What's an IPA To Do?
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There is an overwhelming confluence of interests, incen6ves, and macro-environmental forces that will disrupt the healthcare industry and drive real change.
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What's an IPA To Do?
- 1. www.sage-growth.com What’s an IPA To Do? Prepared for IPN Sage Growth Partners October 22, 2014
- 3. www.sage-growth.com A Growing Client Roster
- 4. www.sage-growth.com Hypothesis: Health Care Will be Disrupted There is an overwhelming confluence of interests, incen6ves, and macro-‐environmental forces that will disrupt the industry and drive real change – Payment model redesign will be a core catalyst for change 4
- 5. www.sage-growth.com A Step Further • Even if no net-‐new, domes6c U.S. HC is a $1T arbitrage opportunity – and its largely in facili6es, specialists, transi6ons, and chronic care management • Health care will experience its industrial revolu6on – 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 • Incen6ves are aligned between payers and enlightened providers beOer then ever – economics and ACA are driving payers to shiQ risk 5
- 6. www.sage-growth.com Lots of QuesOons • The role of physicians – especially independents • The role of hospitals and health systems • The role of subs6tutes • The pace of migra6on to VBP • The pace of provider/payer convergence • WHAT IS THE IPA TO DO? 6
- 7. www.sage-growth.com Focus on Three Swim Lanes Best Care Dominant Delivery Organiza6on(s) Dominant Delivery Network Dominant Enabling Business PlaZorm Best Health Status Best Value
- 9. www.sage-growth.com Financial realiOes are changing
- 10. www.sage-growth.com Volume to value: Reasons for the shiT 10 Risk ShiT Payer Value Based PorVolio 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 LeaviO Partners 2014
- 11. www.sage-growth.com Hospitals won’t disrupt themselves! 11
- 12. www.sage-growth.com Private Health Insurance Benefits by Spending Category 12 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
- 13. www.sage-growth.com The (really) lean health plan 13
- 14. www.sage-growth.com Physician Employment Trends 14 Source: Accenture Physician Alignment Survey 2012. hOp://www.accenture.com/SiteCollec6onDocuments/ PDF/Accenture-‐Clinical-‐Transforma6on-‐New-‐Business-‐Models-‐for-‐a-‐New-‐Era-‐in-‐Healthcare.pdf
- 15. www.sage-growth.com Sustainable? • Hospitals lose on average $176,463 per physician on owned physician prac6ces • The longer a hospital owns physician groups, the higher the likelihood it is losing money on them. • The more physicians a hospital employs, the more likely they incur losses • 78% of hospitals are paying physicians non-‐produc6vity incen6ves (pa6ent sa6sfac6on, clinical quality, and ci6zenship), expected to rise to 94% in 3 years 15 Sources: MGMA 2013 Cost Survey All mul6-‐specialty groups, hospital-‐owned and Report: Hospital-‐owned prac6ces lose up to $100K per doc each year – FiercePrac6ceManagement
- 16. www.sage-growth.com New reality High performing provider organizaOons must manage risk • Market forces driving a heightened need for financial accountability • Insurers seeking to transfer the financial risk of clinical service • The risk-‐transference taking the form of payment-‐for-‐value arrangements • Entrepreneurial provider-‐sponsored organiza6ons are well posi6oned • Organiza6ons may lack technology and solu6ons infrastructure to transform their business models
- 17. www.sage-growth.com Where are you? Are you ready?
- 18. www.sage-growth.com NEW (?) PAYMENT MODELS
- 19. www.sage-growth.com IncenOves Drive (bad) Behavior 19
- 20. 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 20
- 21. www.sage-growth.com The Impact of Truly Independent PCPs 21
- 22. www.sage-growth.com BUILDING CAPABILITIES TO ADDRESS MARKET NEEDS
- 23. www.sage-growth.com CITI research1 Framework for managing populaOon health 1Source: Popula6on Health Management-‐Hill’s Handbook to the Next Decade in Healthcare Technology, 14 May 2013
- 24. www.sage-growth.com What’s an IPA to Do? NOT MUTUALLY EXCLUSIVE 24 Dominant Delivery Organiza6on(s) Dominant Delivery Network Dominant Enabling Business PlaZorm
- 25. www.sage-growth.com If It Were My IPA, I’d be thinking about… • PopulaOon Health – let’s define – needs to be CORE – AOribu6on/iden6fica6on – Surveillance – Risk assessment – Risk stra6fica6on – what’s our triangle look like? – Gap assessment – Coordinate/drive interven6ons • On-‐ramps for providers – especially PCPs – Running through walls to enhance/aggregate primary care – Build a new economic model – “the era of 3x” – Employment op6ons – Find the entrepreneurs 25
- 26. www.sage-growth.com If It Were My IPA, I’d be thinking about… • Aggressively courOng Payers/Purchasers (Insurers, TPA/ASO, Employers, Unions, Purchasing Groups) – Make something different happen – Get out and talk early and oQen – Don’t make assump6ons and don’t ignore purchasers • Embracing transparency wholeheartedly – Prices, Costs, Quality • Don’t forget the infrastructure – And plan the Ecosystem – IT, Rev Cycle, Messaging, CDS, PH, PI, Retail, remote monitoring, etc. etc. etc. • Capital Partners – be creaOve 26
- 27. www.sage-growth.com Contact: Sage Growth Partners 3500 Boston Street, Suite 435 Bal3more, Maryland 21224 410.534.1161