Health Business Blog

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

#CareTalk July 2019. Democrats and HealthCare -The Great Debate

In this edition of #CareTalk, CareCentrix CEO John Driscoll and I discuss the impact of healthcare on the Democratic presidential race.

(0:36) What impact are the TV debates on healthcare having on the Democratic presidential race?
(2:30) Arkansas has been testing out a Medicaid work requirement. What do the results tell us?
(4:30) What should be made of the OpenNotes initiative in Massachusetts, which allows patients to access their doctors’ clinical notes about them?
(7:12) New doctors continue to avoid primary care. Does that matter?
(9:20) Did David avoid getting bit by a shark during his Cape Cod vacation?
(10:16) A judge struck down Trump’s rule to make drug makers disclose prices in TV ads. Does it matter?
(11:01) Is Alexa bad for healthcare?
(11:30) Co-design is a new healthcare buzzword – but how important is it?
Subscribe to the #CareTalk Podcast iTunes: https://apple.co/2DIDTcr Google Play: https://bit.ly/2RobqMB

Partners HealthCare. Too big to succeed?

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Too big to nail?

Question: How do you know when a non-profit healthcare organization is getting too big?

Answer: When it’s considering spending over $100 million to change its name.

Partners HealthCare was founded in 1994 when Massachusetts General Hospital and the Brigham and Women’s Hospital decided to team up (“partner”) to defend themselves against Blue Cross and Harvard Pilgrim, which for a brief moment had gained the upper hand as managed care caught on. As a new MBA at the Boston Consulting Group, I remember seeing the projections: MGH and the Brigham were going to be in trouble as Massachusetts copied California and drove down hospital utilization.

Insurance companies didn’t need to include both MGH and the Brigham in their networks–so they tried to play them off against one another to get better rates. That’s why Partners was created.

The two hospitals never wanted to merge and in the end they didn’t have to. The healthcare economy boomed, no one could exclude Partners from their network, and Partners was able to use its muscle to do very well in managed care contracting.

Partners got its act together and executed well, especially compared to its local academic and community-based competitors.

A quarter century later, the original partners have acquired several other hospitals and physician organizations. It’s the biggest private employer in Massachusetts by far, and rivals the state government itself in terms of workforce size.

Lately the company has had to deal with its success. Healthcare costs are a big issue in Massachusetts –as they are elsewhere– and Partners is in the crosshairs. The company is built for market power and clinical excellence, which does not lead to the lowest cost approach. And leaders within the Partners hospitals have been reluctant to cede authority to the central organization.

Something has to change. In particular Partners has to do a better job of integrating its various components –or so goes the conventional wisdom.

New CEO, Dr. Anne Klibanski was mostly recently the head of research for Partners.  She’s touted as a great listener, and good at getting people to collaborate. But as I told the Boston Globe (New Partners Chief no stranger to role of uniter)

As a good listener, Klibanski could successfully unite the various factions at Partners. “On the other hand,” [Williams] said, “listening might not be the issue. Partners might need someone to bang people’s heads together.”

Now comes word that Partners is thinking of investing $100 million in changing its name to something more alluring like Mass General Brigham Health. It could be worth it to Partners by bringing the different factions together and for marketing and fundraising purposes. (For sure it will be great for branding and marketing agencies!)  But what does that say about the state of healthcare in Massachusetts?

An expert quoted in the Globe (As Partners HealthCare rethinks its strategy, it’s considering whether to change its name) said it best:

“I don’t think those names matter to ordinary human beings who get health care in our state,” said Alan Sager, a professor at the Boston University School of Public Health. “The underlying fights about decentralized versus centralized power are internal matters for Partners. I don’t think they should plague the public with their own organizational anxieties.”

Partners has great hospitals and great people that make it the pride of Massachusetts. It does make business sense for Partners to consider rebranding. But that doesn’t mean it’s good news for the finances of those footing the bill.

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

 

The United Provinces of Canada (at least on healthcare)

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Happy and Healthy?

Happy Canada Day!

We usually think of Canada as a divided nation, with the province of Quebec perennially at odds with the rest of the county and threatening to secede. I was in Montreal over the weekend and it’s fair to say there wasn’t much evidence of enthusiasm for the upcoming Canada Day (the rough equivalent of our 4th of July).

And yet, at least when it comes to healthcare policy, Quebec is very much at peace with the rest of the country.  From the Montreal Gazette (Quebecers united with Canadians on health, divided on language, hockey):

When it comes to stoking national pride, Canadians and Quebecers are united in their appreciation for universal health care and the Canadian passport. They also see eye-to-eye on the importance of the monarchy, Air Canada and Tim Hortons as national symbols, in that they don’t find them particularly important.

A national survey asked the question, “How important are each of the following as a source of personal or collective pride in Canada?”

Universal healthcare scored highest. Seventy three percent of Canadians and 70 percent of those from Quebec ranked it as very important. Anglophones and Francophones responded the same way.

We usually think of the United States of America, but when it comes to healthcare that is certainly not the case. If anything, Americans might be united against the idea of a Canadian-style system.

Kind of odd, then that the people living under that regime are so proud of it.


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

Should ICER be NICER? The case for analyzing the value of drugs

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It’s a tree of ICE, for those who hold fast to it

The headline in today’s Boston GlobePrice watchdog’s influence on drug makers expands; As nonprofit assesses treatments, some fear it inhibits key options— could have been written by a drug industry lobbyist. [And maybe it was, since the online headline instead uses the squeaky phrase ‘mouse that roared.’]

The article itself is more balanced. Of course it quotes the parents of a couple of kids who take expensive meds, objecting to anyone putting a price tag on their lives. But it also quotes health economics experts pointing out that the price can’t be infinity.

The Institute for Clinical and Economic Review (ICER) follows a data-based approach to assessing the value of drugs, utilizing Quality Adjusted Life Years (QALY) and other well developed metrics. It provides guidance on what a drug could be worth, both on an absolute basis and relative to other treatment options. It doesn’t set prices or prevent a drug from being made available by a public or private health plan. At most, it helps contain the prices of drugs that enter the market and points out cases of outright rip-offs.

Elsewhere in the world (pretty much everywhere) there are real forces limiting drug prices and impacting access. In the UK for example, the National Institute for Health and Clinical Excellence (NICE) decides which drugs and treatments will be provided to patients in the National Health Service. Sometimes drugs are rejected or their use is heavily restricted. On the flip side, patients don’t pay for the drugs that are approved.

In the US the drug pricing forces are heavily weighted in favor of higher prices. We shouldn’t fret about an entity like ICER.

Many drug companies have decided to play ball with ICER by providing data to help justify the value of their products. Some, like Vertex and Serepta have pulled back, saying ICER is biased against drugs for rare diseases. I don’t read ICER’s analyses that way.

The quality of ICER’s research is high, but of course the reports are limited by the data and analytical techniques that are available to the organization. The correct response is to build up the availability of real world evidence (RWE), especially from clinical registries that demonstrate how a drug actually improves (or doesn’t improve) the lives of patients. Patient-generated data and information from claims and electronic medical records can be helpful as well.

With better data we can have answers we are more confident in, and we can accumulate evidence on how drugs perform after they are launched, which can offer a refined understanding of their value.

Thanks to the 21st Century Cures Act, enacted in 2016, there is an increased demand for the generation of RWE. The industry is ramping up its spending on RWE for drug approval, safety monitoring, and reimbursement. New analytical techniques and enhanced data availability from wearable devices and other electronic sources are ushering in a heyday for RWE.


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

 

 

Circling the wagons in Rhode Island: I’m quoted in the Boston Globe

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I’m getting tired of this

Looks like Rhode Island would rather create a health system monopoly than allow in a competitor from Big Bad Massachusetts. Partners HealthCare has been trying to acquire the second largest hospital system in RI, but now the governor has pulled together the three biggest systems to see if they can come together instead.

Partners is staging a tactical retreat (see Partners pulls out of talks for Rhode Island health system) in the Boston Globe.

Thankfully, I am not privy to the details of how things operate in Rhode Island and I don’t know how hard these three systems’ heads are being banged together to get them to team up. But my guess is there’s a good chance the parties will fail to coalesce and that Partners will be back.

Here’s what I told the Globe:

“It was clear that some of the powers that be in Rhode Island want to maintain a Rhode Island-dominated health care system,” said David E. Williams, president of Health Business Group, a Boston consulting firm.

“I don’t think it’s actually going to solve any of their economic problems,” Williams said, “and I think it’s reasonably likely that Partners will be back at the table in three to six months after Rhode Island determines that going it alone is not viable.”

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