In this edition of #CareTalk, CareCentrix CEO John Driscoll and I have a little fun at the expense of our neighbors to the North. Will Canada build a wall along its Southern border to keep out US patients?
(0:43) Are Canadians right to worry that Americans are going to clean out their pharmacies, leaving nothing for the locals?
(1:43) What are “authorized generics” and are they a good idea?
(3:22) Are skilled nursing facilities a piggybank for accountable care organizations?
Looking through my news alerts today I saw a couple items that support the old adage, “there’s nothing new under the sun.”
Exhibit 1: Biosimilars
Two academics have been arguing for a few months that biosimilars aren’t like generics after all and that the US should regulate the prices of biotech drugs once they go off patent. They’ve been banging their heads against the wall and are getting tired of it. “Time to throw in the towel on biosimilars,” they write in the Wall Street Journal.
Maybe I shouldn’t be so cynical –I think I’ll write to the authors and see if I can lend them a hand!
Exhibit 2: Medical Tourism
In 2007 I got pretty excited about medical tourism (aka medical travel) as a way to reduce costs without cutting quality –at a time when we were throwing our hands up about costs and coverage in the US. I went so far as to travel to Singapore and South Korea to research the topic and set up a TripAdvisor-style website to facilitate the phenomenon. Here’s the transcript of my interview with the author of the first serious book on the topic.
It’s a great topic to write about, and there are some excellent anecdotes, but it didn’t catch on in a big way a decade ago and I’m skeptical it will do so now. Before the Affordable Care Act many middle class people were uninsured, so going abroad for orthopedic or heart surgery could mean the difference between losing one’s house/retirement savings or not. It was still a novel idea. But with the ACA there were many fewer people for whom it made great sense.
Most of what I saw was people going abroad for cosmetic treatments or dentistry. The other category was immigrants going back to their home country for treatment. (My sister-in-law went back to Canada for LASIK, for example.) Then as now, the US is the biggest destination country for medical “tourists.”
I really haven’t followed the field lately, but I’m seeing the same kinds of stories now (A prescription for a passport? Health plans covering medical tourism) that I saw then. This one says the industry is $439 billion growing at 15-25% per year. I haven’t reviewed the research but I promise you the market definition must be pretty broad!
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)
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.
(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?
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.