Posted by on in Digital Health, Providers

A number of observers have noted that the Apple’s partnership with Epic on HealthKit could reinforce the role of “closed IT system” strategies in general and Epic’s leading position among EMR vendors in particular. Others have noted that prominent PHR failures (Google, Revolution Health) should add some sobriety to the hype around HealthKit. While I don’t disagree with these concerns, I have three other thoughts on the announcement that … 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 Payers

Summary Aetna is stitching its inventory of ACO deals into a national ACO network and will offer them on its proprietary private exchange (PHIX) Linking ACOs and PHIXs is smart because PHIX’s defined contribution feature creates a strong consumer reward for picking a tighter network product Promising a national network of ACOs is bold: ACO deals depend on willing providers and opportunity in local care patterns; in many geographies, the delivery system isn’t ready or interested. If Aetna can create a national network, it should be attractive to major employers (usually wary of adopting strategies available to just a portion … 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

Summary Allegheny Health Network (AHN), the major delivery system in Pittsburgh owned by Highmark, and Johns Hopkins Medicine have signed a MOU to create an affiliation between Allegheny and the Johns Hopkins Kimmel Cancer Center.  Over many years, UPMC has established a very large network of cancer care throughout western Pennsylvania; AHN has responded in kind albeit much less broadly. At this point, there is very little independent cancer care left in the region. By partnering with a prominent UPMC competitor in oncology, the deal is likely designed to shore up the appeal of Highmark’s AHN-centered network among employers in … Read More

Posted by on in Digital Health, Payers

Samsung and Cigna have agreed to a multi-year development alliance for health applications for the Samsung smartphone. The partners will initially focus on content (access to the health-related tips and articles Cigna already offers its customer base). Ultimately, the partnership will “connect individuals with caregivers, doctors and hospitals to improve health and wellness globally.” So far, the announcements have been silent on any exclusivity. In our view, the content deal is a sideshow: health and wellness tips are highly commoditized and an insurer an undifferentiated supplier for this content. I believe building connectivity among patients and their continuous biometric data, … 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, Providers

Market for outsourced revenue cycle management could be big The revenue cycle management (RCM) vendor industry is about $2.0B for hospitals and $11 billion for physicians today. The market is constrained because most providers do their own RCM. Vendors only have a ~10% penetration among hospitals and a 25% penetration among physicians (implying that the potential combined hospital and physician market is $60-70B). However, RCM as a function is getting more complex and outsourcing could quickly start looking more attractive: Value-based contracting models raising the … Read More

Posted by on in Digital Health, Providers

Quick follow-up to our post about the Epic-eClinicalWorks deal: Today’s Healthcare Informatics has an interview with Martin Harrison, CIO of Cleveland Clinic, was asked what is the biggest strategic IT challenge right now. His answer? The challenge element is partly being driven by the complexity of the challenges in this value-driven world. So all the care providers belonging to this collaborative probably will not belong to the same organization. So the biggest challenge to my mind right now … Read More