On January 31, HC3 hosted its Annual State of Chicago Forum at Nixon Peabody LLP. This 6th annual forum brought together local leaders and stakeholders to discuss emerging health care trends and expectations across the industry in 2023.
April Schweitzer, Partner, Nixon Peabody
Kathy Chan, Director of Policy, Cook County Health
Catherine Dimou, MD, Midwest Market Medical Executive, Cigna
Grace Hong Duffin, JD, MPA, CEO, Kenneth Young Center
Nathan Ray, Partner, Healthcare & Life Sciences M&A National Practice Leader, West Monroe Partners
David Smith, Founder & CEO, Third Horizon Strategies and Co-Founder, HC3 IN THE NEWS: HEALTH LEADERS LAY OUT MAJOR ISSUES FACING INDUSTRY IN 2023 | 2.3.2023 | Article Here
Watch the live event:
Event Host’s Remarks
April Schweitzer, Partner, Nixon Peabody
Nixon Peabody is grateful for the membership and collaboration with HC3 and excited to kick off this year by hosting their largest forum to date in their new office space. Nixon Peabody has a longstanding history of representing stand-alone community and/or religious-based hospitals and systems. Currently, they are supporting several health care transformation projects within the state of Illinois. Specifically, April’s practice focuses on the transition of Federally Qualified Health Centers (FQHCs) to value-based care and clinical integration.
Moderator's Remarks and Introductions
David Smith, Founder & CEO, Third Horizon Strategies and Co-Founder, HC3
David Smith provided a brief overview of the forum’s goal focus on emerging trends, signals, and events that may take place in the industry over the next 12 months at both state and national levels. He summarized five issues he’s predicting will be top of mind for stakeholders in the industry in 2023.
1) Increased activity and awareness around price transparency
2) Hospital systems financial strain continues while trying to navigate sustainable solutions
3) Workforce challenges remain a challenge
4) Behavioral health investment to address the ongoing crisis
5) Slow down of digital health investment
For more intel from David: Health Industry Trendspotting 2023 (Cost of Care) (1.25.2023)
DS: What are your thoughts on topline issues within the industry for 2023?
Grace Hong Duffin (GHD): The Kenneth Young Center is a community behavioral health center that provides social services in the northwestern suburbs of Chicago. The first “big thing” on our minds for 2023 is mental health in children. A recent survey of school boards conducted by The National Council of Mental Wellbeing revealed that youth mental health is one of the biggest issues in schools. As part of the work at Kenneth Young Center, we administer surveys to 10th and 12th graders, and from our surveys, we found that 10 percent of both 10th and 12th-grade students in our service area had considered attempting suicide in the past 12 months. These high figures can be attributed to various things, and the isolation during the COVID-19 pandemic may have also served as a catalyst. Several school districts have approached the Kenneth Young Center to provide supportive counseling services. We have seen traditional school counselors not having the proper training to deal with some of the issues children face these days.
The second big thing on our minds is mobile crisis response. The rollout of 988 has commenced nationally, with states adopting and implementing it. Illinois has made considerable strides in implementing this initiative, and there will be increased momentum in the coming months.
Nathan Ray (NR): Coming out of the pandemic, the most significant things driving our work with clients are solutions that will help them navigate the shifting investment climate. Most important is how these solutions will help them execute their visions profitably and sustainably.
A couple of big things will happen this year: exit enrollment/re-enrollment in ACA plans, meaning patients and providers who have not had to deal with eligibility will have to navigate this. Brick-and-mortar retail companies will also continue to play a role in the Medicare Advantage ecosystem, especially CVS and Walgreens, who continue to make investments that demonstrate their commitment to creating a version of health care where basic retail needs are catered to alongside pharmaceutical/primary health care needs. Finally, there will be much learning this year as stakeholders react to and navigate the new realities. There will be many changes, including things like commitments to new technologies and executive turnover, as stakeholders seek to create value in this new climate.
DS: You mentioned Walgreens and CVS - CVS is in the process of acquiring Signify, and there are also discussions that CVS is in the market to acquire Oak Street Health. What do you think the CVS game is, and can that vertical stack of assets be disruptive?
NR: Retail stakeholders seem to understand the period that we are in. They know that several things can be marketed and sold, including relationships. However, making these assets work will take time and effort. That said, being able to fold retail into the last mile services provided by some of their investment targets is a good business model, particularly when knowledge of the customer is layered onto it.
DS: Insurance companies make their bread and butter based on being able to predict risk, which is contingent on uncertainty. As we move into very uncertain times this year, what are the big things on your mind?
Catherine Dimou (CD): In my role at Cigna, I look at health through the lens of value-based care, so my comments will reflect that viewpoint. In terms of risk, Cigna and myself believe firmly in supporting providers. We continuously evaluate our role and approach to interfacing with physicians, hospitals, and hospital systems to ensure we effectively support them in delivering quality care. During the pandemic, we recognized we could not measure a provider’s performance because it wasn’t about overall wellness and how their patients did but about which providers had COVID spikes. In response to this, we adopted a more supportive approach to our value-based program that involved having a stable care-coordination reimbursement that allowed hospitals to support their care management systems. As we look at our approach to value-based care, we are transitioning back to a risk-based model, which involves evaluating how people will perform in the future and their ability to manage patients. At the same time, still providing support as we know there are still challenges.
DS: We are about “26 years into a 40-year transition to value-based care.” Do you believe the pandemic or the current financial situation of hospitals accelerated this transition? Is there anything that will change the pace of transitioning to value-based care?
CD: Having an increased amount of groups, especially Medicare-focused providers, move towards value-based care will help carry the ecosystem further along in the transition timeline.
DS: Kathy, your organization is very important to the vulnerable communities across the city. What are some of the things that are top of mind for you as we move into 2023?
Kathy Chan (KC): Cook County health sees many patients with Medicaid insurance coverage. We run two hospitals and a network of community health centers; we provide comprehensive care to individuals living with HIV and other infectious diseases, we provide correctional health services for individuals at the jail and juvenile correctional centers, and we also run County Care, which is Cook County’s Medicaid managed care plan.
We have two Medicaid priorities as we enter 2023. The first is the pending re-determination process. Illinois’ Department of Healthcare and Family Services (HFS) has presented some preliminary plans. It is anticipated that individuals subject to the first round of re-determination could lose their coverage on July 1, 2023, if they don’t go through the update process. The number of people currently enrolled in Medicaid in Illinois makes this re-determination process a significant interest to stakeholders, especially since some of these beneficiaries were enrolled during the pandemic and haven’t gone through this re-determination process before. What is encouraging is that the state plans to roll out comprehensive public engagement and media to ensure that folks are well informed, in addition to other initiatives that will introduce flexibilities into the process.
The second thing that is top of mind within Medicaid is our efforts to expand our state Medicaid program to low-income individuals who cannot qualify for Medicaid because of their immigration status. The Healthy Illinois Campaign has been the organizer of policy and advocacy drivers, convening a coalition of organizations working to close this gap for the uninsured.
Audience Question: Cyber Security continues to be a significant issue. We have had some major breaches in the last couple of years. What do you foresee changing from a HIPAA compliance requirement over the next couple of years to being at the forefront of this very complex problem?
NR: Understanding how to have a secure perimeter technologically is a big thing in M&A. On an individual device basis, it’s not been a primary focus of health systems. Most organizations have instead focused on security awareness, bringing the issue up to all major players in health care. However, some organizations still have no HIPAA officer or security officer. Unfortunately, a lot of these things are financially motivated. But we do have the systems needed to do these things.
Audience Question: Where are we moving to real-time risk visibility? What is ACO REACH doing to traditional business models?
CD: We are always striving to develop and monitor more real-time data with providers. HIEs (Health Information Exchanges) have helped with that. However, not all areas and markets have these in place. We also look at the risk score to assist in the process. And as we move patients into value-based care, we also continue to be in prospective risk categories.
DS: This area is relevant to all aspects of health care, and the main theme is “liquidity.” In terms of activating these solutions and opportunities to translate them into action.
Audience Question: What are the major differences we are seeing in people utilizing Obama Care (ACA – affordable care act) access to insurance vs employer-sponsored? How are we addressing some of these gaps in access to insurance?
KC: There will be a special enrollment period of the marketplace for individuals that may be ineligible for Medicaid during the unwinding of the PHE (Public Health Emergency). Currently, in Illinois, there is a federal and state collaboration with the marketplace, where the state does not actually manage our own marketplace. So if the state wanted to offer additional subsidies, we would likely have to move to a state-based marketplace. Advocates are pushing for this change; however, more importantly, I think the focus right now should be about focusing on catching people before they “fall off the cliff,” helping navigate them appropriately to the right program – whether it be the marketplace, Medicaid, or a third option whatever it may be. Anyone interacting with patients – providers, care coordinators, and so on – that are likely candidates for redetermination is connecting them to the right resources.
CD: We are seeing growth in IFP (Individual and Family Plans) and Medicare Advantage in our business (Cigna / Insurance). We are seeing employers continue to invest in the continuity of health care access for employees; however, this space has seemed relatively flat. A worker shortage will continue to be an important benefit that we hope to see continue to grow in employer-sponsored health care. Health care is a right, a commitment by our government, and it helps providers be stronger, so it is nicer when a larger group of people are covered.
DS: Grace and Nathan, (drawing upon the audience question) what are some of the most exciting solutions and opportunities that you are seeing develop to address behavioral health?
GH: “Meeting people where they are” by going into communities, getting to these stakeholders early, and with the right resources to support them. There is and needs to be a stronger and more prominent focus on health equity. Behavioral health needs to be seen and treated the same as physical health in regards to how we prioritize and address it. And last but not least, access to behavioral health is still challenging. Ensuring we have the right representation that fosters cultural humility and tools that support their interactions with communities with the most need.
NR: Technology and digital solutions remain critical to innovation and change here. Medicare Advantage and other plans are all talking about real-time data and ways in which they can address people’s needs in a timely manner. An example is Cigna’s “CareAllies” program which supports getting patients across that last mile in ensuring direct connectivity to their care and resources. Other platforms, such as Agilon, make real-time dashboards available, making it a truly “data-driven” solution. Behavioral health is becoming a major component of all of these solutions, and not waiting to be invited into these opportunities.
The last thing and most exciting thing to me coming out of COVID, some of the experimentation of digital platforms that have been in play will help us through this next phase of innovation. Medicare Advantage plans have done things to address loneliness at scale, so we continue to see some interesting and unique ways that groups are advancing opportunities and also being inclusive to behavioral health, specifically as it relates to digital tools.