making out like bandits: the unexpected rise of pcp & urgent care and the hidden battle for...

All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents

without the prior written consent of the Company, is prohibited.

MAKING OUT LIKE BANDITS:The Unexpected Rise of PCP & Urgent Careand The Hidden Battle for Control

2All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.

Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited.

MAKING OUT LIKE BANDITSDisclaimers

This presentation has a lot in it and we’ll go quickly; it’s available for you to look at in detail later:cf. Merchant Med or email [email protected]

Also see the Merchant Med report @ http://bit.ly/2fMtWvr

Note: If you have an NPI – you are being viewed by risk-owners, competitors and provider partners.Your hidden value is being captured in every major market;You can calculate it, capture it, and control it…

mailto:[email protected]

http://bit.ly/2fMtWvr



MAKING OUT LIKE BANDITSThe Plan

Here’s Why You Should Listen

Here’s the Context – Politics & Data

Here’s How Payers Are Thinking about It

Here’s How Risk Owners See You

Here’s Your Risk and Hidden Value – Like a Bandit

Summary and Q&A









Summary and Q&A



MAKING OUT LIKE BANDITSWhy Listen?

Leading the way…

US CTO on RowdMap: “Visionary

Genius”

…in the shift from fee-for-service to pay-for-value.

As featured in…




Health plans and providers in 48 states and the District of Columbia use RowdMap’s benchmarks to reduce the delivery of low-value care.

RowdMap’s benchmarks comprehensively describe the $850 billion the nation spends on care that leads to no better outcomes.

The clients RowdMap serves collectively cover the lives of more than 100 million Americans.

RowdMap was founded in 2011 and has offices in Louisville, KY and Portland, ME.

Payers in Marketplace/Exchange, MA, Medicaid, Commercial/Group and Government Programs

Providers including PCP & Specialty Groups, CINs & Systems, ACOs, Bundles & other CMMI Program Participants




Melanie Rosenthal – Chief Executive OfficerCo-Founder & CEO @ Sprigley [acquired by Eliza Corporation, 2008]; VP of Product Ops @ Eliza [Majority Equity Investment Parthenon Capital, 2011]; Health Dialog, Yale, Human Genome Project, Tufte, Solstice Capital

Henriette Coetzer, MD – Chief Clinical Risk OfficerClinical Transformation, NHS (National Health Service, United Kingdom); Global Medical Director, Towers Watson; Senior MedicalDirector and Clinical Analytics, BUPA and Health Dialog; Product Development, Healthways; Practicing Physician; Patent Holder

Joshua Rosenthal, PhD – Chief Scientific OfficerCo-Founder & CSO @ Sprigley [acquired by Eliza Corporation, 2008]; VP of Product Ops @ Eliza [Majority Equity Investment Parthenon Capital, 2011], Fulbright, Sorbonne (Applied Institute for Advanced Studies),HHS/CMS/ONC/NCHVS Public Adviser and HCTTF Speaker/Guest Lecturer @ Harvard, Hopkins, MIT , SXSW, HDI, RWJ, AF4Q, NPR

Burak Sezen – Chief Information OfficerCo-Founder & CTO @ Sprigley [acquired by Eliza Corporation, 2008]; Platform Architect @ Eliza [Majority EquityInvestment Parthenon Capital, 2011], Health Dialog, Pricewaterhouse Coopers; Ernst & Young; Standards Committees

Kimberly Spalding, CPA – Chief Financial OfficerCo-Founder Tech Republic [acquired by CNET, 2001]; Co-founder & CFO Narrowcast [acquired by QuinStreet, 2011]; Ernst & Young’s Entrepreneurial Services

Marshall Votta – Chief Market OfficerAdvisory Board @RowdMap; SVP @ Leverage Health; VP, Network Development @ NaviNet; Healthspottr; Congressional Campaign & Finance Manager; Health Care Transformation Task Force; MIT, Providence College; Ben & Jerry’s Ice Cream

Ashley Distler & Bryant Hutson – VPs Provider Strategy, Payer StrategyCornell, Xavier; Cincinnati Children’s Hospital, Optimity Advisors, Presence Health; Skydiver, Travel Connoisseur

Industry Leading Advisory Board

David Wennberg, MD

Kyle Rolfing

AbirSen

DaveDickey




CMS: 50% of FFS will be gone by 2018

What if you knew which providers would

drive your success?

What if you knew which providers would sink you? WHAT WOULD YOU DO IF YOU KNEW

who will win and who will lose in value-based arrangements?









Summary and Q&A



MAKING OUT LIKE BANDITSContext

Economic pressures, political changes, and shifting socio-demographic trends will continue to constrain per-member reimbursement. Managing network expenditures represents the only consistent

opportunity across all lines of business and payment/delivery models.

RHIOsPCMH

RomneyCare

HITECHACA

MACRAMIPS

What’s next…

High-Value Network

Focus on providers who manage unwarranted variation and reduce the delivery of low-value care. This network foundation

can support all innovation opportunities and regulatory changes while withstanding competitive threats.




Who will move beyond demand-driven risk management and address the real opportunity: eliminating low-value care?

Currently, thirty cents of every U.S. healthcare dollar goes to low-value care. Reducing that low-value care reduces the cost of ownership of your network. There is a tangible economic impact that can

either be kept, or reinvested in payment to high-value providers or benefit to members.

Benefit-Driven Risk Management v2

Profitability driven by designing benefits and pricing products to reduce demand.

Supply-Driven Risk Management v3

Profitability driven by identifying and reducing waste from low-value care

Member-Driven Risk Management v1

Profitability driven by choosing which members could buy which products.

Health plans have increasingly fewer options to manage risk givenguaranteed issue and standardized benefit designs.

Individual underwriting decreased or eliminated.

Less flexibility in benefit decreased or eliminated.

Demand-Driven




The economic driver for pay-for-value programs is the ability of a government program or marketplace arrangement to not only achieve Triple Aim goals but to also mitigate Low-Value

services, which account for thirty cents of every dollar spent on the delivery of care.

Over $9B in Orange County, CA

$850 Billion Unnecessary Spend in 2014(Institute of Medicine “Best Care at Lower Cost”)

Low-Value Care (30%)

Necessary Utilization(70%)

“It’s generally agreed that about 30 percent of what we spend on healthcare is unnecessary. If we

eliminate the unneeded care, there are more than enough resources in

our system to cover everybody.”

- Dr. Elliott Fisher,Dartmouth Institute for

Health Policy

“Bigger than higher prices, administrative expenses, and fraud, however, was the amount spent on unnecessary healthcare services.” In just a single year, up to 42% of patients receive “Low-Value” Care.

- Dr. Atul Gawande, Harvard University




Risk-Readiness® benchmarks helps physician groups, and hospital systems identify and quantify Risky Revenue and protect and diversify it —

a central tenet of surviving evolving economic pressures.

RowdMap has low-value care and population health benchmarks for…

every physician,every hospital,every zip code

…in the United States.

Identify risky revenue and exactly how it is vulnerableUse gov benchmark data to defend and protect revenue in current economic modelsForm a plan to diversify vulnerable revenue with specific tacticsForm a plan capture value you are currently leaving on the table in current models

Risk-Owners are working to reduce identify vulnerable revenue, and:




Medicare DocGraph Referral file (Patient flows between PCPS, specialists, hospitals and post acute centers)

Dartmouth Atlas of Health Care & Choosing Wisely(Decades of research and data on unwarranted variation by condition and geography to keep things apples-to-apples for comparisons)

CMS FFS Data Sets, CDC Data Sets (MEDPAR, Part B, Part D, BRFSS)(Individual providers, groups, hospitals and post acute centers)

Provider Pattern Intensity Profiles and Risk Readiness for every provider, hospital, post acute center in the US. All preloaded with no IT.

New Government Benchmark DataParticularly powerful when pulled together

Government Benchmark data to determine Risk-Readiness® of Providers / Networks




Here’s why these benchmarks are so powerful

Government benchmark data serves as the common languagenecessary to build relationships with providers to improve the member experience and profitability

The benchmarks are available today with no IT involvement

The data already have a level of analysis on top, so you can see if a provider is over/under benchmarks

It’s from CMS; it’s a standard; it’s already used to day to drive reimbursement




CMS has made historic data releases both relevant both for a populations health and behaviors as

well as the practice patterns of providers across the healthcare delivery system, allowing resource

allocation and quantitative measurement of the impact of a given population health initiative.

Open Weather Data Open Health DataOpen Geo-Location Data

Gov Data Powering a Marketplace






Those parties who can best identify, manage and capture the financial impact of managing a

populations health by improving outcomes, reducing costs, improving experience as well as

reduce low-value services stand to not only benefit financially but also create the greatest degree of public and social good for a population and its health.

Majority of book in FFS arrangement

Majority of Book in Pay

for ValueToday

Paid more to perform more & higher intensity services

Sicker population may be more profitable

Paid the same regardless of service

volume & intensity

Healthier population is more profitable

Population Health as Social Investment

Population Health Proficiency

as Profit Driver

Upside Up/Downside Full Cap

Low-Value Services Driving Billing

Low-Value Services Reduce Profit

MSSP ACO Flat Payment

Government Program

Private Market Arrangement

% o

f R

even

ue

Time









Summary and Q&A



MAKING OUT LIKE BANDITSPayer Mindset

High &

NeutralValue

LowValue

High &

NeutralValue

LowValue

Total Medical Spend Reduction

Post Risk-Readiness®

Implementation Total

Medical Spend

Baseline Total

Medical Spend

Low-Value Care

Low-Value Reduction

Care That Doesn’t Produce Better Outcomes

$850 Billion Unnecessary Spend

Reducing Low Value Care Lowers Your Network’s Cost of Ownership




~$300B of U.S healthcare spend is related to low-value care

from inefficient and unnecessary services.

[Conservative estimate excluding second order savings

from claims payment, admin costs and missed prevention.]

We focus primarily on addressing low-value care from health plans rather than

direct government programs (Medicare & Medicaid FFS). [Conservative estimate excluding providers practicing across

government programs and self-insured employers.] Billions of low-value care

opportunity across the country.

If your organization adopts all of our recommendations across all of your

spend, you could make a modest improvement in your network score

to achieve millions in through a lower cost of ownership from

reducing unnecessary care and focusing on high value alternatives.

Low-Value Careby Specialty

14.4% in Cardiac

9.1% in Ortho

2.25% in Ophthalmology

73.1% in Other

>$900B (1) ~$300B ~ 30% of Your Medical Expenditures

100%

80

60

40

20

0

Inefficient and Unnecessary

Services

Excessive administrative

costs

Inaccurate claims payment

Missed prevention

Total healthcare waste

Managed Care Organizations

Your Organization …addressable by our solutions

1.15% in Gastroenterology




Year 1: 4%

Network Score2.82

Network Score 2.79

Year 2: 5%

Savings: $

Network Score 2.64**

Year 3: 7%

Network Score2.43

Year 4: 9%

Network2.13

Savings: $

Savings: $

Savings: $

Baseline

Regional Benchmark

2.14% Network Improvement

Using proven tactics from a ToolKit, work to improve efficiency of your Network by:

- Reducing member interaction with the least efficient providers (4s and 5s)- Increasing member interaction with the most efficient providers (1s, 2s, 3s)




Your Provider Partners Your Members

Reduced Overall Cost

Reduced Low Value Care

Network Chassis to Serve All Lines of Business

Competitive Product Pricing Reflecting Network Efficiency

Ability to Grow Through High Value Providers

Focused Sales/Marketing Efforts on a Select Few, High Value Providers

Specialized Reporting using Publicly Available CMS Data to Compare Performance to Benchmark

Metrics Aligned with Future Value Models, MIPS/MACRA

Cohesive and Consistent Relationship AcrossAll Payer Relationships

Reduced Low Value Care

Overall Health Care Expenditures

Reduced Cost Sharing

Better Interactions with the System

Your Organization

High Value Networks Built from Benchmarks Directly Improve Your Bottom Line and Benefit Your Physician Partners and Members

Dr. Atul Gawande, OverKill




ToolKit

Pay Providers Based on Their High/Low Value Performance – [Value-Based Pay]

Drive Members to Visit High-Value Providers – [Member Steerage]

Contract High-Value Providers – [Network Sculpting]

Differentiate Benefits for Member Visits to High-Value Providers

List High-Value Providers First/Bold in Your Provider Directories/Transparency Tools

Attribute Members to High-Value Providers during PCP Auto-Assignment

List High-Value Providers First/Bold in Care Coordination Workflows

Price Products Using Your Network’s Low-Value Care PMPM Benchmarks

Share Low-Value Care Benchmarks with Physicians – [Behavior Change]

Encourage Sales/Brokers to Assign Members to High-Value Providers at Time of Enrollment

Share Referral Benchmarks with Physicians – [Referral Efficiency]

For All Lines of Business

Tactics in Blue are for All Lines

of Business including Medicaid

Network Sculpting

ReferralEfficiency

Member Steerage

Value Based Payment

BehaviorChange

Total

5% (0.01)$0.158M

90%(0.11)$2.835M

5% (0.01)$0.158M

0% 0% $3.15M0.12

15%(0.02)$1.181M

70%(0.11)$5.513M

15%(0.02)$1.181M

0% 0% $7.875M0.15

20%(0.04)$2.52M

50%(0.11)$6.30M

20%(0.04)$2.52M

5%(0.01)$0.63M

5%(0.01)$0.63M

$12.60M0.21

20%(0.05)$3.15M

30%(0.08)$4.725M

20%(0.05)$3.15M

20%(0.05)$3.15M

10%(0.03)$1.575M

$15.75M0.27

Grand Total $39.38M0.75

0% 20% 40% 60% 80% 100%

Network Skulpting Referral Efficiency Member Steerage

Value Based Payment Behavioral Change

24


% of Tactic to Use to improve network score and lower your network’s Cost of Ownership

Work with leaders across network, product, sales, marketing and finance to create a ‘RoadMap’ to define goals, select tactics, measure progress and adjust tactics as needed.

Multi-Year StrategyYear

2017

2018

2019

2020









Summary and Q&A



MAKING OUT LIKE BANDITSRisk Owners Goggles

At the core of Risk-Readiness® is

Unexplained Variation:

RowdMap applies the Dartmouth Atlas forUnwarranted Variation methodologies to data on Medicare Parts A,B & D. This research has been repeatedly validated over the last 30 years and we now have a national data set to apply the methodologies at a large scale.

The estimated 30% of medical expense that goes to low-value care.

This unnecessary spending drives billing in a fee-for-service economic model, but success in pay-for-value comes from managing and mitigating these pockets of variation.

Every provider has a unique practice pattern or finger print that informs Risk-Readiness®




You can have great outcomes…On a surgery you don’t need

You can have great patient experience...On a surgery you don’t need

You can have relatively low costs...On a surgery you don’t need

How Much Outcome Does Your Dollar Buy?

Guys, it’s $/Outcome.Think Moneyball




Provider profiles can be at physician level or rolled up to the practice level (aggregating all physicians in

a practice).

Procedure Score measures how

intense a doctor practices medicine, compared to peers.

Does she jump immediately to high intensity treatments

or start with conservative treatments?

Referral Score measures both

the number, performance

and appropriateness of the providers

in this physician’s

value chain.

Pharmacy Score measures,

compared to peers, how a doctor

prescribes medications. How often, how much and what kind of prescriptions are

common with this provider?

Visit Score measures how quickly a visit escalates into

additional services like procedures,

images, tests and eventually surgery.

Overall Value Score

combines the first four

measures into an overall

composite metric.

Blue bars indicate Medicare Part B fee-for-service volume

Low Performing High Performing

Red dot providers exhibit practice patterns that are clinically appropriate, but

optimized around an old economic model.

Green dot providers exhibit practice patterns that align with pay-for-value models and make money for whoever

owns the risk.




Your success in risk will depend less on profitability from flaws in current reimbursement models and incentives, and instead, rely on profitable, high-performing networks that emphasize high-value

care. High-value networks prioritize outcomes per dollar spent.

Typical Approach Value-Based Approach

• Patient or member level• Begins with a visit and a diagnosis• Outcomes are measured by things like patient

satisfaction, A1C compliance, colonoscopy screenings, episodic cost

• Prioritize individualized care pathways based on evidence

• Data transfers and IT systems necessary to measure

• System-wide insight into how geographic supply and demand affect your success

• Population-based measures • Outcomes measured by quality of outcomes per

dollar spent (ROI or Value)• Direction for refining clinical processes in a value-

based context• Available on Day 1, no client data/IT needed

Triple Aim & Clinical Pathway Development

How do I make the most of every patient interaction?

Ecosystem Drivers & Population-Level Outcomes

How do I optimize my inputs and outputs to be successful in managing a population?

Traditional Triple Aim measures will not ensure success in risk over the long-term. A provider may improve outcomes for a patient, but if a disproportionate amount of low-value care is generated, there will be no savings. What does it mean to your risk profile if you have good outcomes on a surgery that

isn’t needed, or great patient satisfaction on a visit that didn’t add value?




What are the financial impacts of my decisions and what does this mean for our 1-year, 5-year, or 10-year forecasts?

Risk-Readiness® benchmarks are tied to dollars. These determine your financial success in value-based payment models and allow you to pay

providers based on their contribution to mitigate low-value care.

Decreased Cost

Average

Increased Cost

Low

Per

form

ing

1

2

3

4

5

Hig

h P

erfo

rmin

g CARDIAC SURGERY

GASTROENTEROLOGY

ORTHOPEDIC SURGERY

DIAGNOSTIC RADIOLOGY PATHOLOGY

$609 $228 $334 $65 $79

$770 $253 $365 $71 $88

$973 $271 $419 $72 $91

$1,191 $303 $467 $121 $106

$1,299 $387 $624 $245 $212

Cardiac Surgery

Gastroenterology

OrthoSurgeon

Diagnostic Radiology

PathologyImpact on

Spend

Risk-Readiness®Benchmark

Arizona $ PMPY per Specialty & Efficiency Score

Medical Economics Reporting









Summary and Q&A



MAKING OUT LIKE BANDITSYour Hidden Value

Provider Revenue Risk Distribution

Vulnerable Revenue

$#

Protected Revenue

$#

Lost Revenue

$#

Capture the Money Left on the Table in FFS Models

Your Revenue Risk-Readiness®

Create a Plan to Diversify this Vulnerable Revenue

Grow Volume and Increase Compensation for this

Protected Revenue

Note this total is from Benchmark line of businessRevenue % typically holds within 5% for other revenue sources

For example if Vulnerable Revenue Benchmark is $100MM at 50% of Revenue Mix, Estimate for total Remunerable Revenue is ~$200MM

(Actual numbers are tuned at high confidence given with act. revenue mix)




Network Sculpting: Find and Contract with High-Value Providers

Years 1-3: Quantify and Identify Your Vulnerable, Protected and Lost RevenueStart Immediately by Using CMS Benchmarks

Referral Efficiency: Share Value Chain Benchmarks with Providers

Member Steerage:Grow into profitable membership through Providers

Value Based Payment:Match incentives to your goals

Behavior Change: Ongoing Improvement

Network Explorer Assessment Network Builder Assessment Network Optimizer Analysis Network Calculator Analysis

Primary Care Value Chain Reporting Specialty Value Chain Reporting Acute Care Value Chain Reporting Post Acute Value Chain Reporting Value Chain and Leakage

Assessment & Reporting

Network Based Growth Analysis Provider Growth Analysis Measuring Growth Analysis

Years 2-5: Diversify Your Vulnerable Revenue and Capture Your Lost RevenueCurate a Culture that Mitigates Low Value Care

Provider Contracting Strategy Provider Compensation Strategy Service Line Benchmarking Medical Economics Reporting

Process Variation & Improvement Assessment

Provider and Group Low Value Care Reporting

Choose to share your claims for inter-year reporting on Risk-Readiness® performance

Years 1-3: Quantify and Identify Your Vulnerable, Protected and Lost RevenueStart Immediately by Using CMS Benchmarks




Primary Care Groups

Network SculptingRegional Benchmarks

Contract High-Value Providers

Determine which providers help or hurt your network score the most. Optimize your network by finding and growing into as many high value

providers as possible.




Primary Care Physicians

Regional Benchmarks

Outagamie and Winnebago Co, WI

Contract High-Value Providers

Determine which providers help or hurt your network score the most. Optimize your network by finding and growing into as many high value

providers as possible.

Network Sculpting




SpecialistPost Acute

Facility

Low-Value

High-Value

Value Chain and Leakage: How does the population flow through the care continuum?Identify natural patient flows and determine if your network is breaking or reinforcing high-value pathways

and then incentivize providers to optimize pathways through referrals.

Target this specialist to better manage patient flows to high

performing post acute facilities.

Primary Care Docs

University of Miami is underperforming and referrals are internal.

This is a concentrated, low value pathway.

Holy Cross has high performing specialists, but its PCPs are referring to a variety of specialists.

This is a fragmented, but high value pathway.

Thickness of lines indicates the number of referrals.

Note: Some markets are oversupplied. This market is controlled by one provider.




Your patients should be going here

Orthopedic Referral Management

Share Referral Benchmarks with Physicians

Use RowdMap’s Referral Report cards to educate PCPs on High Value and Low Value patient flow patterns connected to their practice.

Optimize network performance by empowering PCPs to direct care to high performing specialists. Track referrals and work with

providers to maximize the number of patient interactions in High Value referral chains & consider paying PCPs on it. Reinforcing high value referral chains maximizes the performance of your network.




See how a provider stacks up against peers. Pick a few outliers

and focus on these areas to improve overall risk profile.

Dr. RowdMap

Figure out how far away a provider is from the peer-

adjusted value benchmark.

Figure out what’s driving the variation. Give your process improvement

team priorities for pathway development.

Pinpoint absolute High and Low Value services quickly.

Dr. RowdMap is an average performing provider. What goes into his score and how does he

compare against his peers?

Dr. RowdMap

Share Low-Value Care Benchmarks with Your Physicians

Share individual procedures, codes and metrics with providers and and regional rankings of named providers vs. his or her peers.





What if you knew which providers create protected

revenue?

What if you knew which providers create vulnerable

revenue?WHAT WOULD YOU DO IF YOU KNEW






What if you knew which providers create protected

revenue?

What if you knew which providers create vulnerable

revenue?WHAT WOULD YOU DO IF YOU KNEW


For PCPs and Urgent Care – this is about :

– Lowering Intensity Level / Practicing at Top or License

– Balancing Supply & Demand / Maximizing Impact via Location

– Referring to High Value Specialists /Calculating and Capturing Impact




Health Behaviors Average Risk Scores

Population Demand & Provider SupplyPCPs & Urgent Care Disproportionately Important to Risk

Where is health risk underrepresented or under-coded?

Which areas have lower risk scores than their behavioral profile / cost drivers.

In other words, where does the population sees providers less and therefore has a lower risk profile based on the geography’s ‘supply’.




Diabetes Prevalence –LA County

PCP Density –LA County

Income

Obesity

Depression

Proximity to provider is more important for this geography. Is my network aligned to not only meet adequacy

but to reflect my member demographic?

Population Demand & Provider SupplyPCPs & Urgent Care Disproportionately Important to Risk




Potential Impact to Risk Ownersfrom Network & PCP Referrals

Preferred Network Tampa, FL PMPY

Total Cost= $12,209,105Average Network Score= 2.08

* All Provider Types

Tampa, FL

44


Preferred Physician Distribution Tampa, FL

All Other Physicians Tampa, FL

Percent of physicians in each score bucket

Priorities for Creating Impact for Risk Ownersfrom Network & PCP Referrals PCP Referral Scenario



MAKING OUT LIKE BANDITSABC

PCP Referral Impact for Risk-Owners1 HRR; 1 Specialty; Conservative Scenario = ~$3MM


~$3,750,000,000




Estimated total network expenditures

Customer Medical Claims Expense

Year 1 Year 2 Year 3

Conservative $2M(1%)

$4M(1.5%)

$7M(2.5%)

Average $4M(1.5%)

$7M(2.5%)

$14M(5%)

Aggressive $7M(2.5%)

$14M(5%)

$19M(7%)

$281M% 9.5 -- total savings

opportunity

Estimates of expected savings based on average experience with health plan clients:

Impact to Risk Owners from PCP Referrals Yield




Telling the Future

Network becoming primary driver to mitigate risk for risk owners (supply side vs. demand/trend)

PCPs/Urgent Care as primary focus; primary tactic = referrals

Mitigate Risky Revenue – Exposure for low-value PCPs (poor referrals & practice patterns) is explicit & ‘subtle exclusion’

Grow Protected Revenue (moderate risk-readiness / moderate referrals)

Capture Lost Revenue from High-Value PCPs (high-value referrals & Practice Patterns)









Summary and Q&A



MAKING OUT LIKE BANDITSSummary and Q&A

As PCPs, Urgent Care & ASCs become more important to risk-mitigation & value-based care…

… will PCPs, Urgent Care capture they value they create for risk-owners?



MAKING OUT LIKE BANDITSSummary and Q&A

Will PCPs, Urgent Care capture they value they create for risk-owners?

Hospital-based systems, PCP systems, Specialty systems, and even large groups are now doing this…

… with success, but still work to do…

A workgroup with leading providers sharing best practices for this

making out like bandits: the unexpected rise of pcp & urgent care and the hidden battle for...

Health & Medicine