Health Business Blog

Health care business consultant and policy expert David E. Williams share his views

SafeRide Health looks to improve care through better transportation. Podcast with the co-founders

Need a ride?

SafeRide Health is focused on redesigning the non emergency medical transportation experience to reduce patient risk and streamline care coordination. In this podcast interview, co-founders (and brothers) Robbins and Whit Schrader talk about how losing a friend to DUI in their teenage years got them started down the entrepreneurial path to what became Saferide.

Overview

  • (0:10) What are the main challenges in medical transportation?
  • (0:47) What is the impact?
  • (2:04) What is NEMT? How well does it work?
  • (3:16) There is a revolution going on with transport, especially companies like Uber and Lyft. Lyft is a partner. How does that work?
  • (4:21) What is the experience like for the typical patient? How does it vary depending on whether or not you are involved?
  • (6:12) You said you can drive the no show rate down by half for one client, just by improving transportation. Is that replicable?
  • (6:57) How did you come up with the concept for this company? How does it go as brothers working together?
  • (8:05) How do markets differ: urban/rural, different geographies? Can it work outside of cities?
  • (9:29) Where are things headed? How much tie in is there with healthcare delivery?
  • (10:30) How do autonomous vehicles fit in?
  • (11:23) When you work with Lyft, does the driver know they’re getting a patient versus a regular retail customer?

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

Partners/Harvard Pilgrim merger madness: I’m quoted in the Boston Globe

Beast of the East?

I just finished my post (Partners and Harvard Pilgrim aren’t really going to merge are they?) when I got a call from the Boston Globe asking about the same topic.

I’m quoted on the front page today (Experts puzzle over Partners-Harvard Pilgrim merger talks) and am happy to see I’m not the only one that is struggling to see the logic behind such a combination.

Here’s what I said:

“My guess is that regulators would not like this,” said David E. Williams, president of the Boston consulting firm Health Business Group. “There’s no compelling logic for a merger here. There would be a lot of resistance to it.”

Williams said he doesn’t see a good business reason for a merger since Partners and Harvard Pilgrim, one of the largest health insurers in Massachusetts, could choose to work together more closely while remaining independent.

I’m pretty sure the idea of a merger won’t get very far. Stay tuned.


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

 

Partners and Harvard Pilgrim aren’t really going to merge, are they?

Friday’s news was full of stories about merger discussions between Partners HealthCare and Harvard Pilgrim Health Care. No one denied the reports, so we can assume there’s some truth to the rumors. But why would these organizations contemplate a merger and how likely is it to happen?

From Partners’ perspective:

  • After growing for decades by taking over other providers, Partners has run out of options for major acquisitions. The state blocked Partners’ attempt to buy South Shore Hospital, for example. Meanwhile, Partners’ biggest rival, Beth Israel is becoming more formidable as it combines with Lahey. In some ways a Partners/Harvard Pilgrim merger would be analogous to the proposed Aetna/CVS combination, which was pursued only after Aetna’s planned purchase of Humana was rejected on antitrust grounds.
  • After buying Neighborhood Health, Partners is comfortable with the idea of owning an insurer. But they want one that’s bigger and focused on the commercial market rather than Medicaid.
  • The shift to value based care means providers need more of the capabilities typically found within health plans. This becomes a buy v. build decision.

From Harvard Pilgrim’s perspective:

  • Even though it’s not the number one player in the market, it too may be too big to get away with acquiring a significant competitor, e.g., Tufts Health Plan.
  • The Partners account itself actually has about 100,000 members. Shifting that business away from Blue Cross could be significant even on its own. (Although it kind of reminds me of the Cheech and Chong sketch where Chong proclaims himself a “good customer” –of himself).
  • Possibly, Harvard Pilgrim could gain an exclusive relationship with Partners, where the only way to get care at Partners is by purchasing a Harvard Pilgrim plan. That doesn’t seem likely, but who knows?

Overall

It’s not unusual for health plans and providers to consider tying up. Remember, Harvard Pilgrim’s predecessor, Harvard Community Health Care was a staff model HMO with its own physicians and care facilities. More recently, you see combined payers and providers (“payviders”) emerging in the Medicare Advantage space. There is a certain appeal to combining health insurance and delivery in one entity–Kaiser is Exhibit A– but ultimately it’s not such a superior model.

I don’t think a merger of Harvard Pilgrim and Partners has a compelling rationale and I don’t see it happening. More likely is some kind of limited alliance or joint venture.

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

 

Simplify Healthcare CEO Mohammed Vaid on helping health plans with administrative automation (podcast)

Simplify Healthcare CEO Mohammed Vaid

The average consumer might not know it, but health plans are often mired in complexity and inefficiency as they struggle to configure and deploy new offerings. A surprising number of plans rely on spreadsheet-based systems to manage their plan benefit packages —  a surefire formula for driving up labor costs and making errors. Some have spent tens of millions of dollars trying and failing to automate theses processes.

In this podcast interview, Simplify Healthcare CEO Mohammed Vaid shared his perspective on this problem and its solution.

  • (0:14) What are some of the main inefficiencies you see with health plans?
  • (3:44) Are these problems widely recognized within the plans?
  • (5:08) Have they become more of an issue recently?
  • (7:12) What approaches have been taken to address these problems?
  • (10:12) What are the more promising ways to address these issues, perhaps starting with benefits?
  • (12:12) To what extent have such enlightened solutions been implmented? Are there success stories out there?
  • (14:10) Tell me about Simplify Healthcare and how your company gets involved. What’s the experience like for a customer?

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