Category Archives: Culture

An inspiring product development tale

Just do it

Just do it

The times they are a changing, and in some ways for the better. Nike is releasing a new sneaker designed for people with disabilities who have trouble putting regular shoes on by themselves. The idea for the shoe came from a teen with cerebral palsy who wrote a letter to Nike that ended up with the CEO. A related request came from a Nike employee who had suffered a stroke.

The company then spent three years to design a sneaker with what USA Today calls “an elongated wraparound zipper system to allow a wearer to open close the show with one hand.” They collaborated with the teen to perfect the design.

This isn’t some clunky looking, medicalized shoe. Instead, the Zoom Soldier 8 Flyease is a variation on a Lebron James basketball shoe. It’s cool and stylish.

Advocates for the disabled are pleased, because Nike can make a significant impact on quality of life with this product, and because it represents a new phase of acceptance for people who are a little different. I won’t be surprised if the shoe is a big hit –there are lots of people who have physical challenges of various types who might really like it.

If Nike can make money on the concept, that’s good news for everyone because it will demonstrate that this is a profitable opportunity, which will encourage others to compete.

The situation reminds me somewhat of the highway safety movement a generation ago. Although the problem of avoidable automobile deaths was there if you looked for it, the auto industry –with the exception of Volvo– wanted nothing to do with it. But once the public started to express an interest in safety, the world changed, and car companies started to compete on safety as well as styling and power.

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

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.

Chronically ill man walking

Can I leave now?

Can I leave now?

(Aging inmate population takes toll on prisons; Harsh sentencing of 1980s, 1990s didn’t foresee health care) announces the Boston Globe headline. I’ve been reading a story like this every year or two for the past 10 years. It’s kind of pathetic: cold blooded killers now incontinent, motor cycle gang members with “special medical boots” for a foot condition, etc.

Some prisons have needed to set up geriatric wards, while others have effectively been turned into convalescent homes.

The aging of the prison population is driving health care costs being borne by American taxpayers. The Bureau of Prisons saw health care expenses for inmates increase 55 percent from 2006 to 2013, when it spent more than $1 billion…

‘‘Our federal prisons are starting to resemble nursing homes surrounded with razor wire,’’ said Julie Stewart, president and founder of Families Against Mandatory Minimums. ‘‘It makes no sense fiscally, or from the perspective of human compassion, to incarcerate men and women who pose no threat to public safety and have long since paid for their crime. We need to repeal the absurd mandatory minimum sentences that keep them there.’’

I agree that the “War on Drugs” has put far too many people in prison for far too long. That sentiment seems to be getting more popular. If revulsion at high medical spending for prisoners helps some people come around to a less draconian view of sentencing, so much the better.

Image courtesy of tiverylucky at FreeDigitalPhotos.net


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

What’s the difference between New York and Boston?

A million here, a billion there

A million here, a billion there

We are modest and moralistic in Boston. The lead story in the May 1 Boston Globe criticized Vertex Pharmaceuticals for approving a plan to pay a dozen executives a total of about $54 million if the company becomes profitable, something that has taken 25 years to achieve. If the company becomes profitable it will be because it successfully launches a new drug that will improve the lives of people with cystic fibrosis. Sounds pretty good to me.

The bonuses represent an insignificant percentage of the $15 billion increase in Vertex’s market value in the past 12 months. Critics can complain all they want, juxtaposing the high prices insurers pay for medication with the bonuses awarded. I just don’t see this as a headline issue.

Meanwhile the New York Times yesterday led off with an article about the top paid hedge fund managers (For Top 25 Hedge Fund Managers, a Difficult 2014 Still Paid Well). The top 3 managers each made about $1 billion. That’s right, each one made 20x what the dozen Vertex managers might be due for collectively. To make it to #25 on the list required earning $175 million, still far, far above the Vertex dozen. Oh, and by the way most of the hedge funds had mediocre performance in 2014, in the low single digits, and their operations didn’t contribute much, if anything to improving society.

Some of the funds employ scientists (physicists and astronomers are two examples provided) to help with their trading, yet they earned returns far lower than the non-geniuses who bought and held the S&P 500. Vertex critics are up in arms about taxpayers indirectly paying executive bonuses, but maybe they should instead scrutinize public entities such as pension funds that are paying large fees to hedge funds.

Image courtesy of samandale at FreeDigitalPhotos.net

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

Do it yourself death panel

How are you feelin' today, mom?

How you feelin’ today, mom?

Federal law allows states to recover Medicaid costs from heirs. This little known provision is getting more attention as part of the debate over Medicaid expansion. The Wall Street Journal (New Wrinkle for Health Law) wrote a balanced article about it, highlighting consumer fears about having to sell assets while also sharing the government perspective that “estate recovery helps shore up the program for others who need it.”

The online comments and letter to the editor generally support the view that recipients’ estates should have to pay back the government. The letter (First, Estates Should Repay the Taxpayersis characteristic of the righteous indignation provided by the commenters.

Where is it written that a person is entitled at death to leave assets to children, particularly after someone else, in this case the taxpayers who fund Medicaid, has paid the health-care bills? Where is it written that children are entitled to inherit assets from a parent who has unpaid bills for services received during his or her lifetime?

Maybe if the issue were framed differently the commenters would rethink. Two points in particular:

  • If we seek to reclaim Medicaid payments we need to reclaim Medicare payments as well. Although recipients pay into the system, Medicare is far from self-sustaining. More than 40 percent of Medicare spending is financed from general revenues.
  • If the government starts going after estates for medical expenses more broadly, dying patients will worry that heirs will ration care to preserve their own inheritances. And with so much at stake, it’s not a paranoid thought

So here’s my question for the commenters and letter writers: Are you willing to expand this logic to Medicare and provide your own heirs with an incentive to form a death panel for you?

Image courtesy of artur84 at FreeDigitalPhotos.net

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

 

E-cigarettes: the California Cooler of the 21st century

Just a harmless, tasty treat?

Just a harmless, tasty treat?

If like me you came of age in the 1980s you remember the California Cooler, a sweet wine/juice combo that made it easy for kids to start drinking alcohol even if they couldn’t handle the “adult” taste of beer, wine or liquor. They were very popular at the time but I don’t recall anyone ever saying they were a healthy alternative to anything.

Fast forward 30 years to the e-cigarette era. New data show 13 percent of high school students use e-cigarettes. From the Boston Globe (E-cigarette use spikes among American teens)

In interviews, teenagers said that e-cigarettes had become almost as common at school as laptops, a change from several years ago, when few had seen the gadgets… A significant share said they were using the devices to quit smoking cigarettes or marijuana, while others said they had never smoked but liked being part of the trend and enjoyed the taste — two favorite flavors were Sweet Tart and Unicorn Puke, which one student described as “every flavor Skittle compressed into one.”

Policymakers are confused. E-cigarettes seem safer than smoking, and at least some people must be using them to try to quit. But my view is that at least for kids they lower the barriers to unhealthy behaviors by making drug use more like having a candy or soft drink. The FDA banned nicotine lollipops. Why is this different?

I’m concerned about this delivery method for nicotine, but I’m also worried about marijuana. E-cig entrepreneurs have been busy finding ways to use the devices to deliver THC, and there is a big rise in marijuana laced foods, so-called edibles or medibles. Let’s not fool ourselves and our kids by pretending these drugs are harmless treats.

Image courtesy of patrisyu at FreeDigitalPhotos.net

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

Cancer drugs: Why the high and rising prices?

Cancer drugs. Good stuff cheap?

Cancer drugs. Good stuff cheap?

When Americans talk, pharmaceutical companies listen. And what they’ve heard is that initiatives to contain or regulate medical costs get labeled as “rationing,” a word with very un-American connotations.

While politicians wring their hands, pricing strategists at pharma and biotech companies take action by charging high and rising prices for products for life-threatening illnesses. Cancer is Exhibit A, with many drugs costing more than $100,000 per year of treatment. A JAMA Oncology paper reviewed wholesale prices for cancer drugs approved over the past five years and found that prices are not correlated with a drug’s novelty or efficacy.

The authors conclude:

“Our results suggest that current pricing models are not rational but simply reflect what the market will bear.”

Now it’s possible that there is a greater correlation between actual negotiated prices and novelty or efficacy that isn’t showing up in the researchers’ data on wholesale prices. Still, the main conclusions are likely to stand, and spending on cancer drugs is sure to grow as more drug developers respond to market signals and develop new products.

If those who pay the bills, including private insurers, employers, and the government want to do something about cancer drug prices, they’ll need to embrace objective ways to measure cost effectiveness, and not be afraid of an opponent throwing around the “rationing” word. They’ll have to couple that approach with a commitment to personalized (or “precision”) medicine so that individuals get the specific drugs that are most effective for them, even if they don’t work as well for the general population.

The outcry over Sovaldi pricing for Hepatitis C has shown that there is at least some appetite to take on drug prices, but I don’t expect any dramatic clampdown on cancer drug prices in the near term.

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

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