Category: Uncategorized

Reference based pricing for pharmaceuticals. Podcast with ActiveRADAR CEO David Henka

published date
September 12th, 2018 by
David Henka, President & CEO of ActiveRADAR

Pharmacy Benefit Managers (PBMs) claim to keep drug costs under control, but their convoluted business models and tactics don’t always result in the best deal for employers. Reference based drug pricing is an interesting alternative approach. It’s used for drug cost control in other parts of the world and within the US for things like elective surgery.

“Rebates are like crack cocaine…”

In this podcast interview, drug pricing expert David Henka sheds light on the drug pricing world and describes the reference based approach employed by ActiveRADAR, where he is CEO.

Here’s what we discussed:

  • (0:17) How can we understand the recent dust-up between President Trump and Pfizer’s CEO? What provoked it?
  • (1:00) Why does Pfizer want to see the “blueprint” unveiled —isn’t that supposed to squeeze the drug companies?
  • (2:47) Say more about your “balanced billing” analogy.
  • (4:21) So is Europe like Medicaid, developing countries the uninsured, and the US a commercial payer?
  • (4:59) Isn’t freeloading just good negotiating?
  • (7:23) What about someone like Martin Skrelli, who said just push prices to their logical conclusion: instead of 10% why not 100 or 1000%?
  • (8:52) You mentioned the typical consumer is fairly protected due to fixed deductibles or co-pays. What is the role of PBMs in drug pricing?
  • (11:07)  Would eliminating rebates really drive down costs?
  • (13:37) What other techniques are PBMs using?
  • (15:45) ActiveRADAR is involved in reference pricing. What is it? What implications does it have for PBMs? Are their days numbered?
  • (21:54) Historically generics have helped keep prices under control. How is that working out now? How should we think about “generics” or “similars” for biotech products?

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

The state of healthcare interoperability. Podcast with eHealth Collaborative CEO Micky Tripathi

published date
July 26th, 2018 by
MAeHC CEO, Micky Tripathi

Massachusetts eHealth Collaborative CEO Micky Tripathi has been leading the charge on electronic health records and interoperability for more than 15 years, pre-dating HITECH, meaningful use and the Affordable Care Act. In this podcast, we caught up on the state of play, including :

  • (0:13) How e-health looks today compared with what was envisioned originally
  • (3:01) How interoperability has evolved
  • (11:23) What’s wrong with TEFCA and why he calls it a “regulatory” wet blanket
  • (25:12) The Argonaut Project

As usual, Micky is informative and unafraid to take a stand.


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

Partners buys into Rhode Island: I'm quoted in the Boston Globe

published date
April 20th, 2017 by

Partners HealthCare plans to purchase Care New England in Rhode Island. Not a surprising move, considering  that Partners wants to continue to expand but is running into roadblocks in Massachusetts. Rhode Island is practically down the street.

I’m quoted in the Boston Globe’s coverage (Partners to acquire R.I.’s Care New England)

“This is a logical move for Partners, which has received strong pushback in its recent attempts to expand in Massachusetts, but is less likely to face the same pressures in Rhode Island,” said David E. Williams, the president of Health Business Group, a Boston consultancy. “The acquisition is geographically close to Partners’ existing network, and they already have a clinical collaboration. Rhode Island regulators will likely appreciate Partners’ financial strength and the stability it is likely to promote.”

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

USPSTF adopts my reasoning on PSA screening for prostate cancer

published date
April 13th, 2017 by
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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.