Defining Success in Healthcare

With intense legislative pressure on drug pricing and healthcare transparency as well as broad public support for changes to the healthcare model, managed healthcare executives will need to focus on several areas in 2020 including better transparency, stable or lower healthcare costs, and reinforcing the value managed healthcare organizations provide in the healthcare market of the United States.

“Success in these measures will be defined by stakeholders including patients, providers, and employers having a better understanding and view of their healthcare costs; stable or reduced costs of healthcare that patients and employers actually feel through premiums and cost share; and improvement in the perception of health plans and PBMs by the public,” says Jeremy Schafer, PharmD, senior vice president of New York-based Precision for Value, a group of consultants providing payer insights. “Achieving these objectives will be critical to reduce the risk of seismic changes to healthcare after the 2020 election.”

Here are some other thoughts on what will define success in 2020.

Chris Wing, CEO of SCAN Health Plan, a not-for-profit, Medicare Advantage, health maintenance organization based in Long Beach, California, says there is no shortage of challenges and opportunities ahead.

“In 2020, I expect to see increased competition within the Medicare Advantage market,” he says. “As the population ages and more seniors seek the resources and services needed to age independently, plans must offer flexible benefits that will align with a variety of needs. Along with more entrants into the market, we believe the curve for CMS star ratings will become steeper as a result.”

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He adds that the company will continue to measure success by such standard metrics as enrollment growth and operating margin.

“SCAN also measures how well we are meeting the needs of the older adults in our communities,” he says. “For example, we will continue to monitor the impact of our investments in digital technology, as well as our progress toward addressing social determinants of health.”

Pat A. Basu MD, president & CEO of Boca Raton, Florida-based Cancer Treatment Centers of America, a group of five cancer research centers, notes success is always about the patient so his measure of success includes being in the top 1% nationally in cancer survival rates, patient satisfaction, patient accessibility and affordability, and clinical trial enrollment and access for underserved patients.

“We also believe that to defeat cancer we must combine forces instead of being siloed,” Basu says. “I’d like to expand our partnerships with other providers, payers, employers, and pharma by 100%.”

Christopher Maiona, MD, CMO of Newton, Massachusetts-based PatientKeeper, Inc.,  develops physician healthcare information systems, says that for many of the company’s hospital clients, a key goal in 2020 is to improve physician satisfaction.

“The physician burnout problem is real, and well-managed healthcare provider organizations are extremely sensitive to the causes of it,” he says. “Cumbersome, intrusive technology-particularly EHRs-is one, which is why so many organizations are evaluating and implementing EHR optimization solutions to improve physician work flow and clinicians’ user experience. Successfully improving physician satisfaction will be measured in various ways, including higher patient satisfaction scores, improved quality of care, and reduced medical staff turnover.”

Todd Latz, CEO of GoHealth Urgent Care, a national group of walk-in clinics, believes success in 2020 should be defined by significantly greater consumer self-advocacy.

“We live in an age when there has never been more information available-on quality, on price, on provider reputation. Yet, it is still very difficult for the average healthcare consumer to sort through everything, to understand their benefits, to decide how to best access care, and-perhaps most importantly-to discern how to assess true ‘value,’” he says. “Self-advocacy can and should be measured by how well all of us, as providers, payers, and other participants across the healthcare continuum, help educate consumers on how and what to value in the care they receive.”

When it comes to transparency, Schafer notes the implementation of systems that provide understandable information to patients, providers, and employers on the cost of different healthcare services as well as the cost of alternative services or drugs that may help patients or employers save money will be the measure of success.

Terry Rowinski, president & CEO of Milwaukee-based Health Payment Systems, Inc., a healthcare tech and services solution company, says his company is focusing on the social contract between providers of healthcare services, employers, and employees to provide for and then appropriate use of healthcare insurance products.

“Our healthcare provider network is accessed by partially self-funded employer groups that wish to have a differentiated approach of procuring, measuring, and rationalizing healthcare expense,” he says. “We wish to support their employers’ desires by providing additional resources to the enrolled employees and their families to understand their medical spend and help them pay for their medical expenses thereby fulfilling this social contract.”

Keith Loria is an award-winning journalist who has been writing for major newspapers and magazines for close to 20 years.