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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. …

How Much Will It Take To Improve Patient Safety?


One of the best lines in Jaws comes from Brody after he sees the 25-foot great white shark for the first time. He slowly backs into the cabin, looks at …

Fireside Chat: Why You Should Join the Customer Revolution


Join us in downtown Chicago on Thursday, November 14 at 5:30PM at MATTER. Michael Allen, CFO of OSF Healthcare, will interview David Johnson about critical concepts in Dave’s new book …

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 …

Podcast: Win-Win Partnerships: Strategics and Sponsors Increasingly Team Up


John Soden, Managing Director at Cain Brothers, a division of KeyBanc Capital Markets Inc., and David Johnson talk about a new breed of innovative partnerships between strategic buyers and private …

Will Misuse of Antibiotics Respond to Regulation?


I got my flu shot on Oct. 21. (I’ll let you know how it worked out.) As I waited for my turn at our nearby immediate-care center, I explained to …

House Calls – Cain Brothers Podcast


Welcome to House Calls, where we talk to investment bankers from Cain Brothers, a division of KeyBank Capital Markets Inc. These bankers are working in some of the most interesting …

Finding the Value for Healthcare Consumers in Outcomes-Based Contracting


When you buy something and it doesn’t work, you take it back to the store (or more likely send it back to Amazon via your local Kohl’s) for a refund. …

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 …

Ranking the Regulations that Bother Doctors


I love healthcare industry regulatory burden surveys. From an academic standpoint, I’m interested in the topic of competition versus regulation and how each affects how healthcare markets function—or not—for patients. …

What Revolutionary Healthcare Leaders Are Reading: The Top 5 4sight Health Commentaries Over the Past Six Months


4sight Health’s writers and authors have published 57 blog posts, commentaries, podcasts and videos on 4sighthealth.com from January through June of this year. The topics are as varied as the …

Maybe It’s the Patients, Not the Prices. Is that Stupid?


In most markets for most goods and services, you get what you pay for. The more you pay, the better the goods or the services. Hence, the expression, you get …

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 …

Seeing Through Physician Participation in Value-Based Reimbursement Models


The more things change, the more they stay the same.  I get the point of the expression. But, I didn’t fully appreciate how it applied to healthcare until I read …

If You Scroll Down, You’ll Find Out What Employers Really Think About Healthcare


With open enrollment about a month away at most businesses that offer health insurance benefits to their  workers, it’s time to look at what employers are doing and not doing …

Upselling in Healthcare? It’s Just Business


As wary consumers, we’ve come to expect upselling. Need an oil change? Looks like you need a new air filter and radiator flush, too. That sports coat looks fantastic on …

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 …

Healthcare Blocking and Tackling


Football season is upon us, and you’ll be hearing coaches at every level—high school, college and pro—talking about “getting back to basics” or “stressing the fundamentals” or “blocking and tackling.” …

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 …

Why Fee-for-Service Medicine is Bad for Your Health


The later in the day that you see your doctor you’re more likely to get the flu, get colon cancer and get hooked on prescription pain killers. OK, that’s a …

Higher Practice Skill Mix May Not Be What the Doctor Ordered


“Practicing at the top of your license” and “upskilling your workforce”are two popular healthcare buzz phrases right now. As account-hungry consultants breathlessly will tell you, when medical professionals spend their …

Spend More. Pay More?


Everyone in healthcare is “all in” on a lot of things these days, and two things that are at or near the top of that list are social determinants of …

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 …

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 …

The Rising Cost of Family Coverage Is No Joke


You might have heard about this on the news. A new study is out that says employer-sponsored health insurance is getting really expensive.  (How expensive is it?) Hmm. May your …

There’s No O (outcomes) in ACO


Medicare accountable care organizations say they’re doing a lot to manage and coordinate the care of sick beneficiaries. But a new study says the ACOs don’t have much to show …

The Future of Liberated Data in Medicine


Digitization and globalization of medical knowledge will double every 73 days by 2020.[1] When a patient enters an exam room, they will likely encounter a “Dr. Know-it-All” or come prepared …

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 …

How to Use Social Determinants of Health to Fix Reimbursements


Healthcare providers can no longer ignore the Social Determinants of Health (SDH) in the exam room. Even John Snow considered community assessment factors to identify the source of the cholera …

Should Hospitals Pay Taxes?


Many health systems and hospitals operate as Not-for-Profit (NFP), mission-oriented organizations that do not pay sales, excise, property or other taxes. In exchange, NFPs must publicly report the level of …

Pets versus Babies: Who Offers More Health Benefits at Work?


Everyone, including me, is always on employers to do more to improve the healthcare system in the U.S.  We’re on them to use their healthcare purchasing power and insured-lives market …

Surprise! Surprise! The Surprise Billing Legislation Could Usher in Government Price Controls. Nathan Bays, Guest Columnist


As the Senate Committee on Health, Education, Labor, and Pensions (HELP) prepares to vote on the Lowering Health Care Costs Act, the issue of surprise medical bills will take center …

What Are Healthcare Executives Thinking? Burda on Healthcare


I write a lot about what healthcare organizations and companies do, and I make educated guesses on why they do what they do based on my experiences, industry knowledge and …

States Foul-Tipping Regulatory Approaches to Control Healthcare Prices


A new Viewpoint in the Journal of the American Medical Association said states are trying, but largely failing, to control through various regulatory tactics the prices paid by private health …

More on Why Employers Should Pay Attention to Behavioral Health


More on the what and the why of employers and behavioral health, and what both mean for remaking the nation’s healthcare system into one where outcomes matter, customers count and …

Doctors and the Laws of Supply and Demand – Burda on Healthcare


It’s a great time to go to medical school and become a doctor. Ignore all the manufactured angst from organized medicine and opinion polls of aging physicians who say they …

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 …

What Businesses Say They’re Doing About Their Employees’ Mental Health


The National Institute of Mental Health says 46.6 million adults suffered from some form of mental illness in 2017. Of those, 57.4 percent didn’t receive any mental health treatment for …

The Deep State of Physician Prescribing Patterns


And you thought changing patients’ health behaviors was going to be hard. Try changing physicians’ drug prescribing patterns. That’s the lesson from a new study in Health Affairs that reported …

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 …

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 …

This Is a Story About Where Healthcare Regulations Come From – Burda on Healthcare


Healthcare is one of the most if not the most regulated industry in the U.S. While its businesses like to blame overzealous bureaucrats for all the red tape, the current …

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 …

How to Improve Patient Satisfaction with Transparent Payment Systems


American healthcare patients are demanding more price transparency, affordable services and quality care. Why are they not receiving it? How can healthcare organizations listen to consumers and set themselves up …

The Universal Patient Experience of Debilitating Healthcare Costs


The lack of affordable medical care isn’t just a U.S. phenomenon. It’s a serious problem across Europe, according to a new report from the World Health Organization. WHO’s report identified …

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 …

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 …

How Crony Capitalism in Healthcare Hurts Communities and Markets


Does “pro-business” equate to “pro-market”? Or is crony capitalism blurring the line in the healthcare industry? How can consumers tell if they are being treated fairly? There are two types …

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. …

When Pillars Crumble: A Warning for Healthcare?


Raghuram Rajan’s new book The Third Pillar provides an insightful framework on the relationship between the three pillars of modern society: federal governments, the marketplace and local communities. I’ll share …

MARKET CORNER CONVERSATIONS: TOMER SHOVAL, CEO & FOUNDER, SIMPLEE


Tomer Shoval, CEO & Founder of Simplee, discusses how his relentless focus on the customer created a payment platform for health systems that actually increases customer satisfaction and improves financial …

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 …

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 …

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 …

When Blue is the New Green


I mean, what did you think was going to happen? A new study says big Blues plans that went for-profit dramatically raised their premiums right after their ownership conversions. The …

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 …

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 …

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 …

The Immovable Force That Is Employer-Sponsored Health Insurance


Death, taxes and employer-sponsored health insurance. We know the first two are certainties in life, and new research again confirms the assurance of the third. Researchers from the School of …

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 …

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 …

Medicare Advantage Bends Cost Curve the Wrong Way


Everyone sees what they want to see in the latest figures on national health expenditures released by the Centers for Medicare and Medicaid Services earlier this month. Most people see …

HHS Goes All In on Competition as the Way to Fix Healthcare Woes


Competition good. Regulation bad. That’s my caveman summary of HHS’ manifesto released on Dec. 3 on how to improve the quality and safety of patient care while simultaneously lowering healthcare …

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, …

Med Tech Bets on Value as Its Future Business Model


If you’re looking for a sign that we’re truly approaching a watershed moment in healthcare innovation, look no further than the people whose job is creating new medical technologies that …

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 …

Man or Corporate Culture: Who Has More Power to Disrupt Healthcare?


We’re at a branch point in healthcare’s evolution. We’ll learn soon whether disruptive innovation is the product of individuals or organizations. When we find out, we’ll know the best path …

New Primary-Care Provider, Same Old Price


Patient office visits to primary care physicians are down. Patient office visits to nurse practitioners and physician assistants are up. But switching to NPs and PAs from doctors isn’t saving …

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. …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

MARKET CORNER CONVERSATIONS: Luigi Zingales, University of Chicago


Luigi Zingales, University of Chicago economist, joins David Johnson to discuss the key components of capitalism that encourage innovation rather than creating paralysis in markets. Listen to his thoughts on …

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 …

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 …

Kentucky HEALTH and Medicaid Work Requirements: A Behavioral Economics Lens Sheds Light


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 …

Pool Balls Break

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 …

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, …

Lonnie & Cathy Quinn, Happy Medicare Advantage Members

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 …

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, …

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 …

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 …

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 …

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 …

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). …

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 …

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. …

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 …

clinical academic medicine 

“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 …

best health policy

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 …

academic medicine partners 

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 …

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 …

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 …

health care system

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 …

Healthcare Advisory Services

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 …

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 …

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 …

medicine and health

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, …

Imagine Better Healthcare

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 …

Providence Health & Services

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 …

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, …

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, …