Category: Health plans

Preparing for value based payments. Podcast interview with MediQuire CEO Emily Chen

June 18th, 2018 by
MediQuire CEO Emily Chen

Despite all the noise and dysfunction on healthcare in Washington, DC, the move toward value based payments is continuing apace. But providers and payers continue to straddle the fee-for-service and value-based worlds, slowing and complicating the transition.

MediQuire helps providers and payers measure, improve and get financial reward for improvements in performance and patient outcomes. In this podcast interview, CEO Emily Chen and I discuss:

  • The current state of affairs in value-based payment
  • How the value-based movement has changed (or not) since the new administration arrived in office
  • The key capabilities needed for success
  • How MediQuire helps
  • What the future holds

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

Massachusetts healthcare turmoil: I’m quoted in the Boston Globe, Herald and CEO Magazine

June 13th, 2018 by

I’m always happy to speak with the press to provide my take on healthcare business and policy. In the last few days I’ve been quoted in a few outlets:

Today’s Boston Globe: In a sudden departure, Harvard Pilgrim CEO resigns amid questions about his behavior

Harvard Pilgrim and Partners each said Tuesday that Schultz’s resignation does not affect their discussions about a possible merger.

But David E. Williams, a Boston health care consultant, predicted the leadership change at Harvard Pilgrim would slow any other major moves by the insurer.

“I think it reduces the chance that a deal will happen, especially in the near term,” Williams said. “The Harvard Pilgrim board can’t deal with two major things at once. Partners will want to wait and see if something else shakes out at Harvard Pilgrim.”

Today’s Boston Herald: Harvard Pilgrim CEO resigns over ‘behavior’

Neither Schultz nor a company spokeswoman would comment on the nature of his behavior, or whether he is receiving any severance payments.

“I think the board is likely to be sensitive to that topic here,” said David Williams, president of Health Business Group. “Any expense is going to be borne in some ways by the customer.”

Yesterday’s Boston Globe: Beth Israel and Lahey say they want to learn from missteps in earlier merger

Beth Israel Deaconess and Lahey do seem to have much in common. Both have flagship medical centers and a network of community hospitals. Both are considered high-quality, and they have lower costs compared with the region’s largest hospital network, Partners HealthCare. On their own, both have struggled to compete with Partners, which includes the renowned Massachusetts General and Brigham and Women’s hospitals.

“There’s a decent amount of compatibility and similarity,” said David E. Williams, president of Health Business Group, a Boston consulting firm. “BI and Lahey spent a lot of time getting to know one another and making sure that this is a good fit.”

The current edition of Chief Executive: Athenahealth CEO Jonathan Bush resigns: Avoiding a similar fate

In both cases, Sonnenfeld says the boards didn’t have the fortitude to stand up to the attacks. David E. Williams, president, Health Business Group in Boston, similarly seen this scenario play out before where a founding CEO is ousted by investors.

“It actually usually happens at an earlier stage than what you’re seeing here. What’s so noticeable here is that [the CEO] has been involved with the company for a long time and is a large publicly-traded company,” Williams says.


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

 

 

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

May 9th, 2018 by
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?

May 7th, 2018 by

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)

April 23rd, 2018 by
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.