Our Mission: Creating Health Care Systems for the 21st Century
For nearly 30 years, Leslie Margolin has worked to improve the quality, safety, efficiency, accessibility and affordability of health care. In 2010, Leslie joined forces with Joanna Horsfall to build The Margolin Group, a company devoted to the development and implementation of a strategy to transform how health care and coverage are provided to deliver durable cost savings that lower prices for consumers while delivering, better health, safer, higher quality care, and more fair, value-based and predictable rewards for hospitals, doctors and payers.
The Margolin Group® is unique in its proven ability to bring together, in successful and sustainable partnership, hospitals, physicians, payers, group purchasers, government officials, consumers, and other key stakeholders to be the architects of a new and improved, truly integrated system of care and coverage that addresses system-wide issues that historically have stood in the way of improving the U.S. health care system. Together, they are working to realize their ambitions to arrest escalating costs, unpredictable access to medical care and inconsistent quality and safety.
The Margolin Group specializes in bringing payer, provider and community partners together to develop and implement ‘virtually integrated systems of care and coverage’ that allow each partner to reach beyond the boundary of its individual organizational silo, to work together across the continuum of care and coverage, to design break-through answers to cost, quality, safety, service, consumer experience, access and efficiency issues — in other words, to provide ‘real value for money’ in health care.
The virtually integrated systems that The Margolin Group helps its partners create are called ‘Care Innovation Corridors’® and are designed to deliver all that is excellent about integrated systems like Kaiser, Mayo or Geisinger, but without the burdens and constraints of a closed organization.
The Margolin Group works side by side with its provider and payer partners to eliminate one of the most vexing challenges in U.S. health care today: misaligned incentives that create barriers to working together in the interest of the consumer — barriers that result in duplication that adds cost without adding value. As important, the way members of The Margolin Group work with our clients builds and strengthens new skills of collaborative management and installs supportive infrastructure essential to long-term successful management of integrated systems of care and coverage.
The strategy of virtual integration offers our payer and provider clients six major benefits:
- Allows partnerships to deliver a coordinated, simplified, end-to-end consumer experience without unnecessary duplication of clinical or administrative efforts;
- Systematically and holistically addresses community health challenges, improving community health by delivering consumers safe, high quality care at prices that reflect better value for money than is available in the current system;
- Builds upon – rather than replaces – what is effective in our current health system but eliminates costs associated with non-productive work and/or fragmented, avoidable, unhelpful care;
- Creates a stable, rewarding environment for care providers where better patient care, innovation and quality are rewarded;
- Delivers to all partners new capabilities of collaborative management and supporting infrastructure that are essential to efficient management and continuous improvement in the 21st century; and
- Shares savings created by system-wide improvements with consumers in the form of significant and direct rate relief and with physicians, clinical workers, hospitals and other facilities in the form of incentives for continuous cost, quality and safety innovations and system improvements.
Estimates of unnecessary and avoidable costs, built into our current, fragmented, fee for service health care system, range between 20% and 40%. By focusing on achieving system-wide sharing of best practices and eliminating unnecessary and redundant work, The Margolin Group projects billions of dollars can be released annually across the nation for the benefit of consumers and group purchasers without penalizing hospitals, physicians, or payers working hard to take care of patients today and make sure that safe, high quality, affordable care will be available when it is needed in the future.
Through its Care Innovation Corridors, The Margolin Group offers a private sector solution to a nation-wide health care crisis. It represents neither a government take-over nor a shift away from competitive, private sector leadership that characterizes the American health care system and may well be responsible for the best that U.S. health care has to offer. Indeed, the strategy of virtual integration strengthens competition in the health care market. The shift is in who competes with whom, on what dimensions and how.
OUR UNIQUE APPROACH: ALIGNED INTERESTS
Fundamental to the success of these partnerships is our unique combination of delivering:
- A collaborative approach to problem identification and solution that engages all partners in finding common ground essential to durable, productive partnerships; and
- A fair and equitable approach to sharing the gains generated by cost, quality and service experience improvements.
We support our partners in creating virtually integrated systems of care and coverage tailored to the needs of their communities by connecting hospitals, physicians, and payers in Care Innovation Corridors that allow each to maintain its independence but to work in concert to drive system-wide improvements in cost, quality, safety and efficiency for the benefit of group purchasers and individual consumers. Instead of a hospital competing with a physician group or a payer for its share of the health care dollar, the hospitals, physicians and payer(s) work together to compete with other ‘systems’ to provide value in exchange for the consumer dollar. The only “losers” are those who choose not to play.
We are working to build Care Innovation Corridor partnerships, with their associated best practices, across the nation and to vary the model based on local market conditions and needs. What will not vary will be: 1) the focus on the patient to align interests; 2) the expectation that competition and full transparency will drive essential cost, quality and coverage improvements everywhere; and 3) the commitment to share gains in such a way that all partners, including purchasers and consumers, benefit thereby enabling the reinvestment of funds in a system of continuous improvement.
HOW IT WORKS
We help hospitals and their affiliated medical professionals work together in interest-based collaboration with payers, group purchasers and consumers to create new market place offerings that promote health, identify and eliminate unnecessary and avoidable costs and improve the overall experience of care. Unnecessary and avoidable costs come in two major categories: 1) costs associated with redundant and/or defensive processes conducted by each stakeholder; and 2) costs associated with preventable, unnecessary and/or unhelpful care. New opportunities to improve the overall experience of care come when payers and providers work together to generate, evaluate and implement ideas that create new value for the market that can be monetized.
By agreement, partners plow a share of savings (and revenues related to growth in their market share due to their enhanced value offering) back into the market in the form of pricing relief for the benefit of their customers. The remainder is shared among the partners to fund additional process improvements, cost savings, innovation and growth.
These benefits will be achieved by working together as a ‘system’ where each partner focuses on what it does well – where resources are focused and leveraged based upon the capacity, competency and credibility of the parties — and where unnecessary, redundant work that each partner does to defend itself from the other is minimized or eliminated. The ‘how’ involves use of shared services (e.g., administration and billing, care management, customer service or bed management) and aligned incentives that, for the first time, reward all partners in the system for routing out costs that are masked by the current silo-based system.
Each corridor begins with a core group of hospital, physician, payer, group-purchaser and consumer stakeholders and can expand to encompass extended care capabilities such as Skilled Nursing Facilities (SNFs), Home Health and Hospice partners, and so on across the full continuum of in and outpatient care.
WHY IT WILL WORK
The partners commit to this strategy because they recognize that the current cost trend is unsustainable and that durable cost savings will come only when all parties are focused on, and profit from, achieving the same goals. The elegance of this strategy is that it addresses the cost, quality, safety, community health and access aspirations many think could be found in a government solution, yet it does so through the competitive, innovative vibrancy of the private sector.
The Margolin Group strategy anticipated the ACO model and builds upon it to include payers, group purchasers, community partners and consumers in the overall model of accountability. We evaluate and integrate lessons learned from ACOs and other collaborative organizations.
The time is now. The cost-quality-safety challenge addressed by The Margolin Group is large and it is urgent. Everyone involved in the health care system, from the government, through health plans to virtually all prospective consumer and care delivery partners, is searching for a solution. Our interest-based approach to virtual integration is compelling, comprehensive, durable, strategic and sustainable.