the future of the healthcare marketplace: what’s … · kaiser has doubled its medicaid...

THE FUTURE OF THE HEALTHCARE MARKETPLACE:WHAT’S NEXT?

Ian Morrison PhD

Outline

Looking back at the IHA

IHA Roles

Looking Ahead Political and Policy Uncertainty and Disruption

Scale, Consolidation and Disruption

Employers on the Edge

Consumerism

The End Game

No Matter What

What does it Mean for IHA

IHA Founding Retreat 1994

A group of senior executives from across the California Healthcare system gathered in Napa for a retreat to discuss the creation of a new organization called the Integrated Healthcare Association

Ian Morrison and colleagues from the Institute for the Future facilitated the retreat

The first day of discussion was lively and frank but involved a good deal of finger pointing and was not going that well

The Vision Statement Breakthrough

IHA Proposed Founding Mission Statement

To violently agree on the limited areas of overlap in self interest of our deeply divided membership……

And to keep an eye on the other guys….

So they don’t pull a fast one

IHA Early Days: The IHA DNA

A coalition of the willing who believed in managed care, capitation, integration, delegated risk, primary care, and standardizing approaches to measuring, improving, and advancing the quality and affordability of healthcare for All Californians

IHA Key Roles

Convener

Neutral Truth Teller

Champion of Standards Measurement

P4P

Clinical performance improvement

Force for Value

Atlas as Value Dashboard

Across All Models

Based on data

What the System Needs

Big Tent- All Models and All Payers

Standards

Simplicity

Reduction of Waste Clinical

Administrative

Variation Reduction

Reward Higher Performance but bring everyone up to higher standards

Improve the value of care delivery

Obstacles and Barriers

Political and Policy Uncertainty

Forces of Disruption

Value Fatigue

Recession

Fiscal Meltdown

Employers Self Insured

Institutional Inertia

Geographic variation and Terroir

Three Payers

Three Payers

But ultimately it all comes from households whether as taxes, foregone income at work, or directly as out of pocket costs and premiums paid by consumers

Business Government Households

How Americans Get Health Insurance, 2017

• ACA has impacted a small portion of the insurance market relative to how it is covered in the public debates on health care

• Medicaid is now the largest public insurance program and covers many of the neediest beneficiaries as well as expansion populations

• Medicare is highly valued and Medicare Advantage grows

• Employer-Sponsored health insurance for most Americans and it is the financial lifeblood of the delivery system

Expansion states with Republican governors outnumber

expansion states with Democratic governors, May 2018

WY

WI

WV◊

WA

VA^

VT

UT

TX

TN

SD

SC

RI

PA

OR

OK

OH

ND

NC

NY

NM

NJ

NH*

NVNE

MT*

MO

MS

MN

MI*

MA

MD

ME^

LA

KY*KS

IA*

IN*IL

ID

HI

GA

FL

DC

DE

CT

COCA

AR*AZ*

AK

AL

Independent Governor

(1 State)

States That Have Not Adopted

Expansion (17 States)

Republican Governor

(17 States)

Democratic Governor

(15 States + DC)

NOTES: Coverage under the Medicaid expansion became effective January 1, 2014 in all but eight expansion states: MI (4/1/2014),

NH (8/15/2014), PA (1/1/2015), IN (2/1/2015), AK (9/1/2015), MT (1/1/2016), LA (7/1/2016), ME (TBD) and VA (TBD). Eight states

that have Republican governors as of January 2018 originally implemented expansion under Democratic governors (AR, IL, KY,

MA, MD, NH, VT, WV), and two states have Democratic governors but originally implemented expansion under Republican

governors (NJ, PA). *AR, AZ, IA, IN, KY, MI, MT, and NH have approved Section 1115 expansion waivers. ^Expansion is adopted

but not yet implemented in ME and VA. ◊The WV governor switched parties from Democrat to Republican in August 2017.

REPEAL AND REPLACE IS LIKE BREAKING UP THE BEATLES: JUST KEEP GEORGE AND RINGO AND EXPECT IT TO SOUND GOOD

Subsidies to Medicaid and Exchanges

Guaranteed Issuance

Taxes and Fees RaisedMandates

Stay on Parents Plan

”All you are left with is Ringo” Chris Jennings“Republican policies are ideologically coherent, they just aren’t actuarially coherent.” Ian Morrison

IDEOLOGICAL REPEAL AND REPLACE

TOP STATES IN 2018 EXCHANGE ENROLLMENT

STATE ENROLLMENT (000)

FLORIDA 1,760

CALIFORNIA 1,401

TEXAS 1,227

NORTH CAROLINA 549

GEORGIA 493

PENNSYLVANIA 426

VIRGINIA 410

MICHIGAN 321

NEW JERSEY 295

MASSACHUSETTS 238

MO, WI, NY, OH 238-242

• Use Executive Orders– Association Health Plans– “Across State Lines”– Essential Benefits Erosion

• Cut CSRs (maybe we don’t want them back)• Zero out the individual mandate fine for 2019 and beyond • Cut Medicare and Medicaid Budgets• Give back Obamacare Taxes to rich people in Tax Reform• Don’t enforce the Law• “The Secretary shall”…..Maybe Not• Waiver Authority to states

– Fees for Medicaid– Work Requirements– Short term plans– Essential Benefits/Life time Caps?

• New DHHS Head • Position this as Repeal and Replace, short term• Go for Block Grants long term• Irony: 2018 Signups went well 12.2 million and 80% can

get plans for less than $75 per month, 11 million will effectuate

Sources: Charles Gaba ACA Signups, @Aslavitt, Leavitt Partners

CALIFORNIA CONTEXT

A quarter of all newly insured in the US are Californians California received $20+ billion per year of net new federal money ($15

billion for Medicaid expansion, $5 billion in exchange subsidies) these numbers are growing each year

Roughly a third of Californians are on Medi-Cal (40% in LA County, over 50% in much of the Central Valley)

California has maxed out Medicaid matching dollars using provider taxes and waivers

Currently 65% of Medicaid is paid by the Federal government (historically that was less than 50%)

California has about the lowest rate of provider reimbursement for Medicaid

Kaiser has doubled its Medicaid enrollment program wide since 2013 to 942,000 (up from 377,000 to 709,000 in California alone)

In California 40% price differential North to South on commercial rates HMO higher performing on Value than PPO Medical groups are key to value Covered California is the highest functioning exchange in the country, but

dependent on the flow of federal dollars for subsidies

Sources: KFF, CHCF, Covered California 2017, Kaiser Permanente

California Context

Signals…What Has Changed Since 2017?

• Red signals - repeal and replace failed legislatively, so the ACA lives on (for now)

• Blue signals – the electorate is looking bluer for 2018, with both houses of Congress at least possible to flip, rates will rise as much as 20+% in exchanges (on average 15%)

• Purple signals – conservative states starting to chart a course toward Medicaid expansion

• “Wonk world” is losing interest in value payment – getting impatient to see results, and federal government had put on the brakes (now back on the gas, details TBD)

• Not much pay off on costs and quality from payment reform, ACOs, EHRs etc

• Major disruptive mergers announced, but not much detail on what they will do and how

• POTUS continues to put pressure on drug pricing

• Employers continue to downgrade quality/cost of benefits, and shrink the eligibility pool despite hot economy

• Consolidation has not produced much in the way of savings – diseconomies of scale in research and care delivery

• Status quo is becoming more uncomfortable – costs are still high, but we cut tax revenue while creating conditions that will increase federal spending (i.e.: Medicaid expansion)

2018 Leavitt Partners Annual Strategy Conference

MO

RE

LESS

What is the level and intensity of

our commitment

to VALUEin health care?

2

How much is the COSTof health care creating

backlash among consumers and payers?

3

MORE GOV’T LESS GOV’T

How will we ensure universal ACCESSto insurance?

1SCENARIOS:

Maryland-ish for All

Integrated Value

Market Principles

ACA Lives On

The Scenarios “US Health Care In Mid-2022”


Scenarios, 2017-2022

Divided government returns, but minor “repairs” to ACA fall short. Moderate to high variation across States, with waivers

encouraging conservative principles in marketplaces and Medicaid.

Political rebound of “blue wave” elections drives partisan solution -cost control emerges as driving force, and administered pricing becomes the vehicle with a strong guiding hand from Washington.

Retain Republican leadership and vision of removing ACA

underpinnings, plus significant Medicare/Medicaid cut back; more

consumer shopping – less volume but more profit.

Triumph of the moderates - declare value to be the currency of health care, with bipartisan public investment to bolster faster

move to value in private sector, accelerate IT standards, empower physicians.

Maryland-ish for All

Integrated Value

ACA Lives On

Market Principles


HIP Surveys: Overall, how well does your health insurance plan meet your family's health needs?

1% 2% 3% 1% 1% 1% 1% 3% 6% 4%4% 8% 5% 5% 6% 7% 7% 8% 15% 13%

23%

35%30%

25%36% 32% 28%

38%

35% 42%

38%

35%39% 46% 30% 32%

30%

34% 31% 32%

34%20% 23% 23% 28% 29% 34%

17% 13% 9%

Total 2017(n = 4665)

Total 2018(n = 4419)

OriginalMedicare(n = 646)

MedicareAdvantage(n = 324)

MedicaidMCO

(n = 145)

RegularMedicaid(n = 420)

TRICARE/VA(n = 96)

EmployerSponsored(n = 2228)

Governmentexchange(n = 303)

Individual(n = 160)

Extremely well

Very well

Somewhat well

Not very well

Not at all

KEY TAKE AWAYOverall Americans are feeling less secure with their insurance, across all insurance types.

Total Insured 2017-2018 By Insurance Type (2018)


Employers Now Pay Just 56% Of Expected Employee Medical Costs (Family Policy)

$15,788$7,674

$4,704

Relative Proportion Of 2018 Medical Costs

EmployerContribution

EmployeeContribution

Employee OOP

SOURCE: Milliman Medical Index 2018

Among those with Employer based insurance…

20% ↓

40% ↑

19% 21% ↓

13% ↓

35% ↑

26% ↑ 26% ↓

Not at allconcerned

A littleconcerned

Somewhatconcerned

Very concerned

2017n = 2210

2018n = 2228


Health Care Is A “Budget Buster” At The Federal Level

SOURCE: Congressional Budget Office

CBO: “Overall the Administration’s proposals would reduce mandatory federal spending for health care by $1.3 trillion (or 8 percent) over the coming decade.”

Healthcare is Top Issue for 2018 Election

Health Care is Top Issue for Democrats and Independents

Majorities Support a National Health Plan

SOURCE: KFF Tracking Poll (March 8-13, 2018)

Even Republicans Favor Medicare As A “Public Option”

SOURCE: KFF Tracking Poll (March 8-13, 2018)

Implications For California

Healthcare: Big Picture Politics And

Policy

Prepare for less financial support from DC for Medi-Cal and exchanges

Anticipate belt tightening in the eco-system, generally as margins tighten

Expect even more consolidation as weaker players capitulate

Anticipate mixed signals on volume to value from CMS

Hope that there is no extreme retaliatory behavior toward California and the Coasts from Trump Administration if Repeal and Replace is really dead

Expect California to push ahead on reform despite all this

Anticipate health reform a big part of next Governor’s agenda

Hope we can come up with something that is simple, easy and actually works

Drivers of Disruption

Money: Private Equity and Venture Capital

Big Corporate and non-profit mergers

New Vertical Integration combinations such as CVS Health-Aetna

Volume to Value Shift and Risk Delegation to Providers

Massive and Relentless transformation to ambulatory environment leads to retailization of healthcare, focus on new players and new settings of care

Specialty Pharma ascendant over hospital inpatient

Technology enablers: AI, Machine Learning, Mobile, Cloud, Blockchain, Voice Recognition, Open Data and API

Fear of New Entrants like Amazon, Apple, Google and Facebook is causing major health systems to disrupt rather themselves rather than being disrupted


The Rise of Consumerism


Self-Insured Employers are the financial lifeblood of the healthcare delivery system

Not exiting in a full employment economy but steady erosion of coverage among small business and low income workers

Reaching limits of Cost-Shifting to employees ….but still doing it

Looking for alternatives

Trying many initiatives to increase value

Stitching together responses

Specialty pharma a key concern

What will they support as policy?


18%21%

27%

44% 46%

33%

49%45%

26%

45%

59%

58%

45%

55%

49%

58%53%

57% 51%

87% 88% 89% 87%

2010 2011 2012 2013 2014 2016 2017 2018

HIP Surveys: Fewer employers are looking for a way out; continue to feel responsibility for employee health needs

* Asked only of Employers with 50 or more employeesBase: All Employer Health Benefit Decision Makers; 2014-2016 data from Nielsen’s Strategic Health Perspectives (n=340); LP Surveys (2017 n=538; 2018 n=550)Q800: Please indicate your level of agreement with the following statements. Do you strongly agree, somewhat agree, somewhat disagree or strongly disagree?

Company’s Position on Employer-Sponsored Healthcare: Providing Benefits(Top-2 Box % - Describes Completely/Very Well)

It is our responsibility to ensure our employees' health needs aremet

My company is actively exploring ways to get out of providinghealth insurance to our employees

Employer-based health insurance will soon become a thing ofthe past

My company feels it is worth it to pay the penalty associatedwith not providing employee health benefits rather thanproviding health benefits to our employees.*


HIP Surveys: Employers a bit less sensitive about cost sharing in 2018

Base: All Employer Health Benefit Decision Makers; 2014-2016 data from Nielsen’s Strategic Health Perspectives (n=340); LP Surveys (2017 n=538; 2018 n=550)Q1715 To what extent does your company agree with the following statements about employee cost sharing?

Agreement with Statement about Employee Cost Sharing

70%

80%

57%

78%

65%

83%

73%

84%

Employees will accept paying more if wegive tools to be healthier

Cost sharing is an important tool toencourage smarter health care choices

68%63%

71%66%

77%73%76%

62%

We don’t want to burden our employees, but it is the only way to continue providing

benefits

We have reached the limit on our ability toask employees to pay more

2014 2016 2017 2018

55%57% 58%

54% 53%50% 50%

53%50%

52%49%

52%48%* 47% 46%

44% 45% 44% 43%

66% 67%69% 69% 68% 68%

66%63%

65% 66% 65%63% 64%

62% 61% 62% 63%61% 62%

62% 63% 65%63% 62% 61% 60% 59% 59% 60% 59% 59% 58%

56% 56% 55% 56% 55% 55%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

All Small Firms (3-199 Workers) All Large Firms (200 or More Workers) ALL FIRMS

Percentage of All Workers Covered by Their Employer's Health Benefits, Both In Firms Offering and Not Offering Health Benefits, by Firm Size, 1999-2017

* Estimate is statistically different from estimate for the previous year shown (p < .05).

SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2017.

California Employers: Cost Sharing


HIP Surveys: Many more employers believe cost containment initiatives will work

Base: All Employer Health Benefit Decision Makers; 2014-2016 data from Nielsen’s Strategic Health Perspectives (n=340); LP Surveys (2017 n=538; 2018 n=550)Q1709 How well do you think each of the following initiatives will work to contain costs?

Works “Extremely/Very Well” to Contain Costs

41%

38%

34%

32%

31%

31%

31%

28%

27%

27%

26%

26%

25%

24%

23%

Increased emphasis on wellness and prevention

Focus more on primary care

Cost transparency tools for employees to make choices

Aggressive management of specialty pharmaceuticals

Negotiated reference pricing for specific conditions, hospitals

Improved management of behavioral and mental health

Better manage heavy utilizers of care

Centers of Excellence models

Private exchanges

Focus on accountable care / ACOs

Direct contracting with hospitals

Promoting greater use of bundled payments

Narrow network health plans

Expanded use of Patient-Centered Medical Home (PCMH) model

Consumer Directed Health Plans (CDHP)

60%

61%

59%

52%

50%

55%

53%

48%

47%

47%

50%

49%

45%

47%

49%

2016 2018


HIP Survey: Two in three employers willing to consider insurance provided by local hospital/hospital system; one in four already are.

Consider Contracting with…

Base: All Employer Health Benefit Decision Makers; 2014-2016 data from Nielsen’s Strategic Health Perspectives (n=340); LP Surveys (2017 n=538; 2018 n=550)Q816 Would your company consider offering a health insurance plan provided by a local hospital or hospital system rather than one offered by an insurance company?

14%

7%

6%

19%

34%

19%

2016

Yes, definitely

Yes, probably

No, don't have enoughemployees in onegeography

No, wouldn't trust anyof local hospitals

No , some other reason

Not sure

Local Hospital or System to Provide HI

Yes: 53%

9% 12%5%

4%7% 7%

12% 9%

43%40%

24% 28%

2017 2018

Yes, definitely

Yes, probably

No, don't have enoughemployees in onegeography

No, wouldn't trust anyof local hospitals

No , some other reason

Not sure

Yes: 68%

28% say they have “contracted

directly with health care providers to

lower insurance costs”

Five Dimensions of Consumerism

• Increased use of transparency and consumer navigation tools to guide choices

• Importance of consumer experience to providers and plans, both in terms of patient acquisition, retention and loyalty, as well as patient satisfaction

• Ever higher expectations of service industries driven by their positive experience with high-technology–enabled consumer offerings

• Consumers need to be more proactive and engaged in their own health and wellness

• Rising out-of-pocket cost burden

Source: S. R. Collins, M. Z. Gunja, and M. M. Doty, How Well Does Insurance Coverage Protect Consumers from Health Care Costs? Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016, The Commonwealth Fund, October 2017.

MORE THAN ONE-QUARTER OF INSURED ADULTS WERE UNDERINSURED IN 2016

1213

2223 23

28

0

10

20

30

2003 2005 2010 2012 2014 2016

* Underinsured defined as insured all year but experienced one of the following: out-of-pocket costs, excluding premiums, equaled 10% or more of income; out-of-pocket costs, excluding premiums, equaled 5% or more of income if low-income (<200% of poverty); or deductibles equaled 5% or more of income.

Data: Commonwealth Fund Biennial Health Insurance Surveys (2003, 2005, 2010, 2012, 2014, and 2016).

Percent adults ages 19–64 insured all year who were underinsured*

Source: S. R. Collins, M. Z. Gunja, and M. M. Doty, How Well Does Insurance Coverage Protect Consumers from Health Care Costs? Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016, The Commonwealth Fund, October 2017.

Percent adults ages 19–64 insured all year who were underinsured*

2003 2005 2010 2012 2014 2016

Total 12% 13% 22% 23% 23% 28%

Insurance source at time of survey**

Employer-provided coverage 10% 12% 17% 20% 20% 24%

Individual coverage^ 17% 19% 37% 45% 37% 44%

Marketplace^^ — — — — — 44%

Medicaid 22% 16% 32% 31% 22% 26%

Medicare (under age 65, disabled) 39% 24% 45% 32% 42% 47%

Firm size (base: full- or part-time workers with coverage through their own employer)^^^

2–99 employees — 14% 16% 26% 26% 22%

100 or more employees — 11% 16% 16% 14% 22%

UNDERINSURED RATES BY SOURCE OF COVERAGE

* Underinsured defined as insured all year but experienced one of the following: out-of-pocket costs, excluding premiums, equaled 10% or more of income; out-of-pocket costs, excluding premiums, equaled 5% or more of income if low-income (<200% of poverty); or deductibles equaled 5% or more of income. ** Adults with coverage through another source are not shown here. Respondents may have had another type of coverage at some point during the year, but had coverage for the entire previous 12 months. ^ For 2014 and 2016, includes those who get their individual coverage through the marketplace and outside of the marketplace. ^^ Adults enrolled in marketplace coverage are not shown for 2014 because no one in the sample would have had marketplace coverage for the full year. ^^^ Does not include adults who are self-employed. — Data not available.

Data: Commonwealth Fund Biennial Health Insurance Surveys (2003, 2005, 2010, 2012, 2014, and 2016).

Shallow-Pocketed Consumers Create Challenges And Opportunities

• Consumer/Patient experience matters in value payment for all payers

• High Deductible Care becoming norm In employer sponsored market and exchanges

• HDHP is a blunt instrument and applies to pediatrics too*

• Consumers (particularly women) are becoming key decision-makers in selecting services under these budget constraints

• Loyalty can be bought/changed through cost sharing

• Increased Competition for the Out of Pocket dollar from worksite clinics, retail clinics, pharmacy and free-standing urgent care, ERS and micro-hospitals

• Self-Insured using new channels for employees e.g. Lemon-Aid, Book MD and Omada

• Convenience is key to many consumer choices

• Considerable competition and cream skimming potential by income and geography

• Potential disruptors from Amazon to Apple

• Retail Clinic and Urgent Care activity may be additive not substitutive

• Raise Issues: “Fragmentation of care, relevancy, loyalty, and patient flow”

* Fung et al JAMA Pediatr, 2014 Jul:168(7):649-56

CVS-Aetna becomes CVS Health

• Retail Pharmacy with Clinic Footprint acquires national insurer with ACO and data expertise

• Vision of local footprint for chronic care management and health and wellness

• Execution risk• “Beyond Pink Eye”• Health and Wellness as Substitutive

versus Additive to Medical Care• Specialty pharma and PBMs are in

cross-hairs of national employers• Intense competition for wallet share

of shallow pocketed consumers • Whose problem does this solve?

Cigna Buys Express Scripts

• CIGNA agree to buy Express Scripts for a total of $76 billion ($52 billion in cash and stock , $15 Billion in assumed debt)

• “When we think about Express Scripts, it has PBM capabilities, but it has 27,000 individuals and a significant number of consumer touchpoints around health and well being,” Cigna CEO David Cordani said in an interview Thursday morning. “It expands our service portfolio beyond that of a PBM.”

• Cigna began exploring the tie-up seriously late last year, Mr. Cordani said. One of the drivers for the deal is its ability to broaden Cigna’s offerings and reach. “Having the capabilities to serve an individual whether they are healthy, healthy at risk, chronic or acute is important,” he said.

• Cigna shareholders will own about 64% of the combined company, which will retain Cigna’s name, and Express Scripts shareholders will own about 36%.

Source: WSJ, March 8th, 2018

Amazon, Berkshire Hathaway, JP Morgan Chase

Big Brands come together and announce joint venture to disrupt healthcare for own employees, insurers stock price hit immediately

But….. 1 million lives is less than 1% of privately insured spread all over the

country Can they really scale technology and innovation in an industry that has

resisted it? What can they do about price, absent concentrated local clout?

JP Morgan CEO reassured banking clients in health insurance this is just a GPO deal

Long history of “Cranky, Confused, Aimless and Spineless Employers”

Employers own the margin in healthcare

But they struggle to apply power in collective action and reluctant to risk their own brand in being tough on healthcare

They can innovate and pilot

Atul Gawande will attract followers and partners

You need CMS as the big dog changing the game at scale

OPTUMIZE

Source: The Healthcare Blog, Dec 13, 2017 Tory Wolff, Recon Strategies

The End Game

Integrated Care Integrated Health Systems of different flavors built around Medical Groups “Fair share” of Medicaid and the Uninsured allocated through auto-enrollment Targeted total cost of care targets tied to economic growth Increased focus on population health Large Self-Insured Employers given flexibility

Medical Darwinism 50+ million uninsured Best care in the world based primarily on ability to pay Doctors walk away from the poor Widening performance disparities within and between states

Single Payer “You are not Canadian” FFS Hamster Care Massive transfer of income from rich to poor Reduce the prices and incomes of all actors through government monopsony “Balloon in a Box” Change the mix: Get Rid of the Specialists Good Luck With That

No Matter What: Pursue The Value Agenda

Focus on getting the cost structure down in healthcare delivery Culture: Make it everyone’s problem

Engagement with medical staff on physician sensitive preferences

Cost Discipline as a strategic priority

Waste avoidance, clinical standardization and variation elimination

Labor substitution such as scope of practice extenders, telehealth and alternate sites

Partnering for Long Term Risk Delegation Gov. Leavitt “25 Years in to a 40 Year Journey to Value”

Medicare Advantage for All?

Managed Medicaid for more?

Self Insured Employers: Will they go direct?

Focus on 5/50 Segmentation and Analytics

Social Determinants of Health

Scale Scale matters in health insurance, PBMS, Supply Chain, Capital Creation but is it key for

providers?

For providers: You need to be big where you are but be prepared to partner with others

Local Terroir varies

What does it mean for IHA?

Key Opportunity for All Payer Value Measurement and Improvement infrastructure

The Prisoners Dilemma: A Better outcome is possible with collaboration

How do you standardize when no one is in charge?

Self-Insured Employers need to be on board

Measurement and Performance Improvement in retail healthcare

Disruption is real Elections

Market disruption

IHA DNA still matters

the future of the healthcare marketplace: what’s … · kaiser has doubled its medicaid...

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