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by Benjamin Chu, M.D.
(Presented at the 1999 CAMS Annual Scientific Meeting
The following is an outline of Dr. Chu’s talk, from his powerpoint presentation.
Stresses on the Health System - In-creasing fragmentation?
• Physicians
• Hospitals/Hospital systems/Academic Health Centers
• Insurers/Payers
• Government Payers - Medicare and Medicaid, child Health Plus
• Wall Street
• Patients
Major Themes
•Search for value in health Care
•Market driven efficiencies and the influence of Wall Street
•Integration/Disintegration/Devolution
•Oversupply of physicians and hospitals
•The end of cost shifting and the problem of the uninsured
Physicians
• The migration to groups
• IPA’s, unions, bargaining agents
•Practice management company debacles - Med-partners, FHP
•Gatekeepers, capitation and the effects of the doctor-patient relationship
Hospital Systems
• Integration strategies - do they work?
• Mergers, Acquisitions and the flow of red ink
• Market presence or true efficiencies
• For profits and not-for-profit look-alikes - Columbia/HCA and Allegheny
• Five large systems in New York? Where are the doctors?
Insurers/Payers
• Managed care as hit man to take out cost in healthcare system
• system wide backlash - Bill of Rights, Right to sue - the return of choice
• United Health elimination of pre-authorization - enlightened strategy for survival?
• the end of arbitrage opportunity - Now where is the beef?
Government Payers
• Medicare cuts, negative growth rates and the politics of a senior drug benefit
• Medicaid enrollment loses and lost opportunities
•Managed Care - promise and pitfalls
• Child Health Plus
• The uninsured - billions available, millions go without
The Influence of Wall Street and the For-Profit Sector
• Return on Investment and the market capitulation game
• Market definitions of value - Does growth = value?
•Columbia/HCA, Oxford and Physician Practice Management companies
Academic Health Centers - Big Problems in Paradise
• Internet Cost disadvantage
•Victim of success - Community hospital expertise
• GME cuts and loss of subsidies
•Cultures, egos and difficult decisions
•High visibility, political muscia, powerful boards, efficiencies - prescription for survival?
Dr. Chu is Associate Den for Clinical Affairs and Associate Professor of Clinical Medicine, New York University Medical School.
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