Joining Matthew Holt (@boltyboy) on #THCBGang on Sept 1st were THCB regular writer and ponderer of odd juxtapositions Kim Bellard (@kimbbellard); the double trouble of vaunted futurists Ian Morrison (@seccurve) & Jeff Goldsmith, and Consumer advocate & CEO of AdaRose, Lygeia Ricciardi (@Lygeia). Great conversation going from the personal (Jeff’s Covid August & Ian’s tour round the wilds of Canada) to the policy and political.
Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday July 21 were futurist Ian Morrison (@seccurve); medical historian Mike Magee (@drmikemagee); and fierce patient activist Casey Quinlan (@MightyCasey)
Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday June 30 were THCB regular writer and ponderer of odd juxtapositions Kim Bellard (@kimbbellard); Principal of Worksite Health Advisors Brian Klepper (@bklepper1); futurists Ian Morrison (@seccurve); and fierce patient activist Casey Quinlan (@MightyCasey). Lots of discussion of the Dobbs ruling and also of the CAA regulations which have gotten somewhat less play in the press. Quite the impassioned discussion !
Joining Matthew Holt (@boltyboy) on #THCBGang on April 14 for an hour of topical conversation on what’s happening in health care and beyond were fierce patient activist Casey Quinlan (@MightyCasey); futurists Ian Morrison (@seccurve) & Jeff Goldsmith; Jennifer Benz (@Jenbenz); and policy consultant/author Rosemarie Day (@Rosemarie_Day1).
Lots of chat about McKinsey and conflicts of interest, what’s next with COVID, where employers are now, and Casey has a unique idea about how to profit from data brokers.
By JEFF GOLDSMITH and IAN MORRISON
Hospital consolidation has risen to the top of the health policy stack. David Dranove and Lawton Burns argued in their recent Big Med: Megaproviders and the High Cost of Health Care in America (Univ of Chicago Press, 2021) that hospital consolidation has produced neither cost savings from “economies of scale” nor measurable quality improvements expected from better care co-ordination. As a consequence, the Biden administration has targeted the health care industry for enhanced and more vigilant anti-trust enforcement.
However, as we discussed in a 2021 posting in Health Affairs, these large, complex health enterprises played a vital role in the societal response to the once-in-a-century COVID crisis. Multi-hospital health systems were one of the only pieces of societal infrastructure that actually exceeded expectations in the COVID crisis. These systems demonstrated that they are capable of producing, rapidly and on demand, demonstrable social benefit.
Exemplary health system performance during COVID begs an important question: how do we maximize the social benefits of these complex enterprises once the stubborn foe of COVID has been vanquished? How do we think conceptually about how systems produce those benefits and how should they fully achieve their potential for the society as a whole?
Origins of Hospital Consolidation
In 1980, the US hospital industry (excluding federal, psych and rehab facilities) was a $77 billion business comprised of roughly 5,900 community hospitals. It was already significantly consolidated at that time; roughly a third of hospitals were owned or managed by health systems, perhaps a half of those by investor-owned chains. Forty years later, there were 700 fewer facilities generating about $1.2 trillion in revenues (roughly a fourfold growth in real dollar revenues since 1980), and more than 70% of hospitals were part of systems.
It is important to acknowledge here that hundreds more hospitals, many in rural health shortage areas or in inner cities, would have closed had they not been rescued by larger systems. Given that a large fraction of the hospitals that remain independent are tiny critical access facilities that are marginal candidates for mergers with larger enterprises, the bulk of hospital consolidation is likely behind us. Future consolidation is likely not to be of individual hospitals, but of smaller systems that are not certain they can remain independent.
Today’s multi-billion dollar health systems like Intermountain Healthcare, Geisinger, Penn Medicine and Sentara are far more than merely roll-ups of formerly independent hospitals. They also employ directly or indirectly more than 40% of the nation’s practicing physicians, according to the AMA Physician Practice Benchmark Survey. They have also deployed 179 provider-sponsored health plans enrolling more than 13 million people (Milliman Torch Insight, personal communication 23 Sept, 2021). They operate extensive ambulatory facilities ranging from emergency and urgent care to surgical facilities to rehabilitation and physical therapy, in addition to psychiatric and long-term care facilities and programs.
Health Systems Didn’t Just “Happen”; Federal Health Policy Actively Catalyzed their Formation
Though many in the health policy world attribute hospital consolidation and integration to empire-building and positioning relative to health insurers, federal health policy played a catalytic role in fostering hospital consolidation and integration of physician practices and health insurance. In the fifty years since the HMO Act of 1973, hospitals and other providers have been actively encouraged by federal health policy to assume economic responsibility for the total cost of care, something they cannot do as isolated single hospitals.Continue reading…
Joining Matthew Holt (@boltyboy) on #THCBGang at 1pm PT 4pm ET Thursday for an hour of topical and sometime combative conversation on what’s happening in health care and beyond will be: double trouble futurists Ian Morrison (@seccurve) & Jeff Goldsmith; consultant focusing on platform business models and strategy Vince Kuraitis (@VinceKuraitis), & back after a long while analyst and Principal of Worksite Health Advisors Brian Klepper (@bklepper1).
Today there will be more discussion than usual about platforms and whether health care is ready for them!
On this episode of Health Tech Deals, Ian Morrison is pinch-hitting for Jessica DaMassa! Ian and I worked together 25+ years ago, and he’s been sitting in Silicon Valley looking at the American health care system for a long long time. Some deals – MindMaze raises $105M; Memora Health raises $40M; Ro raises $150M; PriorAuthNow raises $25M; Equip raises $58M. Ian also shares his opinions on the American health system and the digital health space–Matthew Holt
Hi there, I’m Jess DaMassa. Actually, no, Jess DaMassa. Jess DaMassa is a friend of mine and I am no Jess DaMassa. I am Ian Morrison. I am pinch hitting for Jess DaMassa, how could I possibly pinch hit? Matthew told me I had to go and put my kilt on and spruce myself up a bit. But anyway, it’s an honor, a deep honor to be here for the February 18th episode of Health Teach Deals.
So Ian, it’s a Dan Quayle line. No, it’s not the Dan Quayle, it’s the Lloyd Bentsen line about Dan Quayle.
Joining Matthew Holt (@boltyboy) on #THCBGang at 1pm PT 4pm ET Thursday for an hour of topical and sometime combative conversation on what’s happening in health care and beyond will be: futurist Ian Morrison (@seccurve); Queen of all employer benefits Jennifer Benz (@Jenbenz); fierce patient activist Casey Quinlan (@MightyCasey); and & patient safety expert and all around wit Michael Millenson (@MLMillenson)
Joining Matthew Holt (@boltyboy) on #THCBGang at 1pm PT 4pm ET Thursday for an hour of topical and sometime combative conversation on what’s happening in health care and beyond will be: Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune); the double trouble of vaunted futurists Ian Morrison (@seccurve) & Jeff Goldsmith, WTF Health host & Health IT girl Jessica DaMassa (@jessdamassa). Today’s special guest returning to #THCBGang is the “I make unicorns” King Bill Taranto from Merck GHIF (@BillTaranto).
You can surmise that there will be some discussion around #DigitalHealth valuations!
On #THCBGang I hosted the double trouble of vaunted futurists Ian Morrison (@seccurve) & Jeff Goldsmith, and medical historian Mike Magee (@drmikemagee) for an hour of conversation and banter about the health care system, the world in politics, and whether “Don’t Look Up” is a spoof or a documentary. Really good stuff, especially from Jeff on whether Medicare pays enough to keep hospitals alive. (Spoiler alter–he doesn’t think so!)