We are thrilled to announce that Henry Chao, Retired CIO & CTO, Centers for Medicare & Medicaid Services will be joining us at our upcoming Healthcare Payers Assembly as our Keynote Speaker.
The current political climate in the US is uncertain. President Trump has spoken often about the need for healthcare reform and his desire to repeal Obamacare and ACA. It’s tough to predict the future right now. What are you keeping your eye on? What advice do you have for CIO/CTOs trying to navigating this uncertain landscape?
HC: In the 2 decades, I was at HCFA/CMS every administration and sessions of Congress produced some level of disruption to the healthcare landscape from HIPAA starting in 1996 through MACRA in 2015 so change is a constant in public policy and healthcare gets its fair share of change.
In the coming 12-18 months, I think what is inevitable and critical is the execution of “repeal & replace”, namely how to not do harm to the 20+ million people enrolled in either the Marketplaces or through Medicaid Expansion.
I would also closely observe the operational aspects of the Quality Payment Program with regards to the data that will be initially be very difficult to manage, the initial rough spots that will happen between the MIPS and APM tracks, and what will surface as the next generation health data ecosystem that can make sense of all the existing and new data exchanges, transformations, integrations, and who will have the best answer in which to execute a health care decision, a payment decision, and so on.
As a leader in your organization, the first step is to explicitly embrace change. Don’t dance around it. Don’t delay talking about the possibilities. Don’t let fear seep in. Don’t let the rumors spin out of control. Do take the hallway conversations back into productive meetings. Do try to reduce the amount of speculation and provide guidance early and/or share the leadership’s thoughts on what might be done in a time of uncertainty. Do think through and communicate what can be directly controlled and what may need time, clarity, or additional influences to effectively proceed. Do put your collective experiences in weathering uncertainty on behalf of an organization to project what are some logical steps to take to prepare to make progress absent of even half of an answer.
Figure out what the “clearance” process is—in non-government entities, this may be described as knowing who makes decisions on what issues. Even if it’s unclear and chaotic at least you have a chance to not have to repave the path every time a decision is needed. Also, when no decisions are made in a timely fashion, remind everyone that time then makes the decision for you.
Given this constant and the difficulty in predicting the future, it would be wise to develop more than one scenario for anticipating the initial impact of change as well as the related/dependent business processes that will also be affected, in descending order of impact. In these exercises, you can develop high-level assumptions and requirements to be used for ROM estimates and Level Of Effort estimates.
Using the high-level assumptions and requirements, develop and update regularly rough estimates of the costs and resources needed for your scenarios. Separate what would be a “fixed” costs or a constant from the “variable” costs to better manage the debates about what can be realistically cut from the budget.
Apply realism to the so-called “short-term” solutions versus the “longer-term” solutions to assess whether if “short-term,” while appearing attractive, may create the most risk overall.
“Pencils down” is a fleeting concept because “no one raindrop believes it caused the flood.” Product Managers cannot just be an IT PM or technical lead—they must understand the overall business context for delivery and have legitimate authority to determine what is in an increment of delivery and what gets worked on in the backlog.
Resources that work on UX and in an Agile approach towards development are not necessarily thinking about the bigger picture—software still must adhere to a lifecycle discipline especially in regards to security and integration requirements between new and what already exists in the IT ecosystem inter and intra-organization. They need guidance, support, and oversight in order to maximize what they bring to the table.
Trust yourself in making the best calls possible in less than optimal circumstances.
The healthcare industry is being revolutionized by digital technology. How do you envision the role of payers changing in the world of connected health?
I have always believed that data flows between entities happen because of some form of financial implication whether in the positive or negative sense and the quality of the data within the flow is often affected by the magnitude of the financial implication such as payment. Therefore the flow of eligibility and claims are relatively in an optimized state as compared to the flow of data in a HIE to support treatment for a patient.
Government payers like Medicare drive much of the tenor and tempo of change in healthcare because it can drive the public policies towards some national goals. Commercial payers, while driven by different motivating factors share the same goals, for example, better care at lower costs. Both are influential in how access (or eligibility) is created, how coverages and cost shares are determined, how treatment is provided, how reimbursement is determined, and how quality is applied to the overall payment equation. I think that regardless of the access and delivery models promoted by government or commercial payers that there can be greater influence over the implementation of technologies to produce the common goals between government and commercial payers. This can be done through greater inclusion of the policy makers and product people from all payers in discussions of standards, interoperability, sharing of common goals and consistencies in how data is used to across all payer programs. The technical and operational people that are in the mix of the standards and interoperability discussions can complement the policy and product people to work on common reference data models, harmonized privacy and security frameworks, and the implementation of enabling technologies that can more seamlessly manage the integration of clinical and administrative data which is more imperative than ever under the new payment models and risk sharing arrangements.
We are thrilled to have Henry Chao on board at this year’s Healthcare Payers Transformation Assembly as our Gala Dinner Keynote. Take a look at the event here >>
ABOUT HENRY CHAO
Mr. Chao has over 20 years of experience as a Federal Government Senior Executive leading national scale implementations of complex healthcare programs. Over the course of his esteemed career in public service formulating strategies and directing the implementation of major programs, Mr. Chao led innovative solution development efforts and delivered technical capabilities for national and state level healthcare initiatives.
Mr. Chao fully embraced the role of change agent and effectively managed all facets of product and systems lifecycle to meet go-to-market strategies. As a Chief Technology Officer, he established technical standards and reference architectures for the Medicare and Medicaid programs to promote greater efficiency and responsiveness to key healthcare business processes. As a CIO Mr. Chao optimized secure and efficient data sharing across Federal and State Programs through implementation of a data services hub and built from ground up, a major IT organization to support the Insurance Marketplace under the Affordable Care Act supporting one of the most significant program implementation challenges in the history of healthcare in the US. As a recognized and trusted leader he forged strategic relationships and formed coalitions with government and commercial organizations across the healthcare ecosystem to achieve common policy and business objectives.
ABOUT HEALTHCARE PAYERS ASSEMBLY
The Millennium Alliance is pleased to announce that applications for our biannual Healthcare Payers Transformation Assembly is now open. North America’s most prominent IT and business leaders from the Healthcare Insurance industry will be gathering on May 15-16, 2017 at The Biltmore Hotel in Miami, FL, to discuss how to adapt to the industry’s customer-centric makeover.
Technological advances in genomics, personalized healthcare, AI (and more!), coupled with consumer demand for greater price transparency, have changed the face of healthcare in North America. The need for the Healthcare Insurance industry to adapt has never been greater.
Join industry heavyweights like Henry Chao, Retired CIO & CTO, Centers for Medicare & Medicaid Services across a series of executive education roundtables, keynote presentations, collaborative think tanks, educational workshops, and networking sessions offering insight into industry-specific topics and trends, helping you stay one step ahead.
For more information, visit the website >>