rt li h lthretooling health care: when resistance is futile 111115 kaufman.pdfrt li h lthretooling...
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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
It’s Raining Acronyms - Hallelujah
“ Never ask a barber if you need a haircut!”
~Warren BuffetWarren Buffet
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“… the shift is occurring much slower than the hype….”
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 2
The “Black Swans”
CT St t H it l d ASC T ill t
What is the most significant current event in healthcare?
CT State Hospital and ASC Tax will cost hospitals $315M + $130M Medicaid Cuts.
A bottle of 500 doxycycline rose from $20 in October
Section 603, 2015 Budget Act: New off-campus outpatient services will not qualify as an HOPD
3© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
A bottle of 500 doxycycline rose from $20 in October 2013 to $1,849 in April 2014. ~NYT October 7 2014
Adventist Health to pay $118.7 million settlement over Stark, False Claims allegations.
Healthcare Policy Predications and Financial Forecasting
Where the Rubber Meets the Sky*
“Th M j B fi f Fi i l F i I
Where the Rubber Meets the Sky
ACOBundling OWA
• 45% MSSP ACOs cost Medicare more, 18% profitable• 45% Pioneers Dropped Out (HHS says Success!)• 9 Co-Ops have gone out of business• A’s: TSA, VA, ACO
4
“The Major Benefit of Financial Forecasting Is That It Makes Astrology Look Respectable.”
~John Kenneth Galbraith
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved * 1) http://healthaffairs.org/blog/2015/06/19/medicares-rush-to-risk-confounding-theory-and-practice-leaving-acos-vulnerable/ 2) http://healthaffairs.org/blog/2015/06/18/pioneer-acos-anatomy-of-a-victory/3) http://content.healthaffairs.org/content/34/3/371.abstract
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 3
Strategy orLemming Syndrome?
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Adjacency: The Trap of False Enthusiasm
Adjacency: The belief that an organization can sustain growth bysustain growth by entering into a market adjacent to it’s core business.
Failure Rate: 75%(Bain Analysis of 1,850 companies)
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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.”
Oti B l MD CMO ACS
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~Otis Brawley MD CMO ACS
“A tragedy resulting from the d l ti f h d fi it
Tragedy of the Commons:The Fundamental Flaw in the ACA
Who Will Volunteer for a Reduction in Income depletion of a shared finite resource
by individuals, acting independently and rationally according to each one's self-interest.”
a Reduction in Income• Pharma• Insurance Companies• Government• Health Systems• Suppliers• Physicians• Consultants & Lawyers• Employers
Garrett Hardin
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Employers• Healthcare Workers• Unions• IT Companies• Patients
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 5
Supply Costs
A Health System’s “Circle of Life”: Access to Capital
Providing Value to Patients and Stabilizing
Physician Compensation Requires the
Negotiated Rates,
Government Reimbursement
& Volume
ROI on Physician Investment
q
Ability to Borrow
Revenue –Expenses
= Cash
Bond Rating:
Access to Capital (Credit Score)
Personnel
Costs
Capital SpendingService &
Access
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Per Physician Investment:
2004: $58,0002013: $176,000
~HFMA 12/8/14
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
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
administrations
Evaluation of Perioperative Medication Errors andAdverse Drug Events Anesthesiology Oct. 2015
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 6
Strategy Requires a Point of View (POV) Regarding Market Pace and Organizational Competencies
What will the local market look like in five years?
What competencies do I need to succeed in the future? What competencies do I need to succeed in the future? Realistically can I develop them?
What is the industry’s conventional wisdom, have we seen this movie before – how did it end?
What are the financial implications (w/o heroics)?
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Do the practicing physicians have a common understanding and commitment to ‘population health?’
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
Population Health d V land Value
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 7
Same Delivery Model?
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Designing an Optimal Delivery System for a Sub-Population
▪ Virtual
▪ Wearables and Implantables
▪ Primary Care MD Office
▪ Specialty MD Office
The Old Continuum of Care The New Continuum of Care
▪ Kiosk
▪ Pharmacy/Minute Clinic
▪ Primary care MD & NP office
▪ Specialty MD & PA office
▪ Hospitalists
▪ Ambulatory Ancillaries
▪ Specialty MD Office
▪ Ambulatory Ancillaries
▪ Urgent Care
▪ Hospital/ED
▪ SNFy
▪ Satellite ED
▪ Hospital/ED
▪ SNF
▪ Hospice 14© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
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
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved 15
Value= Benefit/Price(Differently better in the eyes of the customer)
Brand
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KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 9
The Consolidated “80 Percenters” : 1) Essential to Value, 2) Likely to Demand Fee For Service, 3) May
Not Participate At AllHospital‐Based Phys.
New Delivery Models
Oncologists
ModelsCardiologists
Gastroenterologists
All Other Surgeons
Neurosurgeons
Orthopedic SurgeonsPCP
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The Driver’s Test on the Road to Actuarial Risk
Inpatients
OutpatientsOutpatients
Office-based
Employees
High Risk
A+
Global Risk
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B+
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 10
Is Wellness a Key Component of Population Health?
Industry Consensus: Wellness centers will become money-makers under population Health
Empirical Research: “Wellness and weight loss programs aren’t saving money, reducing disease burden or helping people slim down.”
~Khanna, & Montrose American Journal of Managed Care 2/19/15
~Healthcare Finance 8/15/15
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“…wellness programs are having little if any immediate effects on the amount employers spend on health care.”
~Rand Corporation – based on 600,000 employee/7 employers and 10 year data from Fortune 100
18.1% GDP
Post ACA Annual Growth in Healthcare Spending
Anecdotes are NOT Evidence
ACA Exchangesg ACOs Minute Clinics PCMH Bundled Payments Value-based Care Wellness
2020
Clinical Integration Population Health
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
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
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
Commercial Coverage: The Math Does NOT Work
$51,000
“28.2% of insured adults have unmet needs due to
22© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
affordability – prefer skipping care vs. shopping.”
~Healthexec Mobile 10/6/2015 Modern Healthcare 10/16/2015
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 12
The New Regulations Impacting the Commercial Insurance Industry will Eventually Impact Providers
Premium Caps, Transparency, Aging Cadillac Tax & Medicaid Expansion
POV: Lower
Revenue Growth Health
Plan Profits
$
Premiums
23
Benefits
Standard Benefits & Universal Coverage © Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
Bureau of Labor StatisticsProducer Price Index: Hospital Component
Percent Change in Hospital Producer Price Index
3%
4%
5.8%
4.9%
3.8%4.4%
3.5%3.0% 3.0% 3.0%
2.1%2.5%
2.2%
1.3%2%
3%
4%
5%
6%
7%
24
0%
1%
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 13
Volume to Value?
Pay for Conformance
Regional Market Power NOT VALUE is Driving
Payment Rates and Profitability
25
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
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
27
g y p y p $ ( p y $ ) p y ga physician excess salary, directorship, up-coding and self-referral.” ~MHC 9/5/15
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
“Broward County Hospital will pay the government $69.5 million to settle allegations that it illegally paid nine doctors for referrals.” ~MHC 9/15/15
Negotiated Rates: Colonoscopy
The Emergence of Price Transparency and Channeling
Negotiated Rates: Colonoscopy
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KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 15
The Emergence of VirtualHealthcare
29
Mass General Pilots Cardiology E-Consults Published: Jun 8, 2015 Medpage Today
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
Telehealth Users*
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved 30*American Well
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 16
The Emergence of New Health Benefit Design
Domestic Medical Tourism,
Tiered NetworksTier 1 - Preferred: Members pay the lowest cost shareTier 2 - Enhanced: Members pay a higher cost share Tier 3 - Standard: Members pay highest cost share
Direct Contracting, Narrow Networks & Balanced Billing:
300% of Medicare
Private Exchanges (Expedia)Rapid adoption of
Transparency, High Deductibles, Reference Pricing
Deselection of Providers
Domestic Medical Tourism, & Bundled Payments
for Elective Centers of Excellence
Single Payer
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Provider-Based Health Plans andCommercial Capitation (Risk)
Rapid adoption of “Population Health”Medicare and Medicaid
Increase in “Value“Value--based based Payments”Payments” Moving to Risk!
Comprehensive Care for Joint Replacement Model Announced
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
Brought to You by United Healthcare
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KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 17
Brought to You by United Healthcare
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Ever Increasing Percentage of Medicare Payments Tied to “Value”
Hospital Name
FY 2015 Estimated
ReadmissionsPenalty
FY 2015 ReadmissionsNet Revenue
Change
FY 2015 Final VBP
Adj. Factor
FY 2015 Estimated VBP
Incentive Payment
FY 2015 VBP Net Revenue
Change
FY 2015 Total P4P Impact
Inc. HAC
FY 2015 % P4P Impact
INOVA FAIRFAX HOSP ($39,645.56) -0.02% 0.9922 ($1,034,238.40) -0.51% ($3,072,601.62) -1.53%
VIRGINIAVIRGINIA HOSP CTR ($150,114.24) -0.18% 1.0069 $434,097.47 0.51% $283,983.23 0.34%
NORTH SHORE UNIV HOSP ($937,785.76) -0.37% 0.9993 ($117,815.36) -0.05% ($3,613,223.42) -1.41%
YALE-NEW HAVEN HOSP ($1,728,414.67) -0.41% 0.9961 ($945,908.23) -0.22% ($6,889,715.58) -1.62%
10 percent: Clinical process of care 25 percent: Patient experience of care (HCAHPS survey) 40 percent: Outcome (hospital mortality measures for acute
myocardial infarction, heart failure, and pneumonia, the central line-associated bloodstream infection measure the catheter associated
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
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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
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
Medicare Yet To Save Money Through Heralded [ACO] Medical Payment Model”
~Kaiser Health NewsBy Jordan Rau and Jenny Gold September 14, 2015
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 19
Strategy Requires Strategy Requires Leaders to Adopt a Point of View (POV) Re: Organizational CompetenciesAre you a value-based network?
The Value-based Network Test
A 2011 Stent Procedures• 50% appropriate, • 38% uncertain
If I had to reduce my message for achieving excellence to just a few
• 12% inappropriate~American College of Cardiology
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How many different sets of
orders?
words, I'd say: it all has to do with reducing variation.”
~W.E Deming
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
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
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
Who is Getting Medicare Advantage Right?
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~NCQA
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 21
The “Value Proposition" of a Traditional Health System
Your care will be noYour care will be no worse than that
provided by our least competent physician!*
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*And we cannot guarantee that your care will be appropriate, efficient, state-of-the-art or meet the highest professional standards.
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
The “Value Proposition” for Future Success
A Value-based Network (VBN) of providers that consistently delivers:y
‒ Superior service‒ Predictable reasonable cost per episode
and‒ Appropriate, accessible, standard care
b d th b t i i di i
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based on the best science in medicine
VBNs are well-positioned for every payment methodologyif they are geographically indispensable
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 22
43© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
It Takes More Than Scale
Henry Ford being reviewed for credit downgrade
MHC M 9 2014~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 billion in revenue mainly due to their health plan which lost $110 million ~Boston Globe 12/14/14
44© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 23
Creating a Value-based D li N t kDelivery NetworkWhat’s the plan? How will you be differently better????
Most Health Systems Have the Same Strategic Plan
Optimize commercial rates
Clinically integrate with employed and independent physicians
Extensive use of protocols, EHR/IT to coordinate care Breakeven on p ,Medicare
Broad rational geographic coverage with a sufficient supply of primary care physicians and specialists
Shared savings relationships with payers
Benchmark financial performance
Top tier quality and patient safetyp q y p y
Service line strategies to drive revenue growth
Highly engaged employees
Operate as a high functioning health system with attractive, modern facilities
46© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 24
Physicians are Seeking Shelter from the Storm
• ICD 10• Regulation• Cyber Security• Deductibles• MGMA-wRVU
47
2014 Medicare Trustees Report, AMA
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
Finding the “Magic” in Physician Employment
"A system will not manage itself. Left to themselves,
CONSOLIDATION & DEEP MANAGEMENTtse e t to t e se es,
components become selfish, competitive, independent profit centers, and thus destroy the system.” ~W E Deming
Central, shared governance Compact: gives and asks Physician hierarchy w/performance
evaluation and routine reports Consolidation of offices. Common name & standard office systems Standard use of clinical guidelines
“The problem is management..It is management's job to direct the efforts of all
48
Referral management Blended comp. plan
direct the efforts of all components toward the aim of the system.”
~W E Deming
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 25
Strategic End Game■ You can demonstrate superior value PER EPISODE which attracts contracts
and market share (try to avoid per unit price reductions)
‒ Mechanism to rapidly implement appropriate care/optimal outcomes‒ Significant decline in employee health plan costs
Bonuses from Medicare and other value-based payment plans‒ Bonuses from Medicare and other value-based payment plans
■ You are geographically indispensable – in control of care delivery/payment
■ Multiple “Centers of Excellence” able to win competitive bids based on
quality and cost
‒ “If you are what you do but you don’t document it then you are not”
■ Payors seek out your network for collaborations e.g., for Medicare
49
Advantage, Tiered Networks etc.
■ ROI from investment in employed and contracted physicians
■ Capacity and services are consolidated and your portfolio of facilities is rationalized
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
Behavior Change Requires a Compelling Reason to Leave Your Comfort Zone
Suits
MAKE IT EASY:MINIMAL WORKFLOW CHANGE
INCREMENTAL RESULTS LEAD TO CREDIBILITY
StatusQuo
ValueNetwork
Suits
Medical Staff
50
Data & Peer Leadership
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 26
Then a Miracle Occurs:Leadership, Trust, Shared Vision
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Global Compliance With Standard Work Attracts Payer Collaboration
MHMD Physician Board of Directors
Clinical Programs Committee
H&V
Cardiology
CV Surgery
Neuro
Neurology
Neurosurgery
Woman/Child
Neonatal
OB/Gyn
Surgery
Anesthesia
Bariatrics
Medicine
Critical Care
Emergency
Oncology
Oncology
Contract
Imaging
Pathology
PCP
Peds
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CV Surgery Neurosurgery OB/Gyn Bariatrics
Orthopedics
ENT
Emergency
Ad hoc
Hospital Medicine
Pathology
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 27
22 Hours of Mandatory In-service
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved 53
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KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
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.”
From an SVP @ FP Hospital Company 4/2014
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David LereahChief Economist of NAR (2005)
From an SVP @ FP Hospital Company 4/2014
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
Healthcare Strategy is All About the Bear Story
That’s OK. I I don’t
think we t just need to
outrun you!can outrun the bear!
Value-based Healthcare
56© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved
KAUFMAN: Indiana 111115 VAv3 (DKB1030) 11/3/2015
Prepared by Nathan Kaufman, Kaufman Strategic Advisors, LLC 29
Rules of the Road To Value■ Healthcare is local
■ Develop tools to accurately measure and optimize appropriateness, outcomes, service, access and cost
■ Avoid the ‘lemming syndrome,’ rely on data not anecdotes
■ Don’t get ahead of your competencies
■ Eliminate waste (cost per episode)
■ Avoid using heroic assumptions
■ Explore opportunities to partner in the MA space
■ Measure success in terms of market share and profitability
■ Ensure that you are geographically indispensable
■ Don’t trade deep discounts for the promise of increasing market share
■ Organizations, consultants and buzzwords do not create value… value creation primarily requires physician leaders and their followers
© Kaufman Strategic Advisors, LLC 2015 ~ All Rights Reserved 57
Focus on the Cost of Everything!
We have heard the bed rental f
Norfolk Southern Railroad:2014 Net Income: $1.99 B
prediction before!
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