Modern Healthcare | Dave Barkholz
June 14, 2016
Mega-mergers by commercial insurers are prompting hospitals to partner up and that’s creating an arms race that is not improving the cost of care for consumers, said panelists at a Nashville Health Care Council luncheon Tuesday.
The real secret weapon is big data, which is still years away from being properly harnessed and shared among providers so they can manage the health of populations better, said Paul Kusserow, CEO of investor-owned Amedisys, one of the nation’s largest home health and hospice providers.
Before providers can really move to away from fee-for-service to capitation and other forms of financial risk-taking, “data is the big element,” he said.
Kusserow was joined on the panel by Dr. Wright Pinson, CEO of the Vanderbilt Health System, Contessa Health CEO and Co-founder Travis Messina and Michael Burcham, founder and CEO of Narus Health.
The panel, titled “Shaping the New Continuum of Care,” was moderated by Dr. David Gruber, managing director and director of research for the Alvarez & Marsal Health Care Industry Group.
Pinson said systems like Vanderbilt are good at and comfortable with providing care for a fee. It gets more complex when they agree to accept bundled payments or a set amount for providing for an entire episode of care such as a joint replacement that requires the financial risk for post-operation treatment as well.
The latter requires coordination with partners that may not be owned by the system and have different electronic medical record systems and revenue-cycle vendors. Those barriers make it difficult to price episodes and assure everyone is getting a fair slice of payments, Pinson said.
Providers have three to five years to get their systems in place before managed care and at-risk payments really start to supplant fee-for-service, Kusserow predicted.
Messina said he was a vice president in Vanguard’s development group when the hospital company was bought by Tenet Healthcare because it didn’t think it had the size and leverage to continue going toe-to-toe with payers.
Today, hospitals are looking at giant proposed mergers between Aetna and Humana and Anthem and Cigna and wondering if they are big enough to maintain pricing for care, he said. Contessa Health arranges and manages the services required to deliver hospital-level care in a patient’s home.
Burcham from Narus said providers also have to get mobile-enabled to communicate with patients. Millennials and those born earlier don’t want to log into a desktop portal to review records and communicate with clinicians. They want it now over their mobile devices and hospitals will have to comply in a secure, convenient manner as they become the majority share of the population, said Burcham who founded the palliative care company.
“Stop building portals,” he said.
Dave Barkholz is Modern Healthcare’s Southern Bureau Chief stationed in Nashville. He covers hospitals, doctors, suppliers and governance across the Southeast. A winner of numerous national journalism awards, Barkholz started his career at Modern Healthcare in 1984 covering the investor-owned hospital companies. He spent the past 10 years in Detroit at Automotive News, a sister Crain publication.