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Eric Klein is is a partner in the Century City office and Leader of the Healthcare Team.

What do Centene, CVS Health-Aetna and Humana all have in common? (Trying really hard not to start off with a “three health plans walk into a bar” joke…). Well, if you were at the 41st annual J.P. Morgan Healthcare Conference, you would know that all three are waiting to see what the upcoming final rule on Medicare Advantage risk adjustment data validation (known as RADV) audits will mean for the industry when it drops in February. And, wait, before you switch-off and think that this is a subject of intensive geekery, you should know that this topic impacts the foundational transformation of the healthcare industry from traditional fee-for-service reimbursement to value-based and risk-based reimbursement models, underlies the ability of the healthcare industry to undertake risk stratification to put healthcare resources where they are needed, and implicates billions and billions of dollars paid to health plans and providers. Estimates vary widely in the marketplace, from $12 billion (MedPac) to $200 billion (Richard Kronick, Health Affairs). That’s worth a look in my book. It’s also enough to cause the chief executive officers of these three plans to discuss the possibility of industry litigation against the federal government – which threat was effective in an earlier round of health plans versus CMS and delayed audits, enforcement actions and repayments under the Medicare Advantage risk adjustment program for years.Continue Reading Day 2 Notes from the 41st Annual J.P. Morgan Healthcare Conference

I was struck on the first day of the 41st Annual J.P. Morgan Healthcare Conference by Sanjay Doddamani (CEO of UpStream Healthcare) saying that “Health is a state of independence.” A simple statement, but a very profound and interesting lens through which to view the Day One Medicare Advantage-focused company presentations. Perhaps it struck a chord in me because, in a flurry of presentations today touting patient net promoter scores (NPS), that simple statement brings to mind the feelings associated with dignity, respect, self-reliance and, perhaps most importantly, choice – concepts that are hard to quantify into a neat NPS number but which we all recognize and understand. Good health indeed does allow us the chance to be independent, while poor health, economic insufficiency and/or aging can force us into dependence, burden and obligation. I don’t have to take a scientific poll to determine which you personally would prefer.Continue Reading Day 1 Notes from the 41st Annual J.P. Morgan Healthcare Conference

Thursday, January 13 was the last day of the virtual J.P. Morgan Annual Healthcare Conference for 2022. And since the conference was virtual, what better topic to start us off today than a consideration of the new Virtual-First trend that surfaced in 2021. We’ll follow that with a dive onto the couch to consider the conference’s mental health offerings and where the behavioral health sector is heading.
Continue Reading Day Four Notes for the 40th Annual J.P. Morgan Healthcare Conference, 2022

Have you been working out recently? We hope so, for today, Day Three of the 40th Annual J.P. Morgan Healthcare Conference, was definitely a day for heavy lifting.  Got a challenge that seems overwhelming? A problem that’s big enough to totally scare other folks? Do you eat triathlons for lunch? Well, then you’re going to like the Day Three companies. Let’s talk about fixing the huge American diabetes problem, providing better healthcare for Medicaid and dual eligible beneficiaries, and helping people beat cancer.  All that, plus a COVID-19 thought exercise…
Continue Reading Day Three Notes for the 40th Annual J.P. Morgan Healthcare Conference, 2022

The phrase “whole person health” kept echoing through the virtual hallways during the second day of the 40th Annual J.P. Morgan Healthcare Conference. Looking at the whole person – not just separate organs or body systems – may seem obvious and commonsense, but it’s not how our (well planned, highly logical) healthcare system currently is structured.
Continue Reading Day Two Notes for the 40th Annual J.P. Morgan Healthcare Conference, 2022

For those of you who know me, I like to have fun with my Zoom backgrounds – choosing photos of interesting scenery or changing them mid-call to reflect my mood or negotiating strategy. Sitting in front of my computer this year for the first day of the 2022 J.P. Morgan Annual Healthcare Conference (the 40th annual!), I was lamenting the bland, boring backgrounds of the presenters who were using low-quality stock shots or empty office views until I realized that I was looking at the wrong thing. I really had to look at the shadows and not the backgrounds. There are a LOT of shadows over this year’s J.P. Morgan Conference – COVID-19, the jittery stock market, the future of Medicare Advantage and recent industry changes.
Continue Reading Day One Notes for the 40th Annual J.P. Morgan Healthcare Conference, 2022

We’ve been talking about telehealth and mental health this week. Here’s both combined in one interesting and highly valued announcement today, followed by several tests – well, 3 million COVID tests a week to be exact, and, speaking of Exact Sciences, developments in the early detection tests for the other major disease that is most feared, cancer.
Continue Reading Day 3 Notes for the 39th Annual J.P. Morgan Healthcare Conference, 2021

It’s Day 2 of the J.P. Morgan Annual Healthcare Conference at its finest – looking closely at healthcare inequities, strategic business shifts and killer robots, all in the same day! (Yes, we did say killer robots and it’s your reward for reading all the way to the end of this article).
Continue Reading Day 2 Notes for the 39th Annual J.P. Morgan Healthcare Conference, 2021

Sitting in the dark before 6 am in my Los Angeles house with my face lit up by yet another Zoom screen, wearing a stylish combination of sweatpants, dress shirt and last year’s JPM conference badge dangling around my neck for old times’ sake, I wonder at the fact that it’s J.P. Morgan Annual Healthcare Conference week again and we are where we are. Quite a year for all of us – the pandemic, the healthcare system’s response to the public health emergency, the ongoing fight for racial justice, the elections, the storming of the Capital – and the subject of healthcare winds its way through all of it – public health, our healthcare system’s stability, strengths and weaknesses, the highly noticeable healthcare inequities, the Affordable Care Act, Medicaid and vaccines, healthcare politics and what the new administration will bring as healthcare initiatives.
Continue Reading Day 1 Notes for the 39th Annual J.P. Morgan Healthcare Conference, 2021

CMI, CMMI, and Changing the Consumer Experience in the U.S. and China

Case Mix Index: Sitting in multiple hospital, payor and physician organization presentations at the J.P. Morgan healthcare conference this year, it is clear that the healthcare market continues to move ahead with the shift toward value and risk-based reimbursement. But, the number one target for healthcare savings in a value or risk-based reimbursement model is the reduction of hospital inpatient admissions and bed days where clinically appropriate, which likely will reduce hospital revenue and perhaps profitability unless proactive responses are taken. Yet, at this year’s conference only a minority of the hospitals presenting spoke to a critical indicator for their financial wellbeing that will become even more important for hospitals’ survival in a risk-based environment.
Continue Reading Day 3 Notes at the 2020 J.P. Morgan Healthcare Conference