Peter Kongstevdt's Topics:

   With more than 30 years experience as a physician, health care executive and global consultant, and now as Clinical Professor, Peter has developed a strong sense of the issues and trends that are most important against the backdrop of the ever changing and unpredictable nature of the health care industry. Peter has a number of topics in which he is conversant, and works directly with clients to identify the elements most appropriate and useful for particular audiences. However, he is not limited to these topics, and can accommodate a variety of needs to deliver speeches and presentations that best address a client's goals and objectives:

• All topics related to health insurance and managed health care
• Health Reform
• Health policy in context of health reform
• Health care and health insurance costs
• Top issues and trends in the payer industry
• Future trends in the payer industry
• Healthcare quality
• How the different sectors in health care interact, and what's useful and important to understand

1) Key Trends and Top Issues Facing the Health Insurance Industry
   In an industry as complex as health insurance and managed health care, what are the key trends and issues that must be addressed? These key trends and issues may vary depending on the audience. For example, key trends for those working in government or health policy will vary when compared to key trends for individuals leading and managing health insurance organizations.

2) Rising Health Care Costs - Let's Find Out Who's Responsible and String Him Up!
   Shall we play a game? How about hangman! We can string up whoever's responsible for health care cost inflation in the U. S., which outpaces all other costs, and continues to rise faster than general inflation. It is easy and popular to blame one or two sectors, or to take a position that simply by controlling one aspect of the system, costs will be brought under control. Reality is far more complex and difficult to address and a better understanding of the various factors involved can lead to better and more informed decision making.

3) The Financial Crisis and its Effect on Health Insurers and Managed Care Organizations
   In the short term, health insurers and managed care organizations are relatively well positioned to weather the storm of the current economic crisis, having generally conservative investments and positive cash flow. But the longer term, and longer may be as short as a few years, the potential effect is far more worrisome. The economic crisis affects all participants in the health sector, and those effects all ripple back to payers. Increasing cost shifting by hospitals facing cash crunches and lowered margins, Medicaid reductions by states already facing reduced tax revenues and potential pension fund pressures, small employers dropping health benefits, rising unemployment - all lead to rapidly mounting pressures on payers and rapidly increasing numbers of uninsured in a volatile political climate. Is there a bright spot in all this? There could be…

4) A New Hope for Integrated Delivery Systems
   Integrated delivery systems came into being during the 1990s as a response to the rise of managed care, and HMOs in particular. Some integrated delivery systems functioned primarily as a negotiating vehicle and added limited value, while others became truly integrated and worked to lower costs and improve outcomes. Their too-rapid growth, combined with a desire to accept financial risk for medical costs led to many failures or substantial reductions in scope and ambition, though many others did indeed thrive. With the new pressures facing the entire health sector, including payment reforms, promotion of medical homes and accountable care organizations, and the possibility of health reform at a national level, the time coming for a resurgence in well run, electronically interconnected, truly integrated systems that are able to provide coordinated care and improved financial and clinical outcomes.

5) Why Health Insurance is Different
   The current debate over "health reform" focuses almost solely on reforming health insurance and access to coverage. But is health insurance similar to other forms of insurance? Should health insurance be treated as insurance at all? The reality is that health insurance is indeed insurance, but of a far different nature than other forms of insurance. Understanding important differences, including those that make us uncomfortable or that do not support a particular policy orientation, is necessary for any useful debate.

6) Consumerism in Health Care
   Organizations operating in the health care sector all view consumers differently, whether health insurers, hospital executives, physicians, nurses and other clinical professionals, regulators, pharmaceutical companies, or any of the other many organizations operating in this sector. Consumer dynamics continue to change, but not always predictably so. How consumers can be segmented and understood in the health sector has some fundamental differences compared to the usual ways of segmenting and categorizing consumers.

7) Evolving Pressures on Hospitals and Health Care Systems
   In the 1980s and 90s, the combination of federal payment reforms and the advent of managed care served to create new pressures on hospitals and health systems. They learned to adapt, and also merged to form larger and stronger regional entities, which resulted in greater stability in their financial performances. Newly evolving factors such as the recession, physician unrest and access problems have resulted in a new set of pressures that threaten that financial stability. How might this manifest itself throughout the rest of the sector and in society as a whole? How might this lead to a resurgence in some older ideas for success?

8) Health Care Chaos - Complexly Adapting Systems Theory and Health Care Leadership and Planning
   The health care sector in the U. S. is highly dynamic making it next to impossible to make linear predictions. Complexly Adapting Systems Theory, often called Chaos Theory, addresses how change in difficult to predict systems such as the weather or ecosystems may be considered. Leaders in health care can use this approach as they consider their organization's future.

9) Quality of Health Care - Differing and Equally Valuable Viewpoints
   Quality of health care is a vital topic, but one that is often viewed and discussed using complex and well-defined approaches. Individuals with differing responsibilities are likely to view quality different. Gaining a better understanding of how the various sectors in health care view quality can enhance an organization's effectiveness at both addressing quality and its market position.

10) Business Process Models and Operational Metrics
   Business process models can be a time-consuming exercise of limited real value, or they can provide a significant boost to operational efficiency and quality. They can only do so if they are sufficiently granular and are associated with performance metrics that encompass entire processes.

About Peter Kongstevdt: 
   Dr. Kongstvedt is a highly regarded independent national authority on the health care industry with particular expertise in health insurance and managed health care. He is a Clinical Professor in the Department of Health Administration and Policy, School of Health and Human Sciences at George Mason University, where he teaches a graduate course on the topic of Health Insurance and Managed Health Care. Dr. Kongstvedt also is principal of the P.R. Kongstvedt Company, LLC, a firm advising health care executives on strategy, operations and effective decision making to achieve greater success. He is also developing electronic multimedia training and education programs for several health sectors, in partnership with Metrix Group.

   Peter is the editor and primary author of three seminal works on managed care:  The Managed Health Care Handbook, which he first wrote in 1985, while the fourth and final edition of this landmark textbook was published in 2000; The Essentials of Managed Health Care, Fifth Edition (published 2007); and Managed Care: What It Is and How it Works, Third Edition (published 2008).  These books are widely considered "the bibles" on managed care and are extensively used in over 230 colleges and universities nationwide, in corporate training and educational programs and as a general reference group with the healthcare industry. He also co-authored Best Practices in Medical Management with David Plocher, M.D. in 1998.

   Peter began his career by practicing general internal medicine in rural southern Illinois at a rural health initiative clinic. After practicing for three years, he moved to Lincoln, Nebraska to be the medical director of a medical group associated with a group-model health maintenance organization.  Soon after he became its chief executive officer as well.

   He continued his successful career as an executive in the managed health care industry, assuming increasingly responsible positions through 1993 when he held the position of executive vice president and chief operating officer at a Blue Cross Blue Shield plan in Washington, DC. In that same year, he became a direct-admit partner at Ernst & Young LLP, and continued his consulting career with global firms such as CapGemini and Accenture until 2008 when he formed the P.R. Kongstvedt Company, LLC.