Outcomes

Culture Change Isn’t a Natural for Healthcare Organizations

“We must begin by asking it, ‘What is losing?’  Losing is a disease. As contagious as polio.  Losing is a disease. As contagious as syphilis. Losing is a disease. As […]
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Opioid Variations and State Interventions

Like companies in any other industry, when providers misbehave, it opens the door to state regulation of their behavior. What’s interesting about a new study in JAMA Open Network is […]
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Why Healthcare is Spinning Its VBR Wheels

It’s like preparing and serving a seven-course meal that your biggest customer ordered only to have the entire menu change between the salad and the main course. That’s what it […]
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The Strained Relationship Between Doctors and Patients

What if you walked into your doctor’s office and there was a sign hanging in the waiting room that said: “Please do not confuse your Google search with my medical […]
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4 Data Principles Healthcare Companies Need to Advance Care Delivery

What if the healthcare industry could use data as efficiently as Amazon? What if physicians could know the habits of patients like Amazon knows consumers’ buying history? What is physicians […]
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Why Proponents Are Finding Innovative Health Plan Designs a Hard Sell

When your phone company or your cable provider offers you a new and innovative service plan, your immediate thought is that you’re going to end up paying more for less. […]
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How to Provide Value-Based Care to Drive Customer Engagement

“Dr. Knows Best” is no longer the only sell healthcare companies can make to consumers. In post-reform healthcare, successful companies need to provide quality value-based care, innovative technological solutions and […]
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Shining a Light on the High Risks of Low-Value Care

Low-value care doesn’t just drive up healthcare costs without providing any discernable medical benefit to patients. It can kill you. That’s the takeaway and market lesson from the latest study […]
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Digital Disillusionment: Are We There Yet?

There are signs that digital health—the promised cure for everything that’s wrong with healthcare—may be slipping into the trough of disillusionment.  You may want to check your heart rhythm on […]
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When Hospitals Merge, Patient Satisfaction Gets Squeezed

When two competing companies merge and get bigger, a common worry of their customers is whether the quality of service will suffer as a result. Should patients worry about the […]
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Price Controls Take Root in Rhode Island. Will They Spread to Your State?

One state’s attempt to control healthcare costs by using “affordability standards” ended up limiting increases in commercial health insurance payments to hospitals and doctors without any changes in utilization or […]
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Forced Resignations at NCH Healthcare System Expose Medicine’s Dark Side

An ongoing feud between independent physicians and hospital administrators in Naples, Florida, exploded last month, damaging the trust between the community, providers and the health system. (1) The furor centered […]
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Wither the Traditional Physician Office Visit

It’s not your imagination or the self-serving forecast of a healthcare consultant angling for your business. Fewer people are seeing their doctors in person in a physical office. It’s a […]
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After the Breakups: Big Payers Find Vertical Love in New Faces

In rapid succession at the end of 2018, CVS closed its $70 billion acquisition of Aetna and Cigna closed its $67 billion acquisition of Express Scripts. The consolidated companies are […]
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Everyone Knows What’s Going to Happen in Healthcare in 2019. Do You?

What’s going to happen in healthcare this year is anyone’s guess. Not really. What’s going to happen in healthcare this year is everyone’s guess. Like most of you, from mid-December […]
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Everything in Healthcare is Changing—Except One Thing

Much has changed in healthcare over the past 25 years. A lot has changed in healthcare over the past 25 minutes. But one thing hasn’t changed, and that’s the public’s […]
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Bundled-Pay Evaluation a Study in Hospital Market-Based Behavior

What would you cut out if you suddenly had to reduce your monthly household expenses by 5 percent, 10 percent, or even 25 percent? I’m sure that some of the […]
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Getting Precise about Precision Medicine: Balancing Hope, Potential and Cost

Definitions of precision medicine are anything but precise. For seriously ill patients and their families, precision medicine therapies provide a hope when all else has failed. They’re willing to risk […]
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#1 Strategy All Successful Healthcare Organizations Should Know

American healthcare companies have a blind spot that will disrupt the growth of their organizations. The old way of American healthcare business has always been a payment battle between large […]
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Market Corner Conversations: Deborah Grisko, President & Executive Director, Almost Home Kids

“At Almost Home Kids, our mission is to provide transitional care in a home-like setting to children with complicated health needs, training for their families and respite care.” – Deborah […]
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How to Create Pro-Market Healthcare Reform in an Opioid Crisis

Over 200,000 Americans have died since 2000 due to opioid overdoses.[1] That’s equivalent to all of Salt Lake City[2] disappearing from our country. The epidemic is destroying communities throughout America, […]
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Want Better Cardiac Outcomes? Just Follow the Money

The line between financial incentives and clinical outcomes just got a little straighter. A new study says money may have erased the difference in readmission rates between the top heart […]
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New Primary Care Provider, Same or Better Outcomes

Expanding the scope of practice for nurse practitioners and physician assistants may be a cost-effective way to manage the health of patients with chronic illnesses. That’s the market-based reform takeaway […]
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Few On The Same Page When It Comes To The Value of Value-Based Reimbursement

Yet another report shows that fee-for-service medicine is hard to kill. This time the culprits are a lack of faith in value-based reimbursement by clinicians and a lack of trust […]
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Pointing the Finger at Health Plans for Providers’ Price Variations

Wide variations in what providers charge for the same medical services are notorious. But providers are not acting alone. They’re aided and abetted—and some would say coerced—by health plans whose […]
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Top Hospitals Make It Tough On Patients Who Want To See their Own Medical Records

All hospitals say that they want to engage patients in their own medical care. But even the best hospitals are making it difficult for patients to access their own medical […]
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Autism Therapy Shines Bright: Early Intervention, Improved Access and Individualized Care Change Lives

Autism Spectrum Disorder (ASD) is the nation’s fastest-growing developmental disorder, one that touches each child and family in unique and complicated ways. A  lifelong condition, ASD requires individualized treatments that […]
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Healthcare Worker Flu Vaccine Rates Offer a Lesson in Self-Policing

Short of making flu shots mandatory for healthcare workers, healthcare employers need to do much more to immunize their staffs from a virus that threatens their health and the health […]
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The Early Patient Gets the Flu Shot

Unnecessary variation in patient care is a quality and cost killer. And it’s not just a problem for complex medical cases. It’s a problem for even the most routine services […]
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A Lesson in Value-Based Payments from Across the Pond

If you paid your kids to clean their rooms and keep them clean, would they? If you stopped paying them, would they keep cleaning their rooms because they realized that […]
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As GM Goes, So Goes Healthcare: Dynamics of Demand-Driven Reform

“For years I [have] thought what was good for our country was good for General Motors, and vice versa.” Charles E. Wilson Last month, General Motors signed a 5-year agreement […]
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Gawande’s Gift: Re-Imagining Corporate Wellness and Healthcare

Amid much fanfare, the Amazon, Berkshire Hathaway, JP Morgan health venture (ABJ) announced on June 20th that its new CEO will be acclaimed author and surgeon Atul Gawande. Gawande starts his new job […]
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How Soccer Explains Healthcare: Collective Performance Defines Success (1)

Soccer ball & stethoscope
The 21st FIFA World Cup kicked off on June 14th when host Russia trounced a weak Saudi Arabian team 5-0 at 81,000-seat Luzhniki Stadium in Moscow. It equaled the most lopsided opening […]
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Destination Medicare Advantage: Lonnie & Cathy’s Quest for Great Health Insurance

Lonnie & Cathy Quinn, Happy Medicare Advantage Members
In 1993, the health insurance industry funded the legendary “Harry and Louise” campaign to mobilize public opinion against the Clinton healthcare reform proposal. The strategy worked. Despite enormous investment of political capital, […]
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Market Corner Conversations: Dr. Mike Roizen, Cleveland Clinic Foundation

Dr. Mike Roizen, Chief Wellness Officer and Chair of the Wellness Institute at Cleveland Clinic, joins David Johnson for Episode 9 of Market Corner Conversations. Dr. Roizen is the creator […]
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Pro-Market and Pro-Business: Not Always the Same, Particularly in Healthcare

Shortly after publishing Market vs. Medicine: America’s Epic Fight for Better, Affordable Healthcare in June 2016, I met with my former investment banking colleague, Jullia Quazi. Jullia arrived with a very funny story […]
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Superhero Healthcare (Part 2): Already Here; Growing Fast; Payment-Driven

Part I of Superhero Healthcare identified several bright spots within American healthcare where liberated caregivers deliver appropriate, efficient care to engaged patients; where the interests of health companies and their customers align; and where compassion, […]
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Superhero Healthcare (Part 1): Liberating America’s Caregivers and Patients!

Dr Superhero
Most weekends in America, long lines form outside cineplexes as ardent fans of DC and Marvel Comics catch the latest iterations on the big screen. Since the dawn of motion […]
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Market Corner Conversations: Dr. Toby Cosgrove, Cleveland Clinic

Toby Cosgrove, M.D., former CEO of the Cleveland Clinic Foundation, joins David Johnson in Episode 7 of Market Corner Conversations. Dr. Cosgrove shares how he built a culture of empathy […]
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Market Corner Conversations: Dr. Rushika Fernandopulle, Co-Founder & CEO, Iora Health

Rushika Fernandopulle, M.D., Co-Founder & CEO of Iora Health, joins David Johnson in Episode 6 of Market Corner Conversations. Rushika shares how he decided that the incremental change model wasn’t working […]
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Scaling Relationship-Based Care: “Different Spokes (Care Models) for Different Folks”

In 1970, Marcus Welby, MD became ABC Television’s first show to top network television ratings. Dr. Welby was a cheerful family practice physician with a soothing bedside manner who was […]
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Market Corner Conversations: Mike Pykosz, Oak Street Health

In Episode 4 of Market Corner Conversations, Mike Pykosz, CEO of Oak Street Health, shares the bottom-up approach Oak Street takes toward its Medicare Part B members. Oak Street creates […]
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Upsizing Dentistry: Putting More Bite into Primary Care

Teeth model stethoscope
Quad/Graphics, the American printing company, was founded near Milwaukee, Wisconsin in 1971 by a husband and wife team. Harry and Betty Quadracci saw advantages in a family approach to doing […]
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Reimbursement Follows Respect: Leading States Pay to Address Social Determinants of Health

For too long, the “Social Determinants of Health” (SDH) have been the big elephant in the exam room. While no one denies that a diabetic living alone in a food […]
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Fortress Healthcare Meanders Toward Value

There are more “suits” in downtown San Francisco each January for JP Morgan’s annual healthcare conference than the rest of the year combined. Heavy rain drenched San Francisco on January […]
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Good Intentions Aren’t Enough: Choosing Wisely Misses the Target

Market Corner Commentary Special Report for November 8, 2017 Earlier this year, the Choosing Wisely campaign celebrated its 5th anniversary. Choosing Wisely is a well-funded, practice-focused organization created to reduce […]
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Capitalizing on Comprehensive Care: Cultivating a Medicare Advantage Mindset

This paper is Part 3 in our series on payment reform. After highlighting various efforts to reign in healthcare costs over the past 50 years in Part 1, Part 2 […]
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Merle Power! Living Long and Prospering

By Kurt Waltenbaugh and David W. Johnson Merle Phillips is a petite 110-year old 4’9” fireball who keeps doing big things. She’s writing her twelfth book and recently created a […]
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Advantage Medicare Advantage: Delivering Healthcare’s Triple Aim to America’s Seniors

Hitting the Sweet Spot for Patients and Providers The United States is experiencing a demographic tidal wave. Baby Boomers are turning 65 in record numbers and that trend will accelerate […]
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Market Corner Conversations: Paul Walczak, NuVista

4sight Health’s inaugural episode with Paul Walczak, the CEO from NuVista, a remarkably innovative post-acute care company coordinating value-based delivery in southern Florida that achieves superior outcomes at very low costs. […]
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The Iceberg Cometh: Welcome to Sickville, USA

In the western suburbs outside Minneapolis, two men lead average lives. Surveying them as part of the general population, no health system, insurer or policy maker would notice anything that […]
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Symbiotic Disruption: Skilled-Nursing-REIT Ecosystem Adapts to Market Dynamics

clinical academic medicine 
Nature thrives on symbiosis. Its many ecosystems would not exist without important relationships between sometimes strange bedfellows. The oceans’ most colorful coral reefs, for example, are often found in clear […]
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“Indumbent” Healthcare Thinking: Prices Don’t Matter

best health policy
In a March 29th New York Times article, author Elizabeth Rosenthal chronicles America’s dystopian system for coding and billing medical treatments. Rosenthal concludes that the medical-billing system itself is a […]
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AHA! Healthcare is Both a Right and a Commodity

market vs medicine
In late January, I participated in an Oxford-style debate regarding whether healthcare is a commodity. The debate was the featured event at Tata Memorial Centre’s Platinum Jubilee Conference in Mumbai, […]
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Scaling Healthcare’s Mt. Everest: Peak Performers Engage Technology and Consumers

by Bryan Cloncs and David W. Johnson Climbing the highest mountains requires organization, preparation and strategy. Scaling Mt. Everest is a full-scale expedition. Large teams rely on a sophisticated infrastructure […]
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Letting Go: Steward Sells Its Hospitals and Embraces Patient-Centric Care

by Robert Fraiman and David W. Johnson Last September, Massachusetts-based Steward Health Care System announced that it would sell its 9 hospitals to Alabama-based Medical Properties Trust (MPT) for $1.2 […]
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Behavioral Health Goes Local: The Emergence of Integrated, Community-Based Services

From addiction to depression to psychosis, mental illness exacts a growing toll on individuals, families, communities and health systems. We can measure its effects in unnecessary deaths, social isolation, reduced […]
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Overcoming Medical Errors of Omission: The Cure Requires Organizational Empathy

Organizations fail or decline more frequently because of what they did not do than because of what they did.                                                             Russell L. Ackoff Professor of Management Science Wharton School, University […]
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Winning “The Cub Way”: It Takes an Organization

health forum education
The Cubs just finished the 2016 regular season with 103 wins and baseball’s best record by a mile. They have spectacular pitching, powerhouse hitting and solid defense. Las Vegas odds-makers […]
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Market Evolution: Addressing Structural Flaws on Public Health Exchanges

health care services
After two-plus years of operations, clear structural flaws have emerged in the design and function of public health exchanges. Health insurance cooperatives have largely failed. Many traditional insurers have suffered […]
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Summer Book Report: 4sight Health’s Busy August

health insurance plans 
With Labor Day weekend approaching, state fairs in full swing, and the barbeque calling, most of us have just half a mind on work. At 4sight Health we’re enjoying the […]
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Being American: How Exceptionalism Is Transforming U.S. Healthcare

Imagine Better Healthcare
Midway through the Rio Olympics, the prowess of the diverse, raucous and remarkably talented U.S. team is on full display. We marvel at the athletes’ dedication. Their enthusiasm is infectious. […]
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Where’s the Beef? Employers Question the Value of Hospital Mergers

In an iconic 1984 commercial for Wendy’s hamburgers, the diminutive octogenarian Clara Peller and two friends are eating hamburgers at the fictional “Home of the Big Bun.” Disappointed by their […]
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Obama Speaks: A Presidential Assessment of Obamacare

4sight Health
Market Corner Commentary for July 27, 2016 Earlier this month, President Obama took the unprecedented step of authoring an academic research article in The Journal of the American Medical Association […]
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Made in America: Venture-Backed Healthcare Solutions

care transformation
Market Corner Commentary for July 20, 2016 Last month, Reed Abelson of the New York Times chronicled the challenges of Oscar Health, the venture-funded health insurance company. Despite massive investment, […]
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It Takes Two to Tango: Cracking the Patient/Customer Engagement Code

4sight Health
The tango is a beautiful, complex, fast-paced dance that gets the heart racing for participants and spectators alike. The intimacy of two partners moving in coordinated lockstep leaves no doubt: […]
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Great Consumer Expectations: Data-Enabled Healthcare Outcomes and Service

health forum education 
Health companies experience excessive variation in clinical outcomes, quality metrics, procedure pricing and customer satisfaction. This frustrates providers, payors, employers and patients alike. All Americans want the healthcare system to […]
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The Post-Acute Gold Rush: Winning the Race to the Claims Office

american health system
Gold’s glitter and the lure of quick riches led 90,000 unruly prospectors to California in 1849. The gold rush was on and it had rules. Prospectors had to actively work […]
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Necessity Turbo-Charges Productivity at Cleveland Clinic Florida

transforming american healthcare
Coming into 2015, Ozzie Delgado confronted a thorny problem. Cleveland Clinic Florida was experiencing expansive demand for surgical services. Occupancy was already at 92% and there would be no capacity […]
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Lactose Intolerance: Aaron Rodgers and the Cheese-Heavy American Diet

Wisconsin may never be the same. Green Bay Packers star quarterback announced this month that he has stopped eating dairy products to “get healthier.” As Bart Simpson might observe, the […]
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Let’s Talk: Constructive End-of-Life Decision-Making

At Jeff Shield’s memorial service, Genie Shields proclaimed that her husband’s death has been a “gift,” one that enriches all who receive it. When it became clear that lymphoma would […]
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Rethinking Healthcare.Gov: As Covered California Goes, So Goes Nation?

Rethinking Healthcare.Gov: As Covered California Goes, So Goes Nation? The 17 state-run healthcare exchanges are real-life “laboratories” for the federally-run exchanges that operate in 34 states. No state exchange has […]
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Two Runners, Two Countries, Two Emergencies: You Decide

For over a decade I’ve plodded up and down the Chicago lakefront with the same group of idiotic runners. Through wind, sun, snow and rain we babble about anything that […]
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Misdirected Fury: The Boston Globe “Spotlights” Concurrent Surgeries

Market Corner Commentary for March 2, 2016: Misdirected Fury: The Boston Globe “Spotlights” Concurrent Surgeries At Sunday night’s 88th Academy Awards, Spotlight won the Oscar for best picture. The movie chronicles […]
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Healthcare’s Productivity Paradox: Ferocious Exploitation of Reimbursed Payment

Market Corner Commentary for February 17, 2016-Healthcare’s Productivity Paradox: Ferocious Exploitation of Reimbursed Payment Las Vegas is a strange place to attend a medical conference. In June 2014, the Healthcare […]
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Big Data’s Ups and Downs: The Good, The Scary and The Creepy

Market Corner Commentary for February 10, 2016-Big Data’s Ups and Downs: The Good, The Scary and The Creepy Big data analytics are essential for understanding consumer preferences. Collecting, measuring and […]
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Pursuing What Works: Genetics, Epigenetics and Chronic Disease

chronic disease management
Market Corner Commentary for February 3, 2016-Pursuing What Works: Genetics, Epigenetics and Chronic Disease Genetics-based therapies represent the pinnacle of medical science. Billions of dollars have poured into research to […]
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U.S. Healthcare in 2016: Enjoy the Sideshow; Watch the Main Event

Market Corner Commentary for January 27, 2016- U.S. Healthcare in 2016: Enjoy the Sideshow; Watch the Main Event For the sixty-second time, the U.S. House of Representatives passed legislation repealing Obamacare […]
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Exchange Matters: UnitedHealth Takes a Stand or Does It?

Market Corner Commentary for January 20, 2016 During an investor call in November, the nation’s largest health insurance company (UnitedHealth Group) delivered a body blow to the Affordable Care Act’s […]
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Dynamic Tension: Rethinking Health System Governance

market-based health care system
Market Corner Commentary- Health System Governance- for January 6, 2015 The winds of post-reform transformation are blowing through healthcare. Long-established health systems confront existential questions: do we buy or sell? […]
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Getting Right with Consumers: Right Businesses. Right Places. Right Prices.

consumerism
Market Corner Commentary for November 11, 2015-Getting Right with Consumers: Right Businesses. Right Places. Right Prices. Consumerism has the force and precision of heat-seeking missiles. Customers flocked to Walmart because it […]
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“Amazoning” Healthcare’s High Prices

prices
“Amazoning” Healthcare’s High Prices A recent Kaiser Health News article reports that prices for basic women’s health services vary dramatically within and across markets. The cost for mammograms in Dallas […]
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Value Rules: Playbook for Post-Reform Healthcare

value
Market Corner Commentary for October 21, 2015-Value Rules: Playbook for Post-Reform Healthcare Warren Buffett famously noted that “price is what you pay and value is what you get.”  In fee-for-service […]
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“The Cubs Way”: Lessons in Leadership, Cultural Change and Performance Improvement

Market Corner Commentary for October 14, 2015-“The Cubs Way”: Lessons in Leadership, Cultural Change and Performance Improvement Any team can have a bad century!  The Chicago Cubs define ineptitude.  They […]
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Doc-Fix Legislation: Medicare Makes Physicians an “Offer They Can’t Refuse”

David Johnson and Nathan Bays-Doc-Fix Legislation: Medicare Makes Physicians an “Offer They Can’t Refuse” After years of temporary fixes and short-term extensions, the U.S. Congress repealed Medicare’s Sustainable Growth Rate […]
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The Tyranny of Average Costing: Profit and COST in Value-Based Delivery

Market Corner Commentary for September 23rd-The Tyranny of Average Costing: Profit and COST in Value-Based Delivery Michael Porter, the eminent Harvard Business School professor, defines “value” in healthcare as “achieving the best […]
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Mind and Medicine: Amplified Healing Through Behavioral Science

Market Corner Commentary for September 16, 2015-Mind and Medicine: Amplified Healing Through Behavioral Science In announcing his Precision Medicine Initiative, President Obama articulated a medical future where genetic discovery shapes tailored […]
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Of Metrics and Meaning: Making Sense of Healthcare Quality Ratings

Market Corner Commentary for September 9, 2015-Of Metrics and Meaning: Making Sense of Healthcare Quality Ratings As healthcare becomes more consumer-focused, hospital and physician rating systems are proliferating.  Yelp is […]
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Kinky Boots, Swedish Dialysis and Demanding Customers

Market Corner Commentary for August 26, 2015-Kinky Boots, Swedish Dialysis and Demanding Customers The oldest and best advice in business is “give customers what they want.”  From Broadway to Sweden, […]
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Individual Mandate: Are You Up for N=1 Healthcare?

Market Corner Commentary for August 19, 2015 (disruption)-Individual Mandate: Are You Up for N=1 Healthcare? Yogi Berra famously observed, “The future just ain’t like it used to be.”   In N=1: How […]
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King for a Day: Winning Strategies in Post-Reform Healthcare

Market Corner Commentary for August 12, 2015 -King for a Day: Winning Strategies in Post-Reform Healthcare-(#Quality Outcomes) Great leaders ask great questions. Banner Health’s CEO recently wrote and asked me, […]
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Medicare at Fifty: More Yesterdays than Tomorrows?

Market Corner Commentary: August 5, 2015-Medicare at Fifty: More Yesterdays than Tomorrows? A version of this commentary appeared in Huron Healthcare’s “Perspectives” on July 30th With Harry Truman watching, Lyndon […]
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Reimbursement Roulette: Health Companies “Double Down” on Revenue

Market Corner Commentary: July 28, 2015-Reimbursement Roulette: Health Companies “Double Down” on Revenue A version of this commentary appeared in “Academy 360” on July 23, 2015 Let the good times […]
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David Jones’ Locker: Humana and the Perils of Vertical Integration

Market Corner Commentary: July 22, 2015-David Jones’ Locker: Humana and the Perils of Vertical Integration American healthcare is losing the iconic Humana brand.  Aetna has announced it will acquire Humana […]
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Crossing the Technology Chasm: Tele-ICUs Save Lives and Money

healthcare in usa 
Crossing the Technology Chasm: Tele-ICUs Save Lives and Money The Leapfrog Group’s[1] fact sheet on ICU Physician Staffing estimates that preventable ICU deaths exceed 54,000 each year. This figure excludes […]
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No One is an Island: Meaningful Second Opinions

Market Corner Commentary: July 1, 2015-No One is an Island: Meaningful Second Opinions A good friend (let’s call him John Donne) in his mid-fifties recently wrote describing his treatment for […]
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Chasing Colonoscopies: It’s the Customer, Stupid!

Market Corner Commentary: June 17, 2015-Chasing Colonoscopies: It’s the Customer, Stupid! Who knew a routine colonoscopy could illuminate the wild world of healthcare consumerism? Before getting to my story, let’s […]
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Deep Web Rising: Healthcare’s Looming Cyber Threat

A version of this commentary first appeared April 30th in “Academy 360”-Deep Web Rising: Healthcare’s Looming Cyber Threat Healthcare is a “target-rich” environment for cyber criminals. Cyber attacks on health […]
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Holy Sheets! Fast-Tracking Delivery Innovation


Holy Sheets! Fast-Tracking Delivery Innovation Hospitals have used cotton linens since the early 1900s.  Crisp, white sheets touch all patients and epitomize healing.  “Hospital corners” describe the proper way to […]
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