Accountable Care: In Search of Anchor Business Model(s) for the ‘All In’ Healthcare Eco-system

By Gregg A. Masters, MPH

Part One in a continuing series exploring the ‘all in’ healthcare eco-system (as enumerated by Reed Tuckson, MD aka @DrReedTuckson below)

There is no room in the cost curve to accommodate things that don’t add value

An article published late last night titled ‘Hospital Groups Will Get Bigger, Moody’s Predicts‘ presented itself while I was just preparing for the extraction process after a long day of engaging with the continued saga of health reform, accountable care, and the delivery mechanisms to witness their growth and efficacy. So I was too tired to do anything but re-tweet the article. This morning energized by caffeine and a modest sense of being untethered from some very important dialogue elsewhere, I am compiling this blog post.

My series of tweets which afford the context of the essential heartburn I experienced reading these ‘deja-vu’ of sorts headlines (I intend to offer further rationale and context interspersed with the tweets) are posted below:

But first up, is the ‘cognitive dissonance’ trigger [as in, you must be kidding, right?]:

2healthguru: Food for thought? NEJM: Patient-centered care poor solution to doctor-centered care bit.ly/Azvc9a via @lsaldanamd #s4pm #epatients

To wit I note an another conventional wisdom assertion (though the track record of strategic market projections may be a little suspect i.e., the mortgage meltdown):

2healthguru: Bond issuer’s think they know healthcare. ‘Hospital Groups Will Get Bigger; Unlikely Partnerships Could Emerge’ bit.ly/Ach16K #aco

Somewhat reminiscent of the crystal ball forecasts of the best and brightest circa mid 1980’s…

2healthguru: Sanford Bernstein’s Abramowitz predicted by the year 2000 there would not be any non-profit hospitals in US. #aco

With reference to the potential over-reach of the Moody’s headline I remind…

2healthguru: Context people. The world wasn’t presented in the last 24 hours! #aco #healthreform

Then the seemingly and perpetually elusive strategic challenge in healthcare, i.e., realizing the proper alchemy between vision and execution as metaphorically enumerated by Dan Fogelberg:

‘..it’s never easy and it’s never clear, who’s to navigate and who’s to steer, and so your flounder drifting ever near the rocks…’

Contrary to the likes of Jeff Goldsmith’s bold and erroneous assertion, that finance and delivery need not be integrated to satisfy & restain the ‘rapacious appetite’ of the healthcare conundrum…

2healthguru: If context is king, history is its oxygen. Leading & bleeding edge sit side by side at alter of c-suite success. Who are you listening to?

So will it be well intended ‘deja-vu all over again’, or have we really learned something this time? Judging from a recent HealthLeaders Media CFO survey, I am not particularly encouraged that we’ve resolved the ‘cultural conflict’ (or perhaps better framed as Deming’s – ‘It is not necessary to change. Survival is not mandatory’) challenge wherein Fogelberg existentially frames the elusive blend between vision, strategy and operations by hospitals or their system parents!

2healthguru: On Moodys: One more time, the ‘finance guys’ are disproportionately represented in the strategy domain. bean counters are not strategists!

I then offer select context from a very large pool of ‘strategic misfires’ aided and abetted by the best and brightest thinkers including the then ‘Big Six’…

2healthguru: Some not too distant strategic gaffs proffered by ‘bean counters’: American Medical International forms AMICARE. #aco #healthreform

2healthguru: Hospital Corporation of America private labels with The Equitable to form Equicor. #aco #healthreform

2healthguru: VHA forms Partners Health Plan in association with Aetna. #aco #healthreform

2healthguru: Aetna merges with US Healthcare. From Aetna, glad I met ya, to Leonard Abramson’s, ‘my way or the highway..’ #aco #healthreform

2healthguru: The ‘ownership churn’ from AMI, to HealthTrust, to Columbia, to Galen, to Epic, to Quorum to you name it, was an unending ‘happy hour’. #aco

2healthguru: The constant? Docs & patients. Left high & dry while hosp ownership rotated like gas prices. NOT an ‘all in healthcare eco-system’ #aco

2healthguru: We need to really think about and flesh out the value proposition in healthcare equation. What/who should be the anchor business model? #aco

2healthguru: Christensen started the conversation, but didn’t answer in Innovator’s Prescription. We need competition of the ‘right kind’. #aco

This led to the following concluding thought/admonition of sorts:

2healthguru: When bondholders drive strategy, it’s all about debt service coverage, not innovation. How does driving via the rear view mirror work? #aco

As mentioned in the introduction, this is a series on the pursuit of the ‘all in heathcare eco-system’ a term I first heard used at the Digital Health Summit at CES 2012 in Las Vegas via United HealthGroup’s Dr Reed Tuckson, Senior VP for Medical Affairs, a man who in my book get’s it.

For Dr. Tuckson’s opening remarks, click here.

As someone who AHIP’s senior brass may not count as a friend per se, i.e., I have been rather critical of their stewardship of the industry since it’s GHAA roots, between the likes of Dr. Tuckson and Mark T. Bertolini, CEO of Aetna aka @mtbert, I actually have some hope for a re-aligned payor community as partner/enablers of ‘patient centered’ accountable care.