Cliff's Confab - a Raucous Caucus ™
the crucible for new ideas in healthcare

Cliff regularly - typically on an annual basis - brings together the best minds in the business for a one day summit where they tackle the most pressing healthcare issues of the day. In this section, you'll find announcements of upcoming Confabs, as well as summaries of some of the more recent ones. Contact Cliff to have him assemble one of his special expert-level Confab teams to work on issues that concern you and your company.

Interim Cliff's Confab: 7 August 2025 (Zoom session)

The need for an interim Confab became clear upon the announcement of major changes coming to virtually all aspects of healthcare via the "Big, Beautiful, Bill" enacted by Congress this year. Thus a confab was convened virtually through a Zoom session, the agenda for which is below:

1 pm - Welcome and timing of major provisions - Cliff Frank

115 pm - Impact of BBB on ACA marketplaces and employer-based coverage

Christine Oliver, NFP insurance, Burlington, VT

150 pm - Impact of BBB on hospitals

John Mordach, health system CFO, Chicago, IL

240 pm - Impact of BBB on Medicaid patients and FQHC's

Joel Hornberger, strategic advisor to Cherokee Health, Knoxville TN

320 pm - Impact of BBB on Medicare, payviders, and the Physician Enterprise

David Kibbe, Chairman of Cone Health's MA plan, Greensboro, NC

355 pm - Wrap-up - Cliff Frank

Video of the event is below.

Christine Oliver: Impact of BBB on ACA marketplaces and employer-based coverage

John Mordach: Impact of BBB on hospitals

Joel Hornberger: Impact of BBB on Medicaid patients and FQHC's

David Kibbe: Impact of BBB on Medicare, payviders, and the Physician Enterprise

Cliff's Confab: 13 March 2025 Tampa, FL

This confab with 50 people was a grim look at health care's difficult future, even before some of the BBB cuts. Peter Fishman showed us how we are missing tax revenue and how under-funded major health programs are in the face of growing needs. Michael Miller showed us that the commercial revenue cow was breathing hard and had no room to feed more to providers. Geoff Tressley showed us how the MA world was getting rough, and that the V28 risk model conversion was having a dramatic impact on MA profitability. A raucous discussion in the afternoon highlighted how there are no good painless solutions. Every major move to provide a fix to the system involved serious pain to somebody - hospitals, insurers, patients, pharma, or the tax base. A systemic collapse starting in rural America is likely, and the resulting new system will likely have multiple layers depending on the level of resources parties can bring to health care. The sad answer to the health care conundrum is that there are no good answers; only pain.

Cliff's Confab: 7 March 2024 Tampa, FL

Private equity has become a big player in health care. This confab examined PE's effects and prospects for the future. Michael Brown brought us up to speed on how PE works, both constructively, and less so. He described the process of acquisition, acceleration of growth, and exit, usually around 7 years after acquisition. Then Mitchell Daitz gave us a tour of the inside of a PE deal, and how those arrangements function over the term of the holding period. He described the changes PE usually brings to an acquired entity, and the focus such ownership brings to bear in the process. Geoff Tressley gave us a look at PE trends and vulnerabilities as interest rates rise, exits slow, and PE struggles to continually add value to their investors.

The confab looked askance at some of the egregious actions of PE-led firms such as Steward and the associated harms to providers, patients, and communities. Trying to balance the innovations and rewards that PE brings to some companies with the substantial harm and subversion of other entities was an exercise that led us to a dead end. Balance was or is in the eye of the shareholder.

Cliff's Confab: 29 June 2023, Tampa, FL

The 2023 Cliff's Confab – a Raucous Caucus ™ was held a bit early this year in order to cover the timely topic of the quickly developing AI phenomenon and its impact on healthcare. Despite the vexxing aspects of travel this time – among them, a combination of smoke from Canadian wild fires, ever-changing FAA landing slots, and other airline difficulties causing significant Confabber absences - a set of about 25 of the finest minds in healthcare today came together with us in Tampa to learn from our panel of experts and share their thoughts on, and experiences with, AI.

Speakers included Fred Goldstein doing an AI 101-type presentation for the newbies, showing us how AI can prepare documents, lists, and conduct various types and levels of analysis. Cautionary note and major takeaway from his talk: human oversight is still required as some 'hallucinations and flights of fancy' can still occur when using AI, potentially delivering unexpected results.

Ted Willich and Matt Berseth (CEO and CTO of NLP Logistics) walked us through some of their complex product lines that actually result in customers writing them checks as opposed to donations. It was great to talk with a real company doing real business in AI-focused product domains that add value and simplify complex tasks for their customers. Ted made very clear that they ALWAYS have human oversight of their models so that goofy outputs and outcomes are rerouted and redirected to avoid glaring mistakes.

Cliff and Mike Monsegur (Pearl Health) showing off the new Cliff's Confab – a Raucous Caucus ™ t-shirt

Dr. Amy Price in person, and Prashant Natarajan from H2O.AI via conference call, presented and described the various dimensions, now and emerging, of AI and some of its vulnerabilities. Dr. Price in particular shared with us a fascinating example of the benefits of AI on a personal level. Growth is curvilinear and adoption is fast. Not necessarily easy. AI extends the reach of the human mind and can find links and correlations we cannot fathom. This power can yield major breakthroughs in drug development, clinical care processes, and multivariate problems that require complex approaches. Very exciting stuff.

Our lawyer friend, Paul Risner carefully laid out some serious business and legal concerns around intellectual property rights, privacy, and malpractice as they relate to AI and our uses of it. The concerns are serious, and will take years to develop case law to support a particular set of limits or guidelines in each of these areas. Having a good cyber insurance policy to cover some of these risks might prove to be a good investment.

Throughout the day the discussion was rapid, vibrant, stimulating, thought-provoking, and passionate - a Raucous Caucus ™ as always.

T-shirts for all with the appropriate tag line – Cliff’s Confab - a Raucous Caucus ™ were distributed at day's end. Sorry, but you had to be there to get one.

Cliff's Confab: 6 Oct 2022

Confab participants met in Tampa to walk through three unrelated healthcare topics:

1) new developments in predictive modeling,

2) ER diversion through tele-emergency medicine, and

3) implications of PCP roll-up models for hospitals, Plans, and private equity.

Predictive modeling is reaching further back in claims and clinical data, to reach forward with greater precision. The key unresolved issue is once we know patients are clearly at risk for certain diseases or complications, what do we do about it? That path forward still remains murky. Are we simply the dog that caught the car, or is there clinical intervention that could change the course of the disease?

ER utilization and the downstream costs associated with it and related admissions, consults, and follow-ups can be curbed and modified if we get patients to call a hotline with ER physicians rather than 911. Experience has shown a 30% reduction in ER visits with higher patient satisfaction and much lower costs. But changing physician and patient inclinations is difficult and takes both time and ongoing attention. For fragile or complex patients, such investments could have a significant ROI. For others, maybe not so much.

PCPs tucked inside big pharmacy, retail, or insurance chains have a long way to go to establish profitability and scale. The major Medicare Advantage bonus plans for shared savings are scattered and do not necessarily line up with the geographies of these retail operations. Elderly patients are loathe to give up their existing physician and making PCPs more effective inside big lumbering organizations is no easy trick. Hospitals are vulnerable to having their PCPs picked off and recruited away. Why would hospitals allow their physicians to prescribe drugs at pharmacies that are trying to steal their physicians? That strategic vulnerability is typical of fractured hospital thinking.

Cliff's Confab - The Virtual Sessions - 2021

As was the case in 2020, Cliff's Confab was held virtually again this year, conducted over two sessions in mid-November. Each session included presentations by several expert-level attendees (brief bios below), and covered various topics and scenarios of concern to healthcare industry professionals that may well play out in the coming months. These presentations each elicited the active participation of about 40 attendees. Below you will find video coverage of both events, broken out into 5 videos, as well as a brief description of each, for ease of viewing the topics that most interest you. Feel free to contact us via this website if you or your company would like further information on these video sessions, or if you have other healthcare management consulting needs. We're here to help.

"Reference Based Pricing"

Presentation by:

Michael Miller, Director of Managed Care

Atlantic Health System

Morristown NJ

What if reference based pricing takes off? Michael Miller explains how reference-based pricing works, how Atlantic Health handles such cases today, and what the implications are for employers and patients if this product design expands - painful for everybody.

"Direct to Employer Contracting 2021"

Presentation by:

Michael A. Guarino, Founder of a large Long Island NY-based IPA, and President,

Practice Management of America, Inc.

Commack, NY

What if Direct Contracting with employers catches fire? Michael Guarino explains that his IPA in Long Island is already engaged in direct contracting and he believes it is going to expand. Employers don't love their insurance company, and if they are willing to look at a path around the insurer, his IPA is ready to step up. Fast-paced presentation and good dialogue on execution issues.

"Medicare to Age 60"

Presentation by:

Larry Giusti, Sr. VP

Gallagher Insurance, Risk Management & Consulting

Jacksonville, FL

What if we go to Medicare Age 60? It's complicated - more than we think. Larry Giusti walks us through the ins and outs. Split enrollment in employer groups that have some older workers? Which Medicare products would count? The impact on employer premiums could be very favorable, and at the same time, tough on hospitals and physicians.

"Capital Backed Primary Care"

Presented by:

I. David Kibbe, Sr. VP Network Development and Contracting

Cone Health

Greensboro, NC

What if corporate Primary Care kills hospital employed Primary Care? David Kibbe explores multiple Primary Care models, and identifies the structural and organizational weaknesses of the hospital-employed PCP model today and in the future, as Medicare Advantage PCP focused care management companies step in to grow their PCP battalions. Creating savings in Medicare Advantage means either goosing risk scores, or crushing hospital utilization - or both. Can hospitals compete in that environment?

"Private Equity Backed Primary Care"

Presentation by:

Geoff Tressley, Director

GTCR, LLC.

Chicago, IL

What if private equity backed specialty groups overwhelm PCP driven models? Geoff Tressley explains that private equity is all about the valuation multiple. Today, value-based models are valued on a multiple of revenue, not EBITA. Hard for churn and burn specialty models to keep up. It's a strange, strange world out there. Can anyone spell 'dot com'?

Cliff's Confab: The Debates 9-11 Dec 2020

In the covid-19 era - like everything else, Cliff's Confab went virtual. A new concept for the Confabs was born as well - healthcare topics covered debate-style between industry experts. The first three sessions covered six debate topics, two each session, over the 3 day period of Dec. 9-11, 2020. While these are private, invitation-only events, we're excited to share videos of these debates with you here.

Note that the videos are individually downloadable, so feel free to download those that are of interest (see below).

For further information on Cliff's Confab or the Debates or any of these videos, you can reach us here.

Video Directory - note that the videos immediately follow the directory.

Debate event 1 - Wednesday, Dec 9, 2020:

Confab 1, Debate 1:

Resolved - That employers will demand a "best of breed" network configuration from BUCAs or they will find a payer that puts together such a network.

Debaters - Michael Brouthers, Founder/Principal, Ikigai Growth Partners; Fred Goldstein, President and Founder, Accountable Health, LLC

Confab 1, Debate 2:

Resolved - That entrenched forces (PBM's, hospitals, insurers, regulators) will squash any significant innovation that threatens any class of these entities.

Debaters - Tom Nasby, Senior Director Network Management, Aetna; Chuck Reiter, III, Esq., Partner, Reiter Burns, LLP

Debate event 2 - Thursday, Dec 10, 2020:

Confab 2, Debate 1:

Resolved - That healthcare is NOT a normal economic good, and programs/policies that encourage healthcare's treatment as such are misguided and should cease.

Debaters - John Harris, Director, Veralon; David Kibbe, Senior Vice President, Network Development and Contracting, Cone Health

Confab 2, Debate 2:

Resolved - That provider burnout is getting worse, and physicians will become key recruits to new technical and product development jobs, thereby exacerbating the PCP shortage.

Debaters - Sanjay Seth, MD, Executive Vice President, HealthEC; Wayne Jenkins, MD, Chief Medical Officer, Centivo

Debate event 3 - Friday, Dec 11, 2020:

Confab 3, Debate 1:

Resolved - That increased payer hassles of providers will lay the groundwork for Provider risk-transfer arrangements to avoid denials, appeals, and legal friction costs for providers.

Debaters - Mike Guarino, President, Practice Management of America; Brent Estes, Senior Vice President, Business Development, Advocate Aurora Health

Confab 3, Debate 2:

Resolved - That primary care supremacy in managed care is unwarranted, unsuccessful and unnecessary to manage cost/quality/outcomes.

Debaters - Mike Shumer, Chief Executive Officer, Medical Life Holdings; Shawn Bassett, Executive Director, Collaborative Health Systems