Ongoing uncertainty, the need to digitally transform operations, and external disruption are three of many challenges, issues, and opportunities facing today’s healthcare leaders. So how can healthcare executives find the information, collaboration, and networking opportunities, both in-person and virtual, to stay on top of things? Indeed, professional associations, many healthcare conferences and digital channels such as LinkedIn, newsletters, blog posts, and Twitter can be an effective way for healthcare leadership to quickly and cost-effectively advance their initiatives and programs.
The HealthCare Executive Group (HCEG) has existed over 30 years to help those championing the transformation of healthcare better understand the challenges, issues, and opportunities facing they face and to facilitate connections with others facing similar concerns. This post shares insight from a long-term member of the HealthCare Executive Group on how HCEG has differentiated itself from the noise, vendor sales pressure and overbearing crowds so common in today’s conferences and digital channels.
How the HealthCare Executive Group Supports Healthcare Champions
Can you tell us a little bit about yourself and your association with the HealthCare Executive Group?
I am Eric Decker, Chief Information Officer at Independent Health, a regional payer headquartered outside of Buffalo, NY. I have been a member of HCEG since 2015 and became a board member of HCEG in 2018.
Why did you join the HealthCare Executive Group?
I was promoted to CIO in early 2015, and being a ‘first-time’ CIO, I was looking for associations where I could meet and network with other healthcare executives at organizations similar to Independent Health. HCEG had been recommended to me by another CIO, and I was really happy with the networking opportunities and content provided at their annual forum.
What do you think makes the HealthCare Executive Group different than other healthcare associations and leadership organizations like HIMSS, CHIME, FACHE, etc?
The relatively small setting of the annual forum distinguishes HCEG from larger associations’ events. There is only one concurrent track, and the break times allow me to reconnect with peers who I had met at previous forum events, as well as make new connections.
How does HCEG solicit input from its members as to what content, events, and services they’d like HCEG to provide to them?
What unique networking opportunities and experiences does the HealthCare Executive Group offer?
HCEG offers more than the usual networking mixers. The extracurricular activities at the Annual Forum and the Executive Leadership Roundtables are very conducive to getting to know other healthcare professionals in a relaxed environment. Too many times the crowds, noise and commercial distractions get in the way of truly forming a meaningful relationship that lasts beyond the networking event itself.
What about the HealthCare Executive Group makes it different than other associations and organizations supporting healthcare leaders?
HCEG’s Annual Forum and Executive Leadership Roundtable events are a ‘safe space’ for healthcare executives to learn, discuss and inform – free from the distractions of large events and without vendors pushing sales pitches. I’m better able to gain perspective on challenges, issues, and potential opportunities.
HCEG events are very informal yet supportive. The friendliness and flexibility of their event and administrative staff was impressive. HCEG helps its members forge meaningful relationships that last long after any single event ends. Industry media that may share comments out of context are not allowed.
Nowadays, there are lots of ways to stay connected and communicate with peers and other business associates. How does HCEG support member connections and information exchange?
A single conference event over two or three days once or twice a year is not enough to keep up with challenges, issues, and opportunities in today’s fast-paced, uncertain healthcare environment.
HCEG provides a nice mix of in-person, physical gatherings throughout the year and also well-coordinated of virtual, digital channels to help stay informed and connected. And offers its members events, opportunities and support to share and acquire information and expertise outside of a single, transactional event.
HCEG’s develops its yearly Top 10 list during their Annual Forum. What can you share about the Annual Forum and the HCEG Top 10 list?
HCEG’s Annual Forum reinforced the information that I know and filled in some of the blanks I was not completely aware of. It has a good mix of sessions that presented a variety of perspectives. I was somewhat surprised by the candor and willingness to the panelists to engage with the audience.
The HCEG Top 10 provides a good overview of what’s happening in the industry. It helped me get a sense of what others are thinking and helped validate – and invalidate – some of my thoughts and assumptions.
Meet Eric and Other Healthcare Champions at HCEG’s 31st Annual Forum
The 31st Annual Forum of the HealthCare Executive Group takes place September 9th – 11th in Boston. Come join Eric Decker and other champions focusing on the healthcare and digital innovation necessary to transform the healthcare system in the United States. Interact with your healthcare peers, learn more about how others are addressing similar challenges, issues, and opportunities, and create new relationships to advance your company-focused and personal missions.
The 2018 HealthCare Executive Group Annual Forum celebrating our 30th-anniversary serving healthcare executives and industry leaders kicks off Wednesday, September 12th at the Hewing Hotel in Minneapolis, MN – the #1 Healthiest City in the United States. The HealthCare Executive Group (HCEG) has the following planned for the 125+ healthcare executives, thought leaders and industry leaders who will participate in the two and half day forum.
Keynotes from Healthcare Industry Executive Leaders
On Wednesday at noon, Andy Slavitt, Former Acting CMS Administrator and current leader of Town Hall Ventures, provides the opening keynote and is expected to share his unique insight about the uncertainty in today’s healthcare environment and where he sees progress being made.
Thursday evening, Dr. Craig Samitt, just days into his new role as President & CEO of BCBS of Minnesota, shares his insight on the current state of health care: “A Seasoned CEO’s Perspectives on Where Healthcare is at and the Challenges and Opportunities Ahead.”
Each of the above keynotes will be provided while annual forum participants enjoy what’s expected to be a delightful breakfast, lunch and dinner service presented by Hewing Hotel staff.
Connect Personally, Professionally and Productively Build Long-Term Relationships
Nine Interactive Sessions for Healthcare Executives
Annual forum participants will benefit from nine interactive sessions covering topics selected and developed by HCEG leadership, session moderators and panelist participants. Each of these sessions are intended to provide actionable insight into current topics of value to the health plan, health system and healthcare provider executives attending our annual forum.
“Payer/Provider Partnerships & Opportunities for the Future”
Are health plans, providers and/or consumers equally prepared for the transformation of healthcare that is underway? Compelling health insurance products are being launched today, based on an expectation of a closer partnership involving clinical and financial changes, enhanced member experience, and market transitions that a multi-system approach typically cannot provide. Hear what payers and providers are doing and how technology is the key enabler.
Tom Howard – Moderator (Payer Division Partner at Cumberland Consulting Group)
Joe O’Hara (Director of ACO Solutions at Horizon BCBS of NJ)
Dr. Matt Hoffman, MD (Chief Medical Informatics Officer at Utah Health Information Network)
“Value-Based Payment & Implications for Healthcare Stakeholders”
Medical device and pharmaceutical companies are looking at new business models as demands to focus on rising costs are made by consumers and government agencies. Hear what companies are actually doing in the movement toward ‘Outcomes-based’ reimbursement. Gain new insights on why value-based payment and pharmacy costs have been HCEG Top 10 items over the last few years.
Jorie Soskin (Value-based Investments at Medtronics)
Other panelists currently being formally engaged
“Chronic Care and Challenges Dealing with High-Cost, Multiple Morbidity Patients”
Panelists will present their experience, insight, and opportunities for using clinical measurement and metrics, payer-provider transparency and clinical improvement to improve outcomes and lower costs for individuals having chronic, co-morbid conditions.
Eric Hamborg (Chief Customer & Revenue Officer at MOBE)
Invited (Chief Medical Officer at Major Health Plan)
“Health & Behavior Change at the Community Level”
Community engagement, efficacy, and empowerment are keys to communities being able to adopt and sustain new behaviors. Panelists will discuss current approaches and strategies to integrate community mobilization and activities more effectively with conventional healthcare strategies, aimed at individual behavior change. Audited results will be shared and discussed as to impact and future implications.
Ben Leedle – Moderator (President, CEO & Board Director at Blue Zones, LLC)
Melissa Lyon, MPH (Public Health Director at Erie County Dept of Health)
Mike Gold (Immediate Past CEO at HMSA – BCBS Hawaii)
Mike Riley (Chief Strategy Officer Naples Community Healthcare System)
Clay Marsh, MD (VP & Executive Dean for Health Sciences West Virginia University)
“Healthcare Single Point of Workflow on Social Determinants of Health”
Focus on the social determinants of health is no longer a sideline conversation and needs a whole new framework of thinking. The reality is SDOH programs are in everyone’s self-interest and there are ways to effectively focus and coordinate efforts for everyone’s benefit. Hear what health plans and provider groups are doing to change the common perspective of SDOH being a public good with limited medical impact.
Brenda Schmidt (Founder & CEO of Solera Health)
Additional session participants are being engaged
“Health Plan Diversification: What does it Mean?”
Panelists share the challenges and opportunities for health plans, health systems, and hospitals to diversify beyond their traditional offerings and the financial, clinical and operational implications of those decisions.
Ian Gordon – Moderator (SVP Health Plan Operations at Regence BCBS)
Tom Vanderheyden (EVP & President of National Solutions at BCBS of MN)
Chuck Divita (EVP Commercial Markets & CFO at BCBS of FL/GuideWell)
Brandon Cady (President & CEO of AIM Specialty Health – Anthem Subsidiary)
“Vision and Perspective for Healthcare from a Washington, DC Perspective”
We’re working to engage the leader of a nationally recognized healthcare association to share insight on the current state of affairs from a Washington, DC perspective.
“Is Block Chain and/or AI in Healthcare’s Future?”
Blockchain and artificial intelligence technologies are catalyzing the pace of innovation and introducing radical shifts that WILL change the business of healthcare. This panel of experts will discuss the potentialities realized at the intersection of AI and Blockchain and the challenges and benefits healthcare executives must understand to not be disrupted by game-changing technologies.
Alan Abramson – Moderator (Senior VP & CIO HealthPartners)
Emily Vaughn (Product Development Director at Change Healthcare)
Justin Adams (CEO at Digitize.AI)
“Technology: From Start to Scale”
Leading healthcare visionaries share their unique insight on the key opportunities and challenges facing healthcare incumbents, especially with potential new market entrants that intend to disrupt healthcare. Is it time to partner or compete with them and how to get to scale the fastest?
Justin Roth – Moderator (Managing Director at TripleTree)
Other panelists are being engaged
A Few Surprises for Participants are Likely!
We’re working on a couple other bits and pieces that we think will be valuable to healthcare executives, industry leaders and others working to advance healthcare in the United States. Unlike most other healthcare conferences that lock down their speakers and content a year – or even more – in advance, we’re focused on bringing the most current, insightful and actionable information, ideas and opinions to our members and forum participants!
Voting and Ranking the 2019 HCEG Top 10 List
Over the last decade, a highlight of the HealthCare Executive Group’s annual forum is the development of the HCEG Top 10 list of challenges, issues, and opportunities that healthcare executives are currently facing. Starting with a list of approximately 25-30 items identified by HCEG members and sponsor partners, forum participants interact with each other to identify the top 10 challenges, issues and opportunities their organizations are facing. After interactive discussion in a roundtable format, the participants rank the items to create the 2019 HCEG Top 10 list.
A new approach this year is that candidates for the HCEG Top 10 list will be reviewed in a roundtable format facilitated by key sponsor partner thought leaders. The objective of the luncheon roundtable discussions will be to clarify the list of challenges, issues, and opportunities facing healthcare executives. Participants can add critical items that may have been missed and have an opportunity for deeper insight into the critical issues for the coming year. The final list of items will then be ranked by forum participants and formally shared with attendees prior to Thursday nights dinner. HCEG Executive Director Ferris Taylor and Chris Link, Sr Consultant at Change Healthcare, will orchestrate the process with assistance from HCEG support staff.
Breakfast, Lunch, and Dinner – Supporting Opportunities to Connect
One of the hallmarks of HCEG’s Annual Forum events is the quality of the venue, the opportunity for intimate interaction among other healthcare executives, and well-planned food, beverage and entertainment accompaniments. Participants can expect to enjoy the following:
Welcome Reception Tuesday Evening
Lunch on Wednesday – With a keynote by Andy Slavitt
Offsite Dinner Reception on Wednesday
Breakfast on Thursday – With a keynote by Dan Buettner
Lunch on Thursday
Dinner + Closing Keynote on Thursday – With a keynote by Dr. Craig Samitt
Nightcap + Winddown on Thursday
Breakfast + Farewell on Friday
Special Executive Leadership Roundtable
In celebration of our 30th Anniversary, the HealthCare Executive Group is hosting a special Executive Leadership Roundtable on Friday, September 14th. Dan Buettner will present “The Blue Zones of Happiness: ‘Lessons from the World’s Happiest People’” during a special Friday morning breakfast event starting at 7:30am. Dan’s presentation will build on and provide additional color and clarity from his “Blue Zones: The Making of a Healthy City” presentation shared the day before.
This event requires individual registration and is limited to executives from health plans, health system, health care providers and local employer organizations. Contact us if you have any questions.
HealthCare Executive Group convenes and supports healthcare executives and thought leaders by providing a platform supporting the creation, curation and sharing of information and insight on current opportunities, challenges and issues in the healthcare industry.
It’s our 30th Anniversary and the HealthCare Executive Group has been in overdrive during the first half of 2018. We held an Executive Leadership Roundtable at the recent HLTH Future of Healthcare Forum, we worked with our sponsor partners to share insight via our ongoing HCEG Webinar Series, we’ve attended a handful of major healthcare industry conferences in support of our members and sponsor partners, and we continue to leverage our social channels to help address the issues, challenges and opportunities facing today’s healthcare executive leader.
We’ve also been preparing for our 2018 Annual Forum taking place September 12th through the 14th in Minneapolis, MN – recruiting industry thought leaders and fleshing out an agenda that promises to share valuable information, insight and networking opportunities. Finally, we’re wrapping up the first half of our 30th Anniversary year by attending the 2018 AHIP Institute & Expo where we’ll support our members and sponsor partners – and gather additional insight to make our 2018 Annual Forum all the more valuable.
Major Healthcare Conferences of 2018
HCEG members and sponsor partners participated in many of the major healthcare conferences taking place in the first part of the year including the:
HCEG members and sponsor partners will be participating in more conferences as the year continues, including, our course, hosting the 2018 HCEG Annual Forum celebrating our 30th Year convening and supporting healthcare executives and thought leaders.
Read on for more about HCEG Members and Sponsor Partners at the AHIP Institute.
HCEG Webinars Offer an Opportunity to Learn from Sponsor Partners
In the first few months of 2018, HCEG and our sponsor partners produced webinars addressing a variety of topics such as Value-based Payment, Post-Acute Care in Medicare Advantage and a deeper dive into the 2018 HCEG Top 10. For more information on these webinars including a recap and recording, check out the following:
HCEG is also working with other sponsor partners on additional webinars planned for the 4th quarter of 2018 after the Annual Forum.
Consider subscribing to our eNewsletter to be kept abreast of these webinars and other information and events of value to healthcare executives and thought leaders.
Preliminary Agenda and Keynote Speakers for HCEG’s 30th Anniversary Annual Forum
We’re pleased to share the preliminary agenda and announce that Andy Slavitt, former Acting CMS Administrator and current leader of Town Hall Ventures, and Dan Buettner, National Geographic Fellow, NY Times bestselling author and principle at the Blue Zones Project will be providing keynote addresses at our 2018 Annual Forum in Minneapolis, MN on September 12 – 14, 2018.
The following represents the current agenda which is being fleshed out and evolving on a weekly basis. We’re also identifying and recruiting more speakers and panelists, and planning enjoyable networking events intended to make our 2018 Annual Forum our best forum ever. If you or someone you know would like to be considered to speak or serve as a panelist at our forum, please use this form.
To learn more and to get an idea about what the HCEG Annual Forum is all about…
HCEG Members and Sponsor Partners at AHIP Institute & Expo
The 2018 AHIP Institute & Expo takes place next week, June 20th through the 22nd in San Diego, CA and HCEG members and sponsor partners will be participating, speaking and exhibiting.
If you’re attending the AHIP Institute, be sure to meet our sponsor partners. Some of our sponsor partners are exhibiting, some are presenting, and some are attending. ALL of our sponsor partners can help your healthcare organization transform itself in today’s rapidly evolving healthcare environment.
Also not to be missed are sponsor partners CareCentrix and Change Healthcare offering refreshments and a Lunch & Learn session.
The HealthCare Executive Group has limited general sponsorship opportunities available to companies interested in supporting our members on a consultative, partnership basis. For more information, contact Juliana Ruiz.
The inaugural 2018 HTLH Future of Healthcare forum took place in Las Vegas earlier this month with 3,500+ attendees and 375+ speakers assembled over four days starting May 5th with the HLTH Hackathon. And HealthCare Executive Group (HCEG) members and sponsor partners were there – interpreting and absorbing key takeaways, presenting as speakers and panelists in various sessions and adding their own unique support and participation at this highly touted, new healthcare conference billed by organizers as ‘The Hottest, Newest, Largest and Most Important Healthcare Event.”
Sessions at HLTH were organized into five tracks that varied each day. So, with 100+ sessions over four days, there were about 4 or 5 sessions covering any particular track – a reasonable and manageable number. HLTH event organizers also assigned all sessions in each track to the same room location; making it easy to navigate between tracks and sessions. There were a few crowded sessions and some rather sparsely populated sessions.
Based on an informal survey of sessions attended by HCEG members and a scan of various recaps of the HLTH Future of HealthCare forum over the past two weeks, a few common threads emerged.
Must Address Multiple Conditions, High-Cost Patients & Care Transition
Many of the sessions at the HLTH event addressed the importance of providing cost-effective services and products to three groups of people:
People with multiple chronic conditions – particularly diabetes, hypertension, hyperlipidemia, asthma and depression.
Patients who drive a large percentage of total health care costs
Patients discharged from the inpatient setting.
Health Happens Outside the Exam Room & Hospital
And many of these same sessions and more than a few of the exhibitors shared information, ideas and approaches aimed at addressing these three populations by focusing on social determinants of health. Quite a few speakers and panelists spoke of the need to extend health services beyond the walls of the treatment room and out into the local community.
As noted in the recent Industry Pulse Research Survey co-authored with HCEG sponsor Change Healthcare, payers are beginning to integrate community programs and resources into their medical practices. Only 18.9% of responders said they were not currently integrating any social determinants of health, a dramatic change over the last few years.
Payment Innovation in Healthcare is Desperately Needed
Another oft-mentioned topic at the HLTH forum was value-based care and the need for payers and providers to come together on sharing not only upside risk but downside risk as well. While the rise of personalized medicine, targeted therapies, specialty pharmaceuticals and molecular diagnostics offer tremendous opportunity, payers are still growing their sea legs figuring out how to measure outcomes and associated value models – at the same time as providers and the healthcare supply-side are beginning to demonstrate outcome values in risk-based payment contracts.
What’s clear is that rapidly evolving medical technologies must be simultaneously supported by reasonable regulatory frameworks and payment model development. Hopefully, the federal government will serve as the vanguard for innovation in the area of reimbursement.
Engagement: The Most Un-Buzzworthy Word at HLTH?
In one session, the moderator quizzed the panel as to what industry buzzword they disliked most and ‘engagement’ was the clear winner (loser?) among panelists as the most over-used and unclear healthcare buzzword. The CEO of Maestro Health, Rob Butler suggested that people don’t want engagement with a medical condition but rather to be connected to their health system and support networks.
HCEG Members & Sponsors at the HLTH Future of Healthcare Forum
More than a few of our HCEG sponsor partners were at the HLTH event – speaking in sessions, as sponsors, participating in 1:1 and small group meetings and exhibiting.
Softheonwas active in several ways with sponsoring the HACK/HLTH ‘hackathon’ where participants collaborated and created meaningful solutions in competition for over $80,000 in prizes. Eugene Sayan, Softheon’s CEO also presented ‘Convergence of Health and Non-Health Data’ along with Jeff Margolis, CEO of WellTok.
Not to stop with those two events, Softheon also joined Lyft to sponsor Wyclef Jean at the JEWEL Nightclub on Tuesday. Softheon also was one of the larger exhibitors at the HLTH Future of Healthcare forum. Check out pictures of HLTH’s After-Hours Activities here.
Change in Healthcare at the HLTH Future of Healthcare Forum
Change Healthcare’s President and CEO Neil de Crescenzo keynoted Tuesday’s General Session “The Patient Experience: Making it Easier for Healthcare Providers to Make it Easier” and shared some common-sense solutions to revolutionize patient experiences, utilizing healthcare data in ways which enable providers to orchestrate and improve patient interactions – all while delivering a seamless experience aimed at improving patient loyalty and new patient attraction.
Change Healthcare was also a major sponsor, giving the first 3,000 attendees a high quality hot/cold mug and having a dominant position in the Exhibit Hall. Change HC also teamed up with Adobe and Microsoft to “Put the ‘Consumer’ in Healthcare Consumer Engagement.” enable health systems to better engage with patients. The joint solution will use Change Healthcare’s Intelligent Healthcare Network, Adobe’s Experience Cloud, and Microsoft’s Azure offering to improve customers’ healthcare experience. You can learn more about this venture here.
CareCentrix CEO John P. Driscoll was a panelist along with David Muhlestein, Chief Research Officer at Leavitt Partners on a Tuesday session titled ‘Aligning Health Policy to Health Possibility.’ This session addressed the potential for technology to transform the health industry through more innovative – and perhaps disruptive – health policy. There were a few moments of ‘extreme interaction’ between the two panelists.
HealthEdgesponsored one of the few handfuls of ‘Meeting Pods’ at the HLTH event. These small group meeting spaces along the hallways seemed like a good idea and through focused effort, HealthEdge had it pod occupied to clients and prospects during the entire HLTH event.
Announcements at HLTH2018 – Large, Small & Mostly Meaningful
One of the interesting media related events at the HLTH event was the “Make an Announcement” opportunity for all HLTH attendees. All sponsors, exhibitors, speakers or otherwise were able to make an announcement about new products, venture funds being launched, collaborations and other ‘newsworthy events’ at a pre-arranged time in a dedicated media area. Some of the major announcements included:
Funding Founders – 6 Minute, Double Opt-In VC ‘speed dating/networking session’ took place about 300 times early in the day for one hour. Based on the early morning start time and lively attendance, the Hosted Buyer and Funding Founders sessions seemed like worthwhile features of the HLTH forum.
Great Meal Service – The HLTH organizers offered a nice selection of good food, well-orchestrated for a conference of this size
Digital Content Delivery, Networking and Logistical Support at the HLTH2018 Forum
In a future post we’ll share some insight and opinion about some of the unique ways in which the HLTH Future of Healthcare Forum organizers differentiated their forum and provided extra value opportunities to attendees.
HLTH 2018 Association Day: Executive Leadership Roundtable – HCEG, CHI, IAIOP and WEDI
As noted above, HCEG was honored to join other associations in an Executive Leadership Roundtable (ELR) as part HLTH’s 2018 Association Day. The theme of the ELR was centered on leadership in healthcare innovation and complimented by author Dr. Sunnie Giles highlighting her just published book on “The New Science of Radical Innovation.” Look for a recap of the roundtable as part of HLTH’s Association Day in a following post.
Ongoing Press Coverage of the 2018 HLTH Future of Healthcare Forum
Given that it’s been a couple weeks since the HLTH Future of Healthcare forum has ended, you can imagine there are a number of other recaps like this one from The HealthCare Executive Group. Here are additional recaps of the HLTH Future of Forum currently available:
More Insight and Ideas on Events for Healthcare Executives
Check back soon for more on the 2018 HLTH Future of Healthcare Forum. We’ll provide a detailed recap of the Executive Leadership Roundtable event that took place on Wednesday, May 9th.
Before the month is out, the HealthCare Executive Group will be opening up registration for our Annual Forum taking place in Minneapolis, MN on September 12 – 14th. We have a special event planned to celebrate our 30th year anniversary. If you’re a healthcare executive who can benefit from collaborating with your C-suite peers, consider becoming a HCEG member.
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.
While 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.
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:
Essential elements of a transition from traditional Fee For Service to Value-based Payment
Independent Health’s story of how important technology-driven strategies are to their adoption of value-based payments
How models being driven by CMS are also impacting commercial contracts
How some health plans are responding to the value-based payment movement including findings from a study of value-based care payments by Humana
The importance of primary care physicians as critical to transforming the way health care is delivered
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
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.
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
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?
“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.”
“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?
“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.
“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.
Today marks the start of National Health IT Week (#NHITWeek,) a collaborative and partner-driven event whose purpose is to promote the awareness and demonstrate the use of information technology in:
Supporting Healthcare Transformation: The many ways in which health IT is driving transformation in healthcare delivery including improvements in quality and safety, interoperability, advances in innovation, and patient and consumer activation and engagement.
Expanding Access to High Quality Healthcare: Use of innovative technologies including telehealth and remote patient monitoring to improve healthcare access, coordination and outcomes.
Increasing Economic Opportunity: Highlighting the importance of a robust, diverse health IT workforce and health IT’s role in supporting economic growth.
Making Communities Healthier: The fundamental role health IT plays in supporting population and public health
As a group of executives, thought leaders and advisory partners serving health plans, health systems and provider organizations throughout the United States, the Healthcare Executive Group (HCEG) is proud to partner with and to support National Health IT Week and the above points of engagement – this week of October 2 – 6, 2017 and throughout the year. You can learn more about #NHITWeek and related events here.
The 2018 HCEG Top 10
To kick of National Health IT Week, the Healthcare Executive Group is pleased to announce the formal release of the 2018 HCEG Top 10 list of opportunities, challenges and issues facing executives of health plans, health systems and provider organizations in the United States.
The HCEG Top 10 has been a keystone of the Healthcare Executive Group for over 13 years and provides insight into the most current, pressing priorities facing their industry. Based on HCEG member input and sponsor partner research, the HCEG Top 10 serves as a framework for continuous and evolving dialog among healthcare executive members on the critical opportunities, challenges and issues facing their organizations. Educational programming including periodic Executive Leadership Round Tables, research initiatives, monthly webinars, whitepapers, blog posts and ongoing member discussion are all driven by the HCEG Top 10.
Help Spread the Word About National Health IT Week
Never before has the digital transformation of healthcare been so pervasive and rapid. Health information technology is key to advancing the imperative points of engagement emphasized during National Health IT Week. Please join the conversation on social media by using the #NHITWeekhash tag. Share how you and/or your organization is using health information technology to transform points of healthcare and health outcomes.
HCEG will be participating in NHIT Week by sharing content via its social channels, member LinkedIn pages, and via this blog. For more information, insight, ideas and commentary about National Health IT Week, healthcare, healthcare information technology and the digital transformation of healthcare, consider following us on Twitter, LinkedIn and Facebook – and subscribe to our eNewsletter.