iProtean – Health Reform

“The book on U.S. health reform is not yet written. ACA [Accountable Care Act] is a chapter. The market will write others. What’s clear is that the affordability of health care—costs—is a theme that will run through each. It’s time to get serious about costs. To avoid the discussion is to guarantee the demise of the system’s strengths and the certainty of a two tiered system long-term: one for those that can afford it, and a second for those that can’t.”


My Take, Paul Keckley, Executive Director, Deloitte Center for Health Solutions. Health Care Reform Memo, February 6, 2012.


The iProtean course The New Healthcare Business Model features insights from Ken Kaufman, Dan Grauman, Lisa Goldstein, Anjana Patel and Jeff Bauer on the implications of health reform and the new business model under which hospitals will operate over the coming years.


Kenneth Kaufman, Kaufman, Hall & Associates

With the economic forces being the way they are, together with health reform legislation, we are now moving from the Medicare business model to what is being referred to as the ‘post reform business model.’  This business model is going to take a number of characteristics, the most important being the change in the business value proposition.


Kenneth Kaufman, Kaufman, Hall & Associates

Board members and healthcare executives must understand that this value proposition is so much harder than the older one.  It will create very significant challenges for many organizations around the country because you are being asked to provide a particular outcome at a particular unit of cost, which has never been the challenge in healthcare.


Lisa Goldstein, Moody’s Investors Service

We will go through a period of readjustment by both Medicare and the commercial payers that will greatly impact financial performance of hospitals.  So now is the time for hospital board members, with senior management, to reevaluate their cost structures, reevaluate their business model, reevaluate the processes of delivering high quality, low cost care to the patients who seek healthcare from them.


Dan Grauman, DGA Partners

Hospitals need to be preparing on many fronts.  There is a great deal of pressure—and this has been underway; it’s not new—in operating hospitals.  More than ever, hospitals are going to have to try to figure out how to deliver care in the most efficient, cost effective way while doing the right thing for patients and maintaining quality standards.  The interesting thing about operating hospitals is that hospitals can’t do this alone.  There is a high interdependency between hospitals and those who control the utilization of services just by virtue of their pen, by determining what’s needed for the patient—the physician.


Anjana Patel, Esq., Sills Cummis & Gross

The goal behind the accountable care organization [ACO] is if you have a group of providers working together in a coordinated fashion, then Medicare will reward you if you meet certain cost cutting metrics and if you achieve certain quality measures.  The reward comes in the form of a bonus payment that will be split up among the different providers within the ACO.


Dan Grauman, DGA Partners

Medicare wants to start slow.  They want it to be successful.  They don’t want big failures on their hands, so they are talking about having ‘upside-only’ arrangements where you are responsible for, let’s say, managing the care of Medicare beneficiaries, and there is a fixed budget that you’re working towards.  If you do better than that budget by a certain percent, then you get to share in those savings because you—the hospital and the doctors, working collaboratively—will have better managed utilization of those patients.  And by bringing the cost under budget, you can share in some of the savings.  So that’s how Medicare is viewing this as a first step.



For a complete list of iProtean courses, click here.


iProtean Symposium & Workshop

Mark the Date!! October 10 – 12, 2012 at The Lodge at Torrey Pines, La Jolla, CA. Faculty: Barry Bader, Dan Grauman, Marian Jennings and Brian Wong, M.D. For more information, click here.


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