Universal Health Services finance chief Steve Filton on cost containment and challenges hospital CFOs face

https://www.beckershospitalreview.com/finance/universal-health-services-finance-chief-steve-filton-on-cost-containment-and-challenges-hospital-cfos-face.html?origin=cfoe&utm_source=cfoe

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As CFO of one of the nation’s largest hospital management companies, Steve Filton understands the challenges hospitals face.

Mr. Filton has served as executive vice president and CFO of King of Prussia, Pa.-based Universal Health Services since 2003.

He  joined the company in 1985 as director of corporate accounting and in 1991, he was promoted to vice president and controller.

Mr. Filton spoke with Becker’s about some of the challenges facing CFOs and his top cost-containment strategies.

Question: What is the greatest challenge hospital and health system CFOs faced in 2018? Do you expect this to be their biggest challenge in 2019 as well?

Steve Filton: I think effectively we’re in an environment where our payers have all concluded that costs and medical spending have to be reduced, and a lot of that burden ultimately falls on providers, like hospitals and doctors. As a [result], I think hospitals are tasked with the difficult goal of continuing to provide the highest quality care in more efficient ways. I think that was the biggest challenge last year and will be the biggest challenge this year. I think, frankly, for the foreseeable future, that’s the challenge of being a provider in today’s healthcare environment.

Q: How do you feel the CFO role has evolved in recent years?

SF: I think CFOs have a particularly challenging role in that our organizations explore the ways to deliver high quality care that’s best for our patients and try to create an environment that is satisfying for our employees. We as CFOs then say, ‘How do we accomplish these things and remain efficient and remain profitable?’ [That way organizations] can continue to do all the things we have to do as far as investing and reinvesting in the business and continuing to be competitive with our labor force and do all the things that allow us to continue to run high quality facilities, which in many cases involve significant expenditures.

Q: What are your top cost-containment strategies?

SF: I think a lot of our cost-containment strategies are focused on what I describe as driving the variability out of our business. I think so many other industries and businesses are accustomed to delivering their products and services in very standardized ways that are determined to be most efficient. I think healthcare has sort of long resisted that, and as a [result], we have lots of variability in the way that we deliver services in our various geographies. Various clinicians will deliver services differently. And I think we could benefit by following the lead of some of our peer industries and becoming much more focused on … delivering all our care and service in that standard way in accordance with best practice protocols. Driving out excess utilization and driving out rework and re-dos and errors — those things I think are a significant focus of getting the hospital industry to be more efficient and cost-efficient.

Question: During your tenure at UHS, what has been one of your proudest moments as CFO?

SF: What I take great pride in is the growth of the company. When I joined the company in the mid-1980s, it had maybe 35 [or] 40 hospitals around the country and maybe $500 million of consolidated revenues. This coming year we’ll have well over 300 domestic facilities and another 100 or so in the United Kingdom and over $11 billion of revenue.  And what I’m proud of is not just the growth of the company, but … the way the company has grown and yet really adhered to its core principles. When I joined the company 30 some odd years ago, it was very committed to high quality patient care and to the satisfaction to our employees. And honestly, if anything, I think the company has recommitted itself to those core principles over the years, and to be a much bigger company [and] not have abandoned our core principles, at least for me, is a source of great pride.

Q: If you could pass along one nugget of advice to another hospital CFO, what would it be?

SF: I tell the folks who work with me and for me all the time that it’s so important to behave every day with the highest level of integrity. I think at the end of the day you can’t replace that. People, I think, will give you a lot of leeway if they trust you, if they believe that you’re behaving transparently and with great honesty. And so I encourage everyone who works for me to do that, and I certainly endeavor to try to do that as best I can. And it’s tough. There are all kinds of pressures on folks in a financial role in this sort of environment. But I think if you behave with integrity, everything else will follow from that.

 

 

 

“The Inevitable Math behind Entitlement Reform”

“The Inevitable Math behind Entitlement Reform”

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That’s the title of a new NEJM Perspective by Michael Chernew and me. After crunching the numbers, our argument is that for long term cost control we will probably need to address growth in per capita health care utilization. The easy “solutions” won’t be enough.

Much of the projected increase in inflation-adjusted spending on health care entitlements, particularly for Medicare, stems from assumed increases in utilization (e.g., 2.75 percentage points of the 5.33% annual projected growth for Medicare spending). Strategies for holding utilization growth below projections (and more in line with very recent historical growth) will thus be central to the success of any attempt at cost containment.

[One approach] is to dissuade patients from seeking care by charging them more at the point of service. About 85% of Medicare beneficiaries have supplemental plans (e.g., Medigap) that reduce their out-of-pocket costs. Policies that limit the generosity of such plans could reduce Medicare spending considerably. However, such strategies would increase beneficiaries’ financial risks, reduce access to care, and probably exacerbate health disparities.

A second strategy is to help beneficiaries improve their health by enhancing long-term care management and preventive services with the goal of avoiding more expensive services. Evidence suggests that although this type of approach is probably beneficial to patients and may be cost-effective, it is generally not cost saving.

The piece continues with some more promising approaches, in our view. Click to read it in full (unfortunately pay-walled though).

 

KKR Closes $1.45 Billion Health Care Strategic Growth Fund

http://media.kkr.com/media/media_releasedetail.cfm?ReleaseID=1050109

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Aims to Back Innovative Growth Companies

KKR, a leading global investment firm, today announced the final closing of KKR Health Care Strategic Growth Fund (including parallel vehicles, “HCSG” or the “Fund”), a $1.45 billion fund dedicated to health care growth equity investment opportunities in the Americas. KKR will be investing more than $265 million of capital in the Fund alongside external investors through KKR’s balance sheet and employee commitments.

“The health care sector has demonstrated strong fundamentals throughout multiple cycles,” said Ali Satvat, KKR Member and Head of KKR’s Health Care Strategic Growth investing efforts. “Significant advances in medical innovation have yielded new products and services for patients, while consolidation and novel approaches to care delivery have the potential to improve clinical outcomes and reduce associated costs. These dynamics have created a significant market opportunity and an unmet need for strategic growth capital. We look forward to working with high-growth companies in the health care space for which KKR can be a unique partner in helping them achieve scale.”

The Fund received strong backing from a diverse group of new and existing global investors, including public pensions, insurance companies, family offices, and high net worth individual investors. “We are pleased that our enthusiasm for the attractive health care growth opportunities that the Fund enables is shared among a diversified group of global investors. This interest in the space, along with our strong team and record in health care, has helped us significantly exceed our initial target for the fundraise,” said Alisa Wood, Member and Head of KKR’s Private Market Products Group.

HCSG aims to generate strong returns for investors by investing in health care-related companies advancing innovative products or services and led by high-quality management teams. In particular, HCSG expects to make equity investments of up to $100 million and focuses on themes such as clinical / technological innovation, cost containment, and consolidation of therapeutic offerings or care providers.

“KKR’s health care investment team has been investing globally across the health care sector for more than 20 years, resulting in extensive industry experience, an established reputation within the space, and a strong track record of scaling health care-related companies,” said Jim Momtazee, KKR Member and Head of KKR’s Health Care investment team. “We believe that we can be a valuable partner to management teams running innovative, high-growth companies by leveraging this experience.”

KKR has deployed approximately $12 billion globally in the health care space across private markets. Beyond delivering financial capital, KKR helps companies grow by providing access to the firm’s operational expertise, global infrastructure, deep network, and resources from its more than 100 current portfolio companies worldwide. Over the last year, KKR has executed a number of transactions as part of the firm’s health care growth equity strategy, including Ebb Therapeutics (formerly known as Cerêve), Slayback Pharma, and Ajax Health.

 

Aetna’s profits rise 39% despite revenue shortfall

https://www.beckershospitalreview.com/payer-issues/aetna-s-profits-rise-39-despite-revenue-shortfall.html

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Aetna saw revenues dip 5 percent in the third quarter of fiscal year 2017 compared to the year prior, but cost containment allowed the insurer to boost net income.

The insurer reported revenue of $15 billion in the third quarter ended Sept. 30, down from $15.8 billion in the same period a year prior. Aetna cited lower premiums in its healthcare segment, fewer members in its ACA exchange business, and temporary suspension of the health insurer fee as contributors to the decline.

However, tapering expenses offset revenue losses. Aetna witnessed expenses drop 7 percent from $14.7 billion in the third quarter of 2016 to $13.7 billion in the same period this year. The insurer attributed the decline to temporary suspension of the health insurer fee, expense management efforts and lower transaction-related cost following the collapse of its proposed merger with Humana in February.

Overall, the payer achieved net income of $838 million in the third quarter of 2017, up 39 percent from $604 million in the same period last year. Aetna also saw its commercial medical loss ratio, or the amount of money it spends on medical claims, shrink year over year from 83.8 percent to 81.4 percent.

Aetna’s earnings report did not mention CVS Health’s proposed $66 billion bid to acquire the company.

An ACA primer: Much more than insurance

http://www.healthcaredive.com/news/an-aca-primer-much-more-than-insurance/429497/

Remember the Affordable Care Act? Enacted in 2010, it expanded healthcare insurance to millions of uninsured Americans and increased access to care. But the ACA is much more than expanded coverage; it set in motion a variety of reforms in the healthcare delivery systems aimed at lowering costs and improving quality of care.

That fact was lost on presidential candidate Donald Trump, who told Fox News recently, “I don’t use much Obamacare, I must be honest with you, because it is so bad for the people and they can’t afford it.” Trump’s comments imply Obamacare is an insurance plan people can buy, which is not the case. As we wrap up year six since the ACA was enacted, here‘s what the law is really about and how it impacts providers.

Population health, workforce salary management key hospital cost control strategies, CFOs say

http://www.healthcarefinancenews.com/news/population-health-workforce-salary-management-key-hospital-cost-control-salaries-cfos-say

But there’s a catch. Hospitals have to first spend money to get systems in place.

The awful (and not so creative) destruction of medicine

The awful (and not so creative) destruction of medicine

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