Tip Kim

While many patients, their families and clinicians are becoming more accepting of palliative care and related end-of-life choices, significant barriers still exist to integrating a cogent, holistic approach into the conventional, well-established standard of care. Issues with reimbursement, eligibility, logistics, communications, accreditation, coordination and the will to have the conversation all lead to a sub-par care solution that almost seems too business-like and less… Show more

While many patients, their families and clinicians are becoming more accepting of palliative care and related end-of-life choices, significant barriers still exist to integrating a cogent, holistic approach into the conventional, well-established standard of care. Issues with reimbursement, eligibility, logistics, communications, accreditation, coordination and the will to have the conversation all lead to a sub-par care solution that almost seems too business-like and less compassionate.

To address this, Zen Hospice Project (ZHP), a San Francisco-based residential hospice and locally prominent player in the contemplative care space, forged a creative working model with a major hospital system. Addressing the knowledge gap, financial issues and inadequate training, ZHP developed a new pathway by which to assist other organizations in achieving successful, sustainable and practical models in end-of-life care.

In this Executive Insights, L.E.K.’s Tip Kim, Joan Kim and Kevin Grabenstatter describe ZHP’s collaboration with this major hospital system to address the significant structural and cultural challenges of end-of-life care in the U.S. healthcare system. Show less

In 2011, L.E.K. Consulting published an article entitled, “Whatever Doesn’t Kill You Makes You Stronger,” asserting that despite the many structural and regulatory threats for payers competing for Medicare Advantage members, the product would still maintain an attractive consumer value proposition for seniors and drive membership into those plans.

Now, more than 15 million seniors are enrolled in a Medicare Advantage plan and member satisfaction remains high. Medicare Advantage… Show more

In 2011, L.E.K. Consulting published an article entitled, “Whatever Doesn’t Kill You Makes You Stronger,” asserting that despite the many structural and regulatory threats for payers competing for Medicare Advantage members, the product would still maintain an attractive consumer value proposition for seniors and drive membership into those plans.

Now, more than 15 million seniors are enrolled in a Medicare Advantage plan and member satisfaction remains high. Medicare Advantage represents the first real “retail” health insurance market of scale, coming a full decade before the “exchange,” and making way for more markets as the number of insured increases. In this Executive Insights, L.E.K. Consulting’s Tip Kim, Andrew Kadar and Andrew Whyinny discuss three of the structures pervasive in Medicare Advantage that are likely to be replicated in other markets, and what is next for payers to achieve success in the “retail” healthcare market. Show less

Conventional wisdom holds that U.S. hospitals will be net beneficiaries of healthcare reform. After all, hospitals currently care for many patients who are uninsured and cannot pay their medical bills. As the Affordable Care Act (ACA) moves more people into insurance coverage, hospitals will be reimbursed through Medicaid for these patients.

However, this conventional wisdom is contingent upon a key assumption: that the uplift from Medicaid expansion will overcome other negative macro… Show more

Conventional wisdom holds that U.S. hospitals will be net beneficiaries of healthcare reform. After all, hospitals currently care for many patients who are uninsured and cannot pay their medical bills. As the Affordable Care Act (ACA) moves more people into insurance coverage, hospitals will be reimbursed through Medicaid for these patients.

However, this conventional wisdom is contingent upon a key assumption: that the uplift from Medicaid expansion will overcome other negative macro forces that will simultaneously affect hospitals in the same time period. In this new Executive Insights, L.E.K. Consulting examines the impact of healthcare reform and other approaching macro forces in sequence. According to our analysis, the net impact of legislative, structural and demographic factors in the wake of healthcare reform will be materially negative for most hospitals in the country.

The authors argue that hospitals will face such acute pain in the future that they and every other player in the healthcare value chain will be forced to innovate and create new paradigms in order to survive. The authors conclude by identifying the strategies that leading hospitals have developed to prepare for their challenging future.

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Pending reimbursement cuts, a narrowing selling period, and a more onerous business environment all contributed to the conventional wisdom that enrollment in Medicare Advantage (MA) would decline. The Congressional Budget Office, owing to a tendency of seniors to leave their plan when their premiums rise, projected that the number of MA members by the end of this decade would fall to nine million from 11 million today. This absolute decline would happen even in light of the wave of Baby Boomers… Show more

Pending reimbursement cuts, a narrowing selling period, and a more onerous business environment all contributed to the conventional wisdom that enrollment in Medicare Advantage (MA) would decline. The Congressional Budget Office, owing to a tendency of seniors to leave their plan when their premiums rise, projected that the number of MA members by the end of this decade would fall to nine million from 11 million today. This absolute decline would happen even in light of the wave of Baby Boomers reaching eligibility.

But L.E.K. Consulting has a contrarian perspective. L.E.K. research shows that there are clear growth opportunities for many insurers that offer Medicare Advantage plans – a position that challenges widely held assumptions about this market. L.E.K.’s new report outlines reasons for market growth, and includes:

-The market dynamics that are supporting projected growth in this market
-Findings from a county-by-county analysis of how pending rate cuts in Medicare Advantage may impact payers in these areas
-Projections for how healthcare reform will reshape the Medicare Advantage market Show less