Data Knows Best - WI Health Plans...KAUFMAN: Wisconsin Assoc Health Plans 091815 (DKB0908) 9/15/2015 Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 1 Data Knows Best Striving
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KAUFMAN: Wisconsin Assoc Health Plans 091815 (DKB0908)
9/15/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 1
Data Knows BestStriving to be Differently Better
Nathan Kaufman, Managing DirectorKaufman Strategic Advisors, LLC11440 West Bernardo Ct., Suite 155San Diego, CA 92127(858) [email protected]
Kaufman Strategic Advisors, LLCEvidence Based Consulting
Strategy Requires a Point of View (POV) Regarding Market Pace and Organizational Competencies
What will the local market look like in five years?‒ Show me the evidence!
What competencies do you need to succeed?‒ Do you possess them?‒ Realistically can you develop them?
What is the industry’s conventional wisdom, have we seen this movie before – how did it end?
“Investors Struggle to Evaluate
Population Health Strategies.”
~H&HN Daily, 05.28.15 by James M. Molloy
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Are the physicians on board?
What are the financial implications (w/o heroics)?
KAUFMAN: Wisconsin Assoc Health Plans 091815 (DKB0908)
9/15/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 4
Unsustainable Economic Trends in Government Spending
“Bundled payments, ACOs, and medical homes can reduce cost levels but not the overall growth rate... Medicare spending will grow faster than projected and
Medicaid spending will double to almost $919 billion in 2023 from $450 billion in 2013. (58% Mg care) ~CMS
grow faster than projected ...and Congress won’t be able to avoid changing course.” (31% MA)
~Richard S. Foster, Chief Actuary for CMS (Ret.) February 28, 2012
7Altarum’s Triangle of Painful Choiceshttp://www.youtube.com/watch?v=QrPaJBh01sE
Segmentation and Focus are Essential(skate to where the money is)
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Courtesy of Brian Silverstein MD
Conclusion: Chronically ill patients whose primary care providers offer highly fragmented care more often experience lapses in care quality and incur greater healthcare costs.Am J Manag Care. 2015;21(5):355-362 - See more at: http://www.ajmc.com/journals/issue/2015/2015-vol21-n5/Care-Fragmentation-Quality-Costs-Among-Chronically-Ill-Patients#sthash.qtsMmUKF.dpuf
KAUFMAN: Wisconsin Assoc Health Plans 091815 (DKB0908)
9/15/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 14
Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis- IOM 2013
Findings point out a majorout a major quality issue for cancer patients who have no way of knowing how much their doctors' financial incentives i fl th i
‘A’ Rating Leapfrog‘5 Star’ Medicare Advantage‘5 Star’ Medical Groups (CA)‘5 Star’ Health Plans (CA) Competing
Self Interests
Value FFS
5 Star Health Plans (CA)Top MA Plans – NCQAJD Powers Best Patient Sat.
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• Organized broad geographic network• Transparent actionable analytics• Compliance w/ hundreds of clinical guidelines• Focus on team care & collective performance• Interconnected EHR• Full acute care continuum• Integrated health plan, physicians and hospitals
• Limited geographic network• Culture of optionality/autonomy/silos• Patients fend for themselves• Focus on individual compensation• Traditional medical staff-hospital disputes
over authority and money• Incomplete continuum of care
“Changing the payment system probably isn't enough to ensure that patient care will improve.”Effects of Alternative Payment on Physician Practices In the US, Rand Corporation, AMA, 3/19/15
Alternative payment models are increasing physician Alternative payment models are increasing physician workload but not income
Alternative payment models haven’t substantially changed the way physicians deliver care
Operational problems in new payment programs are frustrating the physician-participants impacting theirfrustrating the physician participants impacting their enthusiasm
Henry Ford being reviewed for credit downgrade ~MHC May 9, 2014
S&P downgraded CHI’s ratings after CHI lost $641 million for fiscal 2014 on $13.9 billion in revenue (1,500 layoffs) – Healthcare Finance 12/17/14
Partners HealthCare reported a $22 million loss on $11 Partners HealthCare reported a $22 million loss on $11 billion in revenue mainly due to their health plan which lost $110 million –Boston Globe 12/14/14
KAUFMAN: Wisconsin Assoc Health Plans 091815 (DKB0908)
9/15/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 22
You Don’t Have to Agree with My POV
“The housing boom is soon to go bust. And it“Nate, Stop! soon to go bust. And it will affect everyone…”
~Gary Shilling, ForbesOctober 14, 2002
“All the doom and gloom forecasts are not only irresponsible but are downright wrong.”
~David Lereah
, pTake a look at what you have become.Look in the mirror, look hard,You are a real downer.Get a grip, rise above the hate!Really. Man up, money to be made.”
Catch Your Confirmation Bias“People can foresee the future only when it coincides with their own wishes. The most grossly obvious facts can be ignored when they g yare unwelcome.” ~George Orwell, 1945
“It is difficult to get a man to understand something, when his salary depends on