As we hit the halfway mark of 2019, it's worthwhile to step back as take a look at what’s trending, what’s getting attention, and most importantly, what’s impacting your business in the healthcare landscape. There are big policy issues to resolve, practical product and operating decisions to be made, and increased pressure from customers making new, market-altering demands. The following healthcare trends provide context as you anticipate change and manage through obstacles and opportunities ahead.

1. The “Medicare for All” debate will rage on

Is healthcare a right, an individual responsibility, or both? Current proposals falling under the moniker of Medicare for All can be slotted into four categories:

Single payer.  Replace private health insurance markets with a government run system.

Public option. Create a new public health insurance plan available to individuals.

Medicare/Medicaid buy-in. Expand access to current federal and state insurance coverages.

Public/private partnership. Structure a program for individuals similar to Medicare Advantage.

At the heart of all these approaches (and their viability) is cost-how will it be paid for? Cost has been the death knell for most healthcare proposals in the past, and with 

predictions that the current Medicare program is expected to go bankrupt

 in seven years, cost will remain the biggest obstacle going forward. Add to the mix that paying hospitals Medicare rates would bankrupt that sector and support from private insurers and pharmaceutical companies is non-existent, and the stars would have to line-up for Medicare for All to become reality. Progressives would have to win the presidency with a Medicare for All as a key agenda item and Democrats have to hold the House and take the Senate with a large majority to pass a bill. And even then, there are no guarantees.

Medicare for All: Four Things Health Executives Should Know

: No need to panic. Stake out a position that promotes and protects your interests and jump into the debate in preparation for the 2020 election-remember, 40% of 2018 midterm voters said healthcare was the top issue facing the U.S.

2. Uninsured Americans on an upward trajectory

The number of Americans without health insurance has increased by 7 million since 2016. Congressional Budget Office (CBO) projects that under current ACA rules (i.e., no further interference from the Trump Administration) 32 million Americans will be uninsured by 2020.

Should the President and Department of Justice’s unwavering efforts be successful in having ACA completely struck down, the total uninsured population in the U.S. would quickly top 50 million. Closing insurance marketplaces and exchanges, ending Medicaid expansion, and eliminating protections for Americans with pre-existing conditions would be significant contributors. Demolishing Obamacare also threatens ACO survival, HIV and opioid program funding, and Medicare Part D out-of-pocket costs.

What’s the endgame? On the eve of the final ACA enrollment deadline this past December, a U.S. District Court judge ruled the ACA unconstitutional. An appeal to the Fifth Circuit Court will resume the ACA challenge (beginning July 2019) and ultimately, it’s likely the next ruling will go to the U.S. Supreme Court for final resolution-stay tuned.

Contingency planning would be smart as the individual and small group insurance markets would be severely impacted if ACA goes away, and uncompensated care and provider bad debt would skyrocket as all those insurance ID cards disappear.

Vertical integration, consolidation of companies that own different parts of value chain, is reshaping the business of healthcare. On top of the dominance of large multi-hospital systems and national mega-health insurers, we’re seeing retail behemoths aggressively stake their claim across verticals in the health care market-from big box store clinics to 

 to aging-at-home to digital commerce. It’s a true ‘blurring of the lines’ in healthcare delivery. The lure of two organizations combining resources in a joint venture, alliance, or partnership is too good to pass up in a turbulent marketplace like healthcare.

The result is collaboration never before thought possible-some are competitors playing defense, others are seeking scalability, and still others simply want to take advantage of a perfect storm of an industry in transformation. Alas, these associations don’t come easy. Balancing financial, operational, and customer needs between multiple parties takes extraordinary discipline, common vision, and mutual trust.

Given the integrators, disruptors and disintermediators reshaping traditional healthcare markets, can you really go at it alone? Cross-industry teamwork brings access to new markets, delivers cost-critical efficiencies, and enhances customer experiences.

4. Healthcare consumerism is a ‘crawl, walk, run’ journey

Whether GenY, millennial, or boomer, they don’t want to engage with the healthcare system the way it is currently structured. They are demanding virtual health, telemedicine, community clinics, wearables, and active aging. And, they want relationships with companies they can trust to make healthcare simple: be there when I need you, communicate with me honestly, deliver an experience that respects me as a person, and do the right thing for my health.

As more and more financial responsibility shifts to the consumer (i.e., the patient is the payer), you have their attention: give me the most for my money for what’s most meaningful and important to me. But, healthcare purchases-from insurance to prescription drugs to routine check-ups-aren’t easy, given health literacy disparities, variations in sites-of-care, and in general, bureaucracy extraordinaire. Getting to the point of being a savvy healthcare shopper able to make confident, value-based choices takes time and experience. In healthcare, the path to self-reliance is long and full of impediments.

Seven Tactics to Create a Lifetime Healthcare Consumer

 Help your customers! As consumers are forced to take more personal responsibility for healthcare decisions they need help making personalized, value-based choices. Why? Because ultimately, engaged healthcare consumers drive better care, better experiences, better outcomes, and better value.

5. Healthcare technology is an unseen power tool

Healthcare’s future isn’t about wearables, virtual care, and artificial intelligence-it’s about experiences, services, and convenience, all powered by subtle, behind-the-scenes technologies that the customer barely sees. Healthcare innovators are using technology to deliver value to their customers that improves experiences and health outcomes. They are leveraging technology to enhance the healthcare value chain by containing costs, introducing infrastructure efficiencies, increasing individual productivity, promoting self-management, and extending life expectancy.

Take the wearable sector, where one in six consumers own and use one. They started out as a wellness tool, a fitness tracker. Now they have shifted to real-time monitoring of a wide range of patient vital signs with promises of becoming an auto-integrated part of the electronic health record, all unseen by the patient. Tomorrow’s health and medical technology solutions will be invisible in our everyday life, removing barriers, creating convenience and inspiring healthcare action. It’s the new normal.

 The less intrusive the better. Connected healthcare consumers are ready to embrace innovation and willing to be engaged through digital health touchpoints. There’s unprecedented opportunity for health brands to emerge as trusted, go-to resources that are there to help consumers take responsibility for their health.

6. A year from now you may wish you started today

As competitors realign, market rules change, and customer demographics shift, successful healthcare companies don’t sit still, they take a critical look at business plans, operating models, customer experiences, and growth strategies. To do this, context is critical: what’s getting attention in the marketplace that may (or may not) have influence on your future. Here’s a few additional health trends to add to your watch list:

. Physician shortage or not, primary care is at the center of modern care delivery through large organized networks, medical home care models, proliferation of retail clinics, value-based payment, and in-home care delivery.

. An individual’s economic situation and social determinants (nutrition and food, education and literacy, work and home, guns, and addictions) have twice the impact on their health than biology, DNA, and clinical care.

. Cannabis, both medical and legal recreational, is estimated to emerge as a $166 billion industry segment and will become a part of America’s healthcare fabric (medical claims, treatment protocol, workplace rules).

. Changing peoples’ behavior to deal with and improve their health-breaking health inertia-means motivating them to action through personalized emotional drivers and gut-level appeals such as fear, joy, self-esteem, and hope.

. Crisscrossing generations-depression, anxiety, addiction, psychoses, dementia-means identifying and paying attention to warning signs and removing the stigma for getting timely, professional support will help turn mental illness to mental wellness.

 Empowered healthcare consumers are using their newfound influence to choose, challenge, and change the conversation with preferred brands. Healthcare is a complex domain with many issues pushing and pulling its multiple stakeholders-make sure you’re prepared

Lindsay Resnick is executive vice president of Wunderman Thompson Health. He can be reached at 

Articles

From disruptive technology to regulatory ‘known-unknowns’ to the plight of today’s healthcare consumer, 2019 is shaping up to be a year of extraordinary transformation.

Six Mid-Year Healthcare Trends to Watch

Slideshows

Here are five key metrics that executives should pay attention to as they navigate challenges.

5 Metrics that Will Define Healthcare

 picks 10 up-and-coming leaders from across the healthcare industry. From health systems to tech companies, these rising stars have made made big waves in the industry-and we’re excited to see where they go from there.

Our editorial advisory board members faced the difficult task of culling through more than 30 well-deserving nominees and selecting their top 10 standouts.

To be considered, candidates had to meet the following requirements:

Worked in the industry 15 years or fewer;

Led key initiatives at their organizations or relevant organizations;

Taken actions that led to measurable, positive industry impacts;

Accomplished something new or unique in the industry; and

Continued to take on more advanced roles and responsibilities in their managed care career path.

With so many great submissions, the decision was tough! But here are our choices for the Top 10:

clinical program manager, Hospital Readmissions Reduction Program, 

In a role she created, Di Palo, 32, has translated her experience as a pharmacist who worked at the bedside to the boardroom at Montefiore Health System, the University Hospital for Albert Einstein College of Medicine. She co-chairs the executive Hospital Readmissions Steering Committee, connecting historic silos to ensure vulnerable patients safely transition from hospital to home. Di Palo directly leads working groups that tackle key initiatives including care infrastructure, information technology changes, clinical data analysis, multidisciplinary education, and care continuum partner engagement to improve outcomes established by the Institute for Healthcare Improvement’s Triple Aim.

MHE: Why did you choose your profession? 

Di Palo: Administration is in my DNA. My father started as an orderly and through education and perseverance rose through the ranks to hospital CEO. Similarly, I began my career as a teenager at a local independent pharmacy and quickly found that clinical pharmacists are integral in evidence-based medicine delivery and patient advocacy. As a result of infinite curiosity, strong mentors, and a desire to challenge the status quo, I shifted from optimizing care at an individual patient level to a systems level within a visionary organization.

MHE: What has been your biggest learning experience in the industry? What did it teach you?

Di Palo: To successfully transform an initiative from a pilot program to the standard of practice, bidirectional 

 is key. Listening to clinicians, leaders, care providers, and most importantly-patients-allows for the development of innovative and common-sense solutions that fit the culture.

MHE: What change would you like to see in healthcare in the next five to 10 years? 

Di Palo: Patient access, especially to primary care in underserved areas, is integral to quality and cost reduction in chronic disease management. Currently, pharmacists are not considered healthcare providers under Medicare Part B despite robust evidence demonstrating their positive impact on outcomes. Many primary care models integrate pharmacists for longitudinal medication management consistent with state scope practice laws and regulations, however lack of reimbursement prevents patients from clinical pharmacy services. Recognition of pharmacists as healthcare providers at the federal level could facilitate team-based, patient-centered care.

MHE: If you could sit down to dinner with anyone involved in healthcare who would it be? 

Di Palo: Given the opportunity I would like to meet Hippocrates-the Father of Medicine. I admire his revolutionary thinking, discipline, compassion, and ethics. Finally, the modern translation of the Hippocratic Oath-that there is an art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug-is something I firmly believe.

Patrick Fenningham, chief product officer and executive vice president, 

Fenningham, 31, started his career at Johnson & Johnson as a biomedical engineer, before earning an MBA and relocating his talents to Siemens Healthcare, where he focused on market analytics and product management. He went on to become the head of commercial operations at Thomson Reuters Intellectual Property and Science (now Clarivate Analytics). Today, his work includes developing an enterprise-wide product strategy, defining research and development roadmaps, and driving innovation to help strengthen EIR’s position as a leader in modular technology in the healthcare industry.

Fenningham: Ever since my grandfather died of cardiac complications when I was 12 years old, I wanted to understand why it happened. This drove me to enter the medical field. I began my college education by taking the pre-med cardiology track. While there, my interests transformed from cardiology to biomedical engineering. My goal grew to helping patients with all kinds of ailments. I am now focused on improving the overall healthcare experience for patients and caregivers.

Fenningham: If you truly want to make a difference in your space, sit with the people who actually do the work. Early on in my career, I found that those who really knew what was going on with the products and services within a company are the boots on the ground, not the executives or board of directors. As I climbed the ladder into management roles, I always felt my greatest asset was my ability to connect with the people on the front lines. They can tell you everything you need to know if given the chance.

Fenningham: I would like to see an open-source collaboration across the industry using 

 to create predictive indicators that will be used to directly impact patient outcomes.

MHE: If you could sit down to dinner with anyone involved in healthcare who would it be?  

Fenningham: Babak Parviz, PhD, who heads the Amazon Grand Challenge, a division of Amazon primarily focused on cancer research and electronic health record technology. I find it incredibly fascinating when very successful and well-educated groups outside of the healthcare world bring a new perspective to the industry. Understanding his high-level approach on how he plans to tackle healthcare would be exciting.

In his current role, Garipalli, 40, is addressing a demographic that is commonly ignored: seniors living with complex health issues that the healthcare system is unable to manage effectively. Under his leadership, he has grown Clover, which uses proprietary artificial intelligence and machine learning models to improve health outcomes, to nearly 40,000 Medicare Advantage plan members and more than 500 employees.

Prior to Clover, Garipalli founded CarePoint Health, a fully integrated healthcare system serving Hudson County, New Jersey; Ensemble Health Partners, a national revenue cycle company headquartered in Huntersville, North Carolina; and a network of outpatient facilities.

Garipalli: When I first entered healthcare, I saw it solely as an economic opportunity. But I stayed in healthcare because I knew it would offer me the chance to add value to the world. At Clover, our company’s success is directly related to our members’ health; that alignment of mission and business model is something incredibly special and unique. We believe that by leveraging technology in a logical way, we can have a dramatically positive impact on our current and future members’ health.

Garipalli: Four years ago at Clover, we had an idea to offer the same cost-sharing in and out of network and remove that friction for customers. Therefore, we created marketing materials and launched a plan. But CMS had a very different interpretation regarding physician obligations to see customers out of network, and we had to immediately cease the marketing approach. That experience taught me that the learning curve on compliance in Medicare Advantage was much steeper than I had realized. That’s when we hired a chief compliance officer. That experience taught me the importance of hiring subject matter experts, even if it’s a space you’re familiar with.

MHE: What change would you like to see in healthcare in the next 5 to 10 years? 

Garipalli: I’d like to see more healthcare companies focus on underserved populations and helping the most vulnerable members of society. High-quality healthcare should not be restricted to the wealthy. At Clover, we’re committed to making healthcare more equitable, by serving a population that’s far more diverse than the industry average.

Garipalli: Someone who’s been on my mind lately is Jonas Salk, the inventor of the polio vaccine. In the midst of the public debate of pharma pricing and research costs, he was an incredibly important figure who had zero interest in personal profit, sought no patent for the vaccine, viewed public health as a moral commitment, and in turn was responsible for saving hundreds of thousands, and potentially millions, of lives.

Peter Kelly, MBA, executive director and business development leader at 

Kelly, 36, feels fortunate to have spent six years in his early career as an Avalere Health consultant. The firm grew from 45 staff to more than 200 during his tenure. There, he gained specialized knowledge in U.S. healthcare reimbursement and finance, especially for governmental programs. After business school, he joined Universal American as director of strategy and then served as executive director of the New York Medicare Advantage and accountable care organization market. In this capacity, he helped launch the Mount Kisco Medical Group ACO. In 2016, he joined MKMG, which became CareMount in his current capacity. In 2018, the company launched the CareMount Next Generation ACO. The ACO currently manages 35,000 Medicare patients in full alignment with CareMount physicians. He serves as executive director and oversees key areas including strategy, finance, recruiting, risk contracting, data analytics, delivery system performance, and preferred network.

Kelly: I was interested in helping to solve the high cost of healthcare as an undergraduate. Learning more about governmental programs and fee-for-service reimbursement led me to focus on managed care. Then, at Universal American, I spent time with the market leadership of a successful and innovative Medicare Advantage plan in the Houston market, named TexanPlus. This opened my eyes to the possibility and inherent leverage of physician-led delivery systems in managing the medical premium.

Kelly: The importance of building a team. Integrating the healthcare provider and managed care operations spans so many critical functions- finance, clinical operations, contracting, data analytics, quality, med management, and pharmacy. To do it well, you need leaders or rising managers across these areas. Experience has taught me the importance of organizing people and aligning them with a core mission and narrative. For my team at CareMount, the goal is to achieve total quality outcomes for our patients.

Kelly: I think a responsible expansion of 

 is good public policy. Along with it, we need a regulatory framework that creates a transparent and credible glide path for providers to take delegated premium risk under the plans.

Kelly: I would ask Jeff Bezos how he views patients as customers and how to streamline the customer experience in healthcare. We probably could go to a good restaurant, too.

Dan LaVallee, director of Government & Business Relations for Government Programs, 

University of Pittsburgh Medical Center Health Plan

After earning a master’s degree in health policy, LaVallee, 31, joined America’s Health Insurance Plans in 2010. He then became one of the youngest Democratic nominees for Congress in Pennsylvania’s 3rd congressional district in 2014 at age 26. When he didn’t win his bid, he joined UPMCHP in 2015. His work focuses on 

 such as the Medicaid population, the LGBTQ community, the homeless, people with unstable housing, and individuals with intellectual or developmental disabilities, among others.

LaVallee: Ever since I was a child, making an impact for those in need was important to me. I chose this profession to be able to have the greatest impact on the largest number of people-especially the underserved, disadvantaged, and those left behind.

LaVallee: I learned that it is possible to create innovative models to serve underserved and at-risk populations that can then be driven to scale and leveraged. This became clear to me through leading the development of UPMCHP’s permanent supportive housing program into a scalable model for how health plans can partner with housing support providers to reduce homelessness and improve health outcomes for an underserved population.

LaVallee: In order to provide the best and most effective health outcomes, we need to continue to make progress in realizing that each patient- especially those who are often left out of the healthcare system-is a person of worth and dignity. We cannot assume that they will appropriately access the healthcare system if they don’t feel listened to and understood. Hearing directly from the individual-such as the woman who is homeless or the transgender man looking for non-judgmental and competent care-is the only way to effectuate the meaningful change we seek.

LaVallee: I would love to have dinner with Lee Bass, MD, my childhood pediatrician. He was the type of doctor who treated his patients not just as patients, but as people that he valued. After my brother died when I was six years old, Bass, came to my house with a gift of a toy truck and played on the floor with me-not as a child who needed treatment, but as a child who was grieving my brother. I would love to thank and tell him that I am trying to follow in his footsteps.

Sinead Madigan, chief operating officer, 

 started at Health Alliance in 2008 as a pharmacy Medicare specialist. After less than two years, she moved into the corporate relations manager role, advancing the next year to become the director of government relations. After serving as executive director of Medicaid and government relations, she became a vice president in 2016 and assumed the senior vice president of government relations and business operations position in July 2018, then was recently promoted to chief operating officer. She is responsible for building its business and helping forge new relationships, as well as providing better customer service, and maintaining and expanding key provider partnership operations and compliance.

Madigan: I started my career in state government. I believe in servant leadership, and have a keen desire to help others achieve their healthcare goals and understand how to be advocates for their own well-being through health literacy, strong provider-patient relationships, and optimal use of health plan benefits, including those beyond the plan itself.

Madigan: Our industry has been slow to focus on the customer experience. I’ve realized that our teams need to really think like a consumer in everything we do. We continue to break down internal and external silos to achieve continuous improvement for our patients and members.

Madigan: I believe innovation is vital to improving healthcare. While government regulations serve as important guideposts, I would like to continue helping policy makers focus on ways to give the healthcare industry greater flexibility to innovate so we can best serve patients and members to achieve the positive health outcomes we all desire.

Madigan: At the risk of jumping on the thought-leader bandwagon, I would spend time with Bill and Melinda Gates. I would soak up details about their health-focused global initiatives, as well as their big ideas to address healthcare and poverty for more specific needs-ideas our enterprise and industry can springboard off closer to home. Innovation isn’t just a buzzword with the Gates Foundation. It’s a way of life to help people reach their potential.

Brigitte Nettesheim, president, North Central Region and Joint Ventures, 

Nettesheim, 46, began leading strategy for Aetna’s joint venture markets in 2016 and its North Central territory as well in 2018. In these roles, she is responsible for deepening Aetna’s relationships with consumers, employers, and providers, with a focus on transforming the way healthcare is delivered locally. Previously, she led Aetna’s Accountable Care Solutions and was a principal at The Chartis Group. She also held roles at Aetna in strategy, sales, service, and network management. Nettesheim served in the U.S. Army, rising to the rank of Captain.

Nettesheim: As I transitioned out of the Army, I wanted to continue to serve the common good. I saw healthcare as a way to help improve people’s lives. I also saw opportunities to lead and drive change in healthcare. The military teaches you to have focus, agility, and the confidence to be decisive-all great leadership qualities.

Nettesheim: I learned that achieving better health goes far beyond the physician’s office and is heavily influenced by social determinants of health, such as conditions where we live, work, and play. I also learned the importance of having patience. In a large, complex industry like healthcare, sometimes things don’t move as quickly as you would like.

Nettesheim: Our industry has an opportunity to sharpen its focus on consumers and their need for better and more affordable care. Accomplishing that takes teamwork and collaboration, which can be challenging at times due to the industry’s complexity, misaligned incentives, and the wide variety of stakeholders. That’s one reason why I’m so encouraged by some of the more progressive value-based care arrangements like joint ventures that create the aligned incentives among payers and providers needed to deliver greater value to consumers.

Nettesheim: I’d love to sit down with Lyndon Johnson after he signed Medicare and Medicaid into law. Such programs drew debate during his and previous administrations. It would be fascinating to learn more about what drove his commitment to those programs and what he thought about their sustainability at that time. 

Darren J. Sommer, DO, FACOI, founder and CEO of 

, and assistant professor of medicine and technology, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, both in Jonesboro, Arkansas

Sommer 47, created Innovator Health with the intent to provide lifelike telemedicine experiences for patients so they can continue to build strong relationships with their physicians. The technology allows a physician to be at the patient's bedside in their life-size form, with direct eye contact and in 3D. He also personally uses his technology to ensure that more than 3,000 rural and underserved patients have access to telemedicine services annually.

In addition, Sommer created and teaches the first ever integrated telemedicine curriculum for first- and second-year medical students. Hundreds of student physicians are now more comfortable providing telemedicine services after having participated in his training program.

Managed Healthcare Executive has identified 10 emerging industry leaders, working in the areas of pharmacy, health plans, health systems, and technology.

Top 10 Up-And-Coming Industry Leaders in Healthcare 2019

Even before Trump’s oft-quoted sentiment that pharmaceutical manufacturers are “

,” high drug prices have been in the national conversation. But renewed governmental interest (for instance, the recent 

 with heads of major drug manufacturers) has thrust the debate over drug costs-if they’re too high, why they’re so high, who’s shouldering the cost, who’s to blame-into an even brighter spotlight.

Various measurements for total drug spending show a growing problem: CMS estimates that between 2012 and 2016, drug spending increased 26.8%, while a 

 found that net spending on drugs skyrocketed from $250.7 billion in 2012 to $341.0 billion in 2016-an increase of 36%.

But how are patients responding to these high prices? Evidence shows that while prescription abandonment due to cost is still relatively low, a not insignificant number of patients are either not initiating or are not filling current prescriptions-and many more are paying for their medications but struggling to do so.

The PEW study shows that manufacturer rebates also skyrocketed from 2012 to 2016 (from $39.7 billion to $89.5 billion) and that those rebates have played a role in at least partially offsetting those list prices. It also found that policies with capped out-of-pocket expenses, along with manufacturer cost-sharing policies, helped to shelter patients from rising costs.

Four Ways Hospitals Can Deal with Rising Drug Costs

However, other reports show that patients are struggling under the weight of skyrocketing prices. One of the most recent larger-scale 

 found that 42% of Americans struggle to pay for medications, even though the majority (94%) had some kind of health coverage. That same study found that around one-third of patients had purposely missed filling a prescription due to cost at least once in the last year-of that group, 5.6% said they had skipped prescriptions three or more times.

, while lower, also paint a bleak picture: 7.8% of adults did not take their medication as prescribed in order to save money, while a further 1.6% bought their medications outside of the country and 4.2% used alternative therapies. A 

2017 Truven Health Analytics-NPR Health Poll

 found that 29% of Americans had stopped taking medications at some point without telling their doctor. While side effects were the most common reason given for missing doses (29%), 10% cited cost as the reason.

While it is challenging to find information on the most commonly abandoned medications, 

 and created by collaboration between CVS, Harvard, and Brigham and Young Women’s Hospital, found that insulin and proton pump inhibitors (PPIs; examples include omeprazole or lansoprazole) were the most likely drugs to be abandoned. (Interestingly, opiates, anti-platelets, and statins were the least likely to be abandoned.)

Although the abandonment was not directly related to price, the study also found that the larger the copay, the more likely a prescription was to be abandoned: a 1.4% abandonment rate for co-pays of $10 or less, a 3.4% rate for copays between $30 and $40, and a 4.7% rate for copays over $50.

Anecdotally, insulin still seems to be one of the top drugs associated with abandonment due to cost. Over the 2012-2016 period, insulin 

Lower Drug Prices Aren’t Worth Higher Health Risks

That concern isn’t without merit either-

 found that the average per month out-of-pocket costs for patients with diabetes was $360. Additionally, a recent 

, 25.5% of patients said that they had used less insulin than prescribed due to costs. That underuse was associated with a three-fold increase in high HbA1c compared with patients who didn’t underutilize the medications-potentially resulting in further complications that could add to the 

In response to public outcry, Eli Lilly announced that it will release a 

lower-cost generic version of its insulin Humalog

. According to the company, its list price will be 50% lower than the brand name version-though 

 this will have on the overall cost of medication.

Drug costs are a hot political topic, but just how much do they disrupt healthcare?

How High Drug Prices Affect Patients

, we continue to tackle the toughest challenges, and in the process, focus on the most pressing issues impacting our customers, clients, patients, and other stakeholders today. For me, this means using technology, data, and analytics to make healthcare more personal and affordable, expand choice, and improve whole person health and well-being-ultimately giving those we serve peace of mind.

But to use a common phrase, we need to be skating to where the puck is going. Leaders are required to anticipate and address the challenges and opportunities that we’ll confront tomorrow. Taking this long view, and having this insight, prepares an organization to influence the environment, rather than react to it. It enables you to be there for your customers today and in the future as the marketplace changes.

To best put the future into focus, I recommend a clear lens aimed on three areas: continuous learning, servant leadership, and an outside-in, customer-first view.

Education and continuous learning level the playing field. With the move to more value-based care, the need for evidence-based medicine-as well as the explosive growth of digital engagement-healthcare has never been more complex.

That’s why it’s more important than ever to stay current. The best leaders in our industry benefit from not only relentlessly pursuing knowledge within the health care sector, but also more broadly across other industries. This holistic view of the world helps us understand and plan around potential market influencers and disruptors.

Five Ways Digitization Will Impact Healthcare in 2019

For example, in healthcare, we’re witnessing the digital disruption and drive to retail-centricity that many other industries such as media, retail, and consumer finance have already seen. By studying the broader dynamics of other sectors, the disruptors, the market winners and losers, and the forces that influence change, you can navigate and come out on top. Forward-looking leaders remain curious throughout their careers and find opportunities to keep learning; it’s the only way to stay relevant. This means both formal and informal learning. And reading everything you can makes for a better leader and more informed influencer.

2. Servant leadership: The role of empathy

An organization is only as good as its people. Take care of your people and you in turn take care of your customers. I would suggest then modeling the behaviors you want your teams to embrace; most importantly, show caring values in words and actions.

At Cigna, we are laser focused on attracting, developing, and retaining top talent; it is the essential element for future growth. A new generation of talent is entering the workforce: Generation Z. This generation is predicted to change the norms of the workplace by putting culture and experience first in what they’re looking for from their employers. Leaders may need to break out of their comfort zones when it comes to managing Gen Z talent.

Many times, employees are not only looking for performance feedback, but a “life coach” as well. And in the workplace, these employees are looking for leaders who help them succeed by empowering them and removing barriers. This type of empathic servant leadership will be a valuable and effective skill not only with this newly minted cohort of employees, but for the entire workforce. The ability to understand, relate to, and be sensitive to employees’ changing needs will be critical for the long-term success of any company. That means creating an inclusive, flexible, and empathetic workplace for all.

3. An outside-in view: Challenge yourself to think customer first

Customer-centric thinking is critical and needs to be a well-developed skill. Consumer demands and preferences will continue to drive healthcare’s evolution; we know expectations are rising. The best industry leaders will anticipate evolving consumer needs and the growing demand for more virtual solutions.

For example, as one Forbes prediction notes, nearly half of the U.S. workforce could be participating in the gig economy by 2020. They will certainly have different expectations and healthcare demands than workers in traditional roles. Beyond the consumer role, we know that technology advances will also shape the experience. Things like 

, virtual reality, and intelligent automation are becoming increasingly ubiquitous and will shape next-generation customer experiences within healthcare.

These are simply examples: we will only be effective leaders if we listen to our customers and design solutions that work for them on their terms, meeting them where they are. The best customer-empowered leaders take the time to talk to customers, listen carefully, take their feedback unvarnished, and orient products and services accordingly.

Thousands of years ago, Aristotle said leadership is about ethics and action. This is as true today as it was back then. Being an effective leader is not complicated; for me, it always comes down to acting on the three basic concepts I outlined above-developing yourself, focusing on your talent, and being relentless about tuning into the customer. By focusing on these areas, emerging leaders can acquire the skills and mindset needed to manage today’s opportunities, anticipate future needs, and lead their organizations to success.

Mark Boxer, PhD, is executive vice president and global chief information officer for Cigna, where he is responsible for driving the company’s worldwide technology strategy.

There is no one way a leader may develop, but there are three qualities that effective leaders possess.

Three Emerging Leader Qualities That Guarantee Success

Although estimates of the cost of medication nonadherence differ, everyone agrees it's too high. A 2014 study in 

 cited a number between $100 and $300 billion, while a late 2018 analysis in the 

Here are six things healthcare executives should know about improving medication adherence.

 (APhA) Foundation is ‘Align the Incentives. Improve the Outcomes. Control the Costs,’” says Benjamin M. Bluml, RPh, and the Foundation’s senior vice president of research and innovation.

“If we properly invest in and align the incentives for patients, providers, and payers, we consistently observe significant improvements in care delivery, quality of care, and reductions in the total cost for care over time,” he says.

“This means collaborating in a team-based care effort-that includes a pharmacist-to change and improve the way care is delivered,” says Bluml. “After all, the primary treatment modality for chronic disease is medication, so if we don’t get medication right and help people understand its value we're never going to ‘get there.’” 

The Foundation has realized excellent success with patient-centered, team-based care initiatives to improve adherence, Bluml says, specifically citing cardiovascular disease, depression and diabetes. For example, patients made 30-minute appointments with pharmacists on a quarterly basis to review finger-stick blood glucose readings and discuss cholesterol, diet, and exercise goals.

“This gives patients a focus for their role, then an incentive to follow up with their provider,” he says. “Here’s an idea for payers: Tell patients if they keep regularly-scheduled visits with their pharmacist for diabetes-related care they'll get a free BG monitor and test strips to stay on track, and you can even take care of the copayment. You’ll spend your per-member dollars differently, but save $1,000-plus per person per year when they're not in the ER or hospital as much, eliminating huge costs. The member becomes a more engaged, informed decision maker.”

“Payers already know they're paying for medications and that there will continue to be more highly specialized therapies,” says Deborah Hauser, RPh, MHA, and network director of pharmacy for 

She seconds strategic use of medication management therapy programs that incorporate pharmacist “touch points” with patients during the course of therapy and result in engagement.

Survey: Effective Medication Adherence Tools

"This is not about just filling a prescription and walking away,” Hauser says. “If a patient doesn’t take their medication, a pharmacist can also assess whether there's a lack of motivation, a socioeconomic reason, intolerable side effects, or the inability to follow proper instructions.”

When they wonder out loud if their medication is “doing anything,” the pharmacist can explain the medication is not for symptomatic control, but to treat underlying disease, she says. “Especially with costly therapies, when a health plan has standards that apply to their use, there must be accountability. Is the medication being used as intended?”

At Einstein's specialty pharmacy, pharmacists call members to ask, “How many have you taken?” or “Do you have any left over?” and then re-educate and reinforce how important the medication is to overall health status.

“There are a lot of stakeholders here, so who's going to do the work?” says Hauser. “A pharmacist is the best stakeholder to assess and engage the patient about the importance of medication adherence.”

3. Realize one-size-fits-all isn’t long term

At the clinical services and analytics company 

, Kerri Petrin, MPH, and vice president of client services, knows that effecting behavior change in members remains a major challenge.

“We’re first approached by clients because they notice that a static approach to adherence outreach has resulted in flattening population-level adherence rates,” says Petrin. “We see a tremendous value materialize when we’re able to help our clients adopt an evidence-driven, member-centric approach that identifies the best method and time to engage a member-based upon their predicted risk of nonadherence, past receptivity to interventions, and the most effective time to intervene.”

When plans use these concepts to drive intervention strategy, Petrin says, two critical markers of a successful adherence program emerge. “There are steadily improving adherence rates while remaining within the health plan’s target intervention budget. The result is that plans are better able to plan for future member needs and can effectively quantify what it takes to achieve their adherence goals each year.”

Many health plans have been using phone calls, mailings, and emails to encourage patient adherence. “Now they're looking for innovative ways to meet patients when they want and where they want, and that's where smartphones come in,” says Kyle Amelung, PharmD, director of clinical solutions for 

Since nearly 80% of adults in the United States own one and check them nearly 80 times a day-and they’re different ages, have different demographics and incomes, and live in both rural and urban areas, Amelung says. He cites apps as a way to “affect and send a message in real time, receive data back and act on it right away.”

It is, in a word, “convenient.” Conditions really can be managed with digital connectivity and yield improved outcomes for patients and lower costs for health plans.

“A smartphone is not the overall solution but it can certainly be the means to a solution,” he says. “You must have uptake and believability from patients, providers, and payers. And you must remember that none of this will move the dial unless you tie in a human element. Our job is to create that therapeutic formulary for smart devices.”

Don't forget the member probably sees their pharmacist probably once a month, while seeing the physician one to two times a year, says Amelung.

However, when reaching out to a member about medical adherence, remember their health is a personal and intimate topic, says Lindsay Conway, managing director at the 

. “Maybe they don’t feel well and don't want to confide in someone with whom they don’t have an existing relationship. You must earn the right to have what may be an intimate conversation and to earn their trust.”

Top 3 roadblocks to medication adherence and how to avoid them

Having a professional sit down for face-to-face time with a patient costs money, Amelung says.

“We see those kinds of programs most often with the sickest and most complex patients who stand to benefit most from medication. It can be difficult to determine what makes a financially sustainable model,” he says.

Whatever the model, the professional doing interface needs skills and training, says Conway. Most important and most challenging is “coordination, coordination, and coordination.”

“When it’s missing, patients sometimes have to jump over hurdles with automated systems or phone messages,” she says. “We’re seeing more hospitals, health systems and physician groups operate their own pharmacies to solve coordination challenges and offer better care and continuity,” she says.

“If you’re a provider managing a complex population, some patients may be getting medication management from their health plans, others from pharma companies, and each program is a little different,” Conway adds. “So, it’s a challenge to keep track of which patients are getting support; what kind of support; and when you need to step in and provide support.”

Experts agree that with coordination, innovation, support, and education, medication adherence goals can benefit both payer and provider.

is a journalist, producer, and host in Orange County, California.

Key ways healthcare executives can improve therapy compliance.

6 Ways Health Execs Can Improve Medication Adherence

HealthPartners’ President and CEO Andrea Walsh’s approach to leadership in healthcare can be summed up in a single word: people.

While Andrea Walsh might be relatively new in her CEO position at 

-she just finished up her first full year this past summer-she’s certainly not new to the organization.

Walsh has been with HealthPartners for over 24 years, but says that she is still excited by what attracted her to the organization in the first place: being a part of an organization that partners with communities to focus on improving health-in other words, an organization that partners with a variety of people to care for people.

From tips for new healthcare leaders to growing initiatives, Andrea Walsh shows why people are the most important part of every part of healthcare.

Managed Healthcare Executive May 2019 Issue