If analytics is the machine powering your digital transformation initiatives, then data is the power making that digital transformation machine run. The importance of data and analytics has been identified by our members in each of the last ten years HCEG’s Top 10 list of challenges, issues, and opportunities have been created. For 2019, “Data & Analytics” is ranked #1 on the HCEG Top 10. It’s clear that healthcare leaders believe that data is a catalyst to accelerate meaningful change. And that the use of analytics – particularly prescriptive analytics – is a fundamental strategy for succeeding in a new era of healthcare.
Mountains of Data Waiting to Power Your Healthcare Analytics Machine
Good analytics begins with good data and healthcare organizations are sitting on a mountain of data. According to America’s Health Insurance Plans (AHIP), the typical regional payer processes $8 billion in claims each year with each claim providing its own set of unique data points – largely financial and administrative. But healthcare payers are increasingly collecting, matching, and using clinical data to provide richer, more comprehensive insight on their members.
Given the proliferation of Electronic Health Records (EHR) incented by CMS’s Meaningful Use program, it’s no surprise that more and more data is being pulled from EHR’s. And risk-sharing agreements between payers and providers has resulted in health plans sharing more claims data with their provider partners. In fact, the current Industry Pulse report indicates that EHR data is one of the top two primary sources of clinical data with 30% of health plans reporting they utilize EHR data.
Other sources of clinical data that organizations are using to complement their claims data include ancillary data such as pharmacy, lab, and imaging (17%) and real-time admission, discharge, and transfer notifications (10%)
These enhanced data sources are becoming more and more useful due to the power of artificial intelligence (AI) and machine learning.
New research from Dimensional Insight identifies care quality measures and finance as two top use cases for healthcare organization usage of analytics today. Additional use cases for leveraging data by analytics include
Addressing Social Determinants of Health (#3 on the 2019 HCEG Top 10)
Value-based Care and Alternative Payment Models (#4 on the 2019 HCEG Top 10)
Improving Patient Engagement and Satisfaction
Patient Outcomes Improvement
Analytics Budgets are Increasing for Healthcare Organizations
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.
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 beyond 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.
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:
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.
The 2019 HIMSS Global Conference & Exhibition adjourned on Friday, February 15th with 45,000+ professionals from 90+ countries, 1300+ exhibitors, 300+ education sessions spanning 24 topics and 100’s of special programs and networking events taking place over the nearly weeklong event. And HealthCare Executive Group (HCEG) members, sponsor partners, and other Champions of Health were in attendance.
HCEG Executive Director Ferris Taylor – A Champion of Health
This post presents a few highlights and resources from the conference including:
Dr. Karen DeSalvo – Former Office of the National Coordinator for Health Information Technology (ONC)
Aneesh Chopra – First Chief Technology Officer of the United States
All of these Champions of Health discussed what was expected to be major HIMSS conference themes: Data Interoperability, Information Blocking and open API’s based on the Fast Healthcare Interoperability Resources (FHIR) standard. All of which got a boost on the opening day of the HIMSS conference with the CMS and ONC release of new rules intended to make data more accessible.
Champions of Health Discuss Interoperability and Value-Based Care Delivery
On Wednesday evening, another Champion of Health, CMS’s Deputy Administrator and Director of the Center for Medicare and Medicaid Innovation (CMMI) Adam Boehler joined John Doerr, Chairman of Venture capital firm Kleiner Perkins and Aneesh Chopra for an interesting and occasionally provocative discussion on The Intersection Between Interoperability and Value-Based Care Delivery.
As the session title indicates, the discussion centered around the topics of liberating healthcare data and addressing incentives to change payment from fee-for-service to value-based payments. This was an interesting discussion in that none of these three individuals are clinicians but rather brought what was clearly a business focus to the discussion.
Four Key Considerations for Revising Healthcare Incentives
Adam Boehler noted four key considerations for healthcare leaders to address in their quest to revise incentives and effect true change in the healthcare ecosystem
Treat patients as consumers
Help providers become more accountable for outcomes
Adjust incentives to reward more preventive services
Improve how payment policies are aligned to outcomes
Interesting Comments from Champions of Health at 2019 HIMSS Conference
A few interesting comments were made during the chat.
Aneesh Chopra, John Doerr, & Adam Boehler (R)
From John Doerr:
“There is not currently any business case for a large health system to replace their installed EHR system”
“What I believe is missing is a platform to make value-based care more successful and accelerated. We need to blow up fee-for-service to make these platforms happen”
“Artificial intelligence has been overhyped and is now underappreciated”
“On the current trajectory, the United States won’t win the artificial intelligence race”
From Adam Boehler:
“CMMI is a real treasure trove of information [regarding payment model innovations and programs] that is not being taken advantage as much as it should be by healthcare industry participants“
North Carolina as a Hotbed for Healthcare Innovation
Additionally, the group discussed some of the organizations, programs and individuals working on innovative and other potentially transformational changes in various areas around the country. In particular, North Carolina was noted by all as leading the way in the area of value-based care, reimbursement, and improving outcomes.
Seemingly every speaker positively acknowledged that North Carolina is a hotbed of healthcare innovation with John Doerr stating “If what’s happening in North Carolina won’t work, we’re hosed.”
More About Value-Based Care & Delivery – 2019 HCEG Top 10 Item #4
The discussion between Adam Boehler, Aneesh Chopra, and John Doerr in the Orange County Convention Centers Chapin Theater was an insightful, entertaining, comfortable, and welcome break at the end of the 3rd day of the HIMSS conference. Sitting in those comfortable seats at the end of three days of walking, standing and talking made the information, opinion and occasional levity shared among these three healthcare leaders all the more enjoyable.
For every year since the HCEG Top 10 list of challenges, issues, and opportunities have been created by HCEG members, value-based payments have been included on the list. In 2018, value-based payment was ranked as #3 on the list – this year it’s ranked #4. One of HCEG’s members will be writing a guest post covering more of the discussion that ensued during The Intersection Between Interoperability and Value-Based Care Delivery.
Subscribe to our eNewsletter for more on this specific session and other topics of interest to healthcare executives and thought leaders.
Inspirational Stories from Champions of Health at 2019 HIMSS Conference
Not everything in Orlando was just about technology, policy and the business of transforming healthcare. There were sessions featuring inspiring, true-life stories of courage in dealing with the clinical, administrative and financial aspects of the American healthcare system.
Cris Ross, CIO of the Mayo Clinic, shared about his personal struggle with dealing with the very healthcare ecosystem in which he had a role in creating. See this account of some of the challenges Cris Ross faced.
Above the scene view of HIMSS TV crew – Monday, 2/11/19
Whether you attended the HIMSS conference or not, you can access many of the presentation decks shared in the 300+ educational sessions. For information on how to access presentations from HIMSS sessions, see this easy 3-step process here.
What are Others Saying About the 2019 HIMSS Conference?
Thankfully, there’s no shortage of recaps, summaries, post-conference analyses and opinion pieces that can serve to help cut through a lot of the hype and chaff that’s unavoidable in a large conference like the annual HIMSS conference. Here are a few summary recaps that may be of interest.
In addition, our sponsor partners shared via HIMSS formal, live-streamed sessions, hosted luncheon session for attendees to share their experiences with blockchain technologies, offered complimentary smoothies throughout each day, and in general helped attendees to get the most out of their HIMSS conference experience.
More Opportunities for Champions of Health to Convene, Share, & Network
Events like the 2019 HIMSS Global Conference & Exhibition are great opportunities to get a feel for and gain a better appreciation for what’s going on across the entire healthcare ecosystem. There are so many challenges, issues, opportunities, and uncertainties that must be triaged on a daily basis. To many people, meeting and interacting with other individuals, communities, groups, vendor companies and other organizations in a meaningful – however brief – moment is what these conferences are all about.
To continue our mission of convening and supporting Champions of Health, the HealthCare Executive Group offers the following opportunities to healthcare executives and other leaders:
16th Annual World Healthcare Congress – Washington, DC – April 28 – May 1, 2019
Use HCEG2019 for a special HCEG-only discount to this important annual event. Feel free to contact us for more information.
Our 2019 Annual Forum – Boston, MA – Sep 9-11, 2019
HCEG’s 2019 Annual Forum takes place in Boston, Massachusetts on September 9 – 11, 2019. Our planning of the agenda, speakers and special networking events continues and we are close to opening up registration. To learn a bit about last year’s annual forum and see some pictures, check out this recap. And click here to be added to a list to receive the latest information on our 2019 Annual Forum as it becomes available.
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 – Gold Sponsors
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.
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.
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.
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.
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
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.
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.
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:
Establish a single point of accountability and expertise
Clearly identify decision makers and specialists for issue resolution
Risks, Actions, Issues, and Decisions – It’s a RAID!
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.
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
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:
Systems Integration Plan
Summarizing the Webinar
Jeanne Noe shared the following slide at the end of the webinar.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 Twitter, Facebook, LinkedIn 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 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
HCEG members and sponsor partners participated in many of the major healthcare conferences taking place in the first part of the year including the:
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 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:
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.
To learn more and to get an idea about what the HCEG Annual Forum is all about…
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.
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.
It’s no secret that rising pharmacy costs are a serious challenge for the health plans, health systems, sponsors and individuals on the hook for paying for them. Our healthcare executive members ranked “Addressing Pharmacy Costs” as #9 on the 2018 HCEG Top 10 list.
How Can Health Plans and Health Systems Address Rising Pharmacy Costs?
On Wednesday, November 13, 2017, Pete Biagioni, Managing Partner at Cumberland Consulting Group, and Marcia Lambert, Partner at Cumberland Consulting Group presented “Strategies to Address Rising Pharmacy Costs,” Cumberland Consulting Group’s entry in this month’s HCEG Webinar Series.
The webinar provided attendees with a lot of great insight and information on the following:
An overview of trends in growth of pharmacy costs
Pharmaceutical Distribution Channels
Drivers of specialty pharmacy spend
Drug cost management strategies
What strategies health plans and health systems can implement to address rising pharmacy costs
Trends in Rising Pharmacy Costs
Specialty Pharmaceuticals – a 95% increase in just two years!
Pete Biagioni kicked off the presentation by highlighting that prescription drug spending is now the largest category in healthcare benefit spending – outpacing specialty care, inpatient and outpatient costs. Pete added that not only is prescription drug spending the largest healthcare expense but it’s also the fastest-growing category of benefit spending!
Largest contributor to increases in rising pharmacy costs are Specialty Drugs – with a 95% increase* in just two years!
How Drug Prices are Determined in the United States
One interesting part of the presentation was Marcia Lambert’s overview of the Pharmacy Distribution and Reimbursement System for Patient-Administered vs. Provider Administered, Outpatient Prescription Drugs in the U.S. Several very detailed and informative slides were shared. These slides identified the product flow, contractual arrangements and financial payments between the myriad of entities involved with pharmacy distribution in the U.S.
Specialty Pharmacy Trends & Drivers of Specialty Pharmacy Spend
A good part of the presentation covered specialty pharmaceuticals, which are growing at a CAGR of 17% as more products are being developed to treat orphan diseases and provide newer therapies. Some specialty pharmacy trends include:
As more specialty drugs are dispensed, a shift away from the buy-and-bill system (reimbursement through medical benefit) to the pharmacy (reimbursement through prescription drug benefit) can be expected.
As SPs gain more revenue and market share, they’ll come under more scrutiny and attempts at cost containments from payers.
The healthcare system’s grudging acceptance of high-priced orphan disease drugs has given manufacturers more incentive to develop low-volume SP drugs.
The high cost of SP’s will demand more Value-Based/Outcomes-Based evidence
Pharmacy Cost Management Strategies
The Cumberland presenters provided an overview of traditional Strategies to Manage Rising Pharmacy Costs and then dived into a LOT of detailed information on the pros and cons of newer, novel strategies for managing pharmacy costs including:
The Future – Pharmacy Trends and Government Intervention
This rapid paced presentation moved toward its conclusion with Pete Biagioni sharing a few slides listing some ways that government intervention might impact prescription drug prices. And the webinar completed with a short listing of future trends for prescription drugs in the U.S. The entry of Amazon and mega deals like CVS buying Aetna being two likely major impacts.
The Recording, The Content and More Insight from Cumberland Consulting Group
The above is just a portion of the information presented by our sponsor partner Cumberland Consulting Group. You can learn more about “Strategies to Address Rising Pharmacy Costs” by reviewing the entire recording of the webinar available here. If you’d like more information or if you have any questions on the content of this webinar, please feel free to contact Cumberland Consulting Group. You may also want tofollow Cumberland on Twitter.
As more Accountable Care Organizations (ACO) are formed and as value-based reimbursement arrangements between payers and providers expand, the need for assessing non-traditional drivers of health outcomes, leveraging payer, provider and community resources and enhancing collaboration between patients, providers and payers are becoming key to improving outcomes and managing costs.
Our Thursday, October 26, 2017, Harry Merkin, VP of Marketing at our sponsor partner HealthEdge teamed up with Barbara Berger, VP of Care Management at First Care Health Plans, to present “Care Redesign: Lowering Costs While Improving Patient Outcomes,” HealthEdge’s entry in this month’s HCEG Webinar Series. The webinar presented innovative, real-world examples of how First Care Health Plans is improving member outcomes and lowering their cost of care via three primary approaches:
Collaborating with providers and health systems
Partnering with community resources
Making critical information available to key stakeholders
Addressing Discontinuances of Care
Barbara shared that, while the high volume, time-sensitive nature of healthcare delivery often leads to a discontinuance of care delivery and management between the silos in which payers and providers often operate, the increased data sharing associated with the emergence of ACO’s and value-based reimbursement and care models are helping to align care provided by providers and health plan payers. Examples of balancing the proper people, processes and technologies were shared.
Population Assessments and Social Determinants of Health
Barbara emphasized the importance of carefully and thoroughly assessing an individual’s health care, behavioral and social needs as part of a periodic, recurring population assessment and how doing so can have a key, beneficial impact to healthcare outcomes. And with “Social Determinants of Health” forming the basis (bottom) of Maslow’s Triangle of Needs, First Care is starting to include an assessment of member’s social determinants of health in their population assessment program. Factors such as the following are included in the population assessment:
Access to Healthcare Services
Access to Food
Access to Local Community Resources
Access to Transportation Options
After Barbara shared her insight on this currently popular topic, Harry Merkin stated: “The phrase ‘social determinants of health’ is no longer a buzzword!”
Addressing Social Determinants of Health
Barbara shared an overview about First Care’s “Expecting the Best Maternity Program” that combines case management and utilization management to complement care provided by physicians while guiding and supporting members – and their family – through member pregnancies; particularly high-risk pregnancies.
Besides services such as assistance with locating medical providers, toll-free 24/7 access to a clinician and a package of select products and services aimed at supporting pregnant women, the program also includes an innovative “Nurse-Family Partnership” where a First Care nurse is paired with an expecting family to help the patient and her immediate family members understand and manage the pregnancy. First Care nurses regularly reach out to ask questions on how the pregnancy is progressing and answer any questions the patient and family may have.
The program has resulted in a significant per decrease in NICU maternity admissions.
The Recording, The Content and More Insight from HealthEdge
The webinar presented three considerations for payer-provider population health programs:
Be methodical about population assessment
Integrate People, Process and Technology with Providers
Use value-based contracts to align vision of member/patient care
You can learn more about how collaborating with providers and health systems, partnering with community resources and making critical information available to key stakeholders can improve outcomes and lower costs by checking out this recording of the webinar and these few slides from the presentation. If you would like more information or if you have any questions on the content of this webinar, please feel free to contact HealthEdge too.
Our 2017 Annual Forum came to a close at noon this past Wednesday. Over 110 healthcare executives, nationally known healthcare speakers and industry thought leaders gathered in Nashville, TN – Music City and the Healthcare Capital of the United States – to share their insight, ideas and concerns about healthcare reform and digital transformation during these rapidly evolving, uncertain times in healthcare.
The 29th Annual Forum featured three keynote speakers, nine sessions covering the latest topics of interest to executives leading health plans and health systems and three nighttime events structured to support networking between forum participants. All in all, the two and half days of our 2017 Annual Forum added up to one incredible opportunity for those leading the digital transformation of healthcare reform in the United States to come together on an intimate basis , to share and learn with each other collaboratively.
The 2018 HCEG Top 10 List
As has taken place during each of the last seven HCEG Annual Forum events, participants selected and voted on the Top 10 Opportunities, Challenges and Issues facing health plan and health system executives over the coming months and year. This new 2018 HCEG Top 10 list will drive the focus of Executive Leadership Round Tables, webinars, content development and other collaborative opportunities throughout the remainder of 2017 and the coming new year.
What We’ll Be Sharing From Our 2017 Annual Forum
Over the next few weeks, insight, ideas, opinions and concerns generated during the forum will be shared with members and the public at large. We’ll recap forum speaker and participant insight and opinion into how healthcare in the United States will be impacted by healthcare policy reform, digital transformation initiatives and both national and state-level actions. Readers of this blog, our friends on social media, attendees of our webinars and round tables and subscribers to our newsletter can look forward to how speakers, panelists and participants at our 2017 Annual Forum shared insight on the following:
How Clinical and Data Analytics leverage clinical evidence to segment populations, manage health and drive decisions
How the emergence of Population Health Services Organizations are operationalizing population health strategy, chronic care management, driving clinical integration, and integrating social determinants of health
How Value-Based Payments are being used to target specific medical conditions to manage cost and quality of care
How Cost Transparency is inevitable due to growing legislation and consumer demand
And more certain topics that can help healthcare leaders address transformation during these uncertain healthcare times
How We’ll Share
The Healthcare Executive Group will share the following via its web site, blog, social channels – including Twitter, LinkedIn an Facebook, and via other channels including member LinkedIn accounts, sponsor partner media and healthcare industry media. Look for the following:
Quotes from Keynote Speakers & Panelists
Session recaps including Presentation Materials
Thoughts from Forum Participants including social media shares
To succeed in today’s uncertain and tumultuous healthcare environment, health plans, health systems and provider organizations must develop a clear strategic identity supported by a distinctive portfolio of platforms, products, and services that transform their chosen strategy into a winning business model. Change, Innovation and Growth are imperative to survive in today’s healthcare environment.
This September 18th though the 20th, the 29th Annual Forum Healthcare Executive Forum takes place in Nashville, TN at the Thompson Hotel Nashville. Leading experts in health care policy, operations, reimbursement and digital health will examine the opportunities, challenges and issues healthcare executives must face in 2017 and beyond. This blog post provides some details on the speakers and presenters, more detail on the opportunities, challenges and issues that will be discussed, and more on what participants in our 2017 Annual Forum can expect to enjoy.
Keynote Speakers at 2017 Annual Forum
Karen DeSalvo Opening with Interactive Q & A
A great line-up of keynote speakers, moderators and panelists are on tap for the Annual Forum. On Monday the 18th, Karen DeSalvo, Assistant Secretary for Health at U.S. Department of Health and Human Services, will provide the opening keynote address which will be immediately followed by an interactive Q & A session as lunch is served. The interactive Q & A format offers forum participants a unique opportunity to interact among themselves and with a leading healthcare policy executive.
Open discussion on important topics with a diverse set of peers all actively working to address healthcare outcomes and costs in the United States is a distinctive feature of all HCEG events – particularly the Annual Forum.
Donato Tramato, CEO of Tivity Health, Life’s Bulldozer Moments
During breakfast on Tuesday, Donato Tramato, CEO of Tivity Health (formerly Healthways), will provide a motivational keynote address: “Life’s Bulldozer Moments:”How Adversity Leads to Success in Life and Business.” Donato will recount business and life lessons learned and show that adversity can lead to success – how anyone bulldozed by life can pull themselves out of the rubble, dust themselves off and find meaning and purpose.
Later on Tuesday, another Nationally and Internationally recognized healthcare executive speaker will address forum participants as dinner is served.
As with all HCEG forums and executive leadership events, participants will be able to interact with speakers and other forum participants – asking questions and sharing viewpoints, with the objective to develop actionable strategies to each of their organizations.
Unparalleled Mix of Moderators & Panelists
In addition to the keynote speakers, a select group of healthcare industry leaders which includes some HCEG members will serve as moderators and panelists sharing their unique insight and perspective on a number of carefully selected topics. Some of these individuals include:
A complete list of these moderators and panelists can be found here.
Certain Strategies for Uncertain Healthcare Times
The following are a sample of the sessions planned for the Annual Forum:
Recent CMS call letters, proposed mandates and new state and federal level regulations regarding provider networks underscores the value and importance of addressing data quality via effective communication and collaboration between health plan payers and providers. Hear from panel members on approaches for ensuring network adequacy, complying with real-time provider directory updates and related impact of No Surprise Bill legislation sweeping the country.
Leading Edge Technology / Disease Management / Population Health
Disease management and Population Health has struggled in the past and now is giving way from identifying and matching people living longer with multiple chronic conditions to providing cost-effective, scalable mitigation and support services/products needed by this rapidly changing population. Panelists will discuss opportunities, challenges, and issues for improving clinical and costs via services and technologies addressing access to care, supporting interaction among constituents, and reducing costs via analytics, artificial intelligence and alternative/virtual reality services.
Pharmacy Costs / PBM and Rx Transparency
Prescription drugs are a fast-growing part of most large employers’ total medical spend and the increasing prevalence of high-deductible health plans have put on spotlight on the importance of Rx price transparency, benefit design and pharmacy benefit management practices. This panel will examine opportunities for managing the financial and non-financial/clinical aspects of prescription drugs, working in revolutionary ways with PBM’s, while ensuring optimal outcomes and member/patient satisfaction.
Specialty Networks and Risk Sharing at Scale
Value-based care programs and risk-sharing in accountable care organizations are core components for delivering and paying for care more effectively and efficiently. This panel will discuss and explore how opportunities and issues with specialty networks and support for risk-sharing at scale.
Precision Medicine and Behavioral Health Aspects of Substance Abuse/Opioids
As the use and abuse of opioids skyrockets, precision medicine technology that successfully stratifies patient risk by analyzing genetic and non-genetic (environmental & lifestyle) risk factors to accurately predict prescription opioid abuse show promise of helping physicians choose more effective treatments and reduce addiction risk while lowering cost. This panel will explore how health plans and providers can utilize precision medicine to achieve a new standard in healthcare delivery based on evidence-based insights and predictive analytics.
Digital Health & Consumer Engagement
Certain digital health technologies are rapidly becoming an integral way of connecting to and engaging with the healthcare consumer. Though still being decided, this panel will explore the digital technologies most likely to gain consumer acceptance, engagement and lead to real improvements in overall well-being, outcomes and cost-reductions.
Technology Innovation and Healthcare M & A Market Trends
Achieving scale via M & A deals and through dedicated ‘innovation programs” have been a popular way for health plans and health systems to create “quick-win” value. And health plan/health system leaders must employ a smarter, more sophisticated scale equation to derive the most value from these approaches. This panel will review current trends in healthcare innovation and M & A activity and discuss risks and benefits of various value creation strategies.
Additional Forum Events and Opportunities
In addition to a knowledgeable group of healthcare visionaries and thought-leaders exchanging information, ideas and opinions with forum participants, participants at the 29th Annual Forum will enjoy other critical networking and perspective sharing events and opportunities including:
Meet and Greet at Thompson Hotel – Sunday night
Off-Site Reception with great Nashville music on Monday the 18th
Catered breakfasts, lunches and dinners each day of the forum