Competition and Strategies in Minnesota s Provider and Payer Markets

Transcription

1 Competition and Strategies in Minnesota s Provider and Payer Markets Presented to: Minnesota Medical Group Management Association July 28, 2017 Allan Baumgarten, J.D., M.A.

2 Overview v ACA gave a push to trends already in motion: Consolidation of health plans, provider systems Move to narrow networks, high deductible health plans Renewed interest in hospital-owned health plans v What is different about Minnesota? We excel in recounting all the ways that we excel

3 Presentation Outline -1 v Key health plan trends v Growth and profitability by line of business v Disruption in state programs v Transition from Medicare Cost plans v Key provider system trends focus on growth v Continued profitability with declining inpatient days v Significant capital investment v Further consolidation and expansion of market boundaries

4 Presentation Outline - 2 v Strategies of health plans v Focus on niche lines of business/growth opportunities v Narrow networks and risk-sharing v Strategies of provider systems: v Consolidation, partnerships and convenient care v Focus on small clinics v Emergence of regional systems v Health insurance plans v Outlook for 2017 v Looking beyond the ACA coverage expansions the big picture of likely changes

5 Health Plan Trends v Growth, profitability by line of business v Evolution of Minnesota HMOs v Medicare Advantage and Cost plans v Transition for 2018: uncertainty and opportunity v Individual plans, narrow (or high performance) networks and risk-sharing v State public programs v Administrative shortcomings compare to Michigan v Impact of competitive bid

6 Health Plan Trends -2 v Decline of full risk capitation arrangements v Impact of limited risk contracts for Medicare v Incentives under commercial contracts v Challenges of individual market declining enrollment, even with rebates v Role of national health plans: v Goal of new competition: Possible entry of national, forprofit HMO companies through new plans or acquisitions: what is the likelihood?

7 Health Plan Trends: HMO Enrollment, ,500,000 2,000,000 1,500,000 1,000,000 Medicare Public Programs Self-funded Employer (Est) Commercial Insured 500,

8 Enrollment in Individual Plans, , , ,000 PPO HMO 200, , ,000 50, Mar-14 Mar-15 Mar-16 March-17

9 Enrollment in Public Programs, ,000, , , , , , ,000 Other Medica Hennepin Health County HIOs HealthPartners UCare Blue Plus 300, , , /1/17

10 Provider System Trends v Evolution of systems, market share v Continued strong profitability v Declining or flat inpatient utilization v Expanding geographic reach, moving toward population health and risk-sharing; also covering bets for volume incentives

11 Largest Hospital Systems in Minnesota by Revenues System Net Patient Revenues Net Income Margin Fairview/HealthEast $3,115,066,513 $232,076, % Allina $2,966,580,029 $272,337, % Mayo Clinic $2,862,845,059 $504,702, % Sanford Health $2,234,177,344 $275,393, % Essentia $1,650,580,496 $109,305, % HealthPartners $1,431,401,372 $35,864, % Avera $1,064,566,699 $46,108, % CentraCare $956,503,870 $184,882, % Hennepin Health $831,624,000 $40,273, % North Memorial $800,627,280 -$3,051, % Children's $730,224,727 $38,842, %

12 Largest Hospital Systems in Minnesota by Inpatient Days System Set Up Beds Inpatient days Occupancy Fairview/HealthEast 1, , % Allina 1, , % Mayo Clinic 1, , % Sanford Health 1, , % Health Partners , % Essentia , % CentraCare , % Avera , % North Memorial , % Children's , % Hennepin Health , %

13 Twin Cities Hospital Market Share by Revenue, 2015 Other (5.2%) Children's (7.5%) North Memorial (8.2%) Fairview/HealthEast (30.1%) Hennepin County (8.5%) HealthPartners (14.7%) Allina (25.8%)

14 Net Income for Twin Cities Hospitals, ,000,000 Allina Fairview 600,000,000 HealthEast 500,000, ,000, ,000, ,000,000 HealthPartners Children's Park Nicollet* Hennepin County North Memorial Other TOTAL 100,000, ,000, ,000,

15 Inpatient Days in Twin Cities Hospitals, Other 1,400,000 1,200,000 1,000, , ,000 Hennepin County Children's North Memorial HealthEast Park Nicollet* HealthPartners Fairview Allina 400, ,

16 Health Plan Strategies v Limited networks, high deductible health plans v Provider payment increases tied to performance, participation in primary care home models, care coordination v Expansion of Medicaid plans into individual and small business v Transition to Medicare Advantage

17 Provider System Strategies-1 v Expansion/Consolidation/Capital Investment; Going beyond traditional local market boundaries Impact of Fairview/HealthEast merger Case of HealthPartners - UnityPoint Challenge for independent hospitals recent examples of Grand Itasca, District One v Convenient care retail, urgent care and free-standing emergency departments

18 Provider System Strategies - 2 v Moving toward population health and Triple Aim; preparing for increased performancebased payment and risk sharing while also covering bets for volume incentives v Strategic partnerships Clinically integrated networks do they add value? v National networks: Mayo, Cleveland Clinic, MD Anderson

19 Provider System Strategies 3 v Clinically integrated networks: Where is the extra value? v Accountable Care Organizations v Insurance plans what is the outlook for provider-sponsored health plans? v Look at largest provider systems and their strategies: Fairview, HealthPartners, Allina v Transition for Medicare Cost to full-risk: new opportunities for providers?

20 Provider Payment Trends v Most payment still tied to discounted fee-forservice rewarding volume v CMS goal: 50% of Medicare payments based on quality by MACRA pushes movement to alternative payment methods v UnitedHealthcare goal: increase payments tied to value to $65 billion in 2018 v What is actually happening for commercial insurance?

21 Provider System Strategies 4: Smaller Clinics v Impact of MACRA, general trend toward performance-based payment v Participation in data reporting on quality and cost measures v Impact of trends toward narrow networks, high deductible plans

22 Solo Practitioners With Highest Diabetes Care Ratings

23 Outlook v Continued consolidation and partnerships for both health plans and provider systems v Impact of Republican bills look beyond reversing ACA coverage expansions to: v Undoing Medicaid expansion, slashing $$ v Loss of group consumer protections v Medicare ACOs, bundled payments v Medicare change to premium support v Medicaid block grants to states

24 For Additional Information Allan Baumgarten W. 27th Street Minneapolis, MN v Baumg010@umn.edu v 952/ v