Symposium issue for Sept 2015

Survival and the Middle Picture

2016 ConvUrgentCare Symposium Issue

Managing a large enterprise in a predictable environment is tough enough.  But when it turns unpredictable, it becomes a complex web of cash flow management, hard decisions about your employees and leadership, and risky new strategic paths.  As many of you have heard me say, I lived through this in the mainframe computer business.

I have also said the business of taking care of people is no longer a predictable enterprise, and in many ways the hospital business model reminds me a lot of the mainframe business model.  Big computing fell victim to small computing.  High acuity is falling victim to low acuity.  Or better said, the lower the acuity level, it seems, the lower the predictability.  It is now all about questioning your assumptions.  Constantly.   

I am the host of our annual ConvUrgentCare Strategy Symposium and each year we try to bring together speakers that, when taken together, tell a story that helps you manage to an uncertain future.  The 2016 ConvUrgentCare Strategy Symposium is about looking at what we call “The Middle Picture.”  You have heard the big-picture talks from healthcare futurists.  About half of their predictions will come true, you just don’t know which half.  And there are conferences that go into the nitty gritty details on everything from facilities management to ICD-10.

But the middle picture is all about executing on future trends that we know are going to happen and building new teams and partnerships that are 100 percent committed to winning at their particular part of the challenge.

Here are three of those trends we know are going to happen:

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Health Plan Landscape for the Walk-in Operators

March 2016 - Health Plan Landscape for the Walk-in Operators
By Bernie Kuhn

The health plan industry survived the ACA implementation and the first few years of the new plan structures.  The rate of change isn’t slowing however.  Millions of newly covered lives (25% of which auto-renewed in January) on-boarded into the US health system.  Demographic trends and regulatory forces continue to change their business mix from group commercial to individual products.  But the effect of consumerism seems to be the big question.  High deductible plans haven’t driven price shopping so much as they’ve curtailed spending.  Plans have been making investments in consumer technology and engagement which will affect the walk-in business.

As this month’s newsletter is being prepared, the annual health insurance statutory reporting cycle is wrapping up and full year 2015 results hit in April.  Look for major announcements as plans merge for scale and to grow their Medicare Advantage volume (Aetna/Humana).  We expect to see several smaller Blue plans merge into larger plans.  Blue plans may compete amongst themselves (via Anthem/Cigna), and Aetna and UnitedHealth (via Optum) will continue to build their infrastructure as a service arm of health systems.  There may in fact be better money from running operations for health systems than in covering risk and chasing employers – the business case is pretty straightforward if/when a single or dual payer model occurs.  

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May 2016 newsletter - initial content

May 2016 article by Rob Rohatsch

Making the Strategic Provider Staffing Decision

Throughout my career as an emergency medicine physician and as an entrepreneur in urgent care medicine, I have had the pleasure of working with many nurse practitioners (NPs) and physician assistants (PAs) in various staffing models.  In the emergency department (ED) during residency, they were typically assigned to a section of the department where lower acuity cases were triaged.  In my program, they were almost exclusively NPs.  They functioned fairly independently from the physicians but had full access when they had questions.  Their scope of practice in the ED was controlled by the triage nurse with protocols established based on the chief complaint of the patient.  There are some studies that suggest nearly 15% of all patients seen in an ED are seen by either a PA or NP.  After residency, as an attending physician in emergency medicine, I worked with primarily PAs under two different staffing models. In one large urban ED, I worked with PAs assigned to a ‘fast-track’ area of the ED and had patients triaged to them in a similar manner to my residency experience.  In a smaller ED I worked in, I worked along side a PA and we saw patients in an alternating fashion with no triaging based on acuity.  My experience as an ED physician indelibly etched in my mind their value in an acute care setting.

The US health care system is the most costly in the world, accounting for an estimated 20% of the gross domestic product by 2020.  In an attempt to mitigate this alarming statistic, the Institute for Healthcare Improvement (IHI) developed the Triple Aim framework in 2007.

    Improving the patient experience

    Improving the health of populations

    Reducing the per capita cost of health care

So how can we as operators of walk in healthcare services work towards the IHI goals?  Can something as simple as a staffing model change yield improvements in all three areas?  How do the policies of payers, government agencies, and other competing interests confound the ability to make a strategic decision on provider staffing models?  A review of the literature on the subject provides some interesting results. 

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