Posted in Accountable Care, health reform, JP Morgan Healthcare Conference, Medicare

Must listen JP Morgan Healthcare Conference Webcasts: @MolinaHealth

by Gregg A. Masters, MPH

NOTE: This is the third in a series of ‘Must listen’ webcasts produced at JP Morgan’s 34th Annual Healthcare Conference. The first focused on telehealth sector market leader Teladoc, the second on Centene. For background and details on this august annual gathering, see ‘If It’s January, It’s JP Morgan Healthcare Conference. Remaining companies to detail as they represent important ‘bell weather’ insights relative to their respective sectors, include: Aetna, AthenaHealth, Genomic Health,Universal American, Tenet Health, as well as several from the ‘non-profit’ (tax exempt) sector including Baylor Scott and White

Molina Healthcare’s operations and strategy positioning insights are similar to Centene and in many ways constitute bell weather operators in the same space. Market and performance comparisons are material on a number of levels including the ‘urge to merge’ in the HMO or managed care space, and the implications such continuing consolidation holds for movement towards clinical and financial integration in the provider space. Additionally as many predict the future viability of the Medicare Trust Fund may rely largely on the efficacy of how Part C stakeholders articulate a sustainable vision of Medicare Advantage program to extend and enhance the life cycle of the Medicare program itself.

For direct link to the JP Morgan Healthcare Conference, click here. For the associated Molina Healthcare profile, click here, the deck here and webcast, here.

Meanwhile, below are some slides which outline the company’s performance and market sector overall:

JPM_MolinaHealthcareJPM_MolinaHealthcare_revenueJPM_MolinaHealthcare_membership

 

JPM_MolinaHealthcare_home_community
JPM_MolinaHealthcare_medicaid
JPM_MolinaHealthcare_medicaid_growth JPM_MolinaHealthcare_medicaid_spend

JPM_MolinaHealthcare_acquisition JPM_MolinaHealthcare_year_ahead

 

 

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Posted in Accountable Care, ACO, health reform, Medicare

Innovations in Healthcare Delivery: A Brookings Merkin MedTalk Series

In the physician directed and emerging ‘accountable care’ space, few have the depth and range of experience, operating success, learning curves and business model diversity than the collective enterprises associated with the vision and tenacity of Richard Merkin, MD – physician, philanthropist and visionary. In fact, with Davita’s 2012 acquisition of Healthcare Partners into it’s publically traded parent, one might consider Dr. Merkin’s extensive managed (now including ‘accountable care’) portfolio to be a ‘last man standing’ at scale scenario in the physician led integrated delivery system domain.

Clearly there are others, but few match the member scale and market savvy that Dr. Merkin et al, has and continues to assemble. Further consider the C-suite management team behind the Merkin enterprise. Names such as Mark Wagar, President Heritage Medical Systems (AMI, CompreCare, American Physician Partners, Empire Blue Cross and Blue Shield), Richard Lipeles (PacificCare),  Kathy Nix, and Jaya Kurian to name only a few.

So when two trophy nameplates team up, i.e., Brookings and Merkin, to launch the Merkin Initiative industry veterans and health-wonk wannabes should pay close attention.

This impressive series nested at Brookings is titled the ‘Merkin Initiative on Payment Reform and Clinical Leadership‘. It originally streamed live on April 16th, 2014 c/o @BrookingsMed. The program description notes the following:

“Treating Congestive Heart Failure and the Role of Payment Reform: Lessons from Duke University Health System and the University of Colorado Hospital.” The agenda includes seven brief “TED-style” talks that will cover the clinical effects of congestive heart failure (CHF), its economic impact on the health system, as well as firsthand experiences from Duke and Colorado about their CHF care strategies, and how they used alternative payment models to support these innovations.

The tweetstream can be retrieved via #MedTalk.

[Program Note: fast forward to 15:30 mark for beginning of the webcast]

Now sit back and consume this informative series including wrap-up panel of presentations on the ‘tectonic’ ecosystem shift from volume to value. Finally, in the white water of the transformational imperative, I’m reminded of the William Gibson often quoted in tech sectors of late ‘advisory’:

The future is already here — it’s just not very evenly distributed.

 

 

 

 

 

 

Posted in Accountable Care, ACO, Affordable Care Act, Medicare

AHIP Back in the ‘huddle’ and Reminiscent of the ‘GHAA Revolution’?

By Gregg A Masters, MPH

It’s been a very long time since I participated in an AHIP event. In fact for the record I have NEVER been to an AHIP event – that is before this week in DC. I attended, filmed, tweeted, broadcasted from, and now blog about AHIP’s ‘Medicare, Medicaid and Dual Eligible 2013 Program series.AHIP Medicare, Medicaid, Duals DC 2013

As someone who’s guided, counseled and implemented (at times successfully and other times not) some rather large proprietary, non-profit (ah hem, I mean ‘tax exempt’) health systems and their national or regionally branded provider sponsored ‘managed’ (ah hem, I mean ‘discounted’) health plans dating back to the 80s and into the millennium this is awkward if not curious (‘N’ of one?) state of affairs.

AHIP is after all is the ‘go to’ resource for the health plan community and their aligned provider and health system partners.  Yet somehow in my non traditional yet ‘mangled’ healthcare career path I managed somehow to stay outside of that tribe of dedicated and passionate healthcare professionals.

Back then, half of AHIP’s predecessor iteration was known as GHAA – the ‘group health association of America.’ This was an multi-dimensional trade label, as ‘group’ could be seen from an employer’s wholesale purchasing of group health insurance (vs. the ‘individual market)’ perspective but also from the point of it’s constituent member health plans mostly built upon ‘risk savvy’ medical group practice infrastructure – Friendly Hills, Mullikin, Bristol Park, Harriman Jones et al, at least in Southern California – though peer equivalents peppered the national lanscape, ie, Dean, Kelsey Seybold, Scott & White, InterMountain, Park Nicollet, Virgina Mason.

It’s been a while since the vertical integration and rabid consumption of group, IPA, or network model HMOs by national nameplates storming into the managed competition market and away from their indemnity roots (Aetna/US Healthcare, Prudential/PruCare, United HealthGroup, The Equitable/Equicor), but the players back then included the likes of HealthNet, PacifiCare, TakeCare, Maxicare (RIP)’ and many other national startup wannabes ie, Partners/VHA, UniHealth/CareAmerica, HealthPlan of America, HealthCare USA, to name just a few.

Nonetheless, GHAA meetings radiated with excitement and enthusiasm as the disruption vibe of the day was to bring this HMO thing from marginal (a 2nd tier class of docs, hospitals and ‘ancillary providers’ aligned with ‘HMO medicine’) into the mainstream. HMOs other than Kaiser Permanente, Mayo Clinic and the Cleveland Clinic were seen as less than quality ie, ‘cheaper’ medicine. Yes, back then comprehensive HMO benefits where the ‘value play’ in the group health portfolio.

Fast forward to today September 25th 2013. Consider the following: the Affordable Care Act (ACA) though approved by Congress, signed into law by the President and affirmed constitutional by the Supreme Court is a hostage to the antics of the junior Senator from Texas leading a ‘defund ObamaCare’ filibuster of sorts amidst a very real threat of a Federal Government shutdown. [Editor’s Note: Consider this the leading edge of wasting taxpayer dollars to pursue a political, not healthcare solution agenda].
AHIP podium signage
Whereas, in the ‘roll up your sleaves and lets get er done’ tribe, less than a mile away at the AHIP meeting a flock of dedicated healthcare professionals and aligned stakeholders from every sector of the healthcare ecosystem [perhaps absent the patients voice?] are ‘huddling’ to share best practices, enterprise models and the technical guidance that can assist the implementation of both the spirit and intent of a very complex and mostly certainly less than ideal law.

Wow what a contrast! That ‘juxtaposition of irony’ did not escape many of the faculty including no less than one warrior of a previous similar battle, the then OMB Director Alice Rivlin, now Co-chair, Bipartisan Policy Center’s Domenici-Rivlin Task Force and Interim Director of Brookings’ Engelberg Center for Health Care Reform who opined:

‘It really is a very strange time to be here in [Washington DC] the most extreme partisan politics in my memory and I’m afraid the most broken that I have seen our democratic process. Healthcare and health insurance are caught right in the middle of this dysfunctional situation……and [in view of the potential Federal Government shutdown] given this ‘disconnect’… you might wonder, have they lost their minds? And the answer is YES!’ – Alice Rivlin

So amidst this self imposed ‘faux’ crisis the title of the blog is to analogize the ‘return’ of AHIP to its original revolutionary roots. Given the scope, range and depth of the Act, making the ACA work is in the words of previous acting director of CMS and champion of ‘the triple aim’ Don Berwick an ‘all hands on deck’ affair. We need each other all rowing in the same direction if ‘we’ are to matter this time.

If not, the party for the public/private hosting of American medicine – both financing and delivery may be over.  It’s certainly debatable whether AHIP ever migrated away from their GHAA roots or not, but this is one observer’s experience in prior team huddles.

Posted in Accountable Care, Affordable Care Act, Medicare

A Juxtaposition of DC Irony

By Gregg A. Masters, MPH

It’s Monday in DC and the Capitol is distinctly vibrant albeit with a peculiar though eclectic mix of create vs.  deconstruct energies.

imageSome might say this attitudinal ‘chemical cocktail’ is in part sourced from a mix of ‘doers’, but also a smidge if not even a heaping portion of the just say ‘hell no’ [to Obamacare] crowd. For reference see: the latest effort by the House to derail health reform via a defund the act showdown with the Democratic controlled Senate and the President himself.

Yet amidst this continuing dance of oppositional strategizing we’re at the Renaissance Hotel DC for a series of one might characterize as ACA ‘implementation conferences’. These are principally the health plan doers who are under a mandate to reinvent themselves, and craft a sustainable market role for their members. The AHIP cohort is perhaps most visible via Aetna, Humana, United HealthGroup as well as others, who are intent upon making the best of this complex piece of legislation known as ‘the Affordable Care Act’. This gathering of players has huddled to support each others efforts and identify and share best practices to model as the industry collectively pursues the triple aim or alternatively cast as the coveted sustainable healthcare ecosystem.

One can assume the overwhelming mission of those attending the AHIP Conference trilogy are here to learn about if not advocate for the three pillars associated with the ACA: the tweaking of Medicare from volume to value via ACOs and other innovations, the significant expansion of Medicaid and the rapid expected growth in  ‘Dual Eligible’ population.

For conference schedule click here.

The hashtag for the conference is #AHIPMCMCConf.

Posted in Medicare, population health, Triple Aim, Uncategorized

[Re-post] The ‘Medical Aggregators’: Are We Entering Round Deux?

By Gregg A. Masters, MPH

[Originally written by @2healthguru on June 1, 2010 at 11:00 AM]

First a little historical context:

For those with a healthcare ‘event horizon’ slightly more seasoned than the current health reform ‘conversation’, you might remember the initial round of aggregation in medicine lead by disruptive nameplates such as MedPartners (now operating the PBM CareMark), PhyCor, FPA Medical Management, and their second or third tier physician practice management ‘me too’ copycats.

They all emerged from a robust round of venture capital backed industry determination tagged as ‘PPMC’s’, i.e., physician practice management companies. These ‘aggregators’ were the darlings of Wall Street for a while, though with some exceptions, i.e., US Oncology (formerly Physician Reliance Network), most witnessed relatively short life spans, from IPO to unwinding in perhaps a 10 year run (see: MedPartners collapse and Aftermath).

Yet, despite the promise outlined in the offering prospectus’, why did these entities fail so miserably as the ‘white knight’ consolidators or aggregators of a multi-trillion dollar ‘cottage medical industry’? Their business model proferred essentially three core benefits:

  1. Centralized, standardized and more efficient back office medical administrative management
  2. Scale of market asset concentration and therefore increased sophistication and leverage (improved pricing) with third party payor negotiation, and downstream contract management; and
  3. Serve as an ‘anchor play’ with respect to the broader design and implementation of rational though market based local delivery organization and financing, i.e., PPMC’s would harness and more effectively articulate a business culture among physicians that valued clinical integration, medical risk management, and ultimately the allocation of limited health care resources

At least this was the longer term expectation from a ‘win/win’, i.e., payor and provider perspective, of the more established players. Most however, in an effort to demonstrate value (i.e., earn their management fee) to their physician boards, focused on short term margin improvement (better rates, focus on more profitable services via improved payor mix, maximizing the contract revenue/recovery cycle, and reduced overhead, etc.), vs. the strategic focus of managing the risk (both quality and cost) of their local population (i.e., enrolled members).

So rather quickly the strategic basis of the PPMC appeal was subordinated to a short term focus (i.e., increasing net revenues) due to a rising chorus of claims that at its core the business model was merely a third party ponzi scheme which introduced another mouth to feed from an increasingly constrained health care supply chain.

Net/net, the PPMC industry flamed out big time and did not fulfill its ‘roll-up’ promise of the practice of medicine. Now many years later, we are at another tipping point. Witness the current round of promising vehicles with a similar vision of organizing physicians. These candidates include: hospital systems, health plans, integrated delivery systems, emerging ACOs, medical homes,  and even niche play organizers in the concierge, or direct practice space including SignatureMDMDVIPHealthAccess Rhode IslandCarePracticeQliance, and HelloHealth, as well as the rapidly emerging series of retail pharmacy sponsored primary care clinics, e.g., CVS/CareMark Minute Clinic, etc.

Too many docs are unwilling to risk the capital of private practice, and instead are looking to hook-up with one or more of these institutional or VC backed entrepreneurial sponsors. Will they succeed where their predecessors failed? If so, why?

From my perspective, it will clearly depend on the business model chosen to enable competition of the ‘right variety’, and the degree to which the venture embraces, nurtures and expresses physician culture that values collaborative group practice. Top down, corporate strategies dependent upon an over worked and out gunned medical director or VP of medical affairs will miss the mark. The more likely way for these ventures to succeed is by ‘baking’ the culture from the ground up. In other words, ‘seed it and they will come’. One of my mentors (Ernest Holmes) once wrote long ago:

the soil can’t argue with the seed.

Lets nourish the soil first, then make sure we plant the seeds with the right constitution and vision.