HCEG Top 10

The HCEG Top 10 has been a pillar of the Healthcare Executive Group for over 10 years, providing extensive insight into primary opportunities, challenges and issues currently facing healthcare executives in the United States.

Based on HCEG member input gathered during the month’s leading up to HCEG’s Annual Forum, and ranked during several iterations of voting during the Annual Forum, the HCEG Top 10 encourages continuous and evolving dialog on the main issues and concerns facing member organizations. It also serves as the keystone for industry wide analysis and HCEG’s educational programming throughout the following year. The HCEG Top 10 also provides the framework for an annual research survey: The Industry Pulse.

Developed in partnership with Change Healthcare over the past seven years, the Industry Pulse research survey is used to gather additional, more detailed information on the opportunities, priorities and challenges faced by health plans and health systems across the country.

2020 HCEG Top 10

  1. Costs & Transparency – Implementing strategies and tactics to address growth of medical and pharmaceutical costs and impacts to access and quality of care.
  2. Consumer Experience – Understanding, addressing and assuring that all consumer interactions and outcomes are easy, convenient, timely, streamlined,  and cohesive so that health fits naturally into the “life flow” of every individual’s, family’s and community’s daily activities.
  3. Delivery System Transformation – Operationalizing and scaling coordination and delivery system transformation of medical and non-medical services via partnerships and collaborations between healthcare and community-based organizations to overcome barriers including social determinants of health to effect better outcomes.
  4. Data & Analytics –  Leveraging advanced analytics and new sources of disparate, non-standard, unstructured, highly variable data (history, labs, Rx, sensors, mHealth, IoT, Socioeconomic, geographic, genomic, demographic, lifestyle behaviors) to improve health outcomes, reduce administrative burdens and support transition from volume to value and facilitate individual/provider/payer effectiveness.
  5. Interoperability / Consumer Data Access – Integrating and improving the exchange of member, payer, patient, provider data and workflows to bring value of aggregated data and systems (EHR’s, HIE’s, financial, admin and clinical data, etc) on a near real-time and cost-effective basis to all stakeholders equitably.
  6. Holistic Individual Health – Identifying, addressing and improving the member/patient’s overall medical, lifestyle/behavioral, socioeconomic, cultural, financial, educational, geographic and environmental well-being for a frictionless and connected healthcare experience.
  7. Next Generation Payment Models – Developing and integrating technical and operational infrastructure and programs for a more collaborative and equitable approach to manage costs, sharing risk and enhanced quality outcomes in the transition from volume to value. (bundled payment, episodes of care, shared savings, risk-sharing, etc).
  8. Accessible Points of Care – Telehealth, mHealth, wearables, digital devices, retail clinics, home-based care, micro-hospitals; and acceptance of these and other initiatives moving care closer to home and office.
  9. Healthcare Policy – Dealing with repeal/replace/modification of current healthcare policy, regulations, political uncertainty/antagonism and lack of a disciplined regulatory process. Medicare-for-All, single payer, Medicare/Medicaid buy-in, block grants, surprise billing, provider directories, association health plans, and short-term policies, FHIR standards, and other mandates.
  10. Privacy / Security – Staying ahead of cybersecurity threats on the privacy of consumer and other healthcare information to enhance consumer trust in sharing data. Staying current with changing landscape of federal and state privacy laws.

2019 HCEG Top 10

  1. Data & Analytics: Leveraging data (especially clinical) to manage health and drive individual, provider and payer decisions.
  2. Total Consumer Health: Improving members’ overall medical, social, financial, and environmental well-being.
  3. Population Health Services: Operationalizing community-based health strategy, chronic care management, driving clinical integration, and addressing barriers to health such as social determinants.
  4. Value-based Payments: Transitioning to and targeting specific medical conditions to manage cost and improve quality of care.
  5. The Digital Healthcare Organization: HSAs, portals, patient literacy, cost transparency, digital payments, CRM, wearables and other patient-generated data, health monitoring, and omni-channel access/distribution.
  6. Rising Pharmacy Costs: Implementing strategies to address growth of pharma costs along with benefits to quality of care and to total healthcare costs.
  7. External Market Disruption: New players like Amazon, Chase, Apple, Walmart, and Google.
  8. Operational Effectiveness: Implementing lean quality programs, process efficiency (with new core business models), robotics automation, revenue cycle management, real-time/near-time point of sales transactions, etc.
  9. Opioid Management: Developing strategies for identifying and supporting individuals and populations struggling with substance abuse/addiction or at risk of addiction.
  10. Cybersecurity: Protecting the privacy and security of consumer information to maintain consumer trust in sharing data.

2018 HCEG Top 10

  1. Clinical and Data Analytics:   Leveraging big data with clinical evidence to segment populations, manage health and drive decisions
  2. Population Health Services Organizations: operationalizing population health strategy, chronic care management, driving clinical integration, and integrating social determinants of health
  3. Value-Based Payments: targeting specific medical conditions to manage cost and quality of care
  4. Cost Transparency: growing legislation and consumer demand
  5. Total Consumer Health: improving members’ overall well-being and medical, social, financial, and environmental
  6. Cybersecurity: protecting the privacy and security of consumer information
  7. Healthcare Reform:  repeal, replace, or substantial modification of current healthcare laws, Block Grants, Single-Payer, Industry Stability
  8. Harnessing Mobile Health Technology: Improving disease management, member engagement, and data collection/distribution
  9. Addressing Pharmacy Costs: implementing strategies to address growth of pharma costs versus benefits to quality of care and total medical costs
  10. The Engaged Digital Consumer: HSAs, member/patient portals, health and wellness education materials.

2017 HCEG Top 10

Click on a Top 10 item for more information

  1. Value-based Payments: targeting specific medical conditions to manage cost and quality of care
  2. Total Consumer Health: improving member’s overall well-being – medical, social, financial, and environmental
  3. Clinical and Data Analytics: leveraging big data with clinical evidence to segment populations, manage health and drive decisions
  4. Cybersecurity: protecting the privacy and security of consumer information
  5. Cost Transparency: growing legislation and consumer demand
  6. Harnessing Mobile Health Technology: improving disease management, member engagement, and data collection/distribution
  7. Addressing Pharmacy Costs: implementing strategies to address growth of pharma costs versus benefits to quality of care and total medical costs
  8. Care Redesign: leveraging team-based care models, focusing on behavioral health and social needs
  9. Accessible Points of Care: telehealth, retail clinics and micro-hospitals vs. large, integrated systems
  10. Next Generation ACOs: additional programs in bundled payment, episodes of care-shared savings, and growing participant base

2016 HCEG Top 10

  1. The Consumer Experience: omnichannel business, mHealth, HIX, social media and telehealth.
  2. Payment reform: ACOs, P4P, value-based care and value-based reimbursement
  3. Population health: managing total health, including social and environmental determinants
  4. Provider/Plan integration: combining functions of care delivery and financing in a single organization.
  5. Transparency: triple aim price, quality and service measures to support customer decisions
  6. Retail health care: established consumer companies disrupt traditional care providers (TIED)
  7. Pharmacy: cost, compliance, convenience & specialty health (TIED)
  8. Big data and advanced analytics: identifying patterns, opportunities in vastly detailed data sets
  9. Cybersecurity: protecting the privacy and security of customer information
  10. Genomics: customizing prevention and treatment to individual DNA

2015 HCEG Top 10

  1. Payment reform, ACOs, value-based care and value-based reimbursement
  2. ACA implementation (3Rs, MLR, etc.) and adapting to evolving regulations and requirements
  3. Price, quality and access transparency to support the consumer experience
  4. Bend the cost curve in both medical and administrative expenses
  5. Medicare, Medicaid expansion, dual eligibles and other government programs
  6. Member management/strategy, portals, engagement, education and communication
  7. Big Data and the race to advanced analytics and informatics
  8. Consumerism initiative driving health care
  9. Mobile/Digital devices, telemedicine, mHealth and social media
  10. Personal health monitoring, population

2014 HCEG Top 10

  1. Mobile/Digital Devices, Telemedicine, and mHealth
  2. Payment Reform, ACOs, Value-Based Care and Reimbursement
  3. Price, Quality and Access Transparency to support the Consumer Experience
  4. ACA Implementation (3Rs, MLR, etc.) and Adapting to Evolving Regulations
  5. Member Management and Strategy, Portals, Engagement, Education and Communications
  6. Consumerism Initiatives Driving Health Care
  7. Medicare, Medicaid Expansion, Duel Eligible and other Government Programs
  8. Big Data and Race to Advanced Analytics
  9. Personal Health Monitoring, Population Health and Wellness, Incentives and Rewards
  10. Bending the Cost Curve in both Medical and Administrative Expenses

2013 HCEG Top 10

  1. Health Insurance Exchanges (HIXs)
  2. Reform, Regulation and Market Uncertainties
  3. Consumerism Driving Health Care
  4. Care Management, Data Analytics, and Informatics to Improve Outcomes
  5. Medicare, Medicaid and Other Government Programs
  6. New Provider Payment Models & Delivery Systems
  7. Operational Overload and Competing Priorities
  8. Social Media, Mobility, BYOD, and Digital Health
  9. Innovation and Collaboration of Business and IT for Competitive Advantage
  10. Hiring, Engaging and Empowering staff for the 21st Century Workplace

2012 HCEG Top 10

  1. Bend the Cost Trend in both Medical and Administrative Expenses
  2. Care Management, Data Analytics, and Informatics to Improve Outcomes
  3. New Provider Payment Models & Delivery Systems (ACOs, PCMHs)
  4. Medicare, Medicaid and Other Government Programs
  5. Health Information Exchanges (HIEs)
  6. Big Data, Warehousing and Analytical Capability Expansion
  7. Payer/Provider Interoperability
  8. Administrative Simplification, Mandates and Efficiency (HIPAA 5010, ICD-10, MLR)
  9. Health Insurance Exchanges (HIXs)
  10. PHI Privacy and Security

2011 HCEG Top 10

  1. Administrative Mandates (Compliance HIPAA 5010, ICD-10, etc.)
  2. Care Management, Data Analytics, and Informatics.
  3. Health Insurance Exchanges and Individual Markets.
  4. New Provider Payment & Delivery Systems (ACOs, PCMHs, etc.).
  5. Bend the Cost Trend.
  6. Medicare and Medicaid.
  7. Health Information Exchanges and EMRs.
  8. Consumer’s Role in the Modernization of Healthcare.
  9. Reform Uncertainties.
  10. Payer / Provider Interoperability.