United States: Food For Thought (And Health): Day 2 Notes From The JP Morgan Healthcare Conference

Addressing the Social Determinants of Health:  Is the healthcare industry pushing a rock up a hill?  We collectively are trying to provide healthcare with improved quality and reduced cost, but the structure of the nation's healthcare system remains heavily siloed with the social determinants of health often falling wholly or partly outside the mandate and reach of the healthcare delivery system. Bernard Tyson of Kaiser on Monday noted studies that health is determined approximately 30% by family history and genetics, with the majority of the healthcare impact coming approximately 40% from personal behavior, 20% from environmental factors and 10% from healthcare services.  So, the playing field, if the above numbers are correct, is tilted much more toward nurture, rather than nature.  While we are aware of some hospitals starting to provide housing or other limited services to address the needs of their community and therefore also to address healthcare cost containment, those examples are the exception to date, rather than the rule.

David Feinberg of Geisinger (approximately 2 years now at Geisinger after his earlier stint at UCLA and UC Health) shared with the conference attendees several interesting initiatives that provide a more holistic approach. First, as to genetics, Geisinger is starting to do full DNA sequencing on some of its patients, with about 150,000 patients (out of a one million target) completed.  Geisinger is finding about 3-4% of the sequenced patients with medically actionable results that can be addressed and benefit the patient.  Their protocol after the sequencing results are available is to send the results to the patient's primary care physician (PCP) along with an asynchronous medical education opportunity for the PCP to refresh on the relevant condition.  Five days after the PCP is alerted, the patient is notified that there was a positive result and invited to meet with the PCP and a genetic counselor to begin to plan management and treatment as needed.  Interestingly, Geisinger is finding that for each positive result found, they are receiving approximately six new patients – people who have heard about the results of the genetic testing and want to be included in this approach.  A 3-4% actionable percentage can be significant in controlling healthcare costs, but is this realistic in a different market? Geisinger has both a health plan and healthcare delivery system, plus they are not subject to quite the same level of competition as we can find in other urban markets.  But, in evaluating this, keep in mind the July 2016 Department of Health and Human Services finding that approximately 5% of the U.S. population accounts for almost 50% of healthcare spending.  So, in that light, is an investment in genome sequencing an investment in the "public commons" of healthcare that will benefit everyone?

As to the "nurture" side of the health equation, Geisinger has launched Springboard Health to address the social determinants of health.  With an initial effort in the Scranton, Pennsylvania area, selected participants are provided with food to both address food insecurity and to use the approach of "food as medicine" through a fresh food pharmacy.  Participants receive healthy food for themselves and their family, such as vegetables and fruits for diabetic patients that were not purchasing such themselves.  Initial results are indicating that the food initiatives can be powerful, with diabetic level improvements potentially resulting in at least $8,000 per year healthcare cost reductions for health plan participants. Other aspects of the Springboard approach include genome sequencing (as noted above), informatics and big data initiatives, and the use of technology to better connect patients to social services offerings.  While the initial launch is small in sample size, it will be interesting to watch the results.

Of course, this type of initiative works best in an integrated healthcare environment, especially where there is an aligned health plan and healthcare delivery system, such as we find with Geisinger and Kaiser, but also what many hospital systems around the country are targeting as they launch or grow provider-sponsored health plans.

Medicare Advantage – Growth in Plans:  The Medicare Advantage field will become more crowded in the next two to three years.  In discussions at the conference, there is strong interest in commencing or expanding Medicare Advantage health plan business. A number of health systems and other healthcare organizations are looking to start or expand provider sponsored health plans.  Centene noted that they had made initial filings to commence Medicare Advantage health plans in eleven new states.  Molina's purchase transaction with Aetna and Humana for Medicare Advantage contracts in 21 states is pending the outcome of the antitrust trial. We also note the increasing number of support organizations who can provide partial or more complete administrative services and support to Medicare Advantage plans, including the new launch by Blue Cross of Michigan and existing offerings from Lumeris, Evolent and Alignment, among others.  We expect to see much more activity in Medicare Advantage in the next three years, and it is welcome as we move toward almost doubling of the eligible senior population as the Baby Boomers continue to age in.

Physician Compensation: As part of the continuing move toward risk, shared savings and population health management, we are seeing reevaluation and adjustment of physician compensation models.  This is a topic by itself for further exploration, but many hospital systems with employed physician bases are now considering how best to align and incentivize physicians.  It is not an easy question (especially when connected to the question of operating faculty practice plans at academic medical centers or physician networks of independent community physicians), but it is critical to the success of the other initiatives under way.  Presence Health in Chicago noted their desire to double their medical group in the next three years while engaging fully their associates.  Geisinger has launched a new physician compensation model that pegs a base of 50th percentile compensation for all of their employed physicians, which then can vary upward based upon productivity and patient satisfaction.  This effort in part was intended to address physician turnover issues. An interesting side note – Geisinger now is putting on their website their physician rankings and patient reviews, including the negative reviews.  Effectively, this puts the patient into a "secret shopper" role and hopefully results in a better patient experience.  Will this increase or decrease physician turnover, satisfaction and productivity?  It will be interesting to watch.

Branding:  A consistent theme with hospital systems was the importance of branding and brand investment. We heard over and over again the millions of dollars being invested into brand.  This obviously goes hand in hand with expansion, attempts to ultimately lower the cost of patient acquisition and increasing competition.  It's a lot of dollars being spent – we would like to see whether there will be quantification of the results obtained. That said, healthcare is one of the most underbranded industries.  In almost any other industry, you can easily name 2-5 leading brands that are national and respected. That hasn't happened yet at a national scale in healthcare, but we certainly are seeing the stage being set for that.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Events from this Firm
15 Oct 2019, Seminar, Los Angeles, United States

Please join us for Sheppard Mullin's Labor & Employment Law Update & Happy Hour Seminar Series.

16 Oct 2019, Webinar, Los Angeles, United States

This activity has been approved for Minimum 1 Continuing Legal Education credit by the State Bar of California.

16 Oct 2019, Conference, New York, United States

Black women often are misidentified as holding a position other than the attorney role, whether it be the secretary, paralegal, court reporter or even stenographer.

Similar Articles
Relevancy Powered by MondaqAI
In association with
Related Topics
Similar Articles
Relevancy Powered by MondaqAI
Related Articles
Related Video
Up-coming Events Search
Font Size:
Mondaq on Twitter
Mondaq Free Registration
Gain access to Mondaq global archive of over 375,000 articles covering 200 countries with a personalised News Alert and automatic login on this device.
Mondaq News Alert (some suggested topics and region)
Select Topics
Registration (please scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.


The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.


Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions