By STEPHEN SOUMERAI and ROSS KOPPEL

For decades, the costs of health care in America have escalated without comparable improvements in quality. This is the central paradox of the American system, in which costs outstrip those everywhere else in the developed world, even though health outcomes are rarely better, and often worse.

In an effort to introduce more powerful incentives for improving care, recent federal and private policies have turned to a “pay-for-performance” model: Physicians get bonuses for meeting certain “quality of care standards.” These can range from demonstrating that they have done procedures that ought to be part of a thorough physical (taking blood pressure) to producing a positive health outcome (a performance target like lower cholesterol, for instance).

Economists argue that such financial incentives motivate physicians to improve their performance and increase their incomes. In theory, that should improve patient outcomes. But in practice, pay-for-performance simply doesn’t work. Even worse, the best evidence reveals that giving doctors extra cash to do what they are trained to do can backfire in ways that harm patients’ health.

Continue reading…

By NIRAN AL-AGBA, MD

There is a growing body of evidence that hospital mergers lead to higher prices for consumers, employers, insurance, and government.  It is imperative to educate patients and lawmakers as to how the consolidation of hospitals and medical practices raise costs, decrease access, eliminate jobs, and ultimately reduce care quality as a result.  Lawmakers should focus on this “first pillar” of cost control as they go back to the drawing board. 

In 2010, there were 66 hospital mergers in this country. Since the Affordable Care Act went into effect the rate of hospital consolidation has increased by 70 percent. By creating incentives for physicians and health providers to coordinate under accountable care organizations (ACOs), the ACA hindered the ability of regulators to block hospital mergers while incentivizing hospital consolidation. 

Continue reading…

By THCBist

Last week’s news that MD Anderson Cancer Center has pulled the plug on its two year partnership with IBM-Watson led many critics to wonder out loud if the machine-learning revolution is in trouble, and if Big Data could be about to become the latest tech industry buzzword to die a well-deserved death. It’s a little more complicated than that, argues HealthCatalyst’s Dale Sanders in this can’t-miss presentation. The problems with the MD Anderson-Watson partnership probably say more about the “Big Data Industry” and the goings-on at IBM as they do about the technology. Still, there are important lessons we can learn from the episode.

Related:

• “Big Data Bust: MD Anderson IBM Watson Project Dies”   (Medscape, Feb 22)
• “MD Anderson Benches IBM Watson in Setback For Artificial Intelligence”
  (Forbes, Feb 19)
• “As Rometty Prepares to Open HIMSS, MD Anderson Walks Away…”
  (MedCity News, Feb 19″)
• “Watson Can’t Cure Cancer .. or the Stuff That Breaks IT Projects”  (The Register, Feb 20)

By STEVEN FINDLAY

It’s still unclear whether Congress or the Trump administration will try to tackle the prescription drug price/cost issue this year.  Amid ACA repeal and replace, and possible Medicaid and Medicare reform fights, it seems a stretch.   

In recent weeks, Trump has also changed his tune on the subject.  Soaring prescription prices were a populist rallying cry at his campaign stops pre-election and then pre-inauguration. (“They’re getting away with murder,” he bellowed, referring to drug companies.)

But, fitting a post-inauguration pattern, Trump softened his message after a get-together with pharmaceutical executives on Jan. 31.  He mentioned increasing competition and “bidding wars” as a way to bring prices down—whatever that means. 

Continue reading…

By ALYX STERNLICHT

The fourth iteration of Digital Health Marketplace, sponsored by The New York City Economic Development Corporation, in partnership with Health 2.0, is underway! The Digital Health Marketplace connects health technology Buyers and Sellers through curated matchmaking, assistance to facilitate rapid technology adoption, and competitive commercialization awards to encourage piloting and procurement of new digital health technology in NYC.

The past three classes of Digital Health Marketplace has provided over $2M in commercialization awards to innovative NYC health tech startups and their self-chosen healthcare organization pilot partners. This year, a total of $250,000 is available to fund health tech pilots in NYC.

The program helps established healthcare stakeholders, like hospitals and health systems (health tech “Buyers”), de-risk their investments in new technology by simplifying the search for market-ready solutions. At the same time, the program shortens the sales cycle for startups (health tech “Sellers”) by connecting them with relevant, forward-looking Buyers. Buyers and Sellers will be matched based on self-identified interest areas and business needs or abilities once they apply to “Find a Pilot Partner”. Buyers will receive a curated list of startups to choose to meet one-on-one during the half-day Matchmaking Event on April 6, 2017 at the New York Genome Center.

Continue reading…

By GEORGE KALOGEROPOULOS 

Reports coming out of Washington suggest that Republicans may have bitten off more than they would like to chew with repealing & replacing the ACA, with a proliferation of proposals and no consensus on which to support, or how to get the 60 Senate votes needed to turn an eventual consensus plan into law.

There is a general consensus in the GOP to proceed with the budget reconciliation process, but if they pass the bill the House passed in 2015, it will immediately defund plan subsidies and the Medicaid expansion, setting up 25 million or more to lose their coverage right around midterm elections in 2018.

Even a less drastic budget reconciliation bill, for example one that gets rid of the individual and employer mandates by deleting the penalties associated with them, would leave us with a, “zombie ACA”, with everything not budget-related still in place, but malfunctioning with unintended consequences.

All this uncertainty is bad—it’s bad for the government, it’s bad for industry, and most importantly, it’s bad for the tens of millions of confused consumers trying to make informed decisions about how and if they can get health coverage.

Taking a step back

As the saying goes, when you have a hammer, every problem looks like a nail. In this case, when you have a legislative majority, every problem looks like it should be solved by changing the law.

But does that have to be the case? What if Congressional Republicans were to take a back seat and let Tom Price and the Department of Health and Human Services (HHS) begin the process of reforming health reform?

Continue reading…

By CHELSEA POLANIECKI

What do you do when your doctor says something serious, like, “Make an appointment with a Cardiac electrophysiologist stat” or “here is a prescription for some XYZ.” A what? And a whom?! “Oh, and you’ll need to get an MRI too.” Well, that’s overwhelming. It’s no surprise that about 20 percent of first-time prescriptions are never filled, according to a 2010 Harvard Medical School study¹.

Patients often come to a road block and fail to follow through with doctors’ orders because of perceived financial burdens, or simply because they don’t know where to find what they need. The Robert Wood Johnson Foundation (RWJF) feels that no one should be at a loss for health care services because they don’t know where to go for affordable services. The RWJF Choosing Care Challenge will therefore bring tech-enabled solutions to the forefront of this issue.

Continue reading…

By JIM PURCELL

In 1891, Dr. Luther Gulick proposed a red triangle as the YMCA symbol. In his words, the equal sides of the triangle stood for “man’s essential unity– body, mind and spirit– each being a necessary and eternal part of man, being neither one alone but all three.” True then, and equally true today, it highlights what is missing from most traditional approaches to wellness–the mental, emotional, and spiritual components. Hardly surprising given the remarkable resistance mental illness treatments encounter.

The term “mental illness” usually refers to recognized mental illnesses in accordance with the Diagnostic and Statistical Manual (DSM) published by the American Psychiatric Association. These include depression, anxiety, psychotic disorders, and bipolar disorder. While substance abuse and addictions are not so neatly categorized and are sometimes referred to as “behavioral disorders,” an indeed odd phrasing, we will refer to all such afflictions as “mental health or “mental illness.”

Continue reading…

By JOE FLOWER

The economic fundamentals of healthcare in the United States are unique, amazingly complex, multi-layered and opaque. It takes a lot of work and time to understand them, work and time that few of the experts opining about healthcare on television have done. Once you do understand them, it takes serious independence, a big ornery streak, and maybe a bit of a career death wish to speak publicly about how the industry that pays your speaking and consulting fees should, can, and must strive to make half as much money. Well, I turn 67 this year and I’m cranky as hell, so let’s go.

The Wrong Question

We are back again in the cage fight over healthcare in Congress. But in all these fights we are only arguing over one question: Who pays? The government, your employer, you? A different answer to that question will distribute the pain differently, but it won’t cut the pain in half.

There are other questions to ask whose answers could get us there, such as:

• Who do we pay?
• How do we pay them?
• For what, exactly, are we paying?

Because the way we are paying now ineluctably drives us toward paying too much, for not enough, and for things we don’t even need.

A few facts, the old-fashioned non-alternative kind:

• Cost: Healthcare in the U.S., the whole system, costs us something like $3.4 trillion per year. Yes, that’s “trillion” with a “T”. If U.S. healthcare were a country on its own it would be the fifth largest economy in the world.
• Waste: About a third of that is wasted on tests and procedures and devices that we really don’t need, that don’t help, that even hurt us. That’s the conservative estimate in a number of expert analyses, and based on the opinions of doctors about their own specialties. Some analyses say more: Some say half. Even that conservative estimate (one third) is a big wow: over $1.2 trillion per year, something like twice the entire U.S. military budget, thrown away on waste.
• Prices: The prices are nuts. It’s not just pharmaceuticals. Across the board, from devices to procedures, hospital room charges to implants to diagnostic tests, the prices actually paid in the U.S. are three, five, 10 times what they are in other medically advanced countries like France, Germany, and the U.K.
  Continue reading…