We believe in evidence-based decision-making and also in avoiding analysis paralysis. Often times decisions, projects, and plans get delayed because there is not enough evidence or analysis, but the people best equipped to perform this analysis are too busy with primary obligations.
We've launched our Spot Analysis services to help leaders in this position. Some of the most experienced healthcare consultants in our network prefer not to be engaged on continuous full-time projects. This gives us the capacity to have strong leaders support you for ad hoc needs without an extensive consulting engagement.
It's time to dust off the old fashioned consulting model We won't send a partner to walk your halls and drum up bigger projects - we just want to get you what you need. With a quick inquiry form, we can provide you with an estimate of the cost and timing for your inquiry.
Sample spot analysis projects could include:
Review and feedback on materials needed for a board meeting
Customizing materials for a client presentation
Preparing a high-level financial model to assess market opportunity
Preparing a bibliography and analysis on a trend or issue
That nagging thing you need to get done but haven't made it to yet.....
Giving it a try If you've already got a Master Services Agreement (MSA) in place with us, we can develop a standard SOW that allows us to scope projects by email agreement If we do not have an MSA in place, let's get work on one so we can move quickly whenever your ad hoc need arrives.
We will invoice upon project completion. Projects costing <$5000 can even be paid by credit card. So easy!
It’s always a tough time for leaders in healthcare. The current political uncertainty exacerbates the usual challenges by making it hard to plan for the future. The uncertainty also adds a risk-premium to pricing, which is contrary to the pressure executives face to stem the tide of ever-increasing healthcare costs. It seems that we are always being required to do more with less.
The good news is that there actually is a real way to do more with less – through accessing the expert gig economy. Often the executives we talk with identify bandwidth and expertise to be the primary limitations to achieving goals – even to achieving cost savings. Streamlined and targeted expertise from an Executive Exchange can fill these gaps.
Some examples of temporary support who can achieve savings / new revenue far in excess of the cost of the resource include:
Save on Actuarial Costs: A skilled former CFO can assist with modeling, scenario testing, and proformas at a lower price point than outside actuaries – and they can do this with a deeper understanding of the operational realties of the business than many actuaries have.
Save on Cost of Healthcare: A temporary VP of Care Management or Clinical Operations can increase the capacity of clinical program interventions under the Chief Medical Officer to accelerate achieving healthcare cost savings.
VP of Network Management: A skilled executive with expertise in contracts and relationships between payers and providers can audit payer contracts to identify opportunities for increased savings / revenue both with contract terms and in how a contract is administered.
Chief Strategy Officer: There is nothing soft or fluffy about the assistance a short term executive can provide to the internal strategic planning team by establishing a process for ongoing scenario planning that helps the organization to manage environmental uncertainty. This helps to prevent misfires and also helps to get a jump on new opportunities that arise from rapid environmental change.
And the list goes on….
We hear regularly that the gig economy is transforming the workforce. According to a study by Deloitte in 2016, almost half of the executives surveyed (42 percent) expect to increase or significantly increase the use of contingent workers in the next three to five years According to research by the Freelancers Union, fifty-three million Americans, or 34% of the nation’s workforce, qualify as freelancers.
At Spring Street Exchange, we’ve embraced this concept by connecting with a network of skilled, sane, practical, and innovative executives who are looking not for their next job, but instead, the next project where they can make a difference. We are not a search firm that interviews people to fill a need. Instead, we connect with our network to see if we have what you need; if not, we’ll tell you that too.
New constraints require new ways to solve problems. Let’s accelerate, collaborate, innovate, make a difference. ______
At Spring Street Exchange, we’ve been supporting our clients through the healthcare policy uncertainty by staying abreast of the various bills from the US House and Senate and then developing scenarios which allow us to explore their impact. We rely on analysis from various sources and especially read closely the assessment provided by the Congressional Budget Office (CBO). Often, we need to perform secondary analyses to take this perspective and apply it to a particular region, service line, or line of business.
Although I am studying the impact various healthcare bills I don’t consider myself a policy wonk – I rely on others for the nuance of policy and legal process. I am more of a healthcare insider who is earnestly trying to assess the impact of policy on the industry. When you are knee deep in the bills as I am it is easy to focus on the nuanced difference between them because the impact these differences will have on insurance markets and access to coverage are large.
For instance, one provision of the Cruz Amendment of the Better Care Reconciliation Act would allow insurers to offer products that do not meet ACA benefit requirements as long as they have one product that does. The effect of this would be to shift the benefit designs offered in the market overall, with insurers developing skinnier plans to attract a healthier risk population at a lower price. Whether this provision is passed with has huge implications for those with health conditions, for providers, and for health insurance markets.
However, it can also be valuable to lift-up and look at the various proposals as a group. This view allows us to plan more globally for common threads across scenarios. The attached summary of CBO Analyses of the various 2017 GOP proposals provides a high-level summary to help with timing and tracking of the various bills. Hope it’s helpful for you in your scenario planning.
There is nothing soft or ordinary about true collaboration. When we work with our competitors, partners, those outside of the industry...when we hear fresh voices and consider new ways of generating value to the market, we create magic.
At Spring Street Exchange we've been engaged in facilitating collaboration on a number of fronts lately. Whether helping separate entities join together for a common goal, helping an organization seek external partners, or just aligning the efforts of people with different skills on the same team. Universally it seems, that the effort is harder than expected and the results are more impactful than anticipated.
The work of collaboration requires us to think beyond our traditional assumptions and skills sets and to empathize with our partners and customers. Innovation requires us to step into these intersections, and the frontier of healthcare lies with where previously distinct sectors now intersect.
We've relied both on personal skills, technology, and process to navigate this kind of radical collaboration. What have you been using? We'd love to hear your collab stories and questions.
I’ve been flipping through my dog-eared copy of the Congressional Budget Office (CBO) June 26th analysis of the Better Care Reconciliation Act of 2017 (BCRA). The document has gotten coverage by the press, has been summarized through sound bites, and had had its key points extracted. All of this is helpful as are all eager to access the CBO assessment of how the proposed law could impact coverage, premiums, and the healthcare industry.
The BCRA analysis was longer than the versions of the AHCA, probably partly because it has a lot of comparing to do. And I’m not going to pretend that it is a light read.
That said, for the complexity of the topic, I find it to be amazingly accessible. The report is clear on which topics it is difficult to make assumptions around (such as how many and in what way states will pursue waiver opportunities) and where there are clear expectations (such as around impact to funding of Medicaid coverage).
The greatest thing I gather out of reading the CBO text is the dynamics between various provisions and their impact that these could have. This is especially helpful in applying the components of the law to various potential scenarios.
I've heard criticisms that the analysis both exaggerates and under-represents the impact of the law. Perhaps it does both. I hoped it would do more to consider the impact of medical bankruptcy on the economy. Who can make perfect guesses in such an uncertain world? But uncertainty isn't a reason to dismiss analysis grounded in fact and history.
For those of you who haven’t had a chance to read the full text, I highly encourage you to do so…and reach out to share your thoughts!
Post by Nancy Wise References contribution to an article by Jerry Burgess
Those of us in the industry understand that healthcare is extremely complex, and that various components of health policy relate to each other. For industry insiders it can be a challenge to watch public leaders and the media sometimes miss the nuance of these industry dynamics. Truly understanding healthcare often requires more study and focus than many busy Americans have time to apply to this task.
This means that the media coverage on healthcare can sometimes rely on sound bites and data points pulled out of context. There is simply not enough investigative and nuanced reporting on the impacts and dynamics of the political climate on healthcare.
This is why we were so happy to see Sarah Kliff’s article: This is How ObamaCare Explodes (https://www.vox.com/policy-and-politics/2017/5/1/15373372/obamacare-tennessee-zero-insurers), that was published earlier this week (5/1/17). This article explores how it came to be that those eligible for subsidized coverage through the Health Insurance Marketplace find themselves without coverage options in certain regions of Tennessee. The article provides a valuable dive into several personal stories as well as exploring the market dynamics that led to this situation.
Spring Street Exchange’s own Jerry Burgess contributed to the article, sharing some of his insights as a former leader in the Tennessee carrier marketplace. Enjoy!
With premiums in the health insurance marketplaces a hot topic over the past few months, we decided to do some analysis to see if we could sum it up.
It can be difficult to compare premiums because they vary by product, metal level, rating region, and state. Even the same benefit design can be priced differently by rating region within a state. Issuers may change offerings at open enrollment and individuals may have access to different options to choose from each year.
Kaiser Family Foundation (KFF) provides a chart of premiums for the second lowest Silver plan sold in a major market in each of the 50 states. This represents the “benchmark” plan that is used to calculate the level of subsidies available for an individual in this market. We extracted data from the KFF analysis and summarized percent change between 2016 -2017.
States on the left side had extremely high premium hikes (Phoenix, AZ – 145%; Birmingham, AL – 71%) and those on the right were more moderate (Fargo, ND – 9%; Cheyenne, WY – 9%) or very little (Manchester, NH – 2%, Little Rock, AR – 1%).
Those individuals with incomes between 138 – 400% of federal poverty level (FPL) were eligible to receive premium subsidies. For those purchasing the second lowest silver plan in their market, the change in their premium responsibility would be the second number depicted here – for most 0%. Consumers are generally shielded from premium changes because the subsidy amount tracks with the change in price of the benchmark plan and subsidies are tracked to income
Those with incomes over 400% of FPL would be subject to the full price of the premium increase.
The rate of premium increases varies a great deal across the metro areas highlighted in this chart and also across regions not listed here. So, the level of individual market stability varies a great deal as well. Some factors which could influence this variability:
Population health: Many of these markets may have a population accessing healthcare at a greater rate than initially expected.
Delayed reaction: Some markets had artificially deflated prices in the early years of the Marketplace as issuers competed on price to earn the greatest market share. After several years of slower-than-typical premium growth with potential losses. This led some issuers to “right-size” their premiums. (This was complicated by interactions with the risk corridors and risk adjustment listed below.
Federal liability for risk corridors: The government paid out only a fraction of the promised risk corridor payments to issuers. This led may issuers to incur unexpected losses on previous years’ business. In response they have adjusted premiums to account for higher potential risk.
Uncertainty around risk adjustment: The risk adjustment program is intended to provide a stabilizing affect to the market but compensating insurers with a higher level of risk by payments from insurers carrying a lower level of risk. Experience indicates that many issuers are still trying to effectively identify, manage, and adequately report their risk mix. The uncertainty as the market learns to work with the risk adjustment formula leads to a higher risk premium.
Market concentration: Many markets experienced a reduction in the number of issuers offering products on the Marketplace. This leads to greater pricing power to those that remain.
Health of the market before the ACA: The population in some markets may have had low rates of coverage and a long backlog of care. Other markets with relatively high market participation before the ACA (such as Massachusetts) have seen less rate volatility.
It's dangerous for me to be set loose with various CBO analyses on health coverage....
I am working on an effort to compare impacts of the individual mandate with the continuous coverage requirement, which led me to trying to quantify the gap of expectations to reality with regard to coverage assumptions.
You can see here that 2010 projectsios were optimistic, 2012 projections were close to the mark.
By now we all know how important Millennials are to our culture, economy, and workforce. As of 2015, people between the ages of 18-36 were identified as the largest age cohort (~84M)  and represented a full third of the workforce.  Any population this size requires understanding, and with young people driving trends of what’s meaningful and relevant, trying to understand Millennials is all the rage. And yet, much of the focus on understanding Millennials centers around how to tame them into behaving the way older generations would like for them to behave. Or companies trying to get Millennials to buy their stuff.
All of these approaches fail to reach the heart of what makes engaging with Millennials so important: Millennials have a view of the world that lacks the attachment to location, paper, and authority that older generations may have.
This article offers a simple, low-risk, high reward "how to" approach bridging this gap. Does your organization have a Millennial Advisory Committee already? How's it going?
Calculated from US Census data, assuming Millennial cohort includes people born between the years 1981-1999.
Last night Ted Cruz and Bernie Sanders stood together in the national spotlight and squared off about healthcare policy in the United States. Initially I found myself turned off by the debate, as I do not agree with the perspective of either Senator. And, like many Americans, I am tired of stump speeches and campaign rhetoric. Still, the topic is important, dialogue is welcome, and perhaps there is still light at the end of this showcase.
As an industry insider, I find it painful when I come face-to-face with the limitations that politicians often have when addressing healthcare. The industry is simply too complicated to fit into sound bites, and the explanations for how and why various policies are connected can make even the most earnest observer glaze over. While I am only a 7 out of 10 on the healthcare wonkiness scale, I found myself wanting to clarify or refute both Cruz and Sanders on various issues when they misfired.
Let's get real I also wish the Senators had conceded to each other’s intelligence rather than retrenching to their campaign positions. Sanders could have acknowledged that the majority of the Republican leadership does not intend to just decimate healthcare; they intend to propose an alternative. He may disagree with whether that alternative will achieve the stated goals, but it is unfair to tack the worst case scenario on the Cruz plan. And, Cruz homed in on challenges in the health industry, blaming them almost entirely on the Affordable Care Act (ACA) without recognizing that 1) these trends and challenges were in place before the ACA and 2) the ACA actually did make a difference in addressing some of them, even if he does not think it went far enough toward change.
This lack of acknowledgement to each other may be the very gap continues to frustrate so many of us about the healthcare policy debate. It would be great if Democrats would stop pretending that we can keep open a blank check funding Medicare and Medicaid without drastic negative consequences to our economy. In fact, lack of caps on public healthcare spending could be one of the root causes of healthcare inflation. The ACA may have been a first step at expanding access, but there will need to be some pain in spending limits before the industry will behave differently at scale.
It would be great if Republicans would stop suggesting that they are going to be able to immediately lower premiums significantly without scaling down covered benefits. Lower premiums come at a price; it's math. Also, the government has a large role in regulating healthcare, but in the current market-based health system the government is not deciding what healthcare people should receive. I have complete confidence that those in the industry of all political backgrounds are committed to a meaningful solution that helps the most vulnerable Americans and sets the industry on a course to stabilizing costs. We can only do this by being creative, by untethering ourselves from care delivery and financing models of the past, and by boldly stepping forward.
Leading with hope But then again, here were two Senators, in the national spotlight, taking on the issue to which I have committed my professional life. They presented opposing views, each making his own case, calling each other out, and wrestling with the issue. An entire 90 minutes on a major news outlet was dedicated to healthcare. This is good. Indeed, the best points in the debate were the small moments of playful interchange and points when the Senators sought areas of agreement or partnership. Perhaps it is not enough, but it is a start, and for this I applaud CNN, Senator Sanders, and Senator Cruz.
So, for this accomplishment, and in the spirit of telling cynicism to take a seat, I say: More of this, please. More debate, more conversations, more and deeper dives that rely on data and facts. Please, more attempts to find common ground, and more recognition of the human impact of healthcare policy. We need more honest acknowledgement of what is not working. And actual recognition of what is. We need to face that the problems in healthcare started before 2014 and involve more stakeholders than just politics. Let us all do more rolling up our sleeves to carve a solution that is uniquely American. And let's commit to one that is relevant by working with the building blocks we truly have. What did you think of the debate?