Monday, February 13, 2012

Work Comp and Group Health: Lessons from Emory University’s Healthcare Forum

This past Friday, Emory University’s Goizueta Business School hosted its annual Healthcare Forum.  As a graduate of the MBA program there, I’m sometimes invited back to participate in a panel discussion during the event.  This year, I was on a panel entitled “Achieving Financial Objectives” and the discussion focused on the sustainability of the health care financing structure we currently have in place (guess what... it's not sustainable).  The panel was a mix of management consultants, entrepreneurs, and investment bankers – and I thought it was an informative and lively discussion. 
Two insights, in particular, have stuck with me from the discussion:
1)      I know few of us are satisfied with the current state of work comp medical management, but there are some things that our little niche does right.  When I spoke of evidence-based guidelines being presumptively correct and that this was supported, by statute, in certain jurisdictions – well, this got the attention of many of the attendees.  While evidence may be lacking in several areas of health care diagnosis and treatment, physical and occupational medicine is blessed to have ACOEM, ODG, MTUS, and other jurisdictionally-specific sets of guidelines.  We have a long way to go (see Arizona’s battle over the adoption of such guidelines), but we’re headed in the right direction. 
2)      I was surprised at the lack of clarity around the implementation of health care reform.  The investments being made by large providers (hospital systems and large physician groups) as well as the health insurance sector are being made in the context of extreme uncertainty.  I have a better appreciation for the conundrum that most payer CEOs face: hold back chips and wait for the air to clear, running the risk of being late to the game… or go “all in” now and hope it’s the right strategy.  Billions of dollars and lots of “covered lives” hang in the balance.  Tricky times, indeed.
Besides the great panel discussions, we were also treated to an overview of IBM’s Watson technology (of Jeopardy fame) and its potential application in the health care space.  Fascinating presentation.
And we also heard an update from Dr. Richard Wild, Chief Medical Officer for the Atlanta Regional Office of CMS.  He offered an overview of the CMS Value Based Purchasing initiative.  Even the hardcore conservatives in the room had to admit that the strategy appears promising (though implementation may prove increasingly difficult as the program expands).
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