Happy 10th birthday to the Health Business Blog!

Happy 10th birthday to the Health Business Blog

Happy 10th birthday to the Health Business Blog

The Health Business Blog has turned 10 years old! Continuing a tradition I established with birthdays onetwothreefourfivesixseveneight and nine I have picked out a favorite post from each month. Thanks for continuing to read the blog!

March 2014: All 9 Candidates For Mass. Gov: Where Do They Stand on Health Care?

I did my part for democracy by persuading each of the nine candidates for Governor of Massachusetts to be interviewed by me about healthcare policy. We had some notable healthcare bigwigs in the race including (now Governor) Charlie Baker and CMS head Don Berwick.  I interviewed everyone, posted audio, transcripts and an e-book. WBUR wrote an article about my effort.

April 2014: Hooray for high-priced hepatitis treatment Sovaldi

I don’t mind that people are getting rich from a drug that can cure hepatitis C. In fact I’m glad there are incentives in American healthcare for breakthrough products. Our cost problem in the US is not due to expensive products that work, the problem is expensive products, procedures and services that don’t.

May 2014: Should you trust your doctor more than Wikipedia?

A BBC article found errors in 9 out of 10 Wikipedia entries for medical conditions, a story that got a lot of play at the time. But there were serious flaws in the study and the BBC headline was misleading. My advice? Find a good physician and develop a relationship with him or her. To understand your condition in depth use UpToDate (there are reasonably priced 7-day and 30-day subscriptions for patients) and read the peer-reviewed articles referenced there.

June 2014: Hospital Clowns meet the Boston Globe

The Hearts & Noses Hospital Clown Troupe, where I’m chairman of the board, is a great organization that provides professionally trained volunteer clowns to hospitalized children in Massachusetts, and trains other hospital clowns from around the US and the world.

The Boston Globe ran a big feature article about the troupe, which I thought was great!

July 2014: eVisits: The 30 year march?

When I first started working in healthcare I was told that innovations can take a long, long time to be adopted. Now I’m old enough to have experienced it for myself. Case in point, eVisits, which we worked on in 2001 and are just now creeping into the mainstream.

August 2014: The Medical Marijuana Mess

The thin veneer of “medical” marijuana has been stripped away in Colorado, where stores originally providing remedies for patients have been quick to plaster themselves with new signs touting recreational use for all adults. I posted my vacation photos and the implications for “medical” marijuana in my home state of Massachusetts.

September 2014: Apple Health App: A first taste

I tried out the new Health App when it came out. It’s pretty basic but has the potential to be really big as more apps are developed and HealthKit takes off. I will probably wait for the second generation of Apple Watch, but I’m also eager to see how the first adopters fare.

October 2014: Telehealth at Mercy Health: Podcast interview with CFO/EVP Strategy Shannon Sock

I sat down with Shannon to talk about Mercy’s 10-year journey in telehealth. The big, midwestern integrated delivery system has made telehealth a strategic priority since at least 2006. That commitment is ramping up further with the construction of a 120,000 square foot, $50 million virtual telehealth center, slated to open next year.

In this podcast interview Sock described Mercy’s telehealth approach and accomplishments as a first mover. He also touched on the challenges of getting his colleagues to approach telehealth as a strategic asset, the opportunity to diversify Mercy’s revenues by providing services to other systems, direct contracting with employers, and the exciting new possibilities of patient engagement arriving with Apple’s HealthKit and similar initiatives.

November 2014: The making of a moron

Are decision support tools turning doctors into idiots? They might, but if physicians are smart about it they will be able to use the new tools to leverage their skill sets and experience to great effect.

I spoke about the topic of automation recently with my business school section-mate Mike Maples, a “super angel” investor, as we contemplated whether our kids would be able to make a living in the brave new world. He suggested that there would be an increasingly stark divide between those who find ways to leverage technology to do bigger things and those who are displaced by technology.

Physicians and other highly-skilled professionals would do well to keep that thought in mind.

December 2014: In praise of FDA collaboration: the cardiac safety example

The Food and Drug Administration gets a lot of grief. Some think the FDA is too restrictive, keeping useful drugs and devices off the market and thus harming patients. Others complain that the agency is too lax, letting dangerous products get through. What many people don’t realize, however, is that FDA has established an excellent track record of collaboration with stakeholders that’s leading to better, faster development pathways.

I’m directly aware of FDA’s longstanding constructive, collaborative efforts in the areas of HIV and HCV through the Forum for Collaborative HIV Research. Those efforts are now expanding into liver fibrosis and beyond. Most recently, FDA has been a key participant in the Cardiac Safety Research Consortium. which is leading to better, faster, and less expensive ways to test drugs for cardiac safety issues.

January 2015: Do health plans have a future?

Not to be cynical but in the insurance business the best way to make money is to discourage risky people from becoming policyholders and to exclude from coverage anything that a policyholder is likely to file a claim for. Health plans are increasingly not allowed to act in this manner. Are there other ways they can add value and make a profit?

February 2015: Pfizer and Hospira: It’s not about generics

Despite what you’ve read elsewhere, Pfizer’s acquisition of Hospira is not about getting into the generic drug business. What Pfizer is really doing is returning to the strategy that led to its Lipitor heyday: making “me-too” versions of existing drugs and differentiating them through marketing backed up by clinical research. This is not about intensive competition on pricing.


Thank you dear readers for a wonderful decade of blogging! Stay tuned, I’m still going strong.

Image courtesy of Stuart Miles at FreeDigitalPhotos.net.


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


Health Wonk Review: Happy 10th anniversary edition

10 years old and still hitting the mark

10 years old and still hitting the mark

The Health Business Blog turns 10 years old this weekend, so I thought I’d celebrate by hosting the Health Wonk Review. And some fine submissions have come in.

Is that the best you could do? I’m no lawyer, but King v. Burwell, which could overturn ObamaCare subsidies in states that lack their own exchanges, is ridiculous on its face. Of course Congress didn’t intend to deprive people of subsidies based on whether their exchange was state or federal. Managed Care Matters does a nice job of laying out just how lame the plaintiffs are. If they were harmed by ObamaCare it’s hard to see how, and they are ignorant of the law to boot.

Insurance Co-Ops were a late-in-the-day add to the Affordable Care Act, a sop to those who wanted but did not get a so-called public option. It’s awfully hard to start up an insurance company as some of the Co-Ops are demonstrating. InsureBlog says we told you so.

Pricey, pricey, pricey. High cost regions tend to stay that way for a long time, even when controlling for factors such as health status and price variation. Healthcare Economist says that means there are real differences in practice patterns.

Sell to the masses and dine with the classes. A Catholic Health Care CEO sues for defamation after a union advertises his $2.2 million compensation package. Health Care Renewal struggles to understand how an organization that focuses on serving the poor could be comfortable with how the CEO is behaving.

Risk and uncertainty will replace measurement and outcomes as the basis for future healthcare reform. So says the Population Health Blog as it examines the links between the Information Age, health IT, biology, statistics and quantum mechanics.

Speaking of the future, Workers’ Comp Insider suggests a seismic shift in the century-old workers comp system but notes that workers comp has not exactly been a trailblazer.

It’s nice to find an optimistic wonk, but we’ve got one right here at Health System Ed, which marvels about the ONC’s national meeting and its progress on interoperability. But don’t worry, the post includes a dose of skepticism as well.

Some people will do anything to avoid taxes, gain frequent flyer miles and now, avoid ObamaCare. But Colorado Health Insurance Insider shows us why the “easy” ways to game ObamaCare may just turn out to be complex and costly after all.

It says something when a blogger apologizes for a submission that is especially wonky, but if you can make it through Health Affairs Blog’s three-part series on the CMS final 2016 Notice of Benefit and Payment Parameters rule and final 2016 Letter to Issuers in the federal exchange you can’t help but learn something.

Like most providers, The Hospital Leader is dismissive of patient experience scores, confident that patients only respond to big TVs, tasty food and swanky lobbies. And yet a well designed study shows that this quite common opinion is unjustified.

What’s the highest margin activity in the hospital? Becker’s Hospital CFO blog by Copley Raff has the answer: fundraising.  Ka-ching!

Last and likely least, here’s one from my own Health Business Blog. The Pfizer acquisition of Hospira –explained by most observers as Pfizer’s way to get into generics– is really about Pfizer getting back into the “me-too” drug business that was the foundation of its glory days.

Thanks for reading!

Image courtesy of Stuart Miles at FreeDigitalPhotos.net.

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

Thomas Jefferson embraces telehealth

Just slightly ahead of their time

Just slightly ahead of their time

Thomas Jefferson was an innovative guy, so I guess it should come as no surprise that his namesake university in Philadelphia is embracing telehealth in a big way. Thomas Jefferson University Hospitals CEO Dr. Stephen Klasko is in a hurry to transform healthcare delivery, and sees telehealth as a key enabler. TJ has gone so far as to invest in American Well, the telehealth platform company I’ve profiled in the past.

Klasko is focused on keeping patients out of the hospital and especially the emergency department. He also sees the potential to make better use of specialists’ time –letting them quickly dispatch patients with minor issues and provide greater access for those with serious concerns.

Fifteen years after eVisits were commercialized, virtual care seems to be coming into vogue. Why now? As usual with major changes, there is a convergence of various factors.

  • Everyone –patients as well as doctors– has a high-powered smartphone in their pocket, which is capable of amazing things like full motion video. No need to go to a specialized facility or even to a computer
  • Patients have financial incentives to avoid costly care
  • Providers are facing overwhelming demand from newly insured patients along with new  value-based payment models that encourage efficiency
  • Consumers are coming to expect online interaction with healthcare that feels like how they interact in every other aspect of their lives. Doctors and nurses feel the same way

The next few years will be monumental for digital health. I can’t wait to see how it all unfolds.

photo credit: Declaration Drafting Committee, after Jean Leon Gerome Ferris via photopin (license)

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


par8o CEO Daniel Palestrant on matching healthcare supply and demand

par8o CEO Daniel Palestrant

par8o CEO Daniel Palestrant

While running Sermo, an online physician community he cofounded, Dr. Daniel Palestrant came up with the idea for a healthcare operating system, using the Pareto principle to match supply and demand. After selling Sermo, he turned his attention to applying these concepts in a new company, par8o.

par8o has recently raised a Series A financing round and is beginning to publicize its work. In this podcast interview, Palestrant answers my questions about the company’s origins, progress to date, and future plans:

  • What is the meaning of the company’s name? (0:11)
  • Why is Pareto optimization an issue for healthcare? (1:00)
  • What do you mean by the term, “healthcare operating system?” (2:20)
  • Which customer segments are you addressing? (6:33)
  • You started a few years ago. Why are you just raising funding now? (8:46)
  • How has the concept evolved since you came up with it at Sermo? (10:58)
  • What can we expect next? (13:02)
  • How does par8o enable better benefit designs for health plans? (14:54)

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


Nursing shortage or nursing surplus?

I’ve been a bit of a broken record about the so-called nursing shortage since at least 2009. (See here, here, here, here, here and here.) The conventional wisdom has been that we are facing a looming, massive shortage of nurses –in the hundreds of thousands in 10 or 15 years. I’ve always looked at those numbers with raised eyebrows, especially since they are often pushed by those with a vested interest in boosting the number of nursing students.

Of course there are variations by region, specialty, and level of expertise but in general the idea of a big nursing shortage just didn’t make sense to me.

So I was gratified to receive the following note from a researcher at Staffing Industry Analysts:

Hey David,

I ran across your article in 2013 about the nursing shortage rhetoric being hootzpah. Good article, and turns out you were right on the money. Not sure if you’ve seen, but the HRSA just updated its projections and now projects a nursing surplus of 340,000 nurses by 2025 (given current conditions continue).

Wrote an article on it here if you’re interested.

Sure enough, the government’s estimate of the balance between supply and demand has shifted radically. In 2002 HRSA predicted a shortage of 800,000 RNSs by 2020. The latest estimate shows a surplus of 340,000 by 2025. The biggest reason? A huge increase in nursing graduates.

I think the long-term outlook for nursing demand may be even more dire, because forecasters tend to neglect the long-term substitution of capital for labor. There will still be a lot of nursing jobs, but nurse productivity will increase as technology improves, and some tasks done by humans today will be done by robots in the future.