"Public policy must be based on scientific evidence rather than short-term economic interest or political ideology,” said Julio Frenk, M.D., president, University of Miami, in his opening keynote talk. “That has never been more important than it is today.”
Other insights from conference participants included the gradual transformation of U.S. medicine from a volume-based to a value-based model, the growing importance of coordinated care teams, and the recent rise in vertical consolidation in the sector, such as the CVS-Aetna merger and Quest Diagnostics’ alliance with Walmart.
“There is tremendous change throughout the health care sector, from consumer trends to business and investment activity to how the political winds are blowing,” said Steven G. Ullmann, chair and professor, Health Sector Management and Policy, and Director, Center for Health Sector Management and Policy, which organized Miami Business School’s seventh annual conference. “By bringing together the full spectrum of the health care industry, we can learn about the broader issues from each other.”
John Quelch, dean of Miami Business School, welcomed more than 700 health care executives, physicians, consultants, and students to the sold-out event, which was supported by Florida Blue, Boston Scientific and 20 additional sponsors. “Our speakers have come here from as far away as Denmark to share their wisdom at this must-attend conference,” he said.
Attendees paid close attention to the keynote speakers and panelists throughout the day, lining up to ask questions after each session. “The core topics and issues haven’t changed in the past few years,” said Ben Schein, BBA '17, a staff member at EY who was attending his fifth conference. “But, I learn something new and meet more people every year.”
Mackenzie Mayhew, a senior majoring in neuroscience in the College of Arts & Sciences, was one of 125 Vitas scholars whose student registrations were covered by Vitas Healthcare. “For me, the panel on the pharmaceutical sector was an eye-opener,” she said. “I didn’t know much about the industry, and as a future physician I appreciate the knowledge I gained.”
Nercy Radcliffe, founder, and CEO, Providence Healthcare Services, pointed to the speakers’ emphasis on a team approach to patient-centered care. “We as providers definitely have to work together to deliver the best outcomes and engaging patient experiences,” she said.
Creating the Future
Academic medical centers can be leaders in the transformation of healthcare in the U.S. and around the world, according to Frenk. “The value we provide is knowledge – the most powerful force for enlightened social transformation,” he said. “We create knowledge through research, re-create it through education, and translate that knowledge into evidence for decision-making at the household, practitioner and policy level in the corporate world and public sphere.”
Frenk also focused on the importance of delivering value in health care in three key dimensions: Clinical outcomes, including safety and effectiveness; population health, reducing risk factors and increasing wellness; and the patient experience, the interpersonal relationship. “In health, the notion of value is inseparable from ethical values,” he added. “Our fundamental value is the idea of service,” he said.
Frenk pointed out the need for a new U.S. health care model that can anticipate and predict health risks, rather than just reacting to problems. “Quality care must be provided throughout a person’s lifecycle and delivered in the appropriate setting from an acute-care hospital or physician office to the home or hospice,” he said. “Care should also be multidisciplinary, based on teams with complementary professional competencies, and sustainable from a financial point of view.”
Those themes were examined in the first-panel discussion, “Current and Future Impact of Policies on Health Care Sectors," moderated by Patrick Geraghty, CEO of Guidewell Mutual Holding Corporation, Florida Blue’s parent company. “The shift from volume to value is real, but there is so much experimentation going on that the environment is very confusing,” said Joseph Fifer, president and CEO, Healthcare Financial Management Association.
Halee Fisher-Wright, M.D., president and CEO, Medical Group Management Association, added there is general alignment on goals, but not processes. “You can see the move to value-based care in closed systems like Kaiser, but not in other settings,” she said. “We also haven’t looked at the interpersonal aspects of care highlighted by Dr. Frenk.”
Pamela Cipriano, president, American Nurses Association, and Richard Pollack, president and CEO, American Hospital Association, pointed to the importance of professional coordination in delivering high-quality, cost-effective care.
Marilyn Tavenner, president, and CEO, America's Health Insurance Plans, pointed to the growing importance of state legislatures in shaping health policy.
“We are seeing more leadership by the states on Medicaid programs, individual markets and mandates, due to inaction in Washington,” she said. “I think we are too close to the midterm elections for significant legislative action in Congress, but we will see continued regulatory efforts to pick apart pieces of the Affordable Care Act (ACA) and stabilize Medicare.”
The Political Climate
One of the conference highlights was a closing keynote discussion on "Current and Future Health Care Political Climate" between Professor Donna E. Shalala, former University of Miami president and former U.S. Secretary of Health and Human Services, and Drew Altman, president and CEO, the Henry J. Kaiser Family Foundation, on the future of health care policy.
Uncertainty over the future of Medicaid, Medicare, and the Affordable Care Act (ACA) reflects underlying social divisions on values, such as whether health care a right or a privilege, said Altman. “Do we shift coverage for the poor to the states or do we have a national responsibility to care for everyone?”
Altman added that policymakers in Washington have focused on the ACA rather than “a quiet revolution in health insurance” resulting in lower coverage and higher costs. “The number one issue for consumers is paying their medical bills,” he added.
The Business Side
Three conference sessions focused on business and investment trends in health care, including a keynote talk on “Technology and Access to Health Care” by Paul Grundy, M.D., M.P.H., global director of healthcare technology, HealthTeamWorks. “We are moving from the information age to the age of intelligence,” Grundy said. “Artificial intelligence (AI) will play a growing role in recognizing patterns because the machines can dig into the data and see things that we miss. Ultimately, there are two things a physician should do: perform difficult diagnoses and build patient relationships as part of a care team.”
Ben Riestra, chief administrative officer, Lennar Foundation Medical Center, UHealth – the University of Miami Health System, moderated a panel discussion on "Current and Future Trends in the Pharmaceutical, Diagnostic and Medical Device Sectors."
Gitte Aabo, president and CEO, LEO Pharma in Denmark, said her company has reduced the prices on its skin disease products over the past three years, while Robert Donelly, senior director, health policy, Johnson & Johnson, added, “Our net price trend was negative, too.”
Parashar Patel, vice president of global health policy, Boston Scientific, said new medical technology must deliver value to different stakeholders: physicians, health systems, payers, and patients. “The goal is to align in those interests in bringing new devices to market,” he said.
Noting that all health care is ultimately driven by the consumer, Jay Wohlgemuth, M.D., senior vice president, R&D, chief medical officer, Quest Diagnostics, emphasized the importance of convenient access to diagnostic services at the home, workplace or retail center, as well as a medical office building. That’s the driving force behind Quest’s joint venture with Walmart to provide medical diagnostics, pharmacy, nursing and telemedicine services from one location, closing gaps in care for individuals.
An afternoon panel on "Current and Future Trends in the Health Care Business Sector" was moderated by Richard Clarke, former president and CEO, Healthcare Financial Management Association and board member, Mercy Health Ministry.
Consolidation in the industry has moved from horizontal mergers and acquisitions (M&As) aimed at achieving economies of scale to vertical integration, according to Benjamin A. Breier, president and CEO, Kindred Healthcare, which has been sold to Humana and a private equity firm. “Humana has one of the largest Medicare populations in the country, and was seeking a way to reduce costs and keep its members well,” he said.
Charles Alston, market executive and SVP, Healthcare and Institutions Southeast, Bank of America Merrill Lynch, pointed to the importance of culture in successful M&As. “Leadership teams are concerned about costs and access to capital, but a key issue in consolidations is being able to create a common culture,” he said.
Fiona Greig, executive director, director of consumer research, JP Morgan Chase Institute, offered several fresh insights on health care spending. “We have seen spending spike in March, driven by tax refunds,” she said. “That tells us cash flow dynamics influence when consumers utilize and pay for their health care. From a provider perspective, it means you should try to collect that revenue in March.”
Reflecting on the need to improve health care delivery, Jacques Mulder, American health sector leader, EY, noted that health care business leaders have been focused on costs, rather than dealing with clinical risks. “We need to reduce the variation in patient outcomes, and decide how to value those outcomes in M&A discussions,” he said. “Ideally, providers should strive to create an experience where patients want to engage with them. Clearly, our work is ahead of us – not behind us.”
