Healthcare Bowl Season: A Look at the Major Match-ups

Through January 6, 70 teams will participate in the college football bowl season ranging from the lesser known like the Gildan, Royal Purple, Famous Idaho, R&L Carriers and Beef O Grady bowls to the four majors, the Rose, Sugar, Orange and Cotton Bowls. To the teams, it’s a chance to reward a six-plus win season and an assist in their athlete recruitment efforts. To the host Chambers of Commerce and corporate sponsors, it’s a branding strategy to build awareness for their city or their enterprise. To all these, it’s about money!

Likewise in health care: we’re in bowl season and it’s about prestige and money, and positioning for the future. There’s no shortage of match-ups but these are the majors:

The Money Bowl pitting hospitals against private health insurers. It’s the granddaddy of them all. Hospitals own 31% of the revenues in health care, but declining reimbursement from Medicare and Medicaid, steeper discounts with private insurers, intensified competition, and sicker patients have taken their toll. They enjoy a wide fan base but face a stiff test against private plans that have all the weapons-- plenty of money, lots of data, enrollment growth via managed Medicaid, Part C Medicare and health exchanges, and an offense centered around cost management and population health that’s peaking at the right time. The game will be won or lost based on which is best able to align with physicians and deliver value to consumers and employers. And it’s about money: which of the two gets to keep more of what it currently controls.

The M-Deity Bowl pitting physicians against physicians, and then everyone else. The primary care team fields a feisty team of obstetricians, pediatricians, family physicians and general internists with a chip on their shoulders: despite growing demand for medical services, their incomes have not kept pace with specialists. They have a big chip on their shoulder. Theirs is a holy war for respect and money. On the other sideline, specialists are huddled in their guilds—the surgeons and procedurists in tight huddles keeping others away, medical specialists reviewing their playbook, and the special teams players—radiology, pathology, emergency medicine, anesthesiology, and bio-informaticians-- at the end of the bench waiting smugly for their plays that often make the difference in a win or loss.  Nurse practitioners, psychologists, nutritionists, dentists, and health coaches are spectators.  It’s doctor against doctor competing for each guild’s professional autonomy, financial security, and protection of their status as a fan favorite. The M Deity Bowl storyline pits the country’s powerful specialty societies against the underdogs in primary care hoping for an upset.

The Control Bowl pits the states vs. HHS. This match-up showcases governors seeking control of health reforms against HHS with its new offensive scheme, the Patient Protection and Affordable Care Act. HHS is betting on strong play from its linemen: the bulky offensive line controls dispensing of Medicare and Medicaid dollars, and its D line uses a labyrinth of federal rules and programs to complicate opponent’s offensive schemes. States will counter with an innovative playbook—a combination of runs and passes focused on new innovative solutions in Medicaid, workers compensation, state employee health benefits, certificates of need and professional licensing. This bowl features the wide-open offense in the states versus a stubborn HHS defense. But recent injuries due to the faulty rollout of the ACA give the control edge to the states.

The Value Bowl pits large employers against the U.S. health system’s status quo. 95% of large employers provide insurance coverage and want lower health costs and less regulation.  They pay mark-ups for employers that don’t provide coverage, and absorb underpayments by Medicaid and Medicare in their insurance premiums, hospital and doctor bills. Their game plan is simple: focus on value, and build a fan base through their employees. They want to build a dynasty-- a perennial national heavyweight in discussions about how to fix the national health system’s value gaps. They’ll poke holes in the status quo-- administrative waste, medical error, fraud, unnecessary tests and surgery, lack of price transparency, and duplicative services. And they have momentum going into the contest as the CBO forecasts an unsustainable 6% increase in health costs next year that they’ll be expected to absorb. The Value Bowl is about employers’ pursuit of improved accountability from providers, private insurers, drug and device manufacturers and policymakers, and improvements in the value contribution by each.

As the bowl season in healthcare unfolds, all eyes will be on these four key match-ups. There’s much at stake-- the 2014 recruiting season for Healthcare.gov and state exchanges, Election Day 2014 results wherein health reform is the swing issue, the inverse relationship between economic recovery and health cost control, and heightened public awareness of the Affordable Care Act.

The teams are now moving from planning to game day prep: opposition research is finished and playbooks printed. Now the spotlight shifts to execution—how each executes their plan. The health care bowl season is sure draw attention: all the heavy weights are playing in the majors this year.