Thursday, July 02, 2015
Lyceum Newsletter Perspectives

Accountability in Health Care: Definition and Implementation



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.

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.



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


Actual Acquisition Price (AAP)




Average Manufacturer's Price (AMP)






Reimbursement: Average Wholesale Price + Discount




Retail or Usual & Customary Price (U & C)


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. 

Maureen Bailey "Silent Epidemic" (volume 5, issue 2), "Nudging Temptation Aside: Behavioral Economics and Diabetes" (volume 5, issue 5)

Ms. Bailey is the author of the forthcoming book "The Diabetic Diva", a cookbook for diabetics with a foreword by Ron Rosedale, MD.  Dr. Rosedale developed a nutritional protocol that has helped thousands of people reverse type 2 diabetes.  Her work has also appeared in Barron's and The Economist. Read more about Maureen.

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.

Steve Hyde "Personal Choice and Breast Cancer Screening" (volume 5, issue 12)

Mr. Hyde is the author two books: most recently, “Cured! An Insider's Handbook for Health Care Reform” (June 2009, Hobnob Publishing; read review) and, previously, “Prescription Drugs for Half Price or Less,” (2006, Bantam-Dell Division of Random House).  He has been a public company CEO and chairman or board member of numerous companies.  The former federal chief HMO financial regulator and a certified actuary, he started and grew Peak Health Care, Inc., into a highly successful public managed care company, recognized by Business Week Magazine as one of America’s Best Small Companies.  He has extensive experience in managed care operations and strategy, health insurance, managed care regulation, consumer-driven health care, pharmacy benefits, disease management, medical information technology, medical group management, medical network and PPO operations, health benefit design & pricing, health insurance underwriting, community rating, and health service product development and marketing.   Steve is CEO of Hyde Rx Services Corp., a health care management consultancy. Read more about Steve.

Wolfgang Klietmann, MD "Understanding H1N1 as a Pandemic Threat and Public Health Service Challenge" (volume 5, issue 11)

Dr. Klietmann is a clinical pathologist and medical microbiologist and serves at Harvard Medical School faculty as an appointed Lecturer on Pathology.  Prior to his immigration to the United States in 1992, Klietmann founded and was president and physician-in-chief of a major Institute of Laboratory Medicine in Germany which he built into a peerless institution in its scientific standing and innovative diagnostic reputation among private laboratories in Germany.  A prolific author and guest lecturer with over 200 publications and presentations delivered to audiences across the globe, the cornerstone of Klietmann’s career has centered on infectious diseases and bringing together individuals and organizations to share information, technology and resources. His work in biodefense includes a collaboration with MIT in a project for the Department of Defense. He serves as president on the board of directors of the Harvard Business School Health Industry Alumni Association and organized as co-chairman several major conferences held on the campus of Harvard Business School. His memberships in several scientific societies include a fellow of the College of American Pathologists. Read more about Wolfgang.

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

Dr. McNulty is co-founder and chief clinical officer of NovoLogix, Inc, a performance-based health care technology company delivering electronic claims re-pricing processes, prior authorization controls, and integrated patient care and pharmaceutical programs. His expertise includes medication adherence and compliance. Tom is a frequent speaker at industry events and conferences. Read more about Tom.

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

Dr. Nair is an associate professor in the department of clinical pharmacy at the University of Colorado (Denver) School of Pharmacy.  Her current area of research involves pharmacy benefit design in managed care and retail pharmacy including the structure, pricing and reimbursement of medications, factors affecting the reimbursement of medication in retail pharmacy, willingness to pay for retail pharmacists services and consumer attitudes regarding their pharmacy benefit plans and the impact of multi-tiered reimbursement mechanisms on medication utilization.  She is currrently working with Anthem Blue Cross Blue Shield of Colorado to examine the impact of two and three tier co-pay pharmacy benefit plans on the drug utilization patterns of a commercially insured population and a Medicare managed care population.  She is also working with various Pharmacy Benefit Managers to examine the impact of converting prescription Claritin to an over-the-counter status on medication utilization and reimbursement mechanisms. Read more about Kavita.

Susan Pantely "Benefit Design Strategies and Oral Anticancer Medications" (volume 6, issue 1)

Ms. Pantely is a principal and consulting actuary with Milliman.  She works with a broad range of clients, including Blue Cross/Blue Shield plans, HMOs, commercial insurers, government agencies and healthcare providers. Her work includes rate development, provider contract review, reserve certification, capitation development, Medicare risk feasibility studies, HMO start-ups, HMO due diligence, and development of risk sharing and reimbursement arrangements for physician groups, PHOs, and other integrated delivery systems.  In addition, Susan has extensive experience with the valuation, financial analysis, and projection of healthcare services for several state public health insurance (Medicaid) programs. Read more about Susan.

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

Mr. Rose is CEO of Vitality, inc. a company focused on connected-health devices and services. He teaches at the MIT Media Lab and speaks frequently on design and product innovation at conferences and corporate retreats. Previously, he was founder and CEO of Ambient Devices where he pioneered embedding Internet information in everyday objects like umbrellas, light bulbs, bathroom mirrors, and refrigerator doors, to make the physical environment an interface to digital information. Read more about David.

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

Dr. Rowley is a family practice physician and Practice Fusion’s Chief Medical Officer. Dr. Rowley has a first-hand perspective on the technology needs and challenges faced by healthcare practitioners from his 30 year career in the sector, including experience as a Medical Director with Hill Physicians Medical Group and as a developer of the early EMR system Medical ChartWizard. His family practice in Hayward , CA has functioned without paper charts since 2002. Read more about Robert.

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.

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

: 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.

: 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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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.

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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.

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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.

Essential Discussions

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.

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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.


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 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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