Tory Wolff, Author at Recon Strategy

Cigna and Samsung: assembling a “global account”-based business model for mobile

Tory Wolff November 30, 2013

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

Marrying into the right family: the bets underlying United’s revenue cycle management joint venture with Dignity Health

Tory Wolff October 30, 2013

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,

Declining value of the EMR walled garden? An emerging signpost from Cleveland Clinic

Tory Wolff October 4, 2013

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

Change in tactics or change of heart? Speculations on the eClinicalWorks–Epic interoperability announcement

Tory Wolff October 3, 2013

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

Metrics alone will not unleash the market: Porter and Lee ignore the demand side to the peril of their proposed strategy

Tory Wolff September 30, 2013

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

Quiet after the storm: Is there an emerging competitive equilibrium in Ohio?

Tory Wolff September 23, 2013

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

Strategic “crowd-out” via narrow networks: an emerging case study in Wisconsin

Tory Wolff September 16, 2013

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

ACO proliferation and provider “all-payer” care models inexorably lead to tighter network strategies

Tory Wolff September 1, 2013

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

Making flanks something for the enemy to worry about: the Cleveland Clinic-Promedica deal and the emerging battle for northern Ohio

Tory Wolff August 20, 2013

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

When do you know ACOs are here to stay?

Tory Wolff April 11, 2013

Answer: When they form an industry association! Back in February, a group came together to form a national association for ACOs (NAACOS) to, according to the announcement press release, promote the growth of the model, industry standards, best practice sharing and vendor engagement. What was missing from the press release was fixed on the web site which adds as goal #2: “Participate with Federal Agencies in the development and implementation of public policy”. In other words: lobbying. And, of course, as the model evolves from Medicare to commercial and Medicaid populations, state level policy will also need

Cleveland Clinic’s bold land grab in care improvement: the Community Health Systems deal

Tory Wolff March 21, 2013

Summary The deal locks in an option for Cleveland Clinic to grow its clinical practice transfer business 4x its current size and much larger than Cleveland Clinic’s peers There will be significant challenges to executing given the wide geographic dispersion, Community Health Systems’s mostly unranked facilities and strategy of using the hospital “channel” to drive change in care practice In the long run, the deal will reinforce Cleveland Clinic’s advantage in Big Data (it will take time to realize this) Community Health Systems faces little competition in many markets, potentially

Risk-taking providers in private exchanges: Medica’s “My Plan” private exchange

Tory Wolff December 4, 2012

At a TEDMED conference a couple years ago, I had to write some sample “ask me” questions on the bottom of my ID badge as conversation starters. One of them was “Ask me why PHIX+ACO=:-)” Given the presentations on 3D tissue printers and technologies to help blind people just about see again, I was not surprised to have few takers. However, recent news from Minnesota suggests that others see the potential in combining risk-taking providers with exchanges. Medica – one of the early leaders in private exchanges with Bloom Health

Getting the troubled Highmark-West Penn relationship back on track: an outside-in speculation

Tory Wolff December 1, 2012

Summary Highmark and the West Penn Allegheny Health System (WPAHS) are not aligned on their vertical strategy to counter UPMC in the Pittsburgh market WPAHS can only absorb a portion of Highmark’s care demand now being met by UPMC. So its upside on the success of Highmark’s vertical strategy is capped Highmark would prefer a deal with UPMC if it get reasonable rates: the status quo looks better than the uncertainties of a vertical model build A large share of UPMC’s business still comes from Highmark which makes UPMC vulnerable.

Romance of convenience: perspectives on the IASIS-Aurora joint venture

Tory Wolff September 23, 2012

Summary Two major hospital systems have agreed to a joint venture to explore growth opportunities on a “case by case” basis One system is a major non-profit, the other a PE-backed for profit serial acquirer; their strategies, capabilities and geographies of both partners do not overlap The venture is likely focused on sharing capabilities and allowing each partner to take those back to their core markets Given the complementary skill sets, competitors to either system would be wise to expect upgrades in traditional weak spots * * * A few

Heartland Health: Marching towards Kansas City with Mayo on its shoulder

Tory Wolff May 31, 2012

Earlier this month, Heartland Health signed a deal with the Mayo Clinic for its doctors to virtually consult cases with Mayo physicians in return for an undisclosed fee. Heartland Health is a regional medical system in northwest Missouri and includes a ~350 bed acute care hospital (Heartland Regional Medical Center) with 200+ medical staff physicians, and the Heartland Clinic with 100 providers in 23 locations. Heartland is now the fifth hospital system to join the Mayo Clinic Care Network (MCCN), a structure launched by Mayo in September 2011. The deal substantially

The Blues system and PHIXs: not standardizing on a single utility

Tory Wolff May 29, 2012

BCBSMN has licensed the platform for its private health insurance exchange (PHIX) and defined contribution product from eHealth (original announcement April 30). For eHealth, which has seen its government systems revenue fall off by $2M year-over-year in the most recent quarter (per Q1 2012 analyst call), the deal will be a welcome addition to its non-commission revenue stream. It also represents a significant in-road into the Blues system (the previous deal with Blues I could uncover was in mid-2010 for licensing the technology behind Premera’s online Medsupp sales). It appears

Towers Watson’s bold move in private insurance exchanges: leapfrog Aon and leave Mercer’s alliance compromised

Tory Wolff May 23, 2012

With its acquisition of Extend Health, Towers Watson has ensured that (1) PHIXs will be a key competitive arena among the major benefits consultants and (2) that it has taken the lead. Extend Health serves 170K members and has annual revenues of ~$50M+, EBITDA margins of ~30% and a growth rate in the most recent reported quarter of 40% vs. a year ago (all taken from the S-1 filing and acquisition press release). Two leading competitors have been publicly discussing their capability building: Aon Hewitt began their exchange in April

CIGNA fills in its Medicare portfolio with Great American acquisition

Tory Wolff May 15, 2012

Last week, CIGNA acquired the Great American Supplemental Benefits from American Financial Group (AFG) for $295M in cash. Per press releases, the key financials for the acquired business are: A few observations on the acquired business: ~90% of the acquired revenue is driven by MedSupp. Public reports suggest 100K-125K MedSupp lives (250K lives total for the acquired business). Historically, AG’s MedSupp lives have been well distributed in the US with the exception of a sizeable position in Texas (the acquired business is Austin-based). The other 10% includes a variety of

Big box retail as health insurance channel: thoughts on the Aetna-Costco deal

Tory Wolff April 27, 2012

Summary Aetna has struck a deal to sell individual health insurance with Costco, the #6 retailer. The deal targets 9 populous states first with more to follow in 2012 While the deal lacks some of the levers of the very successful Walmart-Humana Part D deal, there is real potential for this channel to attract consumers if employers opt-out on a large scale Given that Aetna has some arrangements with Best Buy (the #9 retailer) and an established alliance with CVS (the #7 retailer), it looks like Aetna is building out

Payment reform: some observations on skepticism

Tory Wolff April 19, 2012

There have been some blog posts (here and here) about a discussion on payment reform at the Massachusetts Health Data Consortium last week. While I did not attend, the commentary is provocative and I would like to offer a few observations. The discussion included some critical perspectives on the prospects for implementing payment reform and whether its implementation will really bend the trend. My main point in response to the dialog is that payment reform needs to be understood as part of a dynamic trajectory, a multi-stage game. Couple variations

Author: Tory Wolff

Recon takes an analytical look behind select developments in healthcare