Rt li H lthRetooling Health Care: When Resistance is Futile 111115 Kaufman.pdfRt li H lthRetooling Health Care: When Resistance is Futile Data Knows Best – It Will Bring You to Tiers!
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KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 1
R t li H lth CRetooling Health Care: When Resistance is Futile
Data Knows Best – It Will Bring You to Tiers! Nathan Kaufman, Managing DirectorKaufman Strategic Advisors, LLC11440 West Bernardo Ct., Suite 155San Diego, CA 92127(858) [email protected]
Kaufman Strategic Advisors, LLCEvidence Based Consulting
New Provider-base Plans:• CHI loses $23.7M on $377M • LIJ loses $12.4M• Piedmont/Wellstar exits Medicare Advantage• ~MHC 9/28/15
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 4
The “Doctor’s Dilemma”
What’s with all this doom and gloom? Right now, I f l t!
If you don’tchange your
lifestyle, there will bfeel great! be consequences.
Dr. Eric WestmanKetogenic Diet
"The combination of high caloric intake, obesity and lack of physical activity will surpass tobacco as the leading cause of cancer death within the next two decades.”
No Regret Expectation: High Rates Driven by Market Power Will Rationalize Over Time
Net Payment per Episode
Hi R l t S (M )
• 70+% Institutional
• Researchers atHip Replacement Surgery (Mass):• $17,910 to $73,9871
Angioplasty (Chicago):• $15,951 to $49,6042
Mammogram (Dallas):• $150 to $1 0453
Researchers at Massachusetts General Hospital found a mistake or adverse event occurred during one out of every two surgeries and in five percent of drug
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• $150 to $1,0453
1 California Healthline, January 22, 20152 Modern Healthcare, July 20 20153 Castlight
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 8
n8’s Observations About Population Health and Other Related Topics
▪ Population health is a model for delivering care - it has nothing to do with economics.
▪ Every hospital has been subjected to risk and bundled payments▪ Every hospital has been subjected to risk and bundled payments since the 90’s -- most have underperformed
▪ Provider systems must manage to the probable future payment models i.e., Performance Risk NOT Actuarial Risk
▪ Effective management of a multi-facility system is a rare competency -- The farther you are away from the bedside the easier it is to create your own reality
▪ Those who deemphasize the importance of specialists will fail to▪ Those who deemphasize the importance of specialists will fail to impact cost and quality (i.e., value)
▪ Organizations are NOT strategies – A strategy is a series of choices that create measurably, differently better long term VALUE for your customers – rewarded with market share and profits
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 11
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
21Altarum’s Triangle of Painful Choiceshttp://www.youtube.com/watch?v=QrPaJBh01sE
Insurance to ReinsurancePremium: $12,000Deductible: $2000/$4,000 (repriced)Co-pay: 30%
Strategy Requires Leaders to Adopt a Point of View (POV) Re: the Market
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 14
The Emergence of More Government Scrutiny – New Focus on Physicians
The OIG states that physicians who enter into “compensation arrangements such as medical directorships must ensure that those arrangements reflect fair market value for bona fide services the physicians actually provide.”
“Georgia system to pay up to $35M (MD to pay $425K) for paying
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g y p y p $ ( p y $ ) p y ga physician excess salary, directorship, up-coding and self-referral.” ~MHC 9/5/15
associated bloodstream infection measure, the catheter associated urinary tract infection measure, the surgical site infection strata, and the AHRQ PSI-90 Composite)
25 percent: Efficiency (Medicare Spending per Beneficiary measure)
Hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and Clostridium difficile infection.
Clinical Care - Process measure: early elective deliveries (PC-01)
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 18
Whoops!
ACO: A Lemming Strategy?
Few ACOs Earned Bonuses:ACO Results in CA:
“The financial results came as a disappointmentbut we were not surprised.”
~National Association of ACOs (NAACOS)
“The progress toward cost stabilization through ACO contracts from Medicare and commercial PPO has been modest at best.” “Medicare Yet To Save Money
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been modest at best.
~Accountable Care in California: Imperatives and Challenges of Physician –Hospital Alignment, James Robinson Ph.D, Integrated Healthcare Assn May 2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 20
Rate the Functionality of Your Delivery Network
CCSIA Coalition of
Competing
CA Kaiser Permanente
‘A’ Rating Leapfrog‘5 Star’ Medicare Advantage‘5 Star’ Medical Groups (CA)‘5 Star’ Health Plans (CA)19 Minute ED Wait in Sacramento Competing
Self Interests
Value FFS
JD 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
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 billion in revenue mainly due to their health plan which lost $110 million ~Boston Globe 12/14/14
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 28
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.”