Max Holle and Tory Wolff, Author at Recon Strategy

How does OptumCare manage its physician staffing once the big deals are done?

Max Holle and Tory Wolff October 28, 2020

OptumCare’s acquisitions usually make headlines. But what happens when the reporters leave? How is clinical capacity managed? What role do micro-acquisitions, recruiting and retirements play in advancing OptumCare capabilities? This is important because OptumCare is a risk-taking engine. Perhaps by understanding post-acquisition moves, we can reverse engineer United’s view on how clinician capacity and specialty mix can maximize value. We looked at two mature OptumCare geographies, Nevada and Texas with large physician presence and healthy United Medicare Advantage market share (just below 50%). Our analysis primarily uses the Medicare

A tale of two cities: Referral networks of orthopedic surgeons in Miami and Seattle

Max Holle and Tory Wolff October 22, 2020

Summary: We conducted a comparative analysis of the referral networks of orthopedic surgeons in King County (the area around Seattle, WA) and Miami-Dade County. Similarities Bigger systems are better at keeping referrals internal So, the level of fragmentation in the referral base is associated with the level of fragmentation in the specialty market structure Despite this, a consolidated referral base does not necessarily mean that systems are able to keep orthopedics referrals internal Miami-Dade Independent physicians make a significant proportion of referrals (9.4%) So, independent surgeons receive a significant

An ADC renaissance: a resurgence of antibody drug conjugates for cancer

Max Holle and Tory Wolff October 21, 2020

Summary: Antibody-drug conjugates (ADCs) have seen a record number of approvals in 2020. This comes after a first era of intense activity in the early 2000s followed by a period of relative quiescence from the late 2000s to mid-2010s. To understand how the nature of the ADC pipeline has changed over time, we have reviewed all 88 ADC oncology programs that have reached phase 2 development and beyond from 1997 onward. We found that, currently, the main contributor to growth is the development of ADCs which use antibodies directed to

A slow summer: An opinionated take on NEJM highlights for August 2020

Max Holle and Tory Wolff September 21, 2020

A cheap, low tech intervention for a common Achilles’ heel When I am out and about, for instance at the grocery store, I am always surprised at the number of people I see with swollen legs. About half a million times a year in the US, these folks end-up in a hospital bed with cellulitis (a skin and subcutaneous infection) of the leg. In a single center randomized trial with 84 patients who had an episode of cellulitis, an Australian group tested whether compressive stockings would make a difference in

An opinionated take on NEJM highlights for July 2020

Max Holle and Tory Wolff August 3, 2020

Stunting and the microbiome Stunting (low growth for age) affects > 20% of children across the globe and has major impact on the brain, on health, and on opportunities for success in life. The precise mechanism of stunting has remained elusive. Sanitation and diet diversity play a role but targeted interventions in these areas have had less impact than hoped for. Jeff Gordon from WashU has spent the last decade exploring the relationship between stunting and the microbiome, and now his group reports on a study that shows a clear

Covid, medical education, and a bit of RNAi: An opinionated take on NEJM highlights for June 2020

Max Holle and Tory Wolff July 6, 2020

What’s your blood type? The first report of a genome wide association study of Covid-19 severity on approximately 4000 patients and controls conducted in Spain and Italy identifies a locus on the 3rd chromosome that spans 6 potential genes for which polymorphisms appear to drive severe disease. Once the culprit gene is determined, this may help us think about drug targets. Reassuringly the study also recovers the correlation of severity with blood group that has empirically been noted in the past (on chromosome 9 although the signal is not as

AI in healthcare III: COVID-19 applications and implications

Max Holle and Tory Wolff June 5, 2020

COVID-19 has accelerated the adoption of AI in healthcare. AI based tools and solutions can work quickly, be deployed at scale, and respond to the dynamic nature of the crisis. Use-cases span all facets of responding to the pandemic, from diagnosis and triage, to treatment and combating new transmission. A wide range of players—including startups, established companies, universities, and more—are bringing their capabilities and perspectives to the table. Startups like Current Health, a UK-based remote-monitoring company supporting Mayo Clinic and Baptist Health with their COVID-19 response, are benefitting the industry’s

Covid, iPSCs, and ADCs: An opinionated take on NEJM highlights for May 2020

Max Holle and Tory Wolff June 1, 2020

Remdesivir works… but not enough to change the public health perspective The eagerly awaited results of the remdesivir NIH trial are out, and it’s solid but not smashing, although this is a partial read since the study was interrupted before completion because of evidence of benefit (and we should get more data in the coming months). Overall, the primary end-point of faster improvement in the treatment group was met while mortality showed a benefit that was just short of statistical significance. Also important is that remdesivir is clearly safe. But

Buying kit for a leadership position in the @Home revolution? Implications of Optum’s acquisition of naviHealth

Max Holle and Tory Wolff May 27, 2020

Summary NaviHealth is a leader in post-acute care management; since it manages but does not provide care, its impact is constrained by quality of available providers By aligning with Optum clinical and technology assets, naviHealth can raise the capabilities of post-acute providers, direct more cases to be discharged directly to the home and speed up the return home for others Given inpatient stays often mark the start of sustained needs for help in the home, a post-acute navigator like naviHealth could be well-positioned to orchestrate longer-term “aging-in-place” support Overview of

Covid’s backhand blow: payer mix degradation and the threat of renewed payer/provider rate brawls

Max Holle and Tory Wolff May 18, 2020

Among Covid’s many repercussions, the recession shock will drive a sustained degradation of provider payer mix. I estimate that each 5% added to unemployment will incrementally reduce hospital[1] operating margin by 1.0-1.5% and hospitals would need to charge 3-4% more on commercial care to maintain margins[2]. Given that hospital costs make up 40-45% of commercial total cost of care and we are facing unemployment scenarios of 15-20% (per Robert Wood Johnson – see table and source notes), we could ultimately expect this hospital rate pressure – if not averted or moderated

Author: Max Holle and Tory Wolff

Recon takes an analytical look behind select developments in healthcare