The HCEG Top 10 list of challenges, issues, and opportunities facing healthcare leaders have been a focus of the HealthCare Executive Group for over a decade. Planned for development by participants at our 2020 Annual Forum, the 2021 HCEG Top 10 list of challenges, issues, and opportunities facing healthcare executives guides our content and programming throughout the coming year. It also serves as the basis for the Industry Pulse research that HCEG and our sponsor partner Change Healthcare have provided over the last decade.
Given the sea change forced by the coronavirus pandemic, the upcoming presidential elections, not hosting our in-person Annual Forum this year, and feedback received about providing more detailed information – a new approach will be used to develop the HCEG Top 10 list for 2021. Four main objectives guide the development of the 2021 HCEG Top 10 list:
Address Impacts from Coronavirus Pandemic & Upcoming Elections
The COVID-19 crisis has clearly altered healthcare priorities and the outcome of the November elections will most certainly do the same. It’s important for the 2021 HCEG Top 10 list to reflect these changed priorities and likely impact from election results.
Deeper Dive into Topics of Interest to Healthcare Executives
In an effort to provide more detailed input and insight into the challenges, issues, and opportunities facing all healthcare stakeholders, candidates for the 2021 HCEG Top 10 list include over 40 ‘sub-topics’ grouped into thirteen ‘themes.” These additional details are expected to provide more value based on the type of healthcare stakeholder: health plan/payer, provider, and risk-bearing provider.
All Virtual Identification, Selection & Ranking Process
Given the absence of our in-person 2020 Annual Forum that was scheduled for this month – and keeping with HCEG’s goal of providing more granular information – the process for identifying, selecting, and ranking core items on the HCEG Top 10 will take place virtually this year.
Open to All Healthcare Industry Participants
Historically, HCEG’s Top 10 process has been limited to HCEG members and attendees of our Annual Forum. Since HCEG is not hosting a physical annual forum this year, and in an effort to collect a wider perspective from a greater number of healthcare industry participants, we’re opening the 2021 HCEG Top 10 process to everyone who cares to participate.
Overview of 2021 HCEG Top 10 Development Process
The following is the high-level process for developing the new HCEG Top 10 list:
Identify “Initial List of 2021 HCEG Top 10 Themes & Sub-Topics” (COMPLETED)
Solicit Feedback on Initial List from Industry at Large (9/16/20 through 11/4/20)
Collect rankings of the Top 10 Sub-Topics identified in Step #2 (11/15/20 through 11/30/20)
Announce 2021 HCEG Top 10 List (12/14/20)
Help Select Candidates for the 2021 HCEG Top 10
The following are the major thematic categories proposed for the 2021 HCEG Top 10. A list of the sub-topics associated with each theme can be found here. Take Step 1 of the 2-Step 2021 HCEG Top 10 development process today. This survey should take less than 5 minutes to complete. If you are unable to complete the entire survey, we urge you to complete as many of the sections as possible that you consider important.
Thank you in advance for sharing your insight. Please contact us at [email protected] if you have any questions or comments. And join our newsletter to receive information, ideas, and insight for healthcare executives and change-makers: bit.ly/hcegnewsltr
The Collective Voice in Health IT is a new podcast series launched by our partner WEDI – the Workgroup for Electronic Data Interchange. The intent of this new podcast series is to offer engaging and intimate discussions with prominent healthcare thought leaders on both current and emerging themes and topics in healthcare: market trends, information technology, and regulations and policies. These important topics are examined from many different angles including the intersection of strategy, operations, marketing, big data, and clinical programs – among other important areas and viewpoints.
In the inaugural episode, Matthew Albright, Communication Committee Chair for WEDI and Chief Legislative Affairs Officer for Zelis Payments and Ferris Taylor, HCEG’s Executive Director, discuss how challenges, issues, and opportunities identified by the 2020 HCEG Top 10 list have exposed inequities and inadequacies in our healthcare system. Matt and Ferris explore priorities top of mind less than six months ago; where those priorities were then and where they are now. To wit, they compare topics ‘Before Coronavirus’ (BC) to where they stand now.
Also included is a discussion about the 2020 Industry Pulse and the recently completed COVID-19 Flash Update survey measuring how priorities identified when the 2020 Industry Pulse was released in February of this year to where healthcare leaders and change-makers think those priorities lie now. The following are some highlights of the inaugural episode of The Collective Voice in Health IT. Listen to the complete podcast hereand access a transcript of the entire podcast here. And look for future episodes here.
Connect, Collaborate & Create – The Collective Voice in Health IT
Matt Albright asked Ferris Taylor: How do we deal with the costs of specialty pharmaceuticals and continue going forward with respect to vaccines and testing and everything else is coming with COVID-19? But even more importantly, right behind that fundamental change of Costs & Transparency was: What’s happening with the consumer and the consumer experience?
“The transition (to the healthcare consumer and the consumer experience) has been slow to develop in healthcare. It was gaining more understanding from both the payers and the providers and all the stakeholders in healthcare of what it really means to be consumer-centric. We know what that means with Amazon or what it means with Alexa, but healthcare was far away from that in terms of consumer centricity and, of course, delivery system transformation, which could include how we make this transition from fee-for-service to value-based reimbursement.
But prior to the coronavirus pandemic, it (the transformation of healthcare) was already deep into digital health and personalized medicine, and holistic healthcare at the personal level.
Now obviously things have changed in the last few months. We couldn’t be more positive that the consumer healthcare experience in the last few months has been less than par. And, of course, one of the biggest and more obvious changes in healthcare has been around the HCEG Top 10 item labeled as Accessible Points of Care. Telehealth has exploded, driven by the absolute necessity for consumers to shelter in place. But the fact they (consumers) still needed access to care and also by providers recognizing that it wasn’t desirable to have patients come into their offices. So that blip in the concerns and issues that were being addressed in coronavirus has certainly impacted the Top 10. And we’ll see statistically how that has changed with the COVID flash survey that we’re just completing right now during the end of July.”
Social Determinants of Health – Aka. Barriers to Entry
Ferris shared his insight on how the coronavirus pandemic has drawn focus to the impact of social determinants of health and the importance of addressing the ‘barriers to health care.”
“I guess the other change, a couple of changes, are to Healthcare Policy, number nine on the HCEG Top 10 for 2020, most certainly has moved up. It seems like regulations change every day. And I’m seeing more discussion around Population Health that has been there (on the HCEG Top 10) for many years. It was starting to get described in the term that we most commonly use: Social Determinants of Health. I personally prefer Barriers to Health but for some reason healthcare has historically and narrowly defined healthcare as medical intervention and has excluded the barriers to health. COVID-19 has certainly challenged that thinking and changed the way that we are thinking about healthcare.”
“I think what’s interesting is when you talk about the priorities coming into 2020 absolutely things have changed. Absolutely its flipped – everything’s been flipped on its head. But the issues themselves or, if you will, the categories of issues haven’t changed, right?
So you talk about Digital Health which we see expressed through Telehealth. You talk about Consumer-Based or Consumer-Centric healthcare. And you talk about how, in the last six months, we’ve seen how that’s kind of failed on a certain level. And certainly, Social Determinants of Health has played itself out in the inequities in the races and the genders and the status of the people who have been ended up hospitalized and actually dying of this disease.
So actually, it seems to me in 2019 the priorities and what came out of your Top 10 had it right? It’s just that now it’s been put under a pressure test. All of those issues have kind of sped up. And the other thing, which I think is interesting and maybe it’s tied somehow to how it’s affected consumer-based health, is that everybody’s talking about it. Right?
I had no idea that at the beginning of this year that I would know so much about viruses and how they were spread and so much about how vaccines were pursued.”
Healthcare Reform – Needs a Grass Roots Movement?
[31:09 – 32:40]
Matt Albright: “I think healthcare has suddenly become a dining room table conversation, a backyard barbecue topic – with social distancing, of course. A conversation where people are talking about the priorities of their group or a group in a specific industry – and looking to their own industry. Suddenly, this industry (healthcare) is everybody’s concern and suddenly every aspect of what you just talked about: telehealth, digital health, inequalities, all of those issues are suddenly being discussed by the people.
Matt queried Ferris with two questions about the ongoing pace and longevity of processes and approaches wrought by the pandemic.
Do you think that, because everybody’s talking about it, there will be a grassroots push to see these things sped up? Virtual health, telehealth, the exchange, data interchange, interoperability of health IT, and transparency issues. Or do you think we’re going to be so exhausted as a healthcare industry after this pandemic, especially at the provider and hospital levels, are kind of economically bereft that we won’t be able to move forward very fast?
How do you think the last six months adds to what’s going to happen next once we conquer this thing?
Never Let a Good Crisis Go to Waste
Ferris shared how the coronavirus crisis has accelerated the transformation of the healthcare system:
“One of our board members, a past COO at a large payer in the Pacific Northwest, said: ‘Don’t waste a crisis but take advantage of it.’ And in some ways, that old and trite saying that: ‘necessity is the mother of invention’ – is really coming into play here. Healthcare was already moving from analog to digital. We can come back to fax machines at some other point.”
Inequities & Inadequacies Exposed
[35:30 – 37:38]
“The COVID crisis has exposed a lot of inequities and inadequacies in our healthcare system. Lack of preparation. Safety concerns. We were disregarding a lot of public health issues that are now very much top of mind. And underneath all of that is as I listen to our members and the discussions back and forth, going back to this 2019 HCEG Top 10 priority number one Data & Analytics, it’s now moved to much more of a foundational function across Costs & Transparency, Consumerism, and Digital Transformation.
At the heart of these priorities are the challenges have also been exposed around electronic data aggregation, how we exchange data, how we get the right data at the right time about the right person in the hands of the right decision-maker in a near real-time environment to function as a healthcare system. And so platforms, technology infrastructure, interoperability, as you mentioned, have become significantly more important in terms of supporting healthcare and moving us from a transactional type of consumer experience to a much more continuous interactive, personalized, holistic consumer experience in health.”
“There isn’t a single person in the United States that is not much more cognizant of their personal health, how they feel, and how they’re protecting their health today than they were six months ago. It’s a different world.” – Ferris Taylor
When Will Consumer-Driven Healthcare Take Hold?
[42:47 – 44:48]
Matt Albright shared:
“And you know, I’m an impatient American. So my next question to you is going to be: When? I think we’ve legislatively done things out of emergency and some of the states and certainly CMS is kind of pushing to keep certainly some of the waivers that are in telehealth to keep them permanent. So we’re starting to see that already but on the same token the interoperability rule enforcement has been delayed because the hospitals just don’t have the bandwidth to make that lift right now. And the transparency rules are being argued in court.
So I guess, I don’t think we have the question here, but when are we going to see this consumer-driven healthcare take place? And when are we going to see, McKinsey says 20% of our healthcare visits will be virtual – our healthcare payouts – be in just a year or two? When do you think we’re going to see that? Is that going to have to wait for Congress to have lots of discussions about it and three or four years later we have regulations? What do you think?
“Well, and you know, there’s an interesting connection between Congress and the healthcare consumer. And that is, Congress exists because of voters. And voters are consumers of healthcare and consumers have experienced a very different healthcare environment in the last six months than they had experienced over the last number of years or even decades.
So part of the answer around when (consumer-driven health becomes widespread) shows up in the emergency orders, the state initiatives, governors’ responses, and even at the federal level some of the initiatives and emergency orders that President Trump and others, agencies have issued and put out there.”
Healthcare System Survival Mode – Uncertain Recovery Timeline
[44:49 – 46:57]
Ferris shared an analogy and his take on when the healthcare system may recover.
“Obviously, along with when is how, how do we finance it? And how do all of those pieces come together? Right today, it’s hard right today to give a specific answer to your question. I kind of feel, I don’t know about you, but I feel hunkered down in the foxhole in the middle of a war with bullets flying. Flying over my head. I’m sheltering in place. I haven’t been on a plane since I think the last time I saw you in Jacksonville. And that was my last trip and I had a whole bunch of them planned but life has changed. But when you’re in that foxhole, it’s not the time to stand up and get up on a Podium and say let’s do this. Let’s do that.
I think we’re in a survival mode right now in healthcare. We’re still dealing with a surge. But as we start to flatten the curve and as we get back into the Healthcare System, the benefit designs to deal with a pandemic like COVID and the incorporation (of new services) into those designs and into the pricing for 2021. Or it might even be that it takes 2022 to get all of the financial part of this back in place so we have a stable healthcare system.
I have no doubt that we will get back to this new reality of consumerism, transparency, interoperability and the incorporation of 21st Century Technologies: artificial intelligence, machine learning, interoperability and real-time data exchange.”
Inveterate (Chronic) Innovation – Table Stakes for Survival
“So, I think the answer to your question is: this too will pass, and we will get through COVID-19. I don’t know exactly when that will be. But on the other side in my 30 years in healthcare, I continue to just be very impressed with the inveterate innovation that has come into healthcare.
[49:27 – 51:41]
Innovation is here to stay. It’ll have to get priced out. It will have to get built into the financial models that make healthcare work. Hospitals, some hospitals are doing fine financially. Some, especially rural hospitals, are under extreme pressure. Different specialties in healthcare are experiencing different results. Health plans are concerned about all of the delayed, non-essential healthcare comes back. Is that going to hit them financially and with premium increases?
We’re a very state of the art, world-renowned healthcare industry and we’ll figure this out. I think that stability on the other side of the bridge will be consumer-centric. It’ll be transparent – whether it’s from costs or delivery processes or anything else. The delivery system will be much more virtual and if you push me, I’m going to say some time in 2021 – for sure 2022 – we’ll be back on track.”
Matt Albright added:
“Good. Ferris, I think you bring a great perspective. There’s no longer looking forward to Innovation. Innovation has already happened and we’re not calling it innovation anymore. We’re calling what we do on a day-to-day basis now with healthcare as innovation. I think that’s a terrific point. And I think there’s a lot to be said for how quickly our healthcare system reacted and proactively moved to take care of this pandemic.
And frankly, I’d probably have to say the same for our political systems. They came out very quickly. The governors came out very quickly with emergency orders that freed the providers to do what they needed to do. And even Congress, there’s a criticism to be had there, but they turned things around very quickly to get things moving. So, I think that’s a great point, things are already happening. Things are already here. Maybe there’s nothing that we need to wait for?”
2020 Industry Pulse Flash Update
[51:42 – 52:28]
Matt concluded the inaugural episode of The Collective Voice in Health IT podcast series with a question as to when the results and analysis of the COVID-19 Industry Pulse Flash Update survey will be available.
“I looked at the initial results of the flash survey on Tuesday, so just two days ago. We’ll have something ready to publish in two to three weeks. And I think Michael (McNutt – WEDI Director of Education & Events) and Charles (Stellar – WEDI CEO) and you and I have talked about coming back here in August with a WEDI-specific webinar. We can have questions coming in and be able to respond to those in an interactive way. So three to four weeks and we’ll be back on the air. Thank you, Matt, Michael, and Charles, for a great discussion.”
Connect, Collaborate & Create Solutions – The Collective Voice in Health IT
Matt closed the initial episode of The Collective Voice in Health IT with a call for the health information technology community to connect, collaborate, and create solutions for a Better Health System. If you’d like to participate in identifying, creating, and sharing information, ideas, and opinions on areas of interest to healthcare leaders and change-makers, reach out to us here.
Last year was a very busy year for the HealthCare Executive Group (HCEG.) In addition to hosting our 31st Annual Forum in our birthplace of Boston, Massachusetts, HCEG hosted two Executive Leadership Roundtables, presented the CIO & CTO Strategy Track at the 16th Annual World Health Care Congress, delivered seven webinars in conjunction with our sponsor partners, published 35 blog posts addressing challenges, issues, and opportunities facing healthcare leadership, and presented at several of our partner’s conferences and events.
Moreover, in 2019 HCEG became an Educational Partner with America’s Health Insurance Plans (AHIP) and a Collaboration Partner with the Health Information Management Systems Society (HIMSS.) For 2020, we have an equally insightful and interesting agenda of live, in-person and virtual events and content in store.
Looking Back at HCEG Events – Live, In-Person & Virtual Healthcare Innovation & Transformation
31st HCEG Annual Forum
Our 2019 Annual Forum marking our 31st annual event since HCEG was founded in 1988 took place in Boston, Massachusetts – the birthplace of the HealthCare Executive Group. Check out this page for the agenda, photos, and some proceedings from the forum. You can also view video interviews of various speakers and attendees here.
In addition, HCEG presented the CIO & CTO Strategy Track at the 16th Annual World Health Care Congress. This track consisted of six separate sessions over two days. See the recap of the WHCC event and the CIO & CTO Strategy track presented by HCEG here.
2020 HCEG Top 10 List & 10th Annual Industry Pulse Survey
The 2020 HCEG Top 10 list of challenges, issues, and opportunities facing healthcare industry leaders, innovators, and change-makers was created by participants of our 31st Annual Forum. This list was then used as the basis for the Industry Pulse research survey sponsored by HCEG and sponsor partner Change Healthcare.
Webinars & Blog Posts Advancing Healthcare Innovation & Transformation
One of the ways we share healthcare information, insight, & ideas is via our Webinar Series Events and blog posts. Our blog posts share insight, information and ideas on items in the HCEG Top 10 list, recaps of webinars and HCEG hosted events, and other information of interest to healthcare industry leaders, innovators, and change-makers.
Check out this blog post for information, insight, & ideas presented in our webinars and blog posts in 2019.
Looking Forward to HCEG Events & Content in 2020
For 2020, the HealthCare Executive Group has a full schedule of live, in-person and virtual events and a full calendar of content throughout the year. In addition to releasing the results of the 10th Annual Industry Pulse research survey conducted in partnership with Change Healthcare next month, we’ll be creating the 2021 HCEG Top 10 list at our 32nd Annual Forum this coming September.
We’re also looking forward to our new Educational Partnership with America’s Health Insurance Plans (AHIP) and acceptance a Collaboration Partner with the Health Information Management Systems Society (HIMSS.)
32nd HCEG Annual Forum
Our 32nd Annual Forum will be held in Boston, MA on September 21-23, 2020. We’re planning our best forum ever and have some interesting speakers, special events and new information-sharing opportunities planned. Sign up here to receive Annual Forum updates and registration details.
In addition to our Annual Forum, we’re planning to host several Executive Leadership Roundtables at major healthcare industry conferences:
The results of the 10th Annual Industry Pulse survey will be released next month. This important industry survey is based on the 2020 HCEG Top 10 List and offers a deeper dive into the top challenges, issues, and opportunities facing healthcare leadership. Here’s last year’s Industry Pulse report.
Every year, HCEG events – including live, in-person events and virtual events like webinars and blog posts – are driven by items on the current HCEG Top 10 list. In addition, HCEG hosts and presents a Webinar Series Event nearly every month on the 3rd Thursday of the month. And publishes blog posts on a bi-weekly basis. In addition to topics centered on specific events and HCEG Top 10 items, content created and curated by HCEG will be focused on the following themes in each month of 2020:
2019 Recap & 2020 Preview
2020 HCEG Top 10 List
2020 HIMSS Conference
10th Annual Industry Pulse Results
2020 World Health Care Congress
32nd HCEG Annual Forum Agenda
AHIP Institute & Expo 2020
HCEG Top 10 Mid-Year Review
32nd HCEG Annual Forum
2020 HLTH Forum
2021 HCEG Top 10
11th Annual Industry Pulse Survey Opens
2020 HCEG End of Year Recap
Connect with Healthcare Industry Executives, Leaders, Innovators & Change-Makers
The 2019 Annual Forum of the HealthCare Executive Group (HCEG) took place on September 9th through the 11th at the Commonwealth Hotel in Boston, MA. In this 31st forum, healthcare leaders and other champions of healthcare system transformation had the opportunity to share their insight, ideas and information on key healthcare topics. Current investment trends, new business models needed to accommodate an increasingly consumer-focused marketplace, the imperative to decrease administrative costs, healthcare’s huge cost control problem, and other current challenges, issues, and opportunities of today’s uncertain healthcare environment were key themes.
Mabel Jong, principle at MJC Communications, LLC and professional on-camera interviewer, panel moderator and award-winning journalist with over two decades of experience specializing in healthcare and business news production interviewed a dozen healthcare leaders participating in HCEG’s Annual Forum. This blog post presents a number of these interviews.
Where Venture Capitalists are Focusing Their Healthcare Investments
Ricardo Johnson, Senior Director – Healthworx, at CareFirst BCBS – shares insight on healthcare innovation and the types of investments corporate venture capital groups and private equity firms are making in health plans and risk-bearing payer/provider partnerships. Ricardo provides an overview of what he sees as key areas of focus for investment and where more investment is needed.
Differentiating Business Models to Serve High-Risk, Poly-Chronic Patients
Ian Laird, National VP of Growth of DaVita Health Solutions, shares insight on value-based care, the unique needs of small patient populations that represent 40 to 50% of the total cost of care for a typical medical practice and the need for modern medical practices to accommodate differentiated business models.
Healthcare Innovation and the Importance of ‘Getting Out of Our Own Way’
Dr. Jason Woo, MD, Founder of Learning Core Leadership Through Service, shares insight on the various mindsets that help or hinder healthcare executives as they transform their organizations. Dr. Woo notes that positive growth in healthcare has lagged that of most other industries and that healthcare still has the same problems now as it did 30 years ago.
Taking Administrative Costs Out of the Healthcare Ecosystem
David Querusio, CTO of Harvard Pilgrim Health Care shares insight on how recent hospital and provider group mergers may be taking administrative costs out of the system, the importance of developing and providing a ‘platform’, and strategic innovations taking place in the healthcare value chain on both the payer and provider side.
Healthcare’s Huge Cost Control Problem
Niall Brennan of the Health Care Cost Institute (HCCI) conveyed insight into HCCI’s cutting-edge research to help people understand why healthcare spending is the way it is, the geographic variation in how healthcare money gets spent nationally, and how the ongoing consolidation of healthcare markets can result in less competition and less flexibility for negotiations between providers, payers and employer groups.
Extracting Waste in Healthcare: An Imperative for Today’s Healthcare Leaders
Bruce Jones, CIO of Excellus BCBS, shares his take on the need for healthcare leaders to look at every single process and figure out what the waste is in those processes and the need to take out that waste with new technologies like robotics process automation and artificial intelligence. Bruce also talks about the need for the healthcare industry to adopt more quality processes like Lean Six Sigma.
Remaining Focused in Disrupted Healthcare Environment
Mariya Filipova, VP Innovation at Anthem, relates how to remain focused while dealing with all of the changes rapidly transforming healthcare. And how creative collaborations between formerly competitive organizations are coming together to improve outcomes and reduce costs. Mariaya also shares insight on the process of managing patient consent and provider credentialing as examples.
Transportation as a Key Benefit for Medicaid & Medicare Beneficiaries
Megan Callahan, VP Healthcare at Lyft, shares her take on Lyft’s experience providing non-emergency medical transportation to Medicaid and Medicare beneficiaries; how NEMT saves time and improves outcomes but also increases independence and happiness of those who utilize this increasingly common non-medical benefit.
Impressions of HealthCare Executive Group’s 31st Annual Forum
Sheri Johnson, AVP of Member Enrollment & Billing at UCare, an independent, non-profit health plan providing coverage and services across Minnesota and western Wisconsin on the importance of always striving to ensure the best member and patient experience, leveraging readily available member/patient data, and being open to creating or entering partnerships with others whose mission is complimentary toward improving healthcare outcomes and lower costs while sustaining longevity.
The HealthCare Executive Group and Its Evolution Over the Years
Richard Lungen, Managing Member of Leverage Health and HCEG board member shares his take on what makes the HealthCare Executive Group and its long-running annual forum different than other healthcare conferences, how it’s participants have changed over the years to include not only health plans but health systems, various types of providers, investors and other diverse organization.
Healthcare Leaders Leverage the HealthCare Executive Group
In addition to our Annual Forum, the HealthCare Executive Group offers periodic Executive Leadership Roundtables, live presentations, webinars, regular blog posts, and other original and curated content to support the information and networking needs of today’s healthcare leaders. Our next events include the following:
Executive Leadership Roundtable at 2019 HLTH Forum
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