Consulting
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History has several examples of those who believe they have read enough to venture where they have not been before. You might have read about this effort: Well researched, everyone was doing it, how bad could it be, we could stop if we needed to, and most the usual questions. Who was this? It was the Donner Party. The cost of a guide and scout seemed so expensive……. Hindsight provides much insight and clarifications. Our hindsight is now your foresight. You want someone who has actually done it before, perhaps even done it in several markets. Healthcare and politics always seem to be a local phenomenon.
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The best use of a consultant is focused, with clear objectives and deliverables. Get the best outcome at the most effective and efficient cost through focus. A consultant that allows you to lose focus is simply not a good consultant.
Key Areas:
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Financial Risk – Organizational and Strategy:
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Many believe “risk” is new to health care. Well it might be new to providers. It is most certainly not new to payers. Lloyds of London started in 1680… While we don’t back quite that far, our executives have held positions as CEO, CFO, Medical Director, CTO, as well as several middle management positions in payers, providers, hospitals, and ancillary providers. And we did provide key insights to a Lloyds underwriter for their product offerings to the ACO industry.
Making sure your total risk is understood, anticipated and managed. Many a hospital strategy was waylaid because the hospital could take a large hit, but the risk pool was bankrupted and the physicians disappointed. Structuring the layers is important. Lastly, we have seen aggregate risks explode as each payer contract has downside – there is a portfolio theory to be applied, but there is limited equivalent diversification when a flu season, or natural disaster strikes.
Operational Strategies and Care Redesign:
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We have answered “Now that all the money is in the pool, how do we keep it there?” From reinsurance strategies, care interventions, social determinants, and new clinical programs. From the granular to the policy. Even the most experienced risk providers lean on experts from time to time.
Federal Policy is the Driving Force:
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If not us, please make sure your consultant is current on both policy and knows the difference between bleeding edge vs safely in front of the bear. We are all trying to stay in front of the bear, just make sure you don’t run into a dead end.
There is so much change happening in healthcare strategy being driven by Medicare initiatives. The reason may be that Medicare is the largest payer and only getting larger. Medicare if facing daunting funding requirements in a double whammy, aging population and fewer employed individuals paying the taxes. We are happy to share our current forecasts with you.