHealth Solutions. CMS’s Meaningful Use program. Industry Pulse Social Determinants of Health. Value-based Care. Alternative Payment Models

Healthcare Organizations Focus on Data & Analytics for Digital Transformation

By | Sponsor, Data & Analytics, Webinar Series, Value-Based Payment/Care | No Comments

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.

digital transformation. HCEG’s Top 10 Data & Analytics. Artificial Intelligence, Machine Learning. Electronic Health Records. EHR. Claims Data. EqHealth Solutions. CMS’s Meaningful Use program. Industry Pulse Social Determinants of Health. Value-based Care. Alternative Payment ModelsOther 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%)

RELATED: 9th Annual Industry Pulse Research Survey Results

Popular Use Cases for Healthcare Analytics

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.HCEG Webinar Series Event. “Solving the Rubik’s Cube of Payer Data” Digital transformation. HCEG’s Top 10 Data & Healthcare Analytics. Artificial Intelligence, Machine Learning. Electronic Health Records. EHR. Claims Data. EqHealth Solutions. CMS’s Meaningful Use program. Industry Pulse Social Determinants of Health. Value-based Care. Alternative Payment Models

Leveraging Low-code Development Platforms to Increase Member Engagement. low-code tools, patient engagement, operational effectiveness, healthcare consumerism, customer centricity, Appian, healthcare executive group, HCEG

Using Low-Code Development Platforms to Boost Patient and Member Engagement

By | HCEG Top 10, Sponsor, Tools, Holistic Individual Health, Operational Efficiency | No Comments

Health plan members and health system patients have become more vocal in their demands for clarity and measurable value from their healthcare services. Members see ever-increasing costs and continued transfer of those costs from employers to their employees. New direct to consumer entrants are changing the interaction paradigm. All of these factors are driving healthcare payers toward new ways of engaging with their members and providers.

HIMSS President and CEO Hal Wolf states, “Consumer pressure is driving a disruptive technology-enabled shift in healthcare today.” Accordingly, healthcare organizations and the companies supporting them are looking for ways to deliver their promise of value. This requires a better understanding of individual consumer preferences, better care coordinating, and better delivery across a broad health ecosystem.

New Generations of Healthcare Consumers are Demanding New Healthcare Services & Delivery Channels

In addition, digital generations—Millennials and Gen Z —are increasingly unsatisfied with how they obtain their healthcare services. Recent Accenture research1 found that one-third of millennials and almost half of Gen Z say they don’t have a primary care physician—compared to just 16% of baby boomers.  Millennials are shifting the historical relationship between physician and patient to virtual, retail clinics and digital self-service.

Enabling Total Consumer Health and Improving Operational Effectiveness

The HealthCare Executive Group Top 10 list of challenges, issues, and opportunities facing healthcare leaders in 2019 and healthcare executive group, HCEG Top 10, Challenges, Issues, Opportunities facing healthcare leadership. Innovation and disruption. Data & Analytics, Total Consumer Health, Population Health Services, Value-based Payments, The Digital Healthcare Organization, Rising Pharmacy Costs, External Market Disruption, Operational Effectiveness, Opioid Management, Cybersecuritybeyond reflects the importance of engaging health plan members and health system patients. Total consumer health—defined as improving members’ overall medical, social, financial, and environmental well-being—was ranked second on HCEG’s 2019 Top 10 list. And operational effectiveness—implementing lean quality programs, process efficiency, robotics automation, revenue cycle management, real-time/near-time point of sales transactions, and beyond—was ranked eighth.

It’s clear that healthcare organizations must rapidly develop services and products that engage healthcare consumers and help their organizations stay one step ahead of these major shifts in healthcare consumer preferences.

Address Changing Needs with Low-Code Application Development Platforms

Leadership charged with delivering healthcare products and services must address the changing needs of healthcare consumers in an agile, cost-effective way. Forward-thinking healthcare organizations are using low-code development platforms to digitally transform their organizations and efficiently respond to patient engagement opportunities.

What is a Low-Code Development Platform?

A low-code development platform2 allows you to build enterprise software applications using graphical user interfaces, drag and drop assembly and configuration. With low-code tools, you don’t write the application in traditional software code—you draw it like a flow chart. This greatly accelerates application development by orders of magnitude for both professional programmers and non-technical “citizen developers.”

Low-Code Platforms Enable Innovation, Accelerate Delivery and Improve Agility

Low-code platforms can help build applications that consolidate data, automate key processes, and enable mobile innovation. Instead of changing business operations to match the way commercial off-the-shelf (COTS) software works, companies can use to align their software systems with their business needs.

Leveraging Low-code Development Platforms to Increase Member Engagement. low-code tools, patient engagement, operational effectiveness, healthcare consumerism, customer centricity, Appian, healthcare executive group, HCEG

Low-Code Platforms Offer a Range of Benefits

  • Usability beyond software developers, easing the burden on IT
  • Extended existing applications and data across new channels and devices
  • Reduced IT sprawl, minimizing maintenance and related expenses
  • Flexibility to build new solutions using technology already owned
  • A fast and simple way to create powerful software

Key Features of High-Quality Low-Code Tools

While considering how your healthcare organization might speed up its digital transformation initiatives, keep in mind the key features of high-quality low-code tools include:

  • A single interface that ties together disparate systems so you can work no matter where data is stored
  • Enhanced security through a HIPAA compliant cloud
  • An API to allow drag-and-drop design to build your app once, then easily deploy to any device
  • Easy automation across people, robots, and machines

Areas Where Low-Code Platforms Can Quickly Add Value

No single commercial-off-the-shelf (COTS) software system can address all the member- and patient-related engagement opportunities that healthcare organizations face—at least not without high expenses and potentially long wait times for vendors to add functionality to their product. In addition, many COTS systems don’t integrate with other COTS and the myriad custom-developed systems healthcare organizations typically have installed.

Low-code development platforms can address many member- and patient-related business and functional needs. Capabilities include:

  • Integrating clinical data from providers with financial data from payers
  • Maintaining accurate and complete provider directories
  • Aggregating data to better coordinate patient services
  • Creating member- and patient-facing apps for scheduling services and accessing financial and clinical records
  • Providing real-time support for admissions and discharges
  • Handling complaints, appeals, and grievances automation
  • Managing simple, automated utilization and prior authorizations to ensure members understand what’s covered under their plans
  • Understanding out-of-pocket costs prior to obtaining services to help increase member satisfaction

More About Leveraging Low-Code Development Platforms

There are a number of good resources and references on low-code development platforms:

The Best Low-Code Development Platforms for 2019

Low-code platforms: A cheat sheetLeveraging Low-code Development Platforms to Increase Member Engagement. low-code tools, patient engagement, operational effectiveness, healthcare consumerism, customer centricity, Appian, healthcare executive group, HCEG

What Really Is Low-Code/No-Code Development?

The Forrester Wave™: Low-Code Development Platforms

And some use cases and case studies on using low-code development tools to enhance member and patient engagement:

Member Services, Enrollment, & Relationship Management

Intelligent Contact Center for Healthcare Organizations

Member Engagement & Wellness for Healthcare Payers

Transform Member & Patient Engagement Using Low-Code Application Development Platforms

The future of healthcare depends upon the ability to quickly adapt and provide quality and convenience for providers, payers, and most importantly, health plan members and health system patients. It takes speed and power to deliver transformational healthcare solutions. Low-code application development platforms provide both – enabling organizations to build web and mobile apps faster, run them on a HIPAA-compliant cloud, and manage complex processes, end-to-end, without limitations.

For more information on how to address opportunities, challenges, and issues in today’s rapidly transforming healthcare environment, consider subscribing to our eNewsletter and checking out the products and services offered by our sponsor partners – including Appian, a leading provider of low-code application development platforms.

HCEG Healthcare Executive Group

Special Thanks to HealthCare Executive Group’s 2018 Sponsor Partners

By | Executive Leadership Roundtable, Sponsor | No Comments

As America celebrates Thanksgiving, the HealthCare Executive Group (HCEG) is honored to thank our sponsor partners and acknowledge the support these leading healthcare companies have provided and continue to provide to our healthcare executive members, industry advisors, and associates throughout the year. Through the support of the companies highlighted below, HCEG is able to provide a comprehensive package of information, insight, and networking opportunities.

HealthCare Executive Group (HCEG). sponsor partners Appian, CareCentrix, Solera, Change Healthcare, Cumberland Consulting Group, HealthEdge, HighPoint Solutions, InstaMed, Redcard, Softheon

HealthCare Executive Group – Gold Sponsors

HCEG Healthcare Executive Group. Appian. Enterprise low-code. industry-leading intelligent automation. Digital Transformation Patient, member, and provider data. healthcare payers and providers innovation, consumers, healthHCEG Healthcare Executive Group. CareCentrix purpose-built technology, analytics, experience, post-acute care, patients and caregivers, coordinate care transitions, improve clinical outcomes, and do all we can to help patients heal or age at homeHCEG Healthcare Executive Group. Network partners preventing and managing chronic disease. Health plans, payers securely efficiently network of community-based digital health solutions.
Appian delivers the speed of enterprise low-code and the power of industry-leading intelligent automation. It’s the secret weapon to put your Digital Transformation on the fast track.

Improve decision-making with real-time access to patient, member, and provider data. Appian helps healthcare payers and providers speed innovation, help consumers take control of their own health, and simplify the healthcare journey.

CareCentrix has developed purpose-built technology, analytics, and experience to guide care that keeps patients on the path to the ultimate site of care: home. To address the complexities of post-acute care, CareCentrix engages patients and caregivers, coordinate care transitions, improve clinical outcomes, and do all we can to help patients heal or age at home.

By finding new ways to break down the silos across the continuum of care, CareCentrix is able to identify and capture savings health plans can count on.

Solera connects patients, payers, and physicians to a network of partners who are preventing and managing chronic disease.

Working with Solera, health plans and other payers securely and efficiently leverage a network of community-based and digital health solutions.

Solera helps employers identify and engage those in their workforce with the greatest opportunity for obesity-related chronic disease prevention.

WebsiteWebsiteWebsite
BlogBlog
LinkedInLinkedInLinkedIn
Twitter – @AppianTwitter – @carecentrixTwitter – @soleranetwork
FacebookContactContact
Contact

HealthCare Executive Group – Silver Sponsors

HCEG Healthcare Executive Group. Change Healthcare consulting. value-based healthcare system. healthcare technology company. software, analytics, network solutions, and technology-enabled services.HCEG Healthcare Executive Group Health insurers, new offerings. member populations. government program, commercial or individual product, or dental or TPA offering,
Change Healthcare consulting is a catalyst for your value-based healthcare system. Change Healthcare is a healthcare technology company that offers software, analytics, network solutions, and technology-enabled services to help create a stronger, more collaborative healthcare system. Change Healthcare helps deliver measurable value not only at the point of care, but also before, after, and in between care episodes.Cumberland Consulting Group is a leading healthcare consulting firm providing strategic advisory, implementation, optimization and outsourcing services to some of the nation’s largest payer, provider, and life sciences organizations.Health insurers must act quickly to launch new offerings targeted at member populations in specific market segments. Whether a government program, commercial or individual product, or dental or TPA offering, HealthEdge works with transformative health plans to create and maintain a competitive advantage.
WebsiteWebsiteWebsite
BlogBlogBlog
LinkedInLinkedInLinkedIn
Twitter – @Change_HCTwitter – @CumberlandCGTwitter – @HealthEdge
FacebookFacebookFacebook
ContactContactContact
HCEG Healthcare Executive Group. InstaMed healthcare payments experience. Consumers, providers and payers. payment transaction. private cloud-based technology electronic transactionsHCEG Healthcare Executive Group. RedCard health plans TPAs secure data communication members providers.
HighPoint implements effective IT solutions for payers and providers. HighPoint Solutions tunes out the noise so you can focus on improving healthcare delivery.InstaMed powers a better healthcare payments experience on one platform that connects consumers, providers, and payers for every healthcare payment transaction. InstaMed’s patented, private cloud-based technology securely transforms healthcare payments by driving electronic transactions, moving money and healthcare data seamlessly and improving consumer satisfaction.RedCard helps health plans and TPAs use the power of secure data to build stronger, more effective communication with your members and providers.
WebsiteWebsiteWebsite
BlogBlogContact
LinkedInLinkedIn
Twitter – @HighPtSolutionsTwitter – @InstaMed
FacebookFacebook
ContactContact
HCEG Healthcare Executive Group. Softheon. cloud-based solutions. retail-like, user-friendly experience. personalized communication. Real-time support member engagement. enrollment, member billing, ACA. Direct Enrollment
Overview
Softheon delivers cloud-based solutions that create a retail-like, user-friendly experience and provide personalized communication and real-time support to boost member engagement. Cost effective, and configurable software that supports health plans and states with enrollment, member billing, and reporting for over 3.2M Americans.
Website
Blog
LinkedIn
Twitter – @Softheon
Facebook
Contact

HealthCare Executive Group Sponsorship

Unlike what many organizations allow, our sponsor partners must check their sales and marketing interests at the door. HCEG sponsors participate as supportive thought leaders to HCEG members and associates. HCEG events and content exclude advertising and marketing-speak and participants at our events will never encounter vendor exhibits. Those reading our content and attending our webinars will not be bothered by sales pitches, pop-ups and banner ads.

For more information on the benefits of becoming an HCEG Sponsor in 2019, check out our Sponsorship Prospectus.  

Join Digital Healthcare Leaders & AHIP Forum Attendees in Nashville

If you’re attending the  2018 AHIP Consumer Experience & Digital Health Forum on December 10th – 13th or happen to be in Nashville on December 13th, consider attending HCEG’s next Executive Leadership Roundtable held at Music City Center at 1:00 pm CT.

In addition to lunch and networking opportunities, participants will enjoy the unique perspective and long-running insight of two distinguished panelists: Brian Lobley, President, Commercial and Consumer Markets at Independence Blue Cross and Stuart Hanson, Managing Director, Head of Healthcare Payments at JPMorgan Chase & Co.  HCEG’s Executive Director Ferris Taylor will moderate the roundtable.

This event is complimentary but registration is required. More information here.

Total Consumer Health & The Digital Healthcare Organization in Nashville

Four Pillars Successful Core-System Replacement Project. Healthcare Executive Group. Change Healthcare. digital transformation. Framework. Implementation Readiness. Governance. Business Transformation. Execution Framework

The Four Pillars of a Successful Core-System Replacement Project

By | Annual Forum, Sponsor, Webinar Series, Project Management | No Comments

Completing a successful core-system replacement project at a health plan or health system organization is a major undertaking. And successfully delivering a multi-million dollar digital transformation project is significantly enhanced by establishing a framework based on proven principles.

Framework for Successful Core-System Replacement Project

Last week, our sponsor partner Change Healthcare shared valuable insight in a webinar titled ‘The Four Pillars of a Successful Core-System Replacement Project.’  Jeanne Noe PMP, Director of Consulting Services and Mauricio ‘MJ’ Jimenez, Sr Manager of Consulting Services at Change Healthcare, shared information, insight and practical ideas on how to establish a framework for successful core-system implementation. This framework for a successful core-system replacement project is based on four pillars: 1-Implementation Readiness, 2-Governance, 3-Business Transformation and 4-Execution Framework.

This blog post recaps highlights and detailed content from the ‘Core-System Replacement Project’ webinar presented by Change Healthcare on August 2nd, 2018. Included is a recording of the webinar, the presentation slide deck, and additional information on establishing a framework for successful core system implementation. You can also check out this Twitter Moment summarizing live Tweets shared during the webinar.

Information, Insight & Actionable Ideas for Successful Core-System Implementation

After introductions by HCEG Executive Director Ferris Taylor, Jeanne Noe kicked off the webinar by sharing that the most important indicator of success in a Core-System Replacement project is a strong project foundation. Jeanne emphasized the importance of building a foundation on the Four Pillars of Success before the project progresses – not as you go along.

Why, How, What, Who & When of a Successful Core-System Replacement Project

The presentation from Change Healthcare was packed with information, actionable ideas and insight collected over the course of performing dozens of core-systems replacement projects for major healthcare payers and other risk-bearing entities.

Four Pillars Successful Core-System Replacement Project. Healthcare Executive Group. Change Healthcare. digital transformation. Framework. Implementation Readiness. Governance. Business Transformation. Execution Framework

Starting with the Taxonomy of Why, the importance of clearly defining – and widely sharing – the Strategic Vision, Business Goals, and Objectives were shared. Jeanne noted that explaining why a legacy system is being replaced is a key way to help all project team members achieve project objectives. Yet few healthcare organizations widely communicate the reasons for major initiatives like a core-system replacement project.

Jeanne went on to provide more details and commentary on the How, What, Who & When of a core-system replacement project. Since there’s simply too much information to share about the how, what, who and when in this recap, see the slides listed in the presentation deck for more. Better yet, watch the recording of The Four Pillars of a Successful Core-System Replacement Project here.

Roles Matters – Clearly Defined & Accountable

One of the most valuable bits of insight shared by Change Healthcare’s Jeanne Noe was that too many healthcare organizations make the very common mistake of not clearly defining roles, responsibilities and decision-making authority. Before the project starts – and periodically throughout the projects as objectives change and project resources come and go.

Clearly defining roles, responsibilities and decision-making authority seems obvious but is simply often not addressed.

Key Governance Components of a Successful Core-System Replacement Project

Change Healthcare presented two important actions healthcare executives sponsoring core-systems replacement projects MUST address at the start:

  1. Establish a single point of accountability and expertise
  2. Clearly identify decision makers and specialists for issue resolution

Risks, Actions, Issues, and Decisions – It’s a RAID!

Risks, Actions, Issues, Decisions (RAID) is a framework to report, track, resolve document project

Somewhat similar to the widely known RACI (Responsible-Accountable-Consulted-Informed) approach for managing large projects like core-systems replacement projects, Change Healthcare’s Core-System Implementation Framework uses the RAID framework to report, track, resolve and document project items.

As opposed to the somewhat passive activities defined via the popular RACI approach, Change Healthcare’s RAID approach to governing major projects emphasizes the importance of actions and rapid decision making within a framework of issue identification and risk management.

Business Transformation & Core-Systems Replacement Projects

Mauricio ‘MJ’ Jimenez, Sr Manager of Consulting Services at Change Healthcare continued the second half of the webinar by sharing information, insight, ideas, and tips on the 3rd and 4th Pillars of a Successful Core-System Replacement Project: Business Transformation and Execution Framework.

Business Transformation

MJ emphasized that replacing your core-system is a business transformation, not an IT project or initiative. MJ offered the following as some key considerations to effect a true business transformation:

  • Assign senior resources to serve as ambassador to the rest of the organization.
  • Neglecting employees affected by the transformation will guarantee resistance to change.
  • Relevant content is key and its delivery is enabled through Role-Based Training
  • When meetings grow in number of participants, it is often a reflection of poor communication.

Execution Framework – The Most Critical of the Four Pillars

Four Pillars Successful Core-System Replacement Project. Healthcare Executive Group. Change Healthcare. digital transformation. Framework. Implementation Readiness. Governance. Business Transformation. Execution Framework

Core-system and other major projects undertaken by healthcare organizations will be for naught without a well-designed Execution Framework. Change Healthcare’s MJ Jimenez shared some key experiences, insights, and ideas on how to establish an effective Execution Framework. And offered ideas for executing brilliantly.

The key components of the Execution Framework described include the following:

  • Flexibility
  • Maintains Focus
  • People First
  • Requirements Management
  • Defect Management
  • Systems Integration Plan

Summarizing the Webinar

Jeanne Noe shared the following slide at the end of the webinar.Four Pillars Successful Core-System Replacement Project. Digital transformation. Framework. Implementation Readiness. Governance. Business Transformation. Execution Framework. Requirements Management. Defect Management. Systems Integration Plan. Trizetto FACETS. QNXT, HealthEdge.As noted before, the information, insight, and ideas presented by Change Healthcare are too numerous to recap here. To learn more about what was shared during the webinar, check out the recording of the webinar, the presentation slide deck, and additional information on establishing a framework for successful core system implementation.  Also, check out this Twitter Moment summarizing live Tweets from the webinar.

More Insight & Opportunity for HealthCare Executives

The information shared by the HealthCare Executive Group in its Webinar Series events are one example of services we’re pleased to offer our members and associates. In addition to connecting with us on TwitterFacebookLinkedIn and subscribing to our eNewsletter, consider joining other healthcare executives and industry thought leaders at the HealthCare Executive Group’s 2018 Annual Forum on September 12-14th, 2018 in Minneapolis, MN. We’ll be celebrating our 30th Anniversary helping healthcare leaders navigate the strategic and tactical issues facing their organizations.

Check out this page for more information on our 2018 Annual Forum.HealthCare Executive Group Annual Forum. Executive leadership. 2018 Conference event forum roundtable

Connect with HealthCare Executive Group at the AHIP Institute & Expo

By | AHIP, Annual Forum, Executive Leadership Roundtable, Conferences, HLTH, HCEG Top 10, HIMSS, Sponsor, Webinar Series | No Comments

health care conference, Conference, Health Care, Hospital, Health System, Health Insurance, Health Plan, Benefits, Affordable Care Act, Policy, CMS, Health Care Reform, compliance, pharmaceutical, health IT, network, contracting,health plans,health systems,leadership, medicaid & policy, pophealth analytics, behavioral health,network contracting, employer direct contracting, self-insured, Population Health Analytics, PopHealth, Social Determinants of Health, healthcare, healthcare conference,HealthCare Executive Group convenes and supports healthcare executives and thought leaders by providing a platform supporting the creation, curation and sharing of information and insight on current opportunities, challenges and issues in the healthcare industry.

It’s our 30th Anniversary and the HealthCare Executive Group has been in overdrive during the first half of 2018. We held an Executive Leadership Roundtable at the recent HLTH Future of Healthcare Forum, we worked with our sponsor partners to share insight via our ongoing HCEG Webinar Series, we’ve attended a handful of major healthcare industry conferences in support of our members and sponsor partners, and we continue to leverage our social channels to help address the issues, challenges and opportunities facing today’s healthcare executive leader.

We’ve also been preparing for our 2018 Annual Forum taking place September 12th through the 14th in Minneapolis, MN – recruiting industry thought leaders and fleshing out an agenda that promises to share valuable information, insight and networking opportunities.  Finally, we’re wrapping up the first half of our 30th Anniversary year by attending the 2018 AHIP Institute & Expo where we’ll support our members and sponsor partners – and gather additional insight to make our 2018 Annual Forum all the more valuable.

Major Healthcare Conferences of 2018

health care conference, Conference, Health Care, Hospital, Health System, Health Insurance, Health Plan, Benefits, Affordable Care Act, Policy, CMS, Health Care Reform, compliance, pharmaceutical, health IT, network, contracting,health plans,health systems,leadership, medicaid & policy, pophealth analytics, behavioral health,network contracting, employer direct contracting, self-insured, Population Health Analytics, PopHealth, Social Determinants of Health, healthcare, healthcare conference,

HCEG members and sponsor partners participated in many of the major healthcare conferences taking place in the first part of the year including the:

2018 HIMSS Conference & Exhibition in March

15th Annual World Healthcare Conference in April

Inaugural HLTH Future of Healthcare Forum in May

Check out a recap of our roundtable event held as part of the Association Day at the inaugural HLTH Future of Healthcare Forum here.

WEDI Spring Conference in May

WEDI conference organizers have made complete conference information including sessions handouts available here.

2018 AHIP Institute & Expo next week June 20 – 22

HCEG members and sponsor partners will be participating in more conferences as the year continues, including, our course, hosting the 2018 HCEG Annual Forum celebrating our 30th Year convening and supporting healthcare executives and thought leaders.

Read on for more about HCEG Members and Sponsor Partners at the AHIP Institute.

HCEG’s Executive Leadership Roundtable

In May, we partnered with the International Association of Innovation Professionals, the Center for Healthcare Innovation, and the Workgroup for Electronic Data Interchange and held a unique ELR titled ‘Leadership, Trust & Skills in Overcoming Obstacles to Radical Innovation in Healthcare.’

Check out a recap of the roundtable event held in conjunction with the inaugural HLTH Future of Healthcare Forum here.

The Next Executive Leadership Roundtable – Nashville, TN

We’re planning another Executive Leadership Roundtable to coincide with the AHIP Consumer Experience & Digital Health Forum on December 11 – 13, 2018 in Nashville, TN. Members and sponsors interested in helping shape the theme of this roundtable are urged to contact us at [email protected].

HCEG Webinars Offer an Opportunity to Learn from Sponsor Partners

In the first few months of 2018, HCEG and our sponsor partners produced webinars addressing a variety of topics such as Value-based Payment, Post-Acute Care in Medicare Advantage and a deeper dive into the 2018 HCEG Top 10. For more information on these webinars including a recap and recording, check out the following:

Recapping ‘The 2018 HCEG Top 10 Healthcare Opportunities, Challenges & Issues’ Webinar – Part 1

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

Recapping Value-Based Payment – Getting from Here to There…

The Financial Impact of Post-Acute Care in Medicare Advantage

The HealthCare Executive Group Webinar Series Continues

In August, “The Four Pillars of a Successful Core-System Replacement Project” will be presented by sponsor partner Change Healthcare on August 2nd, 2018 at 2:00PM ET. Reserve your seat for this webinar today!

HCEG is also working with other sponsor partners on additional webinars planned for the 4th quarter of 2018 after the Annual Forum.

Consider subscribing to our eNewsletter to be kept abreast of these webinars and other information and events of value to healthcare executives and thought leaders.

Preliminary Agenda and Keynote Speakers for HCEG’s 30th Anniversary Annual Forum

We’re pleased to share the preliminary agenda and announce that Andy Slavitt, former Acting CMS Administrator and current leader of Town Hall Ventures, and Dan Buettner, National Geographic Fellow, NY Times bestselling author and principle at the Blue Zones Project will be providing keynote addresses at our 2018 Annual Forum in Minneapolis, MN on September 12 – 14, 2018.

The following represents the current agenda which is being fleshed out and evolving on a weekly basis. We’re also identifying and recruiting more speakers and panelists, and planning enjoyable networking events intended to make our 2018 Annual Forum our best forum ever. If you or someone you know would like to be considered to speak or serve as a panelist at our forum, please use this form.

hceh annual forum healthcare executive group annual forum conference

To learn more and to get an idea about what the HCEG Annual Forum is all about…

… Check out these pictures from last year’s HCEG Annual Forum

… See who’s among the previous attendees of HCEG Annual Forum’s

If you would like to register to attend HCEG’s Annual Forum, you can register here. And if you are unsure as to whether you should attend, check out these Nine Reasons to Attend the 2018 HCEG Annual Forum.

HCEG Members and Sponsor Partners at AHIP Institute & Expo

The 2018 AHIP Institute & Expo takes place next week, June 20th through the 22nd in San Diego, CA and HCEG members and sponsor partners will be participating, speaking and exhibiting.

If you’re attending the AHIP Institute, be sure to meet our sponsor partners. Some of our sponsor partners are exhibiting, some are presenting, and some are attending. ALL of our sponsor partners can help your healthcare organization transform itself in today’s rapidly evolving healthcare environment.

Also not to be missed are sponsor partners CareCentrix and Change Healthcare offering refreshments and a Lunch & Learn session.

Date & TimeSponsor PartnerEvent
June 20: 8:00am – 11:00amCareCentrixWelcome Refreshments
June 20: 11:00am – 12:15pmChange HealthcareLunch & Learn

Value-Based Care Market Research: Inside Successful Programs

June 20: 3:45 pm – 4:30 pmCareCentrixThe Future of Care at Home: New Strategies for Post-Acute Care
June 21: 9:30 am – 10:15 amCareCentrixCoffee Break in the Exhibit Hall

Stay Connected and Learn More About HealthCare Opportunities, Challenges & Issues

Check out the following for more information about the HealthCare Executive Group:

Becoming a Member of the HealthCare Executive Group

Attending our 2018 Annual Forum

Subscribe to our eNewsletter

Limited Sponsorship Opportunities

The HealthCare Executive Group has limited general sponsorship opportunities available to companies interested in supporting our members on a consultative, partnership basis. For more information, contact Juliana Ruiz.