Market Corner Commentaries
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Dave Burda curates a weekly email and hosts a weekly podcast discussing news that impacts market-based change.
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Featured Articles
2020: A Year Like No Other – Insights, Comments and Interviews
Market Corner Commentaries
What to Expect When You’re Expecting (A Budget)
The Biden Administration’s top health priorities are COVID and strengthening the Affordable Care Act. The initial flurry of executive actions will go only so far. The rest, especially spending, will …
Market Corner Commentaries
The Many Flavors of Healthcare’s Not-For-Profit/For-Profit Partnerships
With valuations soaring, the market for acquisitions and consolidations has become costly and competitive. As a result, some corporate sponsors, service providers and private equity (PE) investors are looking beyond …
Market Corner Commentaries
2020: A Year Like No Other – Insights, Comments and Interviews
At the beginning of 2020, US healthcare showed every sign of continuing 2019’s wave of growth and consolidation. Soaring valuations and an influx of new investment capital bolstered the optimistic …
COVID-19
COVID-19’s Vexing Biological, Logistical and Political Vaccine Hurdles
Monday, December 14, 2020 will become an auspicious date in American history. The United States recorded its 300,000th COVID-19 death and set daily records for new COVID-19 cases (261,250) and …
Market Corner Commentaries
The Worst and Best of Times: Perspectives from Cain Brothers’ Healthcare 2020 Virtual Conference
2020 has been a year like no other. Investors in U.S. healthcare have navigated remarkable economic and societal disruption by maintaining their focus on long-term value in healthcare businesses and …
Innovation
The Future of Clinical Trials: Decentralized, Diversified, Efficient and Fast
COVID-19 is the most deadly and confounding world health crisis since the 1918 influenza pandemic which killed as many as 50 million people. Hopes for a better future hinge on …
Market Corner Commentaries
Stop Worrying About ACA Repeal (Part B): Concentrate on Game-Changing Interoperability & Transparency Regulations
The Supreme Court began hearings this week regarding the legality of the Affordable Care Act (ACA). Preliminary indications suggest the Court will keep the law largely intact. A final ruling …
Market Corner Commentaries
Stop Worrying About ACA Repeal: It’s Not Going to Happen (Part A)
The 2020 pre-election hysteria regarding the potential demise of the Affordable Care Act (ACA) resembles Chicken Little screaming to the multitudes that the sky is falling. The political theater is …
Innovation
Curating Knowledge in the Digital Age: Mining Massive Data Sets for Healthcare Insights
In the recent article Healthcare’s Age of Liquid Data, we explored why the healthcare industry must move aggressively to make healthcare data extremely connected. We identified three steps to make …
Consumerism
GoFundMe Misery: Unaffordable Healthcare is Unavailable Healthcare
I spent some time this week scrolling through medical campaigns on the GoFundMe website. These campaigns seek funding to pay medical expenses for those with serious illness and injury. Their …
COVID-19
The Future of Hospitals in Post-COVID America (Part 2): The Policy Response
Editor’s Note: This is our second article on the Future of Hospitals in Post-COVID America. The first article, published in July, examined the accelerating pace of industry consolidation and hospital …
Innovation
Where Have All the Patients Gone? The Art and Soul of Recapturing Lost Treatment Volume
On a plane trip to Oberlin College in October 1955, singer Pete Seeger wrote the first three verses of the popular anti-war song Where Have All the Flowers Gone? With …
Innovation
What Pandemic? Investors Love Hotspotting 2.0
Key Takeaways Investors expressed confidence in Oak Street Health’s model for caring for high-cost, low-income patients by sending its shares soaring 90% on the first day of trading after an …
Innovation
Achieving Data Aggregation at Scale: How Health Companies Will Adapt to the Age of Liquid Data
In Healthcare’s Age of Liquid Data, we explored why the healthcare industry must move aggressively to make healthcare data extremely connected. We identified three steps to make this happen – …
Economics
The Future of Hospitals in Post-COVID America (Part 1): The Market Response
Editor’s Note: This is the first of two articles on the Future of Hospitals in Post-COVID America. This article examines how market forces are consolidating, rationalizing and redistributing acute care …
Market Corner Commentaries
No Time to Waste: COVID-19 Is Propelling Operational Transformation in Health Systems
Boxer Mike Tyson famously observed, “Everyone has a plan until they’re punched in the face.” COVID-19 knocked America’s healthcare system to the canvas. Even as hospitals expanded critical care capacity …
Innovation
Making Healthcare Better: Connected Business-Clinical Platforms Save Lives and Money
Founded in 1865, the German company BASF grew to become the world’s largest chemical manufacturer. By the early 1990s, BASF was a household name in Europe and Asia, but was …
Innovation
Home Health Is Where the Growth Is: The Post-COVID Rise of Platform Solutions
Before the COVID-19 pandemic, the home healthcare sector was on the march. With financial pressures intensifying and value-based payment models advancing, providers and payers sought lower costs and better outcomes …
Economics
Collecting & Saving Pennies: Turbocharging Health System Revenue Management & Productivity
In our recent article we identified the following five margin pressures that are coalescing to drive more value into the delivery of healthcare services: Their collective impact poses an existential …
Innovation
Healthcare’s Age of Liquid Data: Extreme Interoperability Sparks Personalized, Real-Time, High-Value Services
Key Takeaways Healthcare data is in solid form (i.e. fragmented, siloed) and needs to thaw so that it can flow freely to where it provides the greatest benefit. Liquid data …
COVID-19
Forward-Looking Crisis Management for COVID-19 Recovery
Key Takeaways: Strategic partnerships, reconfiguring routine care, increasing productivity and effective revenue management are value-based strategies that help enhance competitiveness and ensure long-term market relevance. Combined with increased costs for …
COVID-19
Then and Now: What Woodrow Wilson’s 1918 Pandemic Failure Can Teach Us Today
Key Takeaways: There are eerie parallels between the 1918 and current viral pandemics. Woodrow Wilson’s decision to pursue the war irrespective of the pandemic accelerated the disease spread and increased …
Innovation
Health Tech to the Rescue: Combatting COVID-19 with Virtual Care and Predictive Analytics
With stunning swiftness, COVID-19 knocked America’s healthcare delivery system to its knees. A month into the crisis, normal hospital operations are in upheaval. Avoiding in-person care has become the norm …
Innovation
Now Is The Time. Time To Reconfigure Routine Care.
In our recent article we identified the following five margin pressures that are coalescing to drive more value into the delivery of healthcare services: Their collective impact poses a prominent …
Market Corner Commentaries
Why Strategic Partnerships Are Vital To Hospital and Health Systems Success
In our January 9th, 2020, Market Corner Commentary we identified the following five forces that are coalescing to drive more value into the delivery of healthcare services: More disciplined purchasing …
Market Corner Commentaries
Advancing Advance Care Plans through Medicare: It’s Time to Move
American culture and politics make little room for honest discussions about death and dying. Healthcare thought leader Ian Morrison is fond of saying, “In Scotland, death is imminent. In Canada, …
Market Corner Commentaries
Widen the Funnel and Close the Gaps: The Summit-CityMD Combo Sees “Big Apple” Opportunity through Integrated Care Delivery
Private equity-funded delivery models are emerging to create more integrated care models that position well for value-based contracting. These new asset-light and consumer-oriented business models are changing healthcare’s competitive dynamics …
Market Corner Commentaries
Taking Healthcare’s Pulse: 4sight Health’s 2020 J.P. Morgan Conference Report
Each year on the second Sunday in January, the healthcare world descends on San Francisco for the J.P. Morgan conference and the circus that surrounds it. For the next week, …
Market Corner Commentaries
Healthcare Has No Clothes: J.P. Morgan 2020
(from Taking Healthcare’s Pulse: 4sight Health’s 2020 J.P. Morgan Conference Report) Each year on the second Sunday in January, the healthcare world descends on San Francisco for the J.P. Morgan …
Policy
Healthcare’s Epic Problem & the Audacity of Liberating Patient Data
The gloves are off and the big guns are out. Epic Systems Corporation, the nation’s largest EHR vendor, is applying every fiber of its corporate being to dilute the government’s …
Market Corner Commentaries
Unrelenting Margin Pressures: Overcoming Healthcare’s Softening Revenues and Rising Expenses
Key Takeaways: Despite favorable rating agency outlooks, the 2020s promise to be healthcare’s most turbulent decade since the 1990s. It’s been a great 20-year run for the healthcare industry, but …
Market Corner Commentaries
Overcoming Collateral Damage: Healthcare Price Transparency Now and Forever
Key Takeaways: Providers and payers fight the implementation of transparent prices with all their considerable resources and influence. Monopolies and monopsonies resist transparent pricing for their services because it threatens …
Market Corner Commentaries
Commercializing Breakthrough Drugs In a Value-Based Market
Key Takeaways: Society demands both innovation and fair pricing from drug companies that develop treatments for all diseases. Proving meaningful efficacy and value is essential for successful drug commercialization. The …
Consumerism
Join the Customer Revolution in Healthcare!
“Every time there’s a revolution, it comes from somebody reading a book about revolution.” Mike Tyson David Johnson’s book is available for pre-order today! Book releases 9/6/19.
Market Corner Commentaries
Transforming the Built Environment: Unlocking Value Across the Health Care Continuum
Health care providers suffer from a unique form of institutional irony: delivering institutionalized care in centralized, high-cost facilities impedes their ability to meet their communities’ expansive health and wellness needs. …
Market Corner Commentaries
Mission-Critical Repurposing: Converting Aging Senior Living Properties to Affordable Housing
In 1908, the Jewish Home for the Aged of the Northwest opened in St. Paul, Minnesota, serving eight residents. As the facility deteriorated, the local Jewish community raised funds and …
Market Corner Commentaries
A Second Coming: Medical Education’s Desperate Need for Another Flexner Revolution
On June 26th, 2019, American Academic Health Systems announced its intention to cease all medical activities at Hahnemann University Hospital by September 6th, 2019. With roughly 17,000 annual admissions, Hahnemann …
Market Corner Commentaries
Don’t Let Special Interests Block Pending Rules for Sharing Patient Healthcare Data
On September 23rd, the seven healthcare lobbyists listed below sent a letter to the leaders of the Senate Health, Education, Labor and Pensions Committee (HELP) and the House Committee on …
Economics |
Innovation |
Market Corner Commentaries |
Outcomes |
System Dynamics |
Platforming Health Care to Transform Care Delivery
NEJM Catalyst Article for September 19, 2019 David W. Johnson, MPP Amy Compton-Phillips, MD Hospitals used to be at the center of the health care universe. Today, new business models …
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Economics |
Innovation |
Market Corner Commentaries |
Outcomes |
Policy |
An American Inquiry: Why I Wrote The Customer Revolution in Healthcare
What convinced a former Peace Corps volunteer and healthcare investment banker like me that the U.S. healthcare system (the System) requires revolutionary overhaul? It really came down to just one …
Economics
Should Doctors Make Less Money?
In an August 1st commentary published in the Washington Post, columnist Catherine Rampell asks an intriguing question of the Democratic presidential candidates promoting a Medicare-for-All health insurance program: “Will your …
Economics
Win-Win Partnerships: Strategics and Sponsors Increasingly Team Up
As US healthcare consolidation continues, innovative corporate buyers (strategics) and private equity investors (sponsors) are partnering to accomplish increasingly complex transactions. Such deals can create win-win arrangements that serve market …
System Dynamics
Repositioning Temporary Staffing Services: Meeting Healthcare’s Strategic (and More Permanent) Need for Labor Flexibility
American workers increasingly wear scrubs, not overalls or store uniforms.(1) In late 2017, healthcare surpassed manufacturing and retail to become the largest employer in the U.S. economy. 19 million people …
Outcomes
A GPS for Cardiac Arrest: In Life-or-Death Moments Clinical Apps Save Lives
Resuscitating Your Patients and Building Your Clinical Reputation The plane is in a nosedive. The sweating pilot is fighting to control the aircraft. A nervous co-pilot is furiously flipping through …
Economics
Getting Urgent about Urgent Care: Health Systems Go Big on Retail
Historically, health systems have delivered acute care services in hospitals and ambulatory facilities. Their business models centralize care delivery in expensive settings to optimize their operations and revenue. In avoiding …
Consumerism
An Unbearable Burden (Part 2): Wide Variations in State Health Insurance Costs
The Healthcare Affordability Index (Index) is a simple and powerful metric for assessing the impact of rising healthcare cost on American living standards. The Index measures the relationship between the total …
Policy
Let’s Get Real: Medicare for All Can’t Work, but Affordable Health Insurance for All Can
As it has in the last three presidential elections, healthcare is emerging as a decisive political issue in the 2020 election. Unlike in those previous elections, however, universal health insurance …
Economics
Consolidating Retail Medicine: Positioning Single-Specialty Practices for Acquisition
Single-specialty medical practices are the front door of American medicine. Dentists, Dermatologists, Ophthalmologists, GI doctors, ENT doctors, Internists, Gynecologists, Obstetricians, Urologists and their “retail medicine” counterparts provide high volumes of …
System Dynamics
Interoperability Battle Lines: Data Freedom Fighters vs. Entrenched Data Blockers
On a cold Minnesota morning in January 2018, Fairview Health Services CEO James Hereford addressed Twin Cities business executives regarding healthcare IT and innovation. (1) With an advanced degree in …
Consumerism
The Big (Tech-Enabled) Shift: Turning Healthcare Consumers into Customers
Consumerism was the hot topic at this year’s HIMSS conference in Orlando and at the JP Morgan conference. Attendees debated whether 2019 will mark the year healthcare finally tips toward …
System Dynamics
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 …
Economics
An Unbearable Burden: Paying for Commercial Health Insurance
The Healthcare Affordability Index (the Index) is a simple and powerful metric for assessing the impact of rising healthcare cost on American living standards. The Index measures the relationship between …
System Dynamics
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 …
Consumerism
When the Price Is Right: Aligning Payment with Health System Transformation
In 1952 at the tender age of 25, Elizabeth became the Queen of England upon the death of her father King George V. The popular Netflix series “The Crown” depicts the …
Innovation
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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Innovation |
Market Corner Commentaries |
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 …
Blog |
Economics |
Market Corner Commentaries |
System Dynamics |
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. …
Innovation
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 …
Blog |
Consumerism |
Market Corner Commentaries |
Outcomes |
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 …
Blog |
Consumerism |
Innovation |
Market Corner Commentaries |
Geeking-Up Healthcare: Consumer Giant Best Buy Makes a Big Move
Healthcare has experienced a parade of surprising megamergers and acquisitions during the last year. At first glance, Best Buy’s August acquisition of GreatCall may be the most startling. At a …
Blog |
Market Corner Commentaries |
Outcomes |
System Dynamics |
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 …
Blog |
Market Corner Commentaries |
Policy |
Against the Wind: Hospitals Challenge CMS’s Pro-Market Payment Reforms
Over the past month, the Centers for Medicare and Medicaid Services (CMS) announced several pro-market policies that will enhance pricing transparency, stimulate competition (and fair prices) for routine procedures and eliminate burdensome reporting requirements. …
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Innovation |
Market Corner Commentaries |
System Dynamics |
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 …
Blog |
Market Corner Commentaries |
Policy |
CMS Misdirection: Two Troubling Decisions Damage Market Competitiveness
In well-functioning healthcare markets, governmental regulatory policies ensure access, safety, quality and privacy. The government’s most important role is creating level-field competition through balanced regulation, targeted enforcement actions and price/outcomes …
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Consumerism |
Market Corner Commentaries |
Outcomes |
System Dynamics |
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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Market Corner Commentaries |
Outcomes |
System Dynamics |
How Soccer Explains Healthcare: Collective Performance Defines Success (1)
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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Consumerism |
Economics |
Market Corner Commentaries |
Outcomes |
Destination Medicare Advantage: Lonnie & Cathy’s Quest for Great Health Insurance
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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Economics |
Market Corner Commentaries |
Outcomes |
Policy |
System Dynamics |
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 …
Blog |
Economics |
Market Corner Commentaries |
Outcomes |
System Dynamics |
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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Consumerism |
Market Corner Commentaries |
Outcomes |
System Dynamics |
Superhero Healthcare (Part 1): Liberating America’s Caregivers and Patients!
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 …
Blog |
Economics |
Market Corner Commentaries |
System Dynamics |
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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Innovation |
Market Corner Commentaries |
System Dynamics |
Goodbye “Dr. Know-It-All”: Medicine’s Liberating Knowledge Explosion
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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Consumerism |
Innovation |
Market Corner Commentaries |
Outcomes |
System Dynamics |
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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Consumerism |
Market Corner Commentaries |
Outcomes |
System Dynamics |
Upsizing Dentistry: Putting More Bite into Primary Care
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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Innovation |
Market Corner Commentaries |
System Dynamics |
Platforming Healthcare (TM): 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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Economics |
Market Corner Commentaries |
Outcomes |
System Dynamics |
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 …
Economics |
Innovation |
Market Corner Commentaries |
Policy |
System Dynamics |
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 …
Consumerism |
Innovation |
Market Corner Commentaries |
System Dynamics |
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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Consumerism |
Market Corner Commentaries |
Policy |
System Dynamics |
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 …
Market Corner Commentaries |
Policy |
Taxing Consequences: House Republicans Target Tax-Exempt Hospital Bonds
Market Corner Commentary for November 21, 2017 Having failed to “repeal and replace” the Affordable Care Act, House and Senate Republicans have set their sights on reforming the U.S. tax …
Consumerism |
Innovation |
Market Corner Commentaries |
Outcomes |
System Dynamics |
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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Consumerism |
Economics |
Market Corner Commentaries |
Introducing the Healthcare Affordability Index: High-Cost Private Health Insurance Reduces Family Incomes
Today, Dr. Ezekiel Emanuel and I along with Aaron Glickman published Measuring the Burden of Health Care Costs on U.S. Families in the Journal of the American Medical Association (JAMA). …
Market Corner Commentaries |
System Dynamics |
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 …
Consumerism |
Innovation |
Market Corner Commentaries |
In the Eye of the Storm: When Outcomes Matter, Telemedicine Delivers
During the last week in August, Noah’s Ark found a new home in Houston. Unfortunately, it didn’t deliver medical supplies. Between August 25th and 29th, Hurricane Harvey dropped an almost …
Consumerism |
Innovation |
Market Corner Commentaries |
Battling Cancer: Partnering to Make Headway Against Medicine’s Toughest Foe
Cancer has been humanity’s most persistent nemesis. Bone fragments and written records indicate that cancer afflicted people in ancient Rome, Greece and Egypt. Today, cancer is America’s second leading killer, …
Innovation |
Market Corner Commentaries |
System Dynamics |
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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Consumerism |
Economics |
Market Corner Commentaries |
Outcomes |
System Dynamics |
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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Policy |
System Dynamics |
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 …
Consumerism |
Market Corner Commentaries |
System Dynamics |
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. …
Market Corner Commentaries |
Policy |
Forming a More Perfect Health System: Senate Republicans Confront Their Policy Demons
Senator Mitch McConnell is the most effective Senate Majority Leader since Lyndon Johnson. A tactical maestro, McConnell faces the seeming impossible task of uniting the Republican party’s divergent conservative and …
Market Corner Commentaries |
Outcomes |
System Dynamics |
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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Consumerism |
Innovation |
Market Corner Commentaries |
System Dynamics |
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 …
Economics |
Market Corner Commentaries |
Outcomes |
System Dynamics |
Symbiotic Disruption: Skilled-Nursing-REIT Ecosystem Adapts to Market Dynamics
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 …
Economics |
Market Corner Commentaries |
Outcomes |
Policy |
“Indumbent” Healthcare Thinking: Prices Don’t Matter
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 …
Consumerism |
Economics |
Innovation |
Market Corner Commentaries |
System Dynamics |
Darwinian Outsourcing: Big Pharma Adapts to Market Realities
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 …
Market Corner Commentaries |
Policy |
Trumpian Healthcare Reform: A “Silver Linings” Legislative Playbook
Special Edition: Market Corner Commentary for March 29, 2017 Last Friday was supposed to be the shootout at the healthcare corral where Republican gunslingers were going to take the first …
Consumerism |
Market Corner Commentaries |
Outcomes |
AHA! Healthcare is Both a Right and a Commodity
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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Consumerism |
Innovation |
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Outcomes |
System Dynamics |
Scaling Healthcare’s Mt. Everest: Peak Performers Engage Technology and Consumers
Climbing the highest mountains requires organization, preparation and strategy. Scaling Mt. Everest is a full-scale expedition. Large teams rely on a sophisticated infrastructure of supplies, equipment and support staff. A …
Innovation |
Market Corner Commentaries |
ZDogg Speaks: Rebooting Primary Care (The Unedited Version)
For the better part of a decade, I practiced inpatient hospital medicine at a large academic center (the name isn’t important, but it rhymes with Afghanistan…ford). I used to play …
Innovation |
Market Corner Commentaries |
System Dynamics |
Moving at the Speed of Medicine: Turbo-Charging Performance with Strategic Partnerships
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 generally less efficient, insourcing enables companies to …
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Economics |
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Outcomes |
System Dynamics |
Letting Go: Steward Sells Its Hospitals and Embraces Patient-Centric Care
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 billion in a 15-year sale-leaseback transaction with …
Consumerism |
Innovation |
Market Corner Commentaries |
Mile High Potential: NFL Veterans Tackle America’s Opioid Crisis
Professional football has long since surpassed baseball as America’s most popular sport. The NFL’s Super Bowl is a national party. Super Bowls represent 19 of America’s 20 most-watched TV broadcasts. …
Economics |
Market Corner Commentaries |
Policy |
System Dynamics |
The Rise and Fall of Academic Medicine: AMC Competitiveness in Post-Reform Healthcare
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 slow decline at the peak of its …
Consumerism |
Market Corner Commentaries |
Channel Shifting: Ominous Black Friday Trends for Health Systems
The results are in. The National Retail Federation (NRF) just released their survey results for post-Thanksgiving shopping. The numbers were strong. 154 million consumers shopped this holiday weekend, up 2% …
System Dynamics
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 …
Market Corner Commentaries |
Policy |
Healthcare’s Gettysburg Moment
Seven score and thirteen years ago this month (November 19, 1863), Abraham Lincoln delivered his renowned Gettysburg Address at the dedication for the Soldiers National Cemetery. With the ravages of …
Market Corner Commentaries |
Policy |
Overturning Obamacare: A 5-Point Plan for President-Elect Donald Trump
Two weeks ago, I distributed a 5-Point healthcare plan for presumed President-elect Hillary Clinton. That was then. In a remarkable and unprecedented election surprise, Donald Trump defeated Hillary Clinton and …
Innovation |
Market Corner Commentaries |
Policy |
HealthCare.Gov’s Death-Defying 2013 Launch: Implications for Government-Led Payment Reform
Enrollment for purchasing health insurance on public health exchanges began November 1st. Headlines for this fourth enrollment period include: 22% average price increases; major health insurers dropping coverage; and single …
Market Corner Commentaries |
Policy |
Overhauling Obamacare: A 5-Point Plan for President-Elect Hillary Clinton
Absent a cataclysmic surprise next Tuesday, Hillary Clinton will become the 45th President of the United States. She will govern a divided electorate with highly-polarized elected officials. It’s no longer …
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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
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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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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Medtech in the Fast Lane: Embracing Services, Solutions and Consumerism
by Rafe Hanahan and David W. Johnson Manufacturing built America. The iconic automotive industry epitomizes this organic relationship between industrial strength and economic growth. Since the early days of Ford …
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Winning “The Cub Way”: It Takes an Organization
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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What Would Einstein Do? Embedded Dilemmas in Disrupting Markets
Earlier this month, Ford CEO Mark Fields made two head-scratching announcements to advance transportation services in San Francisco. Ford acquired Chariot, a popular crowd-sourced shuttle-van service that uses algorithms to …
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Market Evolution: Addressing Structural Flaws on Public Health Exchanges
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
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
“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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Summer Book Report: 4sight Health’s Busy August
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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The Big Lift: Improving Public Health Exchanges
Bring out the Xanax. Anxiety among Obamacare supporters is skyrocketing. The bad news just keeps coming. Aetna has joined UnitedHealthcare and Humana in announcing plans to exit almost all public …
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Being American: How Exceptionalism Is Transforming U.S. 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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Back with Vengeance: Vertical Integration’s Demons Wreak Havoc
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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Obama Speaks: A Presidential Assessment of Obamacare
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
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
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 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
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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Healthcare’s Dysfunctional Pricing: Be Afraid. Be Very Afraid.
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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Rethinking Cyber-Security: A New Paradigm for Democratizing Data Exchange
Liberated data connects people, informs decision-making, stimulates innovation, streamlines production, creates wealth and advances humanity. The upward trajectory of human accomplishment arises from ever-more sophisticated data exchange supporting ever-more complex …
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Asset-Light and Ready: Physician Groups Embrace Accountable Care
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
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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Rebate Madness: Branded Drug Pricing Goes Rogue
Like hospitals that optimize revenues through complex assignment of charges, discounts and subsidies, aligned pharmacy benefit managers (PBMs) and pharmaceutical companies manipulate retail and net pricing on “branded” drugs to …
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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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FTC Chasing the Wrong Healthcare Villain in Chicago
Last December the Federal Trade Commission sued to block the proposed merger between Advocate Health Care and NorthShore University Health System. The combined company’s annual revenues would exceed $7 billion. …
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New Rules: Accountable Care Changes Everything
People go to Las Vegas to let loose, take in the shows and have fun but mostly to gamble. At HIMSS 2016, payors, providers, investors and other industry insiders are …
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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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Market vs. Medicine Book Launch: You Are Invited
After more than a year of research, writing, editing, re-writing, and re-editing, Market vs. Medicine: America’s Fight for Better, Affordable Healthcare is being printed and will be available on May …
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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
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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Manipulating Demand: Paying Patients for Lower-Cost Care
Market Corner Commentary for January 13, 2016-Manipulating Demand: Paying Patients for Lower-Cost Care In October, Planet Money aired a podcast with the intriguing title “Pay Patients, Save Money.” Their report …
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Dynamic Tension: Rethinking Health System Governance
Market Corner Commentary- Health System Governance- for January 6, 2015 John Koster MD and David Johnson The winds of post-reform transformation are blowing through healthcare. Long-established health systems confront existential …
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Rational Lending: Demystifying Medical Student Loan Debt
Market Corner Commentary—Demystifying Medical Student Loan Debt, for December 16, 2015 Winston Churchill famously observed that “Russia was a riddle wrapped in mystery inside an enigma.” Churchill’s language provides an …
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Fujifilm’s “Moment”: Disruption, Adaptation and Health System Transformation
Almost every healthcare “transformation” discussion includes Kodak’s cautionary tale – how the once iconic company fails to embrace digital imaging, capsizes and drowns. The story’s moral is to embrace disruption, …
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November Indigestion: The Idiocy and Promise of Benefit Selection
Market Corner Commentary for December 2, 2016- November Indigestion: The Idiocy and Promise of Benefit Selection David Johnson and Nathan Bays Dave’s wife Terri Brady is a Senior Leadership Coach at …
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The Why, The How and The What: Consumerism, Trust and Brand Love
Market Corner Commentary for November 12, 2015-The Why, The How and The What: Consumerism, Trust and Brand Love Health systems are awakening to the market reality that consumerism is redefining healthcare …
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Getting Right with Consumers: Right Businesses. Right Places. Right Prices.
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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Righteous Analytics: Right Data. Right Time. Right Way
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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“Amazoning” Healthcare’s High 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
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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Calm Before the Storm? Rating Agencies Lift Negative Industry Outlooks
Market Corner Commentary for October 7, 2015- Calm Before the Storm? Rating Agencies Lift Negative Industry Outlooks Summer was good to health companies. Many have never been stronger. On August 26th, Moody’s revised …
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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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Rebels with a Cause: Venture Companies Attack Healthcare
Market Corner Commentary for September 2, 2015-Rebels with a Cause: Venture Companies Attack Healthcare There is a meaningful shift occurring in healthcare private equity and venture investing. The “smart money” …
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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
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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Uber Up! Customer Interfacing Discovers Healthcare
Market Corner Commentary: July 15, 2015-Uber Up! Customer Interfacing Discovers Healthcare A version of this commentary first appeared in “Academy 360” on July 9, 2015 More “suits” flock to downtown …
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Polling for Meaning: Healthcare, Hospitals and Consumer Sentiment
Market Corner Commentary: July 8, 2015-Polling for Meaning: Healthcare, Hospitals and Consumer Sentiment A version of this commentary first appeared in “Academy 360” on June 25th Consumers dislike healthcare but …
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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!
Who knew a routine colonoscopy could illuminate the wild world of healthcare consumerism? Before getting to my story, let’s examine the current state of colonoscopies in America.[1] Colonoscopies are the …
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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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Supreme Court vs. Obamacare II: Decision Time
This article first appeared in Huron Perspectives on June 2, 2015-Supreme Court vs. Obamacare II: Decision Time The “Thrilla in Manila” in 1975 was Mohammad Ali and Joe Frazier’s second …
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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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Exploiting Perverse Incentives: Kentucky Basketball and Prime Healthcare
Hoping to become college basketball’s first undefeated champion in almost forty years, the Kentucky Wildcats captured the nation’s attention as they qualified for this year’s “Final Four” tournament in …
Economics
When Healthcare is a “Lemon”: Asymmetric Information and Market Failure
In 1970, George Akerlof published “The Market for “Lemons”: Quality Uncertainty and the Market Mechanism” in The Quarterly Journal of Economics. Highlighting used-car sales, Akerlof explored why market failure occurs …
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Supreme Court vs. Obamacare II: High Drama; Not the “Main Event”
The “Thrilla in Manila” in 1975 was Mohammad Ali and Joe Frazier’s second championship fight. In 1967, Ali refused conscription as a conscientious objector. He was convicted of draft evasion, …