If analytics is the machine powering your digital transformation initiatives, then data is the power making that digital transformation machine run. The importance of data and analytics has been identified by our members in each of the last ten years HCEG’s Top 10 list of challenges, issues, and opportunities have been created. For 2019, “Data & Analytics” is ranked #1 on the HCEG Top 10. It’s clear that healthcare leaders believe that data is a catalyst to accelerate meaningful change. And that the use of analytics – particularly prescriptive analytics – is a fundamental strategy for succeeding in a new era of healthcare.
Mountains of Data Waiting to Power Your Healthcare Analytics Machine
Good analytics begins with good data and healthcare organizations are sitting on a mountain of data. According to America’s Health Insurance Plans (AHIP), the typical regional payer processes $8 billion in claims each year with each claim providing its own set of unique data points – largely financial and administrative. But healthcare payers are increasingly collecting, matching, and using clinical data to provide richer, more comprehensive insight on their members.
Given the proliferation of Electronic Health Records (EHR) incented by CMS’s Meaningful Use program, it’s no surprise that more and more data is being pulled from EHR’s. And risk-sharing agreements between payers and providers has resulted in health plans sharing more claims data with their provider partners. In fact, the current Industry Pulse report indicates that EHR data is one of the top two primary sources of clinical data with 30% of health plans reporting they utilize EHR data.
Other sources of clinical data that organizations are using to complement their claims data include ancillary data such as pharmacy, lab, and imaging (17%) and real-time admission, discharge, and transfer notifications (10%)
These enhanced data sources are becoming more and more useful due to the power of artificial intelligence (AI) and machine learning.
New research from Dimensional Insight identifies care quality measures and finance as two top use cases for healthcare organization usage of analytics today. Additional use cases for leveraging data by analytics include
Addressing Social Determinants of Health (#3 on the 2019 HCEG Top 10)
Value-based Care and Alternative Payment Models (#4 on the 2019 HCEG Top 10)
Improving Patient Engagement and Satisfaction
Patient Outcomes Improvement
Analytics Budgets are Increasing for Healthcare Organizations
According to a recent report from the Society of Actuaries, greater than 60 percent of payers and providers are planning to increase their analytics budgets by 15% or more.
Additionally, the report finds that 89% of healthcare executives plan to use predictive analytics over the next five years. It’s clear that healthcare payers and health systems have a keen focus on leveraging the massive amounts of data they possess. These data serve to reveal trends, patterns, and insights to help ensure their success going forward.
Solving the Rubik’s Cube of Payer Data
i.e. Lining Up All Your Data to Rapidly and Accurately Gain Unique Insights
For insight into how your healthcare organization’s data can be used to improve health outcomes and reduce costs, join our next Webinar Series Event on June 6th at 2:00 PM EDT / 11:00 AM PDT. Our sponsor partner eQHealth Solutions presents “Solving the Rubik’s Cube of Payer Data.”In this complimentary webinar, you will learn how to aggregate and parse provider data, how you can use data captured outside of your own system, and other practical solutions to use your data to create knowledge for actionable use and outcomes. Attendees will have a chance to ask questions and all registrants will receive a copy of the presentation afterward.
The HealthCare Executive Group (HCEG) is a professional association chartered to convene and support executive leaders of health plans, health systems, and provider organizations. Since the HealthCare Executive Group’sinception over 30 years ago, HCEG has offered membership to organizations providing direct insurance benefits and/or direct health services to groups or individuals, either as stand-alone entities or as subsidiaries under a commercial entity. Anoffid starting today, we’re announcing two new individual membership options for healthcare executives and leaders: Individual Membership and Alumni Membership. HCEG is retaining the existing Organizational Membership option for healthcare organizations preferring that option.
New Membership Options in HealthCare Executive Group
These two new membership options provide a pathway for more people to become part of the HealthCare Executive Group on a cost-efficient basis.
Individual Membership
Alumni Membership
Candidates are executives from Payer/Provider Membership eligible organizations.
Past HCEG members who are unaffiliated with vendor organizations. Vendors provide products and services to HCEG member candidate organizations to better serve individuals.
For a very reasonable investment, healthcare executives and others leading the transformation of the healthcare industry can obtain benefits that can provide outsized returns on that small investment – only $99 dollars for a limited time!
Why Healthcare Leaders Should Join the HealthCare Executive Group
Individual Membership and Alumni Membership offer a variety of benefits all year round: Professional Networking & Relationships, In-Person/Live Events, Professional Development Opportunities, Resources, Research & News, and discounts to popular healthcare conferences.
Throughout the year, members can leverage HCEG’s platform, content, events, professional development, and networking opportunities to help them optimize their time, stay up to date on industry issues, enhance leadership skills, and obtain valuable resources to share with their staff and help transform their healthcare organization.
Professional Networking & Relationships for Healthcare Executives
Our members have unparalleled, year-round networking opportunities centered upon a calendar of events and content identified and defined by HCEG members and updated throughout the year via input and research from members and sponsor partners. Our mission and focus are to provide the platform, channels, content and on-going support for convening and connecting our members with their peers, industry thought leaders, and other resources critical to the transformation of the healthcare industry.
In-Person/Live Events for Healthcare Leaders Transforming Healthcare
HCEG offers its members various opportunities to connect with peers and other industry leaders in live, face-to-face venues throughout the year. These events are typically free to HCEG members or are discounted based on HCEG membership.
Executive Leadership Roundtables
Our quarterly Executive Leadership Roundtables(ELR) are bundled with popular healthcare conferences like the AHIP Institute and HLTH Forum. These ELR’s are intimate, participatory opportunities to learn from prominent industry thought-leaders, share ideas and obtain advice and real-world experience from others.
HCEG Annual Forum
As an Individual Member or Alumni Member, you’ll receive discounted registration to our Annual Forum held in September of each year. Our Annual Forum is our marquee event and includes not only prominent keynote speakers but also unique extracurricular networking opportunities. Check out thisrecap of the 2018 Annual Forumcelebrating HCEG’s 30-Year Anniversary.
Individual & Alumni Member Discount to 2019 Annual Forum
After registering as an Individual Member or an Alumni Member and paying the membership fee, new members receive a discount code (via pop-up window and email) to HCEG’s 2019 Annual Forum. This code can be used immediately or at a future date.
Also, and you’re hearing this for the first time here, HCEG members attending our 2019 Annual Forum in Boston, MA on September 9th through 11th will enjoy a very unique, uncommon extracurricular networking event. For more information on what this event includes, contact us.
Thought-Leadership & Professional Development Opportunities for Healthcare Executives
In addition to quarterly ELR’s, our Annual Forum, and partner events, HCEG also offers our members various opportunities for participating in webinars, research surveys, blog posts, and other knowledge sharing channels.
Webinars & Online Discussion Group Opportunities for Healthcare Executives
In addition to attending HCEG’s monthly Webinar-Series events, HCEG members have the opportunity to help define webinars and serve as panelists. In addition, HCEG hosts period online discussions and encourages member participation as an important way for members to demonstrate their thought leadership and grow their network.
Research Surveys for Healthcare Executives & Thought-Leaders
HCEG Top 10 List
Members participate in defining and ranking the HCEG Top 10 List of Challenges, Issues, & Opportunities during HCEG’s Annual Forum. HCEG members, staff and partners then expound on this list and it serves as the basis for content programming going forward.
Industry Pulse
The Industry Pulse research survey is based on the HCEG Top 10 and administered in a partnership between HCEG and sponsor partner Change Healthcare. The 9th Annual Industry Pulse was just released last week and promises to be a source of many reviews, discussion, and elaboration over the coming months and year.
Knowledge Creation, Content Sharing & Promotion for Healthcare Executives
Our members enjoy the opportunity to share information, insight, and ideas with each other and the industry at large via various HCEG channels including our blog, bi-weekly eNewsletter, and social channels. In addition, HCEG promotes certain member insight and content to amplify member content on best practices, new ideas, breaking news, and key advancements.
Become a HealthCare Executive Group Member Today
As uncertainty continues its grip on healthcare in the United States and new digital technologies advance digital transformation opportunities, it’s more important than ever for healthcare leaders to stay abreast of important industry trends, challenges, and opportunities.
Value Well Beyond Conferences, Webinars, & Content
Individual membership in the HealthCare Executive Group is a very cost-effective way for healthcare leaders to reduce uncertainty, stay up to date on changes within their field, and help to transform their organizations.
Special Discount on HCEG Individual Membership
As an additional incentive to join HCEG as an individual, we’re offering a $50 discount off the regular $149 per year rate for a limited time. Use KickoffPromo to expand your knowledge and grow your professional network for only $99!
The trend toward Healthcare Consumerism & Digital Health products and services is driving what healthcare providers, health systems and health plans are offering – or are planning to offer – individuals participating in the U.S. healthcare market. Whether covered by employer-subsidized insurance, government programs like Medicaid or Medicare, the individual commercial market, any other type of coverage or even not covered and paying for your healthcare with cash, healthcare consumerism and leveraging digital health products and services to decrease costs and improve outcomes are two important movements that can’t be ignored.
‘Indeed, Total Consumer Health and The Digital Healthcare Organization are both ranked in the top five items on the 2019 HCEG Top 10 list of challenges, issues, and opportunities:
#2: Total Consumer Health: Improving members’ overall medical, social, financial, and environmental well-being.
#5: The Digital Healthcare Organization: Health Savings Accounts, member and provider portals, member and patient health literacy, cost transparency, digital payment capabilities, CRM, wearables and other patient-generated data, health monitoring, and omnichannel information distribution and transaction access.
“Healthcare Consumer-centric companies accounted for 60 percent of the funding in Q3 2018, raising $1.9 billion in 111 deals compared to $1.7 billion in 138 deals in Q2 2018”
The HCEG Top 10 Challenges, Issues & Opportunities Over the Years
Over the 10 year period in which the HCEG Top 10 list has been published, ‘Healthcare Consumerism’ or a closely aligned similar category has been ranked on the HCEG Top 10 list a total of eight times. And ‘Digital Health’ has also ranked among the HCEG Top 10 challenges, issues and opportunities eight times. Only ‘Payment Reform’ and ‘Big Data & Analytics’ have been listed on the annual HCEG Top 10 list more frequently.
It should be no surprise to most people that healthcare consumerism has long been a top challenge, issue, or opportunity for healthcare organizations of all types. The rise of several factors have been identified by industry experts and trade media as the primary reasons for the growth if consumerism in the healthcare industry:
High-Deductible Health Plans
Employers Shifting Costs from to Employees
Rapidly Increasing Healthcare Costs
And while traditionally a laggard in the adoption of digital technologies, healthcare organizations are not immune to the need to digitally transform themselves. Ignoring the need to adopt digital health technologies can only result in serious disruption, or even extinction, of healthcare organizations both large and small.
Comments on Healthcare Consumerism & Digital Health from HCEG Top 10 Survey Respondents
The executives and industry thought leaders participating in defining the 2019 HCEG Top 10 list at our recent 2018 Annual Forum in Minneapolis, MN included notes and commentary on the specific challenges, issues, and opportunities listed in the survey worksheet. The following are some of those comments related to healthcare consumerism and digital health:
“Data & Analytics (ranked #1) are table stakes to any consumer-focused products and services. And foundational to all Digital Health initiatives.”
“Population Health (ranked #3) could be considered ‘Total Consumer Health’”
Note: A number of participants expressed opinions that “Population Health” and “Total Consumer Health” could be considered the same thing. After some discussion, everyone agreed that Population Health should be considered as population-centric as opposed to person-centered.
“Social determinants of health have a huge impact on health outcome but as a health system we lack the ability to control/impact these barriers.”
“Connecting with our members on a frequent basis is very challenging. We struggle with identifying and delivering the right message at the right time.”
“Different departments have their own goals and objectives and these often create a disjointed member experience.”
“We must move from deploying largely unconnected tactical approaches to a more holistic, coordinated customer experience strategy.”
“It’s not always clear to us what matters to individual patients and how we can measure those things.”
How to Learn More About Healthcare Consumerism & Digital Health
The HCEG Top 10 list drives the content HCEG creates and delivers to its members and associates via blog posts like this, our Webinar Series Events and our Executive Leadership Forums. Accordingly, we’re pleased to share several complimentary opportunities to learn more about opportunities for healthcare organizations to meet the needs of increasingly educated and proactive healthcare consumers AND how specific digital health products and services are supporting the creation, delivery, and consumption of medical and non-medical services and products that improve health outcomes.
Webinar Series Event: The New Engaged Digital Consumer
What Digital Healthcare Organizations Must Do to Survive and Thrive
On Thursday, November 15th, 2018 at 2:00 pm ET, our sponsor partner HealthEdge will present a webinar that provides information from recent market studies and specific examples illustrating how engaged digital consumers regard the services provided by health insurers.
Attendees will learn:
The top organizational priorities health insurance executives are currently facing
Key challenges and solutions that enable health insurers to address these organizational priorities
The most important expectations that members have of their health insurer
How trust levels between members and health insurance organizations are being addressed by new disruptive entities entering healthcare
If you can’t make it, go ahead and register and we’ll send you the recording and slides after the event!
AHIP-ELR: Total Consumer Health & The Digital Healthcare Organization
On Thursday, December 13th, 2018 at 1:00 pm CT/2:00 pm ET, we’re hosting a special Executive Leadership Roundtable immediately after the 2018 AHIP Consumer Experience & Digital Health Forum convenes at the Music City Center in Nashville, TN. Lunch will be provided at no charge and the following topics will be presented and discussed by several healthcare industry leaders:
How competition from new entrants, cost containment pressures associated with value-based care programs, health/entitlement reforms, and technological innovations may impact ‘healthcare consumerism’
Approaches for turning passive health plan members and health system patients into active healthcare consumers
Catalysts for healthcare consumerism change: employer groups demanding better value and trend of health plan members and individuals directly engaging with plans and providers
How value-based relationships demand that healthcare organizations engage with their members and patients
Which tools and services healthcare organization can use to enhance member/patient engagement
Our executive leadership roundtable event is complimentary but registration is required (so we can make sure everyone gets lunch).
Also, you can receive a discount off registration to the 2018 AHIP Consumer Experience & Digital Health Forum by using “HCEG” when you register here.
Become an HCEG eNewsletter Subscriber
If you’re not already on our list, consider joining 2500+ other healthcare executives, industry thought leaders and other participants by subscribing to our eNewsletter. You’ll receive ongoing information on strategic and tactical challenges, issues, and opportunities facing the United States healthcare industry.
More Insight on the 2019 HCEG Top 10 Items Coming Soon!
As 2018 winds down and 2019 takes off, the HealthCare Executive Group will continue to create, curate and promote content and events addressing each of the items on our 2019 HCEG Top 10 list. We’ll be presenting numerous webinars, hosting Executive Leadership Roundtables in conjunction with popular healthcare conference events, and – of course – holding our popular Annual Forum. The 31st HCEG Annual Forum will take place in Boston, MA in September 2019. Stay tuned for more information!
Consider joining our unique organization of healthcare executives and thought leaders today. See this page for more information and/or reach out to us here.
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.
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
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.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.
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:
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.
Harry Merkin, VP of Marketing at HealthEdge and Dave Mika VP of Enterprise Core System Operations at Independent Health shared insight and real world experience on how health plans and their provider networks can transition from traditional fee for service (FFS) to value-based payment (VBP).
This blog post recaps highlights of the webinar and provides access to additional information from the webinar. A recording of the webinar can be found here. You can also check out this Twitter Moment summarizing live Tweets from the webinar.
Value-Based Payment Began in the Late 1990’s
In the late 1990’s, capitation models began paving the way for change from traditional FFS payment models to models focused on helping establish effective, cost-efficient practice models. In the last few years, value-based payments have become the latest and greatest models for reimbursement of care. The importance of value-based payments is supported by HealthCare Executive Group members ranking Value-Based Payment as #3 on the 2018 HCEG Top 10 list.
Moreover, recent statements by current and former HHS officials have supported the need for value-based payment:
“There is no turning back to an unsustainable system that pays for procedures rather than value”, and the transition “needs to accelerate dramatically.” – Alex Azar, Secretary of HHS, 3/5/18 at the Federation of American Hospitals’ conference
“I highly encourage health care leaders to listen intently to his full remarks. The transition to value is moving forward; if you aren’t already preparing for it, it is time to get on-board.“ – Michael Levitt, former governor of Utah and former HHS Secretary
Value-Based Payment Can Lower Costs and Improve Outcomes
Harry Merkin shared the results of a November 2017 Humana study showing that VBP programs achieve meaningful gains in cost and quality vs. traditional FFS methods with total healthcare costs associated with VBC plans 15% lower than care costs of FFS plans. And a more recent survey by the Healthcare Financial Management Association revealed that 70% of healthcare organizations participating in VBP programs have achieved positive results.
Value-based Payment Must Address the Quadruple Aim
Independent Health’s Dave Mika shared real-world insight into the experience his organization has witnessed. A key focus raised by Dave is that health plans looking to implement or extend value-based payment programs must address the four pillars of the Quadruple Aim:
Enhancing patient experience
Improving population health
Reducing costs
Improving the work life of health care providers
Questions from Webinar Participants About Value-Based Payment
HCEG webinar series events always include the opportunity for questions from participants and this webinar was no exception. Two of many questions included the following short, paraphrased responses by Dave Mika – and other questions can be obtained from the webinar recording:
What is the key to gaining alignment with PCP’s?
Answer: Actively reaching out to and collaborating with key stakeholders in the local community.
What data has proven to be most useful to the provider network?
Answer: Information on patient gaps in care– ideally provided at the point of care in the physician’s workflow – can be very effective in improving value.
And More on How to Get There from Here…
In addition to the above, the webinar addressed the following considerations for transitioning from traditional FFS programs to VBP programs:
Aligning delivery and reimbursement models with high-performing providers
Tools for members to self-manage and self-navigate the care delivery system
Technology support including web and digital capabilities
The move to value-based reimbursement appears inevitable, and only those health plans and providers that begin to transition and adapt today will be successful in the future. Change doesn’t happen overnight. To learn more about how making the transition from FFS to VBP, check out the webinar recording, consider contacting HealthEdge for more information and keep in touch with the HealthCare Executive Group by connecting with us on Twitter, Facebook, LinkedIn and subscribing to our newsletter.
The theme of last month’s HCEG Webinar Series event was The 2018 HCEG Top 10 – Healthcare Opportunities, Challenges & Issues. In a previous post, highlights of the following two topics that were discussed by moderator Kim Sinclair, HCEG board chair and CIO at Boston Medical Center Health Plan, and panelists Ferris Taylor, HCEG’s Executive Director and Consultant to Arches Health Plan and David Gallegos, Sr VP of Consulting Services at Change Healthcare, were reviewed:
Which three items on the 2018 HCEG Top Ten list three areas were of most interest?
What’s the state of healthcare consumerism and what’s being seen in the industry?
This second post recaps highlights from the second half of the webinar where the topics of Cybersecurity (Ranked #6 on the 2018 HCEG Top 10) and Addressing Pharmacy Costs (Ranked #9) were discussed. The webinar presentation materials and a recording of webinar can be found here.
Cybersecurity – 2018 HCEG Top Ten Item #6
Topic #3: How are you seeing cyber security and cyber threats impact healthcare organizations beyond the tactical day-to-day prevention activities?
Ferris Taylor:“I think it’s (cybersecurity) fundamental that we need to innovate and improve cybersecurity in all of our healthcare processes. That really means giving people a confidence that their personal information won’t be used in ways that a person doesn’t want it to be used. So, it ties back to consumerism.”
Real World Impact of Medical Identity Theft
“Here in Utah, about three years ago, there was a baby born in the hospital that was heroin addicted. And of course, the Department of Social Services immediately went to the home and removed the three other children from that home. The fundamental problem was that the mother of that heroin baby was not the mother in that home. And it took that mother three months to get her children back. It was a case of medical identity theft where the baby was born. The real mother checked out. We can understand the personal impact that that lack of security around medical information caused for that family.”
David Gallegos: “The world has gotten a lot smaller and technology a lot more complex over the past decade. And clearly cyber terrorism is a big part and a growing concern that every organization needs to take seriously. But you need to keep in mind that the safest computer is one that’s turned off and unplugged. And clearly that’s not very useful.”
“We need to balance both security and usability and the sharing of clinical information. It’s going to be critical to our care model redesigns and our clinical collaboration. This data is also going to be important for us to leverage artificial intelligence and, to help us determine optimal courses of treatment. In some cases, this information is even going to be needed to help really define how whole populations are treated.”
Addressing Pharmacy Costs – 2018 HCEG Top Ten Item #9
Kim Sinclair shared that pharmacy costs continue to rise and is a topic constantly in the news, noting that non-profit hospitals have stated intent of joining together to form their own pharmacy organizations.
Topic #4: What are your thoughts about what healthcare leaders can do about rising pharmacy costs?
Ferris Taylor: “I saw some statistics on pharmacy costs that struck me to the heart. It was from the Health Care Cost Institute over the last four years. It was actually 2012 to 2016 and the cost of prescriptions in the marketplace had gone up by 25%. But the utilization of prescriptions had only gone up by 1.8%. And it wasn’t just pharmacy costs. Emergency Room prices have gone up by 30% and visits went up by 2%.”
Free-Market Economy and Governance
“So, I think, once again, we haven’t transitioned from the buyer being the employer to the consumer becoming more and more important in that purchasing decision. As we discuss pharmacy costs, the other thing that I think we need to recognize is that we have a free-market economy. But industries have responsibilities to govern themselves. And I know some of the bad players in the pharmacy industry are outside of the Pharmacy Association. So, it’s hard to regulate them. But I use those key issues as the things to help us start to address the pharmacy costs”
David Gallegos on the State We’re in with Pharmacy Costs
“What I look at the state we’re in with pharmacy costs. To me it’s entirely self-made. We’ve created these regulations that allow schemes like pay to delay, or evergreening – that’s really pushed generics out further in terms of their development. We create, in a sense, quasi monopolies.”
“We criminalize the ability to negotiate for larger population blocks. I mean it seems ridiculous to me, actually, that drugs that were invented and manufactured here in the United States can often be purchased cheaper outside of our country.”
“Clearly drugs are very important. They reduce admissions that would use other high cost care. And some of them are miracles. They can literally cure diseases – cure the incurable. So, I understand this is not a simple problem. But if a drug cost a million dollars and the person can’t afford it, is it really a miracle?”
“And in any other market, if there was a product that nobody could afford, the supplier would price it differently. And that’s what we have in our market.”
Previous Webinar: Strategies to Address Rising Pharmacy Costs
For more insight on 2018 HCEG Top 10 and the perspective of healthcare executives, check the webinar recording and subscribe to our eNewsletter where we’ll be sharing more information, insight, opinions and ideas of value to healthcare executives and thought leaders. Our newsletter will also share information on future webinars and events like our Executive Leadership Roundtable in Las Vegas this coming May 9th.
Last week we kicked off the first entry in the Health Care Executive Group’s 2018 Webinar Series: The 2018 HCEG Top 10 – Healthcare Opportunities, Challenges & Issues. The new board chair of HCEG, Kim Sinclair, CIO at Boston Medical Center Health Plan, moderated the webinar and was joined by Ferris Taylor, HCEG’s Executive Director and Consultant to Arches Health Plan and David Gallegos, Sr VP of Consulting Services at Change Healthcare, one of HCEG’s long-time sponsor partners.
This blog post provides an overview of webinar highlights of the discussion between Kim, Ferris and David, their responses to attendee questions and some additional information to be shared in a future blog post. The webinar presentation materials and a recording of webinar can be found here.
Note: Verbatim responses are included in quotations and paraphrased responses are not quoted.
Topic #1: Most Interesting Items on 2018 HCEG Top 10 List
Kim asked David and Ferris which three items on the 2018 HCEG Top Ten list three areas were of most interest?
David:
“Of course, they’re all very interesting to me. It’s been a very much a part of my life for the past few years being involved in Healthcare Executive Group and obviously being part of the industry. But really, I think the top three on the list are the top three for a reason. I look at these as the three pillars of value-based care.”
“Any value-based program needs to ensure that it’s that it’s a win-win-win for the payer, for the provider and for the member, in order for it to be sustainable. So, in order for it to be a win-win-win, you really need these three pillars. You need alignment and financial incentives. You need to have strong payer provider integration, or cooperation really, to create a true partnership between the caregiver and the payer. But you also need to have the provider and the payer partner on fundamentally changing the way care is delivered.”
Ferris:
“I don’t think we should minimize the topic of costs in healthcare and that probably shows up in the Top Ten most significantly around Cost Transparency (Item #4). A lot of that discussion in the recent months has been around Addressing Pharmacy Costs (item #9) but it’s not exclusive to that.”
“But here in the HCEG Top Ten is also cyber security (Item #6) and it’s interesting to me that it – like the clinical data and analytics (Item #1) you mentioned David – cuts across almost all of the issues. If we can’t assure the consumer of some sort of privacy around their data and some security, then we have an issue. Cybersecurity was not on the HCEG Top Ten list for many years going back. Three or four years ago it came up to the top of the list.
My top three would also have to include that bigger bucket of consumerism. It’s on the list as Total Consumer Health (Item #5) and Harnessing Mobile Health Technologies (Item #8). And also, The Engaged Digital Health Consumer (Item #10).
“We are in a major transformation of healthcare from the consumer to the buyer being the employer to the consumer. So, I would add those three Kim to the list that David has pointed out.
Keeping Track of David’s & Ferris’s Top 3 Top 10 Picks?
David Gallego’s Top 3 Picks
Ferris Taylor’s Top 3 Picks
#1 – Clinical and Data Analytics
#5 – Total Consumer Health
#2 – Population Health Services Organizations
#8 – Harnessing Mobile Health Technology
#3 – Value-Based Payments
#10 – The Engaged Digital Consumer
Topic #2: Healthcare Consumerism
Kim asked Ferris and David to give their perspective on consumerism and what they’re seeing in the industry absolutely?
David:
“So fundamentally, I think consumerism is about giving people what they want. So, at a high level that means affordable, accessible high-quality care that improves their overall quality of life. That’s simplistic in some ways but I think everyone could agree that’s what people want of health care. You must look at a more granular level as to what consumers want and need as they can vary significantly. And then, so from that perspective, consumerism really needs to be about customization.”
Customized care means the right service and/or right content is delivered at the right time, at the right place and by the right caregiver.
It’s about 24-hour access to care.
It’s about multi-channel access to information and services.
It’s about providing relevant content to current or predicted life events.
It’s about customized care plans to take individual patient specific conditions, genomic, social determinants all into consideration.
It’s about empowering and enabling the consumers so they have the right amount of information to make the right decisions for their health, cost, and quality etc.
Ferris:
“There’s a lot of dimensions of the cost equation, of the price equations that our health care consumers, our members, and our patients just don’t understand. It isn’t consistent with what they experience in the other aspects of their life and I think that takes me to the consumer discussion. And that’s clearly one of my top three.”
“But we are in a major transformation of healthcare from the employer being the buyer to the consumer being the buyer. In December, the American Health Insurance Plans (AHIP) association had an entire three-day conference on consumer experience and digital health. In a nutshell, it really stuck in my mind that as health plans, providers and technology vendors really need to stop thinking like health plans, providers and technology vendors; and start thinking like consumers. People don’t look at healthcare as the only thing in their lives.”
“It’s our responsibility as healthcare stakeholders to find a way that our healthcare messages and our healthcare initiatives can fit into the life flow of our members and our patients; and that of their families, their work, their community and what we need to weave into our initiatives the day to day things that we know, if consumers did them.”
Analogy About Healthcare Spending by David Gallegos
David shared an interesting, very accurate and rather amusing analogy about healthcare spending. “$16 Worth of Groceries for $10!”
Topics Addressed in Next Post: Cybersecurity & Rising Pharmacy Costs
The above represents just a small portion of what Kim, Ferris and David discussed in the first half of the webinar. For more insight on any particular area of interest, you can watch the webinar recording and/or read the transcript here.
In a following post, highlights from the second half will be shared. These include responses to the following two topics posed by Kim Sinclair to Ferris Taylor and David Gallegos:
How are you seeing cyber security and cyber threats impact healthcare organizations beyond the tactical day-to-day front prevention activities?
What are your thoughts about what we as healthcare leaders can do about rising pharmacy costs?
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
Public Safety
Financial Status
After Barbara shared her insight on this currently popular topic, Harry Merkin stated: “The phrase ‘social determinants of health’ is no longer a buzzword!”
Addressing Social Determinants of Health
Barbara shared an overview about First Care’s “Expecting the Best Maternity Program” that combines case management and utilization management to complement care provided by physicians while guiding and supporting members – and their family – through member pregnancies; particularly high-risk pregnancies.
Besides services such as assistance with locating medical providers, toll-free 24/7 access to a clinician and a package of select products and services aimed at supporting pregnant women, the program also includes an innovative “Nurse-Family Partnership” where a First Care nurse is paired with an expecting family to help the patient and her immediate family members understand and manage the pregnancy. First Care nurses regularly reach out to ask questions on how the pregnancy is progressing and answer any questions the patient and family may have.
The program has resulted in a significant per decrease in NICU maternity admissions.
The Recording, The Content and More Insight from HealthEdge
The webinar presented three considerations for payer-provider population health programs:
Be methodical about population assessment
Integrate People, Process and Technology with Providers
Use value-based contracts to align vision of member/patient care
You can learn more about how collaborating with providers and health systems, partnering with community resources and making critical information available to key stakeholders can improve outcomes and lower costs by checking out this recording of the webinar and these few slides from the presentation. If you would like more information or if you have any questions on the content of this webinar, please feel free to contact HealthEdge too.
Payer/Provider Memberships: Candidates are organizations that provide direct insurance benefits (policies, financial, administrative services and other risk-bearing and ASO services) and/or direct health services (medical, dental, vision, etc.) to groups or individuals, either as stand-alone entities or as a subsidiary under a commercial entity.
Individual Membership: Candidates are executives from Payer/Provider Membership eligible organizations.
Alumni Membership: Past HCEG members who are unaffiliated with vendor organizations. Vendors provide products and services to HCEG member candidate organizations to better serve individuals.
For information on becoming an HCEG sponsor partner, see this information and/or contact us.
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%)
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.
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 
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.
