August 2011 - Recon Strategy

Provider incentives in the commercial ACO: retaining a small share of savings in return for future volme growth

Tory Wolff August 24, 2011

Earlier this month, Blue Shield of California announced 2010 results from an ACO partnership with the Catholic Healthcare West hospital system and Hill Physicians. The ACO achieved savings of $20M on a CalPERS population of 41.5K commercial and Medicare lives (where Blue Shield was the secondary payer) — $480 per person or 13% of sponsor costs (average sponsor premium contribution estimated at $3,735 based on press report that $15.5M equaled to 10% of premiums). These results appear to be significantly better than the results of the Medicare Physician Group Practice

Partners’ acquisition of Neighborhood Health Plan: reinforcing the role of community health centers in the care continuum

Tory Wolff August 18, 2011

Much of the public speculation (for example here and here) regarding the acquisition of a local high quality safety net health plan — is it about locking in Medicaid volume? or about doing a “good deed” before regulators make decisions about Partners market influence? – is not very persuasive. Partners is already under intense scrutiny — a program of pushing Medicaid volume to its own facilities would contradict its public promises, exacerbate regulator suspicion and not be very profitable anyway. And if regulators believed Partners has the market power to

The curious absence of payers in public HIEs

Tory Wolff August 12, 2011

Last week, the National eHealth Collaborative published a study of sustainability strategies for 11 leading health information exchanges (actually 12 including the VA). I’ll call these public HIEs to distinguish them from private HIEs – proprietary exchanges among a select group of providers such as an integrated delivery system. Remarkably, payer funding has a relatively small role across the sample: Only 3 report payer funding as an essential part of their current revenue model: Availity (a joint venture among major Blues and Humana), the Rochester RHIO and the Quality Health

Medicaid going mainstream: thoughts on the IBC / BCBSM / AmeriHealth deal

Tory Wolff August 10, 2011

Historically Blues have shied away from Medicaid. Two thirds of plans do not serve any Medicaid and those that do often have disproportionately small shares. No real surprise: Medicaid specialist plans can fluidly move in and out of markets depending on the rates and redeploy their capabilities wherever are the best returns. Blues on the other hand, are prime “hold-up” targets because they are largely stuck in their assigned states. They can only respond to an offer of low rates with a threat of dismantling their Medicaid operations entirely (and

ESRX-MHS Part 2: mail facility speculations (…or: Indulging my Inner SWAGer)

Tory Wolff August 1, 2011

Summary ESRX was running at close to maximum capacity at its mail facilities while MHS has room to spare. ESRX is facing a scenario of significantly increased demand as greater mail penetration is achieved in the Wellpoint book and lacked the capacity to meet this demand. Similarly, ESRX would not be able to meet increased demand from reform coverage expansion. By combining, ESRX avoided having to build a new facility and the combined entity appears to have enough capacity to close at least one older mail facility. Given that a

Month: August 2011

Recon takes an analytical look behind select developments in healthcare

Provider incentives in the commercial ACO: retaining a small share of savings in return for future volme growth

Partners’ acquisition of Neighborhood Health Plan: reinforcing the role of community health centers in the care continuum

The curious absence of payers in public HIEs

Medicaid going mainstream: thoughts on the IBC / BCBSM / AmeriHealth deal

ESRX-MHS Part 2: mail facility speculations (…or: Indulging my Inner SWAGer)

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