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

By | HCEG Top 10, HealthEdge, payment, reimbursement, Risk-Sharing, Value-Based Payment, Webinar Series | One Comment

Our sponsor partner HealthEdge hosted HCEG’s Webinar Series event in March: Value-Based Payments – Getting from here to there…

Harry Merkin, VP of Marketing at HealthEdge and Dave Mika VP of Enterprise Core System Operations at Independent Health shared insight and real world experience on how health plans and their provider networks can transition from traditional fee for service (FFS) to value-based payment (VBP).

This blog post recaps highlights of the webinar and provides access to additional information from the webinar. A recording of the webinar can be found here. You can also check out this Twitter Moment summarizing live Tweets from the webinar.

Value-Based Payment Began in the Late 1990’s 

In the late 1990’s, capitation models began paving the way for change from traditional FFS payment models to models focused on helping establish effective, cost-efficient practice models. In the last few years, value-based payments have become the latest and greatest models for reimbursement of care. The importance of value-based payments is supported by HealthCare Executive Group members ranking Value-Based Payment as #3 on the 2018 HCEG Top 10 list.

Moreover, recent statements by current and former HHS officials have supported the need for value-based payment:

“There is no turning back to an unsustainable system that pays for procedures rather than value”, and the transition “needs to accelerate dramatically.” – Alex Azar, Secretary of HHS, 3/5/18 at the Federation of American Hospitals’ conference

“I highly encourage health care leaders to listen intently to his full remarks. The transition to value is moving forward; if you aren’t already preparing for it, it is time to get on-board.“ – Michael Levitt, former governor of Utah and former HHS Secretary

Value-Based Payment Can Lower Costs and Improve Outcomes

Harry Merkin shared the results of a November 2017 Humana study showing that VBP programs achieve meaningful gains in cost and quality vs. traditional FFS methods with total healthcare costs associated with VBC plans 15% lower than care costs of FFS plans. And a more recent survey by the Healthcare Financial Management Association revealed that 70% of healthcare organizations participating in VBP programs have achieved positive results.

Value-based Payment Must Address the Quadruple Aim

Independent Health’s Dave Mika shared real-world insight into the experience his organization has witnessed. A key focus raised by Dave is that health plans looking to implement or extend value-based payment programs must address the four pillars of the Quadruple Aim

  1. Enhancing patient experience
  2. Improving population health
  3. Reducing costs
  4. Improving the work life of health care providers

Questions from Webinar Participants About Value-Based Payment

HCEG webinar series events always include the opportunity for questions from participants and this webinar was no exception. Two of many questions included the following short, paraphrased responses by Dave Mika – and other questions can be obtained from the webinar recording:

What is the key to gaining alignment with PCP’s?

Answer: Actively reaching out to and collaborating with key stakeholders in the local community.

What data has proven to be most useful to the provider network?

Answer: Information on patient gaps in care– ideally provided at the point of care in the physician’s workflow – can be very effective in improving value.

And More on How to Get There from Here…

In addition to the above, the webinar addressed the following considerations for transitioning from traditional FFS programs to VBP programs:

  • Aligning delivery and reimbursement models with high-performing providers
  • Tools for members to self-manage and self-navigate the care delivery system
  • Technology support including web and digital capabilities

The move to value-based reimbursement appears inevitable, and only those health plans and providers that begin to transition and adapt today will be successful in the future. Change doesn’t happen overnight. To learn more about how making the transition from FFS to VBP, check out the webinar recording, consider contacting HealthEdge for more information and keep in touch with the HealthCare Executive Group by connecting with us on Twitter, Facebook, LinkedIn and subscribing to our newsletter.

Value-Based Payments – Getting from here to there…

By | Healthcare Reform, HealthEdge, payment, reimbursement, Value-Based Care, Value-Based Payment | No Comments

 value-based payments (VBP) models. Capitation models traditional fee-for-service (FFS)

Since the late 1990’s, the reimbursement landscape in healthcare has been changing. Capitation models paved the way for a change from traditional fee-for-service (FFS) payment models to a focus on helping physician partners establish effective, cost-efficient practice models. And now value-based payments are the latest and greatest models for reimbursement of care. In fact, value-based payments were ranked by HealthCare Executive Group members as #3 on the 2018 HCEG Top 10 list.

value-based payments (VBP) models. Capitation models traditional fee-for-service (FFS) MACRAWhile uncertainty surrounding healthcare reform in the United States continues and the industry waits for more definitive reimbursement policy from the federal government, one thing is certain—the trend for value-based payments (VBP) continues. Health plans and providers really have no choice but to transition from the traditional fee-for-service model in order to drive down soaring costs and positively impact patient outcomes.

“There is no turning back to an unsustainable system that pays for procedures rather than value” and the transition “needs to accelerate dramatically.”

– Alex Azar, Secretary of Health and Human Services, March 5, 2018 at the Federation of American Hospitals’ conference

Obstacles in the Path to Value-based Payments

There are many obstacles that must be addressed to successfully implement value-based payments models that reward providers for positive performance and encourage poor performers to improve. In order to achieve the expected outcomes and performance required by VBP, health plans must have the flexibility to develop, implement and administer value-based contracts with providers responsible for care delivery, care management, and care coordination across the medical neighborhood.

value-based payments (VBP) models. Capitation models traditional fee-for-service (FFS) MACRA

How to get there from here…Value-based Payments

On Thursday, March 22, 2018 at 2:00PM ET, Harry Merkin of HealthEdge and Dave Mika of Independent Health will share their insight and real world experience on how to get from here to there with value-based payment. Some of the information they will share includes:

  1. Essential elements of a transition from traditional Fee For Service to Value-based Payment
  2. Independent Health’s story of how important technology-driven strategies are to their adoption of value-based payments
  3. How models being driven by CMS are also impacting commercial contracts
  4. How some health plans are responding to the value-based payment movement including findings from a study of value-based care payments by Humana
  5. The importance of primary care physicians as critical to transforming the way health care is delivered
  6. The type of technology support needed by health plans and providers

The move to value-based reimbursement is inevitable, and only those health plans that adapt will be successful in the future. And developing the capabilities to effectively respond to change doesn’t happen overnight.

Reserve your seat today and learn how to get there from here

Thurs, March 22, 2018 | 11:00am PT / 2:00pm ET Healthcare Executive Leadership Forum at Guidewell Innovation Center

Learn About Value-Based Payments from Industry Thought Leaders

Presenter – Harry Merkin

Vice President of Marketing, HealthEdge

Harry Merkin has worked with both payers and providers through many dynamic changes in healthcare for a number of years. He is currently responsible for Marketing at HealthEdge, including product marketing, demand generation and thought leadership. He previously had similar responsibilities at Evariant and NaviNet and has collaborated with many transformative entities across the healthcare landscape. Harry has helped introduce and promote innovative enterprise software solutions that enable payers to improve their competitive effectiveness, as well as perform valuable communications between payers and providers, and allow providers to effectively collaborate with patients and consumers as well as with each other

Co-Presenter – Dave Mika

Vice President, Enterprise Core System Operations, Independent Health

Dave Mika plays an integral role in leading the operations unit at Independent Health, located in Buffalo, NY. He is responsible for the coordination of activities across the organization to more effectively manage workloads and partner closely with individual business unit owners to achieve operational excellence. A former Army Reserve combat medic and Licensed Practical Nurse with more than 30 years of experience in the health insurance industry, Mika has also held management positions in member appeals, provider relations, project management and product development and implementation.

HCEG Members and Sponsor Partners at the HIMSS Conference in Las Vegas!

By | HCEG Top 10, HIMSS18, Population Health, Social Determinants of Health, Value-Based Payment | No Comments

The behemoth of all healthcare conferences started today: the 2018 HIMSS Conference & Exhibition.  Few healthcare conferences garner the attention of healthcare industry executives and professionals as the annual HIMSS Conference and Exhibition. And HealthCare Executive Group (HCEG) members, sponsor partners and advisors are among the approximate 45,000 healthcare professionals descending upon Las Vegas this week to network with others, attend sessions addressing topics of interest, cut through the clutter and and jockey for position among 10’s of 1000’s of others in the cavernous exhibit halls of the HIMSS conference.

How Big is the HIMSS Conference?

To get an idea about the sheer size of the HIMSS Conference & Exhibition, consider the following statistics provided by HIMSS:

  • Number of Attendees: Approximately 45,000 people – equal to a capacity crowd during a Cubs game at Wrigley Field
  • Geography: attendees from 40 countries will be represented.
  • Exhibitors: About 1300+ vendors – most all of them flush with shiny handouts and branded tchotchke battle each other for the attention, contact information and budget of the attendees from around the globe.
  • Carpet: More than 10 miles of carpet cover the aisles of the exhibit hall
  • Connectivity: About 18 miles of cabling provide internet connectivity throughout the convention center.

HCEG’s Top 10 Mirror Popular HIMSS Themes

Historically, industry executives, media, thought leaders, speakers, influencers and brands predict major HIMSS conference themes in the months and weeks leading up to the conference. Not surprisingly, this year’s major themes closing align with the opportunities, challenges and issues ranked by HCEG’s members in the 2018 HCEG Top 10. These include the following:

Advanced Analytics (Ranked #1 on HCEG Top 10 List)

Clinical, operational and financial processes supported by ever-improving artificial intelligence, machine learning and natural language processing applications have been identified by many as a primary way to make everyone more proactive to improve outcomes and lower costs. And the importance of non-traditional data sources such as social determinants of health, consumer-generated data and data purchased from 3rd parties provide tangible cost savings, time savings and quality of care improvements.

Value-based Payment & Care (#3)

In spite of recent pullback by CMS on bundled payment initiatives and some delays in implementing certain regulations regarding value-based payment programs, information, products and services aimed at accommodating our aging population and increasing levels of chronic conditions are legion in the sessions, exhibit booths and hallway conversations at HIMSS.

Population Health Programs & Services (#2)

Results from the 8th Annual Industry Pulse report, based on the HCEG Top 10, make it is clear that the industry can’t get to value-based payment (VBP) without significantly enhanced clinical data, analytics and agreed upon measures.  And VBP won’t succeed unless there is more focus on bringing communities together to change behaviors and how we think about approaching population health.

Sorting through all the overlapping platforms, data trends, and tools needed to complement the care team and provide patients with optimal outcomes at the lowest cost are no easy feat. Attendees exploring the exhibit hall in search of achieving efficient implementations, streamlined operations, scaled delivery across large markets have their work cut out for themselves this week.

Engaging Healthcare Consumers & Patients (#10)

Whether you agree or not, healthcare services and products are moving from a B2B to a B2C and B2B2C delivery model.

Recent announcements from non-traditional healthcare market participants like the Amazon-Berkshire Hathaway-JP Morgan Chase partnership and the CVS- Aetna merger make it clear that massive change in the traditional healthcare market – lead by the digitization of everything – is imminent. Duplicating the consumer engagement models these new healthcare market entrants have proven in other industries and markets makes it apparent that significant cultural and organizational changes are required to adapt to the digital transformation sweeping the healthcare industry.

Popular Hashtags At the 2018 HIMSS Conference

You can zero in on popular HIMSS-related themes using the following hashtags:

#patientengagement – Being used over 80% more this year in comparison to last year

#AI and its variants #artificialintelligence, #machinelearning and #bigdata

#VR, #AR and #IoT are trending upwards of 100-200% over last years conference

#Aim2Innovate, #TransformHIT, and #EmpowerHIT

Check out this eBook from HIMSS on some of the innovation that will be on display at this year’s conference.

HCEG Sponsor Partners at HIMSS

If you’re at the HIMSS Conference, be sure to check out our sponsor partners exhibits, sessions and special events are hosting. Here are those we know about at this time. We’ll share more as they become known.

Instamed

Visit Booth 5062 to get some water, soft pretzels, Tastykakes and learn more about Instamed’s offerings.

Also, on Tuesday, March 6, 2018 at 7:30pm, InstaMed is also hosting a reception at TAO in The Grand Canal Shoppes of the Venetian Hotel & Casino. See here for more info.

Cumberland Consulting Group

Cumberland Consulting Group is hosting a happy hour on Wednesday, March 7 at 4:00-7:00pm at the Public House in Grand Canal Shoppes at the Venetian. For more information, contact Brigid Turrittin.

Change Healthcare

Visit booth 4202 to meet with Change Healthcare – a HIMSS featured exhibitor.

On Tuesday, March 6th at 9:30, Change Healthcare, Intel and other vendor will present “Blockchain Reset – Seeing Through the Hype and Starting Down the Path.” Location is Sands Hall G Booth 11955ET.

Special ‘HIMSS18-edition’ eNewsletter

Keep your eyes peeled for more information, insight and ideas that HCEG members, sponsor partners and advisors will be gathering from Las Vegas this week. A special ‘HIMSS18-edition’ eNewsletter will be shared later this week including major takeaways, insights from conference thought leaders and some pictures capturing the event. If you aren’t already a subscriber to our newsletter, you can sign up here.

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

By | Top 10, Value-Based Care, Value-Based Payment, Webinar Series | One Comment

Last week we kicked off the first entry in the Health Care Executive Group’s 2018 Webinar Series: The 2018 HCEG Top 10 – Healthcare Opportunities, Challenges & Issues. The new board chair of HCEG, Kim Sinclair, CIO at Boston Medical Center Health Plan, moderated the webinar and was joined by Ferris Taylor, HCEG’s Executive Director and Consultant to Arches Health Plan and David Gallegos, Sr VP of Consulting Services at Change Healthcare,  one of HCEG’s long-time sponsor partners.

This blog post provides an overview of webinar highlights of the discussion between Kim, Ferris and David, their responses to attendee questions and some additional information to be shared in a future blog post. The webinar presentation materials and a recording of webinar can be found here.

Note: Verbatim responses are included in quotations and paraphrased responses are not quoted.

Topic #1: Most Interesting Items on 2018 HCEG Top 10 List

Kim asked David and Ferris which three items on the 2018 HCEG Top Ten list three areas were of most interest?

David:

“Of course, they’re all very interesting to me. It’s been a very much a part of my life for the past few years being involved in Healthcare Executive Group and obviously being part of the industry. But really, I think the top three on the list are the top three for a reason. I look at these as the three pillars of value-based care.”

“Any value-based program needs to ensure that it’s that it’s a win-win-win for the payer, for the provider and for the member, in order for it to be sustainable. So, in order for it to be a win-win-win, you really need these three pillars. You need alignment and financial incentives. You need to have strong payer provider integration, or cooperation really, to create a true partnership between the caregiver and the payer. But you also need to have the provider and the payer partner on fundamentally changing the way care is delivered.”

Ferris:

“I don’t think we should minimize the topic of costs in healthcare and that probably shows up in the Top Ten most significantly around Cost Transparency (Item #4). A lot of that discussion in the recent months has been around Addressing Pharmacy Costs (item #9) but it’s not exclusive to that.”

“But here in the HCEG Top Ten is also cyber security (Item #6) and it’s interesting to me that it – like the clinical data and analytics (Item #1) you mentioned David – cuts across almost all of the issues. If we can’t assure the consumer of some sort of privacy around their data and some security, then we have an issue. Cybersecurity was not on the HCEG Top Ten list for many years going back. Three or four years ago it came up to the top of the list.

My top three would also have to include that bigger bucket of consumerism. It’s on the list as Total Consumer Health (Item #5) and Harnessing Mobile Health Technologies (Item #8). And also, The Engaged Digital Health Consumer (Item #10).

“We are in a major transformation of healthcare from the consumer to the buyer being the employer to the consumer. So, I would add those three Kim to the list that David has pointed out.

Keeping Track of David’s & Ferris’s Top 3 Top 10 Picks?

David Gallego’s Top 3 Picks Ferris Taylor’s Top 3 Picks
#1 – Clinical and Data Analytics #5 – Total Consumer Health
#2 – Population Health Services Organizations #8 – Harnessing Mobile Health Technology
#3 – Value-Based Payments #10 – The Engaged Digital Consumer

Topic #2: Healthcare Consumerism

Kim asked Ferris and David to give their perspective on consumerism and what they’re seeing in the industry absolutely?

David:

“So fundamentally, I think consumerism is about giving people what they want. So, at a high level that means affordable, accessible high-quality care that improves their overall quality of life. That’s simplistic in some ways but I think everyone could agree that’s what people want of health care. You must look at a more granular level as to what consumers want and need as they can vary significantly. And then, so from that perspective, consumerism really needs to be about customization.”

Customized care means the right service and/or right content is delivered at the right time, at the right place and by the right caregiver.

  1. It’s about 24-hour access to care.
  2. It’s about multi-channel access to information and services.
  3. It’s about providing relevant content to current or predicted life events.
  4. It’s about customized care plans to take individual patient specific conditions, genomic, social determinants all into consideration.
  5. It’s about empowering and enabling the consumers so they have the right amount of information to make the right decisions for their health, cost, and quality etc.

Ferris:

“There’s a lot of dimensions of the cost equation, of the price equations that our health care consumers, our members, and our patients just don’t understand. It isn’t consistent with what they experience in the other aspects of their life and I think that takes me to the consumer discussion. And that’s clearly one of my top three.”

“But we are in a major transformation of healthcare from the employer being the buyer to the consumer being the buyer. In December, the American Health Insurance Plans (AHIP) association had an entire three-day conference on consumer experience and digital health. In a nutshell, it really stuck in my mind that as health plans, providers and technology vendors really need to stop thinking like health plans, providers and technology vendors; and start thinking like consumers. People don’t look at healthcare as the only thing in their lives.”

“It’s our responsibility as healthcare stakeholders to find a way that our healthcare messages and our healthcare initiatives can fit into the life flow of our members and our patients; and that of their families, their work, their community and what we need to weave into our initiatives the day to day things that we know, if consumers did them.”

Analogy About Healthcare Spending by David Gallegos

David shared an interesting, very accurate and rather amusing analogy about healthcare spending. “$16 Worth of Groceries for $10!”

Topics Addressed in Next Post: Cybersecurity & Rising Pharmacy Costs

The above represents just a small portion of what Kim, Ferris and David discussed in the first half of the webinar. For more insight on any particular area of interest, you can watch the webinar recording and/or read the transcript here.

In a following post, highlights from the second half will be shared. These include responses to the following two topics posed by Kim Sinclair to Ferris Taylor and David Gallegos:

How are you seeing cyber security and cyber threats impact healthcare organizations beyond the tactical day-to-day front prevention activities?

What are your thoughts about what we as healthcare leaders can do about rising pharmacy costs?

Connect with the HealthCare Executive Group

If you want to learn more about healthcare in the United States and connect with like minded thought-leaders, consider subscribing to our eNewsletter, follow us on Twitter, and connect with us on LinkedIn and Facebook. Better yet, join our unique organization of healthcare executives and thought leaders.

Population Health, Value-Based Care, & The Engaged Digital Consumer – An Executive Leadership RoundTable

By | AHIP, analytics, Executive Leadership Roundtable, HCEG Top 10, Nashville, Population Health, Social Determinants of Health, Value-Based Care, Value-Based Payment | No Comments

On the 2018 HCEG Top 10 list, Clinical and Data Analytics, Value-based Payments and The Engaged Digital Consumer were ranked #1, #3 and #10 respectively by health plan, health system and healthcare provider executives who participated in identifying and ranking the 2018 HCEG Top 10. It seems fair to say that these three topics are front and center on the mind of executives and thought leaders in the healthcare industry.

Leverage Your AHIP Event & Nashville Connection

If you’re attending AHIP’s 2017 Consumer Experience & Digital Health Forum in Nashville or if you’re a healthcare leader in Nashville the afternoon of Thursday, December 7th, consider joining other healthcare executives and thought leaders at our Executive Leadership Roundtable. A panel of prominent healthcare leaders will meet at Nashville’s Center for Medical Interoperability at 1:00pm CT to accelerate the seamless exchange of information to improve healthcare for all by exploring emerging and high-priority healthcare opportunities at the intersection of population health, value based care, and the engaged digital consumer.

Join Healthcare Leaders & Forum Attendees in a Boardroom-like Setting

HCEG Executive Leadership Roundtable events are held in an intimate, informal and free-flowing setting where the free exchange of ideas, questions and comments are encouraged. This roundtable event will be moderated by Dr. David Diloreto with three distinguished panelists sharing their unique perspective and insight:

Dr. David Diloreto Ben Leedle Ferris Taylor David Gallegos
Senior VP of Healthcare-Population Health at General Electric President & CEO at Blue Zones and former President & CEO of Healthways HCEG Board Chair and COO/Consultant at Arches Health Plan Senior VP of Consulting Services at Change Healthcare

Timely Topics for Healthcare Leaders

A timely and valuable set of topics – with a special focus on Social Determinants and Clinical Data Impacting Population Health – are planned for panelists and attendees:

  • Innovative strategies health plans, health systems and provider organizations are using to reduce downstream spending while improving overall health outcomes by addressing social determinants of health.
  • How state-of-the-art data and technologies and opening new opportunities to move consumer health forward.
  • Opportunities to work with community leaders to identify the factors having the most influence on individual health and quality of life.
  • Considerations for tailoring specific approaches and investment to address the needs of health plan members and healthcare patients in their communities.
  • How ground-level community stakeholders can guide health plans and health systems to where funding creates the most effective SDOH improvements.

Extend the Value of Your AHIP Consumer Experience & Digital Health Forum Attendance

In addition to the value described above, this Executive Leadership Roundtable event will include a tour of the Center for Medical Interoperability, lunch and the opportunity for professional networking with roundtable panelists and participants. The Center for Medical Interoperability is a ten-minute ride from the AHIP Consumer Experience & Digital Health Forum being held at the Music City Center in Nashville, TN.

Reserve Your Seat Today!

Attendance at the roundtable is free for current and former HCEG members, attendees of the AHIP Consumer Experience & Digital Health Forum and local healthcare executives.  If you have any questions, please contact us.

Healthcare Executive Leadership Forum at Guidewell Innovation Center