David Williams

Robots are coming
People hate to hear it, but the robots are coming and it’s only a matter of time before they start competing for skilled, white collar jobs.

Nurses are vulnerable –but before you get excited and start attacking me– so, too are consultants and bloggers. So get used to it, and figure out how you’re going to co-exist with and leverage the bots.

One of my pet peeves about robots is when their programmers try to make them act human by intentionally making them imperfect or have them simulate (feign?) empathy.

For example, I can’t stand it when the voice recognition airline rep talks in a sympathetic sounding voice when “she” can’t understand what I’m saying.

But apparently we’ll be seeing more of these little “humanizing” tricks, thanks to research from MIT that concludes that people like this kind of stuff. From the Wall Street Journalwe learn:

  • People like their therapy robots to be baby-faced
  • We feel emotionally closer to robots that sound like our own gender
  • When robots mimic our activity (like folding their arms) we like it
  • And then there’s this one:

“One study showed that people rated online travel booking and dating services more positively when the service communicated clearly that it was working for the consumer (e.g., “We are now searching 100 sites for you”) than when they simply provided search results. Surprisingly, having to wait 30 seconds for results but also receiving this communication of effort slightly increased users’ satisfaction, compared with receiving results instantaneously. Being made aware of the website’s willingness to work on their behalf made people feel that the service was sympathetic to their needs.”

Continue reading “Robots Are Coming and They Plan to Treat You like a Moron”

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I was a bit surprised by the front-page headline and accompanying article in the weekend Wall Street Journal (IBM to Move Retirees Off Its Health Rolls). The headline and subtext of the article are that IBM is ending health benefits for retirees, leaving them to fend for themselves. But as I read through the specifics that doesn’t appear to be at all what’s happening. Unfortunately, the article’s main impact is to leave an unduly negative impression of private health insurance exchanges.

Retiree health benefits are a big deal, especially for employees who retire before they reach the Medicare eligibility age of 65. A typical early retiree in his or her 50s will face high premiums in the individual market compared to a younger, and typically healthier, person. If they are among the few whose company provides generous coverage they are very lucky.

[On a side note, life is about to get easier for early retirees who have to buy their own insurance, thanks to Obamacare's banning of medical underwriting and limits on the ratio of premiums charged to older people versus younger ones.]

When a person turns 65 life gets a lot easier on the health insurance front as the federal government takes over the vast majority of costs. As a result, a retiree on Medicare is much cheaper for an employer to provide health care benefits to, since they are essentially just paying for supplemental coverage.

Continue reading “Health Exchange Confusion: Why We’re Getting the IBM Story Wrong”

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Thanks to David Kerrigan of the Massachusetts Health Connector for pointing out that the Obama Administration has suddenly switched terminology: health insurance exchanges are now health insurance marketplaces. I think it’s a great idea, which is why I wrote a blog post on this very topic on Friday. The Hill (Obama officials ditch ‘exchanges’ in rebranding of healthcare reform law) covers the story.

However, the Hill has a weird angle on this. The article heavily features an anti-ObamaCare activist, Dean Clancy who says:

“They could call them motherhood or apple pie, but it wouldn’t change our feelings about them… We’re encouraged that they’re showing signs of desperation. I think that it’s too late in the game to try to start calling this something different. And [we’re] not going to spend a lot of effort fighting over a word.”

Clancy’s website is called blockexchanges.com, so he may actually have more commitment to the word exchange than the Obama folks. Somehow blockmarketplaces.com just doesn’t have the same ring to it. (That domain is still available at this writing in case you want to grab it.) Blockexchanges also has some misleading information on its home page:

“Remember, without the state exchanges, ObamaCare cannot function.”

Actually, the federal government will step in if the states don’t.

Personally, I don’t sense desperation but rather a gradual wising up about what implementation will require. The term “marketplace” makes a good deal of sense for someone who is comparison shopping for health insurance. Here’s to more commonsense improvements as ObamaCare is rolled out.

David E. Williams is co-founder of MedPharma Partners LLC, strategy consultant in technology enabled health care services, pharma, biotech, and medical devices. Formerly with BCG and LEK. He writes regularly at Health Business Blog, where this post first appeared.

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For years we’ve read that the US faces a looming shortage of nurses. Shortfalls in the hundreds of thousands of nurses are routinely predicted. These predictions have been good for nursing schools, which have used the promise of ample employment opportunities to more than double the number of nursing students over the last 10 years, according to CNN.

Yet somehow 43 percent of newly-licensed RNs can’t find jobs within 18 months. Some hospitals and other employers openly discourage new RNs from applying for jobs. That doesn’t sound like a huge shortage, then does it?

But the purveyors of the nursing shortage message have an answer for that. Actually two answers: one for the short term and another for the long term. The near term explanation is that nurses come back into the workforce when the economy is down. Nurses are female and tend to be married to blue collar men who lose their jobs or see their hours reduced when the economy sours, we’re told. Nurses bolster the family finances by going back to work –or they stay working when they were planning on quitting. There’s something to that argument even if it’s a bit simplistic.

The longer term argument is that many nurses are old and will retire soon, just when the wave of baby boomers hits retirement age themselves and needs more nursing care. Don’t worry, the story goes, there will be tons of jobs for nurses in the not-too-distant future. This logic comes through again in CNN’s story:

Demand for health care services is expected to climb as more baby boomers retire and health care reform makes medical care accessible to more people. As older nurses start retiring, economists predict a massive nursing shortage [emphasis mine] will reemerge in the United States.

Continue reading “The Nursing Shortage Myth”

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A recent story in the New York Times (As Physicians’ Jobs Change, So Do Their Politics) highlights the political shift underway within the physician community. While doctors used to be mainly male small businessmen, who were a natural fit with the Republican Party, they’re now much more likely to be female and employed by larger organizations. According to the Times, that’s making doctors more likely to be out of sync with the GOP, and the article cites examples from around the country. The American Medical Association came out in support of the Patient Protection and Affordable Care Act, which was a surprise to many. State medical societies find themselves increasingly allied with liberal activist groups, and even historically “red meat” issues like malpractice reform aren’t that big a deal for those whose malpractice premiums are paid by their employers.

It seems to me there’s an important facet missing from the article. When I was growing up in the 1970s, being a doctor was viewed as one of the surest ways for an ambitious person to make money. That started to change as the advent of managed care made medicine less lucrative and the explosion of the financial services industry provided opportunities to make a lot more money in investment banking, hedge funds, private equity and venture capital. As I observe my own generation and those somewhat younger than me, it seems that those intent on making a lot of money aren’t as drawn to the physician path.

My father in law, of blessed memory, used to compliment certain physicians by saying, “he’s not a money doctor.” That really boiled it down to the essence.

On the whole, younger doctors –and older ones who are sticking with the profession– seem to have the patients’ interest increasingly at heart. And that’s no bad thing.

David E. Williams is co-founder of MedPharma Partners LLC, strategy consultant in technology enabled health care services, pharma,  biotech, and medical devices. Formerly with BCG and LEK. He writes regularly at Health Business Blog, where this post first appeared.

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Ever since the Patient Protection and Affordable Care Act (PPACA) was passed, opponents have looked for ways to overturn it in the court of law and the court of public opinion. They’ve had reasonable success in both arenas, using opposition to the individual mandate to buy health insurance as Exhibit A. Ironically, President Obama wasn’t a big fan of the individual mandate at the outset. In the primary election, Hillary Clinton favored an individual mandate while Obama opposed it. But somehow the mandate –at its core a Republican concept of personal responsibility– has become synonymous with so-called Obamacare.

With the recent court decision, it seems reasonably likely we will end up in a situation where the individual mandate is overturned but the rest of the law is upheld. Observers have some thoughts on what would happen:

  • Insurance companies will be unhappy. PPACA puts many restrictions on health plans, e.g., minimum medical loss ratio, no exclusions for pre-existing conditions but the upside is the mandate: lots of new customers, and a reduction in adverse selection, because everyone has to buy insurance and you can’t wait till your sick
  • Many fewer people will be enrolled in insurance.  Jonathan Gruber’s objectivity may be suspect, but he persuasively argues that repeal of the mandate would lead to many fewer people in coverage and higher premiums due to adverse selection. And the cost of the law wouldn’t drop by much despite the lower impact
  • Some opponents think/hope that eliminating the mandate will cause the whole law to collapse. I really doubt it.

Continue reading “Individual Mandate: Can PPACA Survive Without It?”

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After reading the July edition of Health Affairs, I’m concerned about the impact of Accountable Care Organizations (ACOs) on cost trends in the US health care system.

In The Accountable Care Organization: Whatever Its Growing Pains, The Concept Is Too Vitally Important To Fail, Francis Crosson of the Kaiser Permanente Institute for Health Policy plays down the various criticisms of ACOs (that they may stifle innovation, unleash a torrent of regulation, and rely too heavily on fee for service payment methodologies) and argues that we need to help them succeed because there are no good alternatives. If not,

both public and private payers will probably be forced into across-the-board reductions in payment rates to providers, because the state of the economy will require cost reductions, and there will be no other obvious course to pursue. Reductions in quality and access may follow…

But the emergence of ACOs is driving hospitals to consolidate, buying other hospitals and physicians practices.

Continue reading “Let’s Hope ACOs Aren’t Our Last, Best Chance for Delivery System Reform”

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FDA is proposing regulation for mobile medical applications. Not a bad idea. But I have some concerns about what it will mean for clinical diagnostics software. Here’s the definitional passage:

Mobile apps that allow the user to input patient-specific information and – using formulae or processing algorithms – output a patient-specific result, diagnosis, or treatment recommendation to be used in clinical practice or to assist in making clinical decisions. Examples include mobile apps that provide a questionnaire for collecting patient-specific lab results and compute the prognosis of a particular condition or disease, perform calculations that result in an index or score, calculate dosage for a specific medication or radiation treatment, or provide recommendations that aid a clinician in making a diagnosis or selecting a specific treatment for a patient.

Apps that provide differential diagnosis tools for a clinician to systematically compare and contrast clinical findings (symptoms/ results, etc.) to arrive at possible diagnosis for a patient.

Continue reading “Is FDA Getting Ready to Stifle Innovation in Diagnostic Software?”

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Over the last decade, the United States has intentionally made itself less attractive to immigrants, forgetting that immigration has been a huge driver of the country’s economic success. In a recent article (America needs a 21st century immigration policy), leading entrepreneurs, executives and investors including Steve Case and Sheryl Sandberg said:

To some, the link between immigration reform and economic growth may be surprising.  To America’s most innovative industries, it is a link we know is fundamental.

The global economy means companies that drive U.S. job creation and economic growth are in a worldwide competition for talent.  While other countries are aggressively creating policies and incentives to attract a highly educated workforce, America has stagnated.  Once a magnet for the world’s top minds, America now faces a “reverse brain drain” and is no longer the first choice for many entrepreneurs creating new companies and jobs.

America needs a pro-growth immigration system that works for U.S. workers and employers in today’s global economy.  And we need it now. Continue reading “We Need a Liberal Immigration Policy to Support Health Care Reform”

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Mitt Romney took a big beating on the Wall Street Journal‘s editorial page last week, the same day he laid out his health care plan in the USA Today and defended his position on the topic in a speech in Michigan. I’m not a big Romney fan but had been feeling sympathetic enough toward him on this issue to defend him. After reading what he has to say, though, I’m not prepared to offer a defense. On the other hand, Massachusetts health reform remains defensible, if incomplete.

Here’s what Mitt Romney should have said:

  • Health reform in Massachusetts has achieved its main goal: more than 98% of residents now have health insurance including 99.8% of children
  • The Massachusetts reform was achieved by bringing together all major stakeholders in the state from both parties, and focusing on addressing a serious problem rather than scoring political points against one another at the expense of the public good
  • Gaining consensus enabled health reform not just to get passed, but actually implemented more or less as envisioned, in contrast to earlier failed attempts at universal coverage
  • Massachusetts’ long history of substantial public sector investments made this kind of reform feasible. Good schools translate into an educated workforce that attracts high-wage employers who can afford to offer health insurance. That made it possible for the state to offer a safety net that was more generous than other states’ (e.g., in its eligibility criteria for Medicaid) even before the enactment of so-called Romney Care
  • Massachusetts, like other states, still has a cost problem. It’s no surprise that Massachusetts health reform didn’t bring costs down. First, that wasn’t its goal. Second, cost problems can’t be addressed in a serious manner without changes in the health care delivery system and reform of Medicare. Tackling the delivery system is very difficult, and states have no power to reform Medicare. That’s why health reform can’t be left purely to the states; it has to be tackled at the national level
  • Even a cold-blooded capitalist like me realizes that pure free-market approaches aren’t effective or fair in health care Continue reading “Does Mitt Romney Deserve the Abuse He’s Getting on Health Care? Yes, He Does.”
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