Office of Recovery: Avellone proposes strong response to substance abuse

Joe Avellone (D), candidate for Governor

Joe Avellone (D), candidate for Governor

Dr. Joe Avellone, Democratic candidate for Governor of Massachusetts, is very concerned about the impact of substance abuse. In particular, he’s zeroed in on addictions to narcotics and heroin that have arisen out of the widespread prescribing of powerful painkillers for serious and not-so-serious conditions.

His Office of Recovery would have high visibility in the Executive Office of Health and Human Services and focus on getting individuals into treatment during their window of opportunity.

In this podcast interview, Avellone describes why he’s making this issue a priority, how his plan would work, and how it compares to efforts elsewhere.

Earlier I interviewed Avellone and all other candidates for Governor about healthcare policy.

By healthcare consultant David E. Williams of the Health Business Group

Back to the 1980s: My day at UC Berkeley

I was in the San Francisco Bay Area on business last week, and spent an interesting and enjoyable day on the University of California Berkeley campus, where I experienced two blasts from the past.

Choosing Wisely is the name of an initiative to prevent unnecessary use of medical tests and procedures. But it could also describe how I selected my 10th grade biology lab partner at Walt Whitman High School in Bethesda, MA in the early 1980s. At the time Mike Eisen was a smart guy who also happened to be the son of two scientists. He was a good  (and mischievous) student who knew a heck of a lot about fruit flies.

It will surprise no one from those days that Mike went on to become a prominent scientist himself with a lab at Berkeley. Speaking on behalf of my classmates, I will say we are also relieved that his mischievousness has been productively channeled into disrupting the scientific publishing industry for the public good as co-founder of the Public Library of Science (PLOS) rather than for the development of nuclear hand grenades or brain erasers, as seemed plausible back then.

In any case, Mike and I had a lot of fun catching up on work and life.

Later I had the pleasure of attending a graduate class taught by Veronica Miller, who is also the Executive Director of the Forum for Collaborative HIV Research, a long term client of ours. This groundbreaking class (US FDA, Drug Development, Science and Health Policy) in the UC Berkeley School of Public Health is all about drug development and the role of the FDA, using the examples of HIV and Hepatitis C.

There were two guest speakers: Romas Geleziunas, a scientist from Gilead who talked about what it will take to cure HIV, and a patient advocate, Matt Sharp, who was diagnosed in 1988 and has been on the leading edge of activism and research ever since. It was interesting to hear him discuss the early days of ACT UP with a group of students who are too young to remember what it was all about.

It made me think back to my 11th grade oral communications class with Mrs. Z in 1984. For our culminating project we had to give a speech on a topic we considered important and that others should know about. I had been reading about AIDS that year and was very concerned about the epidemic and how it could grow to affect the whole society. The conventional wisdom (passed down from the seniors) was it was best to do a speech about Mrs. Z’s cat, since that was the main thing that interested her. I decided to ignore that advice and did my speech on AIDS anyway, and spent a lot of time prepping it. When it came time to deliver my speech, Mrs. Z was chewing gum, filing her nails and looking out the window. I got a B, one of the few grades I remember from high school. (By the way, very few of my teachers were like Mrs. Z!)

On the one hand it seems like the last 30 years have flown by pretty quickly. On the other hand, the early 80s do feel pretty remote.

By healthcare consultant David E. Williams of the Health Business Group

Health Business Group in HealthLeaders

HealthLeaders (‘Vicious Cycle’ Flagged in MA Hospital Financing Disparities) reports today on a white paper we contributed to about the impact of hospital price differences in Massachusetts.  We built on previously publicized price data to highlight the implications for middle class and lower income communities: they effectively subsidize their richer brethren who pay the same premiums but get their routine care from pricier providers.

One of the things that surprised us is that Medicaid managed care plans, which are hired by the state, pay teaching hospitals much more than they pay community hospitals.

The report includes four recommendations to address the disparities:

  1. Require high-cost providers to hold cost growth below the general benchmark under Chapter 224 of health reform
  2. Consider each provider’s payer mix when setting Medicaid (and possibly commercial) rates
  3. Implement a Medicaid Accountable Care Organization (ACO) to contain costs and encourage quality, rather than relying on cutting unit prices
  4. Encourage commercial health plans to design products that reward members who use low cost providers

I’m quoted in the article.

By healthcare consultant David E. Williams of the Health Business Group

Candidates for Governor of Massachusetts: How their backgrounds in healthcare prepare them for the job

I’ve learned a lot about the candidates for Governor of Massachusetts by interviewing all nine of them about healthcare policy. Starting today I’ll be summarizing the results from those discussions so readers can compare the candidates on specific issues.

The candidates have diverse backgrounds: from head of Medicare to surgeon to small business owner to Homeland Security official. Of the nine, five have significant healthcare experience. Even those that don’t come from healthcare have taken the time to study the issues and develop deep perspectives.

I asked everyone to describe how their backgrounds, especially in healthcare, prepared them for the job of Governor. Here are higlights of those answers.

Don Berwick has an international and national reputation in healthcare. He’s a pediatrician who founded the Institute for Healthcare Improvement and more recently ran the Centers for Medicare and Medicaid Services (CMS), an $800 billion federal agency.  To put things in perspective, that budget is about 20x the size of the entire Massachusetts state budget. He pointed to his experience motivating the 5500 CMS employees and his conviction that government employees “are just as eager to be proud of their work, and just as amenable to learning about modern approaches to improvement as any workforce” if they have the right leadership. He wants to bring that approach to the Massachusetts government workforce.

Joe Avellone reflected on two major themes from his long career as a surgeon and healthcare executive. He understands the “absolute sanctity of the doctor-patient relationships” and the importance of preventive medicine. He pledges to keep in mind the individual, “inviolate” relationship between doctor and patient even when thinking systemically about big picture solutions. And he asserts that the state is the right agent to invest in preventive health because of the distant time horizon for a payoff. This means taking the long view on public health threats like childhood obesity, smoking, and Hepatitis C.

Charlie Baker’s experience as CEO of Harvard Pilgrim Health Care and as a senior official in the Weld and Celluci administrations is highly pragmatic. He pledges to create a culture of accountability by setting a high bar, recruiting top people, and measuring their performance. “One of the things I bring is a tremendous appreciation about how important it is to follow through and execute your plans.” He also wants to bring a “maniacal” approach to service delivery on behalf of the people, which will translate into a great experience for everyone doing business with the government.

Unlike some of the other candidates, Martha Coakley does not have a career in healthcare to fall back on when answering my wonky queries. But she points to her eight years as Attorney General and the various learning curves she’s traveled down including in healthcare. She’s learned to appreciate the bipartisan agreement on assuring universal insurance coverage and wants to leverage that consensus in order to cut costs, provide better prevention and address underlying cost drivers such as the prevalence of diabetes and asthma. She suggests that her experience working closely on healthcare issues as AG will translate into rapid progress as Governor and enable Massachusetts to act as a national leader on health reform.

Evan Falchuk was president of Best Doctors, a company that focuses on helping patients get the correct diagnosis. Once a disease is diagnosed properly the patient can get the right treatment. But with wrong diagnosis comes incorrect treatment, extra costs and poor results. Evan applies the analogy of diagnosis and treatment to the public realm. “It’s easy to treat the symptoms rather than the disease and to miss the underlying causes in an effort to take quick action.” He’s learned how hard it is to make complex decisions. “You have to be able to confront reality. You have to take action that is decisive and that reflects the best understanding of what will address the problem you’ve identified.”

Mark Fisher, a Tea Party Member running as a Republican, displays an interesting mix of libertarianism, paternalism and suspicion of big business. His main exposure to healthcare comes as owner of a small business providing health insurance benefits for employees. Health plans refused to provide coverage because he paid 100 percent of his employees’ out-of-pocket costs, thereby neutralizing the intended impact of member cost sharing and potentially driving up costs. “What I learned is that [health plans] are more concerned about making big profits than they are about providing care for those who are paying the premiums.” He intends to bring a “healthy dose of common sense” and skepticism of big healthcare players to Beacon Hill.

Steve Grossman says he’s learned from his private sector and government career (he’s State Treasurer)  that job creation is about investing wisely and creating proper incentives. He cites his experience running a unionized shop that offered earned sick time for more than 25 years. “People who believe that you are willing to invest in them are going to invest in you.” He pledges to “level the playing field” to make sure no one in Massachusetts is left behind on access to quality healthcare even as we grapple with cost containment.

Jeff McCormick has 25 years of experience financing growth companies, including several in healthcare and biotech. He studied biology and molecular genetics in school and so is well versed in the fundamentals of health and medicine. He’s learned the value of a relentless focus on lowering costs and improving outcomes and plans to apply that philosophy to his work on healthcare and other issues as Governor. He vows to bring “a new set of eyes to identify these problems and solutions and not do more of the same old, same old.”

Juliette Kayyem has a background in homeland security in both the federal and state government.  She looks at healthcare through the lens of harm reduction and public health preparedness.  “Homeland Security… is really about buttressing preparedness through various systems that protect people.” As a result she says she wants to focus on public health and community health centers, and to strengthen relationships between elite hospitals and health centers.

Over the coming days I’ll be comparing the candidates’ answers on other key questions.


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

Castlight Health: Early interviews

#Castlight Health has had a very successful initial public offering today and so a lot of people will be hearing about the company for the first time. If you want a little bit of perspective on how the company has evolved, you might want to read interviews I conducted from 2010 to 2013 with the company’s executives.

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