Category: Physicians

Optum buys the former Fallon Clinic. I’m quoted in the Worcester Telegram

published date
July 24th, 2018 by

Optum is a big, successful subsidiary of United HealthCare. In recent years it’s taken to buying up provider organizations including physician practices. Optum is pouring $250 million into the acquisition and expansion of Reliant  Medical Group in Worcester, outbidding traditional providers and injecting new competitive juice into the market.

Reliant –formerly Fallon Clinic– has 2600 employees and is almost 90 years old. Here’s what I told the  Worcester Telegram:

“A lot of these systems are under strain,” said David E. Williams, president of the Health Business Group, a Boston-based consulting firm. “I think what you’re seeing at the same time is there are some national organizations, health plans and companies like Optum that do have a lot of capital and that have diversified businesses that are looking for growth opportunities.”


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

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

published date
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.

Patient-centric payments: Interview with HealthiPASS CEO Rajesh Voddiraju

published date
March 19th, 2018 by

 

HealthiPASS CEO Rajesh Voddiraju

Patient payments are a real friction point in the US healthcare system. Patients don’t understand what they owe, and doctors usually can’t help them figure it out. HealthiPASS is doing its best to solve these problems with a consumer-friendly approach that pays off financially for providers.

In this podcast interview, HealthiPASS CEO, Rajesh Voddiraju answers my questions about how it all works.

Overview:

  • (0:17 )What are the problems with patient payments today?
  • (2:40) What have physician offices been doing about it about it? How successful are those efforts?
  • (6:30) How does HealthiPASS work?
  • (11:50) With the four steps it sounds like you are allowing the physician office to educate the patient about the extent of their financial obligations under high deductible plans. Is that right?
  • (13:09) How does the system interact with existing practice management systems? What is the impact on the office workflow?
  • (18:51)The value proposition for physician offices is pretty clear, but what about for patients? Is it in a patient’s interest to use this system?
  • (21:37) What are you doing to increase adoption?
  • (26:08) How do you expect the market to evolve?

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

Amazon: Force the healthcare system to become patient-centric

published date
February 6th, 2018 by

The announcement that Amazon will work with JP Morgan Chase and Berkshire Hathaway to create a new healthcare organization for employees has health plans and providers running scared. Initial press coverage has focused on the impact of this group on the market value of CVS, United Healthcare and the like –but how many people really care about that?

CareCentrix CEO John Driscoll has the right idea when he suggests that Amazon should compel provider organizations to put the patient first –for real, not just rhetorically. His three specific suggestions are good ones: mandate self-service scheduling, introduce  a universal patient portal, and improve the quality of provider reviews. As simple and straightforward as those sound, they would require Amazon and its partners to overcome serious resistance. It will be fascinating to watch what happens.

Assuming Amazon can make those basic but challenging changes come to pass, I have two additional, ambitious suggestions to help patients:

  1. Ensure that patients receive clear, consistent, actionable follow-up information when they leave a doctor’s appointment or are discharged from the hospital.
  2. Use the full set of information available about a patient to anticipate their needs and help them navigate the system.

The first idea is a simple one, which should be happening anyway, and occasionally does. The challenge is to get the provider system to care enough about what happens upon discharge and provide the tools, training, information and support to enable more seamless and empowering transitions. I was shocked at how poor the discharge instructions were after my release from the emergency department a few months ago, after I was struck by a car. I received basically nothing and had to count on family and clients in the medical system to help me. I know I’m not the only one who’s had this experience.

The second idea is broader and vaguer, but starts to draw on the expertise of Amazon’s partners who are in the financial services and insurance industries and have a lot of information about their customers. The consortium could help patients chart their financial path through the healthcare system, helping them identify what insurance to select, how much to save in their HSA and FSA, and where and when to get their care. It could be a virtual concierge for patients, relying big data and machine learning to provide insights and continuous improvement.

If these suggestions were implemented they would have a high impact, even though they would not completely transform the system. It seems like about the right level for this group to shoot for. If they try to be bolder they will likely fail.

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

BPCI Advanced: Archway’s Dave Terry tells you what you need to know (podcast)

published date
January 29th, 2018 by
Dave Terry. CEO Archway Health

Obamacare appears to be under unrelenting attack, yet the law’s push toward value based payments seems to be alive and reasonably well.  The Center for Medicare & Medicaid Innovation, which was established under Obamacare, has just announced a new episode payment model, called BPCI Advanced.

In this podcast interview, Archway Health CEO Dave Terry talks about the evolution of value based payments, and makes the surprising assertion that voluntary programs may ultimately be more successful in transforming our healthcare system than mandatory ones.

Overview:

  • (0:11) What is value based care?
  • (1:17) When people think about value based payment, usually they think about ACOs. What else is there?
  • (2:15) How are these models evolving?
  • (4:26) Having fewer metrics sounds great. But do the remaining metrics need to be more complex or measured more precisely?
  • (6:18) What’s the connection between value based care and the Affordable Care Act?
  • (8:17) The new program is voluntary, whereas under Obama we were moving toward mandatory programs. What are the implications?
  • (10:18) What is BPCI Advanced? What do providers need to know about it?
  • (12:52) Say more about post acute care. Why can’t post acute providers be episode initiators?
  • (14:17) Explain how DRGs could go from hospital-only to global?
  • (14:50) How is Archway involved in BPCI Advanced?
  • (16:55) Medicare is the driver, but what is the role of commercial payers?


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