Health Business Blog

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

Vaccine reimbursement is equal across providers and insurers. What if we did the same for all care?

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What adjustments are needed?

A seemingly straightforward story caught my eye last week: all Massachusetts providers are being paid the same, generous fee for COVID-19 vaccine administration (Boston Globe). The fee is essentially identical whether the patient has Medicaid, Medicare, commercial insurance –or no insurance. And it doesn’t matter whether the shot is given in a pharmacy, clinic, community hospital, or academic medical center.

It seems logical and makes intuitive sense to the average consumer. But for those in the healthcare field, it’s pretty radical! After all, reimbursement rates for commercially insured patients are usually a multiple of what Medicaid pays and substantially higher than Medicare. And providers and insurers exert extreme efforts negotiating rates (and then trying to keep them secret). Some providers use their market power to drive harder bargains, and insurers do the same.

Bottom line: Reimbursement rates are all over the map, varying wildly depending on who’s the provider and who’s paying. A 2020 Health Care Cost Institute study provides some detail.

This reality has shaped and distorted the US healthcare system:

  • Providers avoid Medicaid patients to cherry pick those with commercial coverage
  • The true cost of Medicaid (and to a lesser extent, Medicare) is obscured by cross-patient subsidies
  • Providers use their market power to extract higher rates, and generate reimbursement ‘synergies’ by acquiring providers with weaker negotiating positions or reclassifying  physician offices as hospital ‘facilities’ that generate their own upcharges
  • Patients get treated in settings that maximize providers’ margins rather than where it’s best for the patients
  • Health plans merge to bulk up against provider systems
  • Health disparities are exacerbated as poorer patients are worth less to providers and get lower priority
  • Tremendous administrative costs are expended to manage the complexity, exploit the rules and search for those who are bending or breaking them

It’s tempting to think we could reform healthcare payment by using this COVID-19 vaccine approach for all reimbursement. But the vaccine is a special case, because there is a specific, national objective to get as many people vaccinated as quickly as possible to end the pandemic and because vaccine administration is pretty simple. Lots of providers are capable of it, and there are unlikely to be differences in outcomes based on provider experience or setting. Across the political spectrum, there is genuine agreement that we want everyone –including poor people and immigrants regardless of status– to get a shot or even two. And we’re happy for providers to prioritize vaccination by allowing them to make good money doing it.

Those conditions don’t hold generally in healthcare. Still, I am in favor of policies that encourage or mandate reducing the gaps in what providers are paid for the same service. There should be a convergence between Medicaid, Medicare and commercial rates, and reimbursement should not vary so dramatically by provider or setting of care.

New approaches, like alternative payment models, often bake in the fee-for-service biases. They shouldn’t.


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

Making diabetic foot ulcers history. Interview with Podimetrics CEO, Jon Bloom

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Podimetrics CEO, Jon Bloom

As an anesthesiologist, Jon Bloom was distressed to participate in so many foot amputations for diabetic patients. He vowed to do something to consign this barbaric, Civil War era procedure to the dustbin of history. Eventually, he met up with some like-minded co-founders at an early Hackathon and the result was Podimetrics.

A decade later, the team has developed and deployed a technology and care management solution that is putting their goal in reach. Of course in the US healthcare system, amputations are lucrative for providers but prevention isn’t. So that’s an extra hurdle Podimetrics has had to clear.

In this episode of the HealthBiz podcast, Jon traces Podimetrics’ path. But we also carve out time to discuss high school marching band, why it took him 8 years to graduate from college, his dreams of being a punk rock musician, and what my son Harry Williams was like as a Podimetrics summer intern.

If your healthcare or life sciences business needs strategy consulting, I’d be happy to discuss. We have two decades of experience working with companies whose strategic opportunities and challenges are similar to Podimetrics. Contact us here.

Check out the rough (AI generated) transcript.

The HealthBiz podcast is available on SpotifyApple PodcastsGoogle PodcastsYouTube and  many more services. Please consider rating the podcast on Apple Podcasts.


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

How the new surge and vaccine success are connected

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Catch a wave and you’re sitting on top of the surge

It’s counterintuitive: a fourth covid-19 wave is evident even as vaccine rollout accelerates. Conventional wisdom blames it on more contagious variants, pandemic fatigue, and states reopening too fast. There’s truth to all of that, but it overlooks the role that vaccination itself plays.

I shared my thinking with the Boston Globe (CDC Director Walesnsky stresses ‘hope,’ not ‘doom,’ after touring Hynes Convention Center. Vaccinations are accelerating even as COVID-19 cases also rise.)

“As spring comes, people in their 20s are relaxing their behavior and going out to restaurants with their friends,” said David Williams, president of Health Business Group, a Boston management consulting firm. “They don’t have to feel as guilty about infecting them if Ma and Grandma have already been vaccinated.”

It’s actually pretty straightforward. We’ve asked younger people to make severe sacrifices over the past year. A central argument has been that they are protecting their older relatives and others in society, who are at mortal risk if infected. Now that the old are largely protected through vaccination, the argument loses its logic.

Vaccine rollout priority has focused on reducing death and hospitalization. That’s why we started with the elderly. If we wanted to reduce the number of infections, we would have started with the young.

Now that the old are vaccinated, we need to make sure young adult vaccination is quickly ramped up. There should be plenty of vaccine available shortly to do so.

“This is the time when we’re going from scarcity to surplus,” said Williams of the Health Business Group. “People who are eligible are now getting appointments, even if they have to work a bit, and a lot more people are now eligible. It still feels tight. But in the next two to three weeks, instead of waking up at 1 in the morning to book an appointment, you should be able to do at 2 in the afternoon.”

Today’s news that the Pfizer vaccine seems to work well in kids and not pose safety concerns is also great news. We should vaccinate the whole population by summer if at all possible.

Image by Manie Van der Hoven from Pixabay


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

Interview with SonderMind CEO Mark Frank

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SonderMind CEO Mark Frank

Mark Frank has a great sense of timing. He graduated from West Point just in time for 9/11 and had a summer job at Lehman soon before its collapse. Then a few years ago, he had an insight that a mental health wave was coming as stigma fell, mental health parity rules took effect, and as stresses increased. He co-founded SonderMind where as CEO he’s helping make behavioral health more accessible, approachable and utilized. 

In this episode of the HealthBiz podcast, Mark describes how his upbringing in Atlanta, Japan and Germany shaped his outlook and how family members have influenced his enlistment in the military and his path with SonderMind.

At Health Business Group, we have two decades of experience in developing robust strategies for telehealth and remote patient monitoring companies whose strategic opportunities and challenges are similar to SonderMind’s. If you need strategy consulting help, please reach out.

Check out the rough (AI generated) transcript.

The HealthBiz podcast is available on SpotifyApple PodcastsGoogle Podcasts, YouTube and  many more services. Please consider rating the podcast on Apple Podcasts. Doing so helps the podcast reach more listeners.


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

Interview with Proprio CEO Gabe Jones on helping surgeons see around corners

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Proprio CEO Gabe Jones

As founder and CEO of Proprio, Gabe Jones is helping surgeons see around corners. If all goes according to plan, the company’s computational imaging innovations will infuse all of surgery, making great surgeons even better and bringing up the average as well. Artificial intelligence, machine learning, computer vision, virtual reality –it’s all in there! 

Gabe’s eclectic background prepared him for his current role. From Japan to the Gates Foundation to intellectual property law, to M&A he’s seen and done a lot over his career.

In this episode of the HealthBiz podcast, Gabe shares his journey and provides some book tips, including speculative fiction like Cryptonomicon and others by Neal Stephenson, Leaders Eat Last by Simon Sinek and Titan by Ron Chernow.

Check out the rough (AI generated) transcript.

The HealthBiz podcast is available on SpotifyApple PodcastsGoogle Podcasts and  many more services. Please consider rating the podcast on Apple Podcasts. Doing so helps the podcast reach more listeners.


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