2019 Industry Pulse Survey value-based payment Value-Based Relationships & Reimbursement:

Value-Based Relationships & Reimbursement: How can Industry Collaborate to Speed the Move to Value?

By | HCEG Top 10, Events | No Comments

Value-based Payment (and Value-based Care Reform) has ranked among HCEG’s Top 10 list of challenges, issues, and opportunities each of the last 10 years that HCEG’s Top 10 list has been published; a clear indication healthcare leaders realize that the move to payment for outcomes (value) vs. volume (FFS) is inevitable. It’s clear that value-based relationships & reimbursement is important to health plans, health systems and provider organizations. But year after year, shared-risk, value-based healthcare appears to be just around the corner. Why so slow? How can healthcare leaders championing the transformation of America’s healthcare system finally begin to realize the value of value-based payment?

In fact, the majority of respondents to the 2019 Industry Pulse Research Survey indicate that value-based relationships including both upside and downside shared risk still appears to be three to five years off.2019 Industry Pulse Survey value-based payment

If what’s apparently widely thought, then why is the move by health plans, health systems, and healthcare providers to value-based reimbursement perpetually stuck at being three to five years away from adopting shared-risk value-based contracts?

Join Us at Hotel Commonwealth for our Complimentary Executive Leadership Roundtable – Breakfast is Included

Healthcare Innovation and Disruption, HealthCare Executive Group, HCEG, 16th Annual World Health Care Congress (WHCC), CIO & CTO Strategy Track, innovation, disruption. healthcare champions, Data Analytics, Pharmacy Costs and Transparency, Importance of Useable Technology, Cybersecurity, HCEG Top 10, Center for Healthcare Innovation (CHI), International Association of Innovation Professionals,Speeding the Move to Value-Based Relationships & Reimbursement

On Wednesday, September 11th, the HealthCare Executive Group is presenting a special Executive Leadership Roundtable as part of their 31st Annual Forum. This interactive roundtable event open to everyone who’s in Boston on September 11th – there’s no charge to join other healthcare leaders from across the country to learn about value-based care and meet others facing similar challenges. To be clear, this special ELR event is open to everyone.

Participants of this special ELR will benefit from:

  • Interactive discussion between attendees and speakers on what the movement to value means
  • Learning about the top challenges and opportunities in transitioning from payment for volume
  • Why healthcare organizations are hesitant to provide value-based care and thoughts on overcoming them
  • Understanding realistic next steps healthcare leaders can take to make real progress in the move to value
  • Recent successes in new payment models and lessons-learned
  • A look at cross-industry partnerships in the movement to value-based care reimbursement

This will be a rare opportunity for Healthcare Champions who gather in Boston on September 11th to learn more about value-based payment and care opportunities and to interact with speakers and other participants on a meaningful basis.

The $64,000 Question (Or the $64B+ Question?) – Always 3 to 5 Years Away

Why is the move by health plans, health systems, and healthcare providers to value-based reimbursement perpetually stuck at being three to five years away from adopting shared-risk value-based contracts?

To learn how to advance value-based care, join us at the Hotel Commonwealth for our September Executive Leadership Roundtable event -Value-Based Relationships & Reimbursement: How can Industry Collaborate to Speed the Move to Value? -and learn from the following session leaders and ELR participants:

Panelists Sharing Insight on Value-Based Relationships & Reimbursement

Moderator: David Di Loreto, MD – Principle – Sg2

Panelists:

Join Others to Learn About Value-based Care in Boston on September 11, 2019

Be a part of this unique, no-cost learning and networking opportunity on the last day of the HealthCare Executive Group’s 31st Annual Forum. Breakfast is included and registration is required.

Healthcare Innovation and Disruption, HealthCare Executive Group, HCEG, 16th Annual World Health Care Congress (WHCC), CIO & CTO Strategy Track, innovation, disruption. healthcare champions, Data Analytics, Pharmacy Costs and Transparency, Importance of Useable Technology, Cybersecurity, HCEG Top 10, Center for Healthcare Innovation (CHI), International Association of Innovation Professionals,

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

By | Partners, Events | No Comments

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

Leverage Your AHIP Event & Nashville Connection

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

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

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

Dr. David DiloretoBen LeedleFerris TaylorDavid Gallegos
Senior VP of Healthcare-Population Health at General ElectricPresident & CEO at Blue Zones and former President & CEO of HealthwaysHCEG Board Chair and COO/Consultant at Arches Health PlanSenior VP of Consulting Services at Change Healthcare

Timely Topics for Healthcare Leaders

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

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

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

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

Reserve Your Seat Today!

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

Healthcare Executive Leadership Forum at Guidewell Innovation Center

HCEG Attends the 2017 Healthcare Summit & CMA Celebration in Nashville

By | Partners, Events | No Comments

Source: emids

After helping host the 29th Annual Forum of the HealthCare Executive Group held last September in Nashville, our board chair Ferris Taylor returned to Nashville last week to attend emids 2017 Healthcare Summit & CMA Celebration. And if those two trips to Nashville weren’t enough, HCEG will be returning to Nashville to host one of our Executive Leadership Roundtable events on Thursday, December 7th – immediately following AHIP’s 2017 Consumer Experience & Digital Health Forum. Nashville really does live up to its moniker of “The Healthcare Management Capital of the United States.”

More About the 2017 Healthcare Summit & CMA Celebration

The 4th Annual Healthcare Summit & CMA Celebration sponsored by emids was an invitation-only event that brought together CEOs and leading executives from the healthcare industry to discuss how they are balancing provider, payer and patient accountability to provide more value and better outcomes for the future healthcare consumer. In this post, we’ll share a short recap of the summit proceedings and set the stage for a following post where we’ll share specific information, ideas and opinions from four panels moderated by industry leaders Justin Roth of TripleTree Investments, Russ Thomas of Availity, Dr Emad Rizk of Verscend and Glen Tullman of Livongo.

Dominant Themes at the Summit

Summit keynotes and sessions addressed opportunities, challenges and issues that healthcare executives and industry leaders must individually and collectively address during this period of uncertain reform and digital transformation of the healthcare industry. These included:

Impact and Continued Entrance of “Outsiders”

There are a whole bunch of companies outside of healthcare looking at the industry and saying, “We can do it better!”  Tomorrow’s healthcare innovations may very well come from outside of the industry… not just Amazon, Google, Lyft, Nike, Apple, etc.… but even other firms likely germinating in someone’s garage or one of the seeming 100’s of accelerators, incubators, or co-working spaces.

Importance of Data Liquidity and Exchange

Click for more info

Data and strategies for using data to drive new modes of thinking for the entire ecosystem of healthcare were a common point of discussion. Advances in artificial intelligence and machine-learning algorithms that tap into unstructured data were a promising area widely discussed.

Engaging Healthcare Consumers & Patients

Just as successful innovations for providers need to fit into their existing “workflow,” consumer solutions need to fit into the consumer’s “Life Flow.”  Consumers don’t want to be more engaged with their chronic conditions – they want to address their chronic conditions and get more engaged in living their lives.

Trust Among All Healthcare Constituents

All healthcare stakeholders – health plan members, patients, providers, and payers must work toward addressing the “trust” issue.  Consumers don’t necessarily care about how much you know as much as how much you care.

Source: emids

Come Back for More – And Going Back to Nashville

Be sure to check back for our next post where we’ll share information gleaned from the four panels presenting at the summit. And more about HCEG’s return to Nashville in December for our Executive Leadership Roundtable and how you can join other healthcare leaders after the AHIP Consumer Experience & Digital Health Forum on Thursday, December 7th.

In the meantime, consider connecting with us on our social channels: Twitter, LinkedIn and Facebook. And subscribe to our eNewsletter so we can push worthwhile information to you on a regular basis.

An Executive Leadership Forum at GuideWell Innovation Center

By | Events | No Comments

Executive Leadership Forum at GuideWell Innovation Center hcldr hitsm innovationOur Executive Leadership Forum held at the GuideWell Innovation Center on Monday, May 8th was attended by 21 healthcare executives and solution provider thought leaders. The three-hour event – titled Operationalizing Before Analyzing: Healthcare’s Modern Journey Powered by Data – focused on some of the underlying challenges and issues regarding how healthcare data and analytics technologies impact consumers, providers and health plans.

The forum included lively discussion on real world use cases for healthcare data and analytics, a demonstration of live 3D interaction possibilities and a tour of the GuideWell Innovation Center. The forum was capped off by a happy hour for participants to network with each other and forum sponsors: MarkLogic and Intel.

In this post, highlights of the discussion between forum participants and key takeaways will be presented. In future posts, an overview of the 3D interaction demo and tour of the GuideWell Innovation Center will be shared.

HCEG Board Chair Ferris Taylor shared some information on the tour of the GuideWell Innovation Center and Live 3D Collaboration in this post on LinkedIn.

Demand for Real-time Data and Transactions

A lot discussion during the forum centered around current complexities and how demand for real-time data and transactions—across clinical, administrative and financial operations–is increasing exponentially every day and putting significant demands on service model / operations and legacy infrastructure, which are mostly batch / file transfer oriented.  Several issues were identified as current concerns:

  1. Many underlying data challenges
  2. Lack of agility in quickly responding to opportunities
  3. Inadequate data governance/provenance with ETL approaches in the legacy data pipeline

All audience members agreed they wanted faster time to market and better ability to respond to clients / market / regulations and be more agile when it comes to data. There was broad agreement that “data integration” is a journey that should follow a new data integration pathway instead of the legacy Extract-Transform-Load (ETL) approach:

Real World Use Cases

Over the course of the discussion there were a number of data capture and analytics use cases shared between forum participants. One use case described enrollment data submitted to the IRS on the 1095-B Health Coverage forms sent to individuals noting their qualified health coverage during each month in the year.

One participant described how the IRS had reported back to the health plan that 40% of the records submitted by the health plan to the IRS had errors in name, social security number and/or dependent status; basic required enrollment data elements that the plan was not able to validate or authenticate during the initial enrollment process and remained that way throughout the entire year. Garbage-In-Garbage-Out.

This “1095-B use case” elicited feedback from one forum participant having recent experience at the Census Bureau with the participant describing how government agencies often don’t have complete, accurate data. Just because CMS might have data of one quality level, they don’t always share that data with related agencies so the IRS or the SSA or state Medicaid administrators likely have different data.

Leverage All Data Types & 3rd Parties

Forum participants shared unique perspectives and a Q&A ensued on the example of how the Census Bureau uses associated data to significantly improve the timelines, accuracy and overall value of census data by editing it against 3rd party sources.  This Census Bureau use case and another use case described by forum participants of a BCBS plan emphasized that 3rd party data sources and unstructured data are very important to service improvement, member/patient experience, innovation and growth-oriented project investments.

Primary Investment Areas: Data Improvement & Integration Projects

Forum members identified the following investment areas for data improvement and integration projects that healthcare executives may implement over the next 12-18 months to modernize healthcare data and applications:

healthcare-data-integration-investment-areas-ELF-Blues-MarkLogicThought Leader Presentations

This Executive Leadership Forum was co-sponsored by MarkLogic and Intel. The information shared by these two sponsors are made available here:

    “Healthcare ‘Next Gen’ Data Projects”Bill Gaynor, U.S. Healthcare Director – MarkLogic, Inc.

    “Intel Healthcare Security Readiness Program Overview”Joan Hankin – Global Director of Marketing & Business Development – Healthcare & Life Sciences at Intel Corporation

In addition to information shared by MarkLogic and Intel, Constance Sjoquist, former Research Director at Gartner, also participated:

    “Disrupting the Status Quo in Healthcare” – By Constance Sjoquist, Chief Content Officer – HLTH, LLC.

Three Basic Tenets Unanimously Agreed

At the end of the forum, participants unanimously agree on three basic tenets:

  1. Complete and accurate data – especially basic demographic and social determinants – MUST begin with the first member/consumer/patient-provider interactions at the point of service
  2. Data needs to be authenticated, validated, verified and ENRICHED against other sources – then normalized across other supportive partners and their ‘systems of record’
  3. Today’s technology can support the capture, validation and use of healthcare data on a relatively inexpensive basis.

Join Other Healthcare Leaders

For more information on the Healthcare Executive Group and how you can become more ‘in the know’ and effective as a healthcare executive or thought leader, check out this information about becoming a member. You can also follow us on Twitter, friend us on FaceBook and follow us on LinkedIn.