Slideshows

A look at what could be some of the biggest and most important drugs of the year.

Top 9 Most Exciting Drugs in the 2019 Pipeline

Although the ACA is still the law of the land, only bits and pieces of it remain intact as President Trump continued to take actions to dismantle it in 2018. Meanwhile, it’s unclear if and when Congress will resume its quest to implement a new healthcare law.

In light of this, it’s hardly surprising that according to Managed Healthcare Executive’s 

, complying with government regulations and policies top health executives’ list of challenges for 2019. Implementing value-based reimbursement is another top concern, with addressing rising pharmaceutical costs and using big data to improve healthcare quality and reduce healthcare costs rounding out the top four concerns. Nearly 200 executives from provider organizations, benefit management organizations, health plans, long-term care organizations, and group purchasing organizations responded to the survey. 

Here’s a closer look at the top industry challenges, and what industry experts advise organizations to do to overcome them.

In MHE’s survey, 32% of respondents listed complying with government regulations and policies as their top concern. In addition to efforts by President Trump and the Republican Congress to get rid of the ACA, this challenge has a lot to do with the fact that some state agencies change rules and requirements yearly, while others issue multiple notices of changes to Medicaid managed care plan operations during the year.

At the federal level, CMS issues more than 400 

 (HPMS) memoranda a year. Some of these communications require operational, reporting, and information technology changes. CMS also issues National Coverage Determinations that may require a health plan to pay for procedures or prescription drugs that they previously didn’t have to cover. “All of these changes require analysis, planning, budgetary and staffing analysis, and implementation,” says Shelley Stevenson, director, Government Programs Practice, 

, which leverages technology to improve patient care. “Many changes impact profitability, provider relationships, and member communication.”

Midterm Election Results: 6 Ways Healthcare Could Change in 2019

Insurers who offer state or federally regulated lines of business are directly impacted by any change in regulations. “Payers that have hospital systems and integrated healthcare systems in their networks are always affected by any policy changes,” Stevenson says. “While integrated health plans often have access to hospital and physician [

], non-integrated plans have to do outreach to access clinical data, such as that to support a prior authorization request. Hospitals and integrated healthcare systems are challenged by regulatory changes that only pertain to medical institutions, such as billing requirements.”

C-suite executives need to stay on top of challenges associated with regulation changes, and then rely on experts in those areas to help them navigate those changes in light of their business goals. “Regulatory considerations need to be front and center as business decisions are made,” says Joe Geraci, partner, 

Susan Feigin Harris, JD, a partner in the law firm 

, says lawyers and compliance officers can be helpful in preventing violations by identifying any weaknesses that require attention as well as performing periodic reviews in order to show a proactive focus on compliance or identify areas that need improvement.

, LLC, advises working with an established and connected association or lobbying group that can demonstrate consistently accurate insights into potential changes to policy and regulation. “When planning, build flexibility and adaptability into systems, contracts, and work processes so significant alterations in policy don’t require wholesale revamps or revisions to key business operations and systems,” he says.

Only 40% of respondents to our survey have started initiatives toward value-based care. Furthermore, only 30% said their compensation is value driven.

“Most payers and providers have been operating under a fee-for-service model, so changing to value-based care can be intimidating, complicated, and expensive,” says Jay LaBine, MD, chief medical officer, naviHealth, a post-acute care management company that manages risk.

While health plans aim to create value and provide better member experiences through improvements in the quality of care and reduced costs, providers have their own ideas and priorities for how to create value. “This is particularly evident as consolidation activity for healthcare providers has escalated over the last 10 years,” LaBine says. “Hospital consolidation has created more buying power on the provider side, therefore putting more strain on payers to implement their own member-focused programs to drive value.”

Value-Based Care: Gaining Ground or Losing Steam?

Kate Grohall, product executive for value-based care at 

, which offers technology solutions for payers and providers, says now that payers are accepting more risk for outcomes under value-based care, they need to build programs and infrastructure that support a more concierge type relationship with members, enabling member engagement and improved healthcare choices. “In other words, they need to go from being the bank when it’s time to pay for care to being a trusted resource and advocate of member savings, quality outcomes, and overall care experience,” she says. “This isn’t an easy transition.”

Meanwhile, providers have huge concerns about how they will transition their business models away from being primarily fee-for-service. “They will have to redesign work flows and create new clinical pathway management strategies with their frontline clinical staff to become successful at managing an entire episode of care,” Grohall says. “Hospitals must also completely revamp their provider contracting strategies and compensation models to align with value-based care delivery and payment models.” 

To overcome challenges associated with creating a value-based environment, health plan executives should collaborate with large health systems to foster greater change within the care continuum. LaBine says this can be accomplished through value-based contracts focused on improving patient experience, patient quality of care, and reducing costs. Health plan executives can overcome challenges by communicating their goals for improved value for their members to patients and providers.

Health plan executives should also consider communicating price transparency directly to their members, LaBine continues. By going straight to healthcare consumers, health plans can encourage members to elect less expensive procedures or services that still achieve the same outcome. “Health plans need to engage with and educate their members, and providers will follow suit,” he says.

In MHE’s survey, 15% of respondents listed addressing rising pharmaceutical costs as their top concern. Although 

 that drug price increases have actually slowed down since 2014, pharmaceutical drug spend by insurers and in turn by patients with high deductibles and copayments has been rising due to increased use, says Yana Paulson, PharmD, chief pharmacy officer at 

 in Los Angeles. For example, in 2017 two-thirds of specialty drug spending growth was due to more individuals being treated and the number of prescriptions being dispensed.

“Payers must increase their focus on structuring drug benefits to not only keep premiums low, but to also ensure that patients with high copays can afford treatment and that enough alternatives are available for specific conditions,” Paulson says.

Another challenge in this area relates to new products coming to market-specifically biopharmaceuticals. “Manufacturers can set high price tags for these drugs, which rarely face competition from alternative products, resulting in high copayments for consumers,” says Nancy Taylor, co-chair of the healthcare and FDA practice at the law firm 

. “In many cases, patients must use these products routinely for certain chronic diseases and there is little ability to negotiate a lower price.”

Health insurers also face challenges in determining when and how to cover new biopharmaceuticals and whether to use prior authorization or limitations on coverage to reduce over or inappropriate use, Taylor says. Hospital systems may not be able to effectively limit prescribing to a formulary due to a physician’s ordering practices and patient needs.

Ron E. Peck, Esq, JD, senior vice president and general counsel, 

, LLC, which provides cost containment strategies for health plans, says communication between participants-pharmacists, physicians, and payers-is of the utmost importance to ensure that the most effective, efficient, and easy-to-follow regimen is prescribed and that patients understand the health and financial benefits of compliance. “Perhaps it even makes sense to incentivize such behavior, such as reducing or waiving copays for medications initially prescribed to treat a condition, but increasing copays for more intensive treatments, needed if and when a patient fails to comply with their treatment plan-eventually worsening their condition,” he says, noting that 20% of new prescriptions go unfilled and 40% of patients do not adhere to prescribed medications. This leads to greater costs down the road for patients and payers.

In order to keep pharmaceutical prices down, heath plans need to employ cost containment programs to manage resources. According to Paulson, here are six initiatives that LA Care has done in this area:

Maximize use of generics by prudent and careful formulary management.

Increase the use of biosimilars in the specialty drug area. Biosimilars are substitutes for biologics (drugs made using a biological method) similar to the way generics are substitutes for brands (drugs made by a chemical method) and like generics they are usually less expensive.

Carefully negotiate drug rebates with pharmaceutical manufacturers.

, such as discounted prices for in-network pharmacies.

Carefully select specialty drugs. Don’t base decisions solely on price; instead choose drugs based on safety and efficacy first to maximize value. Then, employ frequent clinical monitoring to ensure efficacy and adherence.

Offer clinical programs such as reminding patients to get medication refills for chronic conditions in order to avoid hospitalization or emergency room visits and having clinical pharmacists provide medication therapy management consultations, which can, among other benefits, avoid polypharmacy by discontinuing unnecessary drugs.

Only 12% of the survey respondents said their organization is effectively using big data to improve healthcare quality and reduce healthcare costs; 46% said they’ve made some progress toward using big data, but there’s still a lot of work to do; and 42% reported little or no progress in using big data.

Will Hinde, managing director of healthcare at West Monroe Partners, a management and technology consulting firm, believes that many organizations have made little progress in this area because health insurance and health system executives are weighed down by legacy technology that simply isn’t agile or scalable, which prevents them from leveraging big data to its potential. This is further complicated by unreliable and unclean data that result from most organizations lacking master data management discipline. “The result is disparate and lagging reporting, gaps in real-time data, and a lack of clinical analytics, making it difficult to manage populations and drive better quality and cost outcomes,” he says.

Along these lines, Paul Alexander Clark, director of healthcare research at 

, which builds artificial intelligence care management software for health systems, says healthcare leaders struggle to apply information technology innovations and information technology leaders struggle to understand healthcare. “Big data, data science, and artificial intelligence will only deliver value if innovations can be translated to patient care and clinical work flow,” he says. “Bridging the gap between these disciplines demands extraordinary vision, leadership, and committed partnership from healthcare executives and their technology partners.”

Providers and payers look to big data and analytics to do different things. Providers are more focused on the care they deliver, with less insight into cost, says Marcel Tetzlaff, vice president of provider experience and benefits management, SKYGEN USA. Providers have detailed clinical information to use when evaluating a patient’s overall health, whereas the information payers have is more oriented toward identifying the best practitioner who should provide it based on appropriateness of care (quality), efficiency of care (cost), and other measures such as patient satisfaction.

Is end-of-life care the place for big data?

Payers are concerned about the whole breadth of care members receive, because they pay for all of it. Payers also seek to understand member health challenges so they can help them stay healthier. “They have the added responsibility of managing their provider networks-making sure they do a good job for members and that they deliver cost-efficient care,” Tetzlaff says.

A health system or hospital may look at the efficiency of individual physicians within various specialties from time to time, especially as they work to standardize care and reduce costs, but they’re usually not trying to affect the patient’s decision of which physician to use like payers do.

Clark advises healthcare organizations to build partnerships with best-in-class enterprises that will fill the gaps in core competencies to enable the organization to apply and derive value from leading-edge technologies.

“Don’t evaluate and select technology partners solely on their name recognition or success in other industries,” Clark says. “Deeply engage and ensure that they have the knowledge, understanding, and an effective plan to translate their technology into healthcare. To create value, big data, and artificial intelligence innovations must drive down to clinical work flow and point-of-care.” 

Tetzlaff says the optimal situation is when payers and providers share data with one another to fill in gaps in their understanding. “Big data analytics work best when they have bigger data sets to work from and have meaningful and actionable results,” he says. “Full transparency allows patients to make the best possible choice for themselves.”

Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.

Articles

Here’s what healthcare organizations will face in the year ahead, and expert advice on how to deal.

Top 4 Challenges Healthcare Executives Face in 2019

More than 1.5 million people live in Philadelphia, and the city is an economic, education, and healthcare hub to many in the state and in New Jersey and Delaware. In 2012, stakeholders from Philadelphia-area healthcare organizations came together to launch the 

, a health information exchange (HIE) between provider and payer organizations with a goal to improve healthcare communications and data interoperability throughout the area.

Today, HSX’s membership includes more than 100 independent ambulatory practices, 85 post-acute care organizations, eight health plans, seven behavioral health organizations, six accountable care organizations and nine skilled nursing/long term care facilities that share interoperable data with more than 15,000 providers in the region. Nearly 8 million patients are a part of HSX’s data depository.

HSX is the largest HIE in a major metropolitan area created from the ground up by healthcare insurers and healthcare providers working together, and CEO Martin Lupinetti says the organization hopes it will reduce overall healthcare costs and patient confusion.

“We have all these assets: a notification service, a patient matching algorithm, an application program interface. We have all these things that if assembled in the right way, can solve a lot of different healthcare challenges,” Lupinetti says. “So, the short-term goal is really to embrace the power, and how we put those things to good use. We see ourselves as morphing, not just as an HIE, but really as a data company, a data aggregator that offers health information and exchange services.”

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Richard Snyder, MD, chief medical officer at Independence Blue Cross, assisted with the launch of HSX. He says payers and providers realized that the risk of not creating a viable HIE would be more higher costs due care overlap and lack of continuity in treatment.

“This region is saturated with academic health systems and their affiliated providers and facilities,” says Snyder, noting that many patients receive healthcare services in more than one system and use varying EHRs. “Initial use cases for HSX were built on the premise that avoidable redundancy in testing and prescribing coupled with real-time knowledge of a patient’s history and use of healthcare services would prevent avoidable readmissions.”

It was not easy to get competing healthcare organizations to agree that sharing data and patient information would benefit their organizations, says Snyder.

“After previous statewide and regional failed attempts at implementing health information exchanges to address ‘meaningful use,’ we took a different approach,” he says.

That meant identifying pain points for clinicians and administrative staff and coming up with ways to use the proposed HIE to solve those pain points, rather than taking an off-the-shelf, government-dictated solution.

Snyder says that the homegrown model was more attractive to payers and providers. Because stakeholders within the healthcare community assisted with developing by-laws and a participation agreement, Snyder says competing businesses felt protected.

“As a payer HSX member, we have created and maintain a clinical activity history that includes up to four years of documentation of diagnoses, treating physicians and facilities, inpatient stays, emergency department visits, prescriptions, procedures, and lab results based on claims data,” says Snyder. “This clinical activity history can be pushed to emergency department physicians real-time or retrieved by a treating provider to round out the clinical picture that is not contained in their [

]. A competing health insurer or payer cannot request this information.”

HSX is a 501(c)(3) organization, funded by membership fees and grants, so it is able to onboard a diversity of healthcare organizations, says Lupinetti.

“We have a founding principle that any federally qualified health center or city clinic, including heavy Medicaid or underserved clinical practices, do not have to pay for any services,” he says. “That’s based on the fact that we receive grants from CMS really with a purpose of directing the benefit to those in most need.”

Russ Allen, communications coordinator for HSX, says the organization continues to branch out to post-acute care and other continuity of care entities because those end-to-end connections are important to the healthcare community and patients.

“This is vital information that is at their fingertips,” Allen says. “In some cases, it's auto routed or auto pushed to them so they don't have to physically pull it. We’re giving them insight that they didn't have before. We have yet to encounter any organization in the continuum that's really not a good fit.”

Associates in care management and other member support functions at participating healthcare insurers use the HSX data, including the real-time admission discharge and transfer (ADT) data to access discharge plans, facilitate care, and ensure timely follow-up appointments and document discharge dates for purposes of closing out cases.

“Also, the data supplements HEDIS and STARS data collection efforts,” Snyder says. “Often, better coordination of care with primary care physicians has resulted from having this information, such as the avoidance of emergency department visits.”

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Lupinetti says health plans, accountable care organizations, and providers find the encounter notification service valuable, because it sends an alert when one of their patients is hospitalized or goes to an emergency department. It can also send alerts when patients are discharged from hospitals or post-acute care facilities.

“We’re starting to use the data and population health for trends analytics, and report on various interesting aspects of that data,” Lupinetti says.

In July 2018, HSX expanded into New Jersey, joining the 

, a statewide health information organization between providers that has a goal to join a national network of providers called the eHealth Exchange. Lupinetti says that because of the large number of healthcare organizations within the tri-state region, expansion is an important effort to ensure patient continuity of care.

Lupinetti hopes HSX can navigate some of the regulatory and business barriers in New Jersey and Delaware to help the region become more interoperable.

“Some [of the other regional HIEs] are very hospital-focused data sharing exchanges,” he says. “Some are very health plan focused. But they all haven't quite synced together and we think given our neutral status and given we have such a diverse membership that we're a logical choice to really help kind of advance the agenda of regional data sharing.”

Donna Marbury is a writer in Columbus, Ohio.

This massive partnership is breaking down barriers and improving patient care.

Philadelphia HIE Fosters Collaboration Among Competitor

While pharmacy assumes different challenges every year, affordability has stayed at the top of the list. 

, non-adherence and pharmacist compensation capped off the top three, but in 2019, industry experts are identifying new barriers that have even more impact.

The FDA approved 55 drugs as of early December 2018, in therapeutic areas as diverse as influenza, breast cancer, immunodeficiency, pneumonia, and migraines. That is nine more than record-breaking 2017, which had the highest number of approvals in more than two decades, according to an April 12, 2018 

Here are the six top pharmacy challenges health executives can expect in 2019:

Similar to last year, specialty drugs are hiking up the cost of pharmacy. “Innovation with gene therapies and precision medicine increases the fight to afford specialty drugs,” says Susan A. Cantrell, RPh, CEO, Academy of Managed Care Pharmacy (

In 2016, the United States spent 18% of gross domestic product on healthcare-nearly twice the rate of 10 other high-income countries, according to a 

Journal of the American Medical Association. 

This country also claims the highest pharmaceutical spending among its peers.

Although Steve Lucio, associate vice president, Vizient, a performance improvement company located in Irving, Texas, recognizes the effectiveness of specialty drugs, such as those for immunotherapy, he says they can saddle patients with high costs. He also believes that patients have to weigh a drug’s relative value against its price tag.

“The challenge of high costs is lessened if you have control of your healthcare budget and access to drugs,” Lucio says.

“Drugs are eating up more and more of the healthcare pie,” says Jane Lutz, executive director, Pharmacy Benefit Management Institute (

). “Pharmacy is the most frequently-used benefit, and it’s a real-time benefit-you know what you are going to pay when you pick up a prescription.”

She is concerned that the price of drugs is outweighing income when the average annual cost of a specialty drug is $52,000 and the median wage in 2016 in this country was $48,665.

Lucio is looking forward to potential biosimilars-especially in oncology-entering the marketplace in 2019 to help mitigate costs through competition.

On the other hand, Lutz believes that no model exists that can support the development and distribution of orphan and genomic drugs and biosimilars.

Jonathan Gavras, MD, senior vice president and chief medical officer of 

, a PBM headquartered in Eagan, Minnesota, believes it is important to anticipate what’s coming down the pipeline, especially high-cost specialty drugs; develop appropriate policies around cost to be affordable for payers and patients; and keep ahead of drug approvals, many of which are fast tracked.

As a solution, he recommends developing a strong, proactive pipeline management system anticipating costs and ensuring the right indication, right drug, and right person are aligned.

“Negotiating for best drug price shouldn’t present a barricade,” Gavras says. “We need to change reimbursement to a value-based model; manage outcomes and patients; and tie reimbursement to outcomes to prevent adverse effects and hospitalization and increase survival.”

Multiple prescriptions also add to the cost of drugs for individuals. As many as 57% of U.S. adults have less than $1,000 in savings to cover health expenses, and nearly 25% have less than $100, according to PBMI. On the positive side, about 85% of people with commercial insurance pay less than $20 a month out of pocket.

“Solving this problem takes a multistakeholder approach; it is important to manage utilization without compromising care,” Cantrell says. In early 2018, 

AMCP launched an Addiction Advisory Group

 to promote better practices and improve addiction prevention and treatment serviced.

, a medication management consulting company headquartered in St. Paul, Minnesota, agrees with Cantrell that the epidemic is a multifactorial problem, placing blame on the inability to accurately document doses and dispose of waste.

Gavras says that Prime Therapeutics has been identifying high prescribers since 2010, along with users abusing opioids based on a predictive modeling process. The PBM also works with providers to manage therapy and with retailers to prevent patients from filling the same prescription in multiple pharmacies.

In addition, the PBM developed a built-in fraud use system and has created an Opioid Safety Guide on safety storage, disposal of opioids, and overdose prevention, which Walgreens pharmacists provide to Florida Blue members. The intervention resulted in a four-fold increase in members receiving naloxone, an overdose reversal agent.

Separation of medical/pharmacy benefits  

“Today’s healthcare system is highly complex and segmented, especially in how medications and other aspects of care are paid for. The separation of medical and pharmacy benefits is confusing for patients and prescribers alike, and presents a specific hurdle for the adoption of 

 (VBC) models for medications,” Cantrell says.

“Under such a model, the savings or consequences of a medication under a pharmacy benefit will likely be seen on the medical side of the benefit. But capturing and recording that event in the pharmacy benefit, which is needed to execute the VBC model, is hampered by the segmentation of the two benefits. In other words, those responsible for managing the pharmacy benefit may not have access to medical data,” she says.

The top three pharmacy challenges of 2018

“Specialty medications are responsible for churn and volatility because they can be covered under both medical or pharmacy benefits but require a high-touch model because of side effects, changes in dosages, and comorbidities. It is up to PBMs and plans to decide which benefit should cover specialty,” Lutz says.

Gavras emphasizes the need to look at the total cost of drugs, not just the pharmacy benefit, especially because many specialty drugs fall under the medical benefit and never touch the pharmacy benefit; “However, no matter which benefit, these drugs affect healthcare delivery and produce the same cost impact,” he says.

Shortages of some drugs have also presented a challenge to the industry-something Lucio partially attributes to natural disasters such as Hurricane Maria in Puerto Rico, and to low margins on certain drugs which force manufacturers to stop production. “Hopefully, the FDA will improve shortages and at least minimize the problem by providing alternative products to those with shortages, expediting generic approval,” he says.

FDA, shortages decreased to 39 in 2017 from a peak of 251 in 2011

. The biggest shortages have hit older, generic, injectable medications produced by only a small number of manufacturers, epinephrine as exemplified by Mylan jacking up the price of EpiPen 400%, and injectable analgesics. The FDA approved the first generic competitor to EpiPen in August 2018 made by Teva Pharmaceuticals.

Massoomi calls drug shortages the “silent epidemic.”

Some of the strictest regulations to recently surface relate to compounding drugs: 

, which are standards for compounding non-sterile preparations, compounding for sterile preparations, and hazardous drug handling, respectively.

“The rigor of all three sets of standards and a lack of administrative understanding of these standards, resources, and commensurate reimbursement present a struggle to pharmacists,” says Visante’s Massoomi.

“Administrators do not fully appreciate the complexity of these standards or the need for constant monitoring,” he says, leading to his recommendations to hire a compliance expert and develop a compliance policy with living documents to support each product and environment.

Lucio makes technology sound like a necessary evil when he says it is expensive but enables the pharmacy industry to work more safely and effectively.

“We want pharmacists to operate a patient-safe environment, but a business model doesn’t exist to enable that but with so many products and technologies that can cause problems,” says Norman Tomaka, BS, Pharm, MS, clinical consulting pharmacist based in Melbourne, Florida.

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“We need to focus more on technology and be more vigilant of errors that can occur and overzealous about new drugs because not a lot of written information is available,” he says.

Lutz is all for technology, considering it to be a critical part of the solution of keeping drug costs down-especially the use of online tools. “Technology can help us make informed decisions by using data analytics, enhance reporting and provide better access to data, helping us put the best programs into place,” she says.

Managed Healthcare Executive, is based in Sonoma, California.

What experts say will be the year’s biggest problems, and what can be done about them.

Top 6 Pharmacy Challenges of 2019

There’s nothing wrong with wanting to get ahead and move up the career ladder, but sometimes, healthcare executives have trouble advancing their careers the way they’d like. Here are some tips from top executive coaches.

1. It’s not all about vertical movement

Healthcare organizations can be somewhat flat once you reach a director level, as there are often limited opportunities for upward advancement without leaving a place of employment because those positions are already filled. 

, Austin, Texas, says that before you start posting your resume online, you should consider two alternate paths for advancement.  

Four Ways Health Execs Can Advance Their Careers

The first is horizontal-opportunities in other departments that can help you gain more valuable experience. For example, one of Emergent Execs’ clients hit a ceiling in her career, and the next level up on a traditional career path was CFO-but her entrenched CFO was blocking that route. So, she opted to make a lateral move and helped transform the company through her efforts, gaining exposure in another area that she never would have otherwise.

“While you may not have some of the technical expertise required, your hard-won executive skills can make you an instant asset working in a different functional area,” Beasley says. “Sometimes you need to move sideways before you can move up.”

The other alternative is to gain exposure in a less formal way. For example, consider how you might grow your skills or radiate your influence.

“Volunteer for a critical cross-functional project. Take on more of a training mindset. Get certified in some new skillset,” Beasley says. “All of these are ways to expand your influence, and when the company makes decisions about promoting from within, they often look at who has the most influence.”

When it comes to career advancement, Carol Vernon, an executive coach with Communication Matters, Washington, D.C., says the most important thing she recommends to healthcare executives is focusing on their communications skills.

“Too often, leaders wait until they are in executive roles to focus on building executive level communication skills,” she says. “I’d strongly recommend leaders focus on building next-level communication skills now, including seeking opportunities to develop their formal presentations skills as well as their informal communications with their various stakeholders.”

To develop your communication skills, Vernon recommends you start by getting input from different stakeholders about what is working well in terms of how you are communicating both informally as well as in more formal presentations.

“Check to see if you are concise, contextualized, and clear,” she says. “Once you have the input, you can use traditional tools and training (such as courses, speaking opportunities, etc.) to grow specific skills, seek support from a colleague (perhaps a mentoring relationship) or work with an external coach.”

Communicating ideas clearly not only develops relationships but is a key indicator of longer-term potential for higher-level success.

When looking to move up the ladder, it’s important for an executive to have a team below them that is just as successful as he or she is.

“You will advance your career if you put the emphasis on advancing other people’s careers,” says Jim Vaselopulos, founder & CEO of 

., Chicago. “It’s not just about making your boss look good, it’s about building leaders. Your mindset shouldn’t be on just building your own career, but building the success of the people in the organization as a whole.”

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Shifting your focus from own career to the careers of everyone reaps benefits that will play out in career advancement.

Carrie A. L. Arnold, PhD, principal coach and consultant with Denver-based 

, believes a great way for someone to advance their career is to find people in higher levels of leadership who will champion them and work with them to unleash their full potential. 

“Do not wait for someone to tap you on the shoulder with a request to join a formal mentoring program,” she says. “Seek out your next mentor and be willing to advocate for yourself. Ask for time and attention and be willing to listen and learn.”

Ironically, one of the primary reasons executives are not promoted is that they are indispensable in their current position. Beasley says that’s why it’s important to develop someone “on the bench” to replace you if you were moved to a higher role. 

“In order to get that promotion you want, your organization needs to be confident that they can backfill your responsibilities and competencies,” he says. “Identify the best candidates for replacing you in terms of their performance and potential. Make the time to fill in their gaps and prepare them for the day you move on.”

Six Ways Health Execs Can Regain Passion in Their Work

One company he worked with knew that their director of operations was their best internal candidate for replacing the CEO, yet the CEO stayed in that position for two additional years. The CEO’s reasoning? The director of operations was a lynchpin, and there was no one to replace him. 

“It took two years to hire and onboard a new operations exec before the new CEO could be promoted,” Beasley says.

An executive should never rest on laurels and feel they have nothing else to learn.

Arnold recommends people stay as current as possible on the issues facing their particular scope of work. This can be done by being involved in conferences, reading journal articles, and being part of peer groups that contribute to learning. 

“Do not stay isolated thinking you can learn things on your own,” she says. “The job will quickly take up all available space if things are not already blocked off and reserved for development needs.”

Keith Loria is an award-winning journalist who has been writing for major newspapers and magazines for close to 20 years, on topics as diverse as sports, business, and healthcare

Moving up the corporate ladder can be frustrating-here’s are six tips from industry experts

Six Ways Health Execs Can Advance Their Careers More Quickly

It was 2 a.m. Adrienne Boissy, MD, was early in her residency-“the lowest man on the totem pole,” she says. One of the nurses on her team told Boissy that her patient needed her.

This was a young patient in her early 20s, remembers Boissy. The patient, recently diagnosed with multiple sclerosis, had a question.

Before heading to the patient’s bedside, Boissy, who’s now chief experience officer at Cleveland Clinic Health System, did a quick review of the medical literature on multiple sclerosis. The young intern wanted to make sure she was prepared for her patient’s questions.

She wasn’t prepared for this one: “Should I marry my boyfriend?” asked her patient.

This was a young woman who had support from a loving family and an ever-present boyfriend, says Boissy. Her patient wasn’t asking for relationship advice. She was grappling with the uncertainty of her disease; her patient wanted to know if she would be taken care of and loved.

That early experience taught Boissy what being a doctor meant to her. She realized she wasn’t in the business of “fixing” people. She discovered, instead, that her patients needed her to be “present.”

Today, Boissy is also a neurologist at the Cleveland Clinic Mellen Center for Multiple Sclerosis, where she has an active patient panel. She points to that early morning bedside visit as an intern because it guides her approach with patients.

They’re not just worried about their diseases. Boissy’s patients are wrestling emotionally and mentally with the changes neurological disorders, such as muscular sclerosis, have on their lives-changes that require them to adapt and change.

Take, for example, one of her patients who used to run marathons and can now barely lift their left leg. Or another patient whose spouse left after their disease had progressed.
	Her patients need her to slow everything down. They need her to listen. To help them navigate their personal journey with their disease and how they’ll show up to those changes.

Boissy, who grew up in what she calls a dysfunctional family, studied neurology because she thought it would give her a “black and white” way to understand the world and why people act the way they do.
	She was disappointed when she didn’t get the answers she was seeking. But her search has led her to ask more questions.

Such as, “Why do patients have to wait so much?”

“Our patients are tired of waiting,” says Boissy. “Waiting is so pervasive in healthcare. You wait for an appointment. You wait when you get there. You wait in the exam room. You wait for test results. You wait for the phone call back. You wait for the next appointment.”

That’s way too much waiting, in her opinion. And, thinking about her patients, Boissy adds that it’s not the wait itself. It’s what the brain does with the wait.

Patients wonder why they’re not being seen and what’s going on. They’re already worried about their health, and in the absence of a story, patients build their own narrative, she says.

These are patients who think the hospital has forgotten about them or doesn’t care-and they may just get up and leave for those reasons, explains Boissy.

Waiting really drives dissatisfaction among patients, she says. And it frustrates her that patients wait the same way they always have. “That really gets on my nerves,” she says. “In my dream state, I want to eliminate the wait. In this day and age, we need to predict the wait so patients can better plan their lives. We don’t want those [negative] narratives to overtake the brain.”

Cleveland Clinic is trying to understand wait times better, she says. It’s building predictive models around wait times to make it easier to predict when those waits occur. And the goal is to communicate that to patients and better manage their expectations. 

Still, Boissy’s heartened by one aspect of the patient experience where patients are willing to wait. That’s with surgery. Patients are willing to wait two to four weeks for their own surgeon. “That’s a great testimony to the power of relationships,” she says. “Even when they’re offered another surgeon. I think that’s really insightful. It’s why we need to know our patients better.”

There’s no such thing as work-life balance, says Boissy.

“If we expand our view, it’s not just about balancing my clinical hat or my leadership hat or my mom hat,” she says.
	Instead, she tries to embrace what she calls “the joy of imbalance.” For Boissy, that means being at peace. “Sometimes I’m a good clinician, a good writer, a good leader. Sometimes, I’m a good mom. Sometimes, I’ll be exceptional at one of those jobs. It’s hard to do, but I have to forgive myself…I make the most of the moment at work or at home.”

Knowing she gets to walk out the door at Cleveland Clinic also grounds her. “I’m at a hospital where people don’t get to walk out the door. Family members don’t get to walk out the door….That voice is in my head every day when I walk out of the building.”

And when she’s feeling particularly depleted from a stressful day? She watches funny videos of her kids. “It’s just to give me a little bit of perspective,” says Boissy. “That tough as it is, I’m very blessed. And I think laughter is critically important.”

Her career path has had its twists and turns. Boissy trained for many years as a ballerina. Then she taught ballet, managed a sporting goods store, and tended bar.

What changed her mind about pursuing her dream of dancing ballet professionally? The realization that a broken ankle could prevent her from dancing and impact her ability to provide for her future family, she says.

“I’m told I’m not a typical neurologist. I don’t know that I aspire to be one. What’s really important to me is to lead from where [I am].”

Adrienne Boissy learned early on in her career that being present in the moment for her patients was more important than trying to fix them.

Featured Exec Adrienne Boissy: Chief experience officer of Cleveland Clinic Health System 

U.S. cities are home to 62.7% of the American population, according to the U.S. Census Bureau. This number is expected to grow to 87.4% by 2050, according to data and projections by the United Nations Department of Economic and Social Affairs.

Justin Brasell, BBA, MBA, executive vice president, Transwestern, a real estate services firm, cites a variety of reasons for the influx to urban areas. Cities often have higher-paying jobs, public transportation, and top-notch entertainment, food, higher education, and healthcare. Additionally, specialized workforces are emerging in large, urban populations as demand grows for top expertise in specific fields. For example, Houston attracts specialization related to the energy sector, while San Francisco talent is focused on technology.

“As the population ages, there is not only a desire but also a necessity to be in closer proximity to people and resources,” says Andrew Renda, MD, MPH, director, office of the chief medical officer, Humana.

Furthermore, Henry W. Osowski, managing partner, Strategic Health Group LLC, which advises health plans and system leaderships, says increasing mechanization, automation, and innovation in the agriculture sector is decreasing the number of workers required to sustain agricultural production in rural areas.

U.S. cities are home to 62.7% of the American population, according to the U.S. Census Bureau. This number is expected to grow to 87.4% by 2050. Here's how healthcare can keep up.

Managed Healthcare Executive January 2019 Issue