System Dynamics

Frontline Decisions in Real-Time: What Health Systems Can Learn from the U.S. Military’s Defeat of Al Qaeda in Iraq

“The teams were operating independently—like workers in an efficient factory—while trying to keep pace with an interdependent environment. We all knew intuitively that intelligence gathered on AQI’s [Al Qaeda in […]
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Reader Response: Creating a “Freedom Platform” for Health Data

Dave, your article No Time to Waste: Revolutionizing Healthcare Data Collection, Curation and Application is nothing if not provocative and insightful. http://www.4sighthealth.com/no-time-to-waste-revolutionizing-healthcare-data-collection-curation-and-application/What does it mean for health data to be truly […]
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MARKET CORNER CONVERSATIONS: JIM HARDING, FOUNDER & CEO, MULTISCALE HEALTH NETWORKS

Jim Harding, Founder & CEO of MultiScale Health Networks, joins David Johnson for Episode 13 of Market Corner Conversations. Jim discusses how he applied his experience as a serial tech entrepreneur […]
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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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Brand-Heavy and Asset-Light: Moving Beyond the Acute-Care Mindset

For health systems, the day of reckoning is near. A recent Morgan Stanley report states that over 1,000 of the nation’s 5,000+ hospitals are currently weak or at risk of closing. […]
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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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Amplifying Transformation: Addressing Medicare Advantage’s Disadvantages

The U.S. healthcare system will not change the way it delivers care until it changes the way it pays for care. Perverse incentives riddle fee-for-service payment (FFS) and lead to […]
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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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It’s Commercial Health Plans That Are Keeping Fee-for-Service Alive

Far from pulling the plug on fee-for-service medicine, commercial health plans continue to give it CPR. A new report says well over half of commercial health plan payments to providers […]
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MARKET CORNER CONVERSATIONS: MUDIT GARG, FOUNDER & CEO, QVENTUS

Mudit Garg, Founder & CEO of Qventus, joins David Johnson for Episode 12 of Market Corner Conversations. Mudit shares how he views the challenges clinicians push through to provide care data […]
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No Time to Waste: Revolutionizing Healthcare Data Collection, Curation and Application

Healthcare data wants to be free, but it is oppressed. Entrenched oligarchs trap information within closed, centralized systems that prioritize revenue collection, misuse resources and tolerate medical error. Data gasps […]
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A CONCRETE DESCRIPTION OF THE CLOUD

In the simplest terms, cloud computing means storing data and software applications on the Internet, in secure files, then accessing that data and programs over the Internet rather than from physical […]
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Study Refocuses ER Coverage Debate on Patients

A new study reminds us that the squabble between providers and payers over coverage of unnecessary emergency room visits should be more about patients and less about who pays who […]
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Employees’ Premiums Actually Dropped This Year and Nine Other Untold Employer Health Benefits Stories

Every picture tells a story. So does every chart in the Kaiser Family Foundation’s annual employer health benefits survey. Here are 10 small stories from Kaiser’s latest survey that collectively […]
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Reducing Low-Value Care Gets Personal

It’s like FBI profiling but for doctors—doctors who order too many unnecessary diagnostic tests. Researchers from Canada have escalated the fight against low-value healthcare services by focusing on the doctors […]
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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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An Urgent Message for Those Who Want Care on Demand

The news cycle in healthcare seems to be following the news cycle in politics. Twenty-four hours is now 24 minutes if not 24 seconds. With that in mind, let’s hit […]
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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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Dr. Amy Compton-Phillips Talks Platforming at MATTER, Chicago’s Healthcare Incubator

August 23, 2018, Amy Compton-Phillips came to MATTER, Chicago’s healthcare incubator. She presented her perspective on platforming in the industry and at Providence St. Joseph Health. Key points included: The […]
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Belts and Suspenders: Major Healthcare Transactions Position Companies for Whatever Comes Next

During President Richard Nixon’s historic 1972 trip to China, the press asked China’s premier Zhou Enlai to comment on the French Revolution’s impact on world affairs. Zhou famously replied, “Too early to […]
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Kentucky HEALTH and Medicaid Work Requirements: A Behavioral Economics Lens Sheds Light

Pool Balls Break
On Friday, June 29, near the zero hour, a federal judge ruled [1] that Kentucky’s Medicaid waiver approved by the CMS could not go forward on Sunday, July 1 as […]
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MARKET CORNER CONVERSATIONS: Amitabh Chandra, Harvard Business School

Amitabh Chandra, economist and the McCance Family Professor of Business Administration at Harvard Business School, joins David Johnson for Episode 10 of Market Corner Conversations. Chandra shares his path form labor economist to […]
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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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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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MARKET CORNER CONVERSATIONS: JAKE CRAMPTON, MEDSPEED

Jake Crampton, CEO of MedSpeed, joins David Johnson in Episode 8 of Market Corner Conversations. Crampton shares how MedSpeed facilitates “intra-company logistics.” MedSpeed’s customers transform their transportation networks from cost […]
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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

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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Mission First: Mission Health’s Surprising Sale to HCA

On March 22nd, Mission Health in Asheville, North Carolina announced its intention to sell its seven-hospital not-for-profit (NFP) health system to HCA Healthcare, the nation’s largest for-profit healthcare system. The […]
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Goodbye “Dr. Know-It-All”: Medicine’s Liberating Knowledge Explosion

Dr Know It All Icons
The digitization and globalization of medical information is overwhelming traditional medical practices. Physicians confront a continuous avalanche of medical discoveries on disease origins, symptoms and treatments. By 2020, medical knowledge […]
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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: Dr. Amy Compton-Phillips

Amy Compton-Phillips, M.D., joins David Johnson in Episode 5 of Market Corner Conversations. Amy is the executive vice president and chief clinical officer for Providence St. Joseph Health. She oversees […]
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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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Platforming Healthcare: Owning Hospitals Is So 2015

The news that Amazon, Berkshire Hathaway and JP Morgan Chase joined forces to create their own healthcare company rocked the industry. The ten largest health insurers and pharmacy businesses lost […]
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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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Is Tax-Exemption Necessary? Enlightened Health Systems Should Consider the Unthinkable

 In the mid-1800s, English philosopher and political economist John Stuart Mill developed “Utilitarianism,” a framework for making moral decisions. In Mill’s formulation, an action achieves optimal social utility when it […]
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5 Days that Shook the Healthcare World

In 1919, journalist John Reed published Ten Days that Shook the World, a first-hand account of the October 1917 Russian Revolution. During that dramatic 10-day period, Vladimir Lenin’s Bolsheviks took […]
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Lexington, Concord and Medicaid Drug Formularies: Massachusetts Fires Another “Shot Heard Round the World”

Market Corner Commentary for December 13, 2017 On the 19th of April in 1775, a ragtag Massachusetts militia confronted the mighty British army in search of Colonial munitions and rebellion […]
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Honey vs. Vinegar: Value-Based Pricing Wins Customers and Market-Share

Common wisdom holds that “it’s easier to catch flies with honey than vinegar.” That aphorism also applies to payers seeking lower prices for routine healthcare procedures. It “tastes” better when […]
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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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Moving at the Speed of Medicine Part II: Taking “Systemness” to the Next Level

Football is a “system” sport. Offense, defense and special teams function as distinct units with their own coaches, schemes and measures of success. The better teams bring all these components […]
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Amazoning Pharmacy: Attacking “Indumbent” Business Practices

Sky-rocketing drug prices have captured the nation’s attention. President Trump echoes Senator Bernie Sanders when he asserts that drug companies are “getting away with murder.”[1] Republican and Democratic legislators alike assert […]
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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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Senate Republicans Confront Their Healthcare Waterloo: Now What?

Last weekend Senators Jerry Moran of Kansas and Mike Lee of Utah announced they could not support Speaker Mitch McConnell’s Better Care Reconciliation Act of 2017 (BCRA). Their defections put […]
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A Chicago Story: Gun Violence; Budget Cuts and Social Contagion

It was an eventful July 4th weekend in the Land of Lincoln. The Illinois Senate over-rode Governor Bruce Rauner’s veto to pass its first state budget in over two years. […]
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A Seismic Home Care Shift is Redefining Post-Acute Care

Earthquakes occur when pent-up pressures release along geological fault lines. These seismic events reconfigure adjacent landscapes as energy waves distribute from the quake’s epicenter. U.S. healthcare is rife with fault […]
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The Iceberg Cometh: Welcome to Sickville, USA

by Kurt Waltenbaugh and David W. Johnson In the western suburbs outside Minneapolis, two men lead average lives. Surveying them as part of the general population, no health system, insurer […]
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How Health Systems Get Technology, Innovation and the Patient Wrong 

The minute I walked into the new digs of the clinic, I knew it was very different and could get the gist of what they were trying to do. It […]
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Symbiotic Disruption: Skilled-Nursing-REIT Ecosystem Adapts to Market Dynamics

clinical academic medicine 
By Wyatt Ritchie and David W. Johnson Nature thrives on symbiosis. Its many ecosystems would not exist without important relationships between sometimes strange bedfellows. The oceans’ most colorful coral reefs, […]
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Darwinian Outsourcing: Big Pharma Adapts to Market Realities

academic medicine partners 
by Kristin Carey and David W. Johnson Competitive markets drive innovations in business efficiency and strategy. Twenty-five years ago, Big Pharma companies did little outsourcing. Fortified by robust cash flows […]
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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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Moving at the Speed of Medicine: Turbo-Charging Performance with Strategic Partnerships

by David W. Johnson and Jake Crampton Insourcing is a time-honored practice employed by market-dominant companies. Rather than contract with external experts, companies dedicate internal resources for specialized functions. While […]
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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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The Rise and Fall of Academic Medicine: AMC Competitiveness in Post-Reform Healthcare

by David Morlock and David W. Johnson Rome wasn’t built in a day and didn’t collapse overnight. After centuries of growth, prosperity and domination, the Roman Empire began a long […]
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Behavioral Health Goes Local: The Emergence of Integrated, Community-Based Services

by Todd Rudsenske and David W. Johnson From addiction to depression to psychosis, mental illness exacts a growing toll on individuals, families, communities and health systems. We can measure its […]
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Winning “The Cub Way”: It Takes an Organization (Postscript)

On Saturday evening, the Chicago Cubs won the National League pennant and the City of Chicago went crazy. The Wrigleyville celebration rocked until dawn Sunday morning. After a 71-year absence, […]
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Value Quest: Capital Formation Challenges for Non-Profit Health Systems

health care system
by David W. Johnson, James Moloney and Carsten Beith   There’s a battle outside and it’s ragin’ It’ll soon shake your windows and rattle your walls For the times they […]
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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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Epi(c) Pharmaceutical Market Failure

Healthcare Advisory Services
It was hard not to feel sorry for Mylan CEO Heather Bresch as she sat for an extended CNBC interview on the morning of August 25th. Clearly on the hot […]
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Rankings and Reactions: CMS Launches Star Ratings for Hospitals

Providence Health & Services
“The fault, dear Brutus, is not in our stars But in ourselves.” [1]                William Shakespeare On July 27th, the Centers for Medicare and Medicaid Services (CMS) released its first-ever quality […]
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Back with Vengeance: Vertical Integration’s Demons Wreak Havoc

advancing organizational change 
With pride and promise just two short years ago, Catholic Health Initiatives (CHI) introduced Prominence Health, a wholly-owned subsidiary, that would “significantly advance CHI’s ability to excel in a pay-for-value […]
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Healthcare’s Dysfunctional Pricing: Be Afraid. Be Very Afraid.

medicine and health
The Health Care Cost Institute (HCCI) released its annual report of healthcare prices last month. To no-one’s surprise, HCCI found huge variation in commercial prices for 240 common medical services […]
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Asset-Light and Ready: Physician Groups Embrace Accountable Care

Imagine Better Healthcare
Hockey superstar Wayne Gretzky gave the business world its most over-used strategic metaphor, “I skate to where the puck is going to be, not where it has been.”  In healthcare, […]
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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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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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Righteous Analytics: Right Data. Right Time. Right Way

data
Market Corner Commentary for November 4, 2015- Righteous Analytics: Right Data. Right Time. Right Way Technology is on the cusp of channeling diagnosis and treatment toward best outcomes at lowest costs. […]
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Welcome Back, Kotter! Leading Health System Change

#Leading Change-Market Corner Commentary: June 24, 2015-Welcome Back, Kotter!  Leading Health System Change A version of this commentary first appeared in “Academy 360” on June 11th In the popular 1970s […]
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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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