The Changing Healthcare Market & Strategies for Success

Transcription

1 The Changing Healthcare Market & Strategies for Success PPS Annual Conference October 24, 2002 Chuck Felder HCS Consulting 1 Overview What is happening in the economy and how it can affect your practice What is happening in healthcare and how it can affect your practice How market forces affect your practice What you can do to improve the likelihood of success 2 Mobile: , cfelder@hcsconsulting.com 1

2 Demand Issues Trends in healthcare insurance Outlook for PT Orthopedics Geriatrics the graying of America Pediatrics Neurological Macroeconomic issues 3 Supply Issues Competition Other PTs Hospitals & managed care organizations Physician owned practices Corporate PT Substitutes Athletic & Personal Trainers, Pilates, etc Health clubs & home care 4 Mobile: , cfelder@hcsconsulting.com 2

3 Consumer Concerns Limited access High cost Quality concerns Privacy concerns 5 Provider Concerns Limited access to patients/consumers Multiple consumers & significance Patient/client Referral source MD Payor source & type Complex and declining reimbursement Issues with unlimited access Any Willing Provider rules 6 Mobile: , cfelder@hcsconsulting.com 3

4 Provider Concerns Regulatory issues HIPAA Medicare Workers Compensation Rising cost of doing business Recent Medicare interpretation of group therapy 7 Industry Overview Fragmented service market Lots of small offices Highly regulated industry with constantly changing regulatory demands Constantly changing patient care and business parameters Significant price pressures by government and private payors 8 Mobile: , cfelder@hcsconsulting.com 4

5 Changing Face of Healthcare Graying of America Baby boomers will change healthcare E-health issues Consumerism issues Knowledge issues Compliance issues Managed care concentration 9 Mobile: , cfelder@hcsconsulting.com 5

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8 Consumer Selection Drivers for MD s Rep for clinical quality Rep for service quality MD in network Office is close to work/home Experience Recommendation of family/friends Source: VHA unpublished original research with Market Strategies Inc., 2000 Important Very Important 15 Mobile: , cfelder@hcsconsulting.com 8

9 Emerging E-Health Trends The decline of employer-purchased health insurance will be a major stimulus for the powerful influence of consumerism and the emergence of customized marketing in healthcare. Lack of trust in healthcare content and connectivity is deep-rooted and is fast becoming the most significant roadblock to the further adoption of web-based technology in healthcare. Source: First Consulting Group, Inc Mobile: , cfelder@hcsconsulting.com 9

10 Emerging E-Health Trends Demanding connectivity and communication with their providers of care and payors, consumers will begin to vote with their feet. The battle over the physician desktop computer will expand to the battle over the physician hand-held electronic device. Provider-based medical records will become the remnants of the episodic and fragmented healthcare system. Source: First Consulting Group, Inc Emerging E-Health Trends The transformation from traditional supply chain management to electronic supply chain management will set the stage for the etransformation of the care chain tomorrow. etransformation of healthcare has not yet taken hold among providers or payors. Source: First Consulting Group, Inc Mobile: , 10

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13 Consumer-Driven Health Benefits Consumers want specific information & use a portal to search for it Online use growing 110MM Q vs. 97MM Q (13%) Three pillars Self service Personal health accounts Marketplace paradigm Source: Lutz, PricewaterhouseCoopers e-ssentials, July/August Changing Face of Healthcare Healthcare is becoming increasingly competitive Government is likely to step in with more regulations HIPAA, etc Cost control is becoming a bigger issue Technology issues may help with the problem of high labor costs & limited productivity Consumer (patient) backlash and increased information may require more practice resources may need outside help 26 Mobile: , cfelder@hcsconsulting.com 13

14 Industry Issues Market trends more outpatient care Provider cost issues high personnel costs Supply & demand of providers Availability of substitutes Complicated reimbursement issues Lack of business skills by owners 27 Industry Analysis Nationwide return to private practice Need for strategic reviews and planning Personnel productivity issues Too many PT s or not enough? 28 Mobile: , cfelder@hcsconsulting.com 14

15 Industry Analysis Many substitutes are available & often less expensive Consumers are often willing to spend cash on substitutes but consider PT a right with healthcare coverage Can be difficult to switch consumers thought process to paying out of pocket for PT services 29 Strategy Concepts: Porter s Five Forces of Competition Suppliers Bargaining power of suppliers Potential Entrants Threat of entry Industry Competitors Rivalry among existing firms Threat of substitutes Substitutes Bargaining power of buyers Buyers 30 Mobile: , cfelder@hcsconsulting.com 15

16 Competition from Substitutes Many substitutes exist Consumers can t differentiate between PT and the substitutes PT is often significantly more expensive PT is medical 31 Threat of Entry Very easy to enter the market Multiple new small offices Easier to get started groups can help Substitutes very easy to start 32 Mobile: , cfelder@hcsconsulting.com 16

17 Rivalry - Established Competitors Becoming more of an issue Traditional sources of referrals were MD s now expanded to payors, employers, etc Friendly competition or not? 33 Bargaining Power of Buyers Payors have the power and they are being more aggressive Difficult to get into many networks Price pressures are intensifying Consumers likely to be even more demanding 34 Mobile: , cfelder@hcsconsulting.com 17

18 Bargaining Power of Suppliers Vendors are being squeezed on prices opportunity to reduce practice costs Referral sources are a supplier their choices are increasing therefore more difficult to secure consistent referrals Referral sources are also becoming competitors 35 Orthopedic Care Focus Orthopedic care market is likely to expand as baby boomers age However, access to patients and payment is becoming more restricted New consumerism issues may open this up to increased competition Baby boomers more likely to demand & be willing to pay for specialized services but will be cost conscious 36 Mobile: , cfelder@hcsconsulting.com 18

19 Medicare Fee Changes Fees for orthopedic MD care have dropped 2001 to 2002 = 5.4% 1997 to 2002 = 11.6% 1992 to 2002 = 16.8% Overhead has increased 1999 to 2000 = 0.7% 1997 to 2000 = 2.7% 37 MD s As Competitors MD s are finding their revenue dropping due to cuts and restrictions Many are looking to ancillary services to replace the lost income Therapy, MRI, Outpatient surgical centers Stark laws are not that effective 38 Mobile: , cfelder@hcsconsulting.com 19

20 Pacific Region Payor Sources Medicaid 5% Charity 3% Other 4% Private Pay 15% Medicare 16% Workers Comp 22% Managed Care - Capitation 15% 73% of market Managed Care - Fee For Svc 20% 39 Changes in PT Practices Higher co-pays and more demanding patients More competition for the private patient Best practices need to be integrated More regulation & compliance issues E-health issues Evidence based practice issues 40 Mobile: , cfelder@hcsconsulting.com 20

21 Differentiation Making your practice stand out Quality people Exceptional service e-telligent Appropriate marketing Financially sound 41 Mobile: , 21

22 Top Business Issues Facing HC CIOs HIPAA compliance Improving efficiency Cost pressures e-health Medicare cutbacks Improving care Satisfying customers Respondents could choose up to five priorities Source: Modern Healthcare 11 th Annual HMSS Leadership Survey, 2000 Percentage of respondents 44 Mobile: , cfelder@hcsconsulting.com 22

23 Market Trends Market growing or mature? Patient care market will be growing, and opportunity to recruit patients may increase as consumers become more demanding countered by price resistance 45 Mobile: , 23

24 Core Competencies Clinical Quality Clinical processes & people more satisfied employees drives improved service Recruiting & retaining the highest quality clinicians Application of clinical technologies Bundling services into centers of excellence Care management 48 Mobile: , 24

25 Core Competencies Clinicians Clinician relations more satisfied PT s drives improved care delivery experience Care management Convenience for PT s in caring for patients Patient information Care setting Personalized attention 49 Core Competencies Customer-Centric Services Patient/customer-centric services more satisfied patients drives improved financial performance Personalized attention Convenient access to services for patients Comforting care experience 50 Mobile: , cfelder@hcsconsulting.com 25

26 Consumer Issues More expensive & too expensive More complex reimbursement Providers are time restricted Access is restricted Use of substitutes likely to increase Gaining more control Demanding more education 52 Mobile: , 26

27 What To Do! - Consumer Choose carefully Know your plan & benefits Take an active role Plan well for visits Convenience vs. quality Choice vs. restriction Cost Kmart cost vs. Nordstrom service 53 Provider Issues Increased competition More complex reimbursement Lower reimbursement More demanding patients Less time per patient 54 Mobile: , cfelder@hcsconsulting.com 27

28 Strategies to Improve Your Position Differentiation strategies Services & people Marketing Maximize reimbursement Cash services Fitness clients Sport specific programs 55 Marketing Concepts Four Ps Product Price Place Promotion Four Cs Customer solution Customer cost Convenience Communication 56 Mobile: , 28

29 What To Do! - Provider e-health presence Clinical quality Service quality In networks Good location Cultivate relationship with current & past patients to foster referrals 57 What To Do! - Provider Choose your strategy volume or customer intimacy Market well & appropriately Get business help Control costs but recognize that increasing revenue is ultimately better than reducing costs 58 Mobile: , cfelder@hcsconsulting.com 29

30 What To Do! - Provider Use technology to improve productivity Provide patients/consumers with appropriate information Monitor compliance issues closely Leverage practice 59 Supine Punches Lie on foam roll Raise both arms with palms facing each other Raise right hand to the ceiling while rolling to the right Repeat to other side. Repeat 30 times 60 Mobile: , cfelder@hcsconsulting.com 30

31 What To Do! - Provider Pick the right business partners Referral sources Insurance companies Suppliers Consultants Billing & Collections support Compliance support 61 Future of Healthcare Have Fun! Education Core Competencies Compliance Issues Position yourself to succeed Graying of America Consumerism Issues E-health Issues Mobile: , cfelder@hcsconsulting.com 31