Moneyball For Doctors and Nurses (and the People Who Run Hospitals)

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Michael Lewis’ 2003 best seller Moneyball recounts how Oakland Athletics’ manager Billy Beane beat the big-payroll odds in major league baseball by using analytics to field a competitive team. The dynamic between Beane and his Yale-trained geek, Peter Brand is the central theme: together they fought off naysayers using Brand’s sabermetrics model later credited with the Red Sox World Series win the next season.

This week, thousands of financial officers from across multiple sectors in healthcare will descend on Orlando for the Healthcare Financial Management Association Annual Institute (ANI), a four day potpourri of knowledge-sharing sessions punctuated by keynotes from industry luminaries and an active exhibit floor.

The growing complexity of healthcare financial administrative issues is daunting. Case in Point: ANI organizes its 80 sessions in 8 tracks titled Business Intelligence and Analytics, Clinical Integration, Collaboration for Decision-Making, Cost Management-Margin Transformation, Finance-Capital Markets, Payment Trends and Delivery Models, Regulatory and Compliance Updates, and Revenue Cycle and the Patient Experience. There’s something there for everyone—from the rookie in internal audit to the CFO in the C-Suite.

Let’s be honest: healthcare is a big business. It’s made fortunes for inventors who hold patents to medicines, apps and technologies and for investors who bet on for-profit hospitals, big IT platforms and others. In March, 2010, when the Affordable Care Act passed, some predicted the end of the system as we know it. Five years later, it’s a better bet than ever. Why? It’s simple. The healthcare pie continues to increase even while other pies shrink.

Since passage, spending in the U.S. on healthcare has continued its steady climb reaching $3 trillion last year. The National Health Expenditures data show an amazing consistency in where money is spent as the pie gets bigger: comparing 2014 to 2010, the share of spending for hospitals, physician services, drugs and post-acute care are virtually unchanged. Healthcare spending seems pre-destined to grow even when the rest of the economy isn’t: employment in healthcare increased a million while the rest of the economy lost 5 million jobs in the 2007-2010 downturn. While the U.S. GDP struggled to reach 1-1.5% growth in that period, healthcare annual spending increased at a 4% annual clip. And as the recovery continues, so is the expectation that healthcare spending will eclipse our annual GDP growth by at least 2% every year for as long as government bean counters can predict. It seems a safe bet with newly insured and older folks using the system more, investors and lenders are willing to fund new and improved ballparks. It’s like betting on the free agents in the major leagues to pick off the league’s star mercenaries for the pennant chase.

Is Moneyball analogous for healthcare? I think yes. The healthcare industry is akin to free agentry in baseball: the have’s and have not’s in the major league are clearly defined more by their bank accounts than batting averages. Moody’s, Fitch and S&P are high on the investor-owned hospital management companies but tepid about the not-for-profits. Investors are betting on the better financed drug companies to spot and acquire promising therapies that can command $10,000 per dose, and the biggest health plans are leveraging years of premium growth and strong cash reserves to diversify and expand. Unlike baseball, which operates in a limited regulatory climate, healthcare operates in a heavily regulated market and everyone’s a user whether they purchase tickets or not. But the similarities between winners and losers seem aligned. And the two are analogous in another respect: sticker shock. Ticket prices and health costs are increasing faster than household incomes.

What’s this mean? It means access to capital will be a key distinction between pennant chasers and bottom dwellers in our league. It means investors and lenders will bet on organizations who prove their value statistically and dispel myths in their organizations about the relevance of any other metrics of success. It means organizations that can attract employers, government payers and consumers to buy tickets by delivering the most value will win at the gate and on the field. It means addressing sticker shock head-on with transparency and no excuses.

In baseball and healthcare, the spotlight is bright. In both, the separation between winners and losers is a continuing saga. And in both, Moneyball is being played. With due respect, mission, values, ownership and branding are moot if the Moneyball calculus isn’t right.

Paul Keckley is  Managing Director of Navigant’s Center for Healthcare Research and Policy Analysis. He is a regular THCB contributor.

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2 replies »

  1. I keep thinking that we are going to have a convulsion in the system–by the science–that will reset its evolution. I would guess this would be in cancer or aging research and it will be something so attractive that all socioeconomic classes will demand it. And it will undoubtedly be expensive but will lead to scintillating health improvements, so that old health I ==> new health II. E.g. DNA damage-repair processes are desperately needed in preventing malignancies. Autism also.
    These are genome disasters. Base excision repair is one way to fix the DNA. Nucleotide excision repair is another major way. But there are some direct chemical ways to reverse DNA damage. E.g. methyl groups from alkylation changes from 1-methyladenine can be stripped off by iron-dependent enzymes. And RNA polymerase can be used to direct repair processes. Many more such ideas are on the horizon.

    We need a flip to bring back some excitement.

  2. I like the interesting analogy you draw to sports performance analytics/asset valuation (as depicted in Moneyball) and health care performance, Paul. The emphasis on capitalization hits a home run in health care, as evidenced by how closely it is correlated to market share and profitability. What we are lacking is a true box score here, the analytics dashboard which can tell us not only who is winning, but where the opportunities to improve resource efficiency and quality lie, e.g., their OBP and WAR. And where is the WHIP for health care executives, which tells us how well they are keeping their organization competitive in their local markets?