The parent company of Tufts Medical Center plans to expand its hospital network with the addition of Hallmark Health System, a merger that will help both sides compete in a market dominated by bigger institutions…
“Both of these systems were undersized to be able to compete effectively, so it’s a good matchup from that standpoint,” said David E. Williams, president of the Boston-based consultancy Health Business Group. “It’s unlikely that there will be any serious regulatory opposition to this. If anything, I think the regulators will look favorably on this. I think it will help create more competition with Partners than if these companies just stayed on their own.”
This seems like a pretty good outcome for the institutions involved and for the healthcare market in Eastern Massachusetts.
I’m just back from vacation and look forwarding to jumping back into the blog!
United Healthcare announced that it’s exiting most of the Obamacare insurance marketplaces (aka exchanges) next year. Sound like a familiar story? In fact all the recent news coverage is just a rehash of last November’s announcement that United was probably going to exit.
As I wrote at the time (United pulls out of ACA exchanges: Should we care?), United’s exit is not a huge deal. The company specializes in selling high-priced plans to corporate accounts. In the price-sensitive world of the exchanges that’s a losing proposition. No surprise — United wasn’t getting traction.
In January (Like I said: United’s ACA exchange departure is no big deal) I reported on a study that showed that the name brand, high priced commercial players like United were losing out to insurers with a Medicaid managed care background and to mission-oriented Blues plans. United’s departure represents the failure of United, not the failure of the marketplaces. If United says otherwise it’s a sore loser.
Health plans thinking of competing in the marketplaces should say this to themselves a few times before diving in: “Exchange business is price sensitive business. If we can’t compete on price we might as well stay home.”
Now, if United were a little more clever and capable it actually could make a play for the exchange business, in a way that would boost its success in the commercial market as well. In particular, there are opportunities to better manage the way specialty care is delivered and paid for, by emulating the approaches used by the most efficient and innovative specialists. This would drive down the overall cost of insurance and improve care for patients. Some astute players in the bundled payments space are starting to figure it out. Somehow I don’t think United will be the one to make it happen.
I’ll be hosting next week’s Health Care Social Media Review. Please send me your submission via this contact form or email. Submissions are due by end of day Monday, May 12.
Here are the guidelines:
HealthCare SocialMedia Review is the blog carnival for everyone interested in health care social media. It is a peer-reviewed blog carnival; the host of each edition decides which of the posts submitted for consideration are suitable for inclusion.
Our mission is to serve as a hub for posts from the best and the brightest health care social media writers, thinkers, users and proponents worldwide, to contribute to better understanding and adoption of social media in health care. This carnival is intended to showcase posts about health care social media use, best practices, guides, resources, case studies, experiences, new techniques and technologies and new social media communities and tools. We seek to spread the word that the use of social media in health care is becoming unavoidable and is of critical importance to both patients and providers worldwide.
The Health Business Blog turns nine years old this month. Continuing a tradition I established with birthdays one, two, three, four, five, six, seven and eight I have picked out a favorite post from each month. Thanks for continuing to read the blog!
Initial estimates of the costs of the Affordable Care Act to small employers were severely overstated. A new analysis shows a typical Wendy’s will spend about $5000 per year extra, not $25,000 as had been feared.
There are several websites where consumers can see and post ratings of physicians. But the sites contain incomplete and sometimes misleading information. Some doctors are upset and going as far as suing for libel. In this post, I review the state of the sites.
HarvardPilgrim HealthCare is consistently ranked as best health plan in the US and was the first health plan to select transparency vendor Castlight Health to provide patient-specific price information. CEO Eric Schultz lets us in on what he’s up to next.
Daily deal sites like Groupon are (or were) all the rage, so it’s no wonder that healthcare-specific sites have also popped up. These are interesting to talk about but have little real-life impact on the healthcare market. The Dallas based NPR station did a piece on one such site and quoted me. Later, the national Marketplace show picked up the story.
Progressive’s Flo sure is perky. The company has a Snapshot device that is mounted in policyholders’ cars to monitor how safe their driving is. It may seem far-fetched, but I expect the same philosophy to be carried over into healthcare eventually. Are you ready to have Flo monitor your eating, drinking, and sexual behaviors?
GSK has struggled with the manufacturing of the Advair inhaler for 15 years. But its woes are turning out to be a blessing in disguise because manufacturing has created an effect barrier to entry for generic challengers.
I’m all for good hand hygiene and for participatory medicine. But I really dislike the notion that patients have to be the ones to police the handwashing practices of doctors and nurses. I’ll do it if I have to, but it’s pathetic if the profession has to resort to this.
Reference pricing for medical procedures constrains costs by capping the amount an insurer will pay for a procedure and making the patient pay the extra amount. The Wall Street Journal would have us believe that the use of reference pricing is a great argument for free market approaches in healthcare. But if anything, it demonstrates the inadequacy of the private sector to take on cost control.
It’s tempting to draw parallels between the legalization of gay marriage and legalization of marijuana and in fact, both are gaining ground rapidly. But there are serious differences. I predict we’ll look back on gay marriage and wonder why we took so long to legalize it, while we’ll look back on marijuana legalization and kick ourselves.
Massachusetts voters deserve a substantive, competitive campaign for Governor this year. I have decided to do my part to foster a productive debate by conducting one-on-one interviews with each of the nine candidates on health care issues. Most of the candidates are well known in the health care world but even those with non-health care backgrounds have studied the issues and have credible ideas.
In this podcast interview, Juliette Kayyem, Democratic candidate for Governor of Massachusetts discusses her views on healthcare with healthcare business consultant David E. Williams, president of the Health Business Group. This is the last in a series of nine in-depth interviews with the candidates. For a complete schedule and an explanation of the questions visit the intro post.
Excerpts from the interview are below. The full transcript is available here.
Question 1: Does Chapter 224 represent the right approach to addressing rising health care costs? If not, where does it miss the mark and what would you do differently?
“It’s absolutely the right approach in terms of Massachusetts being the first state to try to crack the nut of rising healthcare costs.”
“While it is a great start, there’s no way we can think that we’re done with the challenge of healthcare, both in terms of the burden that places on our state budget, but also in terms of looking at other ways to relieve a healthcare system that’s under stress.”
Question 2: Certain provider systems in Massachusetts are reimbursed significantly more than others for the same services even though there are virtually no differences in quality. Does the state have a part to play in addressing these disparities?
“There’s more that the state can do. But we need to realize that it’s a competitive field and that there are going to be limitations to what the market can correct. Transparency is good, and litigating or having causes of action against abuses is good. Then let the market begin to drive some better behavior, which I do believe it will.”
Question 3: More than a dozen state agencies have a role in health care. Is there an opportunity to consolidate or rationalize them?
“There is no question that rationalizing and consolidating them is important.”
“We need to work through all those different layers to ensure that agencies are working together. What we need to do, what the new Governor needs to do is to ask, can the delivery of service become more efficient?”
Question 4: Government policy has encouraged adoption of electronic medical records. However many providers complain about the systems and the benefits have been slow to materialize. Should state government play a role in helping to realize the promise of health information technology?
“Medical data is the most private and therefore must be the most secure. It’s understandable that medical records have taken some time to catch up. The state can do a lot to encourage hospitals to adopt and invent new storage protocols and transfer protocols while protecting privacy.”
“This is eminently doable with state government, both providing the best practices, the R&D, and the support for private and public hospitals to do this. In the next couple of years this will begin to come to fruition.”
Question 5: Hepatitis C is 3 or 4 times more common than HIV. New drugs that can cure the infection are coming on the market this year but they are very expensive. What role should the state play in ensuring that residents are tested, linked to care, and have access to these new medications?
“We can make things, we can buy them in bulk, we can get them down to the right hospitals or community health centers, but can we actually get them to individuals? I’m committed to finding ways in which we can do what we call that ‘last mile,’ which is most important.”
“Most importantly, we need to look at prevention of Hepatitis C. That’s only going to occur with strong public health education programs, and strong commitment to community health centers and other public education providers that are out in communities helping people live healthier lives.”
Question 6: There are multiple health care related ballot questions. What are your thoughts about them?
“I prefer ballot initiatives going through the legislature. Ballot initiatives don’t allow for the kind of negotiations that are often required for proper implementation.”
“I would support both the fixed nurse-patient staffing ratio and the hospital financial question. If the citizens of the state passed them, I’m not going to oppose them. On the other hand, I would also like to work with the nurses’ union, with hospitals and others to get the legislation that is necessary to ensure that nurses have adequate staffing levels, and whatever other legislation might be appropriate for this space.”
Question 7: In your campaign platform, you talked about reducing health disparities in the Baystate’s underprivileged communities. Are there specific steps you have in mind to achieve this?
“I want to do more in terms of supporting our community health centers, not just empowering them, but actually helping to grow the partnerships between them and hospitals. This will allow hospitals to adapt policies to properly accommodate changing populations in the state, such as the impoverished.”
“I want an ecosystem of the delivery of services that go from the most elite hospitals in the state, which we are incredibly grateful for having, to the community health centers, which are really at the forefront of the delivery of services to our underprovided communities.”
Question 8: Much of the emphasis in health care reform is on adult patients. Is there a need for a specific focus on children’s health?
“It’s about public education. People have to understand that the health and livelihood of our children is dependent on responsible behavior of other parents about their children.”
“If you think of the burden on our healthcare system, a lot of that can be relieved by focusing on our children, and then being healthier in the future.”
“I am into risk reduction. That is what Homeland Security is about. One of the risks that I see coming down our way is the challenge of climate change and how that’s going to impact our children’s health.”
Question 9: Is there anything you’d like to add?
“Campaigns have a tendency to make us have a healthcare policy, and an education policy, and then an employment and a criminal justice policy. Part of what I bring to this race, in conflicts and crisis management in both state and federal government, is a capacity to think about solving the problems of our time in a way that is very holistic.”
“We should begin to view healthcare not as a separate issue reserved for the professionals in the health businesses and the healthcare providers, but one that is intimately tied to educating our children, the delivery of health services through our infrastructure, and that is tied to our economy and economic growth.”