Scott Wellman’s Post

I had the recent opportunity to talk about healthcare financial sustainability with Becker's Healthcare. In the rapidly changing healthcare landscape, leaders are tasked with bolstering financial resilience while enhancing accessibility and quality of care. Addressing severe Medicaid reimbursement inadequacies is the biggest opportunity to achieve that balance. As the number of patients reliant on government programs like Medicaid continues to grow, particularly in rural and underserved communities, the financial strain on nonprofit hospitals increases. Minnesota has an opportunity to adopt a state-directed Medicaid payment program, following the example of other states. Strengthening Medicaid reimbursement would provide critical financial relief and lighten the financial burden placed on businesses to support underpayment of Medicaid through their healthcare costs. This would allow hospitals to meet the rising demand for care in a sustainable way, ensuring that patient care remains uncompromised. Sustainable growth in healthcare isn’t just about navigating financial challenges; it’s about fueling our ability to impact more lives and change the health of our communities. I’m proud to work with a team who does that every day. Check out the article here. ➡ https://mhfv.care/48u9nzN

This is very good news for saving American medicine from its rape by massive, for-profit healthcare corporations (like HCA) and private equity investment companies (like Blackstone). But – there are 2 other ways to win. My 4:41 second video covers all three. Lloyd Sederer MD, former MH Commissioner for NYC and former CMO of the NYS Office of MH. #healthcare #doctors #patients #hospitals #corporatization #for-profit #medicine #AMA #medicare

The Art of Provider Networks: A Strategic Evolution in Healthcare In the realm of healthcare, as in the domain of war, the art of strategy has always been the determinant of victory or defeat. Provider networks, like armies of old, have been forged, allied, and expanded in response to the terrain of policy, market forces, and the ever-shifting needs of the populace. Their history is not merely a chronicle of contracts and reimbursements but a tale of strategy, power, and adaptation. To understand the history of provider networks in healthcare, one must first appreciate the forces that gave rise to their necessity, the battles they waged for dominance, and the wisdom that may guide their future. The Origin of Provider Networks: Necessity as the Mother of Strategy In ancient times, healthcare was a local affair. Physicians served communities independently, and their networks were informal—relationships based on proximity, trust, and reputation. Hospitals, the fortresses of care, were often charitable institutions, serving those who could not pay and relying on donations or religious patronage. The first wave of formal provider networks arose not from the ambition of healers but from the demands of industry. In the early 20th century, as industrial workers faced the perils of accidents and illness, employers recognized the need for accessible, organized care. Companies such as Kaiser Steel in the 1930s created what we might now call “closed networks,” employing physicians directly to care for their workers. The strategy was clear: reduce costs, increase productivity, and ensure loyalty. Like an army with a single chain of command, these early networks minimized inefficiency and conflict. Yet, as healthcare costs began to rise in the mid-20th century, driven by advances in medical technology and the expansion of hospital infrastructure, it became evident that these ad hoc networks would not suffice for the larger battles ahead. The introduction of Medicare and Medicaid in 1965 further altered the battlefield, bringing government payers into the fray and necessitating more structured alliances between providers and payers. Continued (see bio)…

Execs from HCA Healthcare, Tenet Healthcare, Community Health Systems (CHS) and UHS joined payers, pharma & others in the spotlight this week at the annual Wells Fargo Healthcare Conference in Boston. Here are 5 takeaways from the for-profits' discussions: 1. 𝐒𝐲𝐬𝐭𝐞𝐦𝐬 𝐚𝐫𝐞 𝐜𝐡𝐚𝐧𝐠𝐢𝐧𝐠 𝐡𝐨𝐰 𝐭𝐡𝐞𝐲 𝐢𝐧𝐯𝐞𝐬𝐭 For-profit providers are adjusting their capital spending to funnel resources toward future growth strategies. e.g.,Tenet has been slimming down its hospital portfolio for years. Earlier this year, Tenet sold four hospitals to University of California Irvine's health system and 3 SC hospitals to Novant Health. It also announced plans to sell its majority stake in AL-based Brookwood Baptist Health. Recent divestitures have helped Tenet reduce debt and position itself for other growth opportunities. Tenet continues to add ASCs via its United Surgical Partners International, Inc business. Meanwhile, CHS, which is looking to sell facilities worth >$1B in the next few years, is simultaneously turning its attention to acquisition opportunities 2. 𝐏𝐚𝐭𝐢𝐞𝐧𝐭 𝐝𝐞𝐦𝐚𝐧𝐝 𝐫𝐞𝐦𝐚𝐢𝐧𝐬 𝐬𝐭𝐫𝐨𝐧𝐠 CHS' volume growth is sustainable, and they expect more growth into 2025. Same-facility admissions grew 3.8% YoY in Q1 and 3% in Q2. During Q4 of 2023 patients sought delayed check-ups or screenings, which translated to an increased need for higher-acuity, IP care in early 2024. UHS expects acute care volume growth b/w 3% – 4% in 2024. The outlook may seem conservative given particularly strong volumes in 2023, but that was driven in large part by markets such as NV and CA that were slower to recover after the pandemic 3. 𝐌𝐞𝐝𝐢𝐜𝐚𝐢𝐝 𝐬𝐮𝐩𝐩𝐥𝐞𝐦𝐞𝐧𝐭𝐚𝐥 𝐩𝐚𝐲𝐦𝐞𝐧𝐭𝐬 𝐚𝐫𝐞 𝐡𝐞𝐫𝐞 𝐭𝐨 𝐬𝐭𝐚𝐲 Medicaid supplemental payment programs offer a much-needed financial boost for health systems. HCA CFO Mike Marks said the programs 'feel way more durable' with bipartisan congressional support. CHS is waiting for CMS to approve supplemental payment programs in TN and NM–which could be approved in Q4–bc those programs could make a material difference on the health system's balance sheet 4. 𝐀𝐂𝐀 𝐬𝐮𝐛𝐬𝐢𝐝𝐢𝐞𝐬' 𝐟𝐮𝐭𝐮𝐫𝐞 𝐢𝐬 𝐮𝐧𝐜𝐞𝐫𝐭𝐚𝐢𝐧 Health systems are benefiting from enhanced subsidies for ACA exchange plans–which saw #s increase once Medicaid redeterminations began. HCA is in a holding pattern until after Nov's election for a better sense of what will happen with enhanced subsidies. Exchange plans are HCA's 2nd-best payer group, and the system has cost mgmt initiatives in place that could help offset the impact of enhanced subsidies ending 5. 𝐄𝐟𝐟𝐞𝐜𝐭𝐬 𝐨𝐟 𝐭𝐡𝐞 2-𝐦𝐢𝐝𝐧𝐢𝐠𝐡𝐭 𝐫𝐮𝐥𝐞 𝐜𝐡𝐚𝐧𝐠𝐞 𝐚𝐫𝐞 𝐥𝐢𝐦𝐢𝐭𝐞𝐝 The for-profit systems aren't seeing a huge benefit from this year’s 2-midnight rule change that pulled in MA plans. The 2-midnight rule dictates that Medicare must pay for an IP stay if clinicians anticipate patients will be in the hospital for at least 2 midnights

At this point, the easy answer to high health care costs would be to reduce next year’s hospital budgets and call it a win for affordability. But in truth, it would shortchange Vermonters and only further drive up costs overall as we tried to catch up. As nonprofit hospitals, funding to make investments in access for our patients and to support our workforce come from limited sources. Shrinking those sources significantly reduces our ability to make forward progress, let alone preserve what we already have, for the patients who need us today.

Exciting news for value-based care: the Centers for Medicare & Medicaid Services Medicare Shared Savings Program achieved its highest savings on record with an impressive $2.1 billion in savings in 2023 (a ~16% increase from last year alone!). The continued success of the MSSP is due in part to the growing impact accountable care organizations are making in delivering cost-effective, quality health care - and their anticipated expansion as a result of new provisions in the Physician Fee Schedule that seek to strengthen their efforts. Thanks to Modern Healthcare for covering the success of the MSSP and how ACOs are shaping the future of healthcare, particularly for our underserved communities.

It's important to remember the challenges small business owners, including ACOs, face as they navigate the complexities of their operations. Anytime a business (in this case, a collection of physician practices) makes a significant shift in a product or service, it has to forecast the adoption and the corresponding revenue ramp. We’re asking ACOs to invest the effort, time, and capital to reinvent care models and abandon a straightforward FFS reimbursement model in favor of a complex shared savings formula. Upfront payments would create predictability that allows for the development of 3-5 year strategic plans, making significant investments toward those plans while balancing the needs of their board of directors. Full risk would be a step further, giving providers the freedom and responsibility to go all-in without the involvement of additional stakeholders. With the right funding support, ACOs can embrace new VBC programs like ours and reap their potential benefits, such as the envisioned outcomes and financial sustainability. #acos #valuebasedcare #valuebasedhealthcare #primacycare #aco #accountablecareorganizations https://lnkd.in/g5NwMFqR

At this point, the easy answer to high health care costs would be to reduce next year’s hospital budgets and call it a win for affordability. But in truth, it would shortchange Vermonters and only further drive up costs overall as we tried to catch up. As nonprofit hospitals, funding to make investments in access for our patients and to support our workforce come from limited sources. Shrinking those sources significantly reduces our ability to make forward progress, let alone preserve what we already have, for the patients who need us today.

New research raises concerns about the impact of private equity ownership on hospitals, particularly for Medicare patients, suggesting potential risks to patient care and outcomes. This critical issue warrants a broader conversation on the balance between investment and healthcare quality. #PrivateEquity #Medicare #HealthcareQuality

American healthcare might be a mess now, but it CAN be better. 🩺 In the third and final installment of our special blog series by Colin Scharff, learn about the quality of US healthcare, and how we can use policy to fix a broken system. Read now! https://lnkd.in/eQpApYx3 #Blog #Politics #Democrat #Dem #Progressive #Campaign #Campaigns #Campaigning #Nonprofit #NonprofitOrganization #Healthcare #Insurance #HealthInsurance #OpenEnrollment #Policy #HealthcarePolitics #Health