g

THE ONLY HEALTHCARE BUSINESS NEWS WEEKLY | JANUARY 13, 2020 | $5.50

asin
urch Employers are
squeezing the

P pow
gap between
commercial and

er
Medicare payment
rates Page 14

Hospital Solutions to
outpatient loneliness
visits see elusive for
first dip in hospitals /
35 years / Page 10
Page 6
 THE MORE YOU UNDERSTAND
HER WORLD, THE MORE
POSSIBILITIES YOU SEE.
For Julia’s family, early screening for
autism made a lifetime of difference.
Find out more at ScreenForAutism.org

© 2019 Sesame Workshop. All rights reserved.

 14 Cover story
Fed-up employers
wielding their
purchasing power
By Harris Meyer Opinions/Ideas
Self-insured employers 22 Editorial 23 Guest Expert
are using their collective
Better coordination and Intermountain Healthcare CEO
purchasing muscle to
communication is critical Dr. Marc Harrison says that
contract with higher-value
in healthcare—among for industry leaders, there’s
healthcare providers in hopes
caregivers and with patients still much to learn on the
of lowering their costs.
and their family members. journey to value-based care.
Cover photo: Getty Images

24 Letters
Features The leader of a large national medical group cautions
10 Looking for answers to loneliness that proposed Stark law reforms could lead to unintended
consequences, especially in rural settings.
By Maria Castellucci
Research has highlighted the many ill-effects of loneliness and isolation. 26 Innovations
Health systems and insurers are working on ways to help, but effective and
By Jessica Kim Cohen
scalable solutions are still major challenges.
An interdisciplinary team at a Texas healthcare system is using
18 Social workers automation to speed up the process of identifying donor organs
caught in the middle from patients, saving critical time for procurement and transplant.
By Michael Brady
28 Q&A
Hospitals will need
more social workers Dr. Kurt Newman, CEO of Children’s
as the focus on the National Hospital in Washington,
social determinants of D.C., since 2011, discusses his
health intensifies. But organization’s leadership in pediatric
these professionals are medical device innovation and its
struggling to get the anchor role in a new biomedical
payments and licenses research campus.
they need to provide
services. Data

News 27 Data Points

December 2019 saw 30
2 Late News 6 Finance 8 Legal healthcare-related data
Next Generation As competition Federal judges question breaches, affecting just over
ACOs are not saving heats up, hospital if insurers need to 295,000 patients. That’s the
Medicare any money. outpatient visits see recoup CSR payments. lowest monthly patient total for
first dip in 35 years. the entire year.
4 The Week Ahead 9 Finance
Appeals court to hear 7 Politics J.P. Morgan’s annual
arguments in suit over Healthcare is the healthcare conference Diversions
rule requiring list prices biggest issue for voters isn’t cheap or 32 Outliers
for drugs in TV ads. but not for Congress. convenient, but execs It’s a recognition you really
say it’s worth it. don’t want to win. See who
5 Regional News
earned ignominious
Beaumont Health, honors in this year’s
Summa Health deal Shkreli Awards.
moves forward.

ModernHealthcare.com/WebExclusives
HHS’ Office of the National Coordinator for Health Information
A JAMA Network Open study found that adoption of Medicaid Technology is continuing the industry’s push to incorporate social
expansion was associated with a 6% lower rate of total opioid overdose factors that influence health—like food insecurity and homelessness—
deaths compared with the rate in non-expansion states. into patient care though release of its 2020 edition of the ONC’s
The Mayo Clinic has launched a project to create a genomic interoperability standards advisory.
sequencing library that will include data on 100,000 of its patients, The Greater New York Hospital Association made approximately
marking the latest effort by providers to integrate genetic testing into $6 million in 2020 membership dues voluntary as hospitals brace for
routine care delivery. Medicaid reimbursement cuts.
MODERN HEALTHCARE (ISSN 0160-7480). Vol. 50 No. 2 is published weekly by Crain Communications Inc. (except for combined issues for June 24 and July 1, and Dec. 16 and Dec. 23; and no issues on Nov. 25 and
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1155 Gratiot Ave., Detroit, Mich., 48207-2912.

January 13, 2020 | Modern Healthcare 1

 Briefs
„„
„

Next Gen ACOs aren’t

A California appellate court rejected
Dignity Health’s claim that L.A. Care
Health Plan, a large Medicaid plan, owes

saving Medicare money

it $98 million in out-of-network bills for
inpatient care following stabilization of
medical emergencies. The 2nd District
Court of Appeal on Jan. 9 upheld a
The experimental Next Generation Accountable Care Organization model lower court’s summary dismissal of
didn’t save Medicare money during the first two performance years. Dignity’s lawsuit alleging that the
Rather than reducing Medicare spending, the Next Generation health plan owed Dignity’s Northridge
ACO model, which is now in its fifth and possibly final year, added Hospital rates higher than state-set
$93.9 million to net Medicare spending during 2016 and 2017, an rates. Northridge is not within the
analysis of CMS data found. plan’s network of contracted providers.
The study, performed by researchers at the University of Chicago and The appellate panel held that state law
funded by the Center for Medicare and Medicaid Innovation, said the applies “all-patient refined diagnosis
increase was statistically insignificant but the finding is likely a blow to related group rates” to out-of-network
supporters of the model who claimed it’s been saving Medicare money. inpatient post-stabilization services
The Next Generation ACO model under Medi-Cal, California’s Medicaid
forces organizations to take on program.
Next Gen ACO substantial downside risk.
performance in 2018 Medicare was unable to achieve „„
„
Kansas Gov. Laura Kelly and Senate
Percentage of ACOs earning a savings during the first two years Majority Leader Jim Denning on Jan. 9
bonus versus those owing the of the program because it had to outlined a new proposal for expanding
CMS money pay out more in savings than it got the state’s Medicaid program, breaking
back. In fact, before accounting an impasse that had allowed a handful

76% Earning for the payouts CMS had to make, of GOP leaders to thwart bipartisan
a bonus the model actually decreased legislative majorities. The plan would
Medicare spending by $123.2 expand coverage to as many as 150,000
Owing
money 24% million during the first two years,
the study found.
In a Health Affairs blog post,
people. It increases Medicaid eligibility to
138% of the federal poverty level, imposes
a surcharge on hospitals, and includes a
Source: CMS CMS Administrator Seema work training and placement program
Verma said the findings show the that is less stringent than the work
importance of evaluating results of requirements that many Republicans
value-based payment models after shared savings are handed out. desired. The plan also allows Kansas to
The CMS hasn’t announced if it will make the project a permanent move forward on creating a re-insurance
part of the Medicare program, although the changes made to the program designed to make healthcare on
Medicare Shared Savings Program in late 2018 resemble the Next the federal exchange more affordable.
Generation model because ACOs are forced to take on higher levels of
downside risk the longer they’re in the program. „„
„
The ambulatory sector fueled healthcare
The CMS also released data from 2018 participants of the Next job growth in December, accounting
Generation model. Of the participating organizations, 38 got bonuses for two-thirds of the expansion. The
for reaching cost and quality targets while the remaining 12 had ambulatory sector grew by 23,100 jobs
losses and were forced to return money to the CMS. Overall, the CMS while hospitals added 8,800 positions
estimated it saved $184.6 million two years ago. and senior-care facilities brought on
In 2018, the CMS had to pay about $285 million in shared savings to 2,600 employees, according to the U.S.
ACOs that hit targets and received almost $64 million from ACOs that Bureau of Labor Statistics’ most recent
experienced losses, according to the agency. —Maria Castellucci jobs report. But skilled-nursing facilities
continued to downsize, shedding
6,700 jobs as the sector adjusts to a new
payment model. Thousands of therapists
Corrections and clarifications have been laid off over the past year.
A list in the By the Numbers supplement “Largest healthcare system- or Overall, the healthcare industry
provider-owned insurance operations” (Dec. 16, 2019, p. 23) mistakenly expanded by 28,100 jobs in December,
included Tufts Medical Center, which is unaffiliated with the insurer Tufts Group. down from 45,200 in November.

2 Modern Healthcare | January 13, 2020

 FIVE
SPONSORED CONTENT
TAKEAWAYS
THE FUTURE OF WORK IN HEALTHCARE
Future technologies are transforming how
clinicians and staff serve their communities.
During a webinar on December 10, Nanne Finis,
chief nurse executive at Kronos, and Regina Corso,
president and founder of Regina Corso Consulting,
discussed the state of digital transformation in
healthcare. These leaders provided their insights into
how technology is influencing the workplace, as well
as the workforce, currently and in the near future. To
access the full webinar, visit
www.modernhealthcare.com/FutureofWorkWebinar.
In a study by The Workforce Institute at
Kronos Incorporated, researchers found
that while competitive pay is important,
respondents put more value in a devoted
employer and a positive workplace culture.
Making sure your organization’s employees
are compensated fairly is a mere first step to
making sure your employees find
value within your system. Along with
benefits, work-life balance and a
strong leadership team, staff find a lot of value
in good managers who are able to help
them navigate the future of their work and
further their careers.
The future of work depends on nurses,
human resource executives and hospital
IT leaders working for an employer of choice.
An employer of choice is one that delivers
a positive work culture and workplace
environment that attracts and maintains high-
performing employees. As a health system
workforce undergoes significant technological
transformations, organizations with the best
management and work environment will
prevail. The lives of your health system’s
patients depend on the attention of leadership
to fundamental issues and innovation to
improve efficiency and achieve the Triple Aim.
WATCH
THE FULL
WEBINAR
on-demand at
www.modernhealthcare.com/
FutureofWorkWebinar
Healthcare organizations need to emphasize their
focus on the employee experience.
Transforming your workforce with new technology begins
by assessing your retention rate, flexibility in the workplace
and the culture of your system. While an improved patient
experience, quality of care and lower costs are the ultimate
endgame, the real progress begins with addressing your
employees’ needs and determining how to improve their work
experience. If your employees are struggling to see the value
in your workforce management system, new technology and
processes may be able to give more flexibility to clinicians and
staff and create a more positive working environment.
Maturing digital transformation and the use of data
and analytics is a vital part of a valuable workplace.
Intelligent automation and immediate access to
real-time data will help free up managers from
administrative tasks, allowing them to spend
more time interacting with their staff. Supportive
technology can ensure your employees are
more productive. When clinicians and staff are
equipped with updated technology tools, they
feel empowered to provide top-notch care.
New technology for your healthcare organization
will significantly improve the digital employee
experience.
Healthcare organizations who devote time and interest
in the digital employee experience will stand out as
employers who care about their staff and their overall
happiness. Modern Human Capital Management
technology can increase productivity, reduce staff fatigue,
retain talent and provide an overall better employee
experience. Digital technology, such as telemedicine and
electronic health records, also help hospital staff feel as
though they can more effectively serve their patients,
leading to a more successful health system.
Investors ready to hear EDITORS

healthcare financial
Aurora Aguilar Editor
312-649-5218 aaguilar@modernhealthcare.com
Matthew Weinstock Managing Editor

pitches at J.P. Morgan

312-397-7585 mweinstock@modernhealthcare.com
Paul Barr Features Editor
312-649-5418 pbarr@modernhealthcare.com
Erica Teichert News Editor
212-210-0209 eteichert@modernhealthcare.com
JAN. 13-16: More than 9,000 people will descend on San Francisco
David May Assistant Managing Editor
for the J.P. Morgan Healthcare Conference, the banking giant boasts 312-649-5451 dmay@modernhealthcare.com
on its website. As Modern Healthcare finance reporter Tara Bannow
Merrill Goozner Editor Emeritus
writes on p. 9, the annual ritual has come under heat mgoozner@modernhealthcare.com
in recent years for being costly to attend. Healthcare CREATIVE SERVICES
executives still claim attending is worth the price of Patricia Fanelli Creative Services Director
admission (although many have dialed back the size of 312-649-5318 pfanelli@modernhealthcare.com
their entourages). Bannow will be there, so be sure to look Paul Romejko Graphic Designer
for her daily reports online and in our newsletters. 312-649-5335 promejko@modernhealthcare.com
DIGITAL
JAN. 13: A federal appeals court will hear arguments Saman Creel Digital Content Strategist
in a lawsuit drugmakers filed to kill a Trump administration plan 312-649-5225 screel@modernhealthcare.com
that would require disclosure of a drug’s list price in television Emily Olsen Web Producer
ads. A lower court judge stopped the rule from going into effect in July 312-649-5482 eolsen@modernhealthcare.com
because he said Congress did not give HHS authority to require such SENIOR REPORTER
disclosures in direct-to-consumer ads. The disclosure Harris Meyer Chicago
312-649-5343 hmeyer@modernhealthcare.com
requirements likely wouldn’t have much bottom-line impact
on the pharmaceutical industry, but another ruling against REPORTERS
Tara Bannow Finance | Chicago
the proposal would be a blow to the President Donald 312-649-5362 tbannow@modernhealthcare.com
Trump’s healthcare record in an election year. Watch for
Michael Brady Rules and Regulations | Washington
coverage of the hearing from Modern Healthcare policy 202-505-4789 mbrady@modernhealthcare.com
reporter Rachel Cohrs. Maria Castellucci Safety & Quality | Chicago
312-397-5502 mcastellucci@modernhealthcare.com
JAN. 14: A House Energy & Commerce subcommittee plans to
“examine state efforts and successes in addressing the opioid Jessica Kim Cohen Technology | Chicago
312-649-5314 jcohen@modernhealthcare.com
epidemic, as well as opportunities for future federal support.” Witnesses
Rachel Cohrs Politics and Policy | Washington
include state health officials from Massachusetts, North Carolina, 202-681-3353 Rachel.Cohrs@modernhealthcare.com
Pennsylvania, Rhode Island and West Virginia. Steven Ross Johnson Population Health | Chicago
312-649-5230 sjohnson@modernhealthcare.com
JAN. 16-17: The Medicare Payment Advisory Commission has
a jam-packed agenda for its monthly meeting. The congressional Alex Kacik Operations | Chicago
312-280-3149 akacik@modernhealthcare.com
panel will review the “adequacy” of a number of payment updates, for
Shelby Livingston Insurance | Nashville
hospital inpatient and outpatient services, skilled-nursing 843-412-6857 slivingston@modernhealthcare.com
facilities, ambulatory surgery centers and more. The
RESEARCH AND DATA
commissioners will also get a status report on Medicare Tim Broderick Data and Analytics Lead
Part D and hear from staff on ideas for retooling the 312-649-5409 tbroderick@modernhealthcare.com
Medicare Advantage quality bonus. Modern Healthcare Megan Caruso Data Specialist
rules and regulations reporter Michael Brady will be 312-649-5471 mcaruso@modernhealthcare.com
there to bring you breaking news. COPY DESK
Julie A. Johnson Copy Desk Chief
312-649-5236 jajohnson@modernhealthcare.com
Upcoming Modern Healthcare events EDITORIAL SUPPORT
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March 31 - April 1, 2020 Leadership Symposium | Scottsdale, Ariz. 312-280-3173 rocio.villasenor@modernhealthcare.com
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877-812-1581 customerservice@modernhealthcare.com
May 12, 2020 Healthcare Transformation Summit | Austin, Texas
ModernHealthcare.com/TransformationSummit Modern Healthcare editorial office: 150 N. Michigan Ave., Chicago, Ill.
60601-7620. Member of Business Publications Audit of Circulation.

4 Modern Healthcare | January 13, 2020

 MIDWEST

Beaumont Health, As health secretary, Gee was instru-

Summa Health deal

mental in overseeing the state’s Medic-
aid expansion rollout. As of December
2019, more than 460,000 adults have

moves forward gained healthcare coverage through

Medicaid since Edwards expanded the
program through executive order in
2016. Since Medicaid expansion, Loui-
Beaumont Health and Summa Health signed siana’s uninsured rate has been cut by
a definitive agreement to form a $6.1 billion nearly half, falling from 16.6% in 2013,
system. according to U.S. Census data.
Akron, Ohio-based Summa, its four Gee gained national headlines last
hospitals and health plan would be a wholly year when the state announced it had
owned subsidiary of Southfield, Mich.-based entered an agreement with Gilead Sci-
Beaumont, which has eight hospitals. The proposal follows other ences subsidiary Asegua Therapeutics
regional health system combinations that aim to leverage scale to on a plan to expand access to hepati-
boost capacity, among other endeavors. tis C drugs for Medicaid beneficiaries
The organizations signed a letter of intent in July; they plan to close and prisoners. It was the country’s first
the deal by the end of the first quarter. Summa would retain a local subscription-based payment model
board under the combined entity. for drugs.
Beaumont reported $174.4 million in operating income on revenue Under the plan, the state receives
of $4.66 billion in 2018, up from $168.6 million of operating income unlimited access to hepatitis C med-
on revenue of $4.44 billion in the prior year, according to Modern ications in exchange for a fixed price.
Healthcare’s financial database. —Alex Kacik Projections indicate the model will
expand access to treatment to tens of
thousands of residents and could lead
to elimination of the virus in the state
WEST In a statement, Strategic Global Man- over the next several years.
Verity proposes closing L.A. agement disputed Verity’s assertion that
it defaulted on the agreement, citing MIDWEST
hospital after deal falls through
Verity’s own admission that the hospital Feds accuse Indiana hospital
Embattled Verity Health is asking a had been losing money for years. SGM
system of violating Stark law
judge to let it close its Los Angeles hos- said it had raised “serious concerns” in
pital after a deal to buy the company the fall regarding Verity’s compliance The U.S. Justice Department has in-
out of bankruptcy fell through. with the purchase agreement, including tervened in a whistleblower lawsuit
El Segundo, Calif.-based Verity said health and safety issues at St. Vincent. alleging Community Health Network
in a court filing last week that it needs broke the law by billing Medicare for
to close St. Vincent Medical Center and SOUTH services delivered by physicians who
its dialysis clinic on an emergency ba- Louisiana health chief had improper financial relationships
sis within 30 days to avoid continued with the Indiana hospital system.
Dr. Rebekah Gee stepping down
economic losses, which it says amount- Since at least 2008, Community
ed to $65 million in fiscal 2019—more Louisiana Health Secretary Dr. Re- Health knowingly paid employed
than $175,000 per day. bekah Gee is resigning physicians a salary above fair market
St. Vincent would have been includ- Jan. 31, ending a four- value and awarded bonuses based on
ed in the $610 million purchase of Ver- year tenure during the referrals they made to the hospital
ity by Strategic Global Management, which she gained na- system, in violation of the Stark law,
owner of the KPC Group, but that deal tional attention for her according to the complaint-in-inter-
fell through, giving rise to a bitter back- innovative work on vention filed Jan. 6 in U.S. District
and-forth between Verity and SGM. reforming drug pricing. Court in Indianapolis.
Verity blamed KPC in a news release, Louisiana Gov. John Bel Edwards As a result, Community Health sub-
saying it defaulted on a binding pur- said in a statement that Gee had taken mitted false claims to Medicare for
chase agreement to acquire Verity’s on a new job but did not disclose where, those services and received millions of
hospitals. Verity sued KPC and its affil- stating it would be announced “by her dollars in reimbursement, the Justice
iates on Jan. 3. employer at a later date.” Department alleged.

January 13, 2020 | Modern Healthcare 5

 Finance

As competition heats up, hospital

outpatient visits see first dip in 35 years
By Tara Bannow Hospital outpatient visits
2018 visits 879.6 million
Percentage change from the previous year
%-change from 2017 -0.09%
FOR THE FIRST TIME IN 35 YEARS, 8% Change from 2017 -823,000
U.S. hospitals delivered fewer outpa-
tient visits in 2018 than in the prior year 4%
as the competition to provide such care
intensifies. 0%
The American Hospital Association’s
newly released 2020 Hospital Statis- -4%
The last time there was a
tics report shows the nation’s 6,146 year-over-year drop in hospital
-8% outpatient visits was 1983, which saw
hospitals delivered a cumulative 879.6 a 12.9% fall compared to 1982.
million outpatient visits in 2018, 0.09% -12%
less than in 2017, when they delivered
880.5 million outpatient visits. The data, ’83 ’85 ’87 ’89 ’91 ’93 ’95 ’97 ’99 ’01 ’03 ’05 ’07 ’09 ’11 ’13 ’15 ’17
which covers health system-owned Source: AHA Hospital Statistics 2020 edition
ambulatory surgery centers, outpatient
clinics and urgent-care clinics, is the
first year-over-year decline since 1983, cy research, analytics and strategy. Other 2018, compared with $88 billion in 2017,
and comes even as health systems work areas of outpatient utilization were stable a 12.5% jump over 2016.
to expand their outpatient offerings be- or up slightly over 2017, he said. Patients Wesolowski said the same pressures
yond hospital campuses. who used to visit emergency depart- have plagued hospitals for years: contin-
The AHA’s report highlights that pa- ments are now going to urgent-care clin- ued lower payment from public payers,
tients are increasingly gravitating toward ics or other settings, which may or may the shift to outpatient care and the rising
the countless disruptors that tout more not be owned by health systems, he said. costs of drugs and labor. A separate AHA
convenient, cheaper options for prima- Despite the fewer visits, hospitals’ net report said Medicaid paid hospitals 89
ry care, urgent care and even emergency outpatient revenue rose 4.5% year-over- cents for every dollar they spent deliver-
care. CVS Health, for example, plans to year in 2018 on a cumulative basis, even ing care to Medicaid patients in 2018; for
launch 1,500 clinics with expanded ser- as net inpatient revenue rose 2.1%. As in Medicare, it was 87 cents.
vices in its stores by the end of 2021. And prior years, the newest AHA data show Expenses at U.S. community hospi-
UnitedHealthcare recently began refus- the gap narrowing between outpatient tals surpassed $1 trillion for the first time
ing to pay for certain outpatient surger- and inpatient revenue. Hospitals’ net in 2018, up 4.6% year-over-year. AHA’s
ies in hospital settings to save money. outpatient revenue—$494 billion—was community hospital definition excludes
“We’re pivoting to a new business 97% of net inpatient revenue—$508 bil- those not accessible to the public, includ-
model in healthcare, with a much more lion—in 2018, compared with 95% in ing military and veteran hospitals, prison
pluralistic delivery system with many, 2017 and 92% in 2016. hospitals and other specialty hospitals.
many more consumer options,” said Ken It may be patients are going elsewhere Hospitals’ total net revenue surpassed
Kaufman, chairman of management for primary care, but hospitals are still $1 trillion for the second time in 2018.
consulting firm Kaufman Hall. “I think capturing the more-acute services with The AHA also found that hospitals’
it’s very important that especially the higher reimbursement, said Chad Mul- spent $41.3 billion providing uncom-
major health systems rec- vany, director of healthcare pensated care in 2018, or 4.1% of total
ognize this and realize they THE TAKEAWAY financial practices, per- expenses. That’s up 7.6% from $38.4 bil-
have to compete against it.” spectives and analysis at the lion in both 2017 and 2016.
The outpatient drop was Hospitals saw a Healthcare Financial Man- Wesolowski said the increase is likely
specifically in the number cumulative decline agement Association. due in part to Congress zeroing out the
of emergency outpatient in outpatient visits Continued pressure on Affordable Care Act’s penalty for not
visits hospitals saw in 2018, from 2017 to 2018 as hospitals’ budgets pushed having health insurance and new Med-
options continue to
said Aaron Wesolowski, the grow for patients.
profits down 5.2% year- icaid eligibility policies advanced by the
AHA’s vice president of poli- over-year to $83.5 billion in Trump administration. l

6 Modern Healthcare | January 13, 2020

Politics

Healthcare is biggest issue for voters

but not for Congress
By Rachel Cohrs Healthcare tops the polls & Means committees helped derail a
Registered voters were asked to rank bipartisan, bicameral surprise billing fix
MORE THAN HALF of registered vot- three policy issues most important to that providers opposed.
ers nationally consider healthcare one them heading into the 2020 election. The Ways & Means Committee is
of their top issues in the 2020 presi- drafting legislative text to flesh out its
Healthcare 56%
dential election, a new poll found, but one-page outline of an apparently more
observers and congressional aides said The economy 44% provider-friendly proposal, but there is
healthcare will likely be on the legisla- Immigration 33% no firm timeline for progress yet.
tive back burner early this year. Taxes 31% “We’re working on legislative lan-
When asked their top three policy is- Gun control 30%
guage with the minority and hope
sues for the 2020 presidential election, to have a markup in the next couple
Environment 23%
56% of nearly 2,000 registered voters months,” said Erin Hatch, a spokes-
surveyed named healthcare as a top Education 16% person for Ways & Means Committee
factor in determining their vote in a poll Abortion 13% Chairman Richard Neal (D-Mass.).
conducted nationally by the Bipartisan Criminal justice 13%
House Education & Labor Commit-
Policy Center and Morning Consult. tee Chairman Bobby Scott (D-Va.) said
Foreign policy 12%
The second most-cited issue was the he doesn’t plan to offer an entirely new
economy at 44%. Infrastructure 11% proposal. However, Scott said he would
Within healthcare, out-of-pocket costs Trade policy 7% like to mark up some sort of compromise
were the issue of greatest concern for Energy policy 7% legislation on the issue. “We’re trying to
those surveyed. Though there are sev- Other 4% coordinate our activities with the other
eral proposals in Congress that would two committees and we can, rather than
0 10% 30% 50%
lower out-of-pocket drug costs and out- come up with another alternative, come
Percentage selected
of-network medical bills, aides are not up with something that is consistent.”
expecting much progress while other Source: Bipartisan Policy Center/ House Democrats already passed a
Morning Consult
high-profile issues take center stage. major drug-price negotiation bill, but
The Senate is expected to navigate an it won’t get a vote in the Senate as-is.
impeachment trial—though timing is While the calendar will be a challenge, Senate Finance Committee Chairman
unclear—and monitor escalated ten- Senate Finance Committee ranking Chuck Grassley (R-Iowa) last week ap-
sions with Iran. A GOP Senate aide said member Ron Wyden (D-Ore.), a co-au- pealed to House Speaker Nancy Pelosi
impeachment proceedings will short- thor of a bipartisan drug-pricing bill, sees (D-Calif.) to take up the less ambitious
en the negotiating timeline to reach an a larger threat. “I think the biggest obsta- Senate Finance drug-pricing bill in-
agreement on contentious issues. The cle is that (Senate Majority Leader) Mitch stead during a television appearance on
most likely legislative vehicle to address McConnell is saying that pharma counts CNBC. The White House also supports
healthcare issues is a spend- more than the person who’s the Grassley-Wyden legislation.
ing bill Congress must pass getting beat up at the phar- “There’s no question that the con-
by May 22 to extend funding THE TAKEAWAY macy counter,” Wyden said. stant crises in the White House inhibit
for several Medicare and The pharmaceutical in- Congress’ ability to tackle complex poli-
Medicaid programs. Though there are dustry vehemently op- cy issues,” FTI Consulting Managing Di-
several proposals
“Enacting comprehensive in Congress that
poses the Senate Finance rector Charlene MacDonald said. “But
drug-pricing reforms during would lower out- drug-pricing legislation. healthcare, and drug pricing specifi-
a presidential election year of-pocket costs for In the House, action on cally, remains a top legislative priority
is already an unlikely pros- prescription drugs surprise medical bills is ex- for Democrats, so expect efforts to ne-
pect, and the current focus and out-of-network pected to be high on the gotiate to continue into the spring.”
on Iran and impeachment medical bills, aides agenda, but first members The margin of error for the Bipartisan
makes it even more unlike- said progress on the must overcome some turf Policy Center-Morning Consult survey
ly,” said Marc Samuels, CEO policies will likely be battles. A dispute late last was 2 percentage points. Polling was con-
of healthcare consulting minimal in the first year between the House En- ducted online from Dec. 3 to 4 and Dec.
firm ADVI. quarter of 2020. ergy & Commerce and Ways 19 to 21 and results were weighted. l

January 13, 2020 | Modern Healthcare 7

Legal

Federal judges question if insurers

need to recoup CSR payments
By Rachel Cohrs

A THREE-JUDGE PANEL of the U.S.

Court of Appeals for the Federal Cir-
cuit last week voiced concern that
insurers could profit from recouping
cost-sharing reduction payments
mandated by the Affordable Care
Act that the Trump administration
stopped paying in October 2017.
During oral arguments, the U.S. Jus-
tice Department argued that insurers
received increased subsidies when
they raised premiums, which more
than compensated for their losses from
the CSR payments. Forcing the gov-
ernment to repay those funds, which
could allow about 100 insurers to re-
coup $1.6 billion, may be a windfall for
GETTY IMAGES/MODERN HEALTHCARE ILLUSTRATION
the companies.
The point sparked concern from the
judges. ing cases on the same issue, including a The panel’s decision on
“If insurers have already been made class-action lawsuit. four cases brought by
whole, then why should they recover an Lawyers for insurers during oral
South Dakota-based
additional amount?” U.S. Circuit Judge arguments said that the cost-sharing
Timothy Dyk asked. payments and premium subsidies are Sanford Health Plan,
Similarly, U.S. Circuit Judge William separate, unrelated issues and the gov- Montana Health Co-op,
Bryson questioned whether insurers ernment should not be able to use in- Texas-based Community
could get double recovery by recouping surers’ strategy to compensate for their Health Choice and Maine
the CSR payments. losses against them. Community Health
Justice Department attorney Alisa “There is no support to find a rela- Options could decide the
Klein said the federal government saw tionship” between the two payments, fate of several pending
a net increase in costs due to what she said Faegre Baker Daniels attorney
described as a “hydraulic relation- William Roberts, who argued on
cases on the same issue,
ship” between the subsi- behalf of Community including a class-action
dies and CSR payments. Health Choice. lawsuit.
THE TAKEAWAY
More enrollees were eligi- Judges in the U.S. Court
ble for the premium subsi- The Federal Circuit of Federal Claims have passes a law directing money be paid
dies than for cost-sharing panel’s decision will so far sided with insurers without appropriating relevant funds.
reduction payments. determine the fate and ruled that their strat- While attorneys had examples for ei-
The panel’s decision of several pending egies to mitigate losses ther outcome, the Affordable Care Act
on four cases brought by cases on cost- from CSR payments do did not specify the fate of CSR pay-
South Dakota-based San- sharing reduction not affect their eligibility ments in that situation.
ford Health Plan, Montana payments, including for repayment. Some specialized investors have
Health Co-op, Texas-based a class-action The appellate judges shown interest in betting that courts
Community Health Choice lawsuit that could also showed interest in will rule in favor of insurers in CSR
and Maine Community allow about 100 whether the federal gov- cases by offering to pay cash for a
insurers to recoup
Health Options could de- $1.6 billion.
ernment can be sued share of legal awards if the courts rule
cide the fate of several pend- for damages if Congress in insurers’ favor. l

8 Modern Healthcare | January 13, 2020

Finance
J.P. Morgan conference ain’t cheap or
convenient, but execs say it’s worth it
By Tara Bannow “We are a debt-financed
organization and
ATTENDEES IN RECENT YEARS have we are able to meet
lobbed hefty criticism at the annual J.P. with and present to a
Morgan Healthcare Conference, which lot of our investors.
kicks off Jan. 13, for being astronomi- By sharing this
cally expensive to attend and logistically information and
cumbersome. building relationships,
Each year, several thousand people we are able to lower our
descend upon San Francisco’s Finan- interest expense.”
cial District for the annual investor con-
Mike Malewicz
ference, testing the limits of its hotels, Vice president of treasury and
restaurants and Ubers. Hotel rooms chief investment officer
near the conference routinely go for SSM Health
$1,000 per night—if you’re lucky—and
adjacent cafes gladly rent tables for $50 investors. “You’ve got so many people tal for-profit system’s senior director of
or more an hour. Some attendees also congregated in one area that it’s a great government relations. Ortega said he
pay thousands of dollars in admission venue for us to line up the meetings one imagines cost factored into the decision,
fees just to get into the conference. J.P. right after another and make an efficient but couldn’t say for sure. “We ultimately
Morgan declined to share those prices. use of time for investor-relations activity.” made enough contacts last time around
“It does give you pause with whether St. Louis-based SSM Health’s exec- to hold us over for this year,” he said.
you need to be there, how many people utives are saving money by staying at a With the expenses and logistics in-
from your company need to be there and hotel that’s a mile and a half from the volved, the J.P. Morgan conference gets
whether you need to be there every year,” conference—a roughly $6 Uber ride to be a lot; but Malewicz said the return
said Dennis Laraway, chief financial offi- away—for one-fifth the price of hotels for SSM’s patients is “absolutely” there,
cer at Phoenix-based Banner Health. nearby. SSM also cut back on some of because the connections made at the
Despite all that, leaders from the the related activities. conference help lower the health sys-
country’s largest health systems say Mike Malewicz, SSM’s vice president tem’s expenses. “We are a debt-financed
they still see a return on investment for of treasury and chief investment officer, organization and we are able to meet
attending the meet-up, however broke said he strives to be a careful steward with and present to a lot of our investors,”
and exhausted they may be afterward. of the not-for-profit’s resources, which he said. “By sharing this information and
And some have found ways to cut is why he works to cut costs at the con- building relationships, we are able to
costs. They do it by paring back the size ference in creative ways. It helps that he lower our interest expense.”
of the cadre they send, choosing hotels used to live in San Francisco. It’s not just investors. SSM’s team meets
across town and saying “no” to some ex- SSM starts planning for the confer- with peers on best practice issues, bank-
tracurricular activities. ence a year in advance. Kevin Carroll, ers, vendors and even tech companies.
Not-for-profit Banner, which has 28 CEO of the Hotel Council of San Fran- In addition to the connections, David
hospitals, used to bring up cisco, said that’s not un- Banks, chief strategy officer at Advent-
to five executives. This year, common for the gathering. Health, has also found value in simply
Laraway is going solo. He’s THE TAKEAWAY Someone trying to reserve attending the conference. The event fea-
a veteran of the conference Many healthcare a room in San Francisco in tures almost two days of back-to-back
and has presented there leaders complain recent weeks was probably presentations from not-for-profit and
both in his current capacity about the annual J.P. out of luck. for-profit health systems.
and in his past lives as fi- Morgan Healthcare Prime Healthcare Ser- Altamonte Springs, Fla.-based Advent-
nancial chief for Memorial Conference in San vices, based in Ontario, Health uses the same strategies as other
Hermann and Baylor Scott & Francisco for its high Calif., has sent executives systems to cut expenses, but Banks said
White Health. costs and limited to the conference in each attending is always worth it. “The cost is
This year, Laraway’s lodging options, but of the past two years, but very manageable for the return we get
schedule is full of meetings they say the ROI is sitting out this year, said out of what we can get accomplished in
is still there.
with current and potential Fred Ortega, the 15-hospi- 72 hours there in the city,” he said. l

January 13, 2020 | Modern Healthcare 9

 Looking
for
answers to
loneliness
By Maria Castellucci

O YOU HAVE SOMEONE WHO

D LOVES YOU and cares for you?

Do you have a source of joy in
your life? Do you have a sense of
peace today?
Since mid-2018, staff at AdventHealth
have asked patients in outpatient settings
those three questions in an attempt to iden-
tify health needs beyond the physical realm.
In response, patients often say that they
don’t have anyone who cares for them, or
they feel isolated from their community.
In other words, they’re lonely.
“A top trend (among our patients) is loneli-
ness,” said Angela Augusto, director of mis-
sion integration at the Altamonte Springs,
Fla.-based health system. “And we are not ADVENTHEALTH

seeing it in any particular age demographic.

It’s as prevalent with our young patients as
our older generation of patients.”
The responses from AdventHealth patients are on par with trends nation-
THE TAKEAWAY
ally. Studies and surveys estimate between one-third to nearly half of the
U.S. population is lonely. While more
And there is a strong body of research that feeling lonely impacts health health systems
and treatment outcomes. A commonly cited finding is that those who are so- and insurers are
cially isolated have a 50% higher chance of death compared with those who trying to address
aren’t, likening it to smoking 15 cigarettes a day. loneliness given
Given the clear connection between loneliness and health, some provid- its clear impact on
ers and insurers are trying to address loneliness among their patients and health, finding and
scaling effective
members, although it’s unclear what they can do.
solutions are
While the evidence on the impact of loneliness is strong, research on ef- major challenges.
fective solutions is still scarce, so healthcare organizations are largely test-

10 Modern Healthcare | January 13, 2020

 We’re trying some
things, but we don’t
know for sure what
works. I hope that
over time we will
come to a better
understanding of
that by talking to
our patients, by
understanding their
lives better, their
issues better and what
gives them hope and
optimism.”
Dr. Ted Hamilton
Chief mission integration officer
AdventHealth

Loneliness facts:
A variety of social factors affect loneliness, which in turn can affect health. A survey of midlife and older adults showed

Healthier people are Exercise affects Loneliness decreases Partner satisfaction is

less lonely loneliness with age tied to loneliness

51% 41% 24% 26%

report they of those who do of those 70 of adults who are
are in poor not exercise at and older very or somewhat
health all are lonely are lonely satisfied with their
partner are lonely

27% 35% 46% 48%

report they of adults who of adults who are very or
are in good exercise one to ages 45-49 somewhat
health three days per are lonely unsatisfied are lonely
week are lonely

Lower-income adults are About half of midlife and older adults earning less than $25,000 a year report being lonely
more likely to be lonely 31% of that age group who earn more than $75,000 a year report being lonely
Source: AARP

January 13, 2020 | Modern Healthcare 11

 Loneliness among midlife and older adults
by medical condition
Mood disorders* 58%
Depression 55%
Anxiety 54%
Chronic pain* 44%
Sleep disorder 42%
Obesity 42%
41%
Sexually transmitted disease
Diabetes 40%
High cholesterol 37%
*Other than conditions cited specifically
Source: AARP
ing possible solutions without much understanding of
what really helps.
“We’re trying some things, but we don’t know for
sure what works. I hope that over time we will come
to a better understanding of that by talking to our pa-
tients, by understanding their lives better, their issues
better and what gives them hope and optimism,” said
Dr. Ted Hamilton, chief mission integration officer at
AdventHealth.
More studies coming
There is interest in the research community to study
the effectiveness of efforts to address loneliness.
The AARP Foundation, which has been investing
in research into loneliness since 2010, has funded a
forthcoming study from the National Academies of
Sciences, Engineering, and Medicine that will explore
the topic, which should help with the knowledge gap,
said Lisa Marsh Ryerson, the foundation’s president.
Until more research findings are available, systems
and payers are relying heavily on community partners
to fill patients’ social gaps. For instance, caregivers at
AdventHealth trained in chaplaincy are connecting
patients with local faith-based organizations, grief
support groups and volunteer opportunities if they
admit to feeling lonely.
AdventHealth staff, after asking the three questions
during the intake screening process at their outpa-
tient clinics, note in the patient’s medical record if the
indicated responses warrant follow-up. The questions
can also be asked on an intake form.
If they do need follow-up, that triggers a referral to
the trained chaplain, who will call the patient. The
physician is also alerted to the patient’s responses for
consideration during the visit.
AdventHealth is investing $5 million annually in the
program, which it calls Clinical Mission Integration.
12 Modern Healthcare | January 13, 2020
There are “no hard dollar returns” on investment for
the health system to offer this service, said Terry Shaw,
CEO of the system.
“The ROI for us is a much healthier and a much bet-
ter prepared workforce to deal with” patients, he said.
Physicians support it
Hamilton said he’s been surprised by how many
physicians want to talk to patients about their re-
sponses. “Doctors were far more willing to engage in
this kind of assessment of patients than we ever antic-
ipated,” he said.
He said they feel empowered to talk about per-
sonal issues with patients because they know chap-
lains will be following up to help the patients further.
Physicians also comment that they feel a closer rela-
tionship with their patients after discussing their re-
sponses with them.
If loneliness comes up during the phone conversa-
tions with chaplains, they are trained to understand
what might be causing the feelings and what resources
are available in the community that might help them.
Augusto said AdventHealth is only in the beginning
stages of what she hopes the system can offer for lonely
patients. As the system continues to learn more about
the patients, she said there are ways to expand the of-
ferings. For instance, she said there might be an op-
portunity to connect patients who express loneliness
with each other, comparing it to pen pals.
“We are finding ways to be innovative and creative
moving forward beyond the small scope of what we
have started today,” she said.
A focus on the ED
For some health systems, addressing loneliness is a
consequence of other work they are doing for patients.
At Parkland Health & Hospital System in Dallas, ef-
forts to decrease the number of high users of its emer-
gency department led to the understanding that many
use the ED because they lack social support systems.
Patients would come to the ED simply to speak to oth-
ers, get a meal or stay warm.
“One of the things we have found with our
high utilizers is they don’t have this standard defini-
tion of family you and I would think of,” said Nicole
Bernard, a complex case social worker at Parkland.
“They don’t have caregivers, someone to bring them
to their appointments, remind them to take their
medications.”
Research funded by the AARP Foundation shows in-
come is an indicator for loneliness. About 50% of mid-
life and older adults who earn less than $25,000 per
year are likely lonely, according to a 2018 survey from
the organization. “Those who are most underserved
need to be served now in this area,” Ryerson said.
Parkland has partnered with not-for-profit and gov-
ernment institutions to help these patients. Housing
and case management agencies, adult protective ser-
vices, homeless shelters and rehab facilities are among
Parkland’s partners.
One example of a patient who has been helped by
Parkland’s efforts was a woman who came to the ED
almost daily. After spending some time with her, Ber-
nard learned she wasn’t connected with her family and
would use the ED to socialize. Parkland set the patient
up with a case management agency that helped her get
Social Security benefits, a driver’s license and recon-
nect with her daughter. She since moved out of the area
to be closer to her child.
The case management agency was “her family in
the time when she wasn’t connected with her family,”
Bernard said. “Our biggest goal is to find someone who
takes the place of the patient’s family.”
It’s time-consuming to work with these patients to
understand the resources they need. Bernard said she
meets patients where they are in the community and
tries to build a rapport with them.
“Most of my intervention is getting them to a point
where they trust me and they are ready to access the
help we are offering,” she said.
Insurers involved too
Commercial insurers also are interested in combat-
ing loneliness. UnitedHealthcare, Cigna and Humana
have all invested in resources dedicated to under-
standing and addressing the issue.
Humana started its work in this area in 2015 when
it launched the Bold Gold program, which is an effort
to increase the number of self-reported healthy days
of its Medicare Advantage members. To achieve that,
Humana is focusing mostly on addressing loneliness
and food insecurity.
During interactions with Humana members, employ-
ees have been trained to screen patients for loneliness.
In 2019, 1 million members were screened and roughly
30% were lonely, said Dr. Andrew Renda, associate vice
president of population health strategy at Humana.
Like AdventHealth and Parkland, Humana has
been working with outside organizations to address
loneliness. The insurer recently partnered with Papa,
a company that connects college students with older
adults to help with household chores, transportation
and companionship.
The results from the pilot in the Tampa, Fla., region
showed members looked forward to the visits and
had improved outlooks on their mental and physical
health, said Caraline Coats, vice president of popula-
tion health strategy at Humana.
Tailored solutions
Still, there are skeptics regarding the effectiveness
of such tactics. Solutions that rely on people to help
lonely individuals with errands or companionship are
a “red flag,” argues Elena Portacolone, assistant pro-
fessor at the Institute for Health & Aging at the Uni-
versity of California at San Francisco who has studied
One of the things we
have found with our
high utilizers is they
don’t have this standard
definition of family you
and I would think of.
They don’t have caregivers,
someone to bring them
to their appointments,
remind them to take their
medications.”
Nicole Bernard
Complex-case social worker
Parkland Health & Hospital System
loneliness and isolation.
Volunteers can get busy and stop showing up. It’s
also not “dignified,” she said. The person in need of
help is relying on someone else to feel better.
Better solutions are ones based on the person’s
genuine interests such as playing bingo or getting in-
volved in a church choir, Portacolone said. “There’s no
cookie-cutter solution (to loneliness) because we are
all different.”
Renda disagreed that solutions relying on individu-
als to help are undignified. He said the individuals at
Papa aren’t volunteers but paid. “It’s incredibly digni-
fied in the sense that we are offering support they can’t
get elsewhere,” he said in an email.
He added that Humana recognizes solutions to
loneliness are unique to the individual, so it’s explor-
ing various tactics such as helping individuals with
transportation barriers that keep them isolated.
A challenge for Humana is expanding solutions that
show positive results. “We have to find solutions that
are effective at addressing the root cause that are sus-
tainable, that have clinical return on investment and
are scalable,” Renda said.
Another problem is that investment in loneliness
solutions hasn’t been strong, he said. “We need to
build infrastructure and communities to address
these kinds of things.”
Coats added that tackling loneliness “is a tough nut
to crack,” and Humana will continue to adapt its ef-
forts in this area as it learns more. l
January 13, 2020 | Modern Healthcare 13
 “The idea isn’t to hurt local systems.
It’s to make healthcare evolve into
something better than what it is today.”
Dan Ludwig (left)

Not
Employee benefits director
Brakebush Brothers

gonna
take it Fed-up employers are
steering workers to higher-
anymore value healthcare providers
By Harris Meyer

GROWING NUMBER of self-insured employer Medicare payment rates.

A groups are pushing to transform how healthcare

is priced, steering their employees to high-value
providers and negotiating prices as a
percentage of Medicare payment rates.
Faced with sharp premium increases—more
than double the rate of inflation in 2019, accord-
ing to the Kaiser Family Foundation—smaller and
midsize employers increasingly want to identify
lower-cost, high-quality hospitals and physician
groups and design their health plans to encour-
age employees to go to those providers. They aim
to narrow the large gap between commercial and
THE TAKEAWAY
Public and private employers in Colorado, Connecticut,
Michigan, Montana, Texas and Wisconsin are adopting that
approach. They’re considering or launching group
purchasing initiatives with narrow- or tiered-net-
work plans; direct-contracting with providers,
Self-insured such as referring employees to designated centers
employer groups of excellence for some procedures and conditions
want to narrow the under bundled-payment deals with warrantied
current large gap results; on-site primary-care clinics; and contracts
between commercial with advanced primary-care providers.
and Medicare North Carolina tried to tie hospital rates in its
payment rates. public employee plan to a percentage of Medi-

14 Modern Healthcare | January 13, 2020

 care rates but had to back off in the face of
intense hospital resistance.
“I’m seeing a level of boldness on the
part of our members that I haven’t seen
before in my 27 years here,” said Cheryl
DeMars, CEO of the Alliance, a Wiscon-
sin healthcare purchasing cooperative.
“There is a kind of movement afoot.”
Purchasing group leaders say employers
are eyeing these more aggressive measures
to counter the formidable market power
of consolidated hospitals and physician
groups. In 2016, 90% of metropolitan areas
had highly concentrated hospital markets,
while 65% had highly concentrated spe-
cialist physician markets, according to the
Commonwealth Fund.
These employer moves represent a big
change from recent years, when employ-
ers held down health benefit spending
by shifting costs to employees through
higher deductibles and coinsurance. Em-
ployer groups say that strategy may have
reached its limit as employees can no lon-
ger afford the high cost-sharing.
Even with that cost-shifting, business
spending on employer-sponsored private
health plans rose 7.2% in 2018, up from
5.5% in 2017, according to the CMS’ latest
report on national health expenditures.
“Employers are no longer looking to
cost-shift to employees who are already
strapped,” said Morgan Kendrick, An-
them’s senior vice president for national
accounts. “They have a greater appetite for
high-quality, more economically advantageous networks.”
Self-insured employers across the country provide health
insurance to an estimated 110 million Americans.
A major factor accelerating this strategy was a RAND Corp.
report on hospital prices released last May. Covering nearly
1,600 hospitals in 25 states, the report found that employ-
er-sponsored health plans paid hospitals an average of 241%
of what Medicare would have paid for the same inpatient
and outpatient services in 2017. That was up from 236% of
Medicare in 2015. Employers took note.
RAND plans to release an expanded version of its hos-
pital price report this spring, covering more hospitals and
states and adding prices for physician services. That report
will combine the price information relative to Medicare
rates with hospital safety grades from the Leapfrog Group,
offering payers a one-stop shopping guide for selecting
high-value providers.
Anthem’s home state innovation
A similar RAND study commissioned by self-insured em-
ployers in Indiana spurred action when researchers con-
cluded that Hoosier companies paid hospitals an average of
272% of Medicare rates from 2013 to 2016.
In response, 12 self-insured companies asked Anthem
Blue Cross and Blue Shield to develop new health plan op-
tions that would steer members to lower-cost, high-quality
providers, as alternatives to their traditional PPOs with wide-
open networks. Up to that point, Indiana employers had
been reluctant to limit their workers’ provider choices for
fear of backlash, said Gloria Sachdev, CEO of the Employers’
Forum of Indiana.
Anthem responded by rolling out HealthSync, a tiered-net-
work plan that reduces members’ cost-sharing if they use
lower-cost hospitals and physicians.
Franciscan Alliance and Ascension St. Vincent are partic-
ipating as preferred providers under financial risk contracts,
while IU Health and Community Health Network are not.
Major Indiana employers are offering the plan to their work-
ers for 2020, which Anthem said would deliver premium sav-
ings of more than 10%.
In addition, in 2019 Anthem started negotiating hospital
outpatient prices in Indiana based on a percentage of Medi-
care rates, rather than on discounts from retail prices. Em-
ployers’ Forum members already had their inpatient prices
negotiated that way. “We have a completely dysfunction-
al marketplace and this is a strategy to make it functional,”
Sachdev said. “Will this lower hospital prices? We’ll see.”
Following in some big footsteps
Jumbo employers like General Electric Co., Boeing Co.,
Lowe’s and Walmart for years have steered workers to desig-
nated centers of excellence for certain procedures, and have
reported savings to the company and employees, with high
patient satisfaction. But smaller and midsize companies
have been slow to adopt such approaches.
Employers vary by state, however, in their willingness to
push ahead forcefully, depending on the industry, worker ex-
pectations, the competitiveness of the hiring market, and se-
nior executives’ level of concern over health benefit spending,
according to purchasing group leaders. An effort that attracted
some attention last year called the Peak Health Alliance has
employers grouping together to negotiate directly with hospi-
tals and health systems in Summit County, Colo. The alliance
plans to expand to other counties. (See related story on how
four states are working to lower prices, p. 17.)
In 2019, less than 8% of employers said their plan network
was narrow; 14% of firms with 50 or more employees said
they’re using tiered or high-performance networks; and
about 1 in 5 encourages employees to use a center of excel-
lence, according to a Kaiser Family Foundation survey pub-
lished in September. But use of those strategies is growing,
employer groups say.
Employers also are leaning on the insurers administering
their plans to develop higher-value networks. In November,
the Blue Cross and Blue Shield Association announced a
new “high-performance” network plan for employers in 55
markets that will be available in 2021.
But hospital leaders warn that more narrow-network
plans will lead to more patients getting hit with surprise, out-
of-network bills, which already have triggered widespread
public outrage and reform efforts in Congress.
January 13, 2020 | Modern Healthcare 15
 “Limiting networks is why we’re running into the whole
issue of surprise billing,” said Chip Kahn, CEO of the Fed-
eration of American Hospitals. “Patients will be burdened
with having more difficulty finding network hospital
services.”
A wild card is the CMS’ new rule, finalized in November,
requiring hospitals to publish rates negotiated with payers
for at least 300 “shoppable” services, starting in 2021. The
American Hospital Association and other hospital groups are
suing to overturn the rule. The CMS also has proposed a rule
requiring health plans to publish their negotiated in-network
rates as well as rates for out-of-network providers.
Experts say these CMS rules, if they survive legal chal-
lenges, could provide employers with rich data for selecting
lower-cost providers.
Some hospitals back the change
Leaders of hospitals with lower prices and good quality
measures welcome this movement by employers. Indeed,
Beaumont Health System in Southeast Michigan, which
had one of the lowest aggregate average prices relative to
Medicare in the RAND study, has created a marketing unit
to offer itself to self-insured employers as a narrow-network
or center-of-excellence provider.
Ryan Catignani, the eight-hospital system’s vice pres-
ident of managed-care contracting, said Beaumont has
directly contracted with 25 employer groups representing
4,000 members for a narrow network plan and is in talks
with 400 more groups representing 75,000 members.
Fully insured groups can save more than 15% on premi-
ums by choosing Beaumont’s narrow-network plan, offered
in conjunction with UnitedHealthcare, he said. Savings for
self-insured groups depend on the individual group’s claims
experience.
He acknowledged, though, that it’s not easy convincing
Michigan employers to steer employees or limit their choice
of provider because the dominant health plan, Michigan
Blue Cross and Blue Shield, has traditionally offered PPOs
with a broad network. “In Michigan, access is king and em-
ployers are still reluctant to limit employees,” he lamented.
Dr. Robert Vissers, CEO of Boulder (Colo.) Community
Health, a single-hospital system with 30 outpatient sites, is
cautiously optimistic about employers’ interest in organiza-
tions like his, which showed low prices relative to Medicare
in the RAND study.
But he would prefer that payers contract with his sys-
tem based on a global, per-member per-month payment
arrangement rather than focusing on the cost of individ-
ual services.
Other hospitals and physician groups, however, have bris-
tled at moves by employers to steer their workers based on
price and quality measures.
Dan Ludwig, employee benefits director at Brakebush
Brothers, a chicken-products processor based in Westfield,
Wis., said a local health system called and complained when
his 2,100-employee company started sending its workers to a
provider in Appleton, 90 minutes away, for orthopedic, spine
and podiatric care on a bundled-payment basis. That direct
contracting deal saved his company more than $600,000 on
nearly $9 million in health benefit spending in 2018.
“They asked, ‘Why aren’t you partnering with us?’ ” Lud-
wig recalled. “We said, ‘If you are better on quality and price,

Commercial payer prices relative to Medicare rates

For selected states studied by RAND, 2015 to 2017
Relative prices, by state quantiles Average relative prices
ME
Less 210% 229% 237% 277% 283%
than to 228% to 236% to 276% or more 300%
210% VT NH
217% 236% 293
WA MT WI MI NY MA 250%
ND MN RI
237% 277% 279% 156% 178% 228%
241
WY IL IN OH PA
ID 302% SD IA 225% 311% 241% 169% NJ CT 200%
204
CO MO KY
OR NV 269% NE 221% 186% WV MD DE DC 150%
Medicare price

KS TN NC
CA AZ UT 219% AR 208% VA 234% 100%
NM LA
229% OK 225% MS AL SC
50%
TX GA No data
HI AK
244% 243%
FL 0%
229% All Inpatient Outpatient

Note: Prices are calculated based on allowed amounts, including amounts paid by the health plan and the patient. Relative prices represent the allowed
amount paid as a percentage of what Medicare would have paid for the same services.
Source: RAND Health

16 Modern Healthcare | January 13, 2020

How state groups are working to lower prices
A RAND report on hospital pricing last May pushed many
employer purchasing groups into action.
The report infuriated self-insured employers who
previously didn’t know how much they were paying, at least
partly due to gag clauses in contracts between providers
and insurers barring disclosure of negotiated rates even to
plan sponsors, said Gloria Sachdev, CEO of the Employers’
Forum of Indiana. (A bipartisan bill in Congress would
outlaw such secrecy provisions.)
The RAND Corp. researchers found that hospital
systems’ average prices ranged from 150% of Medicare
to more than 400%. Hospitals in Indiana, Wyoming, Maine,
Wisconsin, Montana and Colorado had the highest average
prices relative to Medicare, while those in Michigan,
Pennsylvania, New York and Kentucky had the lowest.
“The RAND analysis showed that Colorado hospitals on
average are being paid 270% of Medicare,” said Robert
Smith, executive director of the Colorado Business Group
on Health. “We’re paying Mercedes prices and getting a
Peugeot.”
Here’s what’s happening in response to price growth in
four states paying higher prices:

Connecticut and Maine Colorado Wisconsin

Starting next year, the state of
Connecticut will offer its 210,000
employees and retirees financial
incentives to get care for about 45
procedures and conditions from lower-
cost, higher-quality providers in its new
“network of distinction.”
In addition, plan members will receive
incentives to get certain procedures
like joint replacements done at selected
centers of excellence across the country,
said Francois de Brantes, a senior vice
president at Remedy Partners, which is
administering the state program.
That effort will be supercharged by the
Connecticut Legislature’s decision to cut
the budget for public employee health
benefits by 10%.
Maine has adopted a similar but more
limited centers of excellence program for
its state employee plan.
In January, the Colorado Business Group
on Health launched a statewide employer
purchasing cooperative, including the state
employee health plan, which will encourage
employees to use higher-value providers.
It will work with insurers to negotiate
prices benchmarked to Medicare rates and
will push insurers to make those same rates
available to small businesses.
The Colorado group also will use
composite patient safety and quality scores
from Quantros to select network providers.
Employer groups say many companies
are leery about steering patients without
reliable quality measures.
“We must generate price sensitivity,
and the only way to do that is to match
the consolidated power hospitals have
with consolidated purchasing power,” said
Robert Smith, executive director of the
Colorado Business Group on Health.
The Alliance, a purchasing
cooperative, has started
negotiating hospital contracts
for its 250 employer members,
representing 100,000 lives,
based on rates of 175% to
225% of Medicare. That’s
substantially less than
they’re current paying. The
cooperative also is negotiating
bundled-payment rates for
orthopedic and imaging
services, encouraging
employer members to offer
workers incentives to use
providers with lower prices and
higher quality.
—Harris Meyer

then let’s talk.’ The idea isn’t to hurt local systems. It’s to make
healthcare evolve into something better than what it is today.”
Still, some business leaders remain reluctant to use their
most powerful weapons to push back against provider de-
mands for high rates, even refusing to exclude expensive,
lower-quality providers from their plan networks. They fear
unfavorable worker reactions or damage to their ability to re-
cruit workers in an intensely competitive hiring environment.
“There is a lot of opportunity out there for employers,” said
Chris Skisak, executive director of the Houston Business Coa-
lition on Health, who is disappointed that his members have
been reluctant to act. “But they aren’t getting the pressure
from the C-suite to demand this. ”
On top of that, insurers serving as third-party administra-
tors for self-insured employers may lack financial incentive
to design plans that favor lower-cost providers because they
often receive a percentage of total spending as their admin-
istrative fee. In addition, steerage strategies aren’t practical
in markets with one dominant hospital system, or where sys-
tems have carved up the market by geography or clinical spe-
cialty, making it difficult to exclude anyone, said Katie Keith,
a Georgetown University researcher who co-authored a 2019
study on responses to provider consolidation in six markets.
Leaders of employer groups warn, however, that if they can’t
work successfully with providers and insurers to slow health-
care cost growth and deliver higher-value care to their work-
ers, the only alternative may be government-regulated rates
through a Medicare for All or other public health plan model.
“Employers and consumers are reaching a fork in the
road, realizing private-sector efforts to get costs and quality
under control are floundering,” said James Gelfand, senior
vice president for health policy at the ERISA Industry Coun-
cil. “So a lot of people are saying if this doesn’t work, maybe
we need to look at more government-centric solutions.” l

January 13, 2020 | Modern Healthcare 17

 A very
particular
set of skills
By Michael Brady

HILE SOCIAL WORKERS have an essential with those issues head-on because there’s never been a good

W
work they do.
role in addressing the social determinants
of health, hospitals and insurers are hav-
ing trouble agreeing on how to pay for the

There’s also confusion about scope of practice and who’s

way for providers to get paid for doing it, even though social
factors are critical to health outcomes. “Social determinants
are everything,” said Kate McDonald, a partner at McDer-
mott Will & Emery.
Yet there’s been increasing interest in how to address them
considered a social worker, which feeds into the difficulties within the healthcare system because they have such an out-
in how to reimburse hospitals for their services. And there sized impact on people’s health. That’s been especially true
is competition for reimbursement from other providers too. as new value-based payment approaches like alternative
The result is that these caregivers’ needed skills may go un- payment models and accountable care organizations grow
used for nonclinical reasons. in usage. The new payment models increasingly tie payment
“Across the board, when I speak to hospitals, to health outcomes rather than rewarding pro-
it’s still a challenge in terms of actually getting the viders for delivering medical procedures and
services of social workers paid,” said Priya Bathija, THE TAKEAWAY services alone.
vice president of the Value Initiative, an effort of Hospitals will need “There’s definitely interest in addressing the
the American Hospital Association. more social workers social determinants of health by changing the
Nonmedical determinants of health account for to address the social paradigm of what is reimbursable through a
an estimated 80% to 90% of a population’s mod- determinants of health insurance plan,” McDonald said.
ifiable health, according to a paper published by health, but these In recent years, states and the federal gov-
the National Academy of Medicine. That includes professionals are ernment have pushed several initiatives aimed
things like where people live, how wealthy they having trouble at addressing the social determinants of health.
are, their level of education and what their home getting the payments One change allows Medicaid man-
and family lives are like. and licenses they aged-care organizations to provide enroll-
need to deliver care.
Historically, the healthcare system hasn’t dealt ees with supplemental benefits such as food

18 Modern Healthcare | January 13, 2020

Margaret Ann Paauw, aid or transitional housing. The
an Amita Health social changes also let health plans pro-
worker, speaks with a
client at the Uptown vide services intended to address
Branch of the Chicago the social determinants of health
Public Library. Paauw in place of traditional medical ser-
works with clients there vices. In 2017, the CMS issued reg-
and at another branch
daily, connecting them ulations requiring managed-care
with needed services organizations to coordinate the
such as medical care, benefits they provide to enrollees
housing and employment.
with the aid their beneficiaries get
from other sources, such as social
services.
And recent changes to the fast-growing Medicare Advan-
tage program allow plans to provide distinct benefits to en-
rollees based on their health status, supplemental benefits
for chronically ill patients that specifically address social de-
terminants of health, and new services such as meal delivery,
transportation and other social supports.
“There are so many opportunities for social workers to work
with individuals to identify which of these resources might be
available to them,” McDonald said. “This provides an avenue
for Advantage plans to reimburse for those services and count
it as a supplemental medical benefit … instead of an admin-
istrative cost.”
A good fit
Despite the difficulties in getting reimbursement for their
services, social workers seem to be well-qualified to help guide
hospitals as they address health matters that fall within the
purview of public health and social services. “Social workers
fit very well in the work that needs to be done to address social
determinants of health,” Bathija said.
Most health systems use social workers to identify and ful-
fill a patient’s need for services by screening them and con-
necting them with food, housing, transportation, counseling
or other services provided within the healthcare system or
through community partners such as homeless shelters or
food banks.
Some health systems deploy social workers as part of inter-
disciplinary care-delivery teams that coordinate care and assist
with discharge planning. Social workers increasingly are part
of teams with physicians, physical therapists, pharmacies and
skilled-nursing facilities to ensure that patients will be able to
comply with an appropriate course of care after discharge. That
can help reduce readmissions and improve patient satisfaction.
The varied types of services that social workers provide with-
in health systems only makes the vexing problem of how to pay
for their efforts worse.
“At the surface level, there appears to be some inconsistency
in paying for things that aren’t really healthcare,” McDonald said.
Some of the problems are mainly administrative and
should become easier to address as social workers’ roles in
the health system grow over time. For example, there aren’t
medical codes—known as Current Procedural Terminology
codes—for the services that social workers provide, accord-
ing to Angelo McClain, CEO of the National Association of
Social Workers.
But other issues could prove more challenging to resolve.
Budget-neutral by law
The CMS recently approved increased payments to
physicians for evaluation and management visits after
complaints from doctors that they weren’t being paid
enough for the amount of time they spend with patients.
That means other providers will see their reimburse-
ments cut to pay for the bump that physicians will receive
beginning in 2021. Meanwhile, social workers face the
prospect of a 7% cut in payments for behavioral health
services under the proposed 2021 physician fee sched-
ule. Federal law requires that the payments remain bud-
get-neutral to keep health spending in check. An increase
for some providers means a decrease for others, making
it a zero-sum game.
Pitting care providers against one another might be
helpful when it comes to limiting reimbursements un-
der original, fee-for-service Medicare, but experts say it
may not the best way to coordinate patient care, address
social determinants of health or drive down total health-
care spending long term.
“Do physicians really need to be coordinating care?
No,” McDonald said. “Let’s move down the spectrum to
lower-cost care providers such as social workers.”
Unlike many healthcare providers, social workers have
a broad scope of practice because they focus on caring for
people and their families within their environment. They
tackle everything from issues of food and income insecu-
rity to drug use and domestic violence. They also serve
as behavioral health providers, care coordinators and
community referral specialists. It’s a holistic approach to
providing care that allows them to work effectively within
integrated care teams.
“There are so many things that social workers can do,”
said Lisa de Saxe Zerden, senior associate dean at the
University of North Carolina at Chapel Hill School of So-
cial Work.
But that broad scope of practice, while beneficial to pa-
tients, creates professional barriers for social workers in the
healthcare field because hospitals and insurers don’t know
how to account for the services that social workers provide.
Licensing challenges
Licensing has proven to be a significant hurdle for pro-
viders and payers alike. There are no national standards
for licensing social workers to work within the healthcare
system and qualifications vary considerably across states.
“There aren’t clear rules about how to credential them,
which creates challenges for payers in terms of deciding
who is appropriate to provide services to their members,”
McDonald said.
Standards vary so much that it’s difficult for research-
ers to get an accurate count of how many credentialed
social workers exist in the U.S., which can make work-
force planning difficult because there’s uncertainty
about availability.
There’s also a bottleneck in the pipeline of social work-
ers who can treat behavioral health issues. New social
work graduates who trained in integrated care settings are
January 13, 2020 | Modern Healthcare 19
 Health systems hiring social workers
despite reimbursement issues
Most healthcare providers arrange for and deliver social and community services on an ad hoc basis, but social
workers specialize in it so they’re better positioned to address the social needs of patient populations.
“The problem is that those services are not always billable,” said Lisa de Saxe Zerden, senior associate dean at
the University of North Carolina at Chapel Hill School of Social Work.
That isn’t preventing some systems from moving forward with creative employment of social workers.

Providence Health & Services’
Providence Beginnings program
is a maternity support initiative
for women who are likely to
have high-risk pregnancies. The
program helps women and their
doctors develop and carry out
maternity-care plans that reduce
the likelihood of pregnancy
complications and issues
postpartum. “Our social workers
help patients find resources in
the community,” said Dr. Judy
Marvin, an obstetrician hospitalist
and senior medical director for
women’s specialty practices at
Providence Health and Services,
part of Renton, Wash.-based
Providence. “But we do not get
reimbursed for much of the work
that we do.”
Similarly, Massachusetts General Hospital in
Boston has a connected wellness program for
seniors focused on the linkage between stable,
affordable housing and health outcomes. Social
workers work alongside nurses and community
resource specialists to connect program
participants with the housing they need.
Last year, Amita Health and the Chicago
Public Library partnered to have licensed
clinical social workers serve people in their
communities and help address some of the
social determinants of health. That allowed
them to deliver care to people who might have
delayed it otherwise. That’s especially true
of mental health services, which are often
stigmatized, so people might not seek them
otherwise.
“We’re meeting people where they are,” said
Sue Warwick, a program director for Amita, a
joint venture based in the Chicago area.
Baylor Scott & White Health,
based in Temple, Texas, employs
social workers to supervise and
train community health workers
to screen targeted patient
populations for social needs. The
model allows the health system’s
social workers to operate at
the top of their license and to
address behavioral health needs,
while community health workers
act as trusted peers who help
connect patients with community
resources and manage chronic
illnesses. It has allowed the health
system to staff and scale the
services of social workers
to address the social
determinants of health at an
unprecedented level.
—Michael Brady

having trouble getting hired because they’re unlicensed, de
Saxe Zerden said.
That’s despite the availability of funding for professional
substance abuse and behavioral health training from the
Health Resources & Services Administration through its
Behavioral Health Workforce Education and Training grant
program.
“Most health systems want their social workers to be li-
censed, but it takes two-plus years for social workers to be
licensed,” de Saxe Zerden said. “We don’t really know where
they go during those two interim years.”
Social workers might work on grant-funded projects, policy
issues or under the direction of a licensed clinical social work-
er during the period between graduation and licensing, but
the data is murky.
Unlike doctors and other health professionals who com-
plete a residency or similar program, there’s nothing avail-
able for social workers who want to work in integrated care
settings. That makes it tough for social workers to work in the
healthcare system early in their careers.
“You don’t have to do clinical work,” said Christine Rine,
associate professor and head of the master’s degree program
in department of social work at Edinboro (Pa.) University.
But “once people have a clinical license, things are more set
in stone in terms of reimbursement.”
It’s a doughnut hole in the professional development of
social workers who work in the healthcare delivery system.
So some hospitals are using community health workers
to provide care, even though they might not be the most
appropriate provider, because it’s easier to get reimbursed
for their services.
“When push comes to shove, they’re using community
health workers instead of social workers because, in their
state, there’s payment for community health workers and
there’s not payment for social workers,” Bathija said. “It’s dif-
ferent in each state based on their Medicaid programs.”
Value-based payment and other models that tie reim-
bursement to healthcare quality could drive new demand
for social workers to address the social determinants of
health as part of integrated care-delivery teams.
But it’s still hard for social workers to get paid for the ser-
vices they provide because fee-for-service payments still
dominate the healthcare system. It’s unlikely the industry
will be able to get enough of the social workers it needs until
it starts paying for the work they do.
“If we have a workforce issue, let’s reimburse and value
the services so that we can develop a larger workforce to
meet this need,” McDonald said. “I think it’s a great theory
and I hope that it pans out, but it’s a complicated, long-
term process.” l

20 Modern Healthcare | January 13, 2020

Congress investigates the
Medicare wage index based on
Modern Healthcare reporting.

Going beyond coverage.

Reporting that ignites action.

Modern Healthcare’s Alex Kacik gets an exclusive look into a federal

audit of the formula Medicare uses to pay hospitals. The reporting spurs
action by congressional delegations and the CMS quickly proposes
changes to the wage index.

Don’t miss the action.

Visit modernhealthcare.com/subscribe

www.modernhealthcare.com
 Care coordination
needs to be more than
just a goal
AURORA AGUILAR Editor

“I
’m dying.” Those were the last words my godmother said to me
on New Year’s Eve. “No,” I responded, believing it.
She was just about to be discharged after a four-week hospital stay.

She wasn’t hooked up to monitors
despite the labored breathing that
led to her admittance. Staff hadn’t
checked on her in at least 90 minutes.
My godmother had asked me the day
before to get her sequined snow boots
to wear at the rehab facility. Earlier she
had handled five weeks of chemother-
apy well, and doctors said they caught
everything.
Shortly after those last words, she
lost consciousness.
The physician who we met with
during a particularly rough Christmas
Day called then to let us know that my
godmother was very ill.
I asked how they could have consid-
ered discharging her that day.
She hadn’t made that decision. She
said she wouldn’t have approved that
decision.
I called for someone to take her vi-
tals, worried that her shortness of
breath could lead to oxygen deficiency.
When the nursing assistant wasn’t
able to capture her blood pressure or
pulse, she called for the nurse who or-
dered a rapid response.
“This is just to get her an ICU bed
fast,” the nurse said.
Then a horde of clinicians stormed
the room.
Less than a minute later, a doctor
we’d never met before came out and
asked if everyone we wanted to be
there was present.
“She’s dying,” he said, adding that
nothing would be done to intervene
in her passing since she had signed
a DNR. None of the family members
there could understand or believe what
was happening. Earlier that day we
were preparing to move her to rehab
and now we were told these would be
her last moments.
We were told she had developed
sepsis and her liver was failing. Her
breast cancer had metastasized to her
liver.
We had no idea. But the doctor said
that information was right in her notes.
It didn’t make sense. Had doctors
failed to communicate the realities of
the situation to us or to each other?
Patients in fragile health need a
champion, and I had been by her side
nearly every day for a month. Other rel-
atives called for daily updates.
But in those last moments with her,
it finally occurred to me that we had
never asked for a comprehensive care
plan. I hadn’t asked if all of the clini-
cians, some of whom we only saw once
during that last month, had a plan to
keep my godmother alive.
I don’t know if that would have made
enough of a difference. But a friend
whose own mother died in hospice
during these past holidays had a com-
pletely different experience.
The communication seemed to
have been clearer. The expectations
were transparent. For example, her
mother was given medication to help
ease her passing.
The doctor tending to my godmother
said she would also receive something
to ease pain and anxiety.
More than two hours passed be-
tween his statement and her time of
death. I never left her side but never
saw medication administered.
Healthcare is personal in its best
and worst moments, and this is my
very personal story, but it opened
my eyes to the confusion and terror
that even someone familiar with the
industry can experience. There is a
nagging regret about what more I
could have done. I can’t help but wish
some better practices were in place.
I wish the rounds had been virtual,
her medical records were more acces-
sible and the clinicians better com-
municated treatments with us and
each other.
Those wishes are also the expressed
goals of our industry’s leaders.
But these changes need to be more
than goals … before they become per-
sonal for any of you. l

22 Modern Healthcare | January 13, 2020

As leaders, we still have a lot to learn in the
journey toward a value-based healthcare system
By Dr. Marc Harrison

A
group of senior healthcare leaders and I recently discussed the transformation from
volume-based care—in which providers are paid based on the number of services
they provide and procedures they perform—to value-based care, which rewards us
based on the health outcomes of our patients.

This transition represents a huge to those focused on ambulatory care,

change in incentives for health systems—
encouraging hospitals and physicians
to provide high-value, evidenced-based
care—determined by comparing clinical
results with the cost of care.
Our discussion was held at the In-
termountain Healthcare Leadership
Institute and I’d like to share some key
lessons learned from it, specifically for
leaders embarking on the transforma-
tion toward value in healthcare.
Value-based organizations have
two objectives: Keeping people well
and providing high-quality care when
they’re sick. Recognizing this, Inter-
mountain recently reorganized into two
basic businesses: Our Specialty Care
Group includes hospitals, specialists
and inpatient services. Our Communi-
ty-based Care Group focuses on keep-
ing patients well by providing access
to care closer to home and through the
lens of prevention and wellness.
We’re increasingly focused on moving
upstream to prevent and manage dis-
ease. We’ve developed a model called
Reimagined Primary Care that focuses
on preventive care. It’s already gener-
ated a 60% decrease in hospital admis-
sions, a 35% decrease in emergency
department admissions and a 20% de-
crease in per-member, per-month costs.
It’s still too easy to make money do-
ing the wrong things. The incentives
in a volume-based healthcare system
can easily lead to overutilization of ser-
vices that may not be completely med-
ically necessary. When transitioning
to value-based care, there are more
Dr. Marc Harrison
is president
and CEO of
Intermountain
Healthcare.
incentives for keeping costs down and
keeping people healthy.
Change requires time and account-
ability. When facing major change,
there’s wide variation in how long it
takes to persuade good people to get on
board. Clearly giving people the “why,”
and the right tools, helps move them to-
ward transformation. Providing data and
requiring accountability are also crucial.
Without them, there isn’t engagement.
Play as a team. If you have the right
people around the table—both in
terms of function and character—and
if they bring a continuous-improvement
mindset, you can solve any problem.
Encourage smart growth. Smart
growth emphasizes population health
and value. A major tenet of Intermoun-
tain’s growth strategy is to keep people in
the least-restrictive, least-expensive en-
vironment as close to home as possible,
so home-based services are increasingly
important. By continuing to grow these
services, you add new, dynamic people
who bring experience from other orga-
nizations and provide opportunities for
standout people within your enterprise
to transition from hospital-based roles
population health management and
telehealth.
Evaluate staffing needs and maintain
the balance between clinical excellence
and affordability. Multiple health sys-
tems in the U.S. have made layoffs due
to shrinking volumes and changes in
payer cost structures. Some reports say 1
in 5 U.S. hospitals is in danger of closing.
Staffing decisions must be grounded in
safety, quality, experience, access and
stewardship, in that order.
Understand that your customers
are increasingly worried about cost.
If you have insurance with a $5,000 or
$10,000 family deductible, there’s a
good chance you’ll never go all the way
through it—which means many people
are pure consumers all year long and
very much aware of their out-of-pocket
costs. Keeping charges affordable must
be a top priority.
Not all leaders are transformational—
and that’s OK. There are transformation-
al leaders and leaders who sustain and
optimize the status quo. In fact, both are
needed. Good leaders have emotional
intelligence and self-awareness. They
have to make the tough decisions and
implement them, and then own them
when they mess up.
Having a sense of purpose and do-
ing the right thing can provide health-
care leaders with immense strength
and energy on the road to value-based
care. The journey is necessary, and the
destination is beneficial for healthcare
systems, employees and everyone
they serve. l

January 13, 2020 | Modern Healthcare 23

 Proposed Stark law reforms administrative burden and increased must be achieved, including
could bring unintended costs that physicians must take into financial, if these reforms are truly
account. This is especially a concern going to propel the industry toward
consequences
for smaller physician groups or coordinated and more affordable care.
Reforms that support the expansion providers serving rural communities. Shawn Morris
and adoption of value-based care I believe the CMS should consider CEO
should move us forward. While the creating a separate exception for rural Privia Health
changes highlighted in the article providers with fewer requirements, as
“Doctors and hospitals support they often have a more difficult time
value-based Stark law changes” transitioning to value-based care. Few quality gains from
(ModernHealthcare.com, Jan. 2) are As a large national medical group hospital mergers?
designed to do just that, the proposed committed to value-based care, my
That shouldn’t be a surprise
regulatory reforms have potential organization must have certainty
unintended consequences that that we are not running afoul of The recent article “Hospital
could hinder rather than help our Stark law while entering into risk- mergers don’t improve readmissions,
healthcare system. based arrangements. Actions that mortality or experience, study finds”
Creating considerable uncertainty, are absolutely necessary to protect (ModernHealthcare.com, Jan. 2)
many of the proposed reforms fail to against waste and abuse should be stated, “Harvard researchers found
use the “bright line” test that we have the agency’s primary focus, and that hospitals acquired by health
been assured is the goal of Stark law again, a provider’s time and financial systems experienced a modest decline
regulations. There are also significant commitment must be considered. in patient experience scores while
differences between the changes Finally, we understand the notion of performance on 30-day readmissions
proposed by the Office of Inspector limiting potential rewards to “non- and mortality rates stayed largely flat.”
General and the CMS. The proposed monetary compensation,” however The scam has always been to
changes will create additional thoughtful alignment of incentives allude to some popular issues to
justify hospital mergers. The big
three are integrated care, improved
quality and value. The sole reason,
however, has always been to preserve
Send nominations or gain market power. What do
for 50 Most hospital administrators know about
healthcare quality? For too many of
Influential Clinical them, the answer is nothing.
Executives In their obsession with dominating
provider care, administrators have
Modern Healthcare is accepting nominations for its annual ranking of successfully marginalized the medical
the 50 Most Influential Clinical Executives. The program, previously the community, notably physicians and
50 Most Influential Physician Executives and Leaders, is now open to all nurses. Employing physicians and
licensed clinicians with an executive title of senior vice president or higher. rendering the organized medical staff
Judging will focus on actions the nominee took in the past year to help impotent has basically taken the group
the organization achieve or exceed financial, operational and clinical that can actually improve medical
goals; steps the nominee has taken to establish or contribute to a culture quality and value out of the equation.
of innovation and transformation (local and national levels); and examples There will be no improvement in
of how the nominee has addressed the Quadruple Aim of improved healthcare quality until the yoke is
community health, a better patient experience, lower costs and reduced removed from the medical profession
clinician burnout. and power is shared appropriately.
The deadline for nominations is March 2. A ballot with 150 names will Dr. Allan Dobzyniak
be posted for voting shortly after the nomination period closes. Modern Eastport, Mich.
Healthcare’s senior editors will make final determinations on the ballot.
Judging for the final ranking of the 50 Most Influential will be based on Letters welcome
readers’ votes as well as input from Modern Healthcare’s senior editors. Write us with your comments.
For more information on required materials and to submit a nomination, To send us a letter electronically,
please visit ModernHealthcare.com/50Most. go to modernhealthcare.com/letters;
by fax, 312-280-3183.

24 Modern Healthcare | January 13, 2020

 Announce your Promotions, New Responsibilities, Retirements or New Hires
ASSOCIATION
Medical Group Management Association,
Englewood, CO
Medical Group Management
Association (MGMA) expands
its executive team to support
growth as the premier
association for medical
practices. Ron Holder, MA,
Holder
FACMPE, FACHE, joins as
Chief Operating Officer and
Albert Hwang joins as Chief
Marketing Officer. Holder’s
leadership experience within
the healthcare industry and his
former role serving on MGMA’s Hwang
Board of Directors will help him
drive the organization toward operational
and financial outcomes that positively
impact MGMA’s future. As CMO, Albert
Hwang will provide strategic oversight and
direction for all marketing and sales
functions within MGMA. Hwang will leverage
his leadership experience to achieve
organizational excellence and financial
growth to drive awareness of MGMA.
DESIGN AND CONSTRUCTION
HOK,
New York, NY
Laura Poltronieri, AIA, has
joined HOK’s global Healthcare
practice as a principal in
Philadelphia. With more than 35
years of experience, Poltronieri
provides inclusive, humane
design for healthcare facilities,
with special expertise in healing
environments for children, infants and
new mothers. She was formerly founding
principal of Poltronieri Tang & Associates.
HOSPITAL
North Kansas City Hospital,
Kansas City, MO
Dr. Stephen L. Reintjes Sr.,
a nationally-recognized
neurosurgeon, was named
president and CEO of North
Kansas City Hospital and its
physician network subsidiary,
Meritas Health. Over the last
30 years, Dr. Reintjes has held numerous
executive leadership positions as a
member of the hospital’s medical staff.
He assumes the role in April 2020.
INSURANCE
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Automating organ referrals saves valuable
time for ICU nurses, transplant teams
By Jessica Kim Cohen
WHEN A PATIENT SEEMS to be dying
in the intensive-care unit, few things
are certain. One thing that is, howev-
er, is that there’s lots to do—and not
much time.
ICU nurses are charged with caring
for patients until their final breaths. Yet,
somewhere in between, they’re expect-
ed to call their local organ procurement
organization, or OPO, to alert them of a
likely death. That’s a CMS requirement:
OPOs must strike agreements with
hospitals, under which hospitals notify
them of every imminent patient death.
“The timing is so important,” said
Mike Breen Eckhard, chief nursing in-
formatics officer at Christus Trinity
Mother Frances Health System, based
in Tyler, Texas. A hospital has to alert
the OPO with enough time so that, if a
patient’s organs are deemed eligible for
donation, a procurement team has time
to recover them while they’re still viable
for a possible transplant.
But “at the time that a patient becomes
eligible to be a donor, the nurses are re-
ally busy with the high level of acuity of
that patient,” Eckhard said. It’s often a
time when patients need hands-on, in-
tensive care—taking a nurse away from
the bedside, even for just a five-minute
phone call, “is not in the best interest of
the patient,” she said.
So, an interdisciplinary team at the
health system worked on coding an
alert system into its electronic health re-
cord software to automate the process.
That involved creating a link between
the health system’s Epic Systems Corp.
EHR and the software system that its
OPO—the Southwest Transplant Alli-
ance—uses, which is from a company
called Transplant Connect.
That link, developed in-house at
Christus Trinity Mother Frances, didn’t
cost anything to build, according to
26 Modern Healthcare | January 13, 2020
At the time that a patient
becomes eligible to be
a donor, the nurses are
really busy with the high
level of acuity of that
patient.”
Mike Breen Eckhard
Chief nursing
informatics officer,
Christus Trinity
Mother Frances
Health System
Eckhard. While it only took two weeks
to create the connection, setting up ap-
propriate legal agreements between the
health system and the Southwest Trans-
plant Alliance took longer.
Now, when a nurse enters patient
information into the EHR—such as a
patient on a ventilator showing signs of
significant brain injury—an automated
referral system sends that data directly
to the Southwest Transplant Alliance,
alerting the organization that a patient
has qualified as a possible organ donor.
That helped Christus Mother Frances
Hospital-Tyler, the first of the health sys-
tem’s hospitals to go live with the system
roughly a year ago, to see a 40% increase
in referrals when comparing January to
October 2019 to the prior-year period.
An automated system not only in-
creases the number of viable organs
available for transplant, but also saves
time for nurses working in the ICU. For
Eckhard, that’s one of the main benefits
of the system.
Christus Trinity Mother Frances has
since rolled out the automated system
to all of its hospitals—in Jacksonville,
Sulphur Springs, Tyler and Winnsboro,
Texas.
Boosting the number of organs do-
nated and improving how procurement
organizations are measured have been
recent areas of focus for the Trump ad-
ministration. The federal government
late last year proposed new rules to
increase organ transplants, including
steps to make it easier for the living to
donate and to standardize how OPOs
are evaluated, to ensure organs from the
deceased don’t go to waste.
More than 113,000 people are
wait-listed for a transplant. And near-
ly 20 people die every day waiting for a
transplant, which makes streamlining
donations from living and deceased do-
nors a national priority.
It’s important for hospitals to strat-
egize how to send timely referrals to
OPOs, since those organ referrals are the
“pipeline” for organ donations from de-
ceased patients, noted Alex Tulchinsky,
chief technology officer at the United
Network for Organ Sharing. UNOS is an
independent not-for-profit organization
the federal government contracts with to
manage the national transplant waiting
list and match organ donors to recipients.
“The more donors there could be,
the more donations there could be,
the more transplants there could be,”
Tulchinsky said. He added that an auto-
mated system, like the one developed at
Christus Trinity Mother Frances, could
help OPOs standardize the information
they collect from hospitals when con-
sidering possible organ donations.
The Southwest Transplant Alliance is
now working to link up the EHRs of two
more health systems in Texas with its
Transplant Connect system. Since the
automated system sends a possible do-
nor’s patient data automatically, it has
saved time typically spent waiting for a
nurse to find time to call the OPO’s staff
and relay that information manually.
“The timing of the call is so critical,”
said Patti Niles, the Southwest Trans-
plant Alliance’s CEO. “It can make a
difference between an organ getting
transplanted or not.” l
 Most breaches in December
due to hacking/IT incidents
Number of breaches reported and Percentage of beaches by type
individuals affected, by month 2010-18 December 2019
60
December 2019 Hacking/IT
Number of breaches: 30 incident
50
Individuals affected: 295,141
Unauthorized
access/
Number of healthcare

40
disclosure
data breaches

30 Theft

Loss More than half of reported

20 breaches in December were
categorized as hacking/IT
Improper
incidents, compared to less
disposal
10 than 23% reported from
2010 to 2018.
All other
0
Jan 2018 July 2018 Jan 2019 July 2019 0 10% 20% 30% 40% 50% 60%

Providers, health plans and their business Top breaches reported in December
associates in December reported 30 By number of patients affected
breaches affecting 295,141 patients to HHS’
Office for Civil Rights. In terms of patients
affected, that’s down 48% from December Truman Medical Centers
2018, when organizations reported 25 114,466 Theft. Laptops were targeted. 12/5/19
breaches affecting 566,963 people. And it’s
the lowest number of people affected in a
Roosevelt General Hospital
single month last year. 28,847 Hacking/IT incident. Network servers were targeted. 12/19/19
July saw the greatest number of
individuals affected by healthcare breaches 17,693 Healthcare Administrative Partners
last year at 26.7 million. Hacking/IT incident. Emails were targeted. 12/3/19
A breach at Truman Medical Centers— Cheyenne Regional Medical Center
the result of a car break-in—was the only 17,549 Hacking/IT incident. Emails were targeted. 12/10/19
incident reported to the OCR in December
PediHealth, dba Children's Choice Pediatrics
that affected more than 100,000 people. 12,689 Hacking/IT incident. Network servers were targeted. 12/20/19
In November, by contrast, healthcare
organizations reported a total of three Sinai Health System
12,578 Hacking/IT incident. Emails were targeted. 12/13/19
breaches, each compromising data from
more than 100,000 people. Colorado Department of Human Services
The Missouri-based health system in July 12,230 Hacking/IT incident. 12/16/19
learned that items, including a password-
protected work laptop, had been stolen from Service Benefit Plan Administrative Services Corp.
an employee’s car. During an investigation,
11,536 Unauthorized access/disclosure. Network servers were
targeted. 12/12/19
the system determined that protected health
information from 114,466 patients had been RiverKids Pediatric Home Health
10,000 Hacking/IT incident. Emails were targeted. 12/2/19
stored on the laptop, including some patient
names, birthdates, Social Security numbers Sunrise Community Health
and limited treatment information.
7,668
Hacking/IT incident. Emails were targeted. 12/5/19
However, “there is no evidence that
anyone accessed, viewed or misused any Note: Numbers are preliminary. Only breaches affecting 500 or more individuals are reported.
patient information,” the system said in a Source: HHS, Office for Civil Rights, breach report at
notice posted online. —Jessica Kim Cohen ocrportal.hhs.gov/ocr/breach/breach_report.jsf

January 13, 2020 | Modern Healthcare 27

‘We feel that we can
really shorten the
timeline of moving
things to market’
When it comes to medical innovation, children’s healthcare can fall between the cracks. received mentorship
From medical devices to pharmaceuticals, the research and regulatory frameworks support to help them
skew toward adults. That forces pediatric specialists to do some retrofitting. Children’s advance. Five of the devices
National Hospital in Washington, D.C., is on a course to change that. The health system is have received different
embarking on a new research and innovation center on 12 acres that once housed Walter regulatory approvals
Reed Army Medical Center. Johnson & Johnson in early 2019 announced its innovation and Children’s National
hub, JLABS, will be taking space there and in November, Virginia Tech committed to spun out about 20 startup
opening a biomedical research facility on the campus. The idea is to accelerate both the companies. I think things
development and adoption of pediatric-specific innovations. Children’s National President are changing and the FDA
and CEO Dr. Kurt Newman, who has held the post since 2011, talked with Modern has gotten behind the idea
Healthcare Managing Editor Matthew Weinstock about goals for the Children’s National that we need to look at
Research & Innovation Campus. The following is an edited transcript. children differently.
Another thing that
MH: What barriers does It took a long time to move a baby, it might require held back the field in the
children’s healthcare face in from using big devices an open operation versus pharmaceutical area is that
terms of innovation? on babies that were really an operation where you’re things had to be tested in
too large and didn’t allow just putting something in a adults at first. The problem
Newman: Most of the devices you to have the kinds of subcutaneous space. Our with that is the diseases
and medications were visualization or to do the cardiologists are working in children are frequently
designed for, tested and kinds of operations that very hard now to refine a very different. The dosing
regulated in relation to adult babies need because you tiny device with a small is different. There are
medicine. As a surgeon, I felt were using a technology battery, but that’s not so many things that are
this most acutely when we devised for adults. approved yet. different that the desire
were trying to use devices. The good news is the Food to take on the pediatric
They were always something MH: Because of that, have and Drug Administration applications or pediatric
that had been approved for there been limitations or has recognized this. diseases was slow.
adults and then we’d try to impact on quality and services They’ve created a number There’s a lot of healthcare
modify it. In many cases, delivered in pediatric settings? of consortiums around the policy now looking at
you’d have to miniaturize country. We happen to be that issue and trying
it or do something else to Newman: Yes. I think the part of one around pediatric to accelerate discovery
make it work in children. medical community has device innovation with the and investment in drug
You weren’t creating devices been very creative and University of Maryland, development for pediatric
with the size of a child in innovative to try and figure where we have a grant in diseases. There’s been some
mind or the behavior and out workarounds, but it was concert with the university’s spectacular successes in the
development, or the types of always trying to retrofit School of Engineering. last few years.
diseases specific to children. things—pacemakers, for This is not just for
example. They could be Children’s National, but MH: How are the 20 startups
MH: What’s an example? quite large. The batteries for researchers across you’ve spun off doing?
are large. If you try and the board.
Newman: Equipment to do use the pacemakers that More than 60 medical- Newman: There’s a lot of
minimally invasive surgery. are designed for adults in device startups have great ideas out there, and

28 Modern Healthcare | January 13, 2020

“There’s a lot of healthcare policy now … trying to
accelerate discovery and investment in drug development
for pediatric diseases.”
they get the intellectual
property protected based
on preliminary research
and then the question
is, are they going to be
commercially sustainable?
The 20 startups are in
different points of evolution.
We have two that are
breaking even, with the
potential of a big success.
There are two more that are
going to do really well. And
then we’ve got about 10 or 12
that are on the borderline.
You just never quite know.
But one of the other
benefits of being involved
with it is that you attract
top talent. And that talent
translates into clinical
growth and into education
and into patient care. It’s
an important part of our
culture, our strategic plan
and our identity.
MH: Looking at the startups
that are doing well, how do you
decide when it is time to bring
something to market?
Newman: One is a company
that has a very innovative
drug that was originally
developed to care for
children with muscular
dystrophy. The idea is
that it has very positive
therapeutic effects, like
steroids without necessarily
the complications of steroids.
That’s in the testing phase
now and in human trials.
But it takes years of testing
to make sure a drug like that
is safe and is better than the
current treatment. One of
the challenges to pediatrics
is that it’s small populations
so you need to work with a lot
of other centers.
Another one that is not
that far along is a device
one of our doctors has been
working on to create an
objective measurement of
pain in babies and using
the pupillary response—
the responses in the eye to
painful stimuli. The holy
grail there is that instead
of using smiley faces on a
chart, which babies can’t
use but children can,
you’d have an objective
measurement to know
whether your treatments
are working or not, whether
you need to increase or
decrease medications. In
some cases, we’ve learned
that the medications we
thought we were using in
babies to help pain were
actually making them more
sensitive to pain.
And back to where we
started, if you can do that in
children because you were
forced into the innovation,
just think about the
application to adults. You’d
have the ability to measure
pain objectively and you
might be able to avoid a lot
of the issues we’ve had with
pain management.
MH: How does the innovation
campus you’re working on fit
into this strategy?
Newman: With the growth
and success we’ve had on
our main hospital campus,
where we have the Sheikh
Zayed Institute for Pediatric
Surgical Innovation, which
is looking into device
development like we were
talking about, we had the
idea that we should create
a whole new campus where
companies could be located
alongside our research and
it would be totally focused
on children. As we did a
scan around the country,
there are a lot of innovation
districts and centers and
hubs and accelerators,
but there wasn’t one that
was focused on pediatrics
and children. We coupled
that with this opportunity
as the Walter Reed Army
Medical Center was being
closed by the government
as part of the base closing
commission, to get some
of the historic land and
buildings that had always
been used for military
research and was very close
to our hospital.
Importantly, it was
also close to the National
Institutes of Health and
it’s also close to the FDA.
We believe that by having
our own research there
alongside others and
partners that are focused
on pediatric innovation,
whether it’s device
development or drug
development, that we will
create something very
unique that will have a lot
of impact in these fields.
We’re under construction,
but the early proof of this is
that Johnson & Johnson and
their JLABS, which is the
part of the company that
focuses on innovation, has
decided to occupy a large
amount of space.
They’ll be hosting 20
to 30 startup companies
that they’ve curated from
around the world that
are focused on pediatric
research and innovation.
Another proof of the
concept is that the Fralin
Biomedical Research
Institute at Virginia Tech
January 13, 2020 | Modern Healthcare
will be our academic
partner on the campus.
They will bring their brain
tumor research group to
work alongside our pediatric
brain tumor research group
to move that field forward.
You can just imagine if
somebody comes up with a
discovery in these research
institutes and then wants
to create a company and
commercialize it, they’ve
got the JLABS right there.
We feel that we can really
shorten the timeline of
moving things to market.
MH: How are you funding
this initially and how will you
sustain it over time?
Newman: The first phase
of the build-out is in the
range of $200 million. That’s
being funded in a number
of ways—operating funds
from Children’s National
that our board has made an
investment in. One of the
buildings will be a clinical
building to bring pediatric
care to the part of the District
of Columbia that’s never had
that before. The district itself
is putting in some funding
around infrastructure,
because they see the
economic development
opportunity of having this
campus. The campus sits
within a larger parcel of land
that is being developed in
terms of mixed use so people
will be able to live there, walk
to work, play. We’ve gotten
some major philanthropy to
support the effort.
Sustainability is an
excellent point, because
we have big plans for
phase two—an expansion
of the research, which
will hopefully come from
some of the returns from
the investments and the
companies, and maybe new
partners will want to come
and make investments. l
29
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Excellent care depends on
outstanding clinical leaders.

Nominate the executives who are

paving the way to better health.
These clinicians are:
• Achieving or exceeding financial, operational and clinical goals
• Establishing or contributing to a culture of innovation and transformation
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Some prizes no one wants
to win—like a Shkreli Award
artin Shkreli inspired a lot of anger when he was up
M to the antics that earned him the sobriquet “pharma
bro.” Now, even as he languishes in federal prison serving
a seven-year term for securities fraud he’s inspired
something else: The Shkreli Awards.
The Lown Institute began handing out the awards in
2018, recognizing the “top ten worst actors in health care
from the past year.”
Not-for-profit hospitals and health systems earned four
spots on the list for 2019, “showing exceptional prowess
at profiteering and corruption,” according to a Lown
news release.
Topping the list were the hospitals and systems that
prompted a series of news stories because of their
proclivity for suing their patients over unpaid bills. Among
them was Ballad Health, whose tale Modern Healthcare’s
Tara Bannow told in a series of stories. UVA Medical
It’s about to get even Goop-ier
he Goop universe is set to expand
T a bit as self-styled lifestyle guru
Gwyneth Paltrow brings her brand to
Netflix to explore “boundary-pushing
wellness topics.”
The pixels were barely dry on
the online media release before
critics pounced, bandying about
words like “nonsense,” “hogwash,”
“pseudoscience” and “dubious.”
Goop, a lifestyle and e-commerce
website—that besides offering beauty
and food advice—traffics in wellness
and health claims and sells a variety of
products of, um, questionable benefit
under its “wellness” banner. Crystal-
The trailer for Paltrow’s
infused water bottle for $84, anyone? Netflix series features
Most memorably, in 2018 Goop paid the actress in a Georgia
$145,000 in civil penalties after California O’Keeffe-esque milieu.
prosecutors accused it of making
unsubstantiated, harmful health claims
regarding “vaginal eggs” and essential oil products it
sold. Don’t even ask about the vaginal steaming. Of the
controversies, Paltrow told Harvard students, per the
32 Modern Healthcare | January 13, 2020
Center, Mary Washington Hospital “Pharma bro”
and Methodist Le Bonheur
Healthcare were also cited as
Martin Shkreli is
infamous for a
5,000% price hike for
contributing to the problem. a decades-old drug.
Dignity Health took the No. 3
spot for using a technicality to stick an employee with a
$900,000 medical bill for her premature baby.
The University of North Carolina Medical Center
earned the No. 6 slot for pressuring “cardiologists to
keep referring pediatric patients for surgery in-house
despite disturbingly high mortality rates,” per Lown.
And the No. 9 spot went to Newark Beth Israel Medical
Center, which “kept a vegetative patient on life support
to boost transplant survival rates.”
In the spirit of full disclosure, Modern Healthcare Editor
Emeritus Merrill Goozner was one of the judges assessing
the various nominees. 
New York Times, “I can monetize those
eyeballs.”
“The Goop Lab with Gwyneth Paltrow”
premieres Jan. 24 on the streaming
service. The trailer promises exploration
of “energy healing,” psychedelics,
psychic mediums, cold therapy and
Goop’s standby, sex.
After watching the trailer, one of
Paltrow and Goop’s most prominent
medical critics, OB-GYN Dr. Jen Gunter,
told Bustle: “This looks like classic
goop: some fine information presented
alongside unscientific, unproven,
potentially harmful therapies for
attention, with the disclaimer of ‘We’re
only having conversations!’ ”
Paltrow says she’s learned from her mistakes. “I
think when we were a little startup and we didn’t
know about claims and regulatory issues, we
made a few mistakes,” she told CNBC. “We’re
very focused, of course, on backing up the things that we
talk about with scientific claims when necessary or being
able to say like, ‘Hey, this is just for your entertainment.’ ” 
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