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Managed Healthcare Executive EXECUTIVE Risk- · PDF fileAs a national healthcare company ......

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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

    ME

    26 | NU

    MB

    ER

    3

    PAGE 18

    http://managedhealthcareexecutive.modernmedicine.com/http://www.ubm.com/

  • 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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