Archive
Health Care Reform – Update
Today’s New York Times reports that Republicans are actively working to unravel and cripple as much of the Health Care Reform legislation as possible. Proposed tactics include withholding funding necessary to enforce the law, restricting the ability of the IRS to collect fees and penalties, and reducing the funding of Medicaid. (Interestingly, Peter Orszag recently submitted an OpEd in the same paper explaining the effect that increasing healthcare costs had on the nation’s public education system.) The Republicans are also planning to delay and impair elements of the law through parliamentary procedure, requesting hearings and attaching provisions to spending bills that would likely complicate an already complex piece of legislation.
In short, the industry is in for a tumultuous ride regardless of how things play out.
Update: Health Care Reform is Happening
Remember when health care reform was freshly signed and the industry pundits were scrambling to figure out what it meant for the industry? It reminds me of the Chinese Curse: May you live in interesting times. Because things are getting interesting, and encouraging. Health plans and providers are starting to get to the business of reforming health care. They don’t call it that, but the various constituents are having active, productive conversations. (BTW. they do describe it like that.). I can’t count the number of times CMOs and COOs have told me that HCR helped bring everyone to the table. As just one example, the whole Medical Home/Accountable Care Organization concept seemed like the most difficult high wire act to pull off (if you understand today’s reimbursement world), but there are numerous MH/ACO programs in active rollout right now(e.g. IBX, BCBSRI, CareFirst.) Admittedly, some of them are small and/or limited to very specific regions or practices, but everyone needs to get comfortable and collect data and measure. Expect this to start to drive new contracting discussions with increasing emphasis on outcomes, and probably more risk being shouldered by the provider.
I’ll continue to catalog examples as we go along, but it seems clear to me: reform is happening and things are getting interesting.
Thursday at the AHIP Conference
Overall, conference turnout was encouraging. I spoke to one of the AHIP board members on Thursday and he reported that the attendance was higher than in recent years. For me, the number of vendors seemed lower, but the overall mood from the booths was upbeat and more optimistic than last year(anecdotal but overwhelming.) People seem to be thinking that the ‘Meaningful Use’ money, once freed up, will drive both sales and hiring. Look for the ICD-10/5010 transition to create huge problems for providers and thus huge opportunities for savvy vendors, the need for care management solutions to increase, and expect similar demand in revenue cycle management solutions to address what will become increasingly complicated reimbursement scenarios going forward.
Next year’s conference will be back in San Diego in 2011. Until then, good selling!
AHIP Conference This Week
For those of us who sell to payers, AHIP’s big annual blowout is perhaps the largest, best single opportunity of the year. It’s an ideal confluence of customers, industry news and a glimpse into the fomenting trends(e.g., new reimbursement models, interpretation of HCR), and the chance to catch up with friends, colleagues and contemporaries. (Plus, it’ s in Vegas.)
By now, you should have already figured out who’s attending and set up appointments, made people aware of your attendance, wrangled invitations to the best parties, and otherwise set the stage for three busy days. Don’t wait to make restaurant reservations, and make sure you have the LV lay-of-the-land for last minute coffee and cocktail rendezvous sites. Fill your case with business cards and pertinent collateral and make your list of the Read more…
The Complexity of Selling to Payers – Another Perspective
Like it or not – I’ve spent my entire career in the healthcare technology space. For years, I actually tried really hard to find a way out, leave the industry only to finally realize that my network, executive level contacts and my domain knowledge was clearly wedded to healthcare technology and not that leveragable.
Guess what? After nearly 30 years…I’m still here.
I digress.
Over the years I’ve sold solutions to integrated delivery networks, hospitals, providers, managed care organizations and yes – to payers. In my opinion the sales process when selling solutions to payers is by far the most complex. A few years back, I attended the “Solution Selling” – workshop – a course designed by Michael Bosworth. It was the most valuable sales related course I have ever taken and really prepared me to handle the sales process inside the walls of payers and health plans. Read more…
World Health Care Congress – Tuesday/Wednesday
CHICAGO – Got slammed last week(plus busy watching lacrosse and sailing this weekend…) so wasn’t able to summarize until now. But, you didn’t miss much. Here’s my synopsis:
- Perhaps the best summary of the WHCC presentations came from a payer Medical Director who opined that the bigger the title the more pedestrian and safe the comments. Consistent with that maxim, Kathleen Sebelius, HHS Secretary, painted a rosy picture of a better healthcare future.
- The Google guy(Alfred Spector) wasn’t any better, and was surprisingly unremarkable. Read more…
World Health Care Congress – Monday
WASHINGTON, DC – At the World Health Care Congress event being held at the Gaylord Convention Center. Here are some notes, quotes and observations from the Day One proceedings:
- Ron Williams(CEO, Aetna) and Denis Cortese, MD(CEO, Mayo Clinic) discuss ‘Rebuilding Health Care.”
- Cortese suggested taking the top 3-5 diseases and top 3-5 procedures, which make up 70% of Medicare costs, and don’t cut the reimbursement rates for those that perform the best. He proposes that you’ll see the system self-organize in response, and it will trickle over into commercial plans.
- Williams believes health plans can help provide transparency, with the following example: Consumers should be able to see procedure pricing at Hosptal A, Hospital B, an ambulatory surgery center, etc. before the service is provided, along with outcome and quality data. A BIG change, but that day is coming. Also stated that health plans have entered a new period that will require big changes is strategy in order to be successful in the next decade.
- Clayton Christensen(Harvard, author of The Innovator’s Prescription) covered the general theme of his book. I’ll cover this more in a separate post. Suffice it to say, his book is a must-read for those in the health care industry.
- Juan Davila(SVP of Provider Networks, BS of CA) presented on a MedeAnalytics application they’ve deployed to work more collaboratively with hospitals. Particularly noteworthy was a Venn diagram mapping out the shared goals between payer and hospital as a way to get cooperation. These were: Higher auto-adjudication rates; Improve claim turnaround time; Quick dispute resolution; Reduced re-work; Cleaner contracts. The goal for BSCA was to be able to pay hospitals fully, quickly, and according to the contract.
- Richard Chung(SVP, Hawaii Medical Services Association) reviewed the health care coverage in Hawaii: 1.3M members, universal coverage since 1974, employer pays 98.5% of coverage, 70% commercial market share. Have had good past performance but costs are continuing to climb, so HMSA is turning their PPO into a virtual IDN. (Christensen pointed out earlier in the day that IDNs typically deliver 15-40% lower cost with better outcomes.)
- Chester Burrell(CEO, CareFirst) – Notable comments:
- CareFirst has had 14% average premium increases the last three years, and will post a similar increase this year.
- Employers are whacking healthcare costs by increasing deductibles, decreasing coverage.
- 57% of employers this year offer a high-deductible health plan this year, up from 3% just a few years ago. He hasn’t seen that rate of growth for any other product before.
- Michael Quilty, Matrix Health Network) – Notable comments:
- There will be a physician shortage of 125K by 2025(this estimate is pre-HCR bill)
- Nurses will play a big role as ‘physician-extenders.’
- Concierge medicine will get big. MDVIP was just purchased in full by Procter & Gamble…
- Who know whether Medicare will get small or grow, but Medicaid will become huge and that is ”where the there is.”
- George Halvorson(CEO, Kaiser) and Alfred Spector(VP, Google) spoke. I’ll have more notes on that session later.
Get Your Zen On
Let’s face it. Selling to payers can be a slog. Decisions can take (seemingly) forever and require (ostensibly) more buy-ins and approvals than there are people in the company. In order to be successful and simultaneously maintain a manageable level of sanity and peace of mind, I find that you need to develop a zen-like state of understanding about your customers. And the best way I know of reaching a state of healthy consciousness is through perspective.
Here’s the simple fact: no matter how complicated and dysfunctional things may seem in your own company, they likely pale in comparison to the operating environment within the typical health plan. Why? It’s simple:
Chronic Disease and the Internet
Chronic disease is big business. The CDC reports that seven out of ten deaths are due to chronic disease, and that more than 133M Americans(almost half the adult population) suffers from at least one chronic condition. In point of fact, well over 50% of all medical expense is due to chronic disease.
Chances are it is of interest to you, too, and certainly should be for health plans and delivery systems looking to provide better engagement with members, patients and their support structure. If so, you’ll find the just release Pew Research report of interest. It has a breadth of eye-opening statistics(81% of people go on-line, but only 62% if they have a chronic disease, and 52% if burdened with two; similar usage falloff for cell phone use; one in four uses some sort of social media; on in five creates health content) worth contemplating.
Granted, it’s rather geeky, esoteric stuff for the average salesperson to be reading. But who has time to be average these days?
Health Care Reform – Quick Notes
“The good news [for Medicare Advantage plans] is there are no MA reimbursement cuts for 2011. The bad news is the hit begins in 2012, and the phase-down now occurs over only two years, so the pain will be more intense than [it would have been] in the earlier drafts.”
—John Gorman, CEO of Gorman Health Group, LLC
=========================================================
Good summary of the HCR bill, from the Kaiser Family Foundation
