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Strategic Outlook on Healthcare Market : A Medical Group Perspective

Strategic Outlook on Healthcare Market : A Medical Group Perspective. Don Crane President and CEO. 2008 Health Care Forecast Feb 22, 2009. Overview. Introduction Environmental Assessment Challenges for Groups Medical Group Responses Q and A. California Association of Physician Groups.

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Strategic Outlook on Healthcare Market : A Medical Group Perspective

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  1. Strategic Outlook on Healthcare Market :A Medical Group Perspective Don Crane President and CEO 2008 Health Care Forecast Feb 22, 2009

  2. Overview • Introduction • Environmental Assessment • Challenges for Groups • Medical Group Responses • Q and A

  3. California Association of Physician Groups

  4. Overview • Introduction • Environmental Assessment • Challenges for Groups • Medical Group Responses • Q and A

  5. Underlying Premium Pressures 8+% More than double rate of inflation! Hospital Unit Cost Benefit Mandates New Technologies Uninsurance Pharmacy Gov’t Cost Shift Source: CHCF/Health System Change (HSC) California Employer Health Benefits Survey, 2006

  6. EMPLOYER REACTION

  7. Annual Growth in Private Health Insurance Premiums Percentage Growth Year Source: KFF/HRET Survey of Employer- Sponsored Health Benefits 2007

  8. Premium Trend

  9. Premiums: HMO vs. PPO

  10. Premium Increases

  11. HMO Premiums

  12. Premium Trend by Product

  13. Enrollment by Plan Type

  14. High Deductible Penetration

  15. Employer Coverage Trend

  16. Concentration of HMO Enrollment - California 2.0% 4.0% 82% 73% Source: Cattaneo & Stroud, Inc.

  17. Commercial HMO Concentration - California 3.0% 2.0% 5.0% 91% 80% Source: Cattaneo & Stroud, Inc.

  18. Concentration of Medicare HMO Enrollment - California • 2.0% 4.0% - 4.0% - 2.0% - 89% • 5.0% • 2.0% 87% Source: Cattaneo & Stroud, Inc.

  19. Overview • Introduction • Environmental Assessment • Challenges for Groups • Medical Group Responses • Concluding Remarks; Q and A

  20. Challenges Declining Commercial HMO • erosion of revenue • tipping point

  21. Challenges Medicare Advantage funding flush…at the moment ….funding cuts possible

  22. Challenges Powerful Competitors: Kaiser • market share • competition in physician recruitment

  23. Challenges HMO vs PPO • Hospital utilization? • Price differential shrinking? • Influence of P4P? • Uneven Playing field

  24. Challenges Influx of high deductible products coupled with inability to administer deductibles • Risk segmentation death spiral • Can’t participate

  25. Challenges • Time of Uncertainty; • Healthplan commitment to Model

  26. Overview • Introduction • Environmental Assessment • Challenges for Groups • Medical Group Responses • Q and A

  27. Medical Group Responses • Get Better • Get Bigger • Collaborate • Lobby

  28. Medical Group Responses 1. Get better • IT • Pay for Performance • QI Programs • CAPG Standards of Excellence

  29. Medical Group Responses CAPG Standards of Excellence • What: A recognition program that rewards members exhibiting established attributes of excellence. • Goals: • Stimulate all groups to improve • Branding

  30. Medical Group Responses CAPG Standards of Excellence -- Three Domains: • Care Management Processes • Health Information Technology • Accountability and Transparency

  31. Medical Group Response 2. Get Bigger • Mergers and Acquisitions • Knox Keene Licensure • Global Risk Contracting • Go into healthplan business?

  32. Medical Group Responses 3. Collaborate • With Plans • With Hospitals • With Employers • With Government

  33. Medical Group Responses Data Sharing Code of Conduct WHO?: CAPG and top 6 Plans WHAT?: • Reciprocal Sharing of new data sets • Coordination of Disease management programs STATUS: Being adopted and implemented.

  34. Medical Group Responses 4. Lobby, lobby, lobby Wither Universal Coverage? Medicare Advantage Misc

  35. Medical Group Responses

  36. Overview • Introduction • Environmental Assessment • Challenges for Groups • Medical Group Responses • Q and A

  37. Strategic Outlook on Healthcare Market :A Medical Group Perspective Don Crane President and CEO 2008 Health Care Forecast Feb 22, 2009

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