Category: Policy and politics

The “Show Me I’m Paranoid” State?

published date
May 23rd, 2019 by
swan 4017568 1280
Head in the swamp?

For seven years, Missouri has been the only state in the country without a prescription drug monitoring program (PDMP). PDMPs are designed to help identify abuse of controlled substances like opioids and to spot potential drug interactions.

Missouri doesn’t have a PDMP because one State Senator blocked the bill year after year by claiming the government might use the data to prevent people from buying guns. The Senator hit his term limit and there was expectation this year that the bill would finally pass, ending Missouri’s ignominious distinction as the lone holdout. Alas, a new group of six Republican Senators took up the mantle of their departed colleague and filibustered the bill again citing privacy and gun rights fears.

The lack of a PDMP is a problem for Missouri but also for surrounding states, which face blindspots in their systems as a result of not being able to share data with Missouri. A variety of local jurisdictions in Missouri have moved forward and are cooperating with other states, but the gaps are serious and have potentially lethal consequences.

The state ranks as the third biggest problem area in the country (only Washington, DC and Michigan are worse) for drug use so it’s not as though everything is working out just great.

Missouri is known as the “Show-Me” State, an expression that conveys the “stalwart, conservative, noncredulous character of Missourians,” according to the Missouri Secretary of State.

Most people credit the birth of “Show-Me” to a speech by a US Congressman in 1899. “I am from Missouri. You have got to show me.”

But there’s another, less flattering origin story, referring to scabs from Missouri who replaced striking Colorado miners around the same time. “That man is from Missouri. You’ll have to show him.”

The second story seems about right for the current situation as the state continues to display willful ignorance about the opioid epidemic. I could include something similar about the attitude toward guns, but on that issue Missouri is sadly more representative of the country as a whole.

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

Remedy Partners founder Steve Wiggins explains why he’s high on bundled payments (podcast)

published date
April 29th, 2019 by
Wiggins Steve P1210186 Edit 1
Remedy Partners founder Steve Wiggins

Steve Wiggins has seen a thing or two in his more than three decades as a healthcare entrepreneur. His Oxford Health Plans introduced “pods,” a precursor of the Accountable Care Organization and he led HealthMarket, an early player in the consumer directed health plan space. He’s carried the same themes into his current  role as founder and Chairman of Remedy Partners, the leader in Medicare’s Bundled Payments for Care Initiative (BPCI).

As you’ll hear in this podcast, Steve’s a big believer in bundles, offering them as a proven solution for a large portion of the healthcare dollar, within almost any healthcare financing framework from traditional commercial coverage to Medicare for All.

Here’s what we discussed:

  • (0:18) What is a bundled payment? How does it relate to other new approaches like ACOs?
  • (3:05) Did bundled payments start in Medicare rather than the private sector? If so, why?
  • (6:52) How well has BPCI worked? What does the future look like?
  • (11:01) How do episodes and bundles tie in more broadly? I often hear that chronic care or end of life care are the big cost drivers, not episodic care. Can those statements be reconciled?
  • (15:10) How should we think about bundled payments and related topics playing into the campaign, or should we just give up on that?
  • (19:14) You’ve founded quite a few healthcare companies over your career. How does this Remedy compare?
  • (21:41) How do you expect the company to evolve in the next few years?

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

Lifespan tries to keep Partners out of RI. I’m quoted in the Boston Globe

published date
April 25th, 2019 by

Big bad Partners HealthCare plans to take over Rhode Island’s number two player, Care New England. Lifespan, the market leader is trying to keep Partners out by appealing to Rhode Islanders’ resentment of out-of-state players and claiming to have the public interest at heart.

“This is not about Lifespan,” [Lifespan’s CEO Dr. Timothy] Babineau said in an interview. “This is about the future of health care in Rhode Island.”

Actually, Lifespan seems to want to go from being the big fish in a small pond to the only fish, by merging with Care New England and Brown, in a so-called “unified” health system, which is just another word for monopoly.

I call them out in the Boston Globe (Lifespan says Partners takeover of Care New England would cost R.I.)

“Lifespan has correctly identified the threat to themselves — but the idea that that is a threat to the public interest is another matter,” said Williams, president of Health Business Group.

“It’s kind of an obvious move to attack a big company for being from out of state, and [saying] they’re going to hurt our local economy and drive up costs,” Williams said. “Really what’s happening is [Lifespan] would like to dominate Rhode Island and not have to worry about somebody else.”

PS –It’s kind of funny that the Boston Globe itself has announced its intention to penetrate Rhode Island with more coverage of local matters. Watch out Providence Journal!

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

#CareTalk March 2019: Gottlieb’s out. What’s next for FDA?

published date
March 21st, 2019 by

The latest edition of #CareTalk is out. CareCentrix CEO, John Driscoll and I explore the departure of FDA Director Scott Gottlieb and other pressing topics.

Here’s what we covered:

(0:28) Scott Gottlieb is out at FDA. Are you sad to see him go?

(2:00) Home health spending is projected to grow faster than any other category of healthcare over the coming years. Is that good or bad?

(4:00) Insulin prices are spiking and both Democrats and Republicans are up in arms. What’s happening?

(5:53) Lyft is talking about the social determinants of health. What?!

(8:47) What do you think about FDA approving ketamine nasal spray as a treatment for depression?

(9:10) What did we learn about healthcare from Michael Cohen’s Congressional testimony?

(9:33) Medicare has a new app. Have you tried it?

(9:59) Did you hear about the $48,500 bill for a cat bite?

Subscribe to the #CareTalk Podcast
iTunes: https://apple.co/2DIDTcr
Google Play: https://bit.ly/2RobqMB

#CareTalk February 2019: Medicare for All?

published date
February 28th, 2019 by

The latest edition of #CareTalk is out. CareCentrix CEO, John Driscoll and I explore Medicare for All and other big topics.

Here’s what we covered:

(0:35) Is “Medicare for All” quickly becoming a litmus test for Democratic presidential candidates?

(2:45) What should be made of the recent moves of home health agencies around primary care?

(5:00) Are pharma rebates to blame for increased drug pricing?

(8:00) President Trump promised a whopping $50 million a year for childhood cancer. What would you do with all that money?

(8:32) Will adding the full list price of drugs in ads make a difference?

(9:03) Will Donald Trump actually end HIV transmission by 2030?

(9:32) We predicted that the Patriots would win the championship this year. What about the other Boston sports teams?

Subscribe to the #CareTalk Podcast
iTunes: https://apple.co/2DIDTcr
Google Play: https://bit.ly/2RobqMB