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
Healthcare payers are sitting on a lot of data, from eligibility data, to claims data, to data obtained from 3rd parties, to data derived from analytics. It’s no surprise that over the last decade “Data & Analytics” has been a consistent entry on the HealthCare Executive Group’s Top 10 list of challenges, issues, and opportunities facing healthcare executives. And currently ranked #1 on the 2019 HCEG Top 10 list. To help share insight, ideas, and actionable information supporting data and analytics, our sponsor partner EQ Health Solutions presented our June Webinar Series event: Solving the Rubik’s Cube of Payer Data.
Chief Strategy & Growth Officer Mayur Yermaneni and Marina Brown, RN BSN, Vice President of Clinical Programs, from eQHealth Solutions shared information and insight on the following four topics:
The current state of the payer market and future considerations
The Rubik’s Cube of Payer Data – the Present Debacle
What tools and technologies will lead to continued payer success?
Top six things to consider when evaluating your healthcare analytics vendor
Highlights from Solving the Rubik’s Cube of Payer Data
This blog post presents some highlights from the webinar and provides access to additional information from the webinar. You can also check out this Twitter Moment summarizing live Tweets from the webinar. The complete recording of the webinar can be found here. To jump to the specific place in the recording, click on the timestamp range [HH:MM] that accompanies each transcripted section below.
For more information on how EQ Health Solutions can advance your organization’s data and analytics initiatives and programs, contact EQ Health Solutions.
Current State of the Payer Market and Future Considerations
Mayur Yermaneni shared some insight into current data and analytics capabilities of healthcare payers: [7:16]
Some payers are firmly in an average spectrum of recognizing current trends and some and some payers are still in the infancy stages of recognizing the impact of these trends. So, I’m trying to generalize some of these themes so that everybody can actually benefit from it.
Margins are Decreasing
So, across the board, one of the key things, and I guess this is not unique to the payer market itself, is that margins are decreasing. With new regulations coming on board there are more and more cost burden associated with the payer market. Some payers are becoming a financial institution from that standpoint [of increasing regulatory burden.]
You see this a lot more in the bigger payer, payers like Aetna’s acquisitions, United’s acquisitions, WellCare and all these acquisitions that are happening is [intended] to counter their decrease in margins by creating economies of scale that they could benefit by actually saying: “If I can actually acquire another of these entities, then I can create a cross burden rate across these common units and hopefully benefit from the margins play game.”
Nobody wants to show up and in tomorrow’s Wall Street Journal. In the current day and age, there’s an entire team dedicated just so that that payer’s name doesn’t show up on tomorrow’s newspaper. Primarily because with the PHI (Protected Health Information), the abundance of PHI information from all different sources. It’s extremely important to say: “Well how do we protect our data?” Payers have a lot more data than anybody else outside of providers.
And there are two different spectrums of the data set – and both are equally critical from the standpoint of ensuring that data security is a key aspect in your space because today, a 100 record, 500 records, or anything above that threshold you’re going to have to report it. So, data security becomes actual strategy nowadays. How do you make sure that your data security is actually playing to your advantage? And your customers have to be able to trust that and that Trust is what’s going to actually give you – even though that has nothing to do with the actual health plan itself, or the benefits members are receiving, or the card that they are receiving. But they still have to be able to trust that their data is secure.
Showing Value Vital in Provider/Hospital Negotiations [10:17]
Finally, when it comes to providing the value of data, the data set that payers are actually having to wrestle with: how are we showing the value that we are providing to the hospital segment, the provider segment, and the member segment?
But if you look at it, you still have to deal with all the other aspects before you get to the value component: administrative setup, data security, operating margins, and everything.Well, how is that actually happening? Big data. Well, I’m not going to bore everybody with the definition of what big data is but, in a nutshell, in today’s world of Instagram, Facebook and Snapchat it’s all about the volume and speed and the frequency of the data that you’re receiving. And in the payer market, it’s a lot of data. It used to be a monthly fee [to obtain/access data]. Now it’s an API call to an HL7 message which is instantaneous. And the amount of frequency that you’re having to deal with is a lot more than what you had before. And the number of types of data that the payer market is actually having to deal with is a lot more. And even in there, the data can be segregated into a couple of different ways:
The data that’s the primary data sources
The derived data sources that you’re generating as a result of your operation or as a result of some of the analysis that you’re doing on top of it.
So now that’s another big trend that the payer market is having to actually wrestle with.
Social Determinants of Health Data are Increasingly Important
Ferris Taylor [HCEG’s Executive Director] indicated that this [Data & Analytics] was the top topic and social determinants of health were one of the key aspects to it. And that hasn’t changed. What has changed is how that’s being viewed. Instead of being a peripheral data source to actually being a central component to how your operations need to be done from social terms of health standpoint.
Marina Brown, EQHealth’s Vice President of Clinical Programs added:
I was just going to say that I do think that this is really a big one for the industry. Social determinants of health are definitely going to help change the way that we deliver health care. And that’s a very important distinguishment. It’s not going to change the way that we do health care because we treat a diabetic the same but it will change the way that we deliver care simply by helping to better guide the interventions that we’re utilizing to create more meaningful behavior change over time.
Tools and Technologies to Solve the Rubik’s Cube of Payer Data
Marina and Mayur shared an overview of the tools and technologies that healthcare payers are using to identify trends, root causes of patient and population-level issues, and transforming healthcare payer’s data and analytics infrastructure.
Another key aspect is artificial intelligence. Now again I don’t want to get into the definitions of artificial intelligence, but the key aspect is, with the advent of big data with the advent of the amount of data you’re having to deal with. It’s not humanly possible for a supervisor or a manager or a management team to be able to simulate all the data and actually say: What am I making use of this data? And how am I going to make use of this data? And what decisions am I making?
So artificial intelligence – or machine learning – and they’re not necessarily synonymous but in some in some aspect they’re synonymous in terms of combining the wealth of data that you’re getting and actually seeing what insights can be derived based on all those data sets; at a much more faster pace and a more timely manner compared to what we would have had to do if we were doing it manually. And there is an element of: how do we use the machine learning algorithms or artificial intelligence approaches to say: Can I do a better prognosis?
Everybody’s aware of [IBM] Watson’s cancer cure approaches to it and Watson has evolved a lot of other stuff. But predominantly in the mainstream the payer market, this hasn’t yet taken off into a full-fledged problem because we’re dealing with not necessarily a literature research but more in the realm of operational research and operational analytics.
Hear more from Mayur and Marina about tools and technologies at [13:09] and [24:53] in the recording.
How can we employ artificial intelligence or machine learning concepts into the operational realm of the payer operation? [14:40]
There are some positive trends. There’s a huge growth of Medicare Advantage (MA) plans. Their margins continue to increase because it’s a catch-22 situation for MA plans because of the risks. And now MA plans are able to accurately reflect their risk scores. And as a result, their premiums are being reflected the right way – which actually helped them from their margin standpoint because their operations were still on the same aspects of it because in the previous era they were not reporting their risk the right way because they didn’t have all the data gathering up opportunities. But now that they’re able to gather their [data analysis] opportunities, they can predict their risk a lot more accurately, so their premiums are going up. As a result, the margins are getting better and also the operations have stayed the same.
Government Plans Off-Loading Operational Functions to Health Plans
And in the Medicaid managed care space what you’re seeing is a lot more growth in that space for, predominantly, what we could say s for one single reason: most of the state administrative entities are actually trying to off-load the burden onto the plans so that risk is being passed on to the managed care plans and the state entities become the administrative agency. Of course, with that, they’re also holding performance measures as an accountability which is not just about the financial side of it but also the quality side of it because they don’t want to sacrifice the quality of care being rendered to their beneficiaries. But as a result, you’re seeing a lot of growth in the managed care space Medicaid managed care well
What does this mean to me or my organization as a payer? [16:29]
If I actually eliminate all the big terminology, fundamentally there are two simple concepts:
Is our plan performing better than what it was before from a cost standpoint? And with the qualifier added, is the plan performing to a level where the plan can afford too? Because one of which you’re collecting to your risk is what you’re paying out. That’s one of the key foundations. That’s a simple question that you’re going to answer.
And the second aspect of it is:
Are we improving the quality of our plan? And quality can be defined in multiple ways. I think the STAR rating, the HEDIS measures, and all that stuff. But at the end of the day it’s really are you improving quality in terms of outcomes for the members?
And the second point is actually impacting the first point from a long-term standpoint. So, if you’re impacting the quality aspects of it, then you’re able to impact the cost aspect of it as well. But it doesn’t happen every year, it happens over as a strategic view. You have to put that as a strategic view long term view so that on the short run your cost structure might have variances but over a long run, you’re actually improving the trends of that one.
Operational Simplicity and the Health of Your Health Plan[17:54]
But what does that mean in terms of a payer when you think about how you have to think about it?
It comes down to two things: operational efficiency and health of your health plan. How do we make a difference in looking at all the data that we have and actually answer these two business questions; and then tie them back to the simple questions of ‘Am I performing better in terms of cost?’ And ‘Am I improving the cost?’
I think that operationally looking at the data is really going to, as a program administrator, is going to give me insight into things like the following:
What care management programs or medical management programs are most needed for my population?
What programs that I’m currently utilizing are really the most effective ones?
Taking that a step farther as you look into those specific programs that are most effective, you’ll also then be able to look at things like: What are the interventions that are most effective in this population. From a utilization review perspective?
Is my UR working only as a gatekeeper for my health plan or are we actually effectively managing acute episodes and beyond that acute episodes? And then really helping us determine all of this ultimately helps us determine what care intervention strategies do we need to tweak? Which ones do we need to add to our programs to create that meaningful behavior change that increases the health of our membership, increases the quality of the care that’s being provided to that membership, and ultimately reduces the cost?
The Rubik’s Cube of Payer Data – the Present Debacle
Mayur shared some insight into the struggle that many payers have regarding reporting and analytics:[20:03]
In a lot of ways, payers are struggling between: Am I doing reporting or am I doing an analysis? And how am I looking at it? Am I doing the analysis for the sake of reporting or am I doing analysis for the sake of improving or answering the two questions that we started out with?
Is our plan performing better than what it was before from a cost standpoint?
Are we improving the quality of our plan?
And those could be the patient member outcomes, quality standards, STAR ratings, keeping benefits cost down, maintaining the profit margin, improving efficiencies. All of these are questions that every payer is asking.
And the list goes on and on and you guys are actually dealing with a lot more in today’s world. I’m sure every organization has a ton more questions to add to it but, fundamentally, why and how to do it is where the biggest question comes into play because often everybody goes down the path of: ‘Okay, I need to solve this reporting problem so I need to have this kind of technology in place. I need to solve my data analysis problem from a predictive modeling standpoint, so I need to have this technology base.
And as a result, you’re creating more and more silos within the analytic space and not necessarily taking advantage of the full spectrum of the data that you have or creating in its entirety in a holistic view. Because at the end of the day, if the technology analytics is being used for the reporting purposes then you only solve 30% of your problems because the majority of your problems are deriving insights from your data and actually saying how can we make a difference in our operations? How can we make a difference in our outcomes?
Payers have multiple data sources and everything is often viewed as a silo.[23:30]
Healthcare organizations are maturing but fundamentally they’re still struggling with the aspects of:
Am I doing quality analysis?
Am I doing financial analysis?
Am I doing operational analysis?
Or am I doing just reporting for the regulatory agencies?
Payers need to design their operational strategy to leverage all quadrants of dimensions: Quality, Financials, Operations, and Predictive Analytics.
Marrying Clinical Expertise with Data Analytic Capabilities [25:04]
I want to talk briefly about the key components that are going to make a difference. Often what happens is an analyst is asked a question and they actually come back and that data set is then presented to clinical leadership. And then clinical leadership asks a follow-up question and then makes some decisions on top of it. But in reality, what if you change that and involve that clinician up front during the analysis itself, along with the data scientist? So, what we view in the industry is that there’s a lot more benefit if you actually pair the clinicians and the data scientists together up front in the design and analysis phase.
So that 1) you can cut down your cycle crime and 2) you’re asking the questions up front and how to think about your operations. And that’s going to help frame your reporting and analytics problem in a way where you’re getting to a solution much faster.
I think that’s a really important point that you’re making. I think bringing these two teams of people together helps to bring about that important balance and maximize your outputs because your data scientists are experts at identifying the trends and the data. And when that information is presented to the clinicians, they can then help interpret those trends. That’s going to ultimately formulate your adjustments to your operations, your program design, etc. I think that’s a great point.
Pairing Clinicians with Data Scientists Frees Up Time for Patient Engagement
And another aspect to it is, when you’re thinking for clinicians, you’re actually taking away their valuable time working with a member. If you’re asking them to understand what’s happening with the data and go into the exercise and then making the decision to it. But if you pair them up front, you’ve solved the problem and then you’re giving them time to have their team’s focus more on the members then they are focusing on the data itself.
Right. Care teams are so busy trying to make that outreach to the members that having that technology available to them, to be able to guide them to identify trends or issues with that particular member, is going to save time. And it ensures too that all of the important or pertinent trends for that particular member, for that particular population, are being identified. Because at the end of the day, clinicians are just that, clinicians. They’re not data analysts.
Developing a Multi-Dimensional, 360-Degree View of Your Data
Marina and Mayur presented some insight and ideas on how to create a decision-making framework providing a multi-dimensional, 360-degree view for your clinical, operational, administrative, and financial teams.
See [28:15] for more information, insight, and ideas on creating a multi-dimensional, 360-degree view of your clinical, operational, administrative, and financial data.
Top Six Things to Consider When Evaluating Healthcare Analytics Vendors
Here are top six things that you should consider when you think about analytics or in the majority of organization’s how you want to get there.
Intuitive Easy-To-Use Platform
Actionable Real-Time Data Visualization
Acceptance of Data in Any Format
For details on the importance of each of the above considerations for evaluating healthcare analytics vendors, listen in starting at [36:04].
Questions from Webinar Series Attendees
Our organization currently executes minimal analytical formalities, processes, etc and we are at an immature analytical state. Would investing and working with an analytics vendor refute all [our efforts] at this stage in our organization? [44:37]
Mayur: No. You can view it from the standpoint of: if you’re in the early stages of maturity then that would be the perfect time to assess how you want to design your system and what kind of systems you want to have in place. And you may not have to go through the same evolution steps that the entities started out early on. You may actually leapfrog by taking in all that stuff up front itself. So absolutely, even if you don’t have all the data organized in a unified view that’s fine too because you do have data sets. The first steps very well could be how do you get them into the unified view. So I wouldn’t hesitate working with and investing in analytics if you’re in the early stages of maturity because this very well could be an opportunity where you don’t have to redo the some of the things that you might have done if you’re already in further stages.
Our organization prides itself on taking the best care of our patients. Can you give us examples of how using an analytics vendor can improve our patient outcomes vs. just us monitoring it internally?[46:03]
Marina responded to this question with an interesting story about how EQ health identified and assisted high-utilization, low literacy, diabetic patients in the Mississippi Delta. Listen at [46:22] as to how EQHealth made life easier for patients and improved their health, all while reducing emergency room visits and inpatient admissions.
My team is discussing the decision to build an analytics platform internally or buy and outsource it with a vendor. Do you have any insight into what is more successful and pros and cons? [50:50]
Mayur: I don’t think there is a right answer or wrong answer. It really centers on your strategy. Are you trying to make that as your core competency or are you wanting to retain your core competency to manage plan operations but want to have the benefit of the analytics and the analytics platform; then at that point you should outsource. But if you’re wanting to make analytics your core competency, then you need to have that in-house. But when you do decide to make it in-house, you still need to… hear the rest of Mayur’s answer at[51:08]
Listen to more questions and answers from Solving the Rubik’s Cube of Payer Data here.
In addition to connecting with us on Twitter and LinkedIn and subscribing to our eNewsletter, consider joining other healthcare executives and industry thought leaders at our 2019 Annual Forum in Boston, MA on September 9-11, 2019. In addition to the always insightful, information-packed sessions and networking opportunities our annual forum offers, we’re including two special networking events on Monday, September 9th:
Tour of the IBM Watson Research Facility in the morning
Red Sox vs. Yankees Baseball Game at Fenway Park in the evening
As America celebrates Thanksgiving, the HealthCare Executive Group (HCEG) is honored to thank our sponsor partners and acknowledge the support these leading healthcare companies have provided and continue to provide to our healthcare executive members, industry advisors, and associates throughout the year. Through the support of the companies highlighted below, HCEG is able to provide a comprehensive package of information, insight, and networking opportunities.
HealthCare Executive Group – Gold Sponsors
Appian delivers the speed of enterprise low-code and the power of industry-leading intelligent automation. It’s the secret weapon to put your Digital Transformation on the fast track.
Improve decision-making with real-time access to patient, member, and provider data. Appian helps healthcare payers and providers speed innovation, help consumers take control of their own health, and simplify the healthcare journey.
CareCentrix has developed purpose-built technology, analytics, and experience to guide care that keeps patients on the path to the ultimate site of care: home. To address the complexities of post-acute care, CareCentrix engages patients and caregivers, coordinate care transitions, improve clinical outcomes, and do all we can to help patients heal or age at home.
By finding new ways to break down the silos across the continuum of care, CareCentrix is able to identify and capture savings health plans can count on.
Solera connects patients, payers, and physicians to a network of partners who are preventing and managing chronic disease.
Working with Solera, health plans and other payers securely and efficiently leverage a network of community-based and digital health solutions.
Solera helps employers identify and engage those in their workforce with the greatest opportunity for obesity-related chronic disease prevention.
Change Healthcare consulting is a catalyst for your value-based healthcare system. Change Healthcare is a healthcare technology company that offers software, analytics, network solutions, and technology-enabled services to help create a stronger, more collaborative healthcare system. Change Healthcare helps deliver measurable value not only at the point of care, but also before, after, and in between care episodes.
Cumberland Consulting Group is a leading healthcare consulting firm providing strategic advisory, implementation, optimization and outsourcing services to some of the nation’s largest payer, provider, and life sciences organizations.
Health insurers must act quickly to launch new offerings targeted at member populations in specific market segments. Whether a government program, commercial or individual product, or dental or TPA offering, HealthEdge works with transformative health plans to create and maintain a competitive advantage.
HighPoint implements effective IT solutions for payers and providers. HighPoint Solutions tunes out the noise so you can focus on improving healthcare delivery.
InstaMed powers a better healthcare payments experience on one platform that connects consumers, providers, and payers for every healthcare payment transaction. InstaMed’s patented, private cloud-based technology securely transforms healthcare payments by driving electronic transactions, moving money and healthcare data seamlessly and improving consumer satisfaction.
RedCard helps health plans and TPAs use the power of secure data to build stronger, more effective communication with your members and providers.
Softheon delivers cloud-based solutions that create a retail-like, user-friendly experience and provide personalized communication and real-time support to boost member engagement. Cost effective, and configurable software that supports health plans and states with enrollment, member billing, and reporting for over 3.2M Americans.
Unlike what many organizations allow, our sponsor partners must check their sales and marketing interests at the door. HCEG sponsors participate as supportive thought leaders to HCEG members and associates. HCEG events and content exclude advertising and marketing-speak and participants at our events will never encounter vendor exhibits. Those reading our content and attending our webinars will not be bothered by sales pitches, pop-ups and banner ads.
For more information on the benefits of becoming an HCEG Sponsor in 2019, check out our Sponsorship Prospectus.
Join Digital Healthcare Leaders & AHIP Forum Attendees in Nashville
In addition to lunch and networking opportunities, participants will enjoy the unique perspective and long-running insight of two distinguished panelists: Brian Lobley, President, Commercial and Consumer Markets at Independence Blue Cross and Stuart Hanson, Managing Director, Head of Healthcare Payments at JPMorgan Chase & Co. HCEG’s Executive Director Ferris Taylor will moderate the roundtable.
2018 celebrates the 30th anniversary of the Healthcare Executive Group – an organization dedicated to supporting and convening senior level executives focused on continuous innovation, evolution, and transformation of the healthcare industry. As part of our mission of promoting healthcare innovation, providing innovative knowledge support and helping to foster and sustain the development of life-long business relationships through real-life and virtual relationships, each year our members develop the HCEG Top 10 list of opportunities, issues, and challenges. This year marks the 10th anniversary of the HCEG Top 10 list of Challenges, Issues & Opportunities.
Healthcare Executives Identify Top Challenges, Issues & Opportunities for 2019
During our 2018 Annual Forum in Minneapolis last week, HCEG executive members from the payer, provider, and technology partner organizations voted on and ranked the Top 10 critical challenges, issues and opportunities they expect their organizations to face in the coming months and throughout 2019.
Starting with a list of 25 topical areas selected by HCEG Board members, advisors, and culled from leading industry research, 100+ forum participants held roundtable discussions over lunch to identify their specific table’s weighted top 10 items. The top ranking items from all tables were then combined to select the ten highest ranking items. Forum participants then ranked these items via a digital ranking process culminating in the official 2019 HCEG Top 10 list.
Our members expect the 2019 HCEG Top 10 items to have a significant and lasting impact in the way health plan members, health system patients, healthcare consumers, and other constituents all become engaged, digital consumers and responsible healthcare stakeholders in 2019 and beyond.
The 2019 HCEG Top 10 List
Data & Analytics: Leveraging data (especially clinical) to manage health and drive individual, provider and payer decisions.
Total Consumer Health: Improving members’ overall medical, social, financial, and environmental well-being.
Population Health Services: Operationalizing community-based health strategy, chronic care management, driving clinical integration, and addressing barriers to health such as social determinants.
Value-based Payments: Transitioning to and targeting specific medical conditions to manage cost and improve quality of care.
The Digital Healthcare Organization: HSAs, portals, patient literacy, cost transparency, digital payments, CRM, wearables and other patient-generated data, health monitoring, and omnichannel access/distribution.
Rising Pharmacy Costs: Implementing strategies to address the growth of pharma costs along with benefits to quality of care and to total healthcare costs.
External Market Disruption: New players like Amazon, Chase, Apple, Walmart, and Google.
Operational Effectiveness: Implementing lean quality programs, process efficiency (with new core business models), robotics automation, revenue cycle management, real-time/near-time point of sales transactions, etc.
Opioid Management: Developing strategies for identifying and supporting individuals and populations struggling with substance abuse/addiction or at risk of addiction.
Cybersecurity: Protecting the privacy and security of consumer information to maintain consumer trust in sharing data.
Highlights of the 2019 HCEG Top 10 List
Last year’s item #7 Healthcare Reform dropped out of the Top 10 but only by one place to number eleven. And last year’s tenth ranking item – The Engaged Digital Consumer – was supplanted by fifth ranking item The Digital Healthcare Organization.
New entrants to the 2019 HCEG Top 10 list include
#7 – External Market Disruption
#8 – Operational Effectiveness
Additional details and analysis of the 2019 HCEG Top 10 list will further explore the reasoning through facilitated discussions at upcoming events and within the HCEG digital community.
The Purpose and Value of the 2019 HCEG Top 10 List
The HCEG Top 10 List is used for two general purposes, each of which is intended to advance the healthcare industry’s move toward the Quadruple Aim of Healthcare.
#1 – Content Development & Programming
Serves as the basis for HCEG’s ongoing content development and educational programming opportunities throughout the year. Each of the Top 10 items is explored at various levels of depth and breadth throughout the year via:
In addition to guiding the overall thought-leadership, content development, and knowledge exchange initiatives throughout the year, HCEG’s Top 10 list is used as the basis for The Industry Pulse, a research survey sponsored by the HealthCare Executive Group and our sponsor partner Change Healthcare.
The Industry Pulse research survey is designed to gather additional insight on priorities and challenges facing healthcare industry constituents across the country and provide stakeholders across the healthcare spectrum real-world, actionable insight into near-term obstacles and opportunities. Combined, the HCEG Top 10 list and The Industry Pulse encourage continuous and evolving dialog on the main issues and concerns facing member organizations. Learn more about The Industry Pulse here.
More About the 2019 HCEG Top 10
Over the coming weeks and months, additional original and curated content based on the 2019 HCEG Top 10 will be shared. And the 2019 Industry Pulse research survey will take place. To stay in the loop and to learn more about the 2019 HCEG Top 10 and the HealthCare Executive Group, visit this page on our website and subscribe to our newsletter.
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.
Completing a successful core-system replacement project at a health plan or health system organization is a major undertaking. And successfully delivering a multi-million dollar digital transformation project is significantly enhanced by establishing a framework based on proven principles.
Framework for Successful Core-System Replacement Project
Last week, our sponsor partner Change Healthcare shared valuable insight in a webinar titled ‘The Four Pillars of a Successful Core-System Replacement Project.’ Jeanne Noe PMP, Director of Consulting Services and Mauricio ‘MJ’ Jimenez, Sr Manager of Consulting Services at Change Healthcare, shared information, insight and practical ideas on how to establish a framework for successful core-system implementation. This framework for a successful core-system replacement project is based on four pillars: 1-Implementation Readiness, 2-Governance, 3-Business Transformation and 4-Execution Framework.
This blog post recaps highlights and detailed content from the ‘Core-System Replacement Project’ webinar presented by Change Healthcare on August 2nd, 2018. Included is a recording of the webinar, the presentation slide deck, and additional information on establishing a framework for successful core system implementation. You can also check out this Twitter Moment summarizing live Tweets shared during the webinar.
Information, Insight & Actionable Ideas for Successful Core-System Implementation
After introductions by HCEG Executive Director Ferris Taylor, Jeanne Noe kicked off the webinar by sharing that the most important indicator of success in a Core-System Replacement project is a strong project foundation. Jeanne emphasized the importance of building a foundation on the Four Pillars of Success before the project progresses – not as you go along.
Why, How, What, Who & When of a Successful Core-System Replacement Project
The presentation from Change Healthcare was packed with information, actionable ideas and insight collected over the course of performing dozens of core-systems replacement projects for major healthcare payers and other risk-bearing entities.
Starting with the Taxonomy of Why, the importance of clearly defining – and widely sharing – the Strategic Vision, Business Goals, and Objectives were shared. Jeanne noted that explaining why a legacy system is being replaced is a key way to help all project team members achieve project objectives. Yet few healthcare organizations widely communicate the reasons for major initiatives like a core-system replacement project.
Jeanne went on to provide more details and commentary on the How, What, Who & When of a core-system replacement project. Since there’s simply too much information to share about the how, what, who and when in this recap, see the slides listed in the presentation deck for more. Better yet, watch the recording of The Four Pillars of a Successful Core-System Replacement Project here.
Roles Matters – Clearly Defined & Accountable
One of the most valuable bits of insight shared by Change Healthcare’s Jeanne Noe was that too many healthcare organizations make the very common mistake of not clearly defining roles, responsibilities and decision-making authority. Before the project starts – and periodically throughout the projects as objectives change and project resources come and go.
Clearly defining roles, responsibilities and decision-making authority seems obvious but is simply often not addressed.
Key Governance Components of a Successful Core-System Replacement Project
Change Healthcare presented two important actions healthcare executives sponsoring core-systems replacement projects MUST address at the start:
Establish a single point of accountability and expertise
Clearly identify decision makers and specialists for issue resolution
Risks, Actions, Issues, and Decisions – It’s a RAID!
Somewhat similar to the widely known RACI (Responsible-Accountable-Consulted-Informed) approach for managing large projects like core-systems replacement projects, Change Healthcare’s Core-System Implementation Framework uses the RAID framework to report, track, resolve and document project items.
As opposed to the somewhat passive activities defined via the popular RACI approach, Change Healthcare’s RAID approach to governing major projects emphasizes the importance of actions and rapid decision making within a framework of issue identification and risk management.
Business Transformation & Core-Systems Replacement Projects
Mauricio ‘MJ’ Jimenez, Sr Manager of Consulting Services at Change Healthcare continued the second half of the webinar by sharing information, insight, ideas, and tips on the 3rd and 4th Pillars of a Successful Core-System Replacement Project: Business Transformation and Execution Framework.
MJ emphasized that replacing your core-system is a business transformation, not an IT project or initiative. MJ offered the following as some key considerations to effect a true business transformation:
Assign senior resources to serve as ambassador to the rest of the organization.
Neglecting employees affected by the transformation will guarantee resistance to change.
Relevant content is key and its delivery is enabled through Role-Based Training
When meetings grow in number of participants, it is often a reflection of poor communication.
Execution Framework – The Most Critical of the Four Pillars
Core-system and other major projects undertaken by healthcare organizations will be for naught without a well-designed Execution Framework. Change Healthcare’s MJ Jimenez shared some key experiences, insights, and ideas on how to establish an effective Execution Framework. And offered ideas for executing brilliantly.
The key components of the Execution Framework described include the following:
Systems Integration Plan
Summarizing the Webinar
Jeanne Noe shared the following slide at the end of the webinar.As noted before, the information, insight, and ideas presented by Change Healthcare are too numerous to recap here. To learn more about what was shared during the webinar, check out the recording of the webinar, the presentation slide deck, and additional information on establishing a framework for successful core system implementation. Also, check out this Twitter Moment summarizing live Tweets from the webinar.
More Insight & Opportunity for HealthCare Executives
The information shared by the HealthCare Executive Group in its Webinar Series events are one example of services we’re pleased to offer our members and associates. In addition to connecting with us on Twitter, Facebook, LinkedIn and subscribing to our eNewsletter, consider joining other healthcare executives and industry thought leaders at the HealthCare Executive Group’s 2018 Annual Forum on September 12-14th, 2018 in Minneapolis, MN. We’ll be celebrating our 30th Anniversary helping healthcare leaders navigate the strategic and tactical issues facing their organizations.
Check out this page for more information on our 2018 Annual Forum.
The HealthCare Executive Group (HCEG) was honored to co-host a special Executive Leadership Roundtable May 9th at the recent HLTH Future of Healthcare Forum. HCEG partnered with the International Association of Innovation Professionals (IAOIP), the Center for Healthcare Innovation (CHI), the Workgroup for Electronic Data Interchange (WEDI) and special guest Dr. Sunnie Giles for the Boardroom-style event. The theme of the roundtable was Leadership, Trust and Skills in Overcoming Obstacles to Radical Innovation in Healthcare. Over a period of 3 hours, Charles Stellar, CEO of WEDI, moderated a panel of innovation and healthcare thought leaders as each shared their respective insight on the following topics:
Ferris Taylor, HCEG Executive Director, shared insights on innovation and technology gleaned from the HCEG member organizations, the HCEG Top 10 and 8th Annual Industry Pulse Survey
Brett Trusko, CEO of IAOIP, shared an International overview of Innovation Certification programs
Lynn Hanessian, Chief Strategist, Edelman Health representing CHI, shared info and highlights from the Edelmen Trust Barometer research, and
Dr. Sunnie Giles shared key findings from her research and recent book supporting “The New Science of Radical Innovation”
Insight into Obstacles to Radical Innovation in Healthcare
After each panelist concluded their presentations and key takeaways, an open Q & A period between panelists and attendees took place. This discussion evolved into an intimate engagement among Executive Leadership Roundtable attendees ensuing into a free-flowing, rather ‘un-conference-like’ approach. Interaction was so engaging that many session participants hung around AFTER the official end of the Executive Leadership roundtable to continue the discussion, network with each other and build professional relationships that are destined to accelerate more considerations in the future.
Insights on Radical Innovation in Healthcare – The HCEG Top 10 and 8th Annual Industry Pulse Research
Ferris Taylor connected the development of the annual issues to the common theme of innovation and technology and then shared five highlights of the 8th Annual Industry Pulse report – a survey of 2000 healthcare stakeholders jointly conducted by HCEG and its sponsor partner, Change Healthcare.
Social determinants of health have now transcended buzzword status
High-deductible health plans are not converting passive patients into active healthcare consumers
Mobile/digital health adoption is not just about functionality and interoperability, but is significantly impacted by privacy and security concerns – more about trust than technology
Industry attention is turning to blockchain, artificial intelligence, robotic process automation and other advanced technologies
Healthcare is transitioning from negative to positive incentives to influence consumer behavior faster than most expect
The Edelmen Trust Barometer
After Ferris Taylor set the context for key areas of need and innovation in healthcare, Lynn Hanessian shared a detailed overview of the Edelman Trust Barometer – a measure of people’s trust in business, government, NGOs and media. Lynn opened with a sobering chart showing a historical decline in trust over the period of 2017 to 2018 – with 14 of 15 sectors showing an overall decrease in trust.
Lynn also shared insight from the Edelman report showing the division of opinion as to the impact of Tech to the Cost of Healthcare: 23% of respondents believed that technology will make healthcare MORE expensive over the next 5 years and 16% believe technology will make healthcare LESS expensive.
Overview of International Innovation Certification Programs
Brett Trusko of the IAOIP shared an overview of how the IAOIP is on a mission to professionalize the practice of innovation around the world. Brett shared the following methods that the IAOPI believes will be critical to promote the IAOIP’s mission of advancing innovation:
Brett also shared an overview of the Current Body of Best Practices for Innovation, why ‘professionalization’ of innovation is important, his beliefs as to why Failure to Innovate is NOT an Option, He closed his presentation with What You Can Do Now to advance the professionalization of innovation.
The New Science of Radical innovation
Dr. Sunnie Giles rounded out the initial roundtable presentations by sharing some highlights from her new book “The New Science of Radical Innovation.” Sunnie shared:
A Definition of Radical Innovation
The Concept of VUCA (especially in healthcare): Volatility, Uncertainty, Complexity & Ambiguity
4 Factors That Make Radical Innovation Challenging for Leaders
How to Harness Volatility, Uncertainty, Complexity & Ambiguity to Increase Innovation in Healthcare
Open Discussion About Innovation at HLTH Future of Healthcare Forum
All in all, the Executive Leadership Roundtable at HLTH was an informative and engaging event. Of the 120+ registrants, over half participated in the roundtable with a number of walk-ins and with many of those individuals remaining afterwards to continue the discussion about the opportunities and challenges for innovation in healthcare. Given that the HLTH Association Day was the afternoon of the last day of the 4-day HLTH forum, all participants and presenters considered it a great success!
HCEG appreciates the collaboration with Brett Trusko from the Association of Innovation Professionals, Lynn Hanessian representing the Center for Healthcare Innovation and Dr. Sunnie Giles of the Quantum Leadership Group. HCEG would also like to extend a special thanks to Charles Stellar of WEDI for moderating the panel and representing WEDI’s role in innovation and technology so well.
Connect with Each Other and The HealthCare Executive Group
If you enjoyed the 2018 HLTH Future of Healthcare Forum, or would like to participated in a greatly scaled down yet equally valuable version of the forum, consider being part of the HealthCare Executive Group’s Annual Forum taking place in Minneapolis, MN on September 12 – 14th. We have a special event planned to celebrate our 30th year anniversary. Moreover, if you’re a healthcare executive who can benefit from collaborating with your C-suite peers, consider becoming a HCEG member.
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.
Harry Merkin, VP of Marketing at HealthEdge and Dave Mika VP of Enterprise Core System Operations at Independent Health shared insight and real world experience on how health plans and their provider networks can transition from traditional fee for service (FFS) to value-based payment (VBP).
This blog post recaps highlights of the webinar and provides access to additional information from the webinar. A recording of the webinar can be found here. You can also check out this Twitter Moment summarizing live Tweets from the webinar.
Value-Based Payment Began in the Late 1990’s
In the late 1990’s, capitation models began paving the way for change from traditional FFS payment models to models focused on helping establish effective, cost-efficient practice models. In the last few years, value-based payments have become the latest and greatest models for reimbursement of care. The importance of value-based payments is supported by HealthCare Executive Group members ranking Value-Based Payment as #3 on the 2018 HCEG Top 10 list.
Moreover, recent statements by current and former HHS officials have supported the need for value-based payment:
“There is no turning back to an unsustainable system that pays for procedures rather than value”, and the transition “needs to accelerate dramatically.” – Alex Azar, Secretary of HHS, 3/5/18 at the Federation of American Hospitals’ conference
“I highly encourage health care leaders to listen intently to his full remarks. The transition to value is moving forward; if you aren’t already preparing for it, it is time to get on-board.“ – Michael Levitt, former governor of Utah and former HHS Secretary
Value-Based Payment Can Lower Costs and Improve Outcomes
Harry Merkin shared the results of a November 2017 Humana study showing that VBP programs achieve meaningful gains in cost and quality vs. traditional FFS methods with total healthcare costs associated with VBC plans 15% lower than care costs of FFS plans. And a more recent survey by the Healthcare Financial Management Association revealed that 70% of healthcare organizations participating in VBP programs have achieved positive results.
Value-based Payment Must Address the Quadruple Aim
Independent Health’s Dave Mika shared real-world insight into the experience his organization has witnessed. A key focus raised by Dave is that health plans looking to implement or extend value-based payment programs must address the four pillars of the Quadruple Aim:
Enhancing patient experience
Improving population health
Improving the work life of health care providers
Questions from Webinar Participants About Value-Based Payment
HCEG webinar series events always include the opportunity for questions from participants and this webinar was no exception. Two of many questions included the following short, paraphrased responses by Dave Mika – and other questions can be obtained from the webinar recording:
What is the key to gaining alignment with PCP’s?
Answer: Actively reaching out to and collaborating with key stakeholders in the local community.
What data has proven to be most useful to the provider network?
Answer: Information on patient gaps in care– ideally provided at the point of care in the physician’s workflow – can be very effective in improving value.
And More on How to Get There from Here…
In addition to the above, the webinar addressed the following considerations for transitioning from traditional FFS programs to VBP programs:
Aligning delivery and reimbursement models with high-performing providers
Tools for members to self-manage and self-navigate the care delivery system
Technology support including web and digital capabilities
The move to value-based reimbursement appears inevitable, and only those health plans and providers that begin to transition and adapt today will be successful in the future. Change doesn’t happen overnight. To learn more about how making the transition from FFS to VBP, check out the webinar recording, consider contacting HealthEdge for more information and keep in touch with the HealthCare Executive Group by connecting with us on Twitter, Facebook, LinkedIn and subscribing to our newsletter.
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?