Category Archives: Podcast

Concierge Cardiology: podcast interview with Wayne Lipton

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Wayne Lipton runs Concierge Choice Physicians, which converts traditional physician offices to “hybrid”concierge practices that provide new options for patients and increase physician income. While we typically hear about concierge practices in primary care, the model is expanding to other specialties.

In this podcast interview, Wayne and I discuss the hybrid concierge model for cardiology:

  • (0:11) What is a typical cardiologist’s practice like these days and how has it changed?
  • (1:01) How have the practice changes worked out for physicians and patients?
  • (1:48) Do patients with cardiac issues use their cardiologist as primary care physicians or do they still maintain primary care relationships?
  • (3:06) Within primary care we’ve seen a shift toward concierge models. Why haven’t we seen that in the specialties?
  • (4:22) What is a hybrid model like? Does a physicians have to remember when they are acting as a concierge versus the traditional hamster wheel model?
  • (6:15) Are a lot of the cardiology concierge patients also concierge primary care patients?
  • (8:26) How does a concierge cardiology practice differ from a concierge primary care practices? How do the economics compare?
  • (11:08) What do health plans think of concierge medicine? What is the impact on new models of reimbursement?
  • (13:37) Would a practice that added on a hybrid model be more or less attractive to an ACO? Would the practices want to participate?
  • (15:50) How broad is the opportunity to add this model in cardiology? Are other specialties also ripe?
  • (18:29) How do you implement?
  • (21:35) How does your company get paid?

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

Kindly Care streamlines home care hiring. Podcast with CEO Igor Lebovic

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Kindly Care got its start by helping families hire, onboard, manage and compensate caregivers. Now it is expanding its offering with Care Exchange, which allows home care agencies to collaborate.

I interviewed CEO Igor Lebovic to find out more.

  1. (0:10) What is the problem you are addressing with Kindly Care?
  2. (0:37) How did you decide to pursue this market?
  3. (2:32) You say you meet the caregivers. How do you meet them?
  4. (3:58) How much overlap is there between what you do and what Nanny Tax companies do?
  5. (4:58) You just launched Care Exchange. What is it?
  6.  (6:10) I’m confused. Are you disintermediating agencies or are you working with them?
  7. (8:52) Care.com and Honor sound like they are doing something similar. How are you different?
  8. (10:28) How are you funded? What are your hopes and aspirations?

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

Recreational marijuana is becoming legal. How will the laws be implemented?

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I opposed the ballot question legalizing recreational marijuana in Massachusetts. Nonetheless, the measure passed and it looks like legalization is going to happen. I asked marijuana entrepreneur Rob Hunt, President of Teewinot Life Sciences, to provide the industry perspective on some of the key issues.

Here’s what he had to say:

How does recreational marijuana interact with the market for alcohol? Do you expect alcohol sales to rise or fall? Why?

The adult use cannabis market should have almost no impact on the alcohol market at all. What this market represents is simply an orderly conversion from a long-standing illicit market to a now regulated legal market. It is not as if this new adult use market is emerging from nowhere, it already exists and has existed for years. Now adult cannabis users simply have a safe way to purchase cannabis from licensed retailers who have laboratory tested state-approved products rather than from a criminal enterprise with no safety considerations or government oversight.  

What is the evidence of the impact of marijuana legalization on the black market?

Adult-use legalization will have a very large impact on the illicit market. Using Colorado and Washington as comp sets, the legalization of adult-use almost eliminated the illicit market overnight for adult cannabis users within the state. There is simply no reason for one to put themselves in a potentially dangerous situation when they can go to a local shop down the street that has a larger selection of tested products at a comparable price. Best of all, in a legal market, the money stays in the local community and generates tax revenues for the state and the Federal Government.

Some (including me) are concerned that the availability of edible marijuana products will pose a danger for children but also for adults and pets, especially when they are packaged as candies or treats. Are these concerns warranted?

The cannabis industry is very aware that edibles must be very closely monitored. The trend is to make edibles less potent for this reason and to make sure that labeling and packaging are obvious and accurate and that the exit packaging is childproof. As for making products that are packaged as candies or treats, it is no different than making an alcohol product as a blend with fruit juices or iced tea. Flavor should not be the consideration, education and making sure products are kept in safe places should be a much larger consideration for adults using any cannabis product.

According to published research, about 30 percent of marijuana users have some degree of marijuana use disorder, including dependence and addiction. What is the argument for introducing a product that causes harm in a significant percentage of users?

I think the most simple answer is that the state is not “introducing” a product at all. This product was, is and would continue to be available to anyone that wishes to consume it on the illicit market. The question that should be asked is “If this product is already available to anyone that wants it, would it not be smarter to regulate it, keep it out of the hands of children, make sure it is labeled and packaged properly, has potency information available and is grown using specific standards?” If the answer to that question is yes, which is what the voters recently decided it was, then the next question, to address the concerns of many should be, “With the revenue and taxes that are being produced from this now regulated program, would it not be prudent to reallocate some of those dollars back to education and treatment for those who need it? Furthermore, perhaps should we not allocate some of the money that was previously earmarked for incarceration to rehabilitation?” 

The medical marijuana ballot initiative was passed in Massachusetts just a few years back. Was that initiative mainly a tactical stepping stone by the marijuana industry on the way to recreational legalization, as appears to have been the case in Colorado? 

The two issues are not at all related. Those who need cannabinoid based medications to treat a host of indications had no other options to procure it outside of these compassionate state programs. This was a health question. It is very likely that cannabinoid based medicine continues to move away from the plant and further into the lab. Patients that require cannabinoid based therapies are not concerned with cannabis, they are focused on the complex chemical compounds that the plant produces called cannabinoids. There are to date one-hundred and eleven of these cannabinoids identified. Many of them have been proven to have efficacious qualities, most notably to treat spasticity and for palliative care. As science progresses, new ratios and formulations of cannabinoids will be developed to advance where these medicines will be used to treat the infirm. 

Legalizing cannabis for use by responsible adults is a social justice question. These laws were passed simply to allow adults to use a product that has been statistically shown to be less harmful than alcohol without fear of arrest or incarceration. 

There is a very clear bright line distinction between these two laws and the reasons for their respective introduction. The one thing they both have in common, as evidenced by the percentage of voters supporting each, is that they are sensible policy by comparison to cannabis prohibition.

What did the Massachusetts ballot measure get right, and what are you concerned about?  

It is too early to tell either way. The law just passed and has not made it through rulemaking yet. We will see how it is implemented before we will be able to opine on what is right and wrong with it. 

What do you project as the net economic benefit or harm to Massachusetts? What are the key factors to consider?

As James Carville once famously said “It’s the economy, stupid” This law will create many new local jobs both directly tied to cannabis and on the ancillary as well. More importantly, it will take jobs away from criminal enterprises. Previously revenue derived from the sales of cannabis flowed directly back to Mexican cartels, Canada, or local criminal organizations. Now it will all stay in the Commonwealth. Then there are the taxes. Not just the excise taxes, but the Federal and State business taxes, payroll taxes and others. Lastly, the state will not need nearly as much capital for prisons, policing or other programs reliant on cannabis prohibition. You will also see much of this windfall redirected to support social welfare programs. That is good for all citizens in the Commonwealth.

As for harms, there will be a greater need for proper cannabis education and that will cost money. New state agencies or internal departments will be created to oversee the program and that will have related costs as well. Finally, there will no doubt be capital required to treat some users as there is with alcohol and tobacco.

There is tension between US and state law in places like Massachusetts that have voted for legalization. What are the key issues and what is your expectation for how they will be addressed by the incoming Administration and Congress?

I do not think there is enough room to discuss all the related issues in a short article. Things to consider are: the 10th Amendment to the Constitution, The Supremacy clause, the Rohrabacher-Farr amendment, the power of the incoming Attorney General – Jeff Sessions, How Trump or Pence decide to direct AG Sessions, how people close to the administration who are strongly supportive of cannabis progression, such as Peter Thiel or Congressman Dana Rohrabacher, influence the administration policy. 

But the most important issue to consider when addressing any political question is – What is the will of the people? What do they want? Because ultimately, politics is about winning elections and if a politician believes that an issue is important enough to the voters in their district, then they will not likely take a stand against it if they wish to remain in office. At this point in time, there is no doubt how the voters feel about advancing cannabis policy. Almost 60% of the electorate supports adult use cannabis and that is taken from polling across both sides of the aisle in liberal and conservative states alike.

Anything else you would like to add? 

Please take a look at what is being done on the true pharmaceutical side of cannabinoid-based therapy. I am certain that it will alleviate many of your articulated concerns. When you realize that these pharmaceutical and biotechnology companies are conducting clinical trials and are undertaking all the same steps with the FDA as for any other forward thinking drug development, I am certain that it will illuminate that this issue is about helping patients and not about finding a way to back-door legalization. I am happy to point you in the right direction.   


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

Podcast interview with Dexcom CEO Kevin Sayer

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Dexcom “Warriors” surround CEO Kevin Sayer on World Diabetes Day 2016

Kevin Sayer is CEO of Dexcom, and on World Diabetes Day he had the privilege of ringing the NASDAQ bell at the start of the session. I caught up with him afterwards to ask about developments in Continuous Glucose Monitoring.

Here’s what I asked:

  • (0:10) What is World Diabetes Day and what does it accomplish?
  • (0:45) Your company is a pioneer in Continuous Glucose Monitoring (CGM). What is the impact on patients?
  • (1:48) Does CGM replace finger sticks or do you have to do both?
  • (2:23) Is CGM relevant only for those with insulin pumps? Is it useful for people who inject insulin?
  • (3:24) What is an artificial pancreas? How does CGM fit in?
  • (5:15) How do you model the financial impact of CGM for individual patients and for populations?
  • (6:49) How important are online patient communities and data registries, such as T1D Exchange? Do they play an important role in your R&D?
  • (8:11) As we look to 2017 and beyond, what are the next big things we can expect?

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

Mass Health Quality Partners: 21 years young

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Barbra Rabson, MHQP President and CEO

Health Business Group is a sponsor of the upcoming anniversary party for Massachusetts Health Quality Partners (MHQP). I asked MHQP’s President, Barbra Rabson to reflect on the first couple decades.

MHQP is about to celebrate its 21st anniversary. What are you celebrating?

We are celebrating the courage and vision it took 21 years ago to found MHQP, and the amazing two decades of progress we’ve made since our inception. Our 21st anniversary is symbolic of our coming of age and reaching a level of maturity. MHQP has become an important part of the Massachusetts healthcare landscape over the decades thanks to the commitment and hard work of our diverse stakeholders – including patients, physicians, hospitals and payers.  More than 40 sponsors and over 300 people are gathering on November 2 to celebrate MHQP’s unwavering commitment to reliable healthcare measurement and transparency and our pioneering work in the Commonwealth and the nation to systematically capture the patient voice and integrate it into care improvements.

At our anniversary celebration we will be honoring the vision of MHQP’s Founding Circle –Blue Cross Blue Shield of MA, Fallon Health Plan, MA Business Roundtable, MA Hospital Association (MHA), MA Medical Society (MMS), Harvard Pilgrim Health Care (HPHC), Tufts Health Plan and the State (Governor Charlie Baker was a founding member of MHQP when he was Secretary of Administration and Finance).

We will also be awarding MHQP’s first award in honor of the late Richard Nesson, MD, a founding visionary of MHQP when he was the Chair of the MHA Board in 1995 when MHQP was established.  We are delighted that Susan Edgman-Levitan, the executive director of the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital and the founding president of the Picker Institute will be the first recipient of MHQP’s H. Richard Nesson Award.

How has the environment changed in MA over the past 21 years? What role has MHQP played in that?

The healthcare environment is drastically different than it was when MHQP was founded in 1995.  When MHQP first started collecting and reporting comparative statewide performance information, we were the only game in town.  For example, MHQP’s first in the nation statewide patient experience survey of acute care hospitals and public release came a full decade before CMS developed the hospital H-CAHPs survey! Likewise, when MHQP began collecting and reporting statewide clinical and patient experiences measures for ambulatory care, MHQP’s data was the only reliable source for quality benchmarks for our provider organizations.  Before MHQP’s comparative quality reports, Massachusetts provider organizations only knew their own performance scores, they had no comparative benchmarks or best practices to drive performance improvements.  Physician leaders  (Barbara Spivak, Tom Lee and others) have told us MHQP’s performance reports were invaluable to them because our reports became the writing on the wall that they needed to make significant investments in their organization in the form of electronic health records and quality improvement infrastructure to advance their performance to the level they aspired to.

Another big change is that our reimbursement systems now provide millions of dollars of incentives for provider organizations to improve performance.  When MHQP first started the term ‘pay-for-performance’ had not yet been coined.  MHQP has always [encouraged] improvements through public reporting of reliable and trusted comparative performance information – relying on physicians’ intrinsic motivation to perform as well as they can. Now that provider compensation depends heavily on measurement we need to work harder to make sure we have accurate and fair measurements of quality care.

Finally, back in 1998 when MHQP first started reporting on patient experiences of care, patient experience was not considered a core measure of quality.  MHQP’s statewide collection and reporting of patient experience helped draw national attention to the importance of listening to patients, and in 2001 the IOM introduced the concept of patient centered care as a key element of quality care in the Crossing the Quality Chasm Report.

Kindred organizations to MHQP have arisen around the country over the last couple decades. How do you relate to them?

MHQP was one of the first regional health improvement collaboratives (RHICs) to be founded in the country. Gordon Mosser (founding CEO of ICSI in Minnesota) and I organized the first meeting of regional collaboratives in 2004.  As a founding member and past Board chair of NRHI (the Network for Regional Healthcare Improvement), it has been very gratifying to see so many new RHICs being established.  There are now more than 40 across the country.  I have been told by many of the younger RHICs that MHQP was a role model for them when they were first starting out, and I take great pride in that.

What does the future hold?

Great question, and one I have been reflecting on as we have been looking back on our first 21 years. One of the biggest challenges (and one of our greatest failures as a health care system) has been that we have not done a good job engaging our patients as a resource to help us improve outcomes. In many cases we have actively refused to seek input from patients, and when given feedback we have ignored it.  We are now trying to make a 180 degree shift on this, to better engage patients in the co-production of solutions, and it is not easy because it requires a shift in mindset.  I believe that MHQP’s two decades of experience capturing the patient voice and integrating that voice into care improvements positions us extremely well to support our practices and healthcare systems as they embark on this journey.

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

MedSentry: Adherence for complex drug regimens (podcast)

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Medication adherence is a tough challenge, especially for high-risk patients, whose complex drug regimens often feature more than a dozen pills. MedSentry is rolling out an end-to-end closed loop adherence system for this population. Although it’s not a large group, it is responsible for a disproportionate share of medical costs.

In this podcast interview, CEO Adam Wallen and I discuss the following:

    1. (0:11) Adherence is a big problem in healthcare. What does it mean? What’s the nature of the problem?
    2. (0:57) Are there multiple reasons for lack of adherence?
    3. (4:05) There are a number of adherence solutions in the market. How well do they work?
    4. (7:46) What is the MedSentry approach? How is it different?
    5. (11:57) What evidence is there that this approach is effective?
    6. (13:17) You have focused on the most complicated patients. Will that continue to be your niche as your commercialize?
    7. (14:55) Do you have a scale-up plan?

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

Dr. Joshua Newman, GM for Healthcare at Salesforce, discusses telehealth solution

Dr. Joshua Newman, MD, MDHS, Chief Medical Officer, Salesforce

Joshua Newman, MD –Salesforce’s Chief Medical Officer

I really like Salesforce’s Health Cloud approach to patient engagement and am excited to see the company add telehealth to the platform. I caught up recently with Dr. Joshua Newman, who is Chief Medical Officer for Salesforce and also General Manager of Healthcare and Life Sciences.

In this podcast interview we discussed the following:

  1. (0:12) How has the rollout of Health Cloud gone since our last discussion about a year ago?
  2. (2:03) There are other telehealth offerings on the market already. Is the new Health Cloud offering different or better?
  3. (4:21) Who is the target user? Is the telehealth solution aimed at particular types of providers or patients?
  4. (6:55) Is there a return on investment? What drives it?
  5. (9:02) Is this mainly a mobile solution?
  6. (9:55) How does the telehealth solution fit with other Health Cloud offerings?
  7. (12:38) What else can we expect from Health Cloud over the next year?

I came away with the conviction that there is the potential for significant impact as the platform matures, health care-specific partners are brought on board, and as customer/patient engagement practices in healthcare catch up with the rest of the economy.

I’m looking forward to hearing more, especially with the big Dreamforce conference coming up in October.

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