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Sunday, February 05, 2012
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Lyceum Newsletter Perspectives
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Open Letter to the American CEO: Five Need-to-Know Facts About Health Care
10/29/2009
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| Health care may be complex, but knowing its basic workings puts the corporate leader at an immediate advantage. |
Dear CEO of Any Company:
Want in on a little secret? Here's what health care's brightest business people think about reform: whatever lawmakers accomplish this fall, it won't alter how the system works or move the needle on costs.
Now—more than ever—you need to understand health care's fundamental underpinnings. As the corporate leader, you aren't just managing health care costs. Even if your business is in a non-health care industry, you are likely seeing new revenue opportunities emerge in health care as it expands across the economy.
Whether cost control or revenue growth, knowing how the system works is a crucial first step towards margin expansion.
Consider these five must-know facts.
1. Supply and demand do not transact with each other. At a recent Lyceum roundtable on health care reform, one entrepreneur noted: "Are we going to change a system where consumers don't pay and payers don't consume? I don't think so, unless Washington suddenly starts advocating market-based solutions."
It's ironic, and perhaps telling, that a section of the economy as large as health care doesn't perform as a normal industry. At ground level, physicians provide services, but payment is received not from customers but from commercial health plans and government. Because supply does not actually transact with demand—unlike any other industry—there can be no market-determined price or consistent measure of quality and value.
What's more, physician service reimbursement occurs under a volume-based framework, called fee-for-service, where doctors submit claims based on specific inputs, not total care.
Medicare, for example, applies a complex reimbursement formula called the resource-based relative value scale ("RBRVS") to non-hospital rendered physician services—about 25 percent of total health care expenses. A 29-member committee, determines exactly how much Medicare will pay for these individualized services. Critically, it also serves, de facto, as the basis for commercial health plan reimbursement. This single committee, therefore, controls nearly $600 billion dollars in industry pricing.
Transparency is non-existent. And the medical value chain is left with cost control as its only profit lever.
2. Market forces also don't shape the drug supply chain. While in-patient and out-patient services exist outside standard economic practices, the other 20 percent of health care—the drug supply chain—does not follow the same framework, except for products that providers directly administer, such as infused and injected biologics. Commercial health plans and pharmacy benefit managers, instead, apply formularies to steer beneficiaries to more effective medication usage.
At least that's the intent. In reality, drug benefit managers also operate in their own opaque system, just not one controlled by a single committee. To optimize business margins, they negotiate directly with drugmakers on behalf of employers, their clients. Volume-driven rebates, pharmacy network spreads and mail service margins all affect formulary placement. Large margins, in particular, characterize generic drugs.
Drug manufacturers, meanwhile, have targeted physicians, directly and indirectly through consumer-directed advertising for branded products. Doctors, however, don't pay for the products. And those eagerly-courted erectile-dysfunctional consumers, happily forking out $30 co-pays, have no conception of actual prices.
Still, Caterpillar's recent effort with Walmart (and now Walgreens) attempts to alter this system by introducing a new competitive force: the retail channel. And unlike the medical side, the entire drug supply chain is publicly-traded, exposing it to shareholder demands and expectations.
The net effect of all this is that prescriptions are prescribed, purchased and paid for outside of anything resembling a normal supply/demand market framework.
3. Information is the most important commodity. In a system as complex as health care, knowing what someone else doesn't know can make all the difference in the world.
Here, there's an important parallel with the financial service industry. Broker-dealers, Wall Street's middlemen, have traditionally operated at the confluence of market data streams. Whether it's corporate news flow or clients orders, no other entity processes as much information. While so-called Chinese walls presumably deter misuse of this information, neither corporations nor institutions possess even a fraction of this information wedge.
In the late 1990s, things changed, as broadband Internet democratized information access. Suddenly, new tools allowed counterparties to know as much—or more than—the broker-dealer. At the same time, electronic share trading networks emerged, allowing institutions to transact directly with each other.
As a result, margins in traditional advisory services shrank, and broker-dealers began turning to high-margin proprietary trading and investment services.
Health records are still 90% paper-based. On the medical side, information is so fragmented that no one entity has a distinct advantage over another. Claims processing, for example, often takes weeks or months to adjudicate, as provider and payer bicker over codes, procedures and contract pricing.
On the pharmacy side, the pharmacy benefit manager functions similarly to the broker-dealer. No other entity controls as much information about manufacturers, payers, providers and consumers.
Just as the Internet revolution recast the financial services landscape, it could likewise upend the traditional flow of information in health care. For medical benefits, it could create new power centers as information is digitized. For the pharmacy side, it threatens to disintermediate existing channels.
4. New revenue opportunities exist across industries. So what if health care is 17 percent or 30 percent of GDP? If it's efficient, then it's creating jobs and contributing to economic growth.
Many different opportunities exist for non-health care companies to take advantage of the industry's growth. Take the affordability problem, for example. Why shouldn't bankers explore new lending channels to help consumers reduce the monthly premium burden? And what about information technology? Washington has already passed legislation that will provide incentives for electronic health record adoption. Like Sarbanes-Oxley, myriad rules will apply, a complex intertwining which creates opportunities for sophisticated software and service vendors.
Health care is first and foremost a service industry. Because supply is finite, economic rules apply as in any other industry. The problem with health care is an inability to define value on a consistent basis. If a company is smart in how it navigates the industry's nuances, then plenty of revenue opportunities will exist.
Retail-centered strategies such as convenient care clinics are challenging traditional delivery of care. Emergent, cash-based business models in the primary care profession are challenging traditional reimbursement practices.
As much as regulatory constraints may burden the system, there's no shortage of innovative strategies. It's just a question of matching resolve with the appropriate resources.
5. The CEO needs to be in control. The health care dollar begins with the employer. It just doesn't necessarily end there. Health benefits is a cost center, and typically reports up through the human resource department to the CFO. In most cases, CEOs never engage in this business unit other than to monitor trend growth. And while the direct cost exposure could be 5% or more of the cost base, the indirect opportunity cost in employee efficiency is much greater.
The problem, though, is that concepts such as presenteeism and workforce productivity are difficult to quantity, and particularly difficult to justify committing big dollars to when shareholders are assessing quarterly performance.
But how much are changes in market conditions now affecting expectations placed on CEOs? We may be emerging from recession, but few people expect economic growth to sustain an accelerated pace. With trend growth lower than in the previous economic cycle—corresponding to reduced revenue expectations—CEOs have little choice but to re-examine cost structures to preserve margins.
Just as health care may present new revenue opportunities, it also creates opportunities for chief executives to drive internal efficiency, simply because only a handful of companies have taken advantage of this, and so much low-hanging fruit exists.
The CEO needs to drive this process. Whether Caterpillar, General Mills, Pitney Bowes, Safeway or Whole Foods, examples exist of CEOs forcing efficiency. But these are just a handful of companies against the thousands out there that could be doing likewise.
Health care may be complex, but knowing its basic workings puts the corporate leader at an immediate advantage. Whether cost control or revenue growth, this is no time for herd mentality.
Be proactive. How smartly you manage health care's various risks and opportunities will determine your company's success.
© Lyceum Associates, Inc. All rights reserved.
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These and other organizations have recently participated in Lyceum roundtables and events.
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Drug Pricing Methodologies
Average Wholesale Price (“AWP”): The most commonly used price index in pharmaceutical transactions, AWP operates as a suggested list price. Buyers, typically, negotiate lower prices through the inclusion of discounts, rebates or free goods. Medicare uses it to calculate the cost of drug products administered in a physician’s office. PBMs, insurance carriers, and other managed care organizations use AWP to calculate payments to retail pharmacies for providing drug products to patients. Pharmacies often use AWP as a cost basis for pricing prescriptions.
Average Sales Price (“ASP”): The Medicare Modernization Act of 2003 established ASP as a drug payment system. The methodology uses quarterly drug pricing data, which drug manufacturers submit to the CMS. In calculating the ASP, the manufacturer must deduct various discounts, including prompt payment discounts. Like AWP, it serves as a baseline to determine Medicare reimbursement rates.
Average Acquisition Cost (“AAC”): The retailer’s cost to buy drugs from wholesalers: the final cost of the drug to the pharmacy after all discounts are subtracted.
Average Manufacturer’s Price (“AMP”): The average price retail pharmacies or wholesalers pay manufacturers. It is based on sales to the retail sector, which generally pays higher prices than other purchasing sectors. The federal government currently uses AMP to calculate rebates in the Medicaid outpatient prescription drug rebate program.
Wholesale Acquisition Cost (“WAC”): A manufacturer’s list price established for sales to wholesalers, and a basis for calculating rebates.
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MANUFACTURER TO PHARMACY (VIA WHOLESALER)
1. MANUFACTURER
↓ Wholesale Acquisition Cost (WAC) or ↓ Average Manufacturer's Price (AMP)
2. WHOLESALER
↓ Actual Acquisition Price (AAP)
3. PHARMACY
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MANUFACTURER TO PHARMACY
1. MANUFACTURER
↓ Average Manufacturer's Price (AMP)
2. PHARMACY
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PAYER TO PHARMACY
1. PAYER
↓ Reimbursement: Average Wholesale Price + Discount
2. PHARMACY
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PHARMACY TO PATIENT
1. PHARMACY
↓ Retail or Usual & Customary Price (U & C)
2. PATIENT/END-USER
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Drug Coding Procedures
Vendors use both the Health Care Common Procedure Coding System (“HCPCS”), devised by CMS, and Current Procedural Terminology (“CPT”), an AMA creation, to bill for drugs/products that are utilized in the physician’s office, clinic or home setting. These include drugs that are injected subcutaneously, intramuscularly, or intravenously, and drugs administered via nebulizers or other DME equipment.
The National Drug Code (“NDC”) serves as a universal product identifier for drugs and biologics. Although similar to NDC, J Codes contain less information, such as the name of the drug manufacturer. J Codes are administered under the HCPCS.
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The newsletter Perspectives features commentary and opinion on economic transition and business innovation across health care, financial systems and consumer business. Many contributions come from our participants, and reflect front-line experience.
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Maureen Bailey "Silent Epidemic" (volume 5, issue 2), "Nudging Temptation Aside: Behavioral Economics and Diabetes" (volume 5, issue 5)
Ms. Bailey is the author of the forthcoming book "The Diabetic Diva", a cookbook for diabetics with a foreword by Ron Rosedale, MD. Dr. Rosedale developed a nutritional protocol that has helped thousands of people reverse type 2 diabetes. Her work has also appeared in Barron's and The Economist. Read more about Maureen.
Tom Cronin "A Better Model for Disease Management" (volume 5, issue 11)
Mr. Cronin is CEO of Neighborhood Diabetes, where he and his partners on the Management Team have grown the company tenfold in the last five years. Prior to involvement in the acquisition of Neighborhood, Tom took a sabbatical from business and was a math teacher at an urban high school and high school varsity soccer coach. Prior to teaching, Tom was CEO and owner of CranBarry, Inc., an established manufacturer and distributor of women's sporting goods. Earlier, Tom was a consultant at Bain & Company, the international strategy consulting firm headquartered in Boston. Read more about Tom.
Bruce Cutter, MD "A New Oncology Business Model" (volume 5, issue 1)
Dr. Cutter is a practicing medical oncologist/hematologist at Cancer Care Northwest, a large integrated oncology group in Spokane, WA. As president and CEO from 2000 to 2007, Bruce lead the development of a comprehensive quality initiative called Foundations of Quality ("FOQ"). FOQ was developed six years ago, in close collaboration with Premera Blue Cross. This program, which includes a pay-for-performance contractual relationship, was founded on the quality principles promulgated by the Institute of Medicine, is physician-driven and collaborative, and based on a commitment by the practice to measurable quality and accountability. Read more about Bruce.
Steve Hyde "Personal Choice and Breast Cancer Screening" (volume 5, issue 12)
Mr. Hyde is the author two books: most recently, “Cured! An Insider's Handbook for Health Care Reform” (June 2009, Hobnob Publishing; read review) and, previously, “Prescription Drugs for Half Price or Less,” (2006, Bantam-Dell Division of Random House). He has been a public company CEO and chairman or board member of numerous companies. The former federal chief HMO financial regulator and a certified actuary, he started and grew Peak Health Care, Inc., into a highly successful public managed care company, recognized by Business Week Magazine as one of America’s Best Small Companies. He has extensive experience in managed care operations and strategy, health insurance, managed care regulation, consumer-driven health care, pharmacy benefits, disease management, medical information technology, medical group management, medical network and PPO operations, health benefit design & pricing, health insurance underwriting, community rating, and health service product development and marketing. Steve is CEO of Hyde Rx Services Corp., a health care management consultancy. Read more about Steve.
Wolfgang Klietmann, MD "Understanding H1N1 as a Pandemic Threat and Public Health Service Challenge" (volume 5, issue 11)
Dr. Klietmann is a clinical pathologist and medical microbiologist and serves at Harvard Medical School faculty as an appointed Lecturer on Pathology. Prior to his immigration to the United States in 1992, Klietmann founded and was president and physician-in-chief of a major Institute of Laboratory Medicine in Germany which he built into a peerless institution in its scientific standing and innovative diagnostic reputation among private laboratories in Germany. A prolific author and guest lecturer with over 200 publications and presentations delivered to audiences across the globe, the cornerstone of Klietmann’s career has centered on infectious diseases and bringing together individuals and organizations to share information, technology and resources. His work in biodefense includes a collaboration with MIT in a project for the Department of Defense. He serves as president on the board of directors of the Harvard Business School Health Industry Alumni Association and organized as co-chairman several major conferences held on the campus of Harvard Business School. His memberships in several scientific societies include a fellow of the College of American Pathologists. Read more about Wolfgang.
Tom McNulty, Pharm.D "New Strategies for Specialty Pharmacy" (volume 5, issue 12)
Dr. McNulty is co-founder and chief clinical officer of NovoLogix, Inc, a performance-based health care technology company delivering electronic claims re-pricing processes, prior authorization controls, and integrated patient care and pharmaceutical programs. His expertise includes medication adherence and compliance. Tom is a frequent speaker at industry events and conferences. Read more about Tom.
Kavita Nair, PhD "Value-Based Benefit Design: Getting It Right" (volume 5, issue 4)
Dr. Nair is an associate professor in the department of clinical pharmacy at the University of Colorado (Denver) School of Pharmacy. Her current area of research involves pharmacy benefit design in managed care and retail pharmacy including the structure, pricing and reimbursement of medications, factors affecting the reimbursement of medication in retail pharmacy, willingness to pay for retail pharmacists services and consumer attitudes regarding their pharmacy benefit plans and the impact of multi-tiered reimbursement mechanisms on medication utilization. She is currrently working with Anthem Blue Cross Blue Shield of Colorado to examine the impact of two and three tier co-pay pharmacy benefit plans on the drug utilization patterns of a commercially insured population and a Medicare managed care population. She is also working with various Pharmacy Benefit Managers to examine the impact of converting prescription Claritin to an over-the-counter status on medication utilization and reimbursement mechanisms. Read more about Kavita.
Susan Pantely "Benefit Design Strategies and Oral Anticancer Medications" (volume 6, issue 1)
Ms. Pantely is a principal and consulting actuary with Milliman. She works with a broad range of clients, including Blue Cross/Blue Shield plans, HMOs, commercial insurers, government agencies and healthcare providers. Her work includes rate development, provider contract review, reserve certification, capitation development, Medicare risk feasibility studies, HMO start-ups, HMO due diligence, and development of risk sharing and reimbursement arrangements for physician groups, PHOs, and other integrated delivery systems. In addition, Susan has extensive experience with the valuation, financial analysis, and projection of healthcare services for several state public health insurance (Medicaid) programs. Read more about Susan.
David Rose "Smart Packaging, Better Health Care" (volume 6, issue 1)
Mr. Rose is CEO of Vitality, inc. a company focused on connected-health devices and services. He teaches at the MIT Media Lab and speaks frequently on design and product innovation at conferences and corporate retreats. Previously, he was founder and CEO of Ambient Devices where he pioneered embedding Internet information in everyday objects like umbrellas, light bulbs, bathroom mirrors, and refrigerator doors, to make the physical environment an interface to digital information. Read more about David.
Robert Rowley, MD "Cloudburst: The New Frontier for Electronic Health Records" (volume 5, issue 11)
Dr. Rowley is a family practice physician and Practice Fusion’s Chief Medical Officer. Dr. Rowley has a first-hand perspective on the technology needs and challenges faced by healthcare practitioners from his 30 year career in the sector, including experience as a Medical Director with Hill Physicians Medical Group and as a developer of the early EMR system Medical ChartWizard. His family practice in Hayward , CA has functioned without paper charts since 2002. Read more about Robert.
David Willcutts "Are Expectations Too High for Health IT Vendors?" (volume 6, issue 2)
Mr. Willcutts is a long time health care services executive and entrepreneur focused on managed care, specialty pharmacy and home care services. He is currently the president and founder of Ready Consultant, LLC an early stage marketplace for healthcare consulting services created in response to the unprecedented level of health care initiatives underway in the US covering areas such as EHR, HIPAA, ICD10, and more. He previously founded Ancillary Care Management (now Novologix) in 1995 growing it to over $450 million in annual revenue before leaving in 2007. Read more about David.
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Selected Health Care Legislation
1965: Social Security Amendments authorized Medicare and Medicaid programs. The act created separate payment systems for in patient hospital care (Part A), and outpatient care, including home care and physician services (Part B). Read more here.
1983: Orphan Drug Act gave tax breaks, subsidies, and special exclusivity privileges to sponsors of drugs for rare diseases, defined as having fewer than two hundred thousand cases in the United States. The act implemented market exclusivity by granting protection for seven years against competition from any drug with a similar effect. Read more here.
1984: Hatch-Waxman “Generic Drug” Act required the FDA to accept bioequivalence as sufficient for approval and established the procedure for a generic drug approval called the Abbreviated New Drug Application (“ANDA”). The act extended patents for time lost during FDA review and for one-half the time lost during FDA-required clinical testing. The act capped the extension at a maximum of five years, and the total patent term at 14 years from the data of the FDA approval. Read more here.
1986: The Health Care Quality Improvement Act protected peer review bodies from private money damage liability, and prevented incompetent practitioners from moving state to state without disclosure or discovery of previous damaging or incompetent performance. Read more here.
1989: Omnibus Budget Reconciliation Act authorized resource-based, relative value scale reimbursement of physicians under Part B of Medicare. Read more here.
1990: Budget Reconciliation Act established Medi-Gap insurance regulation that limited exclusions for pre-existing conditions, requirements for uniformity in policies, civil penalties for duplicative services, mandatory rebates if policies failed to return specified percentages of each premium dollar, and rules for "simplification" and standardization of policies. The act also introduced a series of Medicare reforms that aimed to save $40 billion over five years. Read more here.
1992: Prescription Drug User Fee Act established for a five-year period a mandatory fee to be submitted by a pharmaceutical company along with its application to finance the hiring of new employees and reduce average processing time. Read more here.
1996: Health Insurance Portability and Accountability Act (“HIPAA”) allowed for the protection of health insurance coverage for workers and their families when changing jobs, and established national standards for electronic health care transactions and national identifiers for providers, insurance plans, and employers to promote electronic data interchange. The act also authorized tax-deductible medical savings accounts. Read more here.
1997: Balanced Budget Act added Part C to Medicare, which expanded options for enrollment in managed care plans. Read more here.
1997: FDA Modernization Act reauthorized user fees for another five years, and introduced new inducements to conduct pediatric studies that included granting a sponsor an additional six months of exclusive marketing privileges beyond any patent or other nonpatent rights for which the drug may already be eligible. Read more here.
2003: Medicare Modernization Act provided a new outpatient prescription drug benefit under Medicare beginning in 2006 (Part D). In the interim, it created a temporary prescription drug discount card and transitional assistance program. It also included a provision for establishing health savings accounts. Read more here.
2005: Patient Safety and Quality Improvement Act established a system of patient safety organizations and a national patient safety database, to encourage reporting and broad discussion of adverse events, near misses and dangerous conditions. The Agency for Healthcare Research and Quality oversees many of its provisions. Read more here.
2009: The American Recovery and Reinvestment Act included the Health Information Technology for Economic and Clinical Health ("HITECH") Act, which provisions $19.2 billion in incentive money for the implemention and use of electronic health records. It also legislatively mandated the Office of the National Coordinator for Health Information Technology ("HIT"), and the creation of the HIT policy and standards committees. Read more here.
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 Perspectives features commentary and opinion on economic transition and business innovation. Articles often reflect front-line experience.
We award badges to the five contributors ranking highest in total number of views.
Whether you've published one article or several, we're counting the sum of all reader 'clicks'.
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Our one-page summaries describe in general terms roundtable proceedings. Because each Lyceum event is exclusive to its participants, we do not publish complete details.
- February 3, 2011 "Payers, Providers and Corporate Strategy", New York
- February 24, 2011 "Health Reform, Public Policy and Corporate Strategy", Washington
- March 29, 2011 "Health Care & Risk Management: Design, Implementation and Market Impact", Boston
- April 5, 2011 "Pharmacy Benefit Design, Biosimilars, and Supply Chain Issues", New York
- April 18, 2011 "Provider Business Models: New Opportunities, New Risks", San Francisco
- May 4, 2011 "Risk Management, Public Policy and Industry Realignment", Washington
- May 31, 2011 "Provider Business Models", New York
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Lyceum's highly regarded roundtables connect diverse stakeholders on topics of industry transition and business innovation. Our members share a common goal of making the best possible business decisions.
Lyceum Associates is pleased to offer unaffiliated individuals the opportunity to join corporate participants as members in our exclusive service.
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6. Rights Reserved. All present and future rights in and to trade secrets, patents, copyrights, trademarks, service marks, know-how and other proprietary rights of any type under the laws of any governmental authority, domestic or foreign, including rights in and to all applications and registrations relating to the Service (the "Intellectual Property Rights") shall, as between you and Lyceum, at all times be and remain the sole and exclusive property of Lyceum. All present and future rights in and title to the Service (including the right to exploit the Service and any portions of the Service over any present or future technology) are reserved to Lyceum for its exclusive use. Except as specifically permitted by the TERMS, you may not copy or make any use of the Service or any portion thereof. Except as specifically permitted herein, you shall not use the trademarks, trade names, service marks, trade dress, logos or titles of Lyceum or the Service, or the names of any individual participant in, or contributor to, the Service, or any variations or derivatives thereof, for any purpose, without Lyceum's prior written approval.
7. Third-Party Sites. The Lyceum Web Site may contain references or hyperlinks to third party web sites. Such hyperlinks are provided for Your reference purposes only. Lyceum and the Publishers, as the case may be, (a) do not control such other web sites, and make no guarantee as to the accuracy, currency, content or quality of any such sites and information, including noninfringement of such web sites or the content contained in such web sites; (b) assume no responsibility as to whether such third party web sites contain unintended or objectionable content; and (c) make no endorsement of such web sites or their content.
8. User Contents. You acknowledge that Users are solely responsible for the contents of any messages they post on bulletin boards, chat rooms or other communications devices as may be provided by the Lyceum Web Site or the Services from time to time, as well as for the consequences of any such messages. You agree not to use the Lyceum Web Site or the Services for chain letters, junk mail, "spamming" or commercial solicitations, and not to send any message or material that is unlawful or gives rise to civil liability. All such communications through the Services are public and not private communications, and each of the Publishers reserves the right to remove such communications for any reason or no reason.
9. Restrictions on Use. You agree not to use this Service for any unlawful purpose. We reserve the right to terminate or restrict Your access if, in our opinion, your use of the service may violate any laws, regulations or rulings, infringe upon another person’s rights or violate the terms of this agreement.
10. Subscription, Service and Use Fees. You agree to pay all subscription, service and use fees, if any, that you are charged by Lyceum for the Publication and Services and the Information to which you have subscribed and agree that such fees may be changed without notice. PAYMENT RECEIVED IS NON-REFUNDABLE.
11. Further Subscription, Service and Use Fees. If this Agreement relates to a subscription purchased on behalf of a corporate subscriber under which You are an authorized user, that corporate subscriber agrees that it and each authorized user under such corporate subscription are bound by the terms and conditions of this Agreement and that the terms “You” and “User” include such corporate subscriber and each such authorized user. By accessing the Publications and Services, You represent and warrant that the person who ordered such subscription had sufficient authority to order the Publications and/or Services and to bind such corporate subscriber to the terms of this Agreement.
12. Cancellation. A subscription to the Publication renews automatically every month, unless Lyceum terminates it or You notify us of your decision to terminate your subscription by telephone or e-mail (receipt of which must be confirmed by e-mail reply from Lyceum).
13. Termination. Lyceum may discontinue or change this Service, or its availability to You, at any time.
14. Survival of Terms. The provisions of Paragraphs 3 ("Disclaimer and Limitation of Liability"), 3 ("Further Disclaimer and Limitation of Liability"), 4 ("Indemnification"), 5 (“Intellectual Property”), 6 ("Rights Reserved"), 7 (“Third-Party Sites”), 8 ("User Content"), 9 ("Restrictions on Use"), 10 ("Subscription, Service, Use Fees"), 11 ("Further Subscription, Service and Use Fees"), 13 ("Termination"), 15 (“Governing Law”) and will survive the termination of this Agreement.
15. Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Connecticut.
16. Miscellaneous. You accept that Lyceum has the right to change the content or technical specifications of any aspect of the Service at any time at Lyceum's sole discretion. You further accept that such changes may result in your being unable to access the Service.
17. Amendments to Agreement. From time to time, Lyceum Associates, Inc. may modify these terms and conditions. Accordingly, please continue to review these terms and conditions of service whenever accessing or using this site. Your use of the site after the posting of modifications to these terms and conditions of service will constitute YOUR ACCEPTANCE OF THE TERMS AND CONDITIONS OF SERVICE, as modified. If, at any time, you do not wish to accept the terms and conditions of service, you may not use this Site.
18. Contact Information. Any notice or other communication required or permitted to be given hereunder shall be in writing and shall be given to Lyceum Associates, Inc. at 69 Orchard Place, Greenwich, CT 06830, Attention: President.
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This Lyceum User Agreement (the "Agreement") between you (“You” or "User") and Lyceum Associates, Inc. ("Lyceum") states the terms and conditions governing Your use of the Publications (the “Publications”) and Services (the “Services”) to which You are subscribing from Lyceum. By subscribing to the Publications and/or Services, You agree to the terms of this Agreement. If You do not agree to be bound by the terms of this Agreement, do not subscribe to the Publications and/or Services. YOU SHOULD PRINT OUT A COPY OF THIS AGREEMENT FOR YOUR RECORDS. (Download PDF version here.)
1. Limited Rights. During the term of this Agreement You are granted limited, non-exclusive access to the Publications and Services solely for your personal use. Access under Your Lyceum UserID and password is limited to You and may not be shared with any other individuals or persons. You agree not to use your Lyceum UserID or password for the purpose of providing other users with access to content from the Publications or Services. You agree to use the Publications and Services and any enhancements to the Publications and Services that Lyceum may make in the future only in accordance with this Agreement as it may be amended by Lyceum from time to time. Subscriptions are not transferable.
2. Disclaimer and Limitation of Liability. You understand and expressly agree that use of the Publication and Service is at your sole risk, that any Information downloaded or otherwise obtained through the use of the publications and services is at your own discretion and risk and that you will be solely responsible for any damage to your computer system or loss of data that results from the download of such material and/or data. In no event shall either of the Publisher, any Affiliate, or any of the respective Officers, Directors, Employees, Shareholders, Members, Agents, Representatives, Service Providers or Suppliers be liable to You or anyone else for any consequential, incidental, punitive, special or indirect damages (including without limitation lost profits, trading losses and other commercial damages) that result from the use of the Publication or Services or from any inconvenience, delay or loss of the use of the Publications or Service, even if the Publisher has been advised of the possibility of such damages or losses. The sole and entire maximum liability of the Publisher, its Affiliates, and respective Officers, Directors, Employees, Shareholders, Members, Agents, Representatives, Service Providers and Suppliers, for any reason, and Your sole and exclusive remedy for any cause whatsoever, shall be limited in the aggregate to the prorated amount remaining of the subscription fee paid by You for the Publication and Service for the then-current term of this agreement.
3. Further Disclaimer and Limitation of Liability. You acknowledge that the Information contained in the Publication is not intended as investment, business, tax or legal advice, and neither Lyceum Associates nor the Publishers, as the case may be, shall be responsible for any investment, business, tax or legal recommendations or opinions of third parties cited by the publications or services or in information contained therein.
4. Indemnification. You agree to defend, indemnify and hold harmless each of the Publishers, their respective affiliates, and their respective employees, officers, directors, shareholders, members, agents, representatives, service providers and suppliers, from and against any and all claims, losses, liabilities, costs and expenses (including without limitation reasonable attorneys' fees, costs and expenses) arising from Your violation of this Agreement, state or federal securities laws or regulations, or any third party's rights, including without limitation infringement of any copyright, violation of any proprietary right or invasion of any privacy rights, except to the extent that such liability results from any infringement of copyright, violation of any proprietary right or invasion of any privacy right by the Publishers.
5. Intellectual Property. You agree that the text, graphics, images, video, designs, organizations, compilation, look and feel, and all other protectable intellectual property available through Lyceum's Services is the property of Lyceum, and is protected by copyright and other intellectual property laws. Unless You have our written consent, You may not sell, publish, distribute, retransmit or otherwise provide access to the contact received through this service to anyone, including, if applicable, your fellow students or employees.
6. Rights Reserved. All present and future rights in and to trade secrets, patents, copyrights, trademarks, service marks, know-how and other proprietary rights of any type under the laws of any governmental authority, domestic or foreign, including rights in and to all applications and registrations relating to the Service (the "Intellectual Property Rights") shall, as between you and Lyceum, at all times be and remain the sole and exclusive property of Lyceum. All present and future rights in and title to the Service (including the right to exploit the Service and any portions of the Service over any present or future technology) are reserved to Lyceum for its exclusive use. Except as specifically permitted by the TERMS, you may not copy or make any use of the Service or any portion thereof. Except as specifically permitted herein, you shall not use the trademarks, trade names, service marks, trade dress, logos or titles of Lyceum or the Service, or the names of any individual participant in, or contributor to, the Service, or any variations or derivatives thereof, for any purpose, without Lyceum's prior written approval.
7. Third-Party Sites. The Lyceum Web Site may contain references or hyperlinks to third party web sites. Such hyperlinks are provided for Your reference purposes only. Lyceum and the Publishers, as the case may be, (a) do not control such other web sites, and make no guarantee as to the accuracy, currency, content or quality of any such sites and information, including noninfringement of such web sites or the content contained in such web sites; (b) assume no responsibility as to whether such third party web sites contain unintended or objectionable content; and (c) make no endorsement of such web sites or their content.
8. User Contents. You acknowledge that Users are solely responsible for the contents of any messages they post on bulletin boards, chat rooms or other communications devices as may be provided by the Lyceum Web Site or the Services from time to time, as well as for the consequences of any such messages. You agree not to use the Lyceum Web Site or the Services for chain letters, junk mail, "spamming" or commercial solicitations, and not to send any message or material that is unlawful or gives rise to civil liability. All such communications through the Services are public and not private communications, and each of the Publishers reserves the right to remove such communications for any reason or no reason.
9. Restrictions on Use. You agree not to use this Service for any unlawful purpose. We reserve the right to terminate or restrict Your access if, in our opinion, your use of the service may violate any laws, regulations or rulings, infringe upon another person’s rights or violate the terms of this agreement.
10. Subscription, Service and Use Fees. You agree to pay all subscription, service and use fees, if any, that you are charged by Lyceum for the Publication and Services and the Information to which you have subscribed and agree that such fees may be changed without notice. PAYMENT RECEIVED IS NON-REFUNDABLE.
11. Further Subscription, Service and Use Fees. If this Agreement relates to a subscription purchased on behalf of a corporate subscriber under which You are an authorized user, that corporate subscriber agrees that it and each authorized user under such corporate subscription are bound by the terms and conditions of this Agreement and that the terms “You” and “User” include such corporate subscriber and each such authorized user. By accessing the Publications and Services, You represent and warrant that the person who ordered such subscription had sufficient authority to order the Publications and/or Services and to bind such corporate subscriber to the terms of this Agreement.
12. Cancellation. A subscription to the Publication renews automatically every month, unless Lyceum terminates it or You notify us of your decision to terminate your subscription by telephone or e-mail (receipt of which must be confirmed by e-mail reply from Lyceum).
13. Termination. Lyceum may discontinue or change this Service, or its availability to You, at any time.
14. Survival of Terms. The provisions of Paragraphs 3 ("Disclaimer and Limitation of Liability"), 3 ("Further Disclaimer and Limitation of Liability"), 4 ("Indemnification"), 5 (“Intellectual Property”), 6 ("Rights Reserved"), 7 (“Third-Party Sites”), 8 ("User Content"), 9 ("Restrictions on Use"), 10 ("Subscription, Service, Use Fees"), 11 ("Further Subscription, Service and Use Fees"), 13 ("Termination"), 15 (“Governing Law”) and will survive the termination of this Agreement.
15. Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Connecticut.
16. Miscellaneous. You accept that Lyceum has the right to change the content or technical specifications of any aspect of the Service at any time at Lyceum's sole discretion. You further accept that such changes may result in your being unable to access the Service.
17. Amendments to Agreement. From time to time, Lyceum Associates, Inc. may modify these terms and conditions. Accordingly, please continue to review these terms and conditions of service whenever accessing or using this site. Your use of the site after the posting of modifications to these terms and conditions of service will constitute YOUR ACCEPTANCE OF THE TERMS AND CONDITIONS OF SERVICE, as modified. If, at any time, you do not wish to accept the terms and conditions of service, you may not use this Site.
18. Contact Information. Any notice or other communication required or permitted to be given hereunder shall be in writing and shall be given to Lyceum Associates, Inc. at 69 Orchard Place, Greenwich, CT 06830, Attention: President.
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Disciplined Approach
Step 1 - Planning
We create in partnership with the client an effective roundtable series design that matches content to strategic objectives and emphasizes insight and urgency.
Step 2 - Execution
We advance the roundtable agenda, recruit high-value participants, and rapidly achieve goals.
Step 3 - Reporting
We present key takeaways and essential information in summary reports, and promote follow-up communication among participants.
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Disciplined Approach
Step 1 - Planning
We create in partnership with the client an effective roundtable series design that matches content to strategic objectives and emphasizes insight and urgency.
Step 2 - Execution
We advance the roundtable agenda, recruit high-value participants, and rapidly achieve goals.
Step 3 - Reporting
We present key takeaways and essential information in summary reports, and promote follow-up communication among participants.
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Essential Discussions
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Business Innovation
- Payer/Provider Business Models
- Benefit Design/Employer Strategies
- Information Technology
- Risk Management
Industry Transition
- Health Policy & Reform
- FDA
- Consumer Engagement
Case Studies
- ACOs/Integrated Care Delivery
- Insurance Exchanges
- Biosimilars (Follow On Biologics)
- Drug Distribution/ Alternative Pharmacy Networks
- Oncology Business Practices
- Physician Leadership
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Essential Discussions
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Business Innovation
- Payer/Provider Business Models
- Benefit Design/Employer Strategies
- Information Technology
- Risk Management
Industry Transition
- Health Policy & Reform
- FDA
- Consumer Engagement
Case Studies
- ACOs/Integrated Care Delivery
- Insurance Exchanges
- Biosimilars (Follow On Biologics)
- Drug Distribution/ Alternative Pharmacy Networks
- Oncology Business Practices
- Physician Leadership
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High Return Events
“Market Knowledge”
A large pharmaceutical company weighs investment in different medication adherence programs, but questions how provider consolidation may or may not affect that investment. The Lyceum team designs a series of roundtables addressing adherence issues concerning the company’s specific medication(s). The roundtable series encompasses payers, different vendors, relevant patient groups, and a cross-section of providers. At the series’ conclusion, the Lyceum team delivers its assessment of the landscape and proposes a best course of action.
“Corporate Action"
At the behest of its bankers and its own internal strategists, a health plan considers extending its corporate portfolio into the ownership of physician practices. Although financial models appear sensible, company management worries about hard-to-quantify cultural issues and marketplace uncertainty, from the response of patients to the emergence of alternative provider business models. Based on an interactive roundtable series including diverse provider organizations, employers and other market participants, the Lyceum team submits an independent analysis, allowing management to decide more confidently.
“New Product Development”
Anticipating increased demand for risk management tools addressing global payments, a health information services company plans to develop various proprietary solutions, but discovers that demand may not adequately materialize because of client uncertainty about how the marketplace is evolving. The Lyceum team coordinates a series of roundtables featuring the company, prospective users of its tools, and relevant market participants to provide immediate feedback on the marketplace and inspire greater confidence in the company’s offerings.
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High Return Events
“Market Knowledge”
A large pharmaceutical company weighs investment in different medication adherence programs, but questions how provider consolidation may or may not affect that investment. The Lyceum team designs a series of roundtables addressing adherence issues concerning the company’s specific medication(s). The roundtable series encompasses payers, different vendors, relevant patient groups, and a cross-section of providers. At the series’ conclusion, the Lyceum team delivers its assessment of the landscape and proposes a best course of action.
“Corporate Action"
At the behest of its bankers and its own internal strategists, a health plan considers extending its corporate portfolio into the ownership of physician practices. Although financial models appear sensible, company management worries about hard-to-quantify cultural issues and marketplace uncertainty, from the response of patients to the emergence of alternative provider business models. Based on an interactive roundtable series including diverse provider organizations, employers and other market participants, the Lyceum team submits an independent analysis, allowing management to decide more confidently.
“New Product Development”
Anticipating increased demand for risk management tools addressing global payments, a health information services company plans to develop various proprietary solutions, but discovers that demand may not adequately materialize because of client uncertainty about how the marketplace is evolving. The Lyceum team coordinates a series of roundtables featuring the company, prospective users of its tools, and relevant market participants to provide immediate feedback on the marketplace and inspire greater confidence in the company’s offerings.
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Lyceum members occupy one seat at any event. Lyceum sponsors occupy multiple seats at one or more roundtable series. Members and sponsors qualify as GatherSmart® Executive participants. We expect other participants to pay a participation fee, and to become members or sponsors for continued involvement.
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Lyceum collaborates extensively with its participants on topic and event development.
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Lyceum pursues direct person-to-person contact, optimizing business development.
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Search hundreds of Lyceum roundtable and event participants. GatherSmart® Executive participants enjoy full access.
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The Lyceum Newsletter Perspectives dates back to June 2005, and encompasses more than three dozen discussion topics and over one thousand published pages.
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My GatherSmart is your starting point for dynamic group interaction. Connect to users across our community, search participants at past and future events, and more.
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ChatterSmart is a short-format news forum. Adding your thoughts is as easy as 1-2-3.
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View profile information on users across our entire community. GatherSmart® Executive participants enjoy full access.
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Read Sydney's Weblog Talking Transitions for related commentary and opinion.
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Lyceum Associates welcomes a variety of organizations as members in our service. Members represent diverse stakeholders, including for-profit and non-profit corporations, government agencies, academic institutions, consultancies, and financial service institutions.
User fees support our unique equal-participation, invitation-only format. These fees apply to individual business entities and cover multiple participants.
For enhanced client outreach and business development, we encourage series sponsorships.
Unaffiliated individuals may join Lyceum as contributors, and participate in roundtables and events.
View a checklist of our services.
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Gainful business development and investment require an ability to price future economic shifts within and across industries. Read "Talking Transitions" and learn more.
View the "Talking Transitions" Blog here.
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ACCESS TO THE LYCEUM NEWSLETTER "PERSPECTIVES" AND THE "PERSPECTIVES" ARCHIVES IS LIMITED ONLY TO AUTHORIZED SUBSCRIBERS WHO HAVE READ AND AGREED TO THE LYCEUM USER AGREEMENT, WHICH SOLELY GOVERNS THE CONDITIONS FOR USE OF ANY OF THESE SERVICES AND THE INFORMATION CONTAINED THEREIN. All contents Copyright © 2005-2012 Lyceum Associates, Inc. ALL RIGHTS RESERVED. These Services and the Content contained therein are protected under U.S. and foreign copyright and intellectual property laws, and may not be photocopied, reproduced or retransmitted in any form without the written consent of Lyceum Associates, which may be requested from info@lyceumassociates.com. The content and opinions expressed in "Perspectives" may change and do not constitute investment advice. Lyceum Associates is not responsible for the accuracy of information provided on third-party Web sites. GatherSmart@ is a registered trademark of Lyceum Associates, Inc.
ACCESS TO THE LYCEUM NEWSLETTER "PERSPECTIVES" AND THE "PERSPECTIVES" ARCHIVES IS LIMITED ONLY TO AUTHORIZED SUBSCRIBERS WHO HAVE READ AND AGREED TO THE LYCEUM USER AGREEMENT, WHICH SOLELY GOVERNS THE CONDITIONS FOR USE OF ANY OF THESE SERVICES AND THE INFORMATION CONTAINED THEREIN. All contents Copyright © 2005-2012 Lyceum Associates, Inc. ALL RIGHTS RESERVED. These Services and the Content contained therein are protected under U.S. and foreign copyright and intellectual property laws, and may not be photocopied, reproduced or retransmitted in any form without the written consent of Lyceum Associates, which may be requested from info@lyceumassociates.com. The content and opinions expressed in "Perspectives" may change and do not constitute investment advice. Lyceum Associates is not responsible for the accuracy of information provided on third-party Web sites. GatherSmart@ is a registered trademark of Lyceum Associates, Inc.
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