There were several common themes during presentations at the 2013 Southwest Healthcare Transactions Conference:

·         The uncertainty surrounding the Affordable Care Act and healthcare delivery reform are creating opportunities for companies to help health systems build and manage the infrastructure necessary to succeed under value-based care.

·         Mobile health and telehealth could emerge as solutions for provider shortage.

·         Many health systems are getting big as a defensive strategy and hedge against future uncertainty.

·         Deal multiples are historically high because the sector is awash in capital and the number of solid acquisition candidates is dwindling.

The Health Industry Council’s fifth annual conference at the Omni Dallas Hotel May 8-9 attracted about 175 participants.

Wednesday Pre-Conference Workshop Keynote – Healthcare needs more “disruptive innovation” like TurboTax.

Jason Hwang, a physician, co-author of The Innovator’s Prescription: A Disruptive Solution for Health Care and co-founder of the Innosight Institute, used the analogy to illustrate how similar innovation would allow doctors and hospitals to focus on cases that are more complex.

Hwang noted TurboTax continues to improve its product, eroding the need for individuals and small businesses to hire accountants to complete tax returns. This “disruption” also enables consumers who could not afford accountants.

Hwang said the healthcare system places too much emphasis on doctors and hospitals.

 “The one-size-fits-all model of healthcare works, but it’s expensive,” he said. “Maybe we need tiered levels of healthcare.”

Hwang suggested telehealth and smartphone applications could provide a superior health option for many patients. He said smartphone applications could help patients seek out information and determine whether they need further medical attention. Telehealth allows patients to connect with physicians online or over the telephone more cost-effectively and conveniently.

Hwang said the best disruptive innovations “democratize” services through simplicity, affordability, and convenient accessibility.

eLuminate Health — The Leawood, Kan., startup is an open network that allows healthcare consumers to shop for providers based on price, quality and customer satisfaction.

Tami Hutchinson, president and chief executive officer, said the network’s strength is transparency and agility. The system allows providers to change their prices at any time. She said she has found providers are willing to offer their best price for services in exchange for a shorter accounts-receivable timeline.

Hutchinson called the current healthcare pricing structure “illogical,” with no link to quality, extensive price variability and high profit margins. She said eLuminate’s model would help consumers, payers and providers by improving satisfaction, rewarding quality and aligning incentives—as well as lowering  healthcare costs.

She said the company’s current customers are health plans and consumers, but she expects the business to transform into a purer business-to-consumer model. She said the company planned a product launch for providers in May and for consumers in July.

Nalari Health — The Providence, RI,-based company provides online healthcare for high-risk, high-utilization patients. The company remotely monitors patients and coordinates care with an interdisciplinary team of providers.

Mark Trent, president and chief executive officer, said the company’s goal is to move healthcare into the community and away from more expensive care sites.

Trent said Nalari Health seeks to replicate a complete physician clinical encounter visually and verbally. The “visit” employs video, security text or telephone. Patients are monitored biometrically for weight, glucose, blood pressure and for blood clotting.

The company targets the top 10 percent of patients who account for 60 percent of healthcare costs. They include patients with multiple chronic conditions, the frail elderly, the disabled and Medicare-Medicaid dual eligibles.

Trent said Nalari Health’s model improves care access, timeliness, continuity, flexibility and convenience while dramatically lowering the cost of care.

Open Market Partners — The Dallas-based company has created healthcare cost indices for financial markets to hedge healthcare risks.

Thomas Smith, company co-founder and chairman, said OMP has several patents for financial instruments that allow healthcare investors and providers to manage business uncertainty. He said the company, which represents seven years of research and development, targets chief financial officers to help them manage the risk of marketplace fluctuations.

Smith used the analogy of Southwest Airline’s purchase of oil futures contracts to hedge against price increases, allowing it to remain profitable as fuel prices rose.

Smith said the top 100 procedure codes account for 76 percent of the healthcare market and the top 50 comprise about 60 percent of the market. He said OMP plans to allow buyers to pre-purchase procedures at a fixed price.

Smith said individual indices would include prescription drug costs, health insurance cost and healthcare costs, as well as a comprehensive index. He said every time a contract is created using one of the indices, the company would get a royalty—modeled after the S&P Indices.

MEDgle — Ash Damle, founder of the San Mateo, Calif., cloud-based big-data healthcare analyticals company, said he started the firm to tame what he called a “data tsunami” that healthcare providers face and to “make sense of it on an individual and population level. We are trying to attack the $900 billion of waste, inefficiency and inaccuracy spanning four billion car decisions because health systems and payers cannot access and apply the best medical science.”

The MEDgle (which is a hybrid name suggestive of medicine and Google) database includes diagnostic, predictive and prescriptive analytics. It contains more than 150 million data points, 40,000 symptoms and 4,000 diagnoses based on age, gender, duration and lifestyle.

Damle described the system as a “clinical GPS.” He said the system uses the patient’s symptoms and health history and applies algorithms to calculate the optimum treatment. In a pilot study at a nurse call center, he said MEDgle reduced call time from 10-12 minutes to 6-8 minutes.

Damle said the system is delivered either through an application programming interface, such as an electronic health record, or through web or mobile apps. He said he is talking to providers about mobile data continuously and being accessible through iPhones.

Best Practices in Health Systems Innovation — Rubin Pillay, executive director for Oklahoma State University’s Center for Health Systems Innovation in Oklahoma City, said there is no shortage of innovation in healthcare but it is not producing better outcomes. He said there is a “huge gap” between the potential of medical science and the performance of health systems. He said recommended care is delivered only about half the time.

Paraphrasing a quote by Albert Einstein, Pillay said the people who created the problems in healthcare are also the ones trying to solve them, and those efforts are being hampered by linear thinking.

Pillay said creativity, innovation and entrepreneurship create value that can bridge the gap between potential and performance. Unfortunately, he said, healthcare generally has been inflexible and not open to change.

OSU’s center is a collaborative effort between the university’s Center for Health Science and its Spears School of Business, a model he said is the first of its kind in the U.S.

Neuro Kinetics Inc.— The Pittsburgh-based company is a world leader in eye-tracking technology and diagnostic testing.

Howison Schroeder, chief executive officer, said abnormal eye movements are symptoms associated with about 200 diseases. He said his company attempts to provide cost-effective equipment to “commoditize that information”

The company’s iPortal technology measures the eye’s response to motion and other stimuli. Research indicates that it can detect abnormalities from head trauma that are not identified by other imaging tests, as well as being more objective than testing that relies in part on patient self-diagnosis.

About 1.6 million Americans sustain a traumatic brain injury (TBI) annually, including about 300,000 sports-related concussions.  An estimated 20 percent of U.S. soldiers returning from Afghanistan and Iraq have suffered TBI.

NKI twice has been named Small Manufacturer of the Year by the Pittsburgh Business Times and has won more than $5 million in grants and contracts from the National Institutes of Health and the Department of Defense.

Innovation Fund Panel — Chip Measells, managing partner, The Fund for Health Innovation in Washington, D.C., said his company is focused on care models and technology that center on value-based care.

“If (the company) has proved the model, we will help them roll it out. We can provide scale quickly,” he said.

Kyle Salyers, co-founder and managing director of CHV Capital Inc. in Indianapolis, said his wholly owned venture capital unit is part of Indiana University Health, the state’s largest integrated delivery system.

Salyers said his company’s investment strategy “is about fit. There has to be a well-designed connection between the entrepreneur and the system.”

Larry Stofko, executive vice president, The Innovation Institute, Orange County, Calif., said his organization is funded by St. Joseph Health System. He said his strategy is two-fold: (1) Create for-profit businesses out of expense departments, such as IT and accounting, which can be marketed to other hospitals. (2) Commercialize the entrepreneurial ideas of the health system’s physicians and researchers.

Measells said the uncertainty surrounding the Affordable Care Act and delivery reform “is why we exist. There will be opportunities in value-based care. Many (providers) have not built the infrastructure to coordinate care and that is an opportunity.”

Paul Wallace, managing director, Heritage Group in Nashville Tenn., said he sees “strategic opportunity and fear. Many are seeking defensive protection rather than opportunity. There is a lot of hype around (these changes). Maintaining discipline will be critical.”

Thursday Conference Keynote: The Transformation of an Industry — Michael Slubowski, president and chief executive officer of Sisters of Charity of Leavenworth Health System in Denver, said ” ‘unsustainable’ is the word of the moment in healthcare,” referring to the Medicare cost trajectory, the proportion of nation’s economy devoted to healthcare spending, Medicaid growth and cost shifting to consumers and employers.

Slubowski pointed out that most health systems are sustaining declining volume primarily because of high-deductible health plans and a shift in care to lower-cost outpatient alternatives. He said consumers want lower premiums and are willing to accept narrower networks to get them.

Slubowski said many employers are unwilling to enter shared-savings agreements with providers because they believe the current excess utilization is waste they have been paying for all along. He said hospitals face ACA revenue pressures because of provider payment cuts and value-based care penalties. However, they also will see volume increases from the health insurance exchange enrollees and Medicaid expansion.

Slubowski said health reform in Massachusetts in 2006 offers several lessons. Among them: exchange implementation is like a political campaign; exchanges are stores for health plans, and health plans are stores for providers; price is king, and there is significant opportunity for significant market upheaval. He said what matters most in the exchanges is customer service, transparency, provider capacity and the ability to think like a retailer.

Slubowski said only about half of a provider’s revenue will come from “population health,” which he defined as public insurance programs, small employers and health-exchange customers. He called the remainder “retail health,” driven by price sensitivity because of high deductibles, demand for e-visits and people with chronic conditions seeking value based on price and outcomes.

The Politics of Healthcare Innovation — Cindi Berry, shareholder, Polsinelli PC in Washington, called Douglas Elmendorf, director of the Congressional Budget Office (CBO), the most powerful player in the federal government when it comes to medical innovations. She said the CBO’s score for legislation could advance or kill legislation affecting health policy and funding.

Berry said the pharmaceutical industry finally was successful in getting the CBO to accept research that increased medication use lowers demand for medical services, and that increased cost sharing affects patient compliance with drug therapy.

Julius Hobson, policy adviser for Polsinelli PC in Washington, said there are two kinds of CBO scoring: static, which uses current law and projects costs based on that; and dynamic scoring, which assumes that changing the law will change behavior. He said conservatives have been pushing dynamic scoring. He credited Texas tort reform for providing liability savings that the CBO can use to score medical malpractice legislation.

Berry said there is concern among ACA supporters that the law’s implementation timetable is too aggressive. She predicted the Obama administration would be flexible in supplying states with the necessary resources to successfully expand Medicaid and run exchanges.

Berry said every administration talks about getting tough on healthcare waste, fraud and abuse. However, turning providers into felons creates an unhealthy political landscape.

New School Meets Old School: The Ever Evolving Landscape of Hospital and Health System M&A –Panelists were asked what strategies are driving hospital mergers and acquisitions (M&A) today, compared with the 1980s and 1990s.

Jack Hess, a partner at Financial Resource Group in Dallas and a former Baylor Health Care System executive, said Baylor’s push in the 1980s was geographic expansion. The system employed a hub-and-spoke strategy to grow in the fast-expanding DFW suburbs. He said the dominant 1990s strategy was to build scale to negotiate with managed care companies, which included acquisition—and often “de-acquisition”—of physician practices.

Jim Berend, a partner at Grant Thornton International in Dallas, said in the 1980s the focus was on building multihospital systems. The 1990s were driven more by fear, including fear of managed-care organizations and the strength of for-profit hospital systems. He said many providers believed they could not compete without being large.

Tom Watson, managing partner at BKD in Dallas, said today’s M&A is driven by regulatory issues.

“They are asking: ‘Can we survive under this regulatory environment? Am I big enough?’ “

Barry Sagraves, managing director at Juniper Advisory in Chicago, said some health systems are “getting bigger for the sake of getting bigger. There is confusion between size and scale. Many are getting bigger without figuring out how to achieve cost savings and quality.”

Panelists were asked how expectations have changed over the years on both sides of the M&A sale.

Watson said smaller hospitals cannot borrow like they could before the recent recession.

“Bigger is better in capitalization,” he said.

Barry said most of his clients were distressed 10-20 years ago and had low expectations beyond completing the sale. He said today’s sellers are less distressed, more strategic and “holding up the buyer for more stuff.”

Berend said most of the few remaining independent hospitals are financially strong. However, the effects of Medicare reimbursement cuts may take their toll and those hospitals may find that sitting on the sidelines no longer works.

Watson said he works with a number of smaller hospitals. He said they are fighting to remain independent because they are significant players in their local economies.

“They don’t want to give the car keys to economic development to someone in Dallas. They want to keep local control and protect a community asset,” he said.

Barry agreed, saying, “They don’t want to face community members in the grocery store (after a sale). They also don’t know if the system they would be joining will still be around.”

Berend said a cultural fit is very important for a successful merger.

“If there are other economic issues, a culture clash will exacerbate the situation. It is very important to get the boards heavily involved to get to know each other,” he said.

Watson said sometimes the purchased organization is not willing to be managed by the acquirer. He also said the merger will not work well if the physicians are not on board. He said it is important to get buy-in from all of the stakeholders, especially in a smaller community.

Hess said the M&A activity stemming from the ACA “makes it feel like the 1990s all over again. People feel the need for vertical integration, geographic expansion and doctor acquisitions. They are concerned about reimbursement reduction, expense increases and capital acquisition.”

Berend said, “With uncertainty comes fear. Economy of scale is a natural comfort zone.”

Sector Update Panel: Deal Making Across the Provider and Payer Continuum — Matt Hicks, partner at Excellere Partners in Denver, said the major M&A trend he sees is hospital systems trying to control their local referral bases to fill operating rooms and beds to monetize their infrastructure.

Tom Spivey, managing director at McColl Partners in Dallas, said managed-care organizations feel they are being “disintermediated” by health systems and are driven to buy providers regardless of whether it makes sense.

Spivey said buyers are investing in organizations with strong leadership, technology and infrastructure. He said provider organizations that have chief medical officers can command twice the selling multiples, compared with those without one.

Spivey said investors are not comfortable buying organizations that have not invested in infrastructure that can drive quality outcomes. 

Jonathan Henderson, shareholder in Polsinelli PC in Dallas, called the current M&A climate “a robust sellers’ market. That plays out through higher prices and tighter deal expectations.”

Hicks said he urges clients to create a strong compliance program in anticipation of an acquisition. He said many have stumbled because of a lack of compliance, although buyers can deal with it if it is revealed early in the process.

Henderson agreed, saying, “You’ll pay for it (compliance) before, during or afterward. But you’ll pay for it eventually.”

Spivey said healthcare companies that either lower costs or improve quality are going to be the winners in the future. He predicted that future healthcare will be “bifurcated” based on income.

Where the Action Is for Healthcare Services Investors — Panelists identified several promising areas for health investment:

·         Health insurance exchanges: Dave Eichler, managing member for Psilos Group Managers in New York City, said his company invested six years ago in Medicare exchange company Extend Health, which was sold to Towers Watson. He said Extend Health was successful because Medicare is a guaranteed revenue stream. He said he is unable to predict the impact of exchanges under the Affordable Care Act, but “there will be a big migration.”

·         Consumerism: Christopher Graber, vice president of Waud Capital Partners in Chicago, and Michael McArthur, manager director of Deloitte in Los Angeles, both said healthcare consumers will play bigger roles and firms with customer service skills will be attractive. Graber said there is an opportunity for companies that will help providers collect from patients with high-deductible plans.

·         Value-based insurance design: David Eichler, managing member for Psilos Group Managers in New York City, said the idea of personalizing benefits based on health status is a good idea, but it requires a sophisticated IT platform. About 20 percent of Texas companies said they plan to implement value-based insurance design in 2013 by waiving deductibles, co-pays and co-insurance to encourage treatment compliance, according to a Texas Business Group on Health survey.

·         Risk-bearing companies: Graber called DaVita’s 2012 purchase of HealthCare Partners “landmark” because the California-based physician network was the only truly capitated risk-bearing provider that survived the 1990s. Entering the managed care market led to its business success. The company treated more than one million patients in California, including more than 500,000 capitated commercial patients, 150,000 Medicare Advantage beneficiaries, and 25,000 capitated Medicaid patients. Early entry into managed care enabled the organization to build 25 years of experience managing global capi­tation contracts. Graber warned that companies will need robust IT and scale to succeed.

·         Convergence: McArthur said his company is looking at hospitals, independent physician groups and primary-care physicians who are seeking to create local integrated care groups. He noted that primary-care physicians are getting as much as 10-12 times earnings before interest, taxes, appreciation and amortization (EBITDA), and hospitalists are getting about 6-8 times EBITDA.

·         Post-acute care: Graber said many believe it is early to invest significant capital into this sector because it is unclear whether there is any advantage in assembling distinctively different providers into one company.

·         Telehealth: Eichler said payers are willing to reimburse for this type of care if companies can prove it saves costs.

·         Remote monitoring: McArthur called this area “hot” despite the fact that Medicare is not reimbursing for it. He said commercial payers and accountable care organizations are seeing its value and paying for it. He said the Veterans Health Administration also understands its value.

·         Behavioral health: Panelists noted the ACA has elevated its importance.

·         The intersection of IT and services: Eichler said companies that can show they impact cost and quality of care are attractive.

Lunch keynote address — Scope of More Optimism in 2013: What’s Ahead for the Economy and What We’ll Be Watching — Lunch keynote address — Scope for More Optimism in 2013: What’s Ahead for the Economy and What We’ll Be Watching — Robert Podorefsky, a managing director with GE Capital Markets in Boston, said the issues that were harming the markets that he discussed during his 2012 conference speech are fading. He noted that public U.S. stock market capitalization had risen over $2 trillion since November.

Podorefsky mentioned several other positive trends:

·         Home values are rising. Nationally, prices have increased by 10 percent compared with the previous year, and GDP continued to advance in 2012 despite the lack of net growth in outstanding residential mortgage debt.  He said to pay attention to the National Association of Home Builders Housing Market Index, a forward looking gauge, which had slipped recently.

·         Steady increase in consumption. He said there has been consumer-spending growth for the past 13 quarters but that the growth trend in national health expenditures had been trickling lower, mostly along with nominal GDP, noting that faster nominal GDP growth would likely benefit overall healthcare spending.

·         Steady job growth. He said if the rate of U.S. job creation picked up more consistently to a 2.5 million annual pace, we would likely see a faster drop in the unemployment rate.  He said while the number of job openings is increasing overall, unfilled healthcare jobs exceed 550,000 which is somewhat consistent with last year’s average.

·         The Federal Reserve System’s performance.  Podorefsky said the recent stretch of benign inflation has enabled Fed policy to remain highly accommodative and that the Federal Open Market Committee’s extraordinary consistency was beneficial to risk asset performance overall.  He predicted moderate U.S. economic growth would likely continue but that maintaining low inflation was in part a function of global considerations.

·         Fiscal challenges are abundant. He said higher tax receipts and sequester budget cuts mean the federal government is unlikely to run out of room under pending debt ceiling constraints until September. However, he said continuing political battles over the federal budget represent a drag on economic recovery, and much of the federal Treasury debt is coming due in the next five years.

On the other hand, he said the latest annual rate of real disposable personal income growth is nearly 2 percentage points below the averages seen before the financial crisis.  He said further declines in the unemployment rate should eventually help improve growth in disposable income which would be a positive development for overall nominal economic growth.

The New Valuation Frontier: Fair Market Value in New Payment and Delivery Models — Greg Koonsman, senior partner at VMG Health in Dallas, said he does not believe methods of valuing companies will change because of healthcare delivery reform.

He said there is high demand for acquisitions because many health systems believe the only way to deal with changes is to get bigger.

“Systems offensively and defensively are getting bigger. There is a lot of vertical integration. It’s Business 101. They are getting bigger at any cost. The top 53 non-profit systems are very strong. They generate $220 billion (annually). They have $120 billion in cash. They are poised to get bigger. There is a lot of capital chasing few sellers right now. However, about 2,000 (of the nation’s 5,300 hospitals) should be for sale,” he said.

He said for-profit hospitals are being bought for eight times EBITDA and high-performing organizations are getting more.

Jay Meldrum, partner in transaction services, PricewaterhouseCoopers in Dallas, said his company always uses three valuation approaches: assets, discounted cash flow and market value based on expected growth and margin. He believes discounted cash flow is the most effective way to determine underlying value.

“I’m seeing synergies paid for (by the buyer) but not realized. And I’m not seeing the multiples go down,” he said.

Healthcare Deal Debt Equity Financing Trends — Panelists said the credit markets have returned to levels seen prior to the most recent recession. Interest rates are lower so it is a great time to build facilities, they said.

Jason Shafer, vice president at HCP & Company in Chicago, said his company looks for opportunities to grow companies rather than re-engineer them. He said it supplies capital for family-owned companies that are seeking to expand.

Gavin Bates, principal at Caltius Mezzanine in Los Angeles, said debt and equity capital is strong. However, there is a lack of clarity about where healthcare is going. He said healthcare executives tell him they have clarity about the next 6-12 months.

Mark Francis, managing director of healthcare investment banking at Houlihan Lokey in Dallas, said most of the activity has been refinancing. However, he predicted that 2013 would be the best M&A year in the last 5-6 years.

Shafer agreed that there has a low level of deal-making because valuations “are through the roof and there is a lot of capital available. We are seeing a lot of demand, though.”

The Future of Healthcare: How Technology Will Transform America’s Largest Industry — Christopher Kersey, managing member of Camden Partners Holdings in Baltimore, said healthcare has underinvested in information technology. The sector only spends about 1.4 percent of revenue on IT, which is about 40 percent of what all U.S. industrial sectors spend.

Kersey cited six key technologies driven by healthcare reform: meaningful use technologies, such as health information exchanges and electronic health records; care management, such as population health and transitions of care; analytics; clinical decision support, virtualization, and service-based delivery of applications and storage.

Kersey predicted accountable care will increase IT spending by 43 percent by 2014. He said venture-capital funding of digital health continues to grow. There were 84 percent more deals and 70 percent more funding in the third quarter of 2012, compared with the previous year. He said more than 100 digital health companies each raise more than $2 million in 2012.

He also said the number of mobile devices overtook the world population at the end of last year. He said mobile applications that can enable diagnosis and treatment are empowering and engaging patients.

The Mega-Deal Story: Baylor and Scott & White Merger — Baylor chief executive officer Joel Allison said he and Scott & White chief executive officer Robert Pryor began discussions about a possible merger two years ago. He said the biggest barrier was going too fast for the board members of both hospital systems.

Allison said, “We had to make some of the hardest decisions upfront: the name. We named the management and board members. Those are hard decisions.”

Scott & White chief executive officer Robert Pryor said, “(Harvard’s) Michael Porter asked me how our system could make a margin on delivery of health care to people who can’t afford it. This is about getting big enough to lower the cost of care. We needed to cover a larger geography to make it work.”

Allison agreed: “We need to create a model  that focuses on improvement of quality and lowers costs.”

Allison said one of the merger goals was to create a system that ranks among the top five in the U.S. to have a voice in Austin and Washington.

Pryor said one of the anticipated barriers was the fact that Baylor was faith-based while Scott & White was not. As it turns out, that was not a problem.

“You can’t throw a rock in central Texas without hitting a Baptist,” he quipped.

Allison pointed out that the two board chairs and two chief executive officers are alumni of Baylor University.

Pryor said one of the most frightening experiences for him was to face 300 Scott & White physicians to explain the merger.

“They say dealing with physicians is like herding cats. But cats can’t hurt you. For an hour, every question had a positive slant. (In a merger) you have to know when to stop getting data and say this is good enough. We may find a crazy brother-in-law in the closet but we have to love each other enough that it won’t matter,” he said.

The target date for closing the merger is June 30, Allison said.

Yale-New Haven: A Case Study in Precise Execution of Merger Integration — The 2012 merger of Yale-New Haven (Y-NH) Hospital and the Hospital of St. Raphael was a win-win for the two New Haven, Conn., organizations.

Matt Comerford, managing director of Alvarez & Marsal Holdings in New York, said the acquisition strategy was to create a two-campus hospital providing integrated care, greater efficiency and a stronger financial base.

The merged hospitals had more than 1,500 beds and about 12,000 employees, making it one of the nation’s largest.

The purchase allowed Y-NH to avoid spending $650 million for a new patient tower.

The $160 million purchase price allowed St. Raphael to pay off its debt and address pension liabilities. The hospital had posted deficits in 2008 and 2009 before returning to profitability.

Marna Burgstrom, Y-NH chief executive officer, called the purchase “a Connecticut solution to a Connecticut problem.”

The organizations created detailed workplans to achieve synergy savings. Prior to closing, they split into four work streams: clinical services; non-clinical services, finance, and senior-level integration management. They reviewed the plans and assigned responsibilities for tasks. For the six months after the merger, the system set up an integration management office to handle acquisition issues that arose.

Y-NH plans to be integrated into one system by Sept. 30, 2014, and be poised for growth by Sept. 30, 2015.

CEO Mid-Year Wrap-Up: Opportunities and Challenges Ahead — Steve McHale, chief executive officer of Explorys in Cleveland, said he believes consolidation eventually will lead to 60-100 U.S. megasystems. For physicians, it would mean primarily an employed model. He said health plans would be more provider-oriented and move more of their business to value-based models.

Don Dillahunty, president and CEO of PrimaCare in Dallas, said the future will dictate more of a mid-level provider model, necessitated by the shortage of primary-care physicians. He said urgent clinics and retail clinics will deliver more chronic disease management, health promotion and acute care. He said the increase in closed provider networks will drive more business to those clinics, which he said are more consumer-centric.

Dillahunty said giving the consumer “more skin in the game” potentially could influence population health. He cited a Blue Care Network of Michigan study of obese patients who were given the choice between paying higher health insurance premiums or walking 5,000 steps a day. He noted that 97 percent choose the steps.

J.R. Thomas, chief executive officer of MedSynergies in Dallas, said physician offices will need to push demand rather than solely allowing the patient to decide when they need care. He urged physicians to “see the right patients at the right time at the right place” by doing more preventive care and proactively scheduling patients based on need and timing.

Thomas said the future challenge will be treating Medicaid patients. By contrast, he said those on Medicare are healthier than they were 20 years ago and those with employer-sponsored insurance are younger and have adequate access to care.

- Steve Jacob, Writer for D Healthcare Daily-