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TL;DR: UnitedHealth Group’s worst quarter…ever? The highlights: Going Deeper: UnitedHealth Group earnings analysis OptumHealth Woes Drive Underperformance: The big miss was in Optum, and OptumHealth specifically (the segment housing all of the physicians and clinicians). OptumHealth membership added more full risk membership than expected, and because utilization spiked (notably calling out outpatient care and OP behavioral health), coupled with v28 transition challenges (less revenue from coding), Optum faced significant medical cost pressure from this new cohort. UHG also mentioned these member profiles were not specific to any one market or carrier. So the dynamic played out something like this: CVS, […]

Health systems have a glaring navigation problem, and it’s leading to network leakage and specialist capacity challenges. Provider organizations have poured significant resources into building expansive medical groups and aligning with specialist physician practices. Despite all this investment, prioritizing the right patients and navigating them through these networks feels a bit like herding cats.  In competitive markets, this leaky bucket problem means patients often slip through the (sizable) cracks, losing out on the care they need and taking those potential services elsewhere.  Every time a patient leaves the network, a health system loses thousands in potential downstream service line revenue. […]

I recently had the opportunity to sit down with Pete McCanna, the CEO of DFW-based Baylor Scott and White, one of the, if not the best-run health system in the country. Pete was gracious enough to spend more than an hour with me discussing leadership, Baylor’s health system transformation strategy, thoughts on physician alignment, jobs to be done in healthcare, and innovation. I’ve summarized the main takeaways below and I hope you guys enjoy because I personally loved this conversation. Lots of practical takeaways from a great person. We uhh…talked a LOT. Let’s dive in! PS – Join my Hospitalogy […]

Often the best companies in healthcare are the ones who don’t care to be recognized. They’re the ones working alongside their customers, patients, and physicians to do what needs to be done in the right way by their partners. Today I’d like to introduce one such organization to Hospitalogists: The Garage. Pranam Ben founded The Garage in April 2012, and most healthcare folk who have been around the block might remember this date as the beginning of the Medicare Shared Savings Program. Over the past 13 years in working within MSSP and every major value-based care program, The Garage has […]

Join my Hospitalogy Membership! If you’re a VP or Director working in strategy or corporate development at a hospital, health system or provider organization, you will get a lot of value out of my community as I purpose-build the content, fireside chats, and conversations for this group. Join for free today. Omada Health and the Dropout Comeback The Omada Health Breakdown with Sean Duffy Hinge Health tackled the “pain” problem (literally). It built an AI-enabled virtual PT model that slashes costs, increases access, and claims better outcomes. Employers and payors buy in because it keeps employees healthier and out of […]

I revisited my conversation with Mark Cuban on PBMs, transparency in healthcare costs, and why pharma is the “easiest business [he’s] ever disrupted.” Needless to say, there’s a lotta juice left in that lime. (Sorry, I’ve never said that before.) I pulled 5 of my favorite “out of context” Cuban quotes for your reading enjoyment (don’t worry I included the context below). Without further ado, I present… Cuban Out of Context 1. “It’s cheaper to buy Tadalafil than a bag of M&M’S” “It’s one of the most opaque marketplaces and industries on the planet, and that makes absolutely no sense. […]

Today we’re diving into the world of behavioral health, the structural problems this industry faces, and how risk-bearing organizations today are struggling to grapple with rising utilization and total cost of care challenges involving ‘hidden’ behavioral health needs in their populations.  So I’m here to break down how a company like NeuroFlow solves those problems by providing health plans and integrated health systems an all-in-one platform with the visibility these organizations sorely need to drive real, actionable results for members and get a better handle on total cost of care. It’s a good one! Let’s get after it. This essay […]

Join my Hospitalogy Membership! If you’re a VP or Director working in strategy or corporate development at a hospital, health system or provider organization, you will get a lot of value out of my community as I purpose-build the content, fireside chats, and conversations for this group. Join for free today. DispatchHealth and Medically Home merge, Updates on Marathon Health, 23andMe’s Bankruptcy and more Healthcare news this week source: Business Insider Dispatch-Medically Home Hospital-at-Home Merger: DispatchHealth and Medically Home announce a merger aiming to create the nation’s largest provider of hospital-level care at home, expanding acute care access outside traditional […]

I had a chance to chat with Wellvana’s CEO Kyle Wailes about the Wellvana-CVS acquisition recently announced, so here’s a nice little overview of that conversation. I would love to hear your thoughts on the enablement space after reading more about the deal.Wellvana, a fast-growing value-based care (VBC) enablement company with early backing from Martin Ventures back in 2019, acquired CVS’ Medicare Shared Savings Program (MSSP) business in early March. Remember these assets were tied to CVS acquisitions of Caravan and Signify over the last few year. CVS will still retain ACO REACH presence within Oak Street Health while it […]