Category: Research

Food for health

January 22nd, 2018 by

Fatty, high calorie foods are relatively inexpensive in the US, while fresh fruits and vegetables are expensive, especially in cold weather states but even in agricultural centers. That’s one reason why lower income families often have unhealthy diets.

The SNAP program (aka food stamps) tries to encourage healthy eating on a budget through its SNAP-Ed Connection, but provides few incentives for the purchase of healthy foods or disincentives for the unhealthy stuff.

So I was pleased to see a Kaiser Health News article (When Food Stamps Pass As Tickets To Better Health) on a US Department of Agriculture pilot program called Mas Fresco, which provides funding to induce food stamp recipients to purchase fruits and vegetables.

In theory, the program will encourage healthier eating, which will lead to better health, a reduction in chronic disease, lower healthcare costs, higher productivity and income. It could reduce quality of life and economic disparities. There’s no guarantee that the program will achieve these results, but it strikes me as a good use of federal dollars to give it a try.

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


Clinical registry solution market heads toward $2 billion

September 20th, 2017 by


Specialty medical societies such as the American College of Cardiology and American College of Surgeons sponsor clinical registries that collect observational data on patients with specific conditions or procedures, such as heart failure or joint replacement. This “real world” evidence helps hospitals improve quality of care, meet state and federal reporting requirements, and achieve pay-for-performance bonuses.

Q-Centrix, which provides technology and services that enable hospitals to participate in registries, commissioned Health Business Group to conduct a market sizing and growth study. We found that the market will reach almost $2 billion over the next five years. Q-Centrix is offering a complimentary download of the findings.

Clinical registries have been around for decades, but in recent years they have become central to achieving quality in healthcare delivery. Registries have proved their superiority over other approaches such as electronic medical records and traditional clinical trials, and are being embraced by accrediting organizations, commercial health plans and federal agencies such as FDA and CDC.

Hospitals continue to gain experience with registries and are deriving more and more value from them over time. However, in a digital, automated world, participating in registries is still a remarkably manual and time consuming process. Each patient record for the registry must be “abstracted” according to the specific requirements of that registry and then submitted securely and accurately. Some registries provide software tools to help, but even then the tool is only useful for a specific registry. That’s cumbersome for hospitals that participate in multiple registries, a big issue since hospitals often participate in 10 or more.

Hospitals have rationalized other manual, labor intensive administrative processes by outsourcing. Medical transcription is a good example, where the use of outsourcing and automation are now the norm.  The same approach is being taken in the registry world, which is why companies such as Q-Centrix are thriving.

At Health Business Group, we were excited to conduct research into this dynamic and growing market, especially since there was very little information published about the topic. To formulate our projections we reviewed secondary data sources, leveraged the Health Business Group knowledge base, and conducted interviews with dozens of hospitals, specialty societies, market experts, and industry participants. We also fielded an online survey of hospitals to develop a detailed understanding of industry trends and their root causes.

Health Business Group specializes in the assessment of healthcare markets and development of growth and M&A strategies for healthcare companies and investors. To learn more, contact us or visit our website.

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


USPSTF adopts my reasoning on PSA screening for prostate cancer

April 13th, 2017 by
Which way on PSA?

I oppose over-testing and over-treatment, so I really had to think hard five years ago when I turned 45 and my doctor offered PSA screening for prostate caner. The US Preventive Services Task Force (USPSTF) had just come out against PSA screening, concluding that the harms outweighed the benefits.

Nonetheless (Why I decided to get a PSA screening test for prostate cancer), I did go forward. As I wrote:

I know that PSA is a very imperfect indicator. I definitely want to avoid the stress and possible discomfort of having a biopsy. I’m worried about false positive and false negative biopsy results. And I don’t relish the significant potential for incontinence, impotence, or bowel problems from treatment.

But at this stage of my life I am willing to accept a significant risk of morbidity in exchange for a small reduction in mortality risk, which is my impression of what my choice to have the PSA test means. In 10 or 20 years I probably won’t feel that way. And I hope there will be better detection, follow-up and treatment options by then.

I’m also confident in my ability to make informed choices with my physicians along the way. The PSA test itself was done as part of routine blood work and there was no additional risk from that. My doctor and I agreed that if the PSA is elevated we’ll discuss what to do next. At that stage I’ll also have the chance to do more research and get more opinions if necessary. I’m not automatically going to get into a cascade of follow-up and treatment.

Now the USPSTF appears to be coming around to my way of thinking. In particular, they note that more men are choosing “active surveillance,” i.e., keeping a close watch rather than jumping straight to aggressive treatment.

The choice about whether to undergo PSA testing and what to do once results are in is a great opportunity for shared decision making. And this is what should be encourage.

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

Just a granule of sugar makes the medicine go down (and out)

December 15th, 2016 by
What Would Mary Do?

Many drugs fail in development due to safety problems. A study indicates that impurities in the non-active ingredients may sometimes be to blame. According to lead researcher Daniel Weinbuch from Leiden University:

“We found that sugar excipients themselves contain nanometer-sized particles, which can damage proteins and make drugs unsafe. These nanoparticle impurities in sugar could even trigger the immune system itself.”

Obviously, drug companies need to learn about this problem and find sugar manufacturers who can make pure products.

It’s unfortunate that this problem exists, but it also holds out the possibility that some drugs that were previously thought to be unsafe could actually be safe. If so, it would be time to restart the development process.

The academic paper (Nanoparticle Impurities in Pharmaceutical-Grade Sugars and their Interference with Light Scattering-Based Analysis of Protein Formulations) was published in Pharmaceutical Research.

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


Mass Health Quality Partners: 21 years young

October 11th, 2016 by
Barbra Rabson, MHQP President and CEO

Health Business Group is a sponsor of the upcoming anniversary party for Massachusetts Health Quality Partners (MHQP). I asked MHQP’s President, Barbra Rabson to reflect on the first couple decades.

MHQP is about to celebrate its 21st anniversary. What are you celebrating?

We are celebrating the courage and vision it took 21 years ago to found MHQP, and the amazing two decades of progress we’ve made since our inception. Our 21st anniversary is symbolic of our coming of age and reaching a level of maturity. MHQP has become an important part of the Massachusetts healthcare landscape over the decades thanks to the commitment and hard work of our diverse stakeholders – including patients, physicians, hospitals and payers.  More than 40 sponsors and over 300 people are gathering on November 2 to celebrate MHQP’s unwavering commitment to reliable healthcare measurement and transparency and our pioneering work in the Commonwealth and the nation to systematically capture the patient voice and integrate it into care improvements.

At our anniversary celebration we will be honoring the vision of MHQP’s Founding Circle –Blue Cross Blue Shield of MA, Fallon Health Plan, MA Business Roundtable, MA Hospital Association (MHA), MA Medical Society (MMS), Harvard Pilgrim Health Care (HPHC), Tufts Health Plan and the State (Governor Charlie Baker was a founding member of MHQP when he was Secretary of Administration and Finance).

We will also be awarding MHQP’s first award in honor of the late Richard Nesson, MD, a founding visionary of MHQP when he was the Chair of the MHA Board in 1995 when MHQP was established.  We are delighted that Susan Edgman-Levitan, the executive director of the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital and the founding president of the Picker Institute will be the first recipient of MHQP’s H. Richard Nesson Award.

How has the environment changed in MA over the past 21 years? What role has MHQP played in that?

The healthcare environment is drastically different than it was when MHQP was founded in 1995.  When MHQP first started collecting and reporting comparative statewide performance information, we were the only game in town.  For example, MHQP’s first in the nation statewide patient experience survey of acute care hospitals and public release came a full decade before CMS developed the hospital H-CAHPs survey! Likewise, when MHQP began collecting and reporting statewide clinical and patient experiences measures for ambulatory care, MHQP’s data was the only reliable source for quality benchmarks for our provider organizations.  Before MHQP’s comparative quality reports, Massachusetts provider organizations only knew their own performance scores, they had no comparative benchmarks or best practices to drive performance improvements.  Physician leaders  (Barbara Spivak, Tom Lee and others) have told us MHQP’s performance reports were invaluable to them because our reports became the writing on the wall that they needed to make significant investments in their organization in the form of electronic health records and quality improvement infrastructure to advance their performance to the level they aspired to.

Another big change is that our reimbursement systems now provide millions of dollars of incentives for provider organizations to improve performance.  When MHQP first started the term ‘pay-for-performance’ had not yet been coined.  MHQP has always [encouraged] improvements through public reporting of reliable and trusted comparative performance information – relying on physicians’ intrinsic motivation to perform as well as they can. Now that provider compensation depends heavily on measurement we need to work harder to make sure we have accurate and fair measurements of quality care.

Finally, back in 1998 when MHQP first started reporting on patient experiences of care, patient experience was not considered a core measure of quality.  MHQP’s statewide collection and reporting of patient experience helped draw national attention to the importance of listening to patients, and in 2001 the IOM introduced the concept of patient centered care as a key element of quality care in the Crossing the Quality Chasm Report.

Kindred organizations to MHQP have arisen around the country over the last couple decades. How do you relate to them?

MHQP was one of the first regional health improvement collaboratives (RHICs) to be founded in the country. Gordon Mosser (founding CEO of ICSI in Minnesota) and I organized the first meeting of regional collaboratives in 2004.  As a founding member and past Board chair of NRHI (the Network for Regional Healthcare Improvement), it has been very gratifying to see so many new RHICs being established.  There are now more than 40 across the country.  I have been told by many of the younger RHICs that MHQP was a role model for them when they were first starting out, and I take great pride in that.

What does the future hold?

Great question, and one I have been reflecting on as we have been looking back on our first 21 years. One of the biggest challenges (and one of our greatest failures as a health care system) has been that we have not done a good job engaging our patients as a resource to help us improve outcomes. In many cases we have actively refused to seek input from patients, and when given feedback we have ignored it.  We are now trying to make a 180 degree shift on this, to better engage patients in the co-production of solutions, and it is not easy because it requires a shift in mindset.  I believe that MHQP’s two decades of experience capturing the patient voice and integrating that voice into care improvements positions us extremely well to support our practices and healthcare systems as they embark on this journey.


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