Intermountain’s Newest Partner

Did I really witness what I think I did last night?

4 missed extra points? 4?! In a row? Unfathomable. But I’ll take the Cowboys W though.

Anyway, here’s this week’s healthcare roundup!

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Intermountain and UC Health Partner, form CIN

In early January, Utah-based health system Intermountain Healthcare announced plans to partner with Colorado-based UC Health. Under the joint venture, the two powerhouse health systems will form a clinically integrated network (CIN) in the Colorado area.

Within the CIN, the venture will include 700+ primary care physicians, hundreds of clinics, hospitals, and specialist support. Over time, Intermountain and UC Health will accelerate the transition to value-based care in Colorado, initially targeting 300,000 residents. Finally, Intermountain’s SelectHealth insurance segment will enter Colorado in 2024, also supported by the partnership. The CIN itself will remain insurance-agnostic.

• Intermountain gets: Access to a new market (Colorado) in a state with a growing population. New membership & expansion for SelectHealth. And finally, a CIN for its value-based care enablement platform, Castell, to partner with (presumably) for continued growth.
• UC Health gets: Agency to enter a substantial population health strategy with an experienced player in Intermountain, a strategy that would be difficult for them to pursue on their own time and dollar.

I know what you’re thinking – “but hospital consolidation…not again! This is just another way for hospitals to merge without merging” And yes, that is a legitimate concern anytime two huge systems announce anything substantial. One also needs scale to pursue population health strategies, and there’s not a ton of overlap in clinical footprint between the two systems to begin with.

So far, Intermountain’s actions in value-based care have matched up with its words, including lowering costs and premiums in Utah. Castell has been a key driver in Intermountain’s “Reimagining Primary Care” model around population health and value-based payment success, and has decreased MA admissions by 60%, commercial admissions by 25%, and reduced PMPM costs by 20%.

Final point – don’t we want hospitals to be venturing into partnerships like these? For all the complaining about how backwards hospital operators are (justifiably so), then they finally start to pursue interesting stuff…and now the same level of discontent.

Damned if you do, damned if you don’t.

Nurses vs. Hospitals – The strike heard around New York

A 3-day nurses strike between several high profile New York health systems and 7,000 unionized nurses ended after three days on January 12. And the emotions surrounding the strike were a perfect microcosm of the tension that exists – and has festered – between nurses and hospitals.

Let’s back up for a sec. How did we get here? Why are nurses striking everywhere?

To start, Omicron ravaged hospitals at the start of 2022, setting records for daily cases and stretching hospital capacities to their absolute limit. A perfect storm of events emerged from there. All of these factors (and more, I’m sure) contributed to the labor dynamics that exist today.

For nurses:

• ‘Rona surges. Full-time nurses got sick and surge capacity caused hospitals to sign contracts at super high rates for travel nurses.
• Nurses quit. Burnout from 2 years of ‘Rona and retirement of experienced nursing leaders caused hundreds of thousands of nurses to leave the workforce altogether, leaving a void and stressing nursing ratios. Nursing unions and clinicians increasingly blamed hospital management for manifesting the understaffing crisis.
• Staffing agencies flourish. Existing and newly funded staffing agencies pulled nurses out of local hospitals with the promise of lucrative travel positions elsewhere.
• Inflation persists. General inflation rose by 8%+ year over year, adding financial pressure to every American.

For hospitals, this caused:

• Squeezed margins. Systems couldn’t find enough nurses to staff beds or run elective procedures throughout 2022. Lack of volumes coupled with poor market performance led to poor financial performance after relief dollars ran dry.
• No discharge destinations. Hospitals also couldn’t find places to discharge patients (e.g., skilled nursing facilities or rehab) since there was a shortage of personnel THERE too.
• Overwhelmed EDs. Shortages in the ED added to the problem, including a higher than normal length of stay due to observation, boarded patients, and also clinician burnout from unsustainable nurse-to-bed ratios.

And so, as a result of the above dynamics, we saw quite a few strikes between nurse unions and health systems with inflamed rhetoric. But because hospitals are so desperate to find full-time clinicians, bring down travel nurse costs, and improve retention in order to boost volumes, most health systems caved pretty quickly to union requests, ending strikes before they began. Those requests included boosts in pay, formation of task forces, better career advancement, and other changes.

Here’s where things have changed a bit. Most notable among these provisions, and central to the NY strike, seems to be the contractual addition of enforceable staffing ratio requirements in the ED and other inpatient units. It shows a marked shift in power dynamics – at least for now – between clinician and hospital in the U.S. Hospitals like Montefiore and Mount Sinai conceded *a lot* in this agreement even prior to the ratio language – 19% raises over 3 years, free healthcare, funded pensions, etc.

Hopefully the agreement improves relations and the disconnect between clinicians and management. Hopefully nurses feel adequately staffed, and hopefully, the labor dynamic in healthcare improves over the course of 2023.

Partnerships and Strategy Updates:

Aledade changed its legal structure to that of a Public Benefit Corporation, meaning its governance is focused not solely on maximizing shareholder value, but also must consider furthering its designated ‘public benefit purpose.’ In Aledade’s case, that purpose has been defined as ‘To deliver better health, better care, and lower costs, creating a healthcare system that is good for patients, good for practices, and good for society.’ I’m not sure what this changes as far as teh the actual governance or oversight changes, but there’s another well-known PBC – Mark Cuban’s Cost Plus Drugs. (Read more)

Optum partnered with 2 health systems – Owensboro Health and Northern Light Health in Maine. Both of these partnerships are similar in structure – the systems will offload their revenue cycle and IT functions (including ALL of the employees) to Optum. Look for more systems to engage in similar moves in order to cut costs and headcount on the admin side.

HealthTrust and Ardent Health Services renewed their GPO agreement. (Read more)

CHS and Health Net renewed their Medi-Cal contract. (Read now)

Inside Intermountain’s $600M campaign to reimagine pediatric care (Read more)

Transcarent partnered with the Cleveland Clinic that allows Transcarent members virtual access to the CC’s 3,500 medical specialists. (Read more)

DocGo partnered with Redirect Health to offer non-emergent medical transport to Redirect Health’s members across NJ and NY. (Read more)

Finance and M&A Updates:

UnitedHealth Group’s (Lord UHG) full-year results: $324.2B in revenue, $20.1B in net income for the year. revenue by segment, before intercompany elims:

• Premiums: $249.7B; Optum Health: $71.2B; OptumRx: $99.8B; OptumInsight: $14.6B; Intercompany elims: $108.3B
• My full investor day breakdown here

Interesting little update on the Sanford-Fairview merger. Ownership of the University of Minnesota Medical Center (an academic medical center) is at the center of issues at hand during regulatory review, with local leadership stating they weren’t made aware of merger plans prior to the announcement. (Read more)

Kaufman Hall released its hospital M&A 2022 in review, in which it anticipates seeing more ‘cross-market’ hospital mega-mergers. Interesting, sounds a lot like what I wrote about in June! And then I had a post titled ‘2022: Year of the Cross-Market Health System Mega-Merger’ in November! Jokes aside, it’s a nice summary of key data points and activity among hospitals in 2022.

Digital Health and Startup Updates:

Mark Cuban Cost Plus Drugs partnered with RxPreferredBenefits, giving employers and their members using its PBM access to MCCPD medications and the goal of extending the offering to local, independent pharmacies. (Read more)

ShiftKey raised $300M. (Read more)

Paytient, a BNPL healthcare fintech company focused on its creation of health payment accounts, raised $40.5M in a Series B led by Mercato Partners and $7.5M of which consisted of debt from Silicon Valley Bank. (Read more)

Suki provided some updates on its 2022 growth and operations, including a 7x increase in users. (Read more)

Policy and Payment Updates:

This was a fantastic, comprehensive write-up from Brendan Keeler & the Second Opinion team on key regulations to know for healthcare operators entering 2023. (Read more)

A couple of deadlines coming up from the Inflation Reduction Act:

• 9/1/23 – CMS drops the 10 drugs selected for negotiation
• 9/1/24 – Prices for these drugs are set, taking effect in 2026

The WSJ penned an thought-provoking op-ed on the British National Health Service on the current pitfalls facing its national healthcare system. (Read more)

VMG Health provided an overview of changes to the MPFS’ final rule for diagnostic imaging & radiology. (Read more)

Costs, Data, and Other Updates:

The Veterans Affairs received another $1.8B to move forward with the Oracle-Cerner EHR rollout. (Read more)

FDA grants accelerated approval for Leqembi (Read more) Jared’s perspective on balancing speed and safety in drug approvals (Read more)

I always enjoy looking at recent B2B marketing stuff in health tech, and the Differential’s roundup was great here. (Read more)

Would love for subscribers to weigh in on this one: Ophelia, an opioid addiction treatment co, crafted a new marketing campaign called ‘F*ck Rehab for Opioids’ and it has drawn plenty of attention. (Read more)

Miscellaneous Maddenings

• I had a roller coaster of a golf round this past Saturday. Started off number 1 with three hosel shanks (give me a break, I was still tight alright?!) but ended with 2 birdies on the last 4 holes, including drives of 311 yards (onto the green) and 353 yards (on the cart path). Not my best round, but a pretty fun one regardless!
• The story about JP Morgan buying Frank and discovering fraud is a great one. Alex Johnson had a great breakdown. (Read more)
• The horrifying reason the chainsaw was invented. Basically a medieval C-section! Ahhh!!! (Read more)

Hospitalogy Top Reads

• X=primary care published a nice overview of the direct primary care landscape (Read more)
• This was a great dive into hospital market dynamics with a specific focus on HCA’s strategy. (Read more)
• Would you sell your extra kidney? (Read more)
• Damar Hamlin’s collapse and the mental health concerns facing the NFL (Read more – paywall WSJ)

That’s it for this post! Join 14,000+ executives and investors from leading healthcare organizations including HCA, Optum, and Tenet, nonprofit health systems including Providence, Ascension, and Atrium, as well as leading digital health firms like Tia, Carbon Health, and Aledade by subscribing here!