Insights for Healthcare Leaders & Change-Makers
Lots of interaction, information, and insight have been happening lately and we're pleased to provide an update to you on this last day of Q3 2021. We've held a handful of roundtables and a webinar since early August and share highlights from some of those roundtables and a recording of the webinar “Current and Former Health Plan Executives Weigh in on the State of the ACA Marketplace” below.

Additional Focus Area Roundtables are scheduled for Q4 2021 and several Webinar Series Events are scheduled for Q4. We'll also be sharing results from two surveys created in partnership with sponsors along with a webcast presenting the digital transformation of a 20-year old regional health plan. Check out the sponsor and partner resources including a special offer on the 2021 WEDI National Conference taking place October 18th through the 21st. We appreciate our sponsors and partners and urge you to review how they serve health plans, health systems, and healthcare providers.

We hope the information in this newsletter is of use and we look forward to sharing more about other content, events, and networking opportunities currently being developed.
Highlights from Recent Focus Area Roundtables
In September we had a number of Focus Area Roundtables on select 2021 HCEG Top 10+ priorities. Check out the following highlights from three of the roundtables, look for highlights on other roundtables coming soon, and consider joining upcoming roundtables.
See Upcoming Roundtables below for information on 45-minute these discussions facilitated by industry thought leaders where all participants get to meet others, learn from experts, share information and ask questions.
September Webinar Series Event
Current and Former Health Plan Executives Weigh in on State of ACA Marketplace

Three health plan leaders discussed their current and past experience getting on and operating in the ACA Marketplace. See the recording of this webinar presented by Softheon and learn:

* How to survive new and existing politics and both CMS and state-based regulatory challenges
* Opportunities regarding reconciliations, member communication needs, audits, and the dynamics of Medicare and Medicaid markets
* How to reduce ACA overhead, simplify member experiences and accelerate optimal results by using integrated, insurance exchange technologies.
Intelligent Care Management Technologies
Intelligent Care Management Technologies provides an integrated, holistic approach to care beyond the often disjointed utilization management, case management, and other clinically-focused services historically performed by some health plans.

Read this new post presenting 5 Reasons Why Health Plans Must Adopt Intelligent Care Management Technologies.
Intelligent Care Management Technology: Driving Alignment Towards the Quadruple Aim
On Thursday, October 7, 2021 at 12:00 PM PT / 3:00 PM ET, healthcare leaders will share information on harnessing the power of intelligent care management technologies (ICMT) to connect payers and providers. This HCEG Webinar Series event presented by VirtualHealth also presents how plans can use intelligent care management technologies to achieve the Quadruple Aim.
Offering 2nd Opinions to Plan Members & Employees
Recent years have seen phenomenal growth of the second opinion market – primarily driven by payers and self-insured employers trying to control staggering healthcare costs. Offering virtual 2nd opinions to plan members and employees presents several opportunities and considerations.
Increase Member Engagement & Decrease Costs with Virtual 2nd Opinions
On Thursday, October 14, 2021 at 11:00 AM PT / 2:00 PM ET, Medical Review Institute of America (MRIoA) will present how virtual 2nd Opinions help payers and self-insured employers increase member engagement by using evidence-based medicine to educate plan members while decreasing healthcare costs.
Digital Transformation Leads to Better Member Engagement
HCEG has partnered with Change Healthcare Consulting to create a webcast presenting how a health plan that's been around for 20 years radically transformed itself. Ferris Taylor moderates a discussion with two principals from the health plan and two consultants involved with the transformation. An overview and discussion of actions taken, lessons learned, and insights for success are included in the webcast.

This webcast will be shared to the HCEG Network as soon as it is released in the coming days.
Payer-Provider Payment Solutions
To assess payment-related challenges payers and providers are experiencing, identify gaps in the current payer-provider payment system, and help determine what’s holding back the adoption of new payer-provider payment solutions, HCEG and Zelis Healthcare are hosting a mini-survey on Payer-Provider Payment Solutions. Healthcare stakeholders are urged to complete this three-minute survey.

All survey respondents can receive survey results and be entered into a drawing for one of four $25 Amazon gift cards.
Look for the results of this survey in an upcoming newsletter.
Upcoming Roundtables - Connect, Learn, & Share
Leaders at health plans, health systems, and care provider organizations are invited to participate in roundtable fashion at the following upcoming Focus Area Roundtables:
Data & Analytics for Costs and Payment #2 - October 20th
The 2nd roundtable facilitated by MultiPlan takes place on Wednesday, October 20th at 12:00 PM PT / 3:00 PM ET. The discussion will focus on Data & Analytics to Operationalize and Optimize the No Surprises Act:

1. What strategies can plans and providers use for identifying Qualified Payment Amounts (QPA)?
2. What operational impacts do you anticipate in implementing a QPA strategy?
3. What resources are likely to present challenges, issues, or opportunities in implementing and optimizing a QPA strategy?

Request an invite here.
Next-Gen/Value Payment Models #2 - October 26th

The 2nd roundtable facilitated by Zelis Healthcare takes place on Tuesday, October 26th at 11:00 AM PT / 2:00 PM ET. The discussion will focus on current value-based payment program developments and topics raised in the first session.

See highlights from the first roundtable here.

Request an invite here.
Interoperability #3 - December 7th

The 3rd roundtable on Interoperability facilitated by Surescripts is scheduled for Tuesday, December 7th at 10:00 AM PT / 1:00 PM ET. 

The discussion will focus on interoperability-related topics collected during the first two roundtables including stakeholder collaboration, electronic prior authorizations, ePrescribing, and other topics of interest to roundtable attendees.

See the Part 1 and Part 2 recap of the first roundtable and request an invite here.
Recent Sponsor Information & News
Kerstin Lucas of HealthSparq shares three strategies for health plans to take the Transparency in Coverage mandate to the next level and create a competitive advantage.

Read more here
MultiPlan shares the latest information on its Payment and Revenue Integrity services.

Read more here
Zelis presents a summary of the latest requirements from the No Surprises Act regarding Member ID Cards and Advanced Explanation of Benefits.

Read more here.
MRIoA presents information on their virtual 2nd opinion, data analytics, prior authorization, initials MD reviews, and other services at the upcoming 41st SIIA Annual National Educational Conference.

Read more here
Tom Skelton, CEO of Surescripts, presents an overview of how pharmacists, prescribers and patients are engaging with each other today—and how the past 18 months have shifted the responsibilities and challenges they face.

Read more here
Softheon explores five significant changes health plans need to be implementing so they can best serve their customers during these ever-changing and unprecedented times.

Read more here
Change Healthcare Consulting shares how they assisted a Health Plan with a mock CMS Medicaid Services program audit and provided support for the plan’s real audit. 
Read the case study here.
An issue brief from VirtualHealth summarizing a panel discussion on new approaches to operationalize advancements in value-based care solutions.

Read more here
Partner Events & Resources for Healthcare Leaders
2021 WEDI National Conference

This year the 2021 WEDI National Conference presents an in-depth look at how data affects SDOH, the new healthcare app economy, cybersecurity, new rules/regulations, and implementation guidance.

This virtual event takes place October 18th through the 21st and you can receive a 20% discount by using 'HCEG' when you register here.
Uncommon Resources

From time to time, we like to share some resources of potential value to those operating in the healthcare space.

MyHealthGuide Newsletter

This free newsletter is published weekly by MyHealthGuide, LLC. It presents news, press releases, and announcements for the Self-funded Community. Subscribe here and check out the latest issue here.

Women in Healthcare Information Technology

Women in Healthcare IT is an organization focused on helping pave the way for women and girls in healthcare information technology. The organization promotes leveraging individual networks and sharing experience and expertise via events and mentor programs. It also offers career counseling and advice to help women achieve their career goals. See their website here for more information.

Thanks to Our Sponsors
Learn more about our sponsors here. And learn about sponsoring and partnering with HCEG here.
Connect with HCEG
If your or your organization is interested in learning more about becoming a member or expanding your thought leadership and brand awareness, email us at or call 617.302.6224 • 617.302.6224
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