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Reprioritizing healthcare priorities in the wake of COVID [PODCAST]

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The Hospital Finance Podcast

In this episode, we are joined by Ferris Taylor, Executive Director of The HealthCare Executive Group, to discuss their annual top 10 list of challenges, issues, and opportunities for healthcare executives.  

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Highlights of this episode include:

  • Background on HealthCare Executive Group and how their annual top 10 list is created. 
  • How the coronavirus pandemic shifted priorities for healthcare executives, as seen on HCEG’s updated top ten list for 2021.
  • Reasons why the consumer experience moved up to the top of the list as a 2021 priority for healthcare executives. 
  • Why accessible points of care jumped several spots on HCEG’s top ten list as a priority for 2021.
  • What challenges, issues, and opportunities appeared on the list as a result of the pandemic?
  • And more…

Mike Passanante: Hi, this is Mike Passanante and welcome back to the award-winning Hospital Finance Podcast®. Each year The HealthCare Executive Group gathers healthcare executives from payer, provider, and healthcare technology organizations to rank their top 10 challenges and opportunities going into the next year. However, 2020 presented a host of new challenges that reshuffled priorities among these groups. To talk us through the issues that are at the top of the list for key healthcare executives, I’m joined by Ferris Taylor, executive director of The HealthCare Executive Group. Ferris, welcome back to the show.

Ferris: Thank you. Glad to be here.

Mike: Always enjoy our discussions, Ferris. And for those who may not be familiar with The HealthCare Executive Group, could you just start out by telling us a bit about your organization?

Ferris: I would love to, and I’ll be brief, Mike. HCEG’s a national network of health plan and provider executives, primarily focused on innovation and technology. We’re celebrating our thirty-third year in working together to improve and reshape healthcare. And in today’s environment that’s a big statement. But I think it’s important for your listeners to recognize that we were founded by a technology company, Digital Equipment, or DEC, back in 1988. When they disbanded their healthcare users’ group. And, basically, that group of users came back and said, “Wait a minute. We want to continue the type of discussions that we’re having.” We find value, independent of the technology company that was coordinating the user’s group, in networking and sharing perspectives, as we’ll talk to today, about the issues and challenges, and opportunities across the whole healthcare spectrum. So HCEG continues to exist, to facilitate that kind of exchange and dialog and networking, as you and I are doing here today. We do webinars, roundtables, and there are lots of discussion around critical issues. Our overall mission is guiding healthcare executives through innovation, change, and growth. So listeners can learn more at HCEG.org, but that’s our organization.

Mike: Excellent. Thank you for that summary, Ferris. So let’s start off. Your group made a decision to move forward into 2021 by asking healthcare executives to reprioritize their 2020 priorities in light of the pandemic. So why don’t you start out by running us through the 2020 list briefly, and then we can focus on the areas that maybe moved up on the list?

Ferris: I’d be glad to do that. And it’s interesting, Michael. It’s traditional, 10 or 15 years, HCEG, at the end of the year, with our member organizations, which are more typically the smaller, regional health plans, and the integrated delivery systems provider organizations. We end the year by going through a David Letterman type of process, to vote on, from a list of 25 or 30 potential issues, a top 10 list. And you and I, a year ago, beginning of 2020, talked about what was on that 2020 list. And what happened was we did not have our annual meeting, three-day meeting, where we really dive into these issues. So it was important for us this year to step back and say, “Okay. We’re in the middle of a pandemic everybody in healthcare is scrambling to catch up and get on top of COVID. We’re in the middle of social unrest going through an election cycle with all of the divisive political discussions that are there. We didn’t have the opportunity to really say, “Let’s start from scratch again and create a 2021 list.” But in the middle of COVID, we did say, “It’s time to ask the industry, given the crisis, what’s changed in that 2020 list that you and I talked about a year ago?” And so we went out with a survey. It was an industry polled survey, but a COVID flash survey. And we basically asked people to look at that top 20 list. And you and I talked about the first five on the list for the 2020. I’ll just quickly review them. Cost and transparency was at the top of the list. And with surprise billing and the unaffordability of healthcare interventions if you didn’t have insurance, the fact that for six years or so we’ve been dealing with the Affordable Care Act. And it’s funny that affordable was in the ACA terminology. I think it was the Accessible Care Act and we made great progress there. But we didn’t make progress with the cost side of healthcare. And so costs and transparency moved up on the list in 2020. But right behind it was the whole consumer experience. I think healthcare has been challenged to make healthcare access and interventions easy and convenient and timely, streamlined, integrated, and cohesive to fit into what I like to call the life flow of the individuals and the families that are dealing with medical situations. So number two was consumer experience. Delivery transformation was a new terminology of the top 10 in 2020. And that’s a very robust top ten issue, operationalizing and scaling the delivery system to be able to deal with the consumer transformation, but also what we like to call value-based care or value-based reimbursement. But our members were also talking about social determinants of health, improving health quality and outcomes and like that. Data and analytics, number four on the 2020 list, leveraging the new technologies and the advanced analytics, but also new sources of very disparate, non-standard, unstructured, and highly variable data again. Genomic data, social, economic, financial data integrated with healthcare data. And that related to number five that you and I talked about in terms of interoperability and consumer access to data. CMS had announced the FHIRE initiative, the Fast Health Information Access Intuitive. So data and analytics were there and interoperability related directly to that. It’s interesting that six and seven and eight on the top ten 2020 next generation– well, holistic individual health and next-generation payment models and accessible points of care were those next three issues. And part of that related to how do you get around both the integration of medical and mental behavior health, but also social determinants of health. The whole individual and the whole population. Here we were, last year, Mike, talking about that, little did we know what would be coming down the pike with COVID. And so you and I can talk today about next-generation models. Accessible points of care was the whole remote access, telehealth, mHealth, wearable devices, digital devices, retail and home health-based care that came into play. Health policy was number 9 on the list I think primarily because of coming into the election cycle, the politics around Medicare for all or single-payer Medicaid buy-in, block grants, and all of those things. Of course, health policy was there. And I think rounding off the top 10 list, Mike, privacy and security. A critical issue that’s been out there from a number of years ago, but healthcare is in the crosshairs from cybersecurity point of view and attacks, ransomware, and like that. So that was the top 20 that we came into 2020 with, and. Any questions or comments that you have there?

Mike: Well, it’s certainly interesting. As you began to survey everyone who initially set those priorities, how things changed. We saw the consumer experience moving from number 2, which is pretty strong, but it went right to number 1. And that’s maybe not surprising giving the environment that we’re in. What can you tell us about what they were thinking there?

Ferris: We could probably spend the whole time just on that one issue. I think that really COVID and the pandemic. I like to think the last few months about a Mike Tyson quote. Everybody has a plan till they get popped in the mouth, and COVID was certainly not just a one hit to the mouth. We’re, what, on our third or fourth wave of surges. Healthcare has taken a real hit, but in the middle of that hit is the recognition that we need a more consumer-centric healthcare system. Consumerism has been– online appointment scheduling. Well, that was really wonderful. It’s a bit of convenience, but even around that, there are a lot of fundamentals that needed to change to really put the consumer and the patient at the center of healthcare. And COVID has, in all of the negatives that it’s created, it has definitely exposed the flaws and the gaps that we have in making that transition to a more consumer-centric healthcare. And both the payer at 64% and the provider at 53% now indicate a much stronger interest in an accelerated adoption of consumer-centric care. From a personal point of view, it’s always been intriguing to me, Mike, and you and I and your listeners, as opposed to many products and services in the marketplace, we are all consumers of healthcare. And it should be very easy for us to step back and say, “As a consumer, well, how would I like this healthcare system to function?” And rather than a current experience projected forward. I think what COVID has forced us to do is to say, “Out beyond COVID, out beyond BC, before COVID, what should healthcare look like?” And then work backwards from that. A colleague of mine, Clayton Christensen, who passed away a year ago, in a site, his organization is continuing this amazing– they’ve written an entire book on how to frame innovation. And I highly recommend it to the listeners. But to do that, in the context of consumer-centric healthcare, something happens to us, Mike. Every one of us working in healthcare, when we used to walk through the front door of the office, we take off our consumer hat. Put on our business hat and forget what it’s like to be a consumer. Even if we’re working from home, it’s very easy, at least for me, to think about what health care should be in a consumer-centric world. But we have a long ways to go. So it wasn’t surprising to me, when we did this COVID-based flash survey and asked about re-prioritizing the 2020 top 10 list, that consumers went to the top of the list.

Mike: Yeah. And an even bigger jump perhaps was the accessible points of care. And that moves from number 8 up to number 4 on the list. And again, one can see, as you’ve mentioned, why that might move up. But can you add some color around that for us?

Ferris: Well, and a good friend and colleague of mine, Emma Johnson, a few years ago, stepped into the American Telemedicine Association. And for perfect timing for sure. When the COVID crisis hit, in-person care became less attractive. Providers didn’t want patients coming into their office. Patients didn’t want to be going out into the public to get exposed to COVID. So the big component of that change was Telehealth, Telemedicine. I have talked with provider groups, hospital systems, and like that, that prior to COVID, said they may have had 30 or 40 telephone consults a month. And within a month after, the March 13th, and the recognition that we were in the middle of a pandemic, their Telehealth consults were in the neighborhood of 3000 consults a month. Now, naturally, there are a lot of infrastructure and adoption. And other challenges had to be addressed. But also, accessible points of care, especially virtual care consults, became accessible. And executive orders, health plans, change reimbursements so that providers were being reimbursed on an equal basis to end personal consults. Copays were delayed or no longer applied to Telehealth consults. But I think we need to look beyond just the virtual care consults to what has happened with remote patient monitoring, using medical devices of making that data more accessible between patients and providers, in-home care, chronic condition. Behavioral health consults have changed dramatically as well. So underneath that transition to number 4, in terms of accessible points of care, it very much was fundamentally that providers and patients were forced into a situation where they wanted to give it a try. And the incentives, the reimbursement environment, was such that they’re willing to give it a try. And we actually ask, in the flash survey, we drilled into this Telehealth, Telemedicine concept in quite a bit of detail. And I won’t go into all of that. But the results of our research were that Telehealth volumes are here to stay, that the providers have now found it convenient, patients, consumers, once again, it fits into their lifestyle. And they will question now whether they need to go to the doctor’s office or they can do a Telehealth consult. It’s less intense from a resource point of view. And it’s not for everything. But Telehealth is now front and center. We also ask questions about reimbursement. And most of the pairs are saying that Telehealth reimbursement will actually be more after COVID than it was during COVID. The providers for the physicians and the hospitals, this is really good news because they haven’t had the reimbursement for Telehealth or virtual consults that they had for in-person consults. Now, it will yet to be seen how that carries on beyond COVID. We’re not there yet. We’ve seen back in October 1st, a number of health plans when the executive order started to disappear, started applying copays and applying those to deductibles. And reimbursement started to change. So this still has to settle out. But there is no doubt that accessible points of care and consumerism or consumer-centric health care are going to be critical going forward.

Mike: Well said, Ferris. Next area, I wanted to touch on with you, was healthcare policy. And that just moved up a notch from number 9 to number 8 on your list. But that’s a pretty big umbrella. So can you give us some context around that topic?

Ferris: Well, the challenge Michael for a number of years with the HCG in our top 10 is you put these issues out there. And they’re all pretty big umbrellas. But any point in time, there are components of that umbrella that become much more critical and much more focused. I will say that in terms of healthcare policy, back going into 2020, it was more around what will be the political environment to– and administrating the environment around the healthcare. And, again, I had mentioned Medicare for All or single-payer or a Medicaid buy-up. Those were all discussions going into 2020. But now, given the COVID experience, it was not surprising to me that healthcare policy became much more important. Later, we can drill down, or listeners can go to the research itself and see the details, but especially for the hospitals and the physicians, their lifeline during COVID was the executive orders and the funding that was going into the hospitals and the attention that was given to getting the right supplies, the personal protection equipment, the ventilators. I think we’re still going to see, and in responding to the COVID flash survey, I think everybody was saying, “Okay. We’re not out of this if COVID starts declining. We still got to have a rollout of a vaccination process, and that’s going to be a long-term issue that’s going to need some healthcare policy put around it.” Of course, we’re now coming on the other side of the elections. There were surprises there. It was not what a lot of people expected, one side or the other, but in fact, healthcare policy is still front and center in the Senate, the Congress, the Executive office. And who knows where the judicial side will come down on healthcare policy, but it is a top issue. I would also say that, as we dove into the research, what COVID has exposed is the disparities in healthcare and the inequities in healthcare, and that is a component of healthcare policy that is crying to be addressed. We as a society, morally and socially, are not willing to accept what we’ve actually experienced in COVID with the inequality and the inequity of what’s happened in healthcare, and that type of a topic will move right into healthcare policy. And so we expect that issue to be there, and at the point where we start with a brand-new 2021 top-10 list, I expect that that could even move up significantly further in the top-10 list. I’m glad you pointed it out because it was down at the bottom, didn’t move a lot, but to make that kind of a move in the middle of COVID deserves some of our attention.

Mike: No doubt. No doubt. And you already had a pretty robust list of 10 topics, but COVID exposed several more, and these healthcare leaders added a number of items to your list as a result of the pandemic. What are some of the highlights there, Ferris?

Ferris: So, to put this in context, in that flash survey in August to September, in the middle of COVID when we went out, the first question that we ask is, “Is this 2020 top-10 list still the list of priorities?” And the first thing that I saw, 34% of the responders. And it was 288 to, primarily, health plan provider. 40% of them were C-suite executives who responded, but 288 people across the country. Basically, 34% said, “Nope. That’s a list of priorities. Now is in the middle of COVID.” So that was a higher percentage than I expected. When I add everything together, about two-thirds were saying, “No. The list needs to be prioritized or needs to be added to.” And actually, 19% were saying, “There are critical things that need to be added to the list.” So we’ve already talked about what changed. In the aggregate level, going back to one of your earlier questions, Mike, it is interesting to me when we break out pairs versus providers on that number one issue, yes in total cost and transparency was at the top of the list, got replaced by consumer experience in total, and pairs still had that as the top issue. Providers had cost and transparency as the top issue because of the financial crisis that they were facing in the middle of COVID. So there is a lot of detail that’s down underneath this. But in answer to your question, we had a hundred and some odd suggestions of what should be added to the top 10 list. And we sorted through those. It was an open-ended question rather than us putting a preconceived list of what should be added to the top 10 out there, so we had to do some word mapping and like that. As would be expected, the major thing that needs to be added to the top 10 list is the COVID-19, but it’s broader than that. It’s really pandemic-related issues. Those dominated that new priority list for the top 10. Providers had to be focused on the surge in the ER and intensive care or COVID patients and were finding financial support classing around them, and businesses were shifting to work-from-home, and we had flaws in testing rollout and medical equipment and like that. So it doesn’t shock me that pandemic preparedness, which to some degree– and we haven’t researched the way that a lot of other organizations had, but we had pandemic preparedness plans in place as a healthcare industry. I spent a couple of years on the hospital side and I know– 15 years ago, we had plans set aside to deal with the pandemic, but those need to be reinforced. I think everybody’s now saying, “Will this–” or, “What will be the next pandemic that comes along, and how should we take the lessons learned from COVID?” And we’re still learning them going into the vaccination process. But how do we take that big issue? And again, it’s a broad definition if I put it out there, but I would really say that it’s the COVID-19 pandemic response is the number one thing that needs to be added to the top 10. Another topic that there were a lot of comments around. Was that a telemedicine component? And we’ve already talked about that. And we already had that in the top 10 list under accessible points of care, but that’s going to need a lot more clarification and detail put into it. So I would simply add that to the existing top 10. The third primary suggestion that I think is going to carry forward for some time as a priority that needs to be added to this top 10 list. We ended up calling up Mike, supply chain optimization or configuration. There’s still a lot of discussion both at the guidelines level with the CDC or the government or the state administration on how you roll out vaccines. Who gets vaccinated first? Where does each segment of the population fall in the supply chain? We’d already addressed that– not addressed it, we were facing it when we did the COVID survey in terms of personal protection equipment. I can tell you we have in our association a medical director from a major integrated delivery system on the East Coast. And once a week, on Fridays, this medical director goes to a community health and center and practices. And in talking with her, she did not have n95 masks. And this was in August. We still had not been supplying them. I have a brother-in-law that had been importing from China n95 masks and boxed up 20 of them and sent them to her, but– not to beat a dead horse, but we all know that the supply chain, from an equipment point of view, from a vaccination point of view, from a prescription point of view, needed to function differently. And I think there will be a lot of focus on that. Other things that kind of fit into other topics already on the top 10, addressing the disparities in healthcare, we’ve talked about. Interesting, as I looked at those 100 plus additions that were suggested, data and analytics took on a new term and we ought to add it into it. And that was the integration of data and analytics into the healthcare system. Now, on our top 10 list, number 5, we talked about it a year ago. My goal was interoperability and consumer access to data. But it isn’t just the added accesses, integration of that data and analytics into the healthcare system. And the final one that I would mention for the listeners that came out of this list of suggestive things that needed to be added to the top 10, is just that broad category of improving healthcare quality. And we were experiencing that in the middle of COVID. It is now front and center. How will it get ranked if we have it as a separate category, or whether it belongs in healthcare policy? Whether it belongs in the next generation payment models that we have ahead of us? But that whole improving outcomes and quality, it also fits into that number 2 number three topic that we see in the re-prioritize list around delivery system transformation. Healthcare needs to restructure around consumerism, around value-based care. Core to that is excess access to care, confidence in the quality of care, focus on the outcomes that come out of care as opposed to just the activities that we typically do in healthcare. Those were the primary additions that we saw come out of the research. We actually shared the word map. The size of the words show the number of times that those issues were mentioned in the research. And I think every single organization can benefit by looking at the research itself and saying to themselves, “Which of these apply to my organization, my hospital, my physician practice, my health plan?” We’re in different geographies. We’re in different economic settings. And so no organization, Mike, can deal with 10 issues at once. In an HCEG top 10 there’s two or three that are important to each organization. And for the interim period here, HCEG is putting out a 2021 list, which is a re-prioritized, that we’ve talked about, 2020 list. Plus, and it’s that augmented list of top 10 issues that includes pandemic response, supply chain optimization, and the addition of these other topics into the already-existing top 10 list that we’ve talked about today.

Mike: And if someone wanted to read more about that or get a copy of those results, where can they go?

Ferris: You can always go to the HCEG website, hceg.org. I will say, sort of in closing, Michael, that I have a favorite quote. From our last interviews over the last couple of years, I’m one that always finds context in quotes. But there’s an E. L. Doctorow quote out there that I use a lot, and I think it’s very relevant to where we’re at right now in healthcare, and that is this, “It’s like driving at night in the fog; you can only see as far as your headlights. But remember, you can make the whole trip this way.” And we lose sight of that sometimes, where in a blinding sandstorm or in the fog I’m going to stop and pull over. And if healthcare stops and pulls over in the middle of this COVID pandemic, we’ll get rear-ended. There are a lot of consumer-centric companies out there. We talked about this fact last year, Mike. Amazon, Facebook, Google, the Walmarts, and the CVSs, the Walgreens. There’s lots of companies out there that are looking at healthcare and saying, “We can do this better.” So if we stop moving forward, we’re going to get run over. But also, we can’t go too fast, or you miss the turnoffs; you miss the intersection, and we’ll have to stop and go back. So there’s an appropriate degree of caution, but, and I’m essentially an optimist, we can get through this. We will get through this. We just have to keep moving forward. And we haven’t mentioned it, Michael, but one of the things that– as I look at the last year or two of research and discussions with our members, the very best news in all of this is not talked about a whole lot. But if I look back at industry polls that we released in February of 2020, just before the COVID crisis. It was that payers and providers were not on the same page. They disagreed about how important consumerism was. Providers were not all that excited about buying into value-based care and value-based reimbursement. The best news of all in a global basis, with respect to the COVID research, is that has changed dramatically. Payers and providers are now putting in the same priority order. They’re coming to the table to collaborate and to cooperate and to look for out-of-the-box solutions, the third alternative. Not just my way or your way, but a new way forward in healthcare. And deep down underneath the research of the COVID flash survey is a really exciting piece of information that payers and providers are now coming together and looking together for solutions. And there are dozens of examples of that we can talk about, Michael. But we can make it through this. Let’s not go too fast. Let’s not go too slow. But let’s keep driving forward in the middle of the pandemic, and we will solve these problems.

Mike: Ferris, as always, great insights and inspirational thoughts here as we move into the next phase of things. I’m certainly looking forward to additional results from your group as we move through 2021 and the healthcare landscape changes again. So, Ferris, thanks so much for coming back to the show. I appreciate it, and you’re always welcome back.

Ferris: And thank you, Michael, and the best of 2021 to all the listeners. As I just said, we all, as stakeholders, can do a better here. And we’ve seen more change in 10 or 12 months than we’ve seen in 10 or 12 years, and all that change is great. It will help us have a better healthcare system. BC or before COVID versus after COVID. So great success for 2021, and we look forward to working with all of your listeners on the best solutions to move healthcare forward.

Mike: Thank you. Stay well.

Ferris: Likewise. Thank you.


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