Posted by on in Biopharma, Medical Devices

The recent World Medical Innovation Forum on Cancer convened by Partners Healthcare in Boston was attended by leaders in oncology from around the world including top: clinicians, bench scientists, policy leaders, and executives from hospitals and life-science companies.  Two plus days of intense discussion and sharing of perspectives ably curated by Partners Innovation head Chris Coburn covered a range of topics from technology developments, to the healthcare system, and the patient/ doctor perspectives. The mind-map below is an attempt to organize the key themes that I heard through the conference and to try to convey why I came away feeling … Read More

Posted by on in Biopharma, Payers, Population Health, Providers

A couple of years ago, we addressed the question of whether drug companies could use new business models to capture more of the value they create. At the time, we pointed out that drug makers had struggled to get payers interested in new models, and that any potential solution would need to consider aspects of the drug (as it relates to the overall care paradigm and system), and of the payer. Fast forward to 2016, and there are a number of factors that suggest that now may be the right time for drug makers and payers to partner in creating value by sharing clinical and … Read More

Posted by on in Biopharma, Payers

In this morning’s New York Times (June 3,2014), Andrew Ross Sorkin asks,“DO drug companies make drugs, OR money”? That’s a fair question in the context of what I’ll call a “fee-for-product” reimbursement regime. Another way to look at this question is, “CAN drug companies make drugs, AND money”? Value has not been an easy sell As the U.S. healthcare services system moves from fee-for-service to a value-based system, the biotech and pharmaceutical (biopharma) industry should have an opportunity to capture more of the value it creates. But … Read More

Posted by on in Uncategorized

We’ve all heard the term, “Boiling the Ocean” to refer to an approach that is broad and ambitious and generally leads to lots of work and very little insight.  Historians will argue about whether it was Will Rogers or Mark Twain or someone else who first used this phrase but that’s besides the point. As the story goes: In 1914 the Germans were sinking U.S. ships in the North Atlantic. It was a turkey shoot because the Germans had the U-boat and we didn’t. Somebody asked … Read More

Posted by on in Payers, Providers

Here’s a quick look at relative prices in MA using CHIA data for you to play with. What you could do for instance is select Commercial and Medicare on the left (use CTRL key for multiple selection) and then on the right, check off say only BCBS. That wold show you the difference between TMEs for Medicare and Commercial just for BCBS. Can also filter by hospital system (on the right). Have fun. P.S. You may need to scroll to the right or re-size on your browser … Read More

Posted by on in Providers

In 2011, we would tell our payer clients (tongue firmly ensconced in cheek) that the answer to all questions was “private exchanges”. In 2012, the punchline changed to “narrow networks”. In 2013, what is not a joke is that payers and health systems are really having to grapple with difficult strategic choices on partnerships, affiliations and M&A relating to facilities and medical groups in order to actually deliver on the value promise of narrow networks (higher value care). Two key inputs into these choices are: The geographic catchment area of each entity  The referral patterns across entities (graph/ network analysis) … Read More

Posted by on in Payers

When it comes to employee benefits, employers need to be generous either to attract and retain talent or because it is “the right thing to do”. The recession and jobless recovery has unquestionably reduced the first imperative and it appears now that the employer mandate penalty may perversely be gutting the second. Why? A classic paper in the Journal of Legal Studies (Gneezy, Rustichini 2005) looked at the impact of introducing fines for parents who were late to pick up their kids at daycare centers. Lateness INCREASED. Subsequently when the fines … Read More

Posted by on in Payers, Providers

In our last post we introduced two potential scenarios. “Provider bastions” in which buyers of health care services select upfront the network that they will trust to deliver their care in a coordinated manner.  “Value-based deconstruction” in which buyers of healthcare choose the site-of-service for every interaction with the delivery system based on incentives built on micro level information about value – outcomes and cost.  Obviously there are factors unique to firms that will have a tremendous impact on optimal strategic choices for them. All we do here is raise some key strategic implications at a high … Read More

Posted by on in Payers, Providers

It seems like every day there’s some news outlining strategic actions that various players are taking or other developments with respect to health reform. Here’s a sample of recent news: Employer adopts a tightly limited provider network  Customers sign on to private exchange Hospital chain grows through acquisition Insurers boycott state exchange … Read More

Posted by on in Payers

In 2011 we commented that while the health reform law, the ACA, had several positive intended consequences, it also could spawn several perverse effects and side-effects. Now in an attempt to ward off some of those unintended consequences, the administration has delayed the employer mandate from 2014 to 2015. Reactions range from praise (from the unlikely alliance of Democrats and business groups), derision (from Republicans and right leaning think tanks) and bemusement or befuddlement (across the spectrum). Of course, perturbing a portion of a … Read More