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Lyceum Newsletter Perspectives

Accountability in Health Care: Definition and Implementation

03/23/2011

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Value establishes a road map to accountability and effective medical system reform.
 
Nowadays, medical system reform and accountability are synonymous; the 'Accountable Care Organization', or ACO, headlines as reform's key vehicle.

As a means to resolve health care's value deficit and reorganize delivery systems, the ACO seems an appropriate provider structure to target. The problem is, while many people have discussed ACOs, few have attempted to define precisely what accountability is, or to delineate how the health care system can become accountable, other than by accepting financial risk.

My goal in writing this article is to clarify the concept of accountability. To accomplish this, I've chosen to address three questions:
  1. How should we define accountability?
  2. How do accountability and value intersect?
  3. Who should be accountable to whom?
Let's begin with question number one. If we wish to define accountability, the dictionary seems a good place to start. It describes 'accountable' as “subject to the obligation to report, explain, or justify something; responsible; answerable.”

OK, we might be getting somewhere, except that we don't have much actionable guidance or specificity.

So that we can take a deeper dive, we might ask this clarifying question: What exactly are we reporting, explaining, and justifying in the process of becoming accountable? 

Furthermore, I would like to propose 'measurement' as a cornerstone to our answer. Accountability, it would seem, starts—but does not end—with measurement and the output of its reporting. 

Beyond measurement and reporting, accountability would also seem to involve an obligation to do something with the data and information that a provider's individual and organizational efforts generate. This 'something' needs to benefit customers (or patients) and other stakeholders to whom the provider is accountable.

Let's call this 'something' clinical and economic value—in mathematical terms, the sum of quality plus outcomes, divided by costs.

Value then is the key deliverable—the 'something'—that a person or organization is responsible to and answerable for, in the process of becoming accountable. If accountability is the destination, value (as measured by its components of quality, outcomes, and cost) is the road map to getting there.
 
Understanding value
Since we've identified value as a key contributor to accountability (to becoming accountable), it likewise deserves greater scrutiny. We throw around the term, after all, with as much imprecision and vagueness as quality. It often seems more a marketing tool than a concept to improve health care.
 
Hence our second question: How do accountability and value intersect?

Value, defined in terms of its components of cost, quality and outcomes, features both a numerator and a denominator. The numerator consists of quality plus outcomes.

Quality is difficult to define. The Institute of Medicine ("IOM"), however, outlines six fundamental principles that allow us to achieve at least a functional definition.[1]

Quality care, according to the IOM, is care that is safe, effective (meaning evidence-based), timely, efficient, equitable, and patient-centered.

From these principles we can develop an actionable concept. We can now identify appropriate measurements, processes, controls, and outcomes that drive quality and therefore our key result—value.

Let me give several examples of how we might apply the IOM’s principles in the real world to enhance patient care and improve quality and value . A quality, and therefore potentially value-enhancing, result could be the ability of a patient with a newly diagnosed cancer to get an appointment with an oncologist in a timely manner. The organization would measure, report, and act on a metric such as “average number of days to new patient appointments”.

Another example could be assuring that patients with breast cancer receive the most effective treatment. Providers can accomplish this, by, one, prospectively utilizing evidence-based clinical pathways, two, measuring pathway compliance, and three, assuring appropriate feedback and physician accountability.

And not only should a patient receive the most effective treatment, the provider should simultaneously conduct treatment in a way that is safe and efficient—both of which involve separate sets of measurements that target significant process and system changes.

I strongly suspect that these principles matter a great deal to patients. I can also confidently state that if someone were to compare performance on these parameters there would be wide variation across physician practices. For patients, it could create better choices in seeking care for serious illnesses such as cancer.

Quality principles produce true outcomes (not just process measures). There are, though, other outcome measurements that are quite important, even critical. For example, in oncology, depending on the specific cancer and how far it has spread, appropriate outcomes could include measurements such as survival, disease-free survival, or quality-of-life.

Measuring such outcomes is important, but doing so requires that providers treat and follow relatively large populations over prolonged periods of time: months, even years. It also requires, of course, the ability to capture and measure sophisticated clinical data.

it would be easier and quicker, with the potential for real-time feedback, if providers could obtain process and outcome measures that flow directly from the quality principles.

Cost makes up our value equation's denominator. Without getting into too much detail, there are a number of important considerations involving cost. First, always remember that not all costs are financial. Second, although there is no question that health care costs are unsustainable and that cost savings must be sought throughout the system, a single-minded focus on costs can actually be value-destroying if it negatively impacts the numerator of the value equation. Recall that an inability to define and measure quality and a fear that quality would suffer contributed to the failure of capitation and its inherent incentives in the 1990s.

Fortunately, quality care is, in fact, cost-effective care. That's where we can realize the biggest bang for our buck.

By addressing value, we create the opportunity to have our cake and eat it too—as we drive down costs on the basis of improved, value-based patient care.

To be sure, a focus on quality and outcomes, and their interrelationship with costs, represents a fundamental change in medicine. For this to occur, we need to reform not just health care's organization, but its culture too, including new incentives and priorities, and appropriate resource allocation.

Highly skilled and committed organizational leadership will have to come into place, and be held accountable for its results.

Definitions:
 
Value=(Quality+Outcomes)/cost. The key deliverable for an individual or organization attempting to demonstrate accountability

Accountable: subject to the obligation to report, explain, or justify something; responsible; answerable
 
Institute of Medicine Quality Principles:
    • safe
    • effective
    • timely
    • patient-centered
    • equitable
    • efficient

Accountability's chain of command
The final question I'd like to address as we attempt to better understand accountability is, Who should be accountable to whom?

Physicians and the other members of the health care team still need to be accountable to the individual patient. Ethical principles such as beneficence and patient autonomy will still guide this fiduciary relationship. Processes and systems, incentives, and most fundamentally culture, though, must change.

Increasingly, the care delivery unit will form around a team—beyond that an organization—in contrast to the individual physician. Accountability will still frame this emergent system, as some person will be answerable to the person receiving care.

At the same time, we need to include groups in the accountability chain that ultimately pay the bills and whom the individual's health impacts: businesses, taxpayers, and society as a whole. In order to drive improvement, the health care system needs to regard a realistic chain of responsibility and accountability.

A major focus of accountability, and a fundamental change from our current model, is the role that populations play as a key driver and recipient of accountability. In order to assess quality, outcomes, and costs (the components of value), we must be able to measure and interpret data and information.

This cannot occur on a one-to-one basis. It takes significantly-sized populations (and a degree of standardization) in order to obtain results in which we can have statistical and clinical confidence. Further, we must assure that value is delivered not just to an individual patient, but to an entire patient population.

Currently, we cannot realistically hold to account the individual physician or the patient-care team for what happens to the entire population (as opposed to the individual).

In effect, what is needed is for the health care organization to become the care delivery unit for populations. This is even true for the individual if you drill down far enough. Health care organizations, of course, have leaders, accountable for the performance of the organization.

Ultimately, health care organizations, and in particular their leaders, must become accountable for the care of a population of patients. This focus on populations, along with the role of the health care delivery organization (and its leadership), is a profound change from our current health care delivery model and culture.
 
For an excellent discussion of delivery system redesign, I recommend Richard Bohmer's Designing Care.[2]

Before implementing accountability we need to define it first. This begins by understanding and addressing value: the provider's—and health care organization's—most important deliverable. Value constitutes that critical 'something' necessary to the process of becoming accountable.

Once accountability is understood in the context of value and its component parts, the system can hold health care organizations and their leadership to account, and society can effectively transform the dysfunctional health care system.

More than ever, we need to commit ourselves to structural and cultural change, and outstanding leadership.

[1] "Crossing the Quality Chasm: A New Health System for the 21st Century" (2001) Institute of Medicine (IOM)
[2] "Designing Care: Aligning the Nature and Management of Health Care", Richard M. J. Bohmer, Harvard Business Press, 2009

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After many years of both patient care and leadership, Bruce is now a health care consultant. Key leadership accomplishments over the past ten years have included design and implementation of a community-based, integrated oncology delivery system, together with development, in close collaboration with a health plan, of a comprehensive quality initiative combined with a pay-for-quality contractual arrangement. Bruce is the co-series leader in the Oncology Business Practices Roundtable Series. Read more about Bruce.

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Drug Pricing Methodologies

Average Wholesale Price (“AWP”): The most commonly used price index in pharmaceutical transactions, AWP operates as a suggested list price. Buyers, typically, negotiate lower prices through the inclusion of discounts, rebates or free goods. Medicare uses it to calculate the cost of drug products administered in a physician’s office. PBMs, insurance carriers, and other managed care organizations use AWP to calculate payments to retail pharmacies for providing drug products to patients. Pharmacies often use AWP as a cost basis for pricing prescriptions.

Average Sales Price (“ASP”): The Medicare Modernization Act of 2003 established ASP as a drug payment system. The methodology uses quarterly drug pricing data, which drug manufacturers submit to the CMS. In calculating the ASP, the manufacturer must deduct various discounts, including prompt payment discounts. Like AWP, it serves as a baseline to determine Medicare reimbursement rates.

Average Acquisition Cost (“AAC”): The retailer’s cost to buy drugs from wholesalers: the final cost of the drug to the pharmacy after all discounts are subtracted.

Average Manufacturer’s Price (“AMP”): The average price retail pharmacies or wholesalers pay manufacturers. It is based on sales to the retail sector, which generally pays higher prices than other purchasing sectors. The federal government currently uses AMP to calculate rebates in the Medicaid outpatient prescription drug rebate program.

Wholesale Acquisition Cost (“WAC”): A manufacturer’s list price established for sales to wholesalers, and a basis for calculating rebates.

MANUFACTURER TO PHARMACY (VIA WHOLESALER)

1. MANUFACTURER

Wholesale Acquisition Cost (WAC) or Average Manufacturer's Price (AMP)

2. WHOLESALER

Actual Acquisition Price (AAP)

3. PHARMACY

MANUFACTURER TO PHARMACY

1. MANUFACTURER

Average Manufacturer's Price (AMP)

2. PHARMACY

 

 

PAYER TO PHARMACY

1. PAYER

Reimbursement: Average Wholesale Price + Discount

2. PHARMACY

PHARMACY TO PATIENT

1. PHARMACY

Retail or Usual & Customary Price (U & C)

2. PATIENT/END-USER

Drug Coding Procedures

Vendors use both the Health Care Common Procedure Coding System (“HCPCS”), devised by CMS, and Current Procedural Terminology (“CPT”), an AMA creation, to bill for drugs/products that are utilized in the physician’s office, clinic or home setting. These include drugs that are injected subcutaneously, intramuscularly, or intravenously, and drugs administered via nebulizers or other DME equipment.

The National Drug Code (“NDC”) serves as a universal product identifier for drugs and biologics. Although similar to NDC, J Codes contain less information, such as the name of the drug manufacturer. J Codes are administered under the HCPCS.

The newsletter Perspectives features commentary and opinion on economic transition and business innovation across health care, financial systems and consumer business.  Many contributions come from our participants, and reflect front-line experience. 

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Tom Cronin "A Better Model for Disease Management" (volume 5, issue 11)

Mr. Cronin is CEO of Neighborhood Diabetes, where he and his partners on the Management Team have grown the company tenfold in the last five years. Prior to involvement in the acquisition of Neighborhood, Tom took a sabbatical from business and was a math teacher at an urban high school and high school varsity soccer coach. Prior to teaching, Tom was CEO and owner of CranBarry, Inc., an established manufacturer and distributor of women's sporting goods. Earlier, Tom was a consultant at Bain & Company, the international strategy consulting firm headquartered in Boston. Read more about Tom.


Bruce Cutter, MD "A New Oncology Business Model" (volume 5, issue 1)

Dr. Cutter is a practicing medical oncologist/hematologist at Cancer Care Northwest, a large integrated oncology group in Spokane, WA.  As president and CEO from 2000 to 2007, Bruce lead the development of a comprehensive quality initiative called Foundations of Quality ("FOQ"). FOQ was developed six years ago, in close collaboration with Premera Blue Cross. This program, which includes a pay-for-performance contractual relationship, was founded on the quality principles promulgated by the Institute of Medicine, is physician-driven and collaborative, and based on a commitment by the practice to measurable quality and accountability. Read more about Bruce.


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Tom McNulty, Pharm.D "New Strategies for Specialty Pharmacy" (volume 5, issue 12)

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Kavita Nair, PhD "Value-Based Benefit Design: Getting It Right" (volume 5, issue 4)

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David Rose "Smart Packaging, Better Health Care" (volume 6, issue 1)

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Robert Rowley, MD "Cloudburst: The New Frontier for Electronic Health Records" (volume 5, issue 11)

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David Willcutts "Are Expectations Too High for Health IT Vendors?" (volume 6, issue 2)

Mr. Willcutts is a long time health care services executive and entrepreneur focused on managed care, specialty pharmacy and home care services. He is currently the president and founder of Ready Consultant, LLC an early stage marketplace for healthcare consulting services created in response to the unprecedented level of health care initiatives underway in the US covering areas such as EHR, HIPAA, ICD10, and more. He previously founded Ancillary Care Management (now Novologix) in 1995 growing it to over $450 million in annual revenue before leaving in 2007. Read more about David.

Selected Health Care Legislation


1965: Social Security Amendments authorized Medicare and Medicaid programs. The act created separate payment systems for in patient hospital care (Part A), and outpatient care, including home care and physician services (Part B). Read more here.


1983: Orphan Drug Act gave tax breaks, subsidies, and special exclusivity privileges to sponsors of drugs for rare diseases, defined as having fewer than two hundred thousand cases in the United States. The act implemented market exclusivity by granting protection for seven years against competition from any drug with a similar effect. Read more here.


1984: Hatch-Waxman “Generic Drug” Act required the FDA to accept bioequivalence as sufficient for approval and established the procedure for a generic drug approval called the Abbreviated New Drug Application (“ANDA”). The act extended patents for time lost during FDA review and for one-half the time lost during FDA-required clinical testing. The act capped the extension at a maximum of five years, and the total patent term at 14 years from the data of the FDA approval. Read more here.


1986: The Health Care Quality Improvement Act protected peer review bodies from private money damage liability, and prevented incompetent practitioners from moving state to state without disclosure or discovery of previous damaging or incompetent performance. Read more here.


1989
: Omnibus Budget Reconciliation Act authorized resource-based, relative value scale reimbursement of physicians under Part B of Medicare. Read more here.


1990
: Budget Reconciliation Act established Medi-Gap insurance regulation that limited exclusions for pre-existing conditions, requirements for uniformity in policies, civil penalties for duplicative services, mandatory rebates if policies failed to return specified percentages of each premium dollar, and rules for "simplification" and standardization of policies. The act also introduced a series of Medicare reforms that aimed to save $40 billion over five years. Read more here.


1992
: Prescription Drug User Fee Act established for a five-year period a mandatory fee to be submitted by a pharmaceutical company along with its application to finance the hiring of new employees and reduce average processing time. Read more here.


1996: Health Insurance Portability and Accountability Act (“HIPAA”) allowed for the protection of health insurance coverage for workers and their families when changing jobs, and established national standards for electronic health care transactions and national identifiers for providers, insurance plans, and employers to promote electronic data interchange. The act also authorized tax-deductible medical savings accounts. Read more here.


1997: Balanced Budget Act added Part C to Medicare, which expanded options for enrollment in managed care plans. Read more here.


1997: FDA Modernization Act reauthorized user fees for another five years, and introduced new inducements to conduct pediatric studies that included granting a sponsor an additional six months of exclusive marketing privileges beyond any patent or other nonpatent rights for which the drug may already be eligible. Read more here.


2003: Medicare Modernization Act provided a new outpatient prescription drug benefit under Medicare beginning in 2006 (Part D). In the interim, it created a temporary prescription drug discount card and transitional assistance program. It also included a provision for establishing health savings accounts. Read more here.

2005: Patient Safety and Quality Improvement Act established a system of patient safety organizations and a national patient safety database, to encourage reporting and broad discussion of adverse events, near misses and dangerous conditions. The Agency for Healthcare Research and Quality oversees many of its provisions. Read more here.


2009: The American Recovery and Reinvestment Act included the Health Information Technology for Economic and Clinical Health ("HITECH") Act, which provisions $19.2 billion in incentive money for the implemention and use of electronic health records.  It also legislatively mandated the Office of the National Coordinator for Health Information Technology ("HIT"), and the creation of the HIT policy and standards committees.  Read more here.

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6. Rights ReservedAll present and future rights in and to trade secrets, patents, copyrights, trademarks, service marks, know-how and other proprietary rights of any type under the laws of any governmental authority, domestic or foreign, including rights in and to all applications and registrations relating to the Service (the "Intellectual Property Rights") shall, as between you and Lyceum, at all times be and remain the sole and exclusive property of Lyceum. All present and future rights in and title to the Service (including the right to exploit the Service and any portions of the Service over any present or future technology) are reserved to Lyceum for its exclusive use. Except as specifically permitted by the TERMS, you may not copy or make any use of the Service or any portion thereof. Except as specifically permitted herein, you shall not use the trademarks, trade names, service marks, trade dress, logos or titles of Lyceum or the Service, or the names of any individual participant in, or contributor to, the Service, or any variations or derivatives thereof, for any purpose, without Lyceum's prior written approval. 

7. Third-Party Sites.  The Lyceum Web Site may contain references or hyperlinks to third party web sites. Such hyperlinks are provided for Your reference purposes only. Lyceum and the Publishers, as the case may be, (a) do not control such other web sites, and make no guarantee as to the accuracy, currency, content or quality of any such sites and information, including noninfringement of such web sites or the content contained in such web sites; (b) assume no responsibility as to whether such third party web sites contain unintended or objectionable content; and (c) make no endorsement of such web sites or their content.

8. User Contents.  You acknowledge that Users are solely responsible for the contents of any messages they post on bulletin boards, chat rooms or other communications devices as may be provided by the Lyceum Web Site or the Services from time to time, as well as for the consequences of any such messages. You agree not to use the Lyceum  Web Site or the Services for chain letters, junk mail, "spamming" or commercial solicitations, and not to send any message or material that is unlawful or gives rise to civil liability. All such communications through the Services are public and not private communications, and each of the Publishers reserves the right to remove such communications for any reason or no reason.

9. Restrictions on Use.  You agree not to use this Service for any unlawful purpose.  We reserve the right to terminate or restrict Your access if, in our opinion, your use of the service may violate any laws, regulations or rulings, infringe upon another person’s rights or violate the terms of this agreement.

10. Subscription, Service and Use Fees.  You agree to pay all subscription, service and use fees, if any, that you are charged by Lyceum for the Publication and Services and the Information to which you have subscribed and agree that such fees may be changed without notice. PAYMENT RECEIVED IS NON-REFUNDABLE.

11. Further Subscription, Service and Use Fees.  If this Agreement relates to a subscription purchased on behalf of a corporate subscriber under which You are an authorized user, that corporate subscriber agrees that it and each authorized user under such corporate subscription are bound by the terms and conditions of this Agreement and that the terms “You” and “User” include such corporate subscriber and each such authorized user. By accessing the Publications and Services, You represent and warrant that the person who ordered such subscription had sufficient authority to order the Publications and/or Services and to bind such corporate subscriber to the terms of this Agreement.

12. Cancellation.  A subscription to the Publication renews automatically every month, unless Lyceum terminates it or You notify us of your decision to terminate your subscription by telephone or e-mail (receipt of which must be confirmed by e-mail reply from Lyceum). 

13. Termination.  Lyceum may discontinue or change this Service, or its availability to You, at any time.

14. Survival of Terms. The provisions of Paragraphs 3 ("Disclaimer and Limitation of Liability"), 3 ("Further Disclaimer and Limitation of Liability"), 4 ("Indemnification"), 5 (“Intellectual Property”), 6 ("Rights Reserved"), 7 (“Third-Party Sites”), 8 ("User Content"), 9 ("Restrictions on Use"), 10 ("Subscription, Service, Use Fees"), 11 ("Further Subscription, Service and Use Fees"), 13 ("Termination"), 15 (“Governing Law”) and will survive the termination of this Agreement.

15. Governing Law.  This Agreement shall be governed by and construed in accordance with the laws of the State of Connecticut.

16. Miscellaneous.  You accept that Lyceum has the right to change the content or technical specifications of any aspect of the Service at any time at Lyceum's sole discretion. You further accept that such changes may result in your being unable to access the Service.

17. Amendments to AgreementFrom time to time, Lyceum Associates, Inc. may modify these terms and conditions. Accordingly, please continue to review these terms and conditions of service whenever accessing or using this site. Your use of the site after the posting of modifications to these terms and conditions of service will constitute YOUR ACCEPTANCE OF THE TERMS AND CONDITIONS OF SERVICE, as modified.  If, at any time, you do not wish to accept the terms and conditions of service, you may not use this Site. 

18. Contact Information.  Any notice or other communication required or permitted to be given hereunder shall be in writing and shall be given to Lyceum Associates, Inc. at 69 Orchard Place, Greenwich, CT 06830, Attention: President.

This Lyceum User Agreement (the "Agreement") between you (“You” or "User") and Lyceum Associates, Inc. ("Lyceum") states the terms and conditions governing Your use of the Publications (the “Publications”) and Services (the “Services”) to which You are subscribing from Lyceum. By subscribing to the Publications and/or Services, You agree to the terms of this Agreement. If You do not agree to be bound by the terms of this Agreement, do not subscribe to the Publications and/or Services.  YOU SHOULD PRINT OUT A COPY OF THIS AGREEMENT FOR YOUR RECORDS. (Download PDF version here.)

1. Limited Rights.  During the term of this Agreement You are granted limited, non-exclusive access to the Publications and Services solely for your personal use. Access under Your Lyceum UserID and password is limited to You and may not be shared with any other individuals or persons. You agree not to use your Lyceum UserID or password for the purpose of providing other users with access to content from the Publications or Services. You agree to use the Publications and Services and any enhancements to the Publications and Services that Lyceum may make in the future only in accordance with this Agreement as it may be amended by Lyceum from time to time. Subscriptions are not transferable.

2. Disclaimer and Limitation of Liability.  You understand and expressly agree that use of the Publication and Service is at your sole risk, that any Information downloaded or otherwise obtained through the use of the publications and services is at your own discretion and risk and that you will be solely responsible for any damage to your computer system or loss of data that results from the download of such material and/or data.  In no event shall either of the Publisher, any Affiliate, or any of the respective Officers, Directors, Employees, Shareholders, Members, Agents, Representatives, Service Providers or Suppliers be liable to You or anyone else for any consequential, incidental, punitive, special or indirect damages (including without limitation lost profits, trading losses and other commercial damages) that result from the use of the Publication or Services or from any inconvenience, delay or loss of the use of the Publications or Service, even if the Publisher has been advised of the possibility of such damages or losses.  The sole and entire maximum liability of the Publisher, its Affiliates, and respective Officers, Directors, Employees, Shareholders, Members, Agents, Representatives, Service Providers and Suppliers, for any reason, and Your sole and exclusive remedy for any cause whatsoever, shall be limited in the aggregate to the prorated amount remaining of the subscription fee paid by You for the Publication and Service for the then-current term of this agreement.

3. Further Disclaimer and Limitation of Liability. You acknowledge that the Information contained in the Publication is not intended as investment, business, tax or legal advice, and neither Lyceum Associates nor the Publishers, as the case may be, shall be responsible for any investment, business, tax or legal recommendations or opinions of third parties cited by the publications or services or in  information contained therein.

4. IndemnificationYou agree to defend, indemnify and hold harmless each of the Publishers, their respective affiliates, and their respective employees, officers, directors, shareholders, members, agents, representatives, service providers and suppliers, from and against any and all claims, losses, liabilities, costs and expenses (including without limitation reasonable attorneys' fees, costs and expenses) arising from Your violation of this Agreement, state or federal securities laws or regulations, or any third party's rights, including without limitation infringement of any copyright, violation of any proprietary right or invasion of any privacy rights, except to the extent that such liability results from any infringement of copyright, violation of any proprietary right or invasion of any privacy right by the Publishers.

5. Intellectual Property.  You agree that the text, graphics, images, video, designs, organizations, compilation, look and feel, and all other protectable intellectual property available through Lyceum's Services is the property of Lyceum, and is protected by copyright and other intellectual property laws.  Unless You have our written consent, You may not sell, publish, distribute, retransmit or otherwise provide access to the contact received through this service to anyone, including, if applicable, your fellow students or employees.

6. Rights ReservedAll present and future rights in and to trade secrets, patents, copyrights, trademarks, service marks, know-how and other proprietary rights of any type under the laws of any governmental authority, domestic or foreign, including rights in and to all applications and registrations relating to the Service (the "Intellectual Property Rights") shall, as between you and Lyceum, at all times be and remain the sole and exclusive property of Lyceum. All present and future rights in and title to the Service (including the right to exploit the Service and any portions of the Service over any present or future technology) are reserved to Lyceum for its exclusive use. Except as specifically permitted by the TERMS, you may not copy or make any use of the Service or any portion thereof. Except as specifically permitted herein, you shall not use the trademarks, trade names, service marks, trade dress, logos or titles of Lyceum or the Service, or the names of any individual participant in, or contributor to, the Service, or any variations or derivatives thereof, for any purpose, without Lyceum's prior written approval. 

7. Third-Party Sites.  The Lyceum Web Site may contain references or hyperlinks to third party web sites. Such hyperlinks are provided for Your reference purposes only. Lyceum and the Publishers, as the case may be, (a) do not control such other web sites, and make no guarantee as to the accuracy, currency, content or quality of any such sites and information, including noninfringement of such web sites or the content contained in such web sites; (b) assume no responsibility as to whether such third party web sites contain unintended or objectionable content; and (c) make no endorsement of such web sites or their content.

8. User Contents.  You acknowledge that Users are solely responsible for the contents of any messages they post on bulletin boards, chat rooms or other communications devices as may be provided by the Lyceum Web Site or the Services from time to time, as well as for the consequences of any such messages. You agree not to use the Lyceum  Web Site or the Services for chain letters, junk mail, "spamming" or commercial solicitations, and not to send any message or material that is unlawful or gives rise to civil liability. All such communications through the Services are public and not private communications, and each of the Publishers reserves the right to remove such communications for any reason or no reason.

9. Restrictions on Use.  You agree not to use this Service for any unlawful purpose.  We reserve the right to terminate or restrict Your access if, in our opinion, your use of the service may violate any laws, regulations or rulings, infringe upon another person’s rights or violate the terms of this agreement.

10. Subscription, Service and Use Fees.  You agree to pay all subscription, service and use fees, if any, that you are charged by Lyceum for the Publication and Services and the Information to which you have subscribed and agree that such fees may be changed without notice. PAYMENT RECEIVED IS NON-REFUNDABLE.

11. Further Subscription, Service and Use Fees.  If this Agreement relates to a subscription purchased on behalf of a corporate subscriber under which You are an authorized user, that corporate subscriber agrees that it and each authorized user under such corporate subscription are bound by the terms and conditions of this Agreement and that the terms “You” and “User” include such corporate subscriber and each such authorized user. By accessing the Publications and Services, You represent and warrant that the person who ordered such subscription had sufficient authority to order the Publications and/or Services and to bind such corporate subscriber to the terms of this Agreement.

12. Cancellation.  A subscription to the Publication renews automatically every month, unless Lyceum terminates it or You notify us of your decision to terminate your subscription by telephone or e-mail (receipt of which must be confirmed by e-mail reply from Lyceum). 

13. Termination.  Lyceum may discontinue or change this Service, or its availability to You, at any time.

14. Survival of Terms. The provisions of Paragraphs 3 ("Disclaimer and Limitation of Liability"), 3 ("Further Disclaimer and Limitation of Liability"), 4 ("Indemnification"), 5 (“Intellectual Property”), 6 ("Rights Reserved"), 7 (“Third-Party Sites”), 8 ("User Content"), 9 ("Restrictions on Use"), 10 ("Subscription, Service, Use Fees"), 11 ("Further Subscription, Service and Use Fees"), 13 ("Termination"), 15 (“Governing Law”) and will survive the termination of this Agreement.

15. Governing Law.  This Agreement shall be governed by and construed in accordance with the laws of the State of Connecticut.

16. Miscellaneous.  You accept that Lyceum has the right to change the content or technical specifications of any aspect of the Service at any time at Lyceum's sole discretion. You further accept that such changes may result in your being unable to access the Service.

17. Amendments to AgreementFrom time to time, Lyceum Associates, Inc. may modify these terms and conditions. Accordingly, please continue to review these terms and conditions of service whenever accessing or using this site. Your use of the site after the posting of modifications to these terms and conditions of service will constitute YOUR ACCEPTANCE OF THE TERMS AND CONDITIONS OF SERVICE, as modified.  If, at any time, you do not wish to accept the terms and conditions of service, you may not use this Site. 

18. Contact Information.  Any notice or other communication required or permitted to be given hereunder shall be in writing and shall be given to Lyceum Associates, Inc. at 69 Orchard Place, Greenwich, CT 06830, Attention: President.

 

Disciplined Approach

 
3-step process
 
 
 
Step 1 - Planning
 
We create in partnership with the client an effective roundtable series design that matches content to strategic objectives and emphasizes insight and urgency.
 
Step 2 - Execution
 
We advance the roundtable agenda, recruit high-value participants, and rapidly achieve goals.
 
Step 3 - Reporting
 
We present key takeaways and essential information in summary reports, and promote follow-up communication among participants.
 

Disciplined Approach

 
3-step process
 
 
 
Step 1 - Planning
 
We create in partnership with the client an effective roundtable series design that matches content to strategic objectives and emphasizes insight and urgency.
 
Step 2 - Execution
 
We advance the roundtable agenda, recruit high-value participants, and rapidly achieve goals.
 
Step 3 - Reporting
 
We present key takeaways and essential information in summary reports, and promote follow-up communication among participants.
 

Essential Discussions

 
Categories 
Business Innovation
  • Payer/Provider Business Models
  • Benefit Design/Employer Strategies
  • Information Technology
  • Risk Management
Industry Transition
  • Health Policy & Reform
  • FDA
  • Consumer Engagement
Case Studies
  • ACOs/Integrated Care Delivery
  • Insurance Exchanges
  • Biosimilars (Follow On Biologics)
  • Drug Distribution/ Alternative Pharmacy Networks
  • Oncology Business Practices
  • Physician Leadership
 

Essential Discussions

 
Categories 
Business Innovation
  • Payer/Provider Business Models
  • Benefit Design/Employer Strategies
  • Information Technology
  • Risk Management
Industry Transition
  • Health Policy & Reform
  • FDA
  • Consumer Engagement
Case Studies
  • ACOs/Integrated Care Delivery
  • Insurance Exchanges
  • Biosimilars (Follow On Biologics)
  • Drug Distribution/ Alternative Pharmacy Networks
  • Oncology Business Practices
  • Physician Leadership
 

High Return Events

 
“Market Knowledge”
 
A large pharmaceutical company weighs investment in different medication adherence programs, but questions how provider consolidation may or may not affect that investment. The Lyceum team designs a series of roundtables addressing adherence issues concerning the company’s specific medication(s). The roundtable series encompasses payers, different vendors, relevant patient groups, and a cross-section of providers. At the series’ conclusion, the Lyceum team delivers its assessment of the landscape and proposes a best course of action.
 
“Corporate Action"
 
At the behest of its bankers and its own internal strategists, a health plan considers extending its corporate portfolio into the ownership of physician practices. Although financial models appear sensible, company management worries about hard-to-quantify cultural issues and marketplace uncertainty, from the response of patients to the emergence of alternative provider business models. Based on an interactive roundtable series including diverse provider organizations, employers and other market participants, the Lyceum team submits an independent analysis, allowing management to decide more confidently.
 
“New Product Development”
 
Anticipating increased demand for risk management tools addressing global payments, a health information services company plans to develop various proprietary solutions, but discovers that demand may not adequately materialize because of client uncertainty about how the marketplace is evolving. The Lyceum team coordinates a series of roundtables featuring the company, prospective users of its tools, and relevant market participants to provide immediate feedback on the marketplace and inspire greater confidence in the company’s offerings.
 

High Return Events

 
“Market Knowledge”
 
A large pharmaceutical company weighs investment in different medication adherence programs, but questions how provider consolidation may or may not affect that investment. The Lyceum team designs a series of roundtables addressing adherence issues concerning the company’s specific medication(s). The roundtable series encompasses payers, different vendors, relevant patient groups, and a cross-section of providers. At the series’ conclusion, the Lyceum team delivers its assessment of the landscape and proposes a best course of action.
 
“Corporate Action"
 
At the behest of its bankers and its own internal strategists, a health plan considers extending its corporate portfolio into the ownership of physician practices. Although financial models appear sensible, company management worries about hard-to-quantify cultural issues and marketplace uncertainty, from the response of patients to the emergence of alternative provider business models. Based on an interactive roundtable series including diverse provider organizations, employers and other market participants, the Lyceum team submits an independent analysis, allowing management to decide more confidently.
 
“New Product Development”
 
Anticipating increased demand for risk management tools addressing global payments, a health information services company plans to develop various proprietary solutions, but discovers that demand may not adequately materialize because of client uncertainty about how the marketplace is evolving. The Lyceum team coordinates a series of roundtables featuring the company, prospective users of its tools, and relevant market participants to provide immediate feedback on the marketplace and inspire greater confidence in the company’s offerings.

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Lyceum members occupy one seat at any event. Lyceum sponsors occupy multiple seats at one or more roundtable series. Members and sponsors qualify as GatherSmart® Executive participants. We expect other participants to pay a participation fee, and to become members or sponsors for continued involvement.

Lyceum collaborates extensively with its participants on topic and event development.

Lyceum pursues direct person-to-person contact, optimizing business development.

Search hundreds of Lyceum roundtable and event participants.  GatherSmart® Executive participants enjoy full access.

The Lyceum Newsletter Perspectives dates back to June 2005, and encompasses more than three dozen discussion topics and over one thousand published pages.

Read biographies of recent newsletter contributors

My GatherSmart is your starting point for dynamic group interaction. Connect to users across our community, search participants at past and future events, and more.

ChatterSmart is a short-format news forum. Adding your thoughts is as easy as 1-2-3.

View here.

View profile information on users across our entire community. GatherSmart® Executive participants enjoy full access.

Read Sydney's Weblog Talking Transitions for related commentary and opinion.

View here.

Lyceum Associates welcomes a variety of organizations as members in our service.  Members represent diverse stakeholders, including for-profit and non-profit corporations, government agencies, academic institutions, consultancies, and financial service institutions.

Participants

User fees support our unique equal-participation, invitation-only format. These fees apply to individual business entities and cover multiple participants.

For enhanced client outreach and business development, we encourage series sponsorships.

Unaffiliated individuals may join Lyceum as contributors, and participate in roundtables and events.

View a checklist of our services.

Lyceum Matrix

 

Gainful business development and investment require an ability to price future economic shifts within and across industries. Read "Talking Transitions" and learn more.

View the "Talking Transitions" Blog here.


Help Center

ACCESS TO THE LYCEUM NEWSLETTER "PERSPECTIVES" AND THE "PERSPECTIVES" ARCHIVES IS LIMITED ONLY TO AUTHORIZED SUBSCRIBERS WHO HAVE READ AND AGREED TO THE LYCEUM USER AGREEMENT, WHICH SOLELY GOVERNS THE CONDITIONS FOR USE OF ANY OF THESE SERVICES AND THE INFORMATION CONTAINED THEREIN. All contents Copyright © 2005-2012 Lyceum Associates, Inc. ALL RIGHTS RESERVED. These Services and the Content contained therein are protected under U.S. and foreign copyright and intellectual property laws, and may not be photocopied, reproduced or retransmitted in any form without the written consent of Lyceum Associates, which may be requested from info@lyceumassociates.com. The content and opinions expressed in "Perspectives" may change and do not constitute investment advice.  Lyceum Associates is not responsible for the accuracy of information provided on third-party Web sites.  GatherSmart@ is a registered trademark of Lyceum Associates, Inc.

Help Center

ACCESS TO THE LYCEUM NEWSLETTER "PERSPECTIVES" AND THE "PERSPECTIVES" ARCHIVES IS LIMITED ONLY TO AUTHORIZED SUBSCRIBERS WHO HAVE READ AND AGREED TO THE LYCEUM USER AGREEMENT, WHICH SOLELY GOVERNS THE CONDITIONS FOR USE OF ANY OF THESE SERVICES AND THE INFORMATION CONTAINED THEREIN. All contents Copyright © 2005-2012 Lyceum Associates, Inc. ALL RIGHTS RESERVED. These Services and the Content contained therein are protected under U.S. and foreign copyright and intellectual property laws, and may not be photocopied, reproduced or retransmitted in any form without the written consent of Lyceum Associates, which may be requested from info@lyceumassociates.com. The content and opinions expressed in "Perspectives" may change and do not constitute investment advice.  Lyceum Associates is not responsible for the accuracy of information provided on third-party Web sites.  GatherSmart@ is a registered trademark of Lyceum Associates, Inc.

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