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EXECUTIVEManagedHealthcareExecutive.com The C-Suite Advisor
Managed H
ealthcare Executive
Risk-sharingpitfallsSEVEN MISTAKES
TO AVOID
SPECIAL REPORT Prescription drug spending surges
March 2016 VOL. 26 NO. 3
MA
RC
H 2016
Risk-sharing pitfalls | C
adillac tax delay: What to do now
| Prescription drug spending surges | D
ementia costs surpass all other diseases
VOLU
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26 | NU
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MANAGING RISK FOR PATIENTS: SMART
SHARING YOURGJ?9FAR9LAGFK RISK WITH US:POPULATION HEALTHIER
ManagedHealthcareExecutive.com MANAGED HEALTHCARE EXECUTIVE MARCH 2016 1
Opinionfrom DANIEL J. HILFERTY
n the past decade, no industry has under-
gone as much transformation as healthcare. With ad-
vancements in science, medicine, and technology, not to
mention the vast changes brought by the Aff ordable Care
Act, healthcare companies must be ready to innovate at
every juncture.
As a national healthcare company serving nearly 10
million people in 25 states, Independence Blue Cross and
its affi liates understand this well. We have created a strat-
egy that focuses on encouraging and developing innova-
tion in everything we do.
Th rough the Human-Centered Innovation Program, we
aim to solve some of the most pressing healthcare prob-
lems by moving forward with promising ideas that put
people and physicians at the center of everything we do.
In doing so, we believe we can make the healthcare experi-
ence more convenient, more eff ective, and less expensive.
On the cutting edge We developed our own sophisticated scientifi c modelthat
can identify who is at risk for serious health issues that
could require a hospital visit. Th is allows us to intervene
to help lower that risk by off ering customized programs
and services that can help members stay well. Our success
rates have been so higha 40%to50% reduction in hos-
pital admission rates among critically ill patientsthat
were expanding the program. Weve collaborated with
NYU Langone to identify those at risk for type 2 diabetes,
and intervene before they become symptomatic.
Were also committed to bringing oncology care ad-
vances to our members. Th ats why we are so interested
in companies such as NantHealth, which uses genomic in-
formation and medical data to develop personalized treat-
ment plans for people with cancer and other diseases. We
recently contracted with the company for whole genomic
sequencing for members with certain types of cancer and
are the fi rst major insurer to cover this testing.
Supplying necessary resourcesWe also disrupted the status quo by rethinking the way
primary care doctors practice. Tandigm Health, a joint
investment between Independence and DaVita Health-
care Partners, is a physician-led management company
that provides more than 380 primary care physicians
with analytical tools and access to real-time data to help
them better manage chronic conditions like diabetes
and heart disease. Tandigm physicians are rewarded for
the quality of care they provide, not for the number of
patients they see.
We are also investing in and collaborating with exciting
new companies such as Biomeme and CareCam. Biomeme
provides quick DNA testing and onsite disease tracking on
smartphones. CareCam helps chronically ill patients stay
well using mobile technology and video coaching.
Helping others succeed Last May, we joined other industry leaders to form the
CEO Council for Healthcare Innovation Collaborative. Th e
goal is to connect early-stage health companies with large
healthcare institutions to help them better understand
the problems that need solving. Th ese connections will
make it easier for new companies to more quickly produce
products and services that improve peoples health.
We dont view ourselves as a healthcare company, but
as an innovation companypowered by partnership, in-
vestment, and information. It all starts with putting the
needs of people and their physicians at the center of ev-
erything we do.
ABOUT THE AUTHOR
Daniel J. Hilferty is the president and CEO of Independence Blue
Cross. He is a member of the Managed Healthcare Executive
editorial advisory board.
Making the healthcare
experience more convenient,
more effective, less expensive
Human-centered healthcare innovation
I
http://managedhealthcareexecutive.modernmedicine.com/
2 Managed Healthcare Executive.comMANAGED HEALTHCARE EXECUTIVE MARCH 2016
EXECUTIVEEditorial Advisory Board
David Calabrese, RPh, MHP, is vice president and chief pharmacy offi cer of OptumRx, a pharmacy benefi ts fi rm that
manages more than 200 million prescriptions each year on behalf
of 25 million members.
Kevin Ronneberg, MD, is vice president and associate medical director for health initiatives at HealthPartners, an
integrated, nonprofi t healthcare provider and health insurance
company located in Bloomington, Minnesota.
Mark Boxer, PhD, is executive vice president and global chief information offi cer for CIGNA, where he is responsible for
driving the companys worldwide technology strategy.
Daniel J. Hilferty, MPA, is president and chief executive offi cer of Independence Blue Cross, a leading health
insurer in southeastern Pennsylvania with nearly 10 million
members in 25 states.
Joel V. Brill, MD, is the chief medical offi cer for Predictive Health, LLC, which partners with stakeholders to improve coverage
of value-driven care that optimizes health for people.
Margaret A. Murray, MPA, is the founding chief executive offi cer of the Association for Community Affi liated Plans,
which represents 54 nonprofi t safety net health plans in 26 states.
Roy Beveridge, MD, is senior vice president and chief medical offi cer for Humana, where hes responsible for developing
and implementing Humanas clinical strategy with an emphasis on
advancing the companys integrated care delivery model.
Don Hall, MPH, is principal of DeltaSigma LLC, a consulting practice specializing in strategic problem solving for managed
care organizations. He most recently served as president and chief
executive offi cer of a nonprofi t, provider-sponsored health plan.
Douglas L. Chaet, FACHE, is senior vice president of contracting and provider networks at Independence Blue Cross in
Philadelphia. He is also the founder and chairman emeritus of the
American Association of Integrated Healthcare Delivery Systems.
Dennis Schmuland, MD, is chief health strategy offi cer, U.S. Health & Life Sciences division of Microsoft Corp., where he
is responsible for setting the companys strategy and overseeing
solutions for the managed care industry.
Perry Cohen, PharmD, is chief executive offi cer of The Pharmacy Group and the TPG family of companies, which provides
services to associations, healthcare and information technology
organizations, payers and pharmaceutical companies.
Paul J. Setlak, PharmD, MBA, is associate director, Outcomes Solutions, at Astellas Pharma, where he focuses on
strategic market access, pricing and reimbursement.
Mission Managed Healthcare Executive provides healthcare executives at health plans and provider organizations with analysis, insights, and strategies to pursue value-driven solutions.
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