Posted by on in Digital Health, Payers

Samsung and Cigna have agreed to a multi-year development alliance for health applications for the Samsung smartphone. The partners will initially focus on content (access to the health-related tips and articles Cigna already offers its customer base). Ultimately, the partnership will “connect individuals with caregivers, doctors and hospitals to improve health and wellness globally.” So far, the announcements have been silent on any exclusivity. In our view, the content deal is a sideshow: health and wellness tips are highly commoditized and an insurer an undifferentiated supplier for this content. I believe building connectivity among patients and their continuous biometric data,… Read More

Posted by on in Providers

In 2011, we would tell our payer clients (tongue firmly ensconced in cheek) that the answer to all questions was “private exchanges.” In 2012, the punchline changed to “narrow networks.” In 2013, what is not a joke is that payers and health systems are really having to grapple with difficult strategic choices on partnerships, affiliations and M&A relating to facilities and medical groups in order to actually deliver on the value promise of narrow networks (higher value care).Two key inputs into these choices are: The geographic catchment area of each entity The referral patterns across entities (graph/ network analysis) In… Read More

Posted by on in Payers, Providers

Market for outsourced revenue cycle management could be big The revenue cycle management (RCM) vendor industry is about $2.0B for hospitals and $11 billion for physicians today. The market is constrained because most providers do their own RCM. Vendors only have a ~10% penetration among hospitals and a 25% penetration among physicians (implying that the potential combined hospital and physician market is $60-70B). However, RCM as a function is getting more complex and outsourcing could quickly start looking more attractive: Value-based contracting models raising the stakes in documentation, reporting, benchmarking, and dispute resolution Continued proliferation of high deductible… Read More

Posted by on in Digital Health, Providers

Quick follow-up to our post about the Epic-eClinicalWorks deal: Today’s Healthcare Informatics has an interview with Martin Harrison, CIO of Cleveland Clinic, was asked what is the biggest strategic IT challenge right now. His answer? The challenge element is partly being driven by the complexity of the challenges in this value-driven world. So all the care providers belonging to this collaborative probably will not belong to the same organization. So the biggest challenge to my mind right now is the effectiveness of interoperability. We talk about it a lot, but the effectiveness and sophistication are going… Read More

Posted by on in Digital Health, Providers

Epic is famous for its intense focus on interoperability across its own systems coupled with its conservatism regarding interoperability with other EMRs. In 2012, KLAS said Epic has the “deepest data sharing of all the vendors” across its own practice and hospital EMRs (see this example in which Cleveland Clinic and neighboring system MetroHealth — both on Epic — have put interoperability in place). But when it comes to non-Epic systems, customers must work through defined “exits” to the Epic system (“we don’t let anyone write on top of our platform” per Epic’s CEO) and interoperability –… Read More

Posted by on in Providers

Summary Michael Porter and Thomas Lee have articulated a strategy for fixing healthcare focused on restructuring providers and assessing them based on metrics “that matter to patients” The most compelling example they cite of system-wide improvement (vs. anecdote) is the case of IVF where public outcomes reporting demonstrates widespread and consistent performance improvement However, the IVF story has several unique features which make it an exception rather than a model for improving healthcare System improvement cannot be a matter of supply-side restructuring and outcomes metrics: market forces needs to be brought to bear to demand those improvements. For that you… Read More

Posted by on in Providers

Summary In August and early September, several Ohio provider systems have picked sides in the competition between Catholic Health Partners and Cleveland Clinic The recently announced Health Innovations Ohio collaboration signals that Catholic Health Partners is playing for the overall Ohio market; however, there is no clear, attractive competitive response for Cleveland Clinic Cleveland Clinic lacks a footprint in populous southern Ohio to match Catholic Health Partners but it is not obvious which systems there would seek an alliance or an acquisition Cleveland Clinic and Community Health Systems joint venture has quickly evolved changed form a clinical collaboration to an… Read More

Posted by on in Payers, Providers

Last week, I argued that, if payers want to secure competitive advantage from improved provider care, they would need tighter, more exclusive alignments with these providers to “crowd out” the free riders (the “free riders” in this case are the other payers who have members being treated by the same providers and who can therefore share in any improvements). Two deals last week suggest a case study of the concept may be developing in southeastern Wisconsin: On September 9, Anthem announced that it will be teaming up with highly ranked Aurora Healthcare on a narrow network product for… Read More

Posted by on in Payers, Providers

A new study in JAMA (by McWilliams et al.) looks at the Medicare expenditures of patients seeing providers enrolled in the BCBS of Massachusetts version of the ACO (Alternative Quality Contract or “AQC”). The AQC model covers only commercial lives and all of the relevant providers had FFS reimbursement from Medicare during the time of the study (several later became ACO Pioneers). The study tests whether providers rewarded to be more efficient for one pool of patients (BCBCMA commercial HMO lives) will take the same approach to care with other patients irrespective of payer. The study found a significant… Read More

Posted by on in Payers, Providers

Summary Earlier this year, Catholic Health Partners, the largest provider in Ohio, signed two deals which put it on a competitive collision course with Cleveland Clinic Cleveland Clinic has few options to further solidify its already strong position inside Cleveland, so it had to look elsewhere for a competitive response  With a clinical affiliation with Promedica, Cleveland Clinic can competitively threaten Catholic Health Partners in Toledo / northwest Ohio If Cleveland Clinic’s relationship with Promedica matures into a full affiliation, they could acquire Promedica’s Ohio insurance license, opening a whole new range of potential strategic pathways for Cleveland Clinic… Read More