Health Business Blog

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

Harvard Pilgrim and Tufts are merging. Here’s why it doesn’t really matter

Hail to the Chief! Tom Croswell is slated to lead the combined Tufts/Harvard health plan

Harvard Pilgrim and Tufts –the second and third largest health plans in Massachusetts–  are merging.  It deserves the front page treatment it’s receiving today (check out the comprehensive coverage in the Boston Globe) –and will have an impact on employees and members– but I predict that the long term impact on Massachusetts healthcare overall will be modest at best.

To boil it down, despite being ranked by NCQA as the top two health plans in the whole country for many years (here’s 2014 for example), it’s been a long time since either Harvard or Tufts had a major influence in the local market. That’s harsh but I don’t think I’m overstating things.

In 2001 when I was setting up my business and looking for health insurance, I asked around about which insurer to use. My doctors said they were indifferent, but a friend at Partners Health Care told me Blue Cross was the only plan they paid attention to.

The last time Tufts tried to seriously impact the market was about 20 years ago, when Partners HealthCare manhandled them in rate negotiations.  And former Harvard Pilgrim CEO, Charlie Baker admitted publicly around the early aughts that when Harvard Pilgrim tried innovative reimbursement structures, hospitals just ignored them and converted everything into Medicare equivalents. And clearly the attempt to channel volume to community hospitals and away from Partners was a bust.

At least in Baker’s current job as Governor he has some influence.

I don’t mean to be cynical at all. I’ve followed both of these mission-driven companies for many years and would love the new combined entity to be an influential innovator –not just in holding down costs but in radically improving experience and quality as well.

But after so many years of banging their heads against the wall, will they give it another go? I kind of doubt it. As the number 2 player in an insurance market led by Blue Cross Blue Shield, and a healthcare market dominated at the Massachusetts level by Partners and BI/Lahey and overall by the federal and state governments, I see their role mainly around the margins. I’m not sure their leadership is ready to go all out to change the system either.

In the last several years, under CEO Andrew Dreyfus, Blue Cross has actually passed Harvard Pilgrim and Tufts in the NCQA ratings. It’s been more innovative as well, with the Alternative Quality Contract (AQC) in particular.

I looked back this morning at my blog coverage of these companies over the years and picked out some highlights.

I’ve interviewed the CEOs of all three:

  • Tom Croswell, who will head the combined entity and is currently CEO of Tufts (2018)
  • Eric Schultz, then CEO of Harvard Pilgrim in a four-part video series in 2011 and again in a podcast in 2013
  • Charlie Baker, when he was running for Governor in 2014. (I interviewed every candidate that year)
  • Andrew Dreyfus, CEO of Blue Cross Blue Shield in 2012

In my coverage (which is by no means comprehensive) I found a few examples of Harvard Pilgrim and Tufts trying to make waves in the market.

There’s much more to say, of course, but I do wish the new entity luck! Massachusetts can use all the help it can get.


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

Life Image CTO Janak Joshi discusses real world evidence (RWE) –podcast

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Real world evidence?

Real World Evidence (RWE) is becoming more important in US healthcare, but the fragmented system and lack of interoperability makes it hard to collect and analyze. In this podcast, Life Image CTO Janak Joshi discusses  the state of the field and how it’s evolving.

Overview:

  • (0:12) How would you describe the evolution of medical data?
  • (2:36) Real world evidence and real world data are becoming more prominent in healthcare –and for good reason. What are some of the challenges in assembling RWD and RWE? How can they be overcome?
  • (6:36) Is it really true that unstructured notes are becoming quantifiable and useful?
  • (9:46) There are major efforts by the US government and private sector to improve interoperability and end data blocking. You have groups like CommonWell and Carequality –now working together. What’s the current state of play and how are things changing?
  • (13:56) You talk about data brokers like Datavant and HealthVerity. How much of their success is because the US system is so broken? Do you see them having the same success elsewhere?
  • (17:31) Promoters of AI and Machine Learning –including Life Image—tout the opportunity to revolution healthcare with these new techniques. Is it for real or overhyped? And how does interoperability tie in?
  • (22:20) What are you most excited about over the next few years?

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

#CareTalk Shorts – Trump sends dialysis patients home

Kidney dialysis is one of the most opaque and problematic sectors of the healthcare economy. It’s controlled by a duopoly that extracts big dollars from private payers while maintaining a symbiotic relationship with the Federal government. Patients aren’t particularly well served and costs are rising.

President Trump’s executive order aims to encourage the use of home dialysis. That’s a good thing, as CareCentrix CEO John Driscoll and I discuss in this edition of #CareTalk Shorts.

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

Noisy hand dryers – how to cope? Hint: Lower you hands

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Noisemaker in chief
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Noise reduction nozzles. Anyone ever seen one of these in the wild?

Nora Louise Keegan, a 13 year old Canadian has generated great publicity with her recent article in Pediatrics & Child Health (Children who say hand dryers ‘hurt my ears’ are correct: A real-world study examining the loudness of automated hand dryers in public places).

She conducted a rigorous study to measure the peak loudness of dryers at two distances from the wall, both with and without hands in the dryer’s air flow. She measured the sounds at different heights, corresponding to the ear canal height of younger and older kids and of adult men and women.

I encourage you to read the article. It is brief and well-written.

When I saw the write-up in the Washington Post, I immediately remembered writing about this very issue back in 2013 (when the author was about 7 and starting to develop an interest in the topic).

In my post (Hand hygiene and hearing loss. Avoiding the tradeoff) I wrote:

I’m not so fond of the Excel Xlerator. Sure it’s powerful, but it’s also incredibly noisy. I have sensitive ears, and I’m not embarrassed to admit that when I’m exposed to a loud sound I cover my ears with my hands. But of course if I’m drying my hands I can’t use them to protect from the noise. The Xlerator is loud enough that I suspect it’s a threat to hearing. At the very least it’s so annoying that I bet some people skip hand washing to avoid using it. My gym has one of these beasts and after being bothered by it for a while I decided to research the noise level.

I didn’t do any original research but I found a paper by Jeffrey Fullerton and a colleague from an acoustical consulting firm and corresponded with Jeff about the subject. He told me that the airstream is a major factor in the noise level and advised me to lower my hands a foot or so below the nozzle , which helps make things quieter. This is the approach I use to this day, with some success –although sometimes the sensor doesn’t see my hands and it does take a bit longer to dry.

The new research by Keegan quantifies the difference made by placing hands in the airflow and also identified the Xlerator as the number one bad boy.

When I read the article I circled back to my original sources. The article I cited is gone (maybe the firm snuffed it when the author moved on) but the Acoustical Society of America still has a summary on its site.

My favorite tidbit is that there is (was?) a noise reduction nozzle for the Xlerator. Presumably the manufacturer understood there was a problem.

I’ve never seen one of these in use. Have you?

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

 

 

AdhereHealth CEO Jason Rose on patient adherence (podcast)

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Jason Rose, CEO AdhereHealth

Adherence to medication regimens is a huge challenge, with patients failing to get the benefit of their drugs and payers not getting the results they’re paying for. Adherence is also a major opportunity; for example over half of Medicare Star ratings are based on adherence.

In this podcast interview, AdhereHealth CEO Jason Rose offers his perspective:

  • (0:12) What are the biggest challenges in the pharmacy field? (Here’s the article Jason references in his reply)
  • (1:52) What does adherence really mean? Is it a big deal?
  • (6:15) Who has a financial incentive to do something about it?
  • (8:38) You claim over half of Medicare Star ratings are based on adherence. Is it really true?
  • (12:18) Is adherence a patient-centric term? It sounds more top down.
  • (13:58) How do social determinants of health tie in to adherence?
  • (18:15) What role does AdhereHealth play?
  • (22:27) Is your Pharmacy at Home program just a mail order pharmacy?
  • (24:56) Why did your company change its name?
  • (26:38) Can we expecting sweeping changes in adherence, with the introduction of new tools like AI and wearables?

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