Health Care Insights | Weekly Round Up

Health Care Insights brings you your weekly healthcare round up. Below you will find relevant articles on key industry topics that we thought our readers would benefit from - enjoy.


Top Stories:

How The Upcoming Elections Might Shift The National Health Care Landscape
Here’s a solid prediction about next Tuesday’s elections: They’ll be crucial to the future of universal health care in America — or at least its near-term future.

Health Care Catches Data Fever
The United States is arguably in the midst of a health care crisis, but there is hope on the horizon and it involves learning how to make sense of big data. Over at Communications of the ACM, Oak Ridge National Laboratory (ORNL) shares how it is helping the health care industry benefit from patient data using the power of graph computing.

CFOs Feel Powerless When It Comes To Managing Healthcare Costs, Poll Finds
With U.S. enterprises spending more than $620 billion each year on healthcare costs, and nearly half of all Americans receiving their coverage through their employer, it’s no surprise that four out of five chief financial officers (CFOs) across all industries are feeling the pressure. In fact, nearly all CFOs (97%) believe that employers must “step-up” to the plate to help fix the broken healthcare system.

Omidria™ Granted Pass-Through Reimbursement Status from CMS
Omeros Corporation (NASDAQ: OMER) announced today that it has received transitional pass-through status for its lead product Omidria™ (phenylephrine and ketorolac injection) 1%/0.3% from the Center for Medicare & Medicaid Services (CMS), the federal agency that administers the Medicare program.

Health Groups Aim to Grow Pharmacists’ Care Delivery
Community Care of North Carolina (CCNC), GlaxoSmithKline (GSK), and the University of North Carolina (UNC) Eshelman School of Pharmacy have collaborated to generate new approaches to care delivery through pharmacists that will lower medical costs and improve health outcomes.

Have a great weekend!

A Complimentary Webinar from Healthcare Data Insights

Join us on Tuesday, August 19th for a complimentary webinar:

Moving and Improving: Using Data and Informatics to Inform Your Business Strategy, Save Lives and Improve Quality

Date: August 19th
Time: 11:00AM - 12:00PM EDT
Speaker: David Levine, MD, FACEP, Vice President, Informatics, and Medical Director, UHC
Priority Code: W1BL

Register Here

The University HealthSystem Consortium (UHC), the member organization of 120 non-profit Academic Medical Centers and their affiliates, encourages hospitals to integrate data into their business plans, in part by demonstrating how data can be used to save lives and improve quality scores. With transparent access to data from more than 400 hospitals (which includes more than 5 million inpatient discharges annually and 25 million outpatient encounters), learn how they make the case for member hospitals to “move and improve” with innovative programming based on data.

In this seminar, David will show how members maximize hospital and physician data to measure efficiency and effectiveness. Work in both the inpatient and outpatient settings to capture performance over the continuum of care will be emphasized. The data challenges will be highlighted especially with cost and capturing all inputs to care.

• Key metrics being used to measure overall hospital performance
• How Academic Medical Centers are looking at physician variability
• How to identify key opportunities for cost reduction
• Importance of risk adjustment and using proper compare groups to engage clinicians in improvement
• Challenges of integrating databases and gaps in data

Register here

Q&A with Amy Ramazio of GlaxoSmithKline – A Speaker at IIR’s Gross-to-Net Accounting Forum

At IIR's 2nd Annual Gross-to-Net Accounting Pharmaceutical Manufacturers, Amy Ramazio, Finance Director at GlaxoSmithKline will be the Big Pharma Chairperson, in our all new tailored discussion groups for your specific company size and function!

Below Amy sat down to do a quick Q&A session with us...enjoy!


Q&A:

1. How feasible is collaboration between managed markets, commercial, government programs and Finance?

Successful collaboration will largely depend on the particular individuals involved.  The key is for everyone to have an enterprise view.

2. Key questions to ask before investing and building an automated GTN system?

- What functionality is most important to your organization?
- How much are you willing to invest?
- When do you need the system to go live?

3. How to accrue and forecast patient/ payer related items? What critical/essential information is required and what aspects you can’t afford to overlook.

Forecasting and accruals are typically based on past history with some adjustments where there are specific changes expected in the future.  Having information to develop these adjustments is critical and could include: segment lives and expected trends, TRX data, formulary changes, legislation changes.   


To hear more from Amy, please join us in Philadelphia, June 17-18 for the 2nd Annual Gross-to-Net Accounting Forum. Plus register with the code XP1911BLOG to receive $100 off the current rate!

Register Now!

Q&A with Bob Gladden of CareSource - A Speaker at IIR's Healthcare Data Insights

This June at IIR’s Healthcare Data Insights, Bob Gladden, Vice President for Decision Support and Informatics at CareSource will speak on a session titled “Taking a Persona-Centric, Not a Disease-Centric, Approach to Care Management & Engagement”.

Session Info:
The typical member management program entails profiling members based on their disease states without taking into account the patient as a whole. Beginning in the Fall of 2013, CareSource started using claims and enrollment data to segment their members into a specific persona, then began services to members based upon the persona in which they were identified. Learn how they build data driven personas and understand the results they’ve seen to date.


Q&A:

1. What does data driven decision-making mean to you?

To me it means that when possible, we eliminate the guess work component of decision-making.  There will always be a component to decision making that is not quantitative, but that should be by choice, not because the data isn’t available in a format that can be incorporated into the decision-making process.
2. How do data sets (EHR data, claims data, member feedback, etc.) to inform your business strategy?

As a Medicaid managed care organization, we use claims data extensively to help shape everything from care programs to business strategy.  Ongoing, our strategy continues to be to augment the claims data view of our membership with other data sets that can enrich our view of our members, and help us to identify their needs at the earliest possible moment.  As one example, we are currently working on a partnership with a state Health Department and a major university that will expand our view beyond claims data to include social/economic data. 

3. In general, how difficult is it to get internal buy-in to build out programming that’s based on data?

Actually, at CareSource the difficulty has been to build out the data to support and enhance programs fast enough to keep up with the requests.  Senior leadership here has for some time been asking for more data support to build all of their efforts.  Having leadership asking for this support goes a long way toward the success of having an organization focus decision making on fact and less on hunches.

4. How do you see your use of data evolving in the upcoming year? Are there new opportunities to use data to create more effective, innovative programming?

There are a number of changes that are coming. The most notable in health care is the provider base moving to electronic medical records. Many of these systems were first stood up just to meet requirements for enhanced reimbursement, but now the effort is to fully incorporate this information in work-flow and use it in a meaningful way.  To that end, there are more changes coming that could even eliminate traditional claims as we know them today. It is all part of many exciting developments that will change how we all do business to deliver far more effective and higher quality care.


To hear more from Bob, please join us at Healthcare Data Insights, June 23-25 in Chicago.

Register now and save an additional $100 off the current rate when using the code: XP1902BLOG

HDI Podcast Series with Bob Gladden of CareSource

Healthcare Data Insights Podcast Series

 Below is a teaser from our podcast series with Bob Gladden, VP for Decision Support & Informatics, CareSource

Download the complete podcast and transcript here.

How do you make data-driven decisions across the organization?
Bob: It’s been an interesting journey that we’ve been on. I think we’ve been on this like a number of other companies. I’ve heard some references to how companies are dealing with this today in terms of how decisions are made. Are they made based on individuals having data and pouring through that and coming up with a solid answer? Or is it based on what they call in the industry “HIPPOs”, which simply translates into ‘highest paid person’s opinion’. Now, we have to be careful about calling people HIPPOs. That doesn’t tend to go over well. But, we are working towards certainly the value that those highest-paid individuals have – a lot of energy and a lot of experience that they bring to the table. But, we are trying to shift a little bit so that data becomes more involved and more a part of the decision processes and use the folks that typically in the past were the highest paid person in the room just making the decision.

We’ve now focused that a little differently and we are now using them to help us identify where we need to look and put some energy into changing things. We are actually right now in the process of redesigning our entire care management process in the organization. Within that, we are actually using a very data-driven approach to even design the program, which is certainly a step forward from where we’ve been in the past. It is allowing us to step away from some of the more traditional ways that you might design a care management program.

To hear more from Bob, please join us at Healthcare Data Insights, June 23-25 in Chicago. Register with the code XP1902BLOG and save $100 off the current rate. That is $300 in total savings if you register by this Friday, 5/23. REGISTER HERE!

FLASH SALE! Healthcare Data Insights - Buy One Pass & Get One Free (Offer Only Valid Through 5/13)

Buy one pass and get one free when you register for IIR’s Healthcare Data Insights (HDI) by the end of Tuesday 5/13!

Be empowered to do more with all of the data you already have at your fingertips. Regardless of what your role is—medical, sales/marketing, financial—data-driven decision-making will help put together smarter, better informed strategies. Attend HDI to learn how to implement data-informed programming. 

HDI’s expert speaking faculty includes companies like Intermountain, CareSource, Steward Health Care Network, Molina and MDwise who are already deemed pioneers and masters of data-driven healthcare strategies, and will present case studies on how you can become a master as well!

Register by calling (888) 670-8200 to join us and mention code XP1902SAVE to buy one pass and get one free!

Healthcare Data Insights will take place in Chicago on June 23-25 at the Hilton Garden Inn Chicago Downtown. See you there.

Have any questions? Email Ryan Geswell.

Note: This promotion is valid only through 5/13 and cannot be combined with any other discounts.

Decode Big Data to Drive Decisions | Register for HDI by Friday to Save $500!

 According to PricewaterhouseCoopers, big data and predictive analytics help companies better understand their audiences and how to engage them.

We're not talking to the "data guy". We're talking to YOU-the person making informed decisions based on data that is material to your business (claims data, member feedback, clinical data, etc.) By translating this information into actionable insights, you have the power to make more efficient and effective business decisions.

Don't fall behind as more and more companies grow increasingly data-driven and are more willing to apply analytics-derived insights to key business operations. Join us in Chicago this June 23-25 at IIR's all-new Healthcare Data Insights, where you will hear from speakers who successful implement big data analytics into their business strategy.

Discover how to make the best data-driven decisions for your company with speakers including:
•    Elizabeth Benz, Associate VP of Community Outreach & Engagement, Molina Healthcare of Wisconsin   
•    Greg Poulsen, Senior Vice President, Chief Strategy Officer, Intermountain Healthcare   
•    Bob Gladden, Vice President of Decision, Support & Informatics, CareSource   
•    Dan Munro, Contributor of Healthcare IT, Innovation and Policy, Forbes

Register by Friday 4/25 to save $400! Plus take an extra $100 off when registering with the code: XP1902BLOG

That is $500 in total savings, register today!

Learn more about Healthcare Data Insights here.

Hear from Sanofi, Astellas and more on Oncology Management

It’s no secret—as oncology continues to be one of the fastest growing markets for the pharmaceutical industry, costs for cancer care therapy are increasing exponentially. This is due to an aging population, increased cancer diagnosis, rising cancer care expenses, limited therapeutic clinical and real-world data, and a demanding payer market. As a pharma executive, how are you overcoming these challenges and positioning your company for success?

IIR’s Annual Summit for Oncology Management will show you the way—join industry leaders from Sanofi, Astellas Pharma, Humana, Advanced Board of Internal Medicine and more, as they tackle the most critical issues in oncology on July 21-23 in Philadelphia, PA.

This is your unique opportunity to collaborate with pharma, health plans, hospitals and physicians to discuss the importance of controlling costs, increasing quality, determining value and improving patient experience amidst the evolving cancer care landscape.

To learn more, download our brochure.

Register with code XP1914BLOG and save 15% off of our standard rate. Questions about the event? Email our group manager, Kate Devery (KDevery@IIRUSA.com). For more information, visit our website. We look forward to seeing you this July!

Cheers,
The Oncology Management Team

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It’s radical. It’s revolutionary. It’s trailblazing. What is it?

“It” is the practical and functional use of big data in healthcare. Your claims data, clinical data, EHRs, member feedback and retention statistics are growing exponentially, so what are you doing to capitalize on it? Your opportunity lies in de-coding your data points, and then applying the learning to your business strategy, to make it all WORK. But how?

You answer is at IIR’s Healthcare Data Insights (HDI), taking place June 23-25 in Chicago. HDI will be your portal to the future of big data in healthcare. With case studies from health plans like Centene and Intermountain, you will walk away with strategies that leverage big data insights to create better informed, full supported business strategies—which may save your company hundreds of thousands of dollars and improve patient outcomes! Opt-in for the latest updates.

Be empowered by healthcare pioneers as they demonstrate case studies on how to translate big data into actionable solutions:

• Use State-Provided Redetermination Information to Improve Member Retention Kelly Bonanno, HealthChoices Program Manager, Geisinger Health Plan

• Utilize Big Data to Manage Clinical Interventions Alan Krumholz MD, FAAP, Vice President, Mayo Clinic Health System-Franciscan Healthcare

• Compile Large Data Sets to Improve Care and Drive Down Expenditures Leslie Naamon, Chief Operating Officer, Peach State Health Plan, Centene Corporation

To learn more, download our brochure.

Register with priority code XP1902BLOG and save 15% off of the standard rate. Questions about the event? Contact our group manager, Kate Devery (Kdevery@iirusa.com). For more information, view our website. We hope to see you this June!

Cheers,
The HDI Team

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