Health Business Blog

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

The 30 Years’ War for value-based care: Podcast with Archway’s Dave Terry

When Dave Terry started his career in healthcare three decades ago, he noticed something odd and disturbing. The fee-for-service model meant doctors were paid for quantity, not for quality or cost effectiveness. Since then he’s been working to do something about it: for the first twenty years at American Practice Management, then Partners Healthcare and Harborside Healthcare. He made progress, but also learned the limitations of acting against entrenched interests.

For the last decade he’s gotten even more serious, co-founding Remedy Partners in the wake of the Affordable Care Act and then Archway Health, where he is CEO. Archway helps physicians jump into the meaningful risk-based payment models that are finally on offer from the Feds and private carriers.

I compared Dave’s quest to the Thirty Years’ War, but reminded him that there was a Hundred Years’ War, too, so he better gird himself.

The HealthBiz podcast is now on SpotifyApple PodcastsGoogle Podcasts and  many more services, making it easy to subscribe.

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

Pharma jumps into digital health: Podcast interview with Medullan CEO Ahmed Albaiti

The HealthBiz podcast is now on SpotifyApple PodcastsGoogle Podcasts and  many more services, making it easy to subscribe.

The pharmaceutical industry is one of the last to be transformed by the digital revolution. But companies like Roche and Novartis have been experimenting for a long while, and the fruits are finally ripening.

Medullan CEO Ahmed Albaiti is a digital health pioneer. In this episode of the HealthBiz podcast, he takes us on a trip down the memory lane of digital health, sharing pharma’s successes and failures. We discuss the shock brought on by COVID-19 and why software is often classified as a medical device. He also shares his vision for an integrated and harmonized future for pharma, payers, providers –and patients.

I’m proud to serve as chairman of Medullan’s advisory board.

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

Coordination of benefits. Which plan is primary?

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Get your act together!

I received a couple of ominous looking letters from Boston Children’s hospital, letting me know that my claim has “been suspended” by my insurance carrier, Blue Cross Blue Shield of Massachusetts.

Unlike a couple months ago, when Blue Cross accidentally cancelled my family’s entire policy (oops!) while trying to remove an adult dependent at my request, this time it was due to a “coordination of benefits” issue.

Here’s the situation. Another dependent of mine is a college student in a different state. Our Blue Cross HMO doesn’t work out of state, so we buy an additional insurance plan from the college. (Also one more policy for varsity athletic participation, but that’s another story!)

When this dependent had services at Boston Children’s, we listed the Massachusetts plan as primary. But at least according to the BCBS MA rep I spoke with today, the out-of-state plan should be primary because my dependent is the subscriber, unlike on our family plan where they are listed as a dependent. So even though the out-of-state plan is likely to deny the Massachusetts claim as out-of-network, we need that denial first before submitting to BCBS MA. Make sense?

Oh, and to make things a little more complex, the rep said I need to ask the other plan if they follow the “standard coordination of benefits rules.” Apparently some student plans don’t.

What fun!

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

Congratulations to Boston Children’s new CEO, Dr. Kevin Churchwell

I met Dr. Kevin Churchwell, the new CEO of Boston Children’s Hospital a few years ago. He impressed me then, and I’m excited that he has been named as the new CEO, following the retirement of Sandy Fenwick.

He’s a physician and business leader, and has already run a prestigious pediatric academic medical center, the Nemours/Alfred I. duPont Hospital in Wilmington, DE.

As a parent of kids who have received incredible care there, I have a special fondness for Children’s. I’m excited by this choice of CEO.

Bravo!

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

iPhone and iPad in healthcare: Podcast with DrChrono’s Daniel Kivatinos

The HealthBiz podcast is now on Spotify, Apple Podcasts, Google Podcasts and  many more services, making it easy to subscribe.

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Daniel Kivatinos

Like many healthcare entrepreneurs, Daniel Kivatinos was a tech guy whose bad personal experience with the healthcare system led him to try to make things better. The founding of DrChrono a decade ago coincided with the birth of the iPad and iPhone, and the company has been closely linked to Apple hardware ever since. In fact, Daniel is such a hardcore Apple guy that he recommends buying two Apple watches so you can wear one while the other is charging!

In this edition of the HealthBiz podcast, Daniel charts the history of DrChrono and shares what’s coming next with the Apple Watch, artificial intelligence and more.

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