Covalence Healthcare Consulting

23andMe has filed for #chapter11 #bancruptcy. Their Founder and CEO has "resigned", but still on the board. This is a great example of why organizations cannot take their foot off the innovation pedal - EVER! This applies to any type of organization in any sector of the U.S. economy. Ongoing innovation creates the type of #differentiation that's difficult (and expensive) for #competitors to replicate. What's next for 23andMe? Likely an #acquisition by one of its MANY competitors (Ancestry, MyHeritage, and others). There are many ways for businesses to build a moat and keep competition at bay. But true competitive advantage can only be achieved through establishing a culture, processes, and most importantly, a budget for innovation and new product development. How do you create the culture, processes, and budget for innovation and new product development, you ask? Stay tuned! Covalence Healthcare Consulting will soon launch a new series on this exact topic to help organizations never lose that entrepreneur mindset! DM me for more info. #lifesciences #healthcare #genealogy #testkits #healthcare #medication #allergies #chronicconditions #diseaserisk #businessstrategy #corporatestrategy #competitiveadvantage #productdevelopment #competition #startup #entrepreneur #intrapreneur

Our Founder and Principal Consultant, Mike Rawaan, shares his thoughts on how the anticipated budget cuts will impact state Medicaid programs and offers strategies that states can employ to soften the blow. #Medicaid #CMS #Valuebasedcare #VBC #MCO #ManagedMedicaid #Medicareadvantage #DSNP #healthcarebenefits #medicalbenefits #PBM #congress #healthpolicy #congressionalbudget #hospitals #ruralhealth #SNP #DSNP

The first of our series of videos on trends in the U.S. Healthcare industry in 2025. Part 1: Medicaid What are the impacts of the anticipated budget cuts, and how can states manage their Medicaid programs with a reduced budget with minimal impact on benefits and enrollment? #Medicaid #CMS #Valuebasedcare #VBC #MCO #ManagedMedicaid #Medicareadvantage #DSNP #healthcarebenefits #medicalbenefits #PBM #congress #healthpolicy #congressionalbudget #hospitals #ruralhealth #SNP #DSNP

Covalence Healthcare Consulting is excited to launch a new series of videos—and mini podcasts in the near future—as part of our new approach to sharing insights with healthcare industry stakeholders. We hope you will find the new content insightful and engaging as we attempt to make sense of the changes in our #healthcare industry. We will discuss topics such as: ?? Medicaid ?? Medicare ?? Health exchanges ?? Value-based care (VBC) ?? Drug pricing ?? Government waiver programs and grants ?? Public Health ?? Artificial intelligence (AI) in healthcare ?? Employer-sponsored health plans ?? Investments and M&A ?? And more ... #Medicaid, #Medicare #Healthinsurance #valuebasedcare (#VBC) #CMMI Centers for Medicare & Medicaid Services #publichealth #AI #waivers #government #grants, #ICHRA #healthcarebenefits #healthinsurance

Happy International Women's Day 2025. #WomensDay2025 #WomensDay #equity #Equality

PSA for sales people in #B2B sales. As a buyer or prospect, I am not a fan of having my name repeated over and over during a sales engagement. Let me know your thoughts on the subject. Also, please let me know if this video shows up in LinkedIn’s new Reels section (who needs TikTok?) #businesssales #sales #b2bsales

I know I posted about this only a few days ago, but it appears that the Sycamore Partners acquisition of Walgreens is inevitable. According to the latest The Wall Street Journal (#WSJ) "exclusive," the deal will be worth roughly $10B, which is not far from their market cap over the past 90 days. #WBA's stock has been trading at an average price of $10.32 over that period, with a high of $12.90 and a low of $8.47. The stock closed at $10.26 yesterday, which was the worst day for the markets so far in 2025, but has more than recovered to $10.89 as of this post in pre-market activity. The retail pharmacy industry has felt the winds of change for a while now, but no other chain has felt its impact as much as Walgreens. The #COVID19 pandemic offered a unique opportunity for the pharmacy industry since their presence in the communities offered the most efficient path to distributing #vaccines. Pharmacy industry leaders doubled down on the foot traffic and expanded the urgent and primary care offerings at their retail locations. However, these leaders failed to account for post-pandemic possibilities. Many believed the public would view their pharmacy and #pharmacist as part of their care team and wouldn't change their behaviors. Most completely ignored the shift in shopping behaviors, another byproduct of the #pandemic, and the behaviors of "the healthcare shopper" or the #patient. Walgreens's largest competitor, CVS Health, has sustained their pharmacy business, but not without a few dents. CVS has closed many CVS Pharmacy locations and many CVS MinuteClinic locations. However, they've been able to subsidize their retail business through other subsidiaries such as CVS Caremark and Aetna, a CVS Health Company. This is the end of an era for the largest pharmacy chain in the world, and it's safe to conclude that Walgreens will not be holding on to that title if Sycomoe moves forward with splitting the company in three. I also expect Walgreens Healthcare Solutions to look different post-acquisition. I expect that there will be some divesting and acquisition of new assets in its future. #retailhealth Optum Express Scripts by Evernorth Shields Health Solutions CareCentrix VillageMD #retailhealth #primarycare #valuebasedcare #vbc #urgentcare #healthsystems #medicare #medicareadvantage #IDN #mergers #acquisition #healthcare

This week, executives from the largest U.S. #Consulting firms are heading to D.C. to "defend the spend." I'm very interested in seeing how this will turn out, not because I'm a consultant - my firm, Covalence Healthcare Consulting, has never had a federal government contract - but because the long-term ramifications have the potential to jar the consulting industry in both the public and private sectors. The US government spends ~$24B on consulting services, with nearly 10% going to the #bigfour. Government contracts are a substantial revenue source for firms like Ernst & Young, Deloitte, McKinsey & Company, Bain & Company, Booz Allen Hamilton, Boston Consulting Group (BCG), and others. The U.S. government has been their #cashcow for quite some time. Consultants are great at justifying their work and demonstrating the value of their work. But the question is, how many projects awarded to #consultants will be deemed mission-critical by the new administration? If this review results in significant cuts, the firms will turn to the state governments and the private sector to reclaim the revenue. States typically hire consultants to help them manage their budget or reduce their spending, to phrase it more directly. Seems counterintuitive to pay someone to tell you how to spend less, but it happens all the time! States are willing to pay hefty consulting fees for the insights that will help them reduce spending with minimum negative impact on their citizens, but there's a limit to what they'll pay. Also, the states will likely go through their own review of consulting contracts to cut some fat. Ultimately, this will likely result in a break-even for the consultancies in their state contracts. The private sector offers different circumstances. There are two project types that companies bring in outside help for: 1. Growth - the company needs to grow faster or in a different direction. 2. Reduction - similar to the government, the company needs to cut costs. Growth projects are more prevalent when the economy is booming. Conversely, reduction projects are prevalent when we're in a recession. The Sahm Rule suggests a recession is likely when the three-month average unemployment rate increases by more than 0.5% from the previous year's low. Given where unemployment was in 2024, the mass firings at the federal government in the past 30 days, and hiring freezes in the private sector, one can instinctively predict that we're headed for a recession. I don't know if we're headed for a recession, but if we do, it will be more bad news for the consulting industry. I'd love to hear your thoughts. #managementconsulting #healthcareconsulting #contracting #contractors #healthcare #federalemployees

I’ve been trying to stick with a one-post-a-day cadence, but Reuters just hit my inbox with this story about Walgreens Boots Alliance (WBA) and Sycamore Partners, a #PrivateEquity firm out of New York, resuming conversations about a buyout. The buyout talks began in December, but a deal has not yet been finalized. According to Reuters, Sycamore Partners plans to split Walgreens Boots Alliance (#WBA) into three distinct businesses: U.S. retail pharmacy, Boots UK, and Walgreens Healthcare Solutions (U.S Healthcare). Financing issues for the buyout have caused delays in the past, though they are not expected to be a significant obstacle. However, Walgreens' chairman, Stefano Pessina, who holds ~17% stake in the company, will continue to be an obstacle as he expects to maintain his shares of the company. On paper, the split makes sense, but the devil is in the details. Currently, WBA’s profitable business lines subsidize their retail pharmacy and U.S. Healthcare. Although the U.S. Healthcare division seems to have made a turnaround under Mary Langowski, the question of sustainable growth is still unanswered. Will going private save Walgreens? Not in its current state. Splitting the company up or divesting some of the assets AND going private increases their survival probability. WBA’s U.S. Healthcare is definitely the most intriguing slice of the pie. There’s much potential here, but some of that potential is dependent on the retail pharmacy business. So, if they can maintain a relationship or partnership with the retail pharmacy business after the split, that could be the beginning of a remarkable turnaround story. Grab your popcorn. We're not done with the plot twists. #pharmacy #specialtypharmacy #340B #retialpharmacy VillageMD CareCentrix Shields Health Solutions #UShealthcare #VBC #PCP #carecoordination #pharmacist

UnitedHealth Group’s stock dropped as much as 13% last week, according to reports that the #DOJ is launching an investigation into UHC’s Medicare billing practices based on findings from an investigative report by The Wall Street Journal. The probe focuses on whether UnitedHealth has been inflating diagnoses to secure higher payments from Medicare for certain Medicare Advantage members. Senator Charles Grassley, chairman of the Senate Judiciary Committee, sent?#UHG's?Chief Executive?Andrew Witty?a letter demanding detailed information on the company’s Medicare billing practices Monday. UnitedHealthcare?has denied wrongdoing, asserting that its practices aim to enhance patient care and early disease detection. No surprises there. The outcome of this investigation could have significant implications for UnitedHealth and the broader healthcare industry. However, those implications can take several different forms: ?? One possibility is that the DOJ probe finds wrongdoings, which will likely lead to hefty fines and other punishments for UHC. Additional ramifications could be the DOJ investigating #MedicareAdvantage plan carriers such as Humana, Aetna, a CVS Health Company, Centene Corporation, Kaiser Permanente, Elevance Health, Cigna Healthcare, and others for the same misconduct. ?? Another possible outcome is that the DOJ doesn’t find any wrongdoing, and we maintain the status quo. ?? A third possibility is that UHC proves that its activities, which may seem malicious on the surface, have actually resulted in better outcomes and lower costs of care for its members in the long term. My concern with this probe is that it’s based on an incomplete and one-sided investigation by a reputable publication, #WSJ. This is an instance where the publication's reputation is garnering greater acclaim than its actual work. WSJ has followed the money on a transactional basis. They have uncovered practices that seem suspicious and possibly fraudulent. But they haven’t looked at the other side of this practice to truly understand the net value. A white paper published by FTI Consulting in partnership with Matrix Medical Network (link in comments) points out some key statistics that should factor into that net value calculation: ?? Over 20% of beneficiaries receiving in-home assessments had no other claims during the year, suggesting challenges in access to care. ?? Another 20+% lived in rural areas that traditionally lack access to primary care. Regardless of which outcome will result from the DOJ probe, one thing is inevitable: the in-home assessment model is not going away. With the anticipated changes and #budget cuts to #Medicaid and #Medicare under the new administration, meeting the most vulnerable population where they are – in their home – is more critical than ever! If anything, it will become a staple of the care team with stronger partnerships with #primarycare across the care journey for those vulnerable members. #PCP #chronicconditions