Artificial Intelligence. Predictive Analytics. Bigdata. Machine Learning. HealthCare Executive Group. Benefits Costs. Patient Outcomes. Quality Standards. STAR ratings. Profit Margins. Improving Efficiencies. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.

Insight on Solving the Rubik’s Cube of Payer Data

By | analytics, HCEG Top 10, payer, Sponsor, Webinar Series | No Comments

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.

HealthCare Executive Group Top 10 list. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.

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.]

Mega Mergers

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.”

Data Security

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.Contract negotiations. HealthCare Executive Group. Benefits Costs. Patient Outcomes. Quality Standards. STAR ratings. Profit Margins. Improving Efficiencies. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.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.Artificial Intelligence. Predictive Analytics. Bigdata. Machine Learning. HealthCare Executive Group. Benefits Costs. Patient Outcomes. Quality Standards. STAR ratings. Profit Margins. Improving Efficiencies. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data.

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:

  1. 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:

  1. 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.Rubik’s Cube of Payer Data. Artificial Intelligence. Predictive Analytics. Bigdata. Machine Learning. HealthCare Executive Group. Benefits Costs. Patient Outcomes. Quality Standards. STAR ratings. Profit Margins. Improving Efficiencies. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.

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?’

Marina added: [18:38]

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?

  1. Is our plan performing better than what it was before from a cost standpoint?
  2. Are we improving the quality of our plan?

HealthCare Executive Group. Benefits Costs. Patient Outcomes. Quality Standards. STAR ratings. Profit Margins. Improving Efficiencies. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.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]

HealthCare Executive Group Top 10 list. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.

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.

Marina added:

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

Mayur continued:

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.

Marina added:

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.

  1. Data Security
  2. In-House Experts
  3. Intuitive Easy-To-Use Platform
  4. Actionable Real-Time Data Visualization
  5. Data Accuracy
  6. 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.Artificial Intelligence. Predictive Analytics. Bigdata. Machine Learning. HealthCare Executive Group. Benefits Costs. Patient Outcomes. Quality Standards. STAR ratings. Profit Margins. Improving Efficiencies. EQ Health Solutions. Solving the Rubik’s Cube of Payer Data. Health Plans. Payer market. evaluating healthcare analytics vendor. Data Security. Tools and Technologies.

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.

More Insight for Healthcare Leaders

Our Webinar Series events are one example of how the HealthCare Executive Group helps to share information and promote collaboration between our members, associates and sponsor partners. Our next Webinar Series event will be ‘Using People, Process & Technology to Grow Your Business’ and will be presented by our sponsor partner HealthEdge on July 25th, 2019 at 2:00 pm ET.HCEG. HealthCare Executive Group Webinar Series: ‘Using People, Process & Technology to Grow Your Business’ HealthEdge.

HCEG’s 2019 Annual Forum

Save The Date HCEG Annual Forum

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

For more information, click here and/or contact us at [email protected].

HCEG Webinar Series Event. “Solving the Rubik’s Cube of Payer Data” Digital transformation. HCEG’s Top 10 Data & Healthcare Analytics. Artificial Intelligence, Machine Learning. Electronic Health Records. EHR. Claims Data. EqHealth Solutions. CMS’s Meaningful Use program. Industry Pulse Social Determinants of Health. Value-based Care. Alternative Payment Models

Healthcare Organizations Focus on Data & Analytics for Digital Transformation

By | analytics, Sponsor, Value-Based Payment, Webinar Series | No Comments

If analytics is the machine powering your digital transformation initiatives, then data is the power making that digital transformation machine run. The importance of data and analytics has been identified by our members in each of the last ten years HCEG’s Top 10 list of challenges, issues, and opportunities have been created. For 2019, “Data & Analytics” is ranked #1 on the HCEG Top 10. It’s clear that healthcare leaders believe that data is a catalyst to accelerate meaningful change. And that the use of analytics – particularly prescriptive analytics – is a fundamental strategy for succeeding in a new era of healthcare.

Mountains of Data Waiting to Power Your Healthcare Analytics Machine

Good analytics begins with good data and healthcare organizations are sitting on a mountain of data. According to America’s Health Insurance Plans (AHIP), the typical regional payer processes $8 billion in claims each year with each claim providing its own set of unique data points – largely financial and administrative. But healthcare payers are increasingly collecting, matching, and using clinical data to provide richer, more comprehensive insight on their members.

Given the proliferation of Electronic Health Records (EHR) incented by CMS’s Meaningful Use program, it’s no surprise that more and more data is being pulled from EHR’s. And risk-sharing agreements between payers and providers has resulted in health plans sharing more claims data with their provider partners. In fact, the current Industry Pulse report indicates that EHR data is one of the top two primary sources of clinical data with 30% of health plans reporting they utilize EHR data.

digital transformation. HCEG’s Top 10 Data & Analytics. Artificial Intelligence, Machine Learning. Electronic Health Records. EHR. Claims Data. EqHealth Solutions. CMS’s Meaningful Use program. Industry Pulse Social Determinants of Health. Value-based Care. Alternative Payment ModelsOther sources of clinical data that organizations are using to complement their claims data include ancillary data such as pharmacy, lab, and imaging (17%) and real-time admission, discharge, and transfer notifications (10%)

RELATED: 9th Annual Industry Pulse Research Survey Results

Popular Use Cases for Healthcare Analytics

These enhanced data sources are becoming more and more useful due to the power of artificial intelligence (AI) and machine learning.

New research from Dimensional Insight identifies care quality measures and finance as two top use cases for healthcare organization usage of analytics today. Additional use cases for leveraging data by analytics include

  • Addressing Social Determinants of Health (#3 on the 2019 HCEG Top 10)
  • Value-based Care and Alternative Payment Models (#4 on the 2019 HCEG Top 10)
  • Improving Patient Engagement and Satisfaction
  • Patient Outcomes Improvement

Analytics Budgets are Increasing for Healthcare Organizations

According to a recent report from the Society of Actuaries, greater than 60 percent of payers and providers are planning to increase their analytics budgets by 15% or more.

Additionally, the report finds that 89% of healthcare executives plan to use predictive analytics over the next five years. It’s clear that healthcare payers and health systems have a keen focus on leveraging the massive amounts of data they possess. These data serve to reveal trends, patterns, and insights to help ensure their success going forward.

Solving the Rubik’s Cube of Payer Data

i.e. Lining Up All Your Data to Rapidly and Accurately Gain Unique Insights

For insight into how your healthcare organization’s data can be used to improve health outcomes and reduce costs, join our next Webinar Series Event on June 6th at 2:00 PM EDT / 11:00 AM PDT. Our sponsor partner eQHealth Solutions presents “Solving the Rubik’s Cube of Payer Data.”In this complimentary webinar, you will learn how to aggregate and parse provider data, how you can use data captured outside of your own system, and other practical solutions to use your data to create knowledge for actionable use and outcomes. Attendees will have a chance to ask questions and all registrants will receive a copy of the presentation afterward.HCEG Webinar Series Event. “Solving the Rubik’s Cube of Payer Data” Digital transformation. HCEG’s Top 10 Data & Healthcare Analytics. Artificial Intelligence, Machine Learning. Electronic Health Records. EHR. Claims Data. EqHealth Solutions. CMS’s Meaningful Use program. Industry Pulse Social Determinants of Health. Value-based Care. Alternative Payment Models

HCEG Top 10. Industry Pulse Survey. Challenges, issues, opportunities healthcare industry. Data & Analytics, Total Consumer Health, Population Health Services, Value-based Payments, The Digital Healthcare Organization, Rising Pharmacy Costs, External Market Disruption, Operational Effectiveness, Opioid Management

Total Consumer Health & The Digital Healthcare Organization in 2019

By | Conferences, Executive Leadership Roundtable, HCEG Top 10, The Digital Healthcare Organization, Total Consumer Health, Uncategorized, Webinar Series | One Comment

The trend toward Healthcare Consumerism & Digital Health products and services is driving what healthcare providers, health systems and health plans are offering – or are planning to offer – individuals participating in the U.S. healthcare market. Whether covered by employer-subsidized insurance, government programs like Medicaid or Medicare, the individual commercial market, any other type of coverage or even not covered and paying for your healthcare with cash, healthcare consumerism and leveraging digital health products and services to decrease costs and improve outcomes are two important movements that can’t be ignored.

‘Indeed, Total Consumer Health and The Digital Healthcare Organization are both ranked in the top five items on the 2019 HCEG Top 10 list of challenges, issues, and opportunities:hceg healthcare executive group digital health consumerism healthtech Healthcare Consumerism & Digital Health. Consumer Experience, Population Health Service Organizations, Administrative Expenses, Customer Experience, Personal Health Monitoring. Population Health/Analytics. Retail Health Care

#2: Total Consumer Health: Improving members’ overall medical, social, financial, and environmental well-being.

#5: The Digital Healthcare Organization: Health Savings Accounts, member and provider portals, member and patient health literacy, cost transparency, digital payment capabilities, CRM, wearables and other patient-generated data, health monitoring, and omnichannel information distribution and transaction access.

And a recent report by Mercom Capital Group on 2018 Q3 Digital Health (Healthcare IT) Funding and M&A Report indicates significant investment in products and services aimed at the healthcare consumer and the organizations that service and support healthcare consumers and patients.

“Healthcare Consumer-centric companies accounted for 60 percent of the funding in Q3 2018, raising $1.9 billion in 111 deals compared to $1.7 billion in 138 deals in Q2 2018”

The HCEG Top 10 Challenges, Issues & Opportunities Over the Years

Over the 10 year period in which the HCEG Top 10 list has been published, ‘Healthcare Consumerism’ or a closely aligned similar category has been ranked on the HCEG Top 10 list a  total of eight times. And ‘Digital Health’ has also ranked among the HCEG Top 10 challenges, issues and opportunities eight times. Only ‘Payment Reform’ and ‘Big Data & Analytics’ have been listed on the annual HCEG Top 10 list more frequently.

Healthcare Consumerism & Digital Health. Consumer Experience, Population Health Service Organizations, Administrative Expenses, Customer Experience, Personal Health Monitoring. Population Health/Analytics. Retail Health CareRELATED: The 2019 HCEG Top 10 List of Healthcare Challenges, Issues & Opportunities

Why Healthcare Consumerism & Digital Health?

It should be no surprise to most people that healthcare consumerism has long been a top challenge, issue, or opportunity for healthcare organizations of all types. The rise of several factors have been identified by industry experts and trade media as the primary reasons for the growth if consumerism in the healthcare industry:

  • High-Deductible Health Plans
  • Employers Shifting Costs from to Employees
  • Rapidly Increasing Healthcare Costs

And while traditionally a laggard in the adoption of digital technologies, healthcare organizations are not immune to the need to digitally transform themselves. Ignoring the need to adopt digital health technologies can only result in serious disruption, or even extinction, of healthcare organizations both large and small.

Comments on Healthcare Consumerism & Digital Health from HCEG Top 10 Survey Respondents

The executives and industry thought leaders participating in defining the 2019 HCEG Top 10 list at our recent 2018 Annual Forum in Minneapolis, MN included notes and commentary on the specific challenges, issues, and opportunities listed in the survey worksheet. The following are some of those comments related to healthcare consumerism and digital health:

“Data & Analytics (ranked #1) are table stakes to any consumer-focused products and services. And foundational to all Digital Health initiatives.”

“Population Health (ranked #3) could be considered ‘Total Consumer Health’”

Note: A number of participants expressed opinions that “Population Health” and “Total Consumer Health” could be considered the same thing. After some discussion, everyone agreed that Population Health should be considered as population-centric as opposed to person-centered.

“Social determinants of health have a huge impact on health outcome but as a health system we lack the ability to control/impact these barriers.”

“Connecting with our members on a frequent basis is very challenging. We struggle with identifying and delivering the right message at the right time.”

“Different departments have their own goals and objectives and these often create a disjointed member experience.”

“We must move from deploying largely unconnected tactical approaches to a more holistic, coordinated customer experience strategy.”

“It’s not always clear to us what matters to individual patients and how we can measure those things.”

How to Learn More About Healthcare Consumerism & Digital Health

The HCEG Top 10 list drives the content HCEG creates and delivers to its members and associates via blog posts like this, our Webinar Series Events and our Executive Leadership Forums. Accordingly, we’re pleased to share several complimentary opportunities to learn more about opportunities for healthcare organizations to meet the needs of increasingly educated and proactive healthcare consumers AND how specific digital health products and services are supporting the creation, delivery, and consumption of medical and non-medical services and products that improve health outcomes.

Webinar Series Event: The New Engaged Digital Consumer

What Digital Healthcare Organizations Must Do to Survive and Thrive

Healthcare Consumerism & Digital Health. Consumer Experience, Population Health Service Organizations, Administrative Expenses, Customer Experience, Personal Health Monitoring. Population Health/Analytics. Retail Health CareOn Thursday, November 15th, 2018 at 2:00 pm ET, our sponsor partner HealthEdge will present a webinar that provides information from recent market studies and specific examples illustrating how engaged digital consumers regard the services provided by health insurers.

Attendees will learn:

  1. The top organizational priorities health insurance executives are currently facing
  2. Key challenges and solutions that enable health insurers to address these organizational priorities
  3. The most important expectations that members have of their health insurer
  4. How trust levels between members and health insurance organizations are being addressed by new disruptive entities entering healthcareBig Data/Analytics, Consumer Experience, Population Health Service Organizations,Payment Reform,Mobile/Digital Devices/Social,Administrative Expenses,Consumerism, Personal Health Monitoring

If you can’t make it, go ahead and register and we’ll send you the recording and slides after the event!

AHIP-ELR: Total Consumer Health & The Digital Healthcare Organization

On Thursday, December 13th, 2018 at 1:00 pm CT/2:00 pm ET, we’re hosting a special Executive Leadership Roundtable immediately after the 2018 AHIP Consumer Experience & Digital Health Forum convenes at the Music City Center in Nashville, TN. Lunch will be provided at no charge and the following topics will be presented and discussed by several healthcare industry leaders:

  1. How competition from new entrants, cost containment pressures associated with value-based care programs, health/entitlement reforms, and technological innovations may impact ‘healthcare consumerism’
  2. Approaches for turning passive health plan members and health system patients into active healthcare consumers
  3. Catalysts for healthcare consumerism change: employer groups demanding better value and trend of health plan members and individuals directly engaging with plans and providers
  4. How value-based relationships demand that healthcare organizations engage with their members and patients
  5. Which tools and services healthcare organization can use to enhance member/patient engagement

HCEG Healthcare executive group elr healthcare consumerism digital health AHIP Consumer Experience Digital Health Forum

Our executive leadership roundtable event is complimentary but registration is required (so we can make sure everyone gets lunch).Healthcare Executive Leadership Forum at Guidewell Innovation Center

Also, you can receive a discount off registration to the 2018 AHIP Consumer Experience & Digital Health Forum by using “HCEG” when you register here.

Become an HCEG eNewsletter Subscriberhealthcare executive group hceg leadership management Healthcare Consumerism & Digital Health. Consumer Experience, Population Health Service Organizations, Administrative Expenses, Customer Experience, Personal Health Monitoring. Population Health/Analytics. Retail Health Care

If you’re not already on our list, consider joining 2500+ other healthcare executives, industry thought leaders and other participants by subscribing to our eNewsletter. You’ll receive ongoing information on strategic and tactical challenges, issues, and opportunities facing the United States healthcare industry.

More Insight on the 2019 HCEG Top 10 Items Coming Soon!

As 2018 winds down and 2019 takes off, the HealthCare Executive Group will continue to create, curate and promote content and events addressing each of the items on our 2019 HCEG Top 10 list. We’ll be presenting numerous webinars, hosting Executive Leadership Roundtables in conjunction with popular healthcare conference events, and – of course – holding our popular Annual Forum. The 31st HCEG Annual Forum will take place in Boston, MA in September 2019. Stay tuned for more information!

Consider joining our unique organization of healthcare executives and thought leaders today. See this page for more information and/or reach out to us here.

RELATED: HealthCare Executive Group Promotes National HealthIT Week All Year Long

Four Pillars Successful Core-System Replacement Project. Healthcare Executive Group. Change Healthcare. digital transformation. Framework. Implementation Readiness. Governance. Business Transformation. Execution Framework

The Four Pillars of a Successful Core-System Replacement Project

By | Annual Forum, Project Management, Sponsor, Webinar Series | No Comments

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.

Four Pillars Successful Core-System Replacement Project. Healthcare Executive Group. Change Healthcare. digital transformation. Framework. Implementation Readiness. Governance. Business Transformation. Execution Framework

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:

  1. Establish a single point of accountability and expertise
  2. Clearly identify decision makers and specialists for issue resolution

Risks, Actions, Issues, and Decisions – It’s a RAID!

Risks, Actions, Issues, Decisions (RAID) is a framework to report, track, resolve document project

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.

Business Transformation

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

Four Pillars Successful Core-System Replacement Project. Healthcare Executive Group. Change Healthcare. digital transformation. Framework. Implementation Readiness. Governance. Business Transformation. Execution Framework

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:

  • Flexibility
  • Maintains Focus
  • People First
  • Requirements Management
  • Defect Management
  • Systems Integration Plan

Summarizing the Webinar

Jeanne Noe shared the following slide at the end of the webinar.Four Pillars Successful Core-System Replacement Project. Digital transformation. Framework. Implementation Readiness. Governance. Business Transformation. Execution Framework. Requirements Management. Defect Management. Systems Integration Plan. Trizetto FACETS. QNXT, HealthEdge.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 TwitterFacebookLinkedIn 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.HealthCare Executive Group Annual Forum. Executive leadership. 2018 Conference event forum roundtable

Connect with HealthCare Executive Group at the AHIP Institute & Expo

By | AHIP, Annual Forum, Conferences, Executive Leadership Roundtable, HCEG Top 10, HIMSS18, HLTH2018, Sponsor, Webinar Series | No Comments

health care conference, Conference, Health Care, Hospital, Health System, Health Insurance, Health Plan, Benefits, Affordable Care Act, Policy, CMS, Health Care Reform, compliance, pharmaceutical, health IT, network, contracting,health plans,health systems,leadership, medicaid & policy, pophealth analytics, behavioral health,network contracting, employer direct contracting, self-insured, Population Health Analytics, PopHealth, Social Determinants of Health, healthcare, healthcare conference,HealthCare Executive Group convenes and supports healthcare executives and thought leaders by providing a platform supporting the creation, curation and sharing of information and insight on current opportunities, challenges and issues in the healthcare industry.

It’s our 30th Anniversary and the HealthCare Executive Group has been in overdrive during the first half of 2018. We held an Executive Leadership Roundtable at the recent HLTH Future of Healthcare Forum, we worked with our sponsor partners to share insight via our ongoing HCEG Webinar Series, we’ve attended a handful of major healthcare industry conferences in support of our members and sponsor partners, and we continue to leverage our social channels to help address the issues, challenges and opportunities facing today’s healthcare executive leader.

We’ve also been preparing for our 2018 Annual Forum taking place September 12th through the 14th in Minneapolis, MN – recruiting industry thought leaders and fleshing out an agenda that promises to share valuable information, insight and networking opportunities.  Finally, we’re wrapping up the first half of our 30th Anniversary year by attending the 2018 AHIP Institute & Expo where we’ll support our members and sponsor partners – and gather additional insight to make our 2018 Annual Forum all the more valuable.

Major Healthcare Conferences of 2018

health care conference, Conference, Health Care, Hospital, Health System, Health Insurance, Health Plan, Benefits, Affordable Care Act, Policy, CMS, Health Care Reform, compliance, pharmaceutical, health IT, network, contracting,health plans,health systems,leadership, medicaid & policy, pophealth analytics, behavioral health,network contracting, employer direct contracting, self-insured, Population Health Analytics, PopHealth, Social Determinants of Health, healthcare, healthcare conference,

HCEG members and sponsor partners participated in many of the major healthcare conferences taking place in the first part of the year including the:

2018 HIMSS Conference & Exhibition in March

15th Annual World Healthcare Conference in April

Inaugural HLTH Future of Healthcare Forum in May

Check out a recap of our roundtable event held as part of the Association Day at the inaugural HLTH Future of Healthcare Forum here.

WEDI Spring Conference in May

WEDI conference organizers have made complete conference information including sessions handouts available here.

2018 AHIP Institute & Expo next week June 20 – 22

HCEG members and sponsor partners will be participating in more conferences as the year continues, including, our course, hosting the 2018 HCEG Annual Forum celebrating our 30th Year convening and supporting healthcare executives and thought leaders.

Read on for more about HCEG Members and Sponsor Partners at the AHIP Institute.

HCEG’s Executive Leadership Roundtable

In May, we partnered with the International Association of Innovation Professionals, the Center for Healthcare Innovation, and the Workgroup for Electronic Data Interchange and held a unique ELR titled ‘Leadership, Trust & Skills in Overcoming Obstacles to Radical Innovation in Healthcare.’

Check out a recap of the roundtable event held in conjunction with the inaugural HLTH Future of Healthcare Forum here.

The Next Executive Leadership Roundtable – Nashville, TN

We’re planning another Executive Leadership Roundtable to coincide with the AHIP Consumer Experience & Digital Health Forum on December 11 – 13, 2018 in Nashville, TN. Members and sponsors interested in helping shape the theme of this roundtable are urged to contact us at [email protected].

HCEG Webinars Offer an Opportunity to Learn from Sponsor Partners

In the first few months of 2018, HCEG and our sponsor partners produced webinars addressing a variety of topics such as Value-based Payment, Post-Acute Care in Medicare Advantage and a deeper dive into the 2018 HCEG Top 10. For more information on these webinars including a recap and recording, check out the following:

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

Recapping ‘The 2018 HCEG Top 10 Healthcare Opportunities, Challenges & Issues’ Webinar – Part 2

Recapping Value-Based Payment – Getting from Here to There…

The Financial Impact of Post-Acute Care in Medicare Advantage

The HealthCare Executive Group Webinar Series Continues

In August, “The Four Pillars of a Successful Core-System Replacement Project” will be presented by sponsor partner Change Healthcare on August 2nd, 2018 at 2:00PM ET. Reserve your seat for this webinar today!

HCEG is also working with other sponsor partners on additional webinars planned for the 4th quarter of 2018 after the Annual Forum.

Consider subscribing to our eNewsletter to be kept abreast of these webinars and other information and events of value to healthcare executives and thought leaders.

Preliminary Agenda and Keynote Speakers for HCEG’s 30th Anniversary Annual Forum

We’re pleased to share the preliminary agenda and announce that Andy Slavitt, former Acting CMS Administrator and current leader of Town Hall Ventures, and Dan Buettner, National Geographic Fellow, NY Times bestselling author and principle at the Blue Zones Project will be providing keynote addresses at our 2018 Annual Forum in Minneapolis, MN on September 12 – 14, 2018.

The following represents the current agenda which is being fleshed out and evolving on a weekly basis. We’re also identifying and recruiting more speakers and panelists, and planning enjoyable networking events intended to make our 2018 Annual Forum our best forum ever. If you or someone you know would like to be considered to speak or serve as a panelist at our forum, please use this form.

hceh annual forum healthcare executive group annual forum conference

To learn more and to get an idea about what the HCEG Annual Forum is all about…

… Check out these pictures from last year’s HCEG Annual Forum

… See who’s among the previous attendees of HCEG Annual Forum’s

If you would like to register to attend HCEG’s Annual Forum, you can register here. And if you are unsure as to whether you should attend, check out these Nine Reasons to Attend the 2018 HCEG Annual Forum.

HCEG Members and Sponsor Partners at AHIP Institute & Expo

The 2018 AHIP Institute & Expo takes place next week, June 20th through the 22nd in San Diego, CA and HCEG members and sponsor partners will be participating, speaking and exhibiting.

If you’re attending the AHIP Institute, be sure to meet our sponsor partners. Some of our sponsor partners are exhibiting, some are presenting, and some are attending. ALL of our sponsor partners can help your healthcare organization transform itself in today’s rapidly evolving healthcare environment.

Also not to be missed are sponsor partners CareCentrix and Change Healthcare offering refreshments and a Lunch & Learn session.

Date & TimeSponsor PartnerEvent
June 20: 8:00am – 11:00amCareCentrixWelcome Refreshments
June 20: 11:00am – 12:15pmChange HealthcareLunch & Learn

Value-Based Care Market Research: Inside Successful Programs

June 20: 3:45 pm – 4:30 pmCareCentrixThe Future of Care at Home: New Strategies for Post-Acute Care
June 21: 9:30 am – 10:15 amCareCentrixCoffee Break in the Exhibit Hall

Stay Connected and Learn More About HealthCare Opportunities, Challenges & Issues

Check out the following for more information about the HealthCare Executive Group:

Becoming a Member of the HealthCare Executive Group

Attending our 2018 Annual Forum

Subscribe to our eNewsletter

Limited Sponsorship Opportunities

The HealthCare Executive Group has limited general sponsorship opportunities available to companies interested in supporting our members on a consultative, partnership basis. For more information, contact Juliana Ruiz.

Value-Based Payments – Getting from here to there…

By | Healthcare Reform, HealthEdge, payment, reimbursement, Value-Based Care, Value-Based Payment | No Comments

 value-based payments (VBP) models. Capitation models traditional fee-for-service (FFS)

Since the late 1990’s, the reimbursement landscape in healthcare has been changing. Capitation models paved the way for a change from traditional fee-for-service (FFS) payment models to a focus on helping physician partners establish effective, cost-efficient practice models. And now value-based payments are the latest and greatest models for reimbursement of care. In fact, value-based payments were ranked by HealthCare Executive Group members as #3 on the 2018 HCEG Top 10 list.

value-based payments (VBP) models. Capitation models traditional fee-for-service (FFS) MACRAWhile uncertainty surrounding healthcare reform in the United States continues and the industry waits for more definitive reimbursement policy from the federal government, one thing is certain—the trend for value-based payments (VBP) continues. Health plans and providers really have no choice but to transition from the traditional fee-for-service model in order to drive down soaring costs and positively impact patient outcomes.

“There is no turning back to an unsustainable system that pays for procedures rather than value” and the transition “needs to accelerate dramatically.”

– Alex Azar, Secretary of Health and Human Services, March 5, 2018 at the Federation of American Hospitals’ conference

Obstacles in the Path to Value-based Payments

There are many obstacles that must be addressed to successfully implement value-based payments models that reward providers for positive performance and encourage poor performers to improve. In order to achieve the expected outcomes and performance required by VBP, health plans must have the flexibility to develop, implement and administer value-based contracts with providers responsible for care delivery, care management, and care coordination across the medical neighborhood.

value-based payments (VBP) models. Capitation models traditional fee-for-service (FFS) MACRA

How to get there from here…Value-based Payments

On Thursday, March 22, 2018 at 2:00PM ET, Harry Merkin of HealthEdge and Dave Mika of Independent Health will share their insight and real world experience on how to get from here to there with value-based payment. Some of the information they will share includes:

  1. Essential elements of a transition from traditional Fee For Service to Value-based Payment
  2. Independent Health’s story of how important technology-driven strategies are to their adoption of value-based payments
  3. How models being driven by CMS are also impacting commercial contracts
  4. How some health plans are responding to the value-based payment movement including findings from a study of value-based care payments by Humana
  5. The importance of primary care physicians as critical to transforming the way health care is delivered
  6. The type of technology support needed by health plans and providers

The move to value-based reimbursement is inevitable, and only those health plans that adapt will be successful in the future. And developing the capabilities to effectively respond to change doesn’t happen overnight.

Reserve your seat today and learn how to get there from here

Thurs, March 22, 2018 | 11:00am PT / 2:00pm ET Healthcare Executive Leadership Forum at Guidewell Innovation Center

Learn About Value-Based Payments from Industry Thought Leaders

Presenter – Harry Merkin

Vice President of Marketing, HealthEdge

Harry Merkin has worked with both payers and providers through many dynamic changes in healthcare for a number of years. He is currently responsible for Marketing at HealthEdge, including product marketing, demand generation and thought leadership. He previously had similar responsibilities at Evariant and NaviNet and has collaborated with many transformative entities across the healthcare landscape. Harry has helped introduce and promote innovative enterprise software solutions that enable payers to improve their competitive effectiveness, as well as perform valuable communications between payers and providers, and allow providers to effectively collaborate with patients and consumers as well as with each other

Co-Presenter – Dave Mika

Vice President, Enterprise Core System Operations, Independent Health

Dave Mika plays an integral role in leading the operations unit at Independent Health, located in Buffalo, NY. He is responsible for the coordination of activities across the organization to more effectively manage workloads and partner closely with individual business unit owners to achieve operational excellence. A former Army Reserve combat medic and Licensed Practical Nurse with more than 30 years of experience in the health insurance industry, Mika has also held management positions in member appeals, provider relations, project management and product development and implementation.

Part 2: Recapping ‘The 2018 HCEG Top 10 Healthcare Opportunities, Challenges & Issues’ Webinar

By | Cybersecurity, Executive Leadership Roundtable, HCEG Top 10, Pharmacy, Webinar Series | One Comment

The theme of last month’s HCEG Webinar Series event was The 2018 HCEG Top 10 – Healthcare Opportunities, Challenges & Issues. In a previous post, highlights of the following two topics that were discussed by moderator Kim Sinclair, HCEG board chair and CIO at Boston Medical Center Health Plan, and panelists Ferris Taylor, HCEG’s Executive Director and Consultant to Arches Health Plan and David Gallegos, Sr VP of Consulting Services at Change Healthcare, were reviewed:

  • Which three items on the 2018 HCEG Top Ten list three areas were of most interest?
  • What’s the state of healthcare consumerism and what’s being seen in the industry?

This second post recaps highlights from the second half of the webinar where the topics of Cybersecurity (Ranked #6 on the 2018 HCEG Top 10) and Addressing Pharmacy Costs (Ranked #9) were discussed. The webinar presentation materials and a recording of webinar can be found here.

Cybersecurity – 2018 HCEG Top Ten Item #6

Topic #3: How are you seeing cyber security and cyber threats impact healthcare organizations beyond the tactical day-to-day prevention activities?

HCEG Healthcare Executive Group Webinar-Top-10 Trends Cybersecurity

Ferris Taylor: “I think it’s (cybersecurity) fundamental that we need to innovate and improve cybersecurity in all of our healthcare processes. That really means giving people a confidence that their personal information won’t be used in ways that a person doesn’t want it to be used. So, it ties back to consumerism.

Real World Impact of Medical Identity Theft

“Here in Utah, about three years ago, there was a baby born in the hospital that was heroin addicted. And of course, the Department of Social Services immediately went to the home and removed the three other children from that home. The fundamental problem was that the mother of that heroin baby was not the mother in that home. And it took that mother three months to get her children back. It was a case of medical identity theft where the baby was born. The real mother checked out.  We can understand the personal impact that that lack of security around medical information caused for that family.”

David Gallegos: “The world has gotten a lot smaller and technology a lot more complex over the past decade. And clearly cyber terrorism is a big part and a growing concern that every organization needs to take seriously. But you need to keep in mind that the safest computer is one that’s turned off and unplugged. And clearly that’s not very useful.

“We need to balance both security and usability and the sharing of clinical information. It’s going to be critical to our care model redesigns and our clinical collaboration. This data is also going to be important for us to leverage artificial intelligence and, to help us determine optimal courses of treatment. In some cases, this information is even going to be needed to help really define how whole populations are treated.”

Addressing Pharmacy Costs – 2018 HCEG Top Ten Item #9

Kim Sinclair shared that pharmacy costs continue to rise and is a topic constantly in the news, noting that non-profit hospitals have stated intent of joining together to form their own pharmacy organizations.

Topic #4: What are your thoughts about what healthcare leaders can do about rising pharmacy costs?

Ferris Taylor: “I saw some statistics on pharmacy costs that struck me to the heart. It was from the Health Care Cost Institute over the last four years. It was actually 2012 to 2016 and the cost of prescriptions in the marketplace had gone up by 25%. But the utilization of prescriptions had only gone up by 1.8%. And it wasn’t just pharmacy costs. Emergency Room prices have gone up by 30% and visits went up by 2%.”

Free-Market Economy and Governance

“So, I think, once again, we haven’t transitioned from the buyer being the employer to the consumer becoming more and more important in that purchasing decision. As we discuss pharmacy costs, the other thing that I think we need to recognize is that we have a free-market economy. But industries have responsibilities to govern themselves. And I know some of the bad players in the pharmacy industry are outside of the Pharmacy Association. So, it’s hard to regulate them. But I use those key issues as the things to help us start to address the pharmacy costs”

David Gallegos on the State We’re in with Pharmacy Costs

pharmacy costs increases hceg healthcare executive group

“What I look at the state we’re in with pharmacy costs. To me it’s entirely self-made. We’ve created these regulations that allow schemes like pay to delay, or evergreening – that’s really pushed generics out further in terms of their development. We create, in a sense, quasi monopolies.”

“We criminalize the ability to negotiate for larger population blocks. I mean it seems ridiculous to me, actually, that drugs that were invented and manufactured here in the United States can often be purchased cheaper outside of our country.”

“Clearly drugs are very important. They reduce admissions that would use other high cost care. And some of them are miracles. They can literally cure diseases – cure the incurable. So, I understand this is not a simple problem. But if a drug cost a million dollars and the person can’t afford it, is it really a miracle?”

“And in any other market, if there was a product that nobody could afford, the supplier would price it differently. And that’s what we have in our market.”

Previous Webinar: Strategies to Address Rising Pharmacy Costs

For more about pharmacy costs, see this recap of last December’s webinar titled “Strategies to Address Rising Pharmacy Costs” presented by our sponsor partner Cumberland Consulting Group.

Check out the Webinar Recording for More

For more insight on 2018 HCEG Top 10 and the perspective of healthcare executives, check the webinar recording and subscribe to our eNewsletter where we’ll be sharing more information, insight, opinions and ideas of value to healthcare executives and thought leaders. Our newsletter will also share information on future webinars and events like our Executive Leadership Roundtable in Las Vegas this coming May 9th.

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

By | Top 10, Value-Based Care, Value-Based Payment, Webinar Series | No Comments

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 PicksFerris 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?

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