Grand Rounds Blog

Another NBGH Business Health Agenda conference has come and gone, and health benefits leaders from around the country are processing the various presentations they saw, and determining how to integrate these key learnings into their own healthcare delivery and support practices.

As a first-timer at the conference and a relative newcomer to the health benefits space, I was both inspired and perplexed by my experience. I’m especially inspired by all the innovation in healthcare in just the six years since the ACA passed. The shift to value-based care and a looming excise tax has many organizations—from providers to employers and vendors—rapidly building new solutions to drive access to better healthcare at more affordable prices.

I’m perplexed because it really feels like the problems we’re all trying to solve (e.g., high cost of care, low average quality of care, poor preventive care options, limited access to personal health information, etc.) should have never existed in the first place. How did we get to a place where 40% of certain procedures that are administered aren’t even necessary? Or, that in most states around the country, a person’s odds of selecting a poor quality physician is greater than selecting an above average one? We’re all trying to fix a $3 trillion mess that, while it needs fixing, feels like we’re just fighting to get back to where we ought to be already.

On that note, here are the eight most promising signs I witnessed at the conference that I believe are helping to move healthcare in America in the right direction.

1. Shift to quality as a defining attribute of plan design.

Employers are beginning to think deeply about the constitution of their plan design, and how to ensure their employees are getting the most appropriate level and quality of care for their medical needs. It’s the early innings of a conversation that Grand Rounds is helping to drive and innovate with our customers, and this has the potential for great impact on long-term improvements to the healthcare system, patient outcomes and cost savings.

2. Ready access to data enabling interoperability of healthcare systems.

As former HHS Secretary Kathleen Sebelius said during her keynote, “Interoperability of systems, as a byproduct of data accessibility, is hugely important for providers and patients to have meaningful interactions and produce the best outcomes.” With all the data now available through CMS, claims summaries and other publicly available and proprietary services, more rigorous data analysis can be conducted to not only match consumers and providers more effectively but to also create a doctor-patient relationship that drives better health and well-being for an entire lifetime of care.

3. Consumerism driving innovation in patient user experience.

From mobile apps to wellness programs, the millennial generation is helping to drive change by demanding access to resources that were previously unavailable (or unwarranted) to manage their personal health. Aon’s presentation on the consumer health mindset demonstrated a strong case for how healthcare consumerism is changing the delivery system as a whole. The four perspectives that are driving consumerism today are: consumers want to look/feel their best; consumers want a connected healthcare journey; consumers want to be guided step by step; and consumers want ease of access to highly personalized options. As vendors, we must consider how to address the “new” needs of the modern healthcare consumer.

4. Incentives driving early success in health and wellness programs.

Adrian Gore’s presentation on the work his organization, Vitality, has done in South Africa in driving improvements in wellness across the country underscored the ability of incentives to drive consumer behavior in a healthy direction. His points were echoed by Jenny Goins from State of Kentucky, whose incentivized programs have generated over $10 million in savings over the past two years and 40% program growth in the past six months.

5. ACOs creating regional quality centers for pockets of improved outcomes.

Though still in their early stages, ACOs received a lot of airtime at NBGH because of the promise they hold for individuals and families and early results that show cost trend impact. Vanderbilt’s VP of Corporate Health, John Von Arb, made the strongest connection when he demonstrated the relationship at his institution between physician alignment (driven from the top through an accountability model), productive patient interactions (led by a compensation model that rewards quality and performance) and improved outcomes. Vanderbilt’s story of cutting the trend in half for one of its larger customers in Tennessee is a good example of a provider network making change for the right reasons.

6. Specialty drugs a known issue, with solutions emerging.

According to CVS, by 2018, specialty pharma will represent 50% of all drug spend. Various factors are driving this trend, including an increasingly aging population, rising prices and new regulations. In fact, according to Truven Analytics, specialty drug costs PMPY increased 192% in seven years, while non-specialty drugs increased only 34%. The main takeaway from the discussions was that the trend towards value-based contracts (i.e., ACOs) and the addition of transparency to healthcare delivery system (i.e., Grand Rounds physician quality scoring) represent the highest-yield opportunities to control unnecessary specialty drug prescriptions and avoidable drug spending.

7. Behavioral health – only scratching the surface.

Though most benefits leaders (and vendors) are focused on solving the physical health issues most directly tied to achieving measurable healthcare outcomes, behavioral health poses a very serious risk and cost to the system. Indeed, serious mental illnesses cost America $193 billion in lost earnings every year. Only a small portion of the content at NBGH covered this critical issue, with Sprint leading the way. I’d anticipate this becoming a priority topic in the near future, as further data is uncovered and solutions come to market.

8. Smart people working together to arrive at a solution.

More than anything else, I was impressed with the level of intelligent thought and dynamic dialogue among the speakers and the attendees. Though in theory these are fairly straightforward challenges, the problems we are all attempting to address are incredibly layered, and practically impossible for any one person or company to solve. There is a level of openness in this industry that I admire, and believe is the key to making the healthcare delivery system in America truly great.

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