Movement to Downside Risk in Healthcare
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Michael Barrett, Founder of CURA Health Management presented at the ACO Leadership Forum!
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Movement to Downside Risk in Healthcare
- 1. C U R A March 2ND 2018
- 2. 2018 CURA Health - Confidential and Proprietary Start Movement to Downside Risk Arguably THE Paradigm Shift in Healthcare • Paradigm Shift, big words for change • Why are we changing? • Unsustainability unpacked • Speed and Tipping Points • New Rules…. “Who would of thought?” • Three Levels of Change Management • Strategic • Intermediate Tactical • Granular Cycles Times • Provider Engagement • Another word for leverage?
- 3. 2018 CURA Health - Confidential and Proprietary Start Paradigm Shift to Risk…. Why!? • Headlines that need unpacking • 10,000 people/day into Medicare • MA enrollment opportunity • Unsustainable Federal Budget • Medicare budget expansion • Tax payers unable/willing to pay increased taxes • How much per day? ~ $1.00 per day increase per U.S. family • Provider, $15 million/day revenue evaporation • Bending the Cost Curve • The bend is someone’s revenue • Redundant waste, poor design waste, • Abuse of the patient waste • Fraud • It is about “other peoples money”
- 4. 2018 CURA Health - Confidential and Proprietary Start • Individual market timed…. Sort of. • Rural typically last, • Middle suburban first, • Major suburban second • Slowest adopter loses. • It is your revenue, market share that is saved, harvested by others • Cost per capita/procedure sky rocket • Similar to underwriting death spiral in HMOs, but worse • Fixed costs vs. capital base • Small, nimble, low fixed costs….. Speed and Tipping Points
- 5. 2018 CURA Health - Confidential and Proprietary Start New Rules • VBP, Bundles, Benchmarks, Risk Scores, Quality Scores, etc, etc. • MSSP ACOs, • Regional Benchmarking…. If you have more than 10k lives 90% of ACOs will benefit by splitting into two or more ACOs • Performance based selection - Cost, Quality, Risk Scores • NAACOS Boot Camp • State Level Insurance Regulations
- 6. 2018 CURA Health - Confidential and Proprietary Start CMS-HCC Calculation Example Part I: RAF for Individual Beneficiaries Andrew Webster NAACOS Consulting Actuary Founding Partner, Validate Health
- 7. 2018 CURA Health - Confidential and Proprietary Start Three Levels • Strategic - Does your governing body understand why? • Road map and timeline the changes • Revenue to Cost Centers • Fixed costs vs. Variable Costs • Real Estate vs. Risk • Risk entities, Captives vs Operational Entities • Managing the Strategy Risk vs. Enterprise Risk • Pools vs. War Chest • Leverage and Engagement • 4x Win opportunities • PCP, Specialist, Patients, Hospital (leakage)
- 8. 2018 CURA Health - Confidential and Proprietary Start Intermediate and Granular Cycles • Low hanging fruit? NO! What is 1st? • Analytic Paralysis vs. Incontrovertible Actions • Clinical/Health risk prediction • Early successes • Is it an human interest story? • Does it resolve a systemic failure? • Speed, Tell them again, Speed, Tell them again
- 9. 2018 CURA Health - Confidential and Proprietary Start Intermediate and Granular Cycles • Low hanging fruit? NO! What is 1st? • Analytic Paralysis vs. Incontrovertible Actions • Clinical/Health risk prediction • Early successes • Is it an human interest story? • Does it resolve a systemic failure? • Speed, Tell them again, Speed, Tell them again
- 10. 2018 CURA Health - Confidential and Proprietary Start Provider Engagement vs Leverage Moral Consequence Economic Consequence “More Burden Equals NO DEAL!” Dr. Randall Curnow EVP Clinical Affairs Summit Medical Group
- 12. 2018 CURA Health - Confidential and Proprietary Start Thank you