J.P. Morgan Healthcare Conference

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Looking out at the San Francisco skyline from the top floor of the Westin St. Francis on Day 3 of the 42nd Annual J.P. Morgan Healthcare Conference, the iconic Transamerica pyramid is not too far away. But my mind, being chock-full of value-based care presentations, quickly imagines the building as the shining pyramid of patient segmentation and risk stratification, envisioning the proper way to sort patients for effective intervention and total cost of care reduction. John Kao, CEO of Alignment Healthcare, shared today that only 12% percent of their Medicare Advantage membership accounts for approximately 74% percent of their institutional cost (hospital and facility costs), while conversely their “healthy” membership of 74% accounted for only 5% of their institutional costs. These days, institutional costs and pharmaceutical costs are almost equal, according to the Advisory Board, and together far outweigh professional physician and other provider costs. Therefore, keeping patients out of the hospital and post-acute facilities as medically possible and appropriate and effectively managing medications should result in a large reduction in the total cost of care, right? So, what’s not happening that should be?Continue Reading Day 3 Notes from the 42nd Annual J.P. Morgan Healthcare Conference

Sustainability of our healthcare system was an interesting topic at Day 2 of the 42nd Annual J.P. Morgan Healthcare Conference. Paul Markovich, CEO of Blue Shield of California, expressed the concern that “[T]he status quo is an existential threat to our healthcare system.” Markovich is worried that the healthcare system is losing the public’s trust – which will make it harder to effectively fix our system – while also not delivering the quality of care and accessibility needed by our population. For example, Christopher Riopelle, CEO of Strive Health, shared today that 42% of U.S. patients whose kidneys fail never have seen a nephologist prior to that catastrophic event, and 90% of kidney disease patients are undiagnosed. For a disease that has a total spend of approximately $420 billion, how is our system missing these patients?Continue Reading Day 2 Notes from the 42nd Annual J.P. Morgan Healthcare Conference

One of the topics I followed with keen interest this week at the J.P. Morgan Healthcare Conference is how our healthcare industry today is addressing the mental health needs of Americans. Like much of the rest of healthcare, it is a mix of exciting innovation, contradictions, siloed approaches and the entrepreneurial Wild West. Pull up your favorite couch or chair, and let’s dive in and take a look together.Continue Reading Day 4 Notes from the 41st Annual J.P. Morgan Healthcare Conference

Here’s a new word I heard today that I will awkwardly insert into my next conversation – “transrupt.” It is what happens when you have simultaneous disruption and transformation that both damages the existing system and creates (hopefully) a new and better system. Using it in a sentence: “Amazon transrupted how books are sold.” Or perhaps more apropos to this week – “Someone needs to transrupt the orthopedic/ MSK (musculoskeletal conditions) sector.”Continue Reading Day 3 Notes from the 41st Annual J.P. Morgan Healthcare Conference

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