Health Plans Intelligent Care Management Technologies. EHR Integration. Value-based payment programs. HELIOS. Closing the Loop.

5 Reasons Why Health Plans Must Adopt Intelligent Care Management Technologies

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Over the last 10+ years, nearly all health systems and healthcare providers have adopted some sort of electronic health record system (EHR). And since the start of the pandemic, these care providers have accelerated the use of telemedicine and remote patient monitoring tools to support their care management services. In addition, healthcare consumers are increasing their use of apps to manage their health, well-being, and related spending. These technology-based developments have enabled the collection of patient, clinical, and financial data in types and volumes never before possible; data that is essential to the operation of value-based payment programs.

Health Plans as ‘Keepers of the Data’ Need Advanced Care Management Capabilities

Moreover, recent regulations on data transparency, interoperability, and patients’ access to their data are strengthening health plans as a central repository of longitudinal aggregated data for plan members. By leveraging that data with technologies like artificial intelligence, machine learning, and robotic process automation, health plans are able to assist their provider networks with identifying, delivering, and closing the loop on the preventative, ‘whole-person’ and other population health management services critical to value-based programs.

RELATED:Intelligent Care Management Technology: Driving Alignment Towards The Quadruple Aim – Webinar, Thursday, October 7th, 2021 at 3:00 PM ET

Intelligent Care Management – Exceeding Typical Health Plan Capabilities

Intelligent Care Management Technologies (ICMT) go beyond the often disjointed utilization management, case management, and other clinically-focused services historically performed by health plans and provides an integrated, holistic approach to care.

Here are five reasons why health plans should be adopting Intelligent Care Management Technologies:

  1. Improves Patient Outcomes by Facilitating a Whole-Person Approach to Care

Being able to integrate, interpret, and efficiently utilize large data sets that span an individual’s entire health profile allows plans to help their provider network deliver insight and care at the right time and place. Potential life-threatening issues and medical complications can be caught sooner, enabling care providers to improve patient outcomes with fewer resources and at a lower cost.

  1. Extends Value of Provider Systems and Resources

Beyond not having a more complete patient profile, many care providers lack advanced analytics, guidelines, and tools that plans are better equipped to provide. The intelligent care management technologies shared by a health plan can positively impact provider practice patterns and improve overall care delivery to their patients and the plan’s members.

  1. Reduces Burden and Expense of Provider Network Partners

ICMT is integrated with existing provider and plan workflows with context, priority, and transparency to support faster and more informed care decisions by network physicians, nurses, and other care provider resources. Supporting clinicians helps to reduce the burden of increasing patient volumes and contributes to achieving the Quadruple Aim.

  1. Helps Address Social Determinants of Health and Leverages Community-Based ResourcesHealth Plans Intelligent Care Management Technologies. EHR Integration. Value-based payment programs. HELIOS. Closing the Loop.

ICMT helps tailor care based on social determinants of health, assessment tools, and guidelines to help identify, coordinate, and close the loop on services provided by network providers and local community-based organizations. Closing care gaps and assisting members and patients with obtaining medical and non-medical services from local organizations is an important part of value-based payment programs.

  1. Enables Health Plans to Assist Network Providers with Taking on More Risk

As care provider organizations and payers enter into more value-based care arrangements, it is critical for those organizations to strategically take on more risk and equitably share the cost of providing that care. Money spent on reactive care, avoidable hospital readmissions, and services performed in costly settings – among other things – are not only a waste of money but also burden increasingly scarce provider resources and negatively impact the patient experience. Intelligent Care Management Technologies allow plans to support their provider network by identifying, helping to coordinate and close the loop on proactive care across the care continuum.

RELATED: Intelligent Care Management Technologies: Key Considerations & Opportunities

Spreading Intelligence to Traditional Care Management

As the transition from fee-for-service to value-based payment programs accelerates and employers and consumers demand more their healthcare dollars, payers and providers must work with each other in more collaborative, intertwined ways. Utilizing intelligent care management technologies enables and supports the payer-provider collaboration essential to operating in today’s healthcare environment; and value-based arrangements in particular.

To learn more from healthcare leaders intimately involved with implementing and operating intelligent care management technologies, join us on Thursday, October 7th, 2021 at 3:00 PM ET for our live webinar “Intelligent Care Management Technology: Driving Alignment Towards The Quadruple Aim” presented by VirtualHealth.Health Plans Intelligent Care Management Technologies. EHR Integration. Value-based payment programs. HELIOSIf you’re not available, register anyway and we’ll send you a recording including presentation materials after the event.

Recapping ‘The 2018 HCEG Top 10 Healthcare Opportunities, Challenges & Issues’ Webinar – Part 1

By | HCEG Top 10 | One Comment

Last week we kicked off the first entry in the Health Care Executive Group’s 2018 Webinar Series: The 2018 HCEG Top 10 – Healthcare Opportunities, Challenges & Issues. The new board chair of HCEG, Kim Sinclair, CIO at Boston Medical Center Health Plan, moderated the webinar and was joined by Ferris Taylor, HCEG’s Executive Director and Consultant to Arches Health Plan and David Gallegos, Sr VP of Consulting Services at Change Healthcare,  one of HCEG’s long-time sponsor partners.

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?

David:

“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.”

Ferris:

“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?

David:

“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.

  1. It’s about 24-hour access to care.
  2. It’s about multi-channel access to information and services.
  3. It’s about providing relevant content to current or predicted life events.
  4. It’s about customized care plans to take individual patient specific conditions, genomic, social determinants all into consideration.
  5. 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.

Ferris:

“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?

Connect with the HealthCare Executive Group

If you want to learn more about healthcare in the United States and connect with like minded thought-leaders, consider subscribing to our eNewsletter, follow us on Twitter, and connect with us on LinkedIn and Facebook. Better yet, join our unique organization of healthcare executives and thought leaders.

‘Next Gen’ Data Strategy, Architecture and Technology to Achieve Innovation & Growth

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marklogic ahip institute Operationalize Before You Analyze: Innovation and Growth Powered by DataMany of our sponsor partners participated in the 2017 AHIP Institute & Exhibition in Austin, Texas earlier this month – sharing info on their healthcare products and services; and sharing information via informal and formal presentation sessions.

Bill Fox, VP of Healthcare and Life Sciences of our sponsor MarkLogic, moderated a panel titled “Operationalize Before You Analyze: Innovation and Growth Powered by Data.” The panel of business and technical leaders discussed how they have used “next gen” data strategy, architecture and technology to achieve innovation, growth and modernization results.  Panel members included:

Sunil Godbole, Senior Director, Application Development at Aetna Inc.

Glen Schuster, Consultant, former CTO at Centene Corp

Shahran Haider, Managing Director of Enterprise Data Strategy and Analytics at L.A. Care

Analyzing Data and Operationalizing Data Are Not the Same Thing

Bill Fox began the panel discussion by offering that analyzing data and operationalizing data are not the same thing and that many health care organizations have focused their innovation and growth investment on the “shiny ball” of analytics — the end stage of the data journey — instead of first improving the agility and speed at the beginning “operational” stages of the data journey.

Save Time on Operations – More Time for Innovation

Glen Schuster: “When companies try to do operations and analytics at same time, it’s operations that almost always ‘wins’”

Sharan Haider: “Now is the time to innovate. And to do that, organizations have to free up time and iterate through faster execution cycles that add more value to operations while improving member and consumer experience.”

Sharan Haider: “If we shorten the amount of time needed to get data together, we can innovate and do analytics better and faster.”

Flexible, Secure, Multi-Model Database Systems are Key

Bill Fox: “Next generation systems must be able to provide users with what they want, how they want it, and when they want it. Data can’t be siloed across numerous legacy systems but must be virtualized in a multi-model database capable of supporting multiple data models against a single, integrated back end where structured and unstructured data in multiple formats are all supported by a flexible and secure infrastructure.”

Glen Schuster: “Value-based reimbursement and managing risk demand that healthcare firms deal with their legacy architecture and employ the resources necessary to facilitate change. Data is classically under reported. A company that can gather data and improve its quality will be in a better position to manage its risk and gain a significant competitive advantage.”multi-model database data models integrated backend structured unstructured marklogic hceg ahip institute

Rapid Implementation with Proven Business Case

Glen Schuster: “It’s easier now to create a hard dollar business case for operationalizing data. Do you know where your data is? How difficult is it to collect, combine and operationalize your data? Over-analyzing cost vs. worth can be an unproductive conversation.”

Sharan Haider: “I know I have a problem. I come to conferences and get excited at what I see. But I’m also a realist. I need to be able to implement solutions from my point of view. To be able to collect, merge and manage my data better and faster.”

Sharan Haider: “We are working to develop a 360 view of our provider customer service, appeals and grievances data in 4-6 weeks. What was a long-term pain and seemed unsolvable was suddenly doable.”

Centers of Excellence and Scaled Agile Framework

Sunil Godbole: “We had an impossible data problem and started our journey 2 ½ ago. We strive to make whatever we build with reusable assets. We established a Center of Excellence (COE) and got the best resources available on market. Our COE performs governance, builds frameworks (ex. Logging, alerts, ingest and egress methods, etc.) that we can extend to all lines of business, affiliates, and other data centers.”

Sunil Godbole: “Code quality has to be present. We employ a Scaled Agile Framework (SAFe) and consistently enforce its use. We do brown bags with scrum teams, new developers and business stakeholders to maintain and grow our skills based and data agility-focused culture.”

Learn More About Healthcare Innovation & Transformation

For more insight and ideas on digitally transforming your healthcare operations and analytics, check out our sponsor partners and consider following the Healthcare Executive Group and our sponsors on social media.

Change Healthcare –> @Change_HC
Cumberland Consulting Group –> @CumberlandCG
GuideWell Connect –> @_GWConnect
HealthEdge –> @HealthEdge
MarkLogic –> @MarkLogic
McKesson –> @McKesson
Softheon –> @Softheon
Virtual Health –> @VirtualHealth_

Opportunities, Priorities & Challenges Facing Healthcare in 2017

By | HCEG Top 10 | No Comments

The HCEG Top 10 list of healthcare priorities, challenges and risks faced by healthcare industry executives is developed each year at HCEG’s annual forum. For the past seven years, the HCEG Top 10 list has served as the keystone for industry wide analysis, and subsequent research: The Industry Pulse, an annual survey initiative, conducted over the past seven years in partnership with Change Healthcare – a sponsor partner of the Healthcare Executive Group.

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.

The 7th Annual Industry Pulse Research Survey

On March 29th, a webinar provided an overview of highlights from The Industry Pulse was shared here to help industry leaders better understand the current healthcare environment, as well as to prepare for, and navigate, change. The webinar offered an initial interpretation of research survey results across the following topic areas:

  • The Current State of Clinical & Data Analytics (HCEG Top 10 Item #3)
  • Privacy & Security in a Data Driven Environment (HCEG Top 10 Item #4)
  • Customer Service: Cost vs Quality Transparency (HCEG Top 10 Item #5)

This post presents a recording of that webinar including the entire slide deck presentation and an infographic presenting some key findings from the 7th Annual Healthcare Industry research survey.

Webinar Recording

Presentation

Infographic

Healthcare industry insight recording healthcare industry pulse presentation deck healthcare industry pulse infographic

More Insight, Trends & Analysis

Over the following weeks and months, additional analysis and insight will be gleaned from The Industry Pulse and shared by HCEG and Change Healthcare. To stay abreast of the unique insight offered by the Healthcare Executive Group, the HCEG Top 10 list and The Industry Pulse research survey, be sure to subscribe to our newsletter and follow HCEG on Twitter, Facebook and LinkedIn.