Where the US lags Italy in healthcare

The Wall Street Journal has a fascinating story today (New Push Ties Cost of Drugs to How Well They Work) about tiered pricing for drugs by indication. The idea would be to pay more for certain indications where a drug is particularly effective and less for others where it’s less so. Eventually the concept could be applied to specific individuals, and not just indications.

It’s not a bad idea –I’ve advocated for a similar, software licensing model in the past– but I don’t expect it to catch on in a big way.

I was struck by one paragraph in particular:

A spokeswoman for Roche’s Genentech unit said that when Tarceva was approved to treat pancreatic cancer in 2005, it was the first medicine approved for the disease in more than a decade. She said the drug is now rarely used to treat pancreatic cancer because other drugs have since been approved for the disease. She said Genentech would welcome a system of pricing a medicine based on how it performs in different indications—and has one in place in Italy—but there are challenges to doing so in the U.S., including fragmented patient-record systems. (emphasis mine)

It’s often been said that there is no US healthcare “system.” The lack of a system is very expensive in terms of administrative burden, uncoordinated care, and poor outcomes. This drug pricing issue is just one more example of how we’re kidding ourselves if we think US healthcare is so superior to others’. In fact it helps explain why we pay so much more and yet get less.

By healthcare business consultant David E. Williams, president of Health Business Group.

ResearchKit webinar today

Curious about Apple’s new #ResearchKit and its potential for outcomes research? Digital healthcare consulting firm Medullan (where I’m an advisory board member) is hosting a free webinar from 2-2:30 today, EDT.

Topics will include:

  • The Current State 
  • What the Apple ResearchKit is and is not 
  • Apple software development kit overview 
  • FDA guidance and latest IRB ruling 
  • Implications for the Outcomes Researcher 
  • Challenges that Research Kit addresses
  • Getting started

If you miss it you can still catch the recording. So it’s worth visiting the registration page.

By healthcare business consultant David E. Williams, president of Health Business Group.

Hang up and dial 911

The easy button

The easy button

American consumers are used to fast access to service: Check the web to see when an Amazon package is arriving (sometimes same day now), speak to a customer service rep at Fidelity 24 x 7. If anything, convenience is increasing as pain points are being addressed. For example, I experienced frustration and poor service from the local cab company for 25 years, but now I can just press a button and summon an Uber in minutes, watching the driver’s progress on the map as the car approaches.

Healthcare sort of understands that it needs to change, but access to care is still difficult, tools are clunky, and CYA approaches reign.

One reason people go to the ED is that they know they can access care there. They don’t have to check the hours of operation and don’t need to sign up for an appointment that’s weeks or months away.

While there is a general understanding that ED visits should be reduced, in practice many providers actually encourage overuse. Call the main number of any hospital or physician office and one of the first things you’ll hear on the recording is, “If this is a medical emergency, please hang up and dial 911.” Is it any wonder that people get the message that 911 is the route to take for anything serious?

Generally, once an ambulance is summoned the patient is going to the hospital emergency department unless they convince the EMTs they are well enough to stay put. That’s why I was excited to read about a program in Reno, Nevada that preserves the convenience of 911 and the ED while avoiding some of the downside.

Paramedics are being trained to handle some primary care tasks –such as helping heart failure patients avoid complications– that often degenerate into an ED visit and hospitalization. They are also being given a broader set of destination options when they do transport, such as detox centers and urgent care.

As usual there are challenges: EMTs need different training if they are to fill the roles of primary care and visiting nurses, insurance may not pay for non-traditional approaches like this, and while this is a cheaper and better route than the ED, I doubt it’s cheaper or better than traditional primary care. Clearly Nevada doesn’t want to encourage more 911 calls.

I look forward to learning more about this experiment.

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.

Call to action: America’s Health Rankings Senior Report


Dr. Reed Tuckson

Dr. Reed Tuckson

Rankings reports are a great way to spur the public and policymakers to pay attention to important issues. The 2015 America’s Health Rankings Senior Report from the United Health Foundation, released today, is a case in point. It combines a holistic approach to the definition of health with detailed information for each state.

I had an opportunity to interview Dr. Reed Tuckson, senior medical advisor to the Foundation, about the report.

  1. (0:12) What is the purpose of this report?
  2. (1:28) What should we learn from the high-ranking states and the low-ranking ones? What are some success stories?
  3. (3:28) The report includes a “call to action” from Dr. Jewel Mullen, based on a national prevention strategy. Who is Dr. Mullen and what is the strategy?
  4. (4:55) The report mentions Alzheimer’s and dementia. There is rising prevalence, no cure, and not a lot of effective treatments. How should we be addressing Alzheimer’s?
  5. (7:52) It’s clear from your comments that this report is not meant to sit on the shelf. What impact do you think the report will have?
  6. (10:18) What else would you like to highlight?

By healthcare business consultant David E. Williams, president of Health Business Group.

Payer-provider collaboration: Podcast interview with NaviNet CEO Frank Ingari

Frank Ingari, NaviNet CEO

Frank Ingari, NaviNet CEO

Frank Ingari is CEO of NaviNet, which positions itself as a “real-time healthcare communications network leading the transformation of payer-provider collaboration…”

The payer/provider collaboration theme seems a little utopian, but I’m open minded and gave Frank a chance to explain why it’s real. Have a listen and let me know what you think.

  1.  (0:10) How will value based healthcare change the relationship between payers and providers?
  2. (2:04) Do commercial plans, Medicare Advantage and Medicaid managed care plans differ in their path toward a value based system?
  3. (7:47) You talk about payer/provider “collaboration,” which is not how I think of the typical payer/provider relationship. Help me understand the term “collaboration.” Is that real?
  4. (13:14) What are some key points of friction that NaviNet addresses? How do you do it?
  5. (15:45) Patients generally have no idea that their plan or provider has shifted to a value based arrangement. Is that something they should know about? What would you advise patients to do?
  6. (19:22) You had a big presence at #HIMSS15 in Chicago this year. What were your objectives? Did you meet them?
  7. (20:39) What should we expect from NaviNet for the rest of 2015 and into 2016?

By healthcare business consultant David E. Williams, president of Health Business Group.


Welcoming back insurance exchange expert Dave Kerrigan

David J. Kerrigan

David J. Kerrigan

Health insurance exchange expert Dave Kerrigan is back in the private sector after three years working for the Massachusetts exchange. As a result he’s reviving his A Musing Healthcare Blog. The first new post is about the potential of health exchanges in a world where healthcare costs fall on employees.

Welcome back!