Health Business Blog

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

Dr. Chris Hobson
Dr. Chris Hobson

Orion Health has been the Health Information Exchange (HIE) business around the world for more than 15 years. In this podcast, Chief Medical Officer Chris Hobson and I discuss the past, present and future of health IT.

Topics include:

  • (0:12) There are a lot of buzzwords in health IT: interoperability, population health, precision medicine. What is their relevance?
  • (3:07) What new buzzwords will we encounter as we head into the new decade?
  • (8:07) Health Information Exchanges have been around for 15 years. Have they succeeded? How will they evolve?
  • (12:05) You operate around the world. What are some differences and similarities you see with the US system? What can we learn from abroad?
  • (17:00) How do the priorities of payers and providers differ?
  • (20:16) What are the implications of new legislation focusing on interoperability? TEFCA? 21st Century Cures?

 

 

Partners dissolves into Mass General Brigham. I’m quoted in the Boston Globe

Massachusetts General Hospital and the Brigham and Women’s Hospital joined together as Partners HealthCare 25 years ago. Now they’re changing the name to Mass General Brigham, spending up to $100 million in the process. I’m quoted on the subject in a recent front page Boston Globe article (In major rebranding, Partners HealthCare to change name to Mass General Brigham).

What’s in a name, you may ask? In this case it’s worth parsing the change and exploring the history.

What does Partners mean anyway?

Partners HealthCare never had much brand equity. The word “partners” really described the decision of the two hospitals to partner with one another to offset the power of managed care organizations to play them off against one another. All HMOs needed one of those hospitals in their network, but not both. With Partners it was all or nothing. Partners had no problem playing “take it or leave it” right from the get go, nearly bringing Tufts Health Plan to its knees in the late 90s.

So unlike your typical business combination, which relies on elimination of duplication and other efficiencies to be successful, Partners succeeded right away by virtue of its enhanced market power and high pricing. Duplication remained –and remains to this day. MGH and the Brigham continued to move forward on their own while a new Partners overhead was introduced. No one –not patients, not doctors, not nurses– developed any attachment to Partners as an entity.

Why keep General?

Massachusetts General Hospital has kept the same name since its charter was granted by the Commonwealth of Massachusetts in 1811. It’s a proud name, and maybe sometimes a little too proud. (Some say MGH stands for Man’s Greatest Hospital.)

“Massachusetts” is shortened and “Hospital” is omitted from the new name. Of all the words to keep, why was “General” left intact? It seems so… generic. But it also reminds us of the grand era of American industry. General Motors. General Electric. General Atomics. (Remember that one.) The idea was that the one General company could dominate the industry and we’d all be the better for it.

Outside of this state, errr… Commonwealth, “Mass” doesn’t necessarily mean Massachusetts. It could mean a Catholic Mass or a big pile of something. But MGH is so often referred to here and abroad as Mass General that it must have seemed safe to trim it down officially, since the whole name is long anyway.

Where did the Women go?

How did Brigham and Women’s Hospital (BWH) get its name? Unlike MGH, BWH went through some name changes, although none recently. The Boston Lying in Hospital was founded in 1832 and the Free Hospital for Women came about in 1875. They merged in 1966 to become the Boston Hospital for Women. (Apparently that name didn’t stick right away, since I was always told I was born in the Lying in Hospital –even though I was born after the merger.)

In 1980, the Peter Bent Brigham Hospital, Robert Breck Brigham Hospital and Boston Hospital for Women merged (not partnered) to become BWH.

If they had called it the Women’s and Brigham the Women’s name might have survived the latest consolidation rather than being unceremoniously lopped off.

GSK not G SK

Back in the 1980s and 1990s a lot of big pharmaceutical companies merged. It was typical for them to drop the last name of their multiword names when they did. For example, SmithKline & French became SmithKline Beckman after merging with Beckman and then SmithKline Beecham after merging with Beecham.

When Glaxo Wellcome and SmithKline Beecham came together they followed a similar path. But you may notice they went with GlaxoSmithKline rather than Glaxo SmithKline, because the SmithKline people thought that would make it harder to get rid of their name later on. That’s a true story. I was there.

The stratagem has worked so far.

I wonder whether the BWH folks lobbied for MassGeneralBrigham to avoid a similar fate down the road.

When did Hospital become a bad word?

Remember when there were doctors and hospitals? Now it’s providers, medical centers and health systems. Hospitals still dominate economically and politically, but there is a general (and welcome) shift to lower acuity settings of care. Meanwhile Partners has vacuumed up so many other hospitals, physicians and other players that “hospital” no longer belongs in the name.

An interesting marker of the new company’s brand equity and name recognition is that unlike virtually every other new healthcare organization or company, it omits the word “health” from its name. People already understand it’s a healthcare organization.

What about Harvard?

MGH and BWH are both Harvard hospitals. So why not just call it the Harvard Hospital System or Harvard Health System? The use of the Harvard name could be a topic for its own post (Harvard Pilgrim –originally Harvard Community Health Plan and soon to merge with Tufts but with no name announced yet– is a great example) but the simple answer is that while MGH and BWH are Harvard hospitals, there are others like Beth Israel Deaconess and Boston Children’s that are also affiliated with the University.

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

Don’t worry, be happy with your health plan!

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The Likes have it

Joe Biden said in a recent debate, “one hundred sixty million people like their private insurance.” I agree with Biden’s assessment that it’s foolish to advocate scrapping insurance companies as his rivals Elizabeth Warren and Bernie Sanders want. It’s stupid politically to take such an extreme view and it’s also worth noting that other countries with nationalized health insurance (like the UK and Germany) have private insurers, too.

Still, what does it mean to say people like their private health insurance? I suppose I would be counted in that number. And, by and large I would say I do “like” my insurance, which is with Blue Cross Blue Shield of Massachusetts. They cover the doctors and hospitals I want to use and the drugs my family takes. Their customer service is good. Their website is ok. They’re flexible in their approach to enforcing policies.

The problem is the cost, which soared to about $2800 per month for family coverage, even for a high-deductible plan. At a colleague’s suggestion, I switched to an even higher deductible plan –which is also one where you have to pay for your own prescription drugs within that deductible instead of the first-dollar coverage I had previously. So while the premium dropped by several hundred dollars a month, I ended up with a co-pay on a generic drug of over $1000 –which would have been $100 before.

And did I mention that since it’s an HMO I needed to buy separate insurance for a dependent who’s at school out of state? And that the out-of-state insurance doesn’t cover expenses arising from participation in college sports? So I had to buy a third policy.

I don’t really blame my health insurer for the high and rising premiums. The main driver is the price of healthcare procedures, which continue to go up. I’ve been healthy, but still routinely see bills for my care in the thousands of dollars that would cost hundreds at most in other places. Some of that cost is attributable to the paperwork burdens imposed by the plans.

Warren and Sanders have a point about problems with health insurers and the lack of universal coverage. But in my view, the real way to address problems in the US healthcare system is to build on Obamacare, focusing not just on coverage (which Obamacare provides, especially if Medicaid expansion is fully implemented), but also on the cost, efficiency, and appropriateness of the care provided.

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

 

 

Check out #CareTalk @HLTH2019

CareCentrix CEO, John Driscoll and I talk #CareTalk on the road to the HLTH conference in Las Vegas, where we interviewed some big names include Obamacare architect Zeke Emmanuel, Former CMS Administrator Andy Slavitt, Former Congressman Patrick Kennedy, Walmart Health exec Marcus Osborne, and Boston Children’s Chief Innovation Officer John Brownstein.

You can check out the whole series on the YouTube playlist.

The healthcare cost revolution will not be televised either

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Coming to a TV near you

The quote at the end of yesterday’s Boston Globe article (Consumers struggle to find information on health care costs, poll shows) made me laugh.

“We’re seeing more and more consumer awareness every year,” [an insurance executive] told the Globe. “It’s a revolution that’s occurring, but it occurs over time.”

When I read about this ‘revolution’ it brought to mind an expression/poem/song from long ago: The Revolution Will Not Be Televised! The timeframe for the healthcare cost ‘revolution’ is on the order of decades, and I don’t think anyone will be able to sit still for a TV show of that length!

Not surprisingly, the Pioneer Institute’s survey demonstrated that while people with commercial insurance are interested in obtaining  price information before receiving a healthcare service, they don’t often get it. Only 2 to 7 percent of people check costs on insurers’ websites, according to the Attorney General.

Although that number seems crazily low, it’s actually easy to understand once you consider the multitude of the barriers:

  1. Patients don’t know what services they’re going to need
  2. Choice of provider often trumps cost as a factor
  3. Their health plans may not reward or punish them for saving or spending more money
  4. Next year’s insurance premiums are unaffected by what they do this year
  5. Those with a high deductible plan are likely to blow through the deductible anyway if they have serious medical expenses
  6. Insurers’ cost estimators aren’t easy to use
  7. The estimates may not be accurate anyway
  8. People haven’t heard about the available tools

I’m an educated consumer with a high deductible plan but I don’t try to check the costs ahead of time.

So there’s no need to be glued to your TV (or other device) watching this ‘revolution.’


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