Convenience care, telemedicine and breaking down barriers to geographic competition – a speculation
Posted by Tory Wolff on in Digital Health, Providers
A few problems Geographic barriers to the entry have long protected providers from best-in-class competition. Provider consolidation – theoretically a logical response to the current operating environment — reinforces these barriers by locking up referrals and making systems too big / too few to fail. Instead of pushing providers aggressively on value, payers and regulators may end up nursing underperforming systems (e.g. Highmark’s bail-out of the West Penn Allegheny system) and discouraging disruptive entrants for fear of unintended damage to the stability of the local provider infrastructure. Even if consolidation is necessary for value-based care, the result looks like a leverage… Read More
Working paper: the coming age of algorithmic medicine
Posted by Marc Herant on in Payers, Providers, Uncategorized
Summary In this working paper, we develop the following thesis. In the not so distant future (a decade or two), medicine will be largely governed by algorithms — highly deterministic clinical pathways characterized by a high level of reproducibility of care — that will be developed and improved by providers. These algorithms will include individual patient preference branch-points but not individual provider preference. As a result, payers and providers will agree on coverage on the basis of a set of algorithms and a process of how they should evolve; providers will be paid on a fee-for-service basis for following the… Read More
The Ochsner Health Network: has Ochsner gone “a hospital too far”?
Posted by Tory Wolff on in Population Health, Providers, Uncategorized
Over eight months between October 2014 and June of this year, Ochsner formalized alliances with five major provider systems in Louisiana. The first wave (with St. Tammany Parish, Terrebonne and Slidell) reinforced Ochsner’s stronghold in New Orleans. The second wave (with Lafayette General and CHRISTUS) secured pathways to markets west along I-10 and the coast and northwest along the I-49 corridor to Shreveport. This collection of alliances — dubbed the Ochsner Health Network (OHN) — is effectively statewide with ~30% of the hospital beds and ~30% of the physicians. Key components of the alliances include: a joint clinically integrated physician… Read More
NEJM Highlights September 2015: cells, cells, cells
Posted by Marc Herant on in NEJM Highlights
Promise for systemic amyloidosis (and beyond?) Systemic amyloidosis is an uncommon disease in which abnormal cells (typically antibody-producing B cells) produce large amounts of protein that deposit as amyloid fibrils in various organs (heart, kidney, liver). These are the same kind of deposits that create plaque in the brain in Alzheimer’s disease. In systemic amyloidosis, the deposits cause organ damage, failure, and death and treatment options are limited. GSK is developing a monoclonal antibody directed at serum amyloid P (SAP), a naturally occurring glycoprotein that binds to amyloid fibrils. The attachment of the antibody to SAP which is bound to… Read More
Can convenience care be a platform for an insurance product?
Posted by Tory Wolff on in Consumer Health, Payers, Providers
Summary A Portland-based urgent care operator is launching a health plan from scratch The strategy targets the busy and healthy with the convenience of a retail network providing “store brand care”; a simple, consumer oriented service model at low cost. Carving out this segment can plausibly allow for sustained advantage in admin, medical cost and revenue management. The plan has hit a speed bump with regulators on pricing, so evidence of this model’s market appeal will come slowly. Convenience care has historically played nice with the ecosystem, but Oscar’s explosive valuations may convince some to be more aggressive. Insurers may… Read More
NEJM Highlights August 2015: cancer and joints
Posted by Marc Herant on in NEJM Highlights
The emergence of a new approach to drug development in cancer Cancers are classified by the organ or tissue from which they arise, but as our molecular understanding increases, another level of categorization is emerging based on the molecular characteristics of the tumor. In a novel but sure to be growing approach, Roche/Genentech tested their drug vemurafenib (Zelboraf, currently approved for melanomas with the BRAF V600 mutation) in a study population that was largely agnostic to tumor provenance as long as it was BRAF V600 positive. 122 patients were enrolled with more than half a dozen cancers represented –… Read More
So what if PCPs in ACO practices are not paid differently?
Posted by Diana Poon on in Providers
In a recent study, Ryan, Shortell, et al analyzed the composition of PCP compensation (broken down into salary, productivity and quality/other components) across practices with ACO contracts vs. those with more traditional business models. This note will: provide a quick summary of results offer an alternative interpretation of the data describe two methodological points regarding the data set The major finding As of 2012/2013, there are no major systematic differences in how PCPS are paid in ACO practices vs. others. Whether in an ACO or not, PCPs were paid on average ~50% on salary, ~45% on productivity and 5%… Read More
NEJM Highlights July 2015: a first in class drug for cancer, Sovaldi cures renal failure too (sometimes), convenient primary care
Posted by Marc Herant on in NEJM Highlights
Palbociclib – first to target cyclin dependent kinases – breast cancer As all biology majors know, cyclin dependent kinases are critical elements controlling the machinery of cell proliferation. They have proved difficult targets due to their ubiquitous activity in both normal and abnormal tissue – until now. In a phase 3 study, about 500 patients with metastatic hormone positive, Her2 negative breast cancer were treated with palbociclib (Ibrance, Pfizer, recently FDA approved) vs. placebo. The median disease progression time for patients on drug was 5 months longer than for placebo (9 vs. 4 months, survival data was pending). Adverse effects… Read More
NEJM Highlights for June 2015: the flavor of the month is distinctly cardiovascular
Posted by Marc Herant on in NEJM Highlights
Interventionalist treatment for stroke: In the 80s and 90s, treatment of myocardial infraction was greatly advanced by the introduction of systemic clot busting drugs (t-PA and others); further advance occurred in the 90s when it was shown that immediate cardiac catheterization produced even better results. Acute embolic stroke has followed the same path – in the 90s, it was shown that t-PA treatment within 3 hours of onset of symptoms was beneficial, and ever since there has been a move toward treatment modalities where an interventional radiologist acts on the clot directly. Two randomized controlled studies now show unambiguously that… Read More
NEJM Highlights May 2015: a read on ACO performance, progress in cystic fibrosis treatment, yes developing new drugs is expensive, rethinking industry-medicine relationships, CVS Caremark and smoking cessation
Posted by Marc Herant on in NEJM Highlights
Early results of the ACO experiment: directionally right, but impact is still small In this study, the authors compare metrics for Medicare beneficiaries assigned to the 32 ACOs part of the Pioneer program vs. matched beneficiaries who were not in an ACO. With respect to costs, they find that compared to contemporaneous trends observed in non-ACO members, the ACO beneficiaries yearly spending was approximately $100 below trend (a 1% savings). In a hint of a reversal of a secular trend in health care, office spending visit expenditure increased more in ACOs, while it was the reverse for hospital-based services which… Read More