- KPMG Survey Reveals Major Disconnect Among Healthcare System, Health Plan and Pharma Execs on New Payment Systems
Given increasing clarity that the U.S. healthcare economy is unsustainable in its current form, many healthcare and pharmaceutical executives still see existing business models as sustainable over the next five years, even though they do anticipate major change in the short-term, according to the findings from a recent survey by KPMG LLP, the U.S. audit, tax and advisory firm.
Execs Seem Uncertain About Sustainable Business Models and the Pace of Change
NEW YORK, August 28 – Given increasing clarity that the U.S. healthcare economy is unsustainable in its current form, healthcare and pharmaceutical executives are clearly uncertain whether or not existing business models are sustainable over the next five years, even though they do anticipate major change in the short-term, according to the findings from a recent survey by KPMG LLP, the U.S. audit, tax and advisory firm.
In surveying over 200 senior executives at leading U.S. healthcare systems, health plans and pharmaceutical organizations, KPMG found that the largest percentage of respondents – 40 percent, 53 percent, and 43 percent of systems, plans and pharmaceuticals, respectively – said that their current business model was somewhat sustainable over the next five years, while 20 to 27 percent of respondents in each group said current business models were either not very or not at all sustainable over the next five years.
“The findings really underscore the key question of whether or not any organization can be both committed to non-volume-based care economics while at the same time working to sustain a volume-driven reimbursement status quo, said Ed Giniat, National Sector Leader, KPMG Healthcare & Pharmaceuticals. “The institutional schizophrenia that emerges will be challenging to manage at best. Going forward, the winners—whether health plans, healthcare systems, life science companies, or other organizations—will be defined by their leadership in recognizing the necessity of change and then planning and executing effective strategies based on this recognition.”
In fact, despite their majority opinions that current business models are at least somewhat sustainable, many provider (65 percent) and health plan (41 percent) executives do expect major business model changes in the next five years, while a majority of pharmaceutical executives (63 percent) expect only moderate changes. Nearly half of providers and health plans, and a third of pharmaceutical executives would like to see a more rapid progression to some type of value-based payment, but most anticipate that transition will in fact be accomplished more gradually than not, with less than a quarter of all provider reimbursement fashioned as some type of value-based payment, according to the findings.
“Organizations are clearly considering the effectiveness of their fee-for-service business models but migration to more value-based models will take some time, and will include a mix of old and new delivery and payment systems,” said KPMG’s Giniat. “The only way for more rapid integration to occur is for these stakeholders to lead the change and make it happen, but many of these organizations are using techniques more aligned with sustaining existing models.”
Healthcare Systems: maintain or increase commercial reimbursement rates
For example, when asked how important it is to at least maintain and potentially increase commercial insurance reimbursement rates versus Medicare and Medicaid, 50 percent of providers said it was extremely important. Further, 80 percent of these leading healthcare systems said they have the market position to do just that. Nevertheless, in a contradictory finding, they also cited raising prices on commercial payers as not a very important factor in developing a sustainable long-run business model. Other lower priority factors cited included owning health plans and consideration of non-acute-care components.
“The responses by healthcare systems reflect the conflicts in business planning that arise from being paid for volume currently while contemplating a different payment future,” said Brad Benton, National Account and Advisory Leader for KPMG Healthcare. “However, the evidence is compelling that the traditional reimbursement environment is not sustainable and providers should be focusing on the hard work of business model redesign and real clinical integration to be successful under a value-based payment model.”
Health plans see pay for performance incentives curbing costs
Payers were more optimistic about the possibility of partnerships involving providers and suppliers, with 55 percent of respondents saying it was possible. Additionally, they said they expect that healthcare information technology, evidence-based medicine, disease management, and pay for performance incentives will be the most effective approaches to curbing costs.
Additionally, in response to cost shifting, health plans expect employers will demand lower cost offerings and increased use of wellness and health management initiatives. Health plans also see their biggest growth coming from consumer-directed or high deductible plans, while they expect declines in small group employers and large, fully insured groups. In fact, more than half of the plans surveyed said they are concerned about an exit by large employers.
“Small group employers will likely migrate to exchanges with individuals,” said Cynthia Ambres, a principal, physician and U.S. member of the KPMG Global Healthcare Center of Excellence. “But health plans are also concerned about large employers exiting, as some are already assuming risk and using healthcare plans for administrative services only. Health plans must focus on differentiating themselves to attract the individual market.”
Pharmaceutical executives are also struggling with change strategies. On one hand, 47 percent said a shift toward health system accountability would have a positive impact on their industry, and more than half said they are currently or will be using risk and outcome-based contracting in the future. Additionally, more than 70 percent of the executives said that comparative effectiveness research (CER) data would help show the value of their products.
On the other hand, 54 percent of executives said reimbursement reform would have a negative impact, and more than half said CER would be used as a tool to cut prices. Additionally, 40 percent cited changes in reimbursement as a key reason for the industry’s pipeline drought. Fifty-six percent see the current premium pricing strategy for specialty pharmaceuticals as viable in the next one to two years, and another 39 percent said it would be viable in the next five years.
“You get the sense that the change in reimbursement policy has disrupted the traditional way of moving products into the marketplace, and that even five years out, there is a lot of effort being made to sustain the current pricing models for specialty pharmaceuticals,” said David Blumberg, KPMG National Pharmaceutical Advisory Leader.
The KPMG survey was conducted between January-June 2012 and reflects responses from 104 healthcare system executives, 51 health plans executives and 54 pharmaceutical executives at leading organizations in the U.S. A webcast on the findings from the survey is available via the KPMG Healthcare & Pharmaceutical Institute (HPI). The KPMG Healthcare and Pharmaceutical Institute is a forum for healthcare business leaders to gain insight into emerging issues, consider approaches to help balance risk and controls and improve performance, and further explore the accelerating transformation within the healthcare industry, both domestically and globally.
About KPMG LLP
KPMG LLP, the audit, tax and advisory firm (www.kpmg.com/us), is the U.S. member firm of KPMG International Cooperative (“KPMG International.”) KPMG International’s member firms have 145,000 people, including more than 8,000 partners, in 152 countries.
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- Wolters Kluwer Health, The Altos Group Partner to Develop Sepsis Mortality Reduction Program
Following is information on a new partnership between Innovation Lab, the research arm of Wolters Kluwer Health Clinical Solutions, and The Altos Group to advance development of an innovative sepsis mortality reduction program. As you know, sepsis is a critical issue in healthcare today, claiming more than 215,000 lives annually and adding $16.7 billion in avoidable costs to the system. The sepsis mortality reduction program takes a holistic approach that combines clinical content, intuitive CDS, mobile technology and change management to drive early identification and intervention – before sepsis becomes life-threatening.
The Innovation Lab (iLab) is focused on developing next-generation products that solve customers’ problems and add value to their organizations. Following a carefully defined R&D process that includes engaging customers to test concepts and provide feedback on emerging ideas, iLab accelerates the innovation process by quickly iterating on product concepts without the constraints of a fully commercialized product.
Minneapolis, Minn. — Aug. 28, 2012— Wolters Kluwer Health, a leading global provider of information for healthcare professionals and students, announced today a strategic partnership with The Altos Group to advance development of an innovative sepsis mortality reduction program. Hospitals are currently being enrolled to serve as pilot sites in the program, which brings together mobile technology, actionable clinical content and clinical change management to enable early sepsis identification and intervention.
The Altos Group is a consulting firm that partners with healthcare institutions to implement change management programs that substantially improve patient outcomes. Headed by Julie A. Kliger, MPA, BSN, the firm’s methodology and services have proven particularly effective at impacting sepsis rates. In one case, which was profiled recently by the Agency for Healthcare Research and Quality (AHRQ), a 54.5% reduction in average mortality rates was achieved within three years across nine California hospitals.
“Sepsis is the top preventable cause of death in hospitals. And while hospitals have been proactive in their efforts to reduce its devastating and often fatal consequences, sepsis rates remain unacceptably high because traditional approaches fail to address the human factors involved in early detection and proper treatment,” said Kliger. “By combining The Altos Group’s change management expertise with Wolters Kluwer Health’s advanced decision support technologies and superior clinical content, we are closing the gaps that have hampered hospitals’ efforts to intervene before sepsis becomes life-threatening.”
The sepsis mortality reduction program focuses on early detection and applying best practices to treating the septic patient. In addition to reducing overall patient mortality, costs and lengths of stay, the goal of the program is to identify and address the top healthcare-associated infections (HAI) that drive sepsis mortality. This will be accomplished through a three-pronged approach that couples mobile software with actionable content, driven by Wolters Kluwer Health’s trusted brands including UpToDate®, Lexicomp®, ProVation® Order Sets, and Sentri7®, supplemented by change management consulting services.
“A sepsis crisis is gripping the U.S. healthcare system, claiming 215,000 lives and burdening the system with $16.7 billion in unnecessary healthcare expenditures. Software and clinical content alone are not enough to change that. Sepsis can only be eliminated if we also pay attention to workflow and human factors,” said Linda R. Peitzman, M.D., Chief Medical Officer, Wolters Kluwer Health Clinical Solutions. “The Altos Group brings to our program the guidance and expertise required to build appropriate teams, develop an infrastructure and framework for organizational improvement, and align key stakeholders across a facility. By integrating all three elements, we can affect the change necessary to reduce the needless loss of life to sepsis.”
Hospitals interested in being considered as a pilot site for the sepsis mortality reduction program should contact Andy Strunk, Innovation Lab Program Director, at (425) 214-0121 or email@example.com.
About Wolters Kluwer Health
Wolters Kluwer Health (Philadelphia, PA) is a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Serving more than 150 countries and territories worldwide, Wolters Kluwer Health’s customers include professionals, institutions and students in medicine, nursing, allied health and pharmacy. Major brands include traditional publishers of medical and drug reference tools, journals and textbooks, such as Lippincott Williams & Wilkins; and electronic information providers, such as Ovid®, Medknow, UpToDate®, Medi-Span®, Facts & Comparisons®, Pharmacy OneSource®, Lexicomp® and ProVation® Medical.
Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company. Wolters Kluwer has 2011 annual revenues of €3.4 billion ($4.7 billion), employs approximately 19,000 people worldwide, and maintains operations in over 40 countries across Europe, North America, Asia Pacific, and Latin America.
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- Sprint BYOD Management Now Available for Businesses
Simplifying management and security for companies handling a diverse mix of multicarrier mobile devices; incorporates elements required to manage employee-owned devices used in the workplace
OVERLAND PARK, Kan. – Aug. 27, 2012 –With the consumerization of mobile devices and services, more businesses are adopting bring-your-own-device (BYOD) programs and they need a simple approach to manage the security, administration and shared costs associated with this complex challenge.
Sprint (NYSE: S) recently launched a solution, BYOD Management, to address these key challenges of IT organizations and deliver cost savings while allowing employees to use their preferred device for work purposes to be more productive.
This new turnkey solution helps companies deploy and manage elements of a BYOD program, such as:
- Defining and enforcing compliance of BYOD policies within the workforce.
- Being able to confidently secure corporate data on employee-owned devices with mobile device management and security (MDM&S) capabilities.
- Managing the process for employees to be reimbursed for mobile devices and/or services that align with company policies.
- Detailed reporting/analysis to keep track of BYOD employees and devices.
- Offering a customized Web portal to make it easy for employees to learn more, opt-in and register their personal device for the program.
“IT management has told us about their challenge to stay focused on key priorities while also securing corporate data and managing a dynamic environment where employees use a variety of mobile devices from multiple carriers. Our new BYOD Management service is a simple, turnkey solution that eliminates this challenge by bringing together key elements from our Device Management and Mobility Management offers and adding the critical features needed to manage a BYOD environment,” said John Dupree, vice president of business sales, Sprint. “Along with our focus on helping businesses solve their mobile security and management needs, they can feel assured about Sprint’s commitment to network innovation, which will help meet the growing mobile data demands of business.”
Sprint BYOD Management is the latest addition to Sprint Professional Mobility Services. This portfolio of enterprise-grade managed services was designed to meet any business customers’ unique needs, from providing a greater level of security and management of devices and applications via Sprint Device Management to handling the complexity of cross-carrier expenses, deployment, lifecycle, policy management and dedicated support with Sprint Mobility Management.
Teaming with trusted, leading companies to deliver these services, Sprint Professional Mobility Services offers multiple options to help solve the challenges of any type and size of organization across a multicarrier environment.
Sprint Mobile Security and Network leadership
Sprint is committed to comprehensively addressing mobile security for businesses and consumers, and to developing and raising awareness of security and protection solutions. In 2011 Sprint launched the Mobile Security Council to bring together key players in the mobile ecosystem to address protection, safety and security needs important to consumers and businesses. Charter members of the council are Lookout, Cisco, IBM, Juniper Networks, Motorola Mobility along with its subsidiary 3LM, and Samsung.
In addition, to ensure that demand for connectivity for mobility solutions will be met, Sprint has embarked on a multiyear network initiative, Network Vision, designed to enhance customers’ network experience with faster data speeds, improved voice quality and easier connectivity. Sprint expects to complete the majority of Network Vision by the end of 2013.
About Sprint Nextel
Sprint Nextel offers a comprehensive range of wireless and wireline communications services bringing the freedom of mobility to consumers, businesses and government users. Sprint Nextel served more than 56 million customers at the end of the second quarter of 2012 and is widely recognized for developing, engineering and deploying innovative technologies, including the first wireless 4G service from a national carrier in the United States; offering industry-leading mobile data services, leading prepaid brands including Virgin Mobile USA, Boost Mobile, and Assurance Wireless; instant national and international push-to-talk capabilities; and a global Tier 1 Internet backbone. The American Customer Satisfaction Index rated Sprint No. 1 among all national carriers in customer satisfaction and most improved, across all 47 industries, during the last four years. Newsweek ranked Sprint No. 3 in its 2011 Green Rankings, listing it as one of the nation’s greenest companies, the highest of any telecommunications company. You can learn more and visit Sprint at www.sprint.com or www.facebook.com/sprint and www.twitter.com/sprint.
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- Rochester General Health System Selects ProVation® Order Sets, powered by UpToDate® Decision Support
MINNEAPOLIS, MN — Aug. 21, 2012— Wolters Kluwer Health, a leading global provider of information for healthcare professionals and students, announced today that Rochester General Health System has selected its ProVation® Order Sets, powered by UpToDate® Decision Support, software as its electronic order set solution.
ProVation Order Sets is an easily customizable order set authoring and management solution that provides flexible integration into clinical processes to streamline the delivery of standardized care for improved patient safety, outcomes, clinician performance and regulatory compliance. ProVation Order Sets is built upon ProVation Medical’s award-winning, clinician-designed technology platform. A key benefit is continuous updating of clinical content and medical evidence, including direct links to UpToDate, the resource of choice for more than 600,000 users worldwide.
Located in Rochester, NY, Rochester General Health System is one of the fastest growing health systems in western and central New York State and is the only area health system to be rated by SDI as one of the Top 100 Integrated Health Networks in the U.S. It includes eight clinically integrated affiliates delivering comprehensive healthcare services, including Rochester General Hospital, Newark-Wayne Community Hospital, Hill Haven Assisted Living and Nursing Rehabilitation Center, DeMay Living Center, Rochester General Medical Group, Behavioral Health Network, Independent Living for Seniors, and RGHS Ambulatory Services Division. Rochester General Health System and its affiliates regularly earn national recognition for excellence in a range of clinical specialties.
“Rochester General Health System has a reputation for providing medical excellence,” said Mike Haldane, Vice President and General Manager, Clinical Documentation, Wolters Kluwer Health Clinical Solutions. “We are pleased they have selected ProVation Order Sets, powered by UpToDate Decision Support, to provide its clinicians with point-of-care access to evidence-based order sets.”
About ProVation Medical
ProVation® Medical provides procedure documentation and clinical decision support solutions for hospitals and Ambulatory Surgery Centers. ProVation MD, ProVation MultiCaregiver and ProVation EHR software reduce transcription, paper storage and image printing costs and deliver a high Return on Investment (ROI). ProVation® Order Sets, powered by UpToDate Decision Support, puts evidence-based healthcare into practice by establishing and maintaining standards of care.
ProVation® Medical is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).
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