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Challenges, Issues and Opportunities: A Look at HCEG’s Top 10 for 2020 Ferris W Taylor, Executive Director HealthCare Executive Group (HCEG) December 4, 2019
Challenges, Issues and Opportunities: A Look at HCEG’s Top 10 for 2020
Ferris W Taylor, Executive Director
HealthCare Executive Group (HCEG)
December 4, 2019
www.wedi.org
HealthCare Executive Group (HCEG)Guiding Executives Through Innovation, Change and Growth, since 1988
30+ Years on Forefront of Healthcare Innovation & Technology
HCEG is a national network of select healthcare executives, thought leaders and experts of various
disciplines who’ve come together to navigate the tactical and strategic issues facing the healthcare
industry.
HealthCare Executive Group www.hceg.org
HCEG, founded in 1988 by healthcare technology executives,
provides a forum for an open exchange of ideas, opportunities,
collaboration and transformational dialogue. Each year HCEG
membership identify a “Top 10” list of opportunities, challenges
and issues facing executives in healthcare is the foundation for
educational and programming initiatives throughout the year.
What We Do
HCEG Technology Partners
www.wedi.org
The 2018 HCEG Top 10
1. Clinical and Data Analytics2. Population Health Services Organizations3. Value-Based Payments4. Cost Transparency5. Total Consumer Health6. Cybersecurity7. Healthcare Reform8. Harnessing Mobile Health Technology9. Addressing Pharmacy Costs10. The Engaged Digital Consumer
www.wedi.org
The 2019 HCEG Top 10
1. Data & Analytics2. Total Consumer Health3. Population Health Services4. Value-based Payments5. The Digital Healthcare Organization6. Rising Pharmacy Costs7. External Market Disruption8. Operational Effectiveness9. Opioid Management10. Cybersecurity
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The 2020 HCEG Top 10
1. Costs & Transparency 2. Consumer Experience 3. Delivery System Transformation4. Data & Analytics5. Interoperability / Consumer Data Access 6. Holistic Individual Health 7. Next Generation Payment Models 8. Accessible Points of Care 9. Healthcare Policy10. Privacy / Security
www.wedi.org
New Entrants - Marriage of Previous Items
“Delivery System Transformation” - #3 on was considered a combination of last year’s Item #3 “Population Health
Services” and Item #7 “External Disruption”
“Holistic Individual Health” considered a subset of last year’s Item #2 “Total Consumer Health”
Movement of Previous Items
“Value-based Payments” ranked #4 on last year’s list was replaced with “Next Generation Payment Models” and
dropped a few spots to #7
Participants felt that the label ‘value-based’ was too narrow and becoming an insufficiently defined, worn-out
phrase
“Rising Pharmacy Costs” (#6 in 2019) and “Opioid Management” (#9 in 2019) were considered part of new
“Holistic Individual Health” (#6)
“Operational Effectiveness” (#8 in 2019) dropped off the 2020 HCEG Top 10 list
New Arrivals, Marriages, & Departed
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HCEG Top 10 Rankings Over Last Decade
9
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Alignment with Industry Predictions for 2020
Comparison of 2020 HCEG Top 10 to 100+ predictions from 16 recent ‘Healthcare Industry Predictions for 2020’ reports
10
• Delivery System Transformation (#3 on 2020 HCEG) is referenced most
frequently at eight times
• Data Analytics (#4) and Privacy/Security (#10) are second most frequently
referenced item at six times each
• Consumer Experience (#2), Next Generation Payment Models (#7) and
Healthcare Policy (#9) are next at five times each
• Telehealth, a part of Accessible Points of Care (#8) - not listed explicitly on the
2020 HCEG list – was referenced six times.
Note: Source of Healthcare Industry Predictions: http://bit.ly/2020HCPredictions
www.wedi.org
“It’s tough to make predictions, especially about the future” - Yogi Berra
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www.wedi.org
The 2020 HCEG Top 10 – Likely Key Issues for WEDI
1. Costs & Transparency 2. Consumer Experience 3. Delivery System Transformation4. Data & Analytics5. Interoperability / Consumer Data Access6. Holistic Individual Health 7. Next Generation Payment Models 8. Accessible Points of Care 9. Healthcare Policy10. Privacy / Security
www.wedi.org
Consumer Engagement
& Health
Transforming healthcare (VBR, Consumerism, Transparency, & Real-Time Transactions)
1 - Costs & Transparency7 - Next Generation Payment Models8 - Accessible Points of Care
9 - Healthcare Policy
4 - Data & Analytics5 - Interoperability/Consumer Data
Accessibility10 - Privacy & Security
Overall well-being: medical, social, financial, &
behavioral2 - Consumer Experience
3 - Delivery SystemTransformation
6 - Holistic Individual Health
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Additional Top 10 Insights from Industry Pulse
• Progress on the transition to Value-Based Reimbursement
• What can payers do?
• What are the barriers?
• Impacts of Clinical and Data Analytics
• Barriers to Digital Health
• External Market Entrants
• Cybersecurity challenges
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© 2019 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved.15
When Do You Expect the Majority of Value-based Relationships Within the Healthcare Market to Contain Both Upside and Downside Risk?
9.7%
26.7%
39.8%
17.5%
6.3%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Less than 1
year
1-2 years 3-5 years 5 or more
years
Never
n=206
Pulse Survey Respondent (Health plan director):“Ensure payers and providers share risk and they will be more likely to think outside the traditional
‘box’ to effectively manage populations and provide solutions.”
Pulse Survey Respondent (Health plan manager):“Each entity has their primary objectives in how they operate and utilize clinical data, and they
don't necessarily align. There seems to be a number of attempts to move forward on a large
scale, which may be too overwhelming to successfully implement.”
© 2019 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved.16
How Can Payers Most Effectively Support Providers (e.g. Practitioners, Hospitals, IDNs) to Orchestrate High-value Care?
4.3%
7.7%
10.6%
13.0%
13.9%
22.6%
27.9%
0% 5% 10% 15% 20% 25% 30%
Other (please specify)
Share outcome data
Develop APIs to improve interoperability
Co-develop bundled payments around
episodes of care
Share performance data
Co-develop payer-provider risk management
programs
Standardize quality and outcome measures Other Pulse Survey Respondent Comments:
“By paying them what they are worth.”
“Data sharing is also essential for this to work.”
“Real-time performance management and
interoperability”
“See each other as teammates instead of
rivals.”
n=208
17© 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved.
In your opinion what are the top three (3) primary barriers preventing
the adoption of value-based reimbursement programs?
n=135
5.2%
18.5%
18.5%
20.7%
27.4%
29.6%
35.6%
35.6%
37.8%
38.5%
0% 5% 10% 15% 20% 25% 30% 35% 40%
Other (please specify)
Lack of personal financial incentives
Administrative burden
Lack of consensus on measures
Lack of trust/confidence in measurements
Network contracts are biased towards fee-for-service
Lack of systems to support value-based reimbursement
Confusion surrounding payment models and risk management
Resistance to change
Complexity of changing physician behavior• Several of the top
barriers are
psychological,
which require both
payers and
providers to think in
new ways about
care delivery and
the business of
healthcare
• For value-based
reimbursement
programs to be
effective, there is a
need for
investments in new
technology systems
that can meet their
data and analysis
requirements
18© 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved.
Not Effective / Slightly Effective Moderately Very Effective / Extremely Effective
Empower more productive providers -13.69 4.14 9.55
Enable better engagement -21.26 9.62 11.63
Enhance delivery system efficiency -7.51 2.76 4.74
Improve integrated interactions -16.27 3.25 13.02
Improve overall work flows -13.39 0.60 12.79
Improve population health -16.67 7.02 9.66
Reduce healthcare costs -13.81 -1.55 15.35
Gains in effectiveness of clinical and data analyticsPercentage point change from 2016 to 2017
19© 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved.
Not Effective / Slightly Effective Moderately Very Effective / Extremely Effective
Empower more productive providers -8.11 4.05 4.07
Enable better engagement -13.46 5.52 7.94
Enhance delivery system efficiency -0.04 0.97 -0.94
Improve integrated interactions -10.13 2.42 7.71
Improve overall work flows -11.99 -0.86 12.85
Improve population health -6.80 0.89 5.92
Reduce healthcare costs -4.27 -6.38 10.65
But overall we’re still generally seeing improvementsPercentage point change from 2016 to 2018
20© 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved.
What has limited the widespread consumer adoption of mobile and digital health tools? (Select all that apply)
n=158
10.8%
13.3%
13.9%
18.4%
19.0%
32.3%
32.9%
32.9%
34.2%
35.4%
48.7%
0% 10% 20% 30% 40% 50% 60%
Accuracy of mobile and digital health tools
Other (please specify)
Lack of data transfer
Real-time versus batch processing
Poor data and definition standards
Poor user interface design
Healthcare literacy
System interoperability
Duplicative, redundant, and confusing app environment
Limited functionality
Security and privacy concerns
Response Count: percentages will total over 100%
• The balance between
security and privacy issues
with functionality and
convenience will be an
ongoing challenge for
consumers, health plans,
providers, and health
technology vendors alike
• The need for a
standardized health
information exchange
format continues to be a
necessary building block
• As an industry, we need to
design products with
consumers in mind,
recognizing medical
literacy challenges
Other common responses:
• Consumer limitations: ability and/or proclivity
to engage on mobile platforms
• The complexity of selecting, implementing,
and managing apps
• Lack of a value proposition
21© 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved.
Which technologies are leading to significant
administrative cost efficiencies? (Select all that apply)
n=114
4.4%
6.1%
7.9%
9.6%
10.5%
11.4%
12.3%
13.2%
14.9%
22.8%
22.8%
22.8%
27.2%
63.2%
0% 10% 20% 30% 40% 50% 60% 70%
Augmented and Virtual Reality
Genomic Medicine
Block Chain
Other (please specify)
Community Resource Network Management
Retail Analytics
Consumer Journey Analytics in Healthcare
Consumer Insight as a Service
BPaaS (Business Process as a Services)
Wearables
Member Engagement Hub
AI (Artificial Intelligence)
Robotic Process Automation
Clinical Data Integration
Response Count: percentages will total over 100%
• Responses indicate that
clinical data integration
is critical, with a safe
assumption that it will
be the foundation to
realize greater benefits
from the newer, up and
coming technologies
available
• New to market,
blockchain saw a low
response rate but
assuming it sees the
same level of
investment in
healthcare as other
industries, we are likely
to see a significant
jump next year
PROPRIETARY & CONFIDENTIAL 22
What are two (2) reasons you feel cybersecurity initiatives at healthcare organizations continue to be lower funding priorities despite the rise in the number of cybersecurity breaches?
2.4%
4.2%
5.4%
9.3%
10.5%
11.9%
14.6%
20.3%
21.5%
0% 5% 10% 15% 20% 25%
Other (Please specify):
Because many healthcare organizations have notbeen hit by a cyber attack
There are limited regulatory requirements forcybersecurity
A lack of an overarching corporate cybersecuritystrategy
Not recognized as a priority at the executive andboard level
Too difficult to account for all the human factors(e.g. phishing emails, social engineering)
The cost to fully address cybersecurity gaps is toohigh
There are too many urgent priorities
The sophistication of cyber-attacks increases at ahigher rate than prevention capabilities
“Solutions impede efficiency”
“Overblown issue,
hyped by the industry”
“Poor available solution choices”
n=181
Count = 335
© 2019 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved.24
3.9%
3.9%
5.0%
6.1%
7.2%
8.3%
8.9%
11.1%
13.3%
32.2%
0% 5% 10% 15% 20% 25% 30% 35%
Driving incumbents to act more quickly
Through the gamification of personal health and wellness
Through healthcare adjacent value-added services
Through mobile data collection (e.g. wearables)
Via advanced A.I. capabilities
Launching vertical, all-in-one healthcare companies
Through supply chain innovations
Through refined consumer experiences
Introducing innovations in healthcare delivery
Disrupting current business models
How Do You Feel External Market Entrants Will Have the Greatest Impact in Disrupting Healthcare?
n=180
Pulse Survey Respondent:“Chaos and knee-jerk
reaction to new entrants”
© 2019 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved.25
Key Message:Business Model Disruption is Coming
A confluence of forces will require healthcare to adopt new business models and market strategies
• People: Consumers continue to demand a healthcare experience that mirrors the
access and convenience of other industries, while industry stakeholders are
beginning to explore how to place people at the center of healthcare
• Processes: How the business of healthcare gets done and how care is delivered will
be changed by continued advances in analytics, AI-enabled technologies, value-
based care, and new consumer expectations and demands
• Technologies: Emerging technologies will continue to offer significant opportunities
to healthcare due to lagging traditional business models, new entrants, and a lack
of experienced workers for current and emerging needs
Questions | Comments | Feedback
Ferris W. Taylor - Executive Director [email protected] (801) 703-1090
www.HCEG.org • [email protected]
@Health Care Executive Group
@hcexecgroup
www.wedi.org
Industry Pulse Invite & bit.ly
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