healthcare strategy in the now, near, and far€¦ · healthcare strategy in the now, near, and far...
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Healthcare Strategy in the Now, Near, and Far
Mark E. Grube
Managing Director and National Strategy Leader,
Kaufman, Hall & Associates, LLC
January 24, 2020
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Agenda Slide
The Now, Near, and Far Planning Framework1
2
3
Healthcare’s Now, Near, and Far
A New Planning Cycle for the New Framework
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The Now, Near, and Far Planning Framework
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Companies All Over America Are Endangered, Who Would Imagine Ford Would Be One of Them?
• Weak financial performance
• Weak stock price
• Overreliance on internal
combustion engine
• Late to the game of electric
and autonomous vehicles
• New mobility options
emerging that do not include
cars or traditional car
ownership
The Ford problem set:
• Milk the existing business
model of F-150s and SUVs
for every penny of cash flow
• Envision a completely
different long-term business
of electric and autonomous
mobility
• Build a strong and seamless
bridge between the two
business models
Ford’s management challenge:
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Ford CEO Jim Hackett Views This Challenge Through the Lens of “Now, Near, and Far”
Now
How to be
successful
in the “now” and
simultaneously
make the critical
pivot to the “far”?
Near
How and when to
place bets on the
future and pivot
resources to support
those bets?
Far
How to envision a
future state and
future role, knowing
that any prediction
is uncertain and
subject to change?
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“Now, Near, and Far” Is the Biggest Current Management Challenge for American Business
How to be successful in the “now” and simultaneously make the critical pivot to the “far”
The problem:
What Ford is planning:
• Eliminate “value killers”: Stop selling sedans in the U.S. (frees up $8 billion to support electric and autonomous vehicles); eliminate 7,000 salaried positions globally (approx. 10% of salaried workforce); close six factories and eliminate 12,000 jobs in Europe
• Double down on customer preferences: Transform F-150s and SUVs into electric vehicles with autonomous features
• Drive investments in innovation: Invest $11 billion in electric and hybrid vehicles by this year; partnership with Volkswagen to co-develop electric and autonomous commercial vehicles
• Attract the best intellectual capital: “Our goal is to… attract the entrepreneurs and young businesses” that typically would gravitate toward Silicon Valley (William Ford, Chairman)
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Ford’s Strategy Is Starting to Pay Off
• After a disappointing 2018, Ford’s stock price rose more than 17% in 2019
• Although restructuring costs have hurt profitability, sales of trucks and SUVs have continued to be strong
• Earnings for Ford’s automotive division increased in Q1, Q2, and Q3 in 2019, the first growth of three consecutive quarters for the division in more than three years
• Morgan Stanley upgraded its rating of Ford’s stock, citing restructuring actions, strategy, and product-mix enhancements
• Despite these bright spots, the strategy remains a work in progress as the global economic slowdown, trouble in China, and intensified competition are anticipated to soften results—at least in the near term
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The Ford example illustrates new principles of American business that apply to industries
from restaurants to retail.
Healthcare is no exception.
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Healthcare’s Now, Near, and Far
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What “Now” Looks Like for Legacy Health Systems
• Complete ownership of inpatient care
• Robust outpatient care segment bolted on
• Outpatient the source of much profitability
• Geographic orientation
• Site-specific orientation
• Revenue pressure from all payers
• Struggle to manage costs
• Largest systems are $10-$20 billion in revenue
• New entrants—such as Optum, CVS Health, and Amazon—are focusing exclusively on outpatients
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What “Near” Could Look Like for Legacy Health Systems
$0
$50
$100
$150
$200
$250
$300
$350
$400
$450
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
• Consolidation will continue, with the average size of transactions growing and rising interest in non-contiguous partnerships
• The industry will break into more distinct groups of outpatient versus inpatient providers
• Hospitals/health systems will be forced to defend their profitable outpatient flank, while continuing to support their inpatient flank
• Disruptive competitors—such as Optum, CVS Health, and Amazon—will continue intense focus on outpatients
Average Size of Acquired Hospitals: 2008-2018($ in millions)
13.1% CAGR
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New Entrants Want to Redefine Healthcare Delivery
• $194 billion company
• Rolling out 1,500 HealthHUBs over two years, putting a center within 10 miles of three-quarters of the nation’s population
• Expanding into higher acuity care with launch of clinical trials for a new home dialysis device and a pilot program offering pre- and post-operative care for knee replacements
• Revenue of $100 billion in 2018, up 11 percent over 2017
• More than 45,000 physicians
• Strong presence in 35 of its 75 target markets nationwide
• Partnering with John Muir Health, with Optum providing all back-office services
Note: CopSources: CVS Health: “CVS Health Reports Fourth Quarter and Full Year Results.” Feb. 20, 2019; LaVito, A.: “CVS to Open 1,500 HealthHUB Stores Over Next Two Years.” CNBC, June 4, 2019; Mathews, A.W.: “CVS Begins Clinical Trial for Home-Dialysis Device.” The Wall Street Journal, July 17, 2019; Pifer, R.: “CVS to Test Knee Replacement Program for Aetna Beneficiaries.” HealthcareDIVE, July 23, 2019; UnitedHealth Group: “UnitedHealth Group Reports 2018 Results.” Jan. 15, 2019; Bailey Southwell & Co.: “Chasing the Leader: Healthcare Vertical Integration Follows Optum Model.” Oct. 3, 2018; Japsen, B.: “UnitedHealth’s Optum Now in Half of 75 Targeted Provider Markets.” Forbes, Jan. 17, 2018; Japsen, B.: “UnitedHealth’s Optum: We’ll Lure More Providers to New Partnership Model.” Forbes, July 19, 2019; Walmart: “In Dallas, Georgia, Walmart Unveils Enhanced Store Experience and First-Ever Walmart Health Center”, Sept. 13, 2019.yrights of images belong to their respective owners.
• FY 2019 revenue of $514.4 billion
• Opened first Walmart Health center in September in Dallas, Georgia
• Will deliver services including primary care, labs, X-ray, and EKG, counseling, dental, optical, hearing, community health (nutritional services, fitness), and health insurance education and enrollment
• Will provide low, transparent pricing for key health services regardless of insurance status
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Walmart’s New Health Center in Dallas, Georgia
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Large Insurers Dominate Markets Nationwide
The largest insurer in each market holds more than 60 percent market share in 25 states and more than 50 percent share in 32 states.
Source: Kaiser Family Foundation: Large Group Insurance Market Competition, Market Share of Largest Insurer (2018).
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A Look at the Florida Market
Health System Competitive
Dynamics
Payer Landscape
• Significant consolidation over the last several years• Two national non‐profit health systems (Ascension and AdventHealth)• Three national for‐profit systems (HCA, Tenet, and Community Health
Systems)• Several regional non‐profit health systems (Orlando Health, Baptist
Health South Florida, Memorial Healthcare System, and BayCare)• HCA is the state‐wide leader in inpatient market share (22.6%);
AdventHealth is second (11.7%)
• Significant variation in payer position and value-based contracting by sub-regions within Florida
• The commercial payer landscape is largely led by Florida Blue and UnitedHealth Group
• Humana and UnitedHealth Group are the No. 1 and No. 2 Medicare Advantage leaders within each market
• WellCare leads the aggregated Managed Medicaid market
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Florida Hospital and Health System Transactions2013 to 2019
16
1
17
2
4
5
6
7
8
9 10
11
12
13
14
15
18
19
20
21
3
22
Map Key by Year
Source: Kaufman Hall proprietary database.Note: Transaction summaries can be found on following slide.
2017
2013
2014
2015
2016
2018
23
24
25
26
2019
28
27
• Florida saw a slowdown in activity in 2019 compared to recent years
• Much of the recent activity has involved full change-of-control transactions (acquisitions and member substitutions)
• CHS has been the most active seller in the state, with 5 sales between 2017-2019
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Florida Transactions Overview
Note: Dates represent announced date.
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What “Far” Could Look Like for Healthcare
• New national healthcare platforms will emerge, combining digital and in-person care
• An “outpatient revolution” will take shape, with new players, new types/mixes of services, and new focus on consumer experience
• Health systems will consolidate into significantly larger entities and evolve into provider/payer organizations
• Affordability, access, and consumer experience will be the new competitive differentiators
• Emerging technologies—such as precision medicine and telehealth—will be the norm for diagnosis, treatment, prevention, and engagement
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The Migration of Care to Outpatient Settings Heightens Competitive Threats
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Hospital Outpatient Visits See a Decline
Outpatient Visits
2017 880.5 million
2018 879.6 million
Outpatient visits to health system-owned ambulatory surgery centers, outpatient clinics, and urgent care clinics fell 0.9% in 2018, after 35 years of steady increases, according to the AHA.
Even so, hospitals' net outpatient revenue increased 4.5% year-over-year in 2018, while net inpatient revenue rose 2.1%.
Source: Bannow, T.: “U.S. Hospitals See First Decline in Outpatient Visits Since 1983.” Modern Healthcare, Jan. 8, 2020.
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In Florida, Outpatient Visits Continue to Rise as Inpatient Visits Show Signs of Leveling Off
Source: Florida Agency for Health Care Administration: FloridaHealthFinder.gov website. Accessed Jan. 14, 2020.
Florida Outpatient Visits, 2010-2018 Florida Inpatient Visits, 2010-2018
2.75
2.8
2.85
2.9
2.95
3
3.05
3.1
3.15
3.2
2010 2012 2014 2016 2018
Outpatient Visits
2.5
2.55
2.6
2.65
2.7
2.75
2.8
2.85
2.9
2010 2012 2014 2016 2018
Inpatient Visits
An
nu
al v
isit
s (i
n m
illio
ns)
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A New Planning Cycle for the New Framework
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Pivoting to This New Role Requires a Sophisticated Cycle of Planning
Assess Signals of Disruption
Identify Our Vision and Role
Assess Our Capabilities and Needs
Set Our Strategic Priorities
Map Our Pivot from “Now” to “Far”
2
1
5
4 3
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Assess Signals of Disruption
Identify Our Vision and Role
Assess Our Capabilities and Needs
Set Our Strategic Priorities
Map Our Pivot from “Now” to “Far”
2
1
5
4 3
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What Is the State of Disruption in Our Market and Nationally?❶
Emergence of New Competitors
Changing Consumer Expectations
Increasing demand for enhanced access (including digital), improved experience, and lower prices
Consolidation and Integration Increasing among payers, hospitals, and/or physician groups
Emergence of large, non-hospital competitors with the potential to significantly reorder markets nationally, and/or change care platform
Payer-Purchaser Pressure
Emphasis on lower cost and on risk-bearing arrangements from government and commercial payers, and from large employers
New Care Models Shifts in underlying care models driven by technology and economic incentives
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Assess Signals of Disruption
Identify Our Vision and Role
Assess Our Capabilities and Needs
Set Our Strategic Priorities
Map Our Pivot from “Now” to “Far”
2
1
5
4 3
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Identifying Vision and Role: Newspaper Example❷
GeographySubject Focus Medium
Local
Regional
Statewide
National
Photography
As the Internet emerged, each newspaper had to place bets on future facets of the delivery platform and approach to content. For each newspaper, the answers were different depending on capabilities and mission.
Delivery Method
Home delivery
Retail
Websites
Newsfeeds
Relationship with New Platforms
Participant
Partner
DeveloperDigital
Video
Traditional Future Focused
Broad
Specialized
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Newspaper Example (continued)❷
Advertising Subscriptions Other
Sources: Statistica: New York Times Company’s Revenue from 2008 to 2018; The New York Times Company: “The New York Times Company Reports 2018 Fourth-Quarter and Full-Year Results and Announces Dividend Increase.” Press release, Feb. 6, 2019.
In the past decade, The New York Times has
flipped its revenue model from a focus on print
advertising to a primary focus on building digital
subscriptions and growing digital advertising.
60%
30%
10%
2008 Revenue Mix
32%
60%
8%
2018 Revenue Mix
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Identifying Vision and Role: Hospitals and Health Systems❷
Market and Geography Service Focus
Value-Based Payment Position
Local
Regional
Statewide
Multi-state
Niche
Broad-based
Tertiary/complex
Outpatient-
focused
Wait and see
Testing
Points of Differentiation
Cost
Quality
Access
Experience
Relationship with New Platforms
Participant
Partner
Developer
National
Catalyst
Hospitals and health systems also need to place bets on the future and their role. The answers will vary for different organizations and different services within organizations.
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Assess Signals of Disruption
Identify Our Vision and Role
Assess Our Capabilities and Needs
Set Our Strategic Priorities
Map Our Pivot from “Now” to “Far”
2
1
5
4 3
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What Capabilities Are Essential to Achieve Our Vision, and Where Do We Stand Today?
❸
Digital Capabilities
Consumer Experience
OperationalEfficiency/Cost
Performance
Quality and CareManagement
Clinical andBusiness Intelligence
FinancialStrength
Culture/Innovation
BrandStrength
Leadership andGovernance
Limited
Limited
Challenged
Little toNone
Traditional
Challenged
Limited
Limited/Local
LimitedDepth/
Alignment
Robust/ System-wide
Strong
Strong
Robust
Integrated
Strong
Fully Integrated
Strong/National
Deep MD andAdmin/StrongAlignment
Low/Early Stage Strong/Highly Developed= National
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Assess Signals of Disruption
Identify Our Vision and Role
Assess Our Capabilities and Needs
Set Our Strategic Priorities
Map Our Pivot from “Now” to “Far”
2
1
5
4 3
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What Are Our Strategic Priorities, Based on Our Desired Role and Current Capabilities?
❹
• Do we have the capabilities and infrastructure we need to compete in the outpatient market?
• Where can we win, and where are we likely to lose?
• What is the edge that will help us compete?
Three Fundamental Questions:
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Assess Signals of Disruption
Identify Our Vision and Role
Assess Our Capabilities and Needs
Set Our Strategic Priorities
Map Our Pivot from “Now” to “Far”
2
1
5
4 3
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Using Hackett’s “Now, Near, and Far” Framework❺
Now
Create the Foundation
• Commit to a bold vision for
the organization’s future
• Improve cost performance
• Evolve culture
• Assess potential partners
• Develop plan to enhance
financial position
Near
Make the Pivot
• Execute on initial phases
of a comprehensive
transformation plan
• Implement financial plan
• Enhance access
• Improve consumer
experience
• Approach potential
partners
• Evolve care models
Far
Enter the Future
• Achieve real change
• Be a regional system
differentiated on cost and
access that partners with
a major innovator to
develop a transformative
healthcare delivery
platform
• Monitor new technology,
competitive dynamics,
and business models,
and adjust vision of
“far” as needed
E X A M P L E
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The Keys to Success
Organizations that Successfully Pivot from “Now” to “Far” Will…
• Not seek certainty; it does not exist
• Be ruthless about pruning the portfolio
• Recognize that failure is part of innovation
─ Expect failures in pursuit of new business ideas and models
─ Reward learning from failures
• Recognize that the market is moving too quickly to wait for one major strategic move to be fully implemented before considering the next one
• Have the biggest ideas and pursue those ideas relentlessly
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"Transformation starts with the
realization that, despite our
history and strengths, we don't
have a right to the future. We
have to earn it.”
— J I M H A C K E T T
Source: Thibodeau, I.: “Ford CEO Hackett to Employees: 2019 Will Be a Turning Point.” The Detroit News, March 11, 2019.
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Questions
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Mark E. Grube
Mark Grube, Managing Director and National Strategy Leader for Kaufman Hall, leads a broad array of strategy-related services to regional and national health systems, academic medical centers, community hospitals, and specialty providers nationwide. Mr. Grube has more than 30 years of experience in the healthcare industry, as a consultant and as a planning executive with one of the nation’s largest healthcare systems.
Mr. Grube is a frequent speaker and author on healthcare strategy topics and has published dozens of articles and white papers. He is a three-time winner of the Helen Yerger/L. Vann Seawell Best Article Award from the Healthcare Financial Management Association (HFMA).
Mr. Grube has presented at national meetings of HFMA, The Governance Institute, the American College of Healthcare Executives (ACHE), The Healthcare Roundtable, and the Society for Healthcare Strategy and Market Development (SHSMD). He is a member of HFMA, ACHE, SHSMD, and the Leaders Board for Healthcare Strategy and Public Policy.
Mr. Grube received an M.B.A. from the University of Chicago Graduate School of Business, and a B.S. in Economics, magna cum laude, from Bradley University.
Managing Director and National Strategy Leader
Mark E. GrubePhone: 224.724.3127 [email protected]
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Qualifications, Assumptions and Limiting Conditions (v.12.08.06):
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