No I'm not kidding. Just think about it. If the reimbursement goes to the primary care doctors organizations to manage risk, where does that leave you. Not necessarily in the drivers seat ....but possibly the costly subsidiary! Yes I am talking to hospital CEOs, soon to be known as facility general managers??
It may never go that far, but what if?
Should you be nice to the Community Clinic? Should you try to control it? Should you apply for one of those jobs? We shall see if the talent gravitates to the outpatient and insurance risk side of the business. My money is that it will.
With Ascension's announcement, what if Community Clinics started to buy hospitals in their for profit business line? No? Who ever thought Catholic hospitals would be going for-profit.
Thursday, February 24, 2011
Friday, February 18, 2011
TO ACO or NOT TO ACO? That is the question!
Or at least that is the debate. My money is on the organizations that have a solid integrated system plan that can manage medical loss ratios...ie can manage care and outcomes. And can manage capital investment to proven utilization models.
There is alot of ink or cyber-ink being used to debate whether ACOs are the managed care models of the past; whether they are PHOs or not? This is not the issue.
Its the economy stupid! Its the debt. Medicare, Health Insurance paid by Business and Medicaid will shrink on a per capita basis. No one is willing to pay what it would take to sustain the healthcare cost growth trajectory.
Hospitals are beginning to realize that they will not "make the kind of money" that they have in the past with an ACO model. That is a micro problem but a macro solution. The fact that hospitals will not eat up more of the dollars solves the macro problem. The micro problem for "health professional" (hopefully hospital CEOs are beginning to see themselves in this category) is to assure that individual patients have better outcomes with less money spent on expensive hospital care and that the local structures evolve to make that model sustainable.
Or do we just fight it. Lobby for the end of "Obamacare" and fight for every dollar. I don't see any future in that - even if that is the strategy that wins. I hope we stay the course on this one and begin the painful reshuffling that needs to be done. The shake out!
There is alot of ink or cyber-ink being used to debate whether ACOs are the managed care models of the past; whether they are PHOs or not? This is not the issue.
Its the economy stupid! Its the debt. Medicare, Health Insurance paid by Business and Medicaid will shrink on a per capita basis. No one is willing to pay what it would take to sustain the healthcare cost growth trajectory.
Hospitals are beginning to realize that they will not "make the kind of money" that they have in the past with an ACO model. That is a micro problem but a macro solution. The fact that hospitals will not eat up more of the dollars solves the macro problem. The micro problem for "health professional" (hopefully hospital CEOs are beginning to see themselves in this category) is to assure that individual patients have better outcomes with less money spent on expensive hospital care and that the local structures evolve to make that model sustainable.
Or do we just fight it. Lobby for the end of "Obamacare" and fight for every dollar. I don't see any future in that - even if that is the strategy that wins. I hope we stay the course on this one and begin the painful reshuffling that needs to be done. The shake out!
Tuesday, February 8, 2011
Merger, Acquisition...more and more
Seems that the healthcare landscape is "achangin"! Lots of for profit gobbling up of each other...."consolidation in the market". And lots of seemingly unheard of activity - Catholic to for-profit. A once lonely venture in Chicago, the for-profit market is heating up in the state.
And guess who has the longest sustained bottomline - members of for-profit chains. The big winners in the top tier are for profit (with the non-profit chains running second). The unsustainables continue to be the independent or inner city hospital where there are few buyers but potentially lots of politics to bolster the bottomline on the brink of disaster.
The latest talks in Illinois between Provena and Resurrection are interesting. No real news there- just larger. Both number two in two hospital towns. Neither has a strong brand. So where is the magic going to come from? No large medical group to compete; no academic center wannabees in the mix. Is it a play to get Loyola to play ball. Seems like a drastic measure just to get an academic presence in the mix. Some major decisions to be made. Vision?? Will they beat the competition in the market by virtue of size? Size requires more capital, remember.
And guess who has the longest sustained bottomline - members of for-profit chains. The big winners in the top tier are for profit (with the non-profit chains running second). The unsustainables continue to be the independent or inner city hospital where there are few buyers but potentially lots of politics to bolster the bottomline on the brink of disaster.
The latest talks in Illinois between Provena and Resurrection are interesting. No real news there- just larger. Both number two in two hospital towns. Neither has a strong brand. So where is the magic going to come from? No large medical group to compete; no academic center wannabees in the mix. Is it a play to get Loyola to play ball. Seems like a drastic measure just to get an academic presence in the mix. Some major decisions to be made. Vision?? Will they beat the competition in the market by virtue of size? Size requires more capital, remember.
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