Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Big Pharma Greets Hundreds Of Ex-Federal Workers At The ‘Revolving Door’

Alex Azar’s job hop from drugmaker Eli Lilly to the Trump administration reflects ever-deepening ties between the pharmaceutical industry and the federal government.
Kaiser Health News
Thursday, January 25, 2018

Post-Acute Care Providers Upset Over Being Left Out of Bundled-Payment Test Program

A Trump administration initiative to change how Medicare pays health care providers excludes some of the most enthusiastic backers of a similar Obama-era program – post-acute care providers such as nursing homes and home health agencies.
Morning Consult
Tuesday, January 23, 2018

GAO: CMS Needs More Data to Manage Medicare Opioid Risks

The Government Accountability Office (GAO) has recommended that CMS should collect additional data on Medicare beneficiary opioid risks, including the number of beneficiaries with high-dose opioid prescriptions, the number of providers that overprescribe opioids, and available health plan data on overprescribing indicators.
HealthPayer Intelligence
Tuesday, January 23, 2018

Congress delays medical device tax for two years

Almost no one got everything they wanted out of the Monday deal to reopen the government — except perhaps medical device companies, who managed to fend off an industry-wide excise tax before the first payments were due.
Stat News
Monday, January 22, 2018

CHIP Renewed For Six Years As Congress Votes To Reopen Federal Government

A brief, partial shutdown of the federal government was resolved Monday, as the Senate and House approved legislation that would keep federal dollars flowing until Feb. 8, as well as fund the Children’s Health Insurance Program for the next six years.
Kaiser Health News
Monday, January 22, 2018

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.


Everything in Healthcare Is Design

By Kim Bellard, January 27, 2018

I've been thinking a lot about health and communities lately. But I keep coming back to Dr. Bon Ku is doing at JeffDESIGN.

I am somewhat late to this game.  Dr. Ku co-founded JeffDESIGN three years ago, as a "college within a college".  Since then it has received local, regional, and national attention.  Dr. Ku has done a TEDx talk on their efforts.  So I'm not exactly breaking new ground here.

More importantly, though, they are.

Basically, the goal of JeffDESIGN is to teach medical students "to apply design thinking to solve healthcare challenges." As obvious as that might seem, they believe it is the first such program in a medical school.

Their Health Design Lab is located in a former bank vault.  It looks more like a start-up than a medical school classroom, full of configurable tables, computers, whiteboards, even 3D printers. 

Students get to take on actual problems in the healthcare system, develop solutions, prototype them, and perhaps see them put into use.  Dr. Pugliese told NextCity:  "These kids are all going to graduate as physicians, and they’re going to have a whole new language that nobody who’s ever graduated from a med school has had before."

That's pretty cool.

Dr. Ku is by training an ER physician, and his experiences there shaped his views of the broader forces impacting health.  And, remember, this program -- and, presumably, this point-of-view -- is unique among medical schools.  It shouldn't be.

We simply don't think enough about design in healthcare.  Not the right designs, for the right reasons.  In a a podcast for Knowledge@Wharton, Dr. Ku complained that:

We settle for design mediocrity, like I said. When we design hospitals, we should want to design the best and most beautiful building which happens to be a hospital, but instead, we design mediocre buildings.

He went so far as to say: "most of us don't realize that everything in health care is design."

Think about that:  Everything. In. Health.  Care. Is. Design.

The problem that JeffDESIGN has, through no fault of its own, is that even if all physicians were similarly trained, physicians can't change everything that needs to be redesigned (or, as some would say, actually designed) -- not in healthcare and certainly not in our society. The problems go much deeper.

Too many designers are designing only within their bubble, and no matter how well designed that bubble is, all-too-often they don't think enough about how their bubble overlaps with the others.  Our health is impacted by everything we touch and interact with, and many of those interactions are not designed with our health in mind.  

Design thinking in healthcare isn't about making the process of getting medical care easier, although it should do that too.  Design thinking in healthcare should be about making the process of being healthy easier.  That's a much taller order of magnitude, and that's what Steve Downs meant by wanting to build health into the "operating system" of our daily lives.  

Dr. Ku would agree: you don't have to be trained as a designer to use design thinking.  Dr. Ku boils it down: "I think at the core of human-centered design or design thinking is deep empathy for the end user.”

Certainly anyone working in or around healthcare should have that.

Patients aren't the end users.  People are.  Care is not the end result.  Health is.  Let's design for them and for that.  If you don't have that kind of empathy, maybe you should be doing something else.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting


2018 CMS Medicare Shared Savings Program: 43 Previous ACOs out, 124 New ACOs In

By Clive Riddle, January 19, 2018

CMS recently published 2018 Medicare Shared Savings Program information.  After comparing the listing of 561 2018 MSSP participants to the 480 2017 participants, we found 43 2017 ACOs have exited the program for 2018, and there are 124 new ACOs for 2018.  Caravan Health has sponsored 15 new ACOs, and Community Health Systems is sponsoring 14 of the new ACOs.

Here’s the list for the 43 ACOs exiting the program:

  1. Accountable Care Coalition of Mount Kisco (CT, NY)
  2. Accountable Care Coalition of Western Georgia (AL, GA)
  3. ACO of East Hawaii (HI)
  4. Advanced Premier Physicians ACO (CA)
  5. APCN-ACO (CA)
  6. ApolloMed Accountable Care Organization (CA, FL, HI)
  7. Arkansas High Performance Network ACO of FQHC (AR, KY)
  8. Arkansas HIgh Performance Network ACO (AR)
  9. Bay Area Medical Associates ACO (CA)
  10. Bluegrass Clinical Partners (FL, KY, TN)
  11. Care Covenant (TX)
  12. Catholic Medical Partners-Accountable Care IPA (NY)
  13. CHRISTUS Louisiana ACO (LA)
  14. CHWN ACO (IL)
  15. Collaborative Health ACO (MA)
  16. Community Health Accountable Care (NH, NY, VT)
  17. Connected Care (MI)
  18. Cornerstone Health Enablement Strategic Solutions (NC)
  19. Health Leaders Medicare ACO Network (LA)
  20. Indiana Care Organization (IN)
  21. Kansas Primary Care Alliance (KS, MO)
  22. KCMPA-ACO (KS, MO)
  23. Mary Washington Health Alliance. (VA)
  24. Mercy ACO (AR, MO)
  25. MHT-ACO (GA, MI, OK, SC, TX)
  26. Midwest Quality Care Alliance (KS, MO)
  27. NEQCA Accountable Care, (MA)
  28. North Jersey ACO (NJ, NY)
  29. OneCare Vermont Accountable Care Organization (NH, VT)
  30. Oregon ACO (OR, WA)
  31. Palm Accountable Care Organization (FL)
  32. Physicians Accountable Care Solutions (CA, CO, CT, IL, NY, OH, PA, UT, WV)
  33. Physicians Collaborative Trust ACO (FL)
  34. Primaria ACO (IN)
  35. Primary Care Alliance (FL)
  36. Revere Health (AZ, UT)
  37. Shannon Clinic (TX)
  38. South Shore Physician-Hospital Organization (MA)
  39. SPACO (FL)
  40. Torrance Memorial Integrated Physicians (CA)
  41. UW Health ACO, (WI)
  42. VirtuaCare (NJ)
  43. Western Maryland Physician Network (MD, PA, VA, WV)

And here’s the list of the 124 new ACOs joining the program for 2018:

  1. Accountable Care Coalition of Alabama (AL)
  2. Account. Care Coal. of Community Health Centers (AR, DC, FL, IL, KY, MD, MI, RI)
  3. Accountable Care Coalition of New Jersey (NJ)
  4. Accountable Care of Nevada (NV)
  5. Accountable Care Organization of Aurora (IL, MI, WI)
  6. ACO West Virginia (PA, WV)
  7. Acorn Network (IL, IN, MI)
  8. Adventist Health Accountable Care (CA)
  9. Adventist Health System ACO (FL)
  10. Alabama Physician Network (AL)
  11. Aledade Accountable Care 22 (OH, PA)
  12. Aledade Accountable Care 25 (NJ)
  13. Aledade Accountable Care 35 (LA, MS, TN)
  14. Aledade Accountable Care 37 (MD, TN, VA, WV)
  15. Baptist Health/UAMS Accountable Care Alliance (AR, TX)
  16. Baptist Physician Partners ACO (FL, GA)
  17. Bethesda Health Quality Alliance (FL)
  18. Boulder Valley Care Network (CO)
  19. Bridges Health Partners ACO (PA)
  20. Caravan Health ACO 11 (AL, GA, IL, KY, NM, NV, TX)
  21. Caravan Health ACO 12 (MN, WI)
  22. Caravan Health ACO 13 (MA, NY, VT)
  23. Caravan Health ACO 14 (ID, MN)
  24. Caravan Health ACO 15 (IA, MN, NE, SD)
  25. Caravan Health ACO 16 (AL, TN)
  26. Caravan Health ACO 17 (OR)
  27. Caravan Health ACO 31 (OK)
  28. Caravan Health ACO 32 (OK)
  29. Caravan Health ACO 33 (OK)
  30. Caravan Health ACO 34 (OK)
  31. Carolinas HealthCare System ACO (NC, SC)
  32. Cascadia Care Network (WA)
  33. Centrus Health of Kansas City (KS, MO)
  34. CHSPSC ACO 1 (AL, FL, LA, MS)
  35. CHSPSC ACO 10 (FL)
  36. CHSPSC ACO 12 (GA, NC, SC, VA)
  37. CHSPSC ACO 13 (PA)
  38. CHSPSC ACO 14 (TN, WV)
  39. CHSPSC ACO 15 (KY, TN)
  40. CHSPSC ACO 16 (OK)
  41. CHSPSC ACO 17 (FL)
  42. CHSPSC ACO 2 (IN)
  43. CHSPSC ACO 21 (AL, FL)
  44. CHSPSC ACO 6 (TX)
  45. CHSPSC ACO 7 (AR, LA, MO, OK)
  46. CHSPSC ACO 8 (AK, AZ, NM, NV)
  47. CHSPSC ACO 9 (IN)
  48. Coastal One Health Partners (CA)
  49. ColigoCare (NJ, NY)
  50. Community Health Center Network Of Idaho (ID, OR, WA)
  51. Community Healthcare Partners ACO, (IL, IN)
  52. Connected Care of East Tennessee (AL, GA, TN)
  53. Connected Care of Middle Tennessee (TN)
  54. Connected Care of Mississippi (MS)
  55. Connected Care of West Tennessee (MS, TN)
  56. CPSI ACO 2 (CA, CO, GU, ID, ND, OR, SD, WA)
  57. CPSI ACO 3 (GA, MS, NC)
  58. CPSI ACO 7 (IA, IL, NE, WI, WV)
  59. CPSI ACO 8 (AR, LA, MO, TX)
  60. Crestwood Regional Healthcare Alliance (AL)
  61. CVACC (VA)
  62. DMH Health Network (IL)
  64. Einstein Care Partners (PA)
  65. Family Choice ACO (CA)
  66. Foothill Accountable Care Medical Group, (CA)
  67. Genesis Physicians Group (TX)
  68. Health Alliance ACO (DC, MD, VA)
  69. Healthcare Quality Partners (NJ, PA)
  70. HealthChoice (AR, MS, TN)
  71. Heritage Valley Healthcare Network ACO (OH, PA, WV)
  72. Holy Name Medical Center ACO (NJ)
  73. HP2 (GA)
  74. Independent Physicians Accountable Care (CA, CT, FL, SC, TX, VA)
  75. Inspire Health Partners (IN)
  76. Intermountain Accountable Care (NV, UT)
  77. Keep Well ACO (IL, KS, MO)
  79. Kootenai Accountable Care (ID, WA)
  80. McFarland Clinic, PC (IA)
  81. McLeod Healthcare Network (NC, SC)
  82. MHC Accountable Care Organization (KY, OH, WV)
  83. MHN ACO (IA, IL, NE, SD)
  84. MSHP ACO (NY)
  85. MultiCare Connected Care (WA)
  86. NCH ACO (FL)
  87. NorthShore Physician Assoc. Value Based Care (IL)
  88. OhioHealth Venture (OH)
  89. Orange Accountable Care Organization (FL, MD, NJ, NM, PA, TX)
  90. Pacific Private Practice Network, Inc (CA, TX)
  91. PathfinderHealth (AZ)
  92. Physician Partners of Western PA (PA)
  93. Physician Performance Network of Arizona (AZ)
  94. Primary Comprehensive Care ACO (IL, NC)
  97. Privia Quality Network Gulf Coast II (TX)
  98. QHI ACO (CA, CT, IL)
  99. Renaissance Physicians Accountable Care (TX)
  100. Riverside Health Source (VA)
  101. Rush Health ACO (IL)
  102. Saint Francis Hospital Medicare ACO (AR, IL, MI, MS, TN)
  103. Select Physicians Associates (AL, FL)
  105. Space Coast Independent Practice Association (FL)
  106. St. Dominic Medical Associates (MS)
  107. St. Luke's ACO (IL, MO)
  108. St. Luke's Medicare ACO (NJ, PA)
  109. St. Tammany Hospital ACO (LA)
  110. Steward National Care Network, (FL, MA, NJ, OH, PA)
  111. The Iowa Clinic, P.C. (IA)
  112. The Ohio State Health ACO (OH)
  113. Treasure Coast Integrated Healthcare (FL)
  114. UC Davis Health ACO (CA)
  115. UC Irvine Health Accountable Care Organization (CA)
  116. UC San Diego Health Accountable Care Network (CA)
  117. UCSF Health ACO (CA)
  118. UMC Accountable Care (NM, TX)
  119. United Physicians ACO (MI)
  120. University Health ACO (TN)
  121. UPQC (NV, UT)
  122. Valley Medical Group-Renton (WA)
  123. VillageMD Chicago ACO (GA, IL, IN, KY, TN)
  124. White River Health System Clinically Int. Network (AR)

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

By Claire Thayer, January 19, 2018

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Shutdown Looms; Blame Game Already in Full Swing

A bitterly divided Congress hurtled toward a government shutdown this weekend in a partisan stare-down over demands by Democrats for a solution on politically fraught legislation to protect about 700,000 younger immigrants from being deported.
The Associated Press
Friday, January 19, 2018

Trump again targets drug policy office, proposing 95 percent budget cut

President Donald Trump is planning to slash the budget of the Office of National Drug Control Policy, in what marks his administration’s second attempt to gut the top office responsible for coordinating the federal response to the opioid crisis.
Thursday, January 18, 2018

Four health systems band together to create generic-drug company

Four health systems have joined forces to create a not-for-profit generic-drug company with the goal of creating cheaper, more accessible pharmaceuticals for patients than are currently available on the market.
Modern Healthcare
Thursday, January 18, 2018

UnitedHealth expects $1.7B windfall from tax law

UnitedHealth Group, the country’s largest insurer, will gain $1.7 billion in additional earnings in 2018 because of the GOP tax bill, the company’s CEO said Tuesday.
The Hill
Tuesday, January 16, 2018

U.S. healthcare uninsured rises most in near decade: Gallup

The number of Americans without healthcare insurance rose by 3.2 million people between 2016 and 2017, or 1.3 percentage points to 12.2 percent, according to a Gallup poll released on Tuesday, the biggest jump in the uninsured rate in nearly a decade.
Tuesday, January 16, 2018

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.


Accenture’s Advice to Pharma: It’s The Evidence, Stupid.

Accenture’s Advice to Pharma: It’s The Evidence, Stupid.

By Clive Riddle, January 12, 2018


Remember when Bill Clinton’s first presidential campaign mantra was “it’s the economy, stupid”?  Accenture advises the pharmaceutical industry to substitute evidence for economy in that equation and focus more on evidence-based solutions than products or brand.


Accenture has just released 16-page report: Product Launch: The Patient Has Spoken in which they conclude “brands are not major influencing factors when patients consider new pharmaceutical products. More than two-thirds (69 percent) of patients surveyed said the product’s benefits – i.e., treatment outcomes – are more important than the brand itself, with less than one-third (31 percent) citing a strong affinity to brands in a healthcare setting.”


Accenture tells us that for the report, they commissioned a survey of 8,000 patients in France, Germany, the U.K. and the U.S across eight therapeutic areas – immunology, cardiology, pulmonology, neurology, oncology, rheumatology, endocrinology and eye disease. Respondents represented three main age demographics: baby boomers, Gen Xers and millennials.


Accenture shared the following findings:


When patients were asked which factors influence their healthcare product and treatment decisions:

·         66% cited the doctor/physician relationship

·         55% indicated the ability to maintain their current lifestyle

·         53% said ease of access to the care they’ll need

·         But just 31% listed brand loyalty or popularity, and this ranked twelfth out of 14 influencing factors


The report notes that patient perspectives include:

·         38 % said they feel very knowledgeable about new or existing products coming to market for their condition

·         25 % reported having either very limited or no knowledge of new products that might be suitable for them

·         48 % believe that their doctors discuss the full range of product options with them

·         44 % feel that they have significant input into their treatment selection

·         63 % said they want to be involved in such decisions

·         47% said they’ve thought about switching their treatment at some point

·         62%of those who think about switching end up doing so


So if it isn’t product and brand, what does drive patient treatment choice decisions? Accenture says “despite survey results showing that many patients look online for information about new treatments, physicians remain the primary influencer of their treatment choices. In fact, the reason patients cited most often for switching treatments was a recommendation from their physician (cited by 81 percent of patients who switched treatments), followed by proven benefits compared to current treatment (79 percent) and fewer side-effects than their current treatment (78 percent).”


Regarding demographics, the survey “findings also identified differences in attitude and behavior by age group, with younger patients more likely than older ones to understand which treatments are available—and switch treatments when they believe there’s something better. For instance, while physician recommendation was the most-cited reason across all age groups for switching treatment, Millennials are almost twice as likely as Baby Boomers to be influenced by people posting alternative treatment options on social media.”


Of course what the report doesn’t focus on regarding treatment decisions is the role of insurance coverage, cost-sharing and formularies. But Accenture’s message in this value based era should still resonate. Accenture’s Jim Cleffi, a co-author of the report, tells us “given the significant budgets pharmaceutical companies devote to driving brand equity in the marketplace, our report findings should be a strong signal to the industry that launch strategies need to change. Patients in our study made it clear that outcomes matter most which means that pharma companies should focus their launch strategies and communications more on patient value and impact versus the brand—and do so in a much more precise and personalized way. Reallocating parts of launch budgets to programs that resonate the most with different patient segments would not only better meet patients’ needs and deliver better outcomes, but likely provide the companies with better ROI.”


Accenture provides pharma two recommendations in the report:

1)    Bring an outcome – not just a product – to market. Patients value outcomes over brands, so instead of launching just products, pharmaceutical companies should start launching evidence-based solutions, or products with services as a secondary offering. This will require collaborative data-sharing – between patients, providers and payers – along with advanced analytics to generate robust insights and delivery via digital channels. This mindset should begin at the clinical trial-stage so it informs new launch strategies and full commercialization.

2)    Make it personal and precise. One size no longer fits all; pharmaceutical companies need to understand patient sub-segments and develop value-driven launch strategies tailored to each segment. Harnessing advanced analytics and other new technologies that leverage the proliferation of health data will help enable companies to modify launch strategies that make new treatments more relevant to patients while also driving better-informed resource and investment allocations.

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