What's a Physician To Do?
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How should physicians deal with changes in healthcare
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What's a Physician To Do?
- 1. www.sage-growth.com What’s a Physician To Do? Chicago Health System Presented by: Sage Growth Partners November 6, 2014
- 3. www.sage-growth.com A Growing Client Roster 3
- 5. www.sage-growth.com Hypothesis I: Health Care Will be Disrupted There is an overwhelming confluence of interests, incen9ves, and macro-‐environmental forces that will disrupt the industry and drive real change – Payment model redesign will be a core catalyst for change 5
- 6. www.sage-growth.com A Step Further • Even if no net-‐new, domes9c U.S. HC is a $1T arbitrage opportunity – and its largely in facili9es, specialists, transi9ons, and chronic care management • Health care will experience its industrial revolu9on – Transparency – Standards – Focus on efficiency • In an industrial model – community organizers/entrepreneurs (PCPs) are very well suited to assume the mantle of leadership • The garage is coming to health care • Incen9ves are aligned between payers and enlightened providers beRer then ever – economics and ACA are driving payers to shiT risk 6
- 7. www.sage-growth.com Hypothesis II The Medical Prac9ce Business Model will have to change 7
- 8. www.sage-growth.com Elements of the New Paradigm • All healthcare is local but the ecosystem needs to be beRer defined • Will have to master (at least survive) “foot in two canoes” • PCP as the QB of the healthcare team 8
- 9. www.sage-growth.com PCP as QB – Industrializing Healthcare 9 Logistics Telemetry Supply Chain Performance Management Interoperability Workflow & Business Process Redesign Change Management Practice Transformation Capabilities Requirements
- 10. www.sage-growth.com Lots of QuesTons • The role of physicians -‐ How do I stay independent? • The role of hospitals and health systems • The role of subs9tutes -‐ IoT • The pace of migra9on to VBP • The pace of provider/payer convergence • WHAT IS A PHYSICIAN TO DO? 10
- 11. www.sage-growth.com The Three Dominant Strategies Best Care Dominant Delivery Organiza9on(s) Dominant Delivery Network Dominant Enabling Business Plaform Best Health Status Best Value 11
- 13. www.sage-growth.com Financial realiTes are changing 13
- 14. www.sage-growth.com Volume to value: Reasons for the shiX Risk ShiX Payer Value Based PorZolio 0 20 40 60 80 100 1990 2000 2010 2020 2030 2040 2050 2060 2070 2080 Medicare Medicaid Private Health Insurance Driver: Public Reimbursement as % of Commercial ACO Growth 687 Medicaid MCOs 2013 Porter Research Study 2013 *Including SGR rate cuts CMS Office of the Actuary May 2012 LeaviR Partners 2014
- 15. www.sage-growth.com Private Health Insurance Benefits by Spending Category 18% current OUTPATIENT 32% current INPATIENT 32% current PHYSICIAN 4% current OTHER 15% current DRUGS Fastest Growth 2007 -‐ 2012 Slowest Growth 2007-‐2012 8.2% Growth 10% Growth 8% Growth 6.1% Growth 5.4% Growth Source: Price Waterhouse Coopers Medical Cost Trend: Behind the Numbers 2013 “Other” category includes services such as ambulance, home health and durable medical equipment 15 PCP = 6%
- 16. www.sage-growth.com NEW (?) PAYMENT MODELS 16
- 17. www.sage-growth.com IncenTves Drive (bad) Behavior 17 Trust but Verify Explore New OpTons Build for the Future Legacy Payer RelaTonships Partner with Plans/Purchasers DIY Fee-‐for-‐ Service Contract P4P Contract Shared Savings Contract Full Cap/ Global Budget Contract Private-‐ Label Product Partnership Provider Sponsored Health Plan -‐ Outsourced Services Provider Sponsored Health Plan Lower Risk / Reward Tradeoffs Higher
- 18. www.sage-growth.com Why VBP? • Purchasers are demanding more accountability around quality and cost • Medicare and Medicaid need the “stop loss” • Its a way to take and grow share • It allows a focus on “industrial improvement” • Its working in key markets -‐ Its driving quality outcomes 18
- 19. www.sage-growth.com BUILDING CAPABILITIES TO ADDRESS MARKET NEEDS 19
- 20. www.sage-growth.com Revenue Cycle Redesign & Alignment is CriTcal • Hospitals who have financial rela9onships with physicians will be changed as the reimbursement methodologies change • Volume-‐based methodologies will transi9on to more specific clinical and cost metrics – Risk-‐based purchasing – Reducing readmissions & HAI/HAC • These new methodologies will need to be documented in new contracts with hospitals and physicians – This will be PAINFUL • Foot in two canoes will require new system capabili9es 20
- 21. www.sage-growth.com Which Service Lines Will you Focus On Over the Next 12-‐18 Months? 21 PercentageofPayerCommunity 77% 54% 46% 44% 5% EMPLOYER GROUP PLANS MEDICARE PLANS MEDICAID PLANS INDIVIDUAL PLANS OTHER
- 22. www.sage-growth.com ImplicaTons of a Clinically Integrated Network • Expecta9ons Have Changed: – Payors will be expec9ng hospitals to behave in a different way – Hospitals will be expec9ng physicians to behave in a different way – Physicians and pa9ents will be expected to be more engaged and informed and to work together more closely – Popula9on health management 22
- 23. www.sage-growth.com The (really) lean health plan 23
- 24. www.sage-growth.com CITI research1 Framework for managing populaTon health 1Source: Popula9on Health Management-‐Hill’s Handbook to the Next Decade in Healthcare Technology, 14 May 2013 24
- 25. www.sage-growth.com Build, Buy, Partner Dominant Delivery Organiza9on(s) Dominant Delivery Network Dominant Enabling Business Plaform 25
- 26. www.sage-growth.com If I were a physician, I’d be thinking about… • Business Model ConsideraTons – Running through walls to enhance/aggregate primary care – Build a new economic model – “the era of 3x” – Scope of the “New PCP” – Telemetry, monitoring, driving interven9ons, building supply chains (trading partners) – Employment op9ons – Find the MD entrepreneurs • PopulaTon Health – let’s define – Where do I fit? – ARribu9on/iden9fica9on – Surveillance – Risk assessment – Risk stra9fica9on – what’s our triangle look like? – Gap assessment – Coordinate/drive interven9ons 26
- 27. www.sage-growth.com If I were a physician, I’d be thinking about… • Becoming part of value-‐added network and aggressively courTng Payers/Purchasers (Insurers, TPA/ASO, Employers, Unions, Purchasing Groups) – Make something different happen – Get out and talk early and oTen – Don’t make assump9ons and don’t ignore purchasers – How to do this • Embracing transparency wholeheartedly – Prices, Costs, Quality • Plan the Ecosystem – Do I have the Right Partners? – Technologies: Rev Cycle, Messaging, CDS, PH, PI, Retail, remote monitoring, etc. etc. etc. – Trading partners – Interoperability – Plaform Partners 27
- 28. www.sage-growth.com Contact: Sage Growth Partners 3500 Boston Street, Suite 435 Bal3more, Maryland 21224 410.534.1161 28