Tag Archives: Doug Goldstein

Alternative Payment Models: Yeah or Nay?

So where do we go with our healthcare system under the new administration? Will we move to Alternative Payment bundled-paymentsModels or will FFS continue? A recent study showed that bundled payments for orthopedic joint replacement appeared to be working at lowering costs while maintaining quality.

At the same time, it seems that Dr. Tom Price, the nominee for Secretary of HHS is not a fan of bundled payment.

Along with Gregg Masters and Doug Goldstein, we’ll be exploring some of these and many other issues about the next phase of healthcare reform during the coming months on PopHealth Week.

Let us know what you think.

 

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PopHealth Week is a Production of Health Innovation Media and Accountable Health, LLC.

 

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PopHealth Week – This week we discussed Theranos, Healthways, ACOs and Precision Medicine

Listen to Doug Goldstein (@efuturist) Gregg Masters (@2healthguru) and me (@fsgoldstein) discuss the continuing Theranos Saga, The Healthways acquisition by Sharecare, Precision Medicine and the Cancer Moonshot and ACO results on PopHealth Week:

 

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PopHealth Week Month End Wrap-up: Healthways, Fitbit, Oschner, Aledade & Anthem

by Fred Goldstein, Gregg Masters and Douglas Goldstein

Listen to the episode here:

 

In our second month end ‘news/e/um‘ style PopHealth Week Review this Wednesday June 24 at 9 AM PT/12 PM ET we’ll feature hot topics in the news. Our regular panel of Fred Goldstein @fsgoldstein, Gregg Masters @2healthguru and Doug Goldstein @efuturist will identify newsworthy stories and offer commentary along the way. The initial slate of stories in the news includes:

  • Healthways revised guidance
  • Fitbit’s IPO and Garmin’s lawsuit
  • Ochsner Health System
    • What they are getting, news about Apple Watch – Chronic Care Management
    • News B4 the Release – what they are working on the “New Mission Control”
  • The physician led ACO management company Aledade’s VC raise
  • Insights from the Personalized Medicine Coalition Study
  • Anthem’s sparring bids for CIGNA (and Aetna’s pursuit of Humana) Could the ‘Big Five’ be reduced to the ‘Big Three’?

Here’s some background:

Healthways: A Perenial Disappointment?

 

This company just reported revised downward guidance and their stock was hammered.  Last month, on May 18th their longtime CEO Ben Leedle stepped down and last year a group of dissident sharedholders filed to take over the Board, though they ultimately came to an agreement with a few of them joining the Healthways Board.  As one of the largest population health companies, with unique programs like Silver Sneakers, the Gallup-Healthways Well-Being Index, and relationships with Blue Zones and Dean Ornish, how can they miss?  Well the irreverent 3 have some thoughts you don’t want to miss this.

We’re sourcing our discussion from recent news: ‘Healthways Revises Financial Guidance for 2015‘ and Healthways (HWAY) Stock Sinks on Lower Full Year Revenue Guidance

Fitbit: The Wallstreet Darling of the Wearables Industry?

Fitbit went public, Woohoo! Lets take a walk as we discuss: 

  • the opportunities for wearables
  • Fitbit’s first day pop (can you say JUMP) you know, we can get them to exercise, but hey its only the first month, is it sustainable?; and
  • the recently announced Garmin lawsuit (what? So they hired employees from a competitor….. but maybe… they took more than their minds with them)

The company narrative is here, and recent discussions found via CNBC ‘Fitbit soars 20% on second trading day

The good here, and some questions, here and here. And then there’s the ‘always-in America’ litigation angle via ‘Fitbit Sued by Jawbone for ‘Plundering’ Employees, Secrets‘ with all the gory details of the complaint here.

Ochsner Health System: The New Normal?

Doug Goldstein recently visited Ochsner Health and has some interesting insights to bring us. Perhaps more interesting is this announcement:

 

Ochsner Health System First in Nation to Manage Chronic Disease with AppleWatch

We all know how much buzz the product (better yet, platform) has produced in the digital health and exploding apps market, we’ll lean into the real world implications for its deployment to population health via Ochsner’s first mover vision inside their EHR.

Select Highlights:

…it’s not about the wearable – it’s about the “new mission control” being built into the EPIC workflow that will change how doctors support patients in life, fitness, health and healthcare.’ Douglas Goldstein

Aledade: The Physician Led ACO Management Company “ACOcor” Revisited?

Aledade just completed a $30 million series B raise, see; ‘Bethesda health tech company raises $30 million‘. What implications if any can we draw from this continuing investor confidence in the approach and ‘secret sauce’ enabling the transformation of the U.S. healthcare ecosystem from volume to value? What does this say about the ACO market writ larger and the continued embedding of the ACA’s moving parts as the new normal for American healthcare? For discussion of this milestone event, see: Leading the Transformation: Aledade’s Growth authored by Aledade CEO Farzad Mostahari, MD.

Themes: ACOs continue their market penetration, and the need for physician led ACOs can only be expected to continue to grow as well. Someone need fill that void. Aledade intends to be a front runner.

ACA repeal types are increasingly irrelevant and the King V Burwell trial decision –  which could hit this week – is likely to only affirm the continued availability of Federal subsidies language issues notwithstanding.

Physician led ACOs are another shot at the bow of traditional hospital system led innovations including any ACOs the sponsor.

Personalized Medicine Coalition Study 

Most of us have heard about the 17 year time-line for innovation to transfer from ‘bench to bedside’ into mainstream medicine. Clearly in days past, we could tolerate such a delayed ‘on-ramp’. Yet in the Internet age, with M0ore’s Law and the explosion medical information and informatics, plus opportunities for crowd sourcing and the connected global village are within the means of anyone carrying a smartphone, laptop of PC, such a delay is unacceptable.

Yet, there’s more in the way of innovation uptake. A recent study by the Precision Medicine Coalition outlines some of these concerns, particularly as it relates to ‘alternate payment models’ (APMs):

‘..as APMs continue to develop and these, and other alternate models are proposed, it will be important to consider what effect changing incentives and payment systems will have on the decision by interested stakeholders to invest in personalized medicine. The Report concludes that “if new incentives begin to hamper access to personalized medicines in a meaningful way, the ability to invest in research and development of highly personalized therapies and diagnostics will likely shift to align with the inflexible payment systems.”

“Understanding the dynamics and challenges facing the industry as payors move toward APMs is the first step to ensuring that these therapies can continue to be developed and made available to patients. This Report is an important first step to raising the awareness of these issues as payment models continue to evolve.’

Practical Impact or ‘Reading the Tea Leaves’

As the challenge of integrating the promise of precision medicine (utility of biomarkers and better understanding of disease pathology and associated risk management opportunities) informing and guiding to day to day lifestyle (including health) choices, another potential uptake inhibitor are the hoops payors or risk bearing organizations may require before deeming the application of such technology to better patient outcomes. So in a way, it’s not just about tech innovation adding value to medicine and healthcare, but also the bureaucracies we create to protect the public while stimulating innovation.

PM remains an on the come potential to current medical practice. The theory is compelling, but the 17 year bench to bedside standard is not likely to step aside any time soon. Perhaps incentives [and compelling outcomes studies] can accelerate an otherwise glacial pace of [tech transfer] adoption.

Anthem’s Determined Dance to Acquire CIGNA

Are we revisiting the Big 6, then Big 4, and ultimately fill in the ____ of the too big to fail accounting firms [RIP Arthur Anderson’ but now squarely laid at the feet of America’s Health Insurance Industry market leaders….

This is a story on a number of levels! See: Anthem continues $47B Cigna takeover battle and Anthem offers $47 billion to buy Cigna.

Themes: Is health plan consolidation the antidote to counter the recent and persistent wave of hospital, health system and medical group mergers? One CEO’s post merger standing in way of merger. Will investors stand by and watch a premium bid sit idle?

Bottomline? Might market consolidation for price leverage (and oh yeah, scale and operating efficiencies) enable the construction of a virtual single payor (or Ellwood vision of “SuperMeds”) via acquisitions or arrangements? Is this scale required by ACA as some opine? Or just more opportunity to generate fees and exit packages for senior executives? When has scale reduced costs?

So pull up a chair, get out on a walk, put on your headset, and tune in to PopHealth Week!

 

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PopHealth Week is Booking Guests – Here’s the schedule

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Here’s the PopHealth Week schedule through mid July so please join us every Wednesday at 12 pm eastern or listen to/download the recording at PopHealth Week.

  • June 17 – Steven Blumberg, SVP Atlanticare. ACOs and Population Health.
  • June 24 – News Review with Fred, Gregg and Doug.

July will focus on Population Health in Primary Care Practices:

  • July 1 – Roy Hinman, MD, Island Doctors – Population Health in a Full Risk Primary Care Practice.
  • July 8 – Rushika Fernadopulle, MD, Iora Health – Primary Care that Puts People First, Iora’s unique model.

Listen to earlier shows:

May 20 – David Nash, MD – Population Health or Population Medicine: What Gives?

May 27 – News Review – Evolent’s IPO and Quantified Self, Data, Privacy and Meaningful Use.

June 3 – Jennifer Drago – Waiting to post.

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PopHealth Week May 27 – Evolent’s IPO and the Quantified Self

PopHealth Week

May 27 at 12 pm Eastern

http://www.pophealthweek.com

 

the three cohosts

 

 

Join Fred Goldstein, Gregg Masters and Doug Goldstein as they discuss recent news and issues in population health. This week’s show will focus on Evolent Health and their recently announced IPO as well as the Quantified self and health care data, who’s using it, and what are some of the issues the industry and we face. This show was prerecorded due to scheduling conflicts and will be played at the normal time, 12 pm eastern on Wednesday May 27. There were some issues with the audio, but they have been addressed for next week’s show on June 3 with Jennifer Drago of Sun Health discussing their Community-based Care Transitions Program.

Here’s some background on the two topics:

Topic 1 – Evolent Health Announces Their IPO

Evolent Heath announced their IPO this past month. Here is some information on Evolent from their website (http://www.evolenthealth.com)

 A PARTNERSHIP DRIVEN BY A GREATER PURPOSE

Evolent Health helps progressive health care systems lead, build and own the path to value-based care. No matter your current state of transition, we partner with you to drive real, lasting transformation from the inside out.

OUR COMPANY

Founded in 2011 by UPMC Health Plan and The Advisory Board Company, we are a high-growth firm headquartered in Arlington, Virginia. Across multiple Evolent and partner system sites, our 750-member team of experts works shoulder-to-shoulder with provider leadership to shape the future of health care. Evolent is proud to partner with leading providers and physician organizations in over 25 markets across the country.

OUR OFFERING

Evolent provides the integrated technology, tools and team to advance value-based care. Our work begins with the Blueprint, an immediately actionable strategic roadmap that defines target markets, assesses needed clinical and operational capabilities, and is supported by a detailed business case. We implement the Blueprint through our Market Facing Solutions, which accelerate the path to value and embed and connect crucial capabilities through a Value-Based Services Organization:

  • Tailored clinical programs, patient engagement tools, quality and risk coding, and specialized care teams to deliver Population Health Performance
  • High performance network optimization and management, backed by proven physician compensation models and integrated specialty partnerships foundational to Delivery Network Alignment
  • Leadership, scalable back-office infrastructure, and analytics and reporting teams required for Financial And Administrative Management
  • Organizational governance and design, physician-led practice transformation, and change management to drive “inside-out” System Transformation
  • Data integration, clinical and business content, EMR optimization, and value-business applications through our purpose-build technology solution—IdentifiSM

From Evolent’s S-1:

Financials

2013               2014

Revenue         $40.3M           $100.9M

Loss                 $32.8M           $52.3M

Assumptions

They believe the current market opportunity is $10B and will be $46 by 2020, that health expenditures will increase from $2.1T to $3.2T by 2020, value based care will increase from 10% to 50%, the provider sponsored health plan market will grow to 15% of the total health plan market and they estimate $1T in waste in the system.

A good blog on the topic by Stephanie Baum

6 Takeaways from Evolent Health $100 Million IPO Registration

An interesting piece from Rock Health on who might be next for an IPO

http://medcitynews.com/2015/05/digital-health-ipo/

 

Topic 2 – Quantified Self, Data, Privacy and Meaningful Use

The second issue we’ll discuss is the quantified self, and the incredible growth in personal data that is being gathered and used from wearable devices and other sources.

The Washington Post had a recent article entitled The Revolution will be Digitized by Arianna Eunjung Cha, May 9, 2015

http://www.washingtonpost.com/sf/national/2015/05/09/the-revolution-will-be-digitized/

Kojo Annamdi from NPR had a show on The Digital Fingerprints We Leave Behind Online with some interesting information and statistics

http://thekojonnamdishow.org/audio/#/shows/2015-05-19/the-digital-fingerprints-we-leave-behind-online/88470/@00:00

There have been numerous data breaches including this one:

CareFirst Data breach

http://www.nytimes.com/2015/05/21/business/carefirst-discloses-data-breach-up-to-1-1-million-customers-affected.html?_r=0

And the recent hacking of an adult dating site and sharing of intimate details online:

http://www.welivesecurity.com/2015/05/22/adult-dating-site-hacked-leaking-private-information/

Issues like who owns the data, whose using it, its value, the No MU without Me campaign and others will be addressed. So join us at 12 pm eastern at www.pophealthweek.com and follow us on twitter @pophealthweek.

 

 

 

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