Health Business Blog

I’m taking a break from blogging this week so am rerunning some favorite posts from 2010. Please visit the original post to comment.

Sometimes bio/pharma companies cry wolf over regulations, for example when they claim that the emergence of bio-generics or bio-similars would devastate their businesses by lowering the incentive for investment. But other times they find themselves in a no-win situation and need someone to defend them.

The Avastin/Lucentis story is one such situation and I’ll gladly step up.

Avastin is a highly-effective anti-cancer drug. Lucentis is basically the same drug, but it’s indicated for an ophthalmic condition: wet age-related macular degeneration. Since Lucentis is injected in the eye only a little bit is needed. Some enterprising doctors and pharmacists figured out they could split up one Avastin dose into lots of Lucentis doses. Instead of $2000 or so for a Lucentis treatment they have an Avastin equivalent for less than $100 –maybe as low as $20.

The situation has caused Genentech a lot of grief. Their revenues have suffered, they’ve taken a lot of hits in the press and from eye doctors, and the FDA has started holding Avastin production facilities to stricter standards usually reserved for ophthalmic products. The company is in a tricky situation and has had to fall back on the notion that Lucentis has gone through clinical trials for wet AMD while Avastin hasn’t. That’s a weak argument and is undermined by a new Kaiser study showing equivalence.

In the short run only Genentech loses out. Patients get a much less expensive drug and insurance premiums are a little lower than they would be otherwise.

But it’s also shown the world that the price point for a wet AMD treatment is $20 or so. Now who on earth is going to bother developing a new treatment for wet AMD? I’ve already seen situations where companies chose to drop development of early stage compounds in this therapeutic area because they are afraid they can’t make money.

The problem is really the way that drugs are priced. Avastin is priced by volume, but really what patients are getting is a treatment for cancer that’s worth a certain amount of money, regardless of the amount of physical product used. In the past I’ve proposed a software licensing model for drugs. Despite the challenges of implementation I still think it’s a good idea.

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I’m taking a break from blogging this week so am rerunning some favorite posts from 2010. Please visit the original post to comment.

An oncologist friend spotted my blog post (Overuse of mammography in elderly women with cognitive impairment) and noticed that I’d been unable to access the full American Journal of Public Health article without paying for it. He shared his copy with me and pointed out that the research was funded by the National Institute of Aging (i.e., the taxpayer) and yet access is restricted to paid subscribers. (There is an antidote to this problem, called the Public Library of Science, which was co-founded by my high school lab partner.)

In any case a footnote in the article pointed me to an interesting 2001 article from the Journal of General Internal Medicine (Screening Mammography for Frail Older Women; What are the Burdens?) that is freely available. In this study, the authors followed the paths of 216 frail, elderly women who had undergone screening mammography. The results:

Thirty-eight women (18%) had abnormal mammograms requiring further work-up. Of these women, 6 refused work-up, 28 were found to have false-positive mammograms after further evaluation, 1 was diagnosed with ductal carcinoma in situ (DCIS), and 3 were diagnosed with local breast cancer. The woman diagnosed with DCIS and 1 woman diagnosed with breast cancer were classified as not having benefited, because screening identified clinically insignificant disease that would not have caused symptoms in the women’s lifetimes, since these women died of unrelated causes within 2 years of diagnosis. Therefore, 36 women (17%; 95% confidence interval [CI], 12 to 22) experienced burden from screening mammography (28 underwent work-up for false-positive mammograms, 6 refused further work-up of an abnormal mammogram, and 2 had clinically insignificant cancers identified and treated). Forty-two percent of these women had chart-documented pain or psychological distress as a result of screening. Two women (0.9%; 95% CI, 0 to 2) may have received benefit from screening mammography.

The article provides details of the four women diagnosed with breast cancer.  Two, who died within two years of detection, underwent some quite unpleasant and stressful testing and treatment. For example:

The second woman was an 89-year-old African-American woman with angina and dementia who was functionally dependent in 2 ADLs and who had a circular density in the left breast discovered by screening mammography. Serial mammograms were performed every 6 months for 2 years until it was felt that the lesion was slowly growing. An FNA revealed invasive ductal carcinoma. She underwent a modified radical mastectomy with no evidence of cancer in her axillary lymph nodes. She pulled off all the bandages the night after surgery, requiring restraints, and developed a seroma. She died 15 months later of a myocardial infarction.

The authors point out that –at least at the time of the article– some health care quality measures were based on the percentage of people over a certain age screened for cancer, with no regard for maximum age or individual circumstances that would make screening a bad idea.

The recent debate following the US Preventive Services Task Force recommendations on the age to begin routine mammography screening has focused heavily on the benefits of screening and the potential harm from discouraging screening. I’d like to see the debate broadened to include a frank discussion of the potential harm from too much screening. Excessive screening and associated harm to the frail elderly population is one aspect of that story.

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Wisdom From Wenchypoo’s Mental Wastebasket hosts the latest edition of the Cavalcade of Risk blog carnival, where you can read a roundup of risk-related posts.

I’m hosting the next version in the New Year, so pleas submit using the Blog Carnival form.

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I’m taking a break from blogging this week so am rerunning some favorite posts from 2010. Please visit the original post to comment.

Sara Rosenbaum’s has an informative Perspective (Can States Pick up the Health Reform Torch?) in the current New England Journal of Medicine. She argues that reforming health care at the state level is not a realistic alternative to national health care reform.

I agree with her conclusion but don’t find all of her arguments  persuasive.

Rosenbaum highlights four hurdles:

1. Fiscal reality
2. Practical considerations
3. The law
4. The “reality of health care today”

In number 1, fiscal reality, Rosenbaum cites the high costs of subsidizing health insurance and says “an infusion of federal resources” is needed. I agree that the magnitude of spending is high and that states would have a hard time raising the money. However, the country is just a collection of the states, so on average if the feds can do it at least some states should theoretically be able to afford the same resources. In truth, the federal government has an easier time running large deficits than the states do. But this reason doesn’t seem very strong to me.

Number 2, practical considerations, refers to states tackling  “discriminatory tactics, such as price gouging and exclusion, that insurers use to deny enrollment or provide coverage that is grossly inadequate in relation to medical need. Even if individual states are willing to intervene, insurers are free to evade state regulation simply by pulling up stakes in any jurisdiction with an unappealing political and regulatory climate.” This argument is the least persuasive to me. Sure, national plans might avoid certain states, but in doing so they will alienate national employers and lose business as a result. And much of the commercial market is made up of local Blues plans. Those local plans aren’t going to close up and go elsewhere.

Number 3, the law, makes the most sense. Rosenbaum mentions that ERISA “exempts from state regulation self-funded employer plans that use large insurers only as plan administrators.” Because even smaller companies self-fund these days, it excludes more than half the commercial market from state regulation.

Number 4, “reality of health care today”, has some merit. As an example, Rosenbaum points to the Washington, DC area where she lives. People may live in Maryland, work in DC, and seek care in Virgina. Obviously no single state can control its neighbors.

In my view, Rosenbaum has missed the biggest hurdle of all: Medicare. Medicare spending is so large and influential that it overwhelms anything going on in the commercial market. No matter what happens at the state level (including with Medicaid, where states have at least some influence) providers are going to be profoundly influenced by what Medicare does. For example, the 21 percent rate cut due to go into effect on Monday is of far more interest than any state activity. And Medicare is a federal program, so there’s nothing at all the states can do about.

So Rosenbaum is right: states can’t lead reform. If reform is to occur, the federal government will have to act. And it will need to tackle Medicare.

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I’m taking a break from blogging this week so am rerunning some favorite posts from 2010. Please visit the original post to comment.

The hospital discharge process is a rocky one. Such “transitions of care” are fraught with challenges as patients move from a highly supervised to less supervised settings, caregivers change, and information about the patient and their needs is transmitted. These hand-off’s are tough and the ball often gets dropped. Not infrequently the patient ends up right back in the hospital in a preventable readmission.

Discharge isn’t a neat, tidy process. For example, patients typically have test results pending when they leave the hospital. But what happens to those results? According to a study in the Journal of General Internal Medicine reported in Today’s Hospitalist (Pending test results go AWOL), the pending tests are not being reported on hospital discharge summaries:

• All patients in the study had tests pending at discharge, but only a quarter mentioned that any tests were pending
• Only 13 percent said what those tests were

The study’s author, Dr. Martin Were, was “shocked” by the results:

“We already know that outpatient providers aren’t very good at following up on pending tests documented in the discharge summary,” Dr. Were says. “Imagine how much worse the follow-up is when pending tests aren’t even documented.”

And while information technology might help manage pending test results, Dr. Were says that’s only half the battle. There are no accepted standards for who should receive those results and who is responsible for following up on them…

“I expected discharge summaries to be inadequate, but I didn’t expect them to be that inadequate”

…And it’s a problem… that’s being exacerbated by the growth of hospital medicine for two reasons: More and more patients are seen by separate inpatient and outpatient physicians, and sicker patients are being discharged soon from hospitals.

There’s a major quality and patient safety opportunity here and I expect the gaps to be closed over time. In the meantime I wonder how much performance varies between best in class hospitals and others.

This should also be a wake-up call for patients and families. Although there’s not that much a patient can do to change what happens in the hospital or at discharge, I’d suggest finding a good primary care physician who’s tightly integrated into a hospital system that uses good information technology. That way the physician knows you, and has access to your medical record including lab tests performed in the hospital. I don’t think it’s necessary or even desirable to avoid hospitals that use hospitalists as long as you have the other pieces in place.

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I’m taking a break from blogging this week so am rerunning some favorite posts from 2010. Please visit the original post to comment.

Health care policy discussions in the US are often framed in absolutist terms. In particular, there is a widespread belief among the public that treatment –especially for serious illnesses– should be undertaken without regard to cost. Many are wary about comparative effectiveness research –the main concern is that the government will use the results to ration care. With this backdrop, I was interested to read a new paper in Health Affairs: Cancer Therapy Costs Influence Treatment: A National Survey of Oncologists by Peter Neumann et al.

Peter is the director of the Center for the Evaluation of Value and Risk in Health (CVER) at Tufts Medical School. I’m a member of the CEVR Executive Advisory Board so have been following the comparative effectiveness debate more closely of late.

Here’s the abstract:

A national survey of medical oncologists indicates that rising cancer treatment costs are influencing clinical practice, even as oncologists tend not to communicate with patients about costs. The survey shows that 84 percent of oncologists say that patients’ out-of-pocket spending influences treatment recommendations. Only 43 percent always or frequently discuss costs with patients. Among those surveyed, 79 percent favor more comparative effectiveness research; 80 percent support more cost-effectiveness data, although only 42 percent feel well prepared to interpret it. The results suggest that physicians support federally funded comparative effectiveness research but that they wish to retain a central role in making decisions about how and when to use expensive cancer treatments. The results also support educating physicians about cost-effectiveness and how to communicate with patients regarding cost.

Like it or not, your oncologist is probably already taking cost into account in prescribing treatment. To expand a bit on the 79 and 80 percent numbers in the abstract,  80 percent refers to the percent of oncologists who think more cost-effectiveness data should be used in coverage and payment decisions. Seventy-nine percent want more government research on comparative effectiveness of cancer drugs.

While oncologists want government sponsored research and want the results to be used for payment, they don’t tend to want the government or insurance companies to “determine whether a drug provides good value.” Not surprisingly, 60 percent of respondents think physicians should make the determination. But it is interesting to me that the next two choices were a nonprofit (57 percent) and patients (37 percent). For comparison 21 percent said government and 6 percent insurance companies.

Overall I’m encouraged that oncologists are so enlightened about comparative effectiveness. They have observed through their own clinical and research experience that costs have to be a consideration even in life and death matters. They want more, objective research on the subject. And they do not seek to monopolize the interpretation and implementation of the results.

Those who oppose comparative effectiveness research on the grounds that it will lead to the rationing of care should be aware that oncologists are already taking cost into account and expect to do so to a greater extent in the future. We might as well have them base their decisions on solid research.

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More than 20 years ago, a senior colleague told me a good shortcut to weed through a business literature search: just limit the search to the Wall Street Journal. They cover most topics and usually get the story right. I’ve followed that advice a lot, even in the era of Google when searches are much simpler, and it’s still a good tip. Yesterday’s Journal, though, had an article that really missed the mark.

Here’s the headline and lead paragraph:

Law Prompts Some Health Plans To Cut Mental-Health Benefits

Members of the Screen Actors Guild recently read in their health plan’s newsletter that, beginning in January, almost 12,000 of its participants will lose access to treatment for mental-health and substance-abuse issues.

The article then continues to list other employers that have dropped mental health and substance abuse coverage in reaction to a new law that requires larger plans to treat such coverage the same way they treat coverage for physical ailments –if they offer mental health and substance abuse coverage at all. It quotes the Screen Actors Guild CEO saying it can’t afford the increase in costs caused by the mandate.

But a look at the data contained in the article itself demonstrates that the Journal has the story roughly backwards. Of firms surveyed by Kaiser Family Foundation, 69 percent were not changing their mental health and substance abuse benefits at all. Of the 31 percent that were changing such benefits, 66 percent were eliminating limits on coverage. Only 5 percent of the 31 percent (or about 1.5 percent of the total) were dropping their mental health coverage. In essence, the Journal decided for some reason to focus on this 1.5 percent of employers as the big story.

A closer read of the Screen Actors Guild (SAG) story also shows that this is a pretty atypical situation. Deep in the article it is revealed that the entertainment industry is among the top three in illicit drug and heavy alcohol use, so naturally they will have high mental health and substance abuse treatment costs. Second, the Guild’s decision only affects a plan that is open to members who make less than $30,000 per year. “Higher earners qualify for a more comprehensive plan,” it says, presumably one that includes mental health benefits.

As noted elsewhere in the article, the Congressional Budget Office projects mental health parity will raise premiums just 0.4 percent, hardly noticeable amid the typical double-digit increases. In addition, a leading actuary cites “ample” evidence that spending on mental health and substance abuse benefits lowers overall costs.

I’m going to give the Journal the benefit of the doubt on this one and assume it was just a poor choice of angle for the story. But it will be a bit disturbing if the story is a sign of the Journal aligning its traditionally independent news section with its reactionary editorial page under Rupert Murdoch’s ownership.

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Kaiser Permanante’s Dr. Ted Eytan is a passionate advocate of patient centered care, supported by health information technology. I first encountered him last month at a Robert Wood Johnson Foundation meeting where he gave an inspiring talk about Kaiser’s success in engaging patients and families.

In this podcast interview, Ted speaks about his role at Kaiser Permanente and how he got there, the ways life is changing for patients and their families as electronic health records and personal health records roll out, and the potential for mobile health and social media. We then turn to the topic of walking meetings (Ted is a major proponent and practitioner), innovation within large organizations, and what’s ahead for 2011.

If you want to hear more from Ted, check out his blog and Twitter posts.

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Kaiser's Dr. Ted Eytan speaks with David Williams [ 10:50 ] Play Now | Play in Popup | Download

This is the transcript of my recent podcast interview with Dr. Scott Weingarten of Zynx Health.

David E. Williams:            This is David Williams, co-founder of MedPharma Partners and author of the Health Business Blog.  I’m speaking today with Dr. Scott Weingarten, he is CEO of Zynx Health.  Scott thanks for your time today.

Dr. Scott Weingarten:            Thank you very much David.

Williams:            Let’s talk a little bit about Accountable Care Organizations (ACOs).  What is an ACO and is there any connection with Meaningful Use and clinical decision support?

Weingarten:            In ACOs, physicians, other health care providers and hospitals align and are accountable for quality and cost outcomes across some period of time for a population of patients.

Many of the details of the structure and financing of ACOs are yet to be defined. We expect to hear more from CMS regarding those details in the near future, but regardless of how those details emerge you see hospitals and physicians aligning and preparing to demonstrate the best quality outcomes at an affordable cost.

The ARRA/HITECH legislation is closely aligned with the ACO language in the Patient Protection and Accountable Care Act. Meanwhile Meaningful Use requires deploying health care information technology and creating the health care information technology infrastructure. As you start looking at draft definitions for Stage Two and Stage Three it’s clear that organizations will need to simultaneously improve their clinical processes and their clinical and financial outcomes.

I believe that Meaningful Use and ARRA really lay the foundation for succeeding in a reformed health care system, succeeding as an ACO, and being prepared for value based purchasing, Medicare shared savings and even bundled payments.

Clinical decision support is also tightly aligned with the requirements for demonstrating Meaningful Use and for becoming an ACO.

Clinical decision support is prominently featured in the draft definitions of Stage Two Meaningful Use criteria and to a lesser degree in the Stage One criteria that have already been published in final form. The Patient Protection and Affordable Care Act requires the practice of evidence based medicine. If you look at the language related to Patient Centered Medical Homes it requires what they call evidence informed medicine.

Clinical decision support is absolutely essential if you’re going to take a large organization of aligned physicians and hospitals and other health care providers and practice evidence based or evidence informed medicine while demonstrating improved clinical and financial outcomes. Deploying health care information technology without clinical decision support is unlikely to demonstrate significant either benefits.

Williams:            As you mentioned the ACO rules haven’t been completely laid out yet, but you do see this alignment that’s going on with hospitals and IDN’s with other affiliated organizations.  What are some of the challenges that they encounter when they’re working with these affiliations or alignments especially if they aren’t directly controlled? It seems like it would be that much harder when you’re actually trying to align with other entities.

Weingarten:            It is challenging.  We’ve seen some steps towards alignment with clinical integration initiatives that have been going on for some years. Aligning the clinical care between physicians in their office setting with the care in the hospital setting is certainly one challenge, but let me give you an example related to alignment through clinical decision support.

If you take a chronic illness such as heart failure, one day the patient may be seen in his physician’s office and then a week later it’s possible for this patient’s condition to worsen and require hospitalization. Hopefully the patient gets better quickly in the hospital and is discharged. Then two weeks after discharge the patient is seen back in his physician’s office.

If you look at Stage Two, the draft requirements include evidence based order sets.  You would like the evidence based order sets to be consistent between the ambulatory setting and the hospital setting.  It would be very confusing and potentially adversely impact patient care if the order sets for heart failure in the ambulatory setting and drug recommendations were significantly different than the recommendations in the hospital, and certainly the discharge order sets.

Williams:            You remind me of an article that I just read recently in Today’s Hospitalist. It reported on some research about difficulty coordinating inpatient and outpatient care for heart failure. When the patients come into the hospital, the doctors typically stop whatever medications they’ve been taking.  They put them on something else –often after a delay. When they’re discharged they’re not necessarily taking anything until they see their ambulatory physician, whenever that may be. Some of these issues could be resolved with consistent order sets, but you won’t have the whole picture until there are other kinds of alignment and coordination.

Weingarten:            That’s a wonderful example. Certainly as an ACO you’re going to be very focused on strategies to safely reduce hospital readmissions.  So care coordination and ensuring patients get the best possible care during transitions is absolutely essential. Everyone that’s familiar with the data on the very high rate of readmissions for heart failure can see that ensuring this consistency of care is critical, not only for succeeding as an ACO but more importantly for the patients. Certainly the last thing patients want is to be readmitted to the hospital because their condition worsens.

Williams:            The first draft of Meaningful Use requirements for Stage One included a fair amount on clinical decision support, but quite a bit of that has been pushed back now into Stage Two.  I’ve been reading recently that both hospitals and physicians are struggling just to get to Stage One of Meaningful Use. What’s your perspective? Do you think organizations are soon going to start giving up when they find out they’re not going to qualify for some of the incentive payments that perhaps they were hoping for?

Weingarten:            Good question. I believe there will be some organizations that are unable to demonstrate Meaningful Use in the required time frame. But I believe that a substantial number will be able to demonstrate Meaningful Use.

In fact I believe a larger number of providers than I originally envisioned will be able to demonstrate compliance with Stage One Meaningful Use criteria. So I am somewhat optimistic that a substantial number of hospitals and physicians will demonstrate compliance with Stage One in the necessary time frames. Certainly when I look at surveys in the field, many hospitals and physician groups are devoting substantial resources and attention to be able to demonstrate Meaningful Use. Many organizations are increasingly optimistic that they will succeed.

Williams:            Are there specific things that Zynx is doing to help your customers move along the path towards Meaningful Use and development of ACO’s?

Weingarten:            Yes. First, on Meaningful Use, Zynx has been very focused on clinical decision support, whether it’s alerts in Stage One or evidence based order sets for Stage Two as well as care plans and care coordination.  Zynx has quite focused for several years on components of clinical decision support that ended up in the Meaningful Use criteria.

As it relates to ACOs, Zynx has focused on the clinical processes that will improve quality and cost outcomes since the inception of Zynx in 1996. We’re highlighting those clinical processes that have been proven, based on the scientific literature, where you’re more likely to get physician, nursing and other health care provider acceptance to reduce mortality, to reduce readmissions, to safely reduce cost and to safely reduce length of stay.  I believe that improving all four of those outcomes will be absolutely essential as organizations prepare to become ACOs.

Furthermore we’re providing an assessment for an increasing number of our clients who have asked us to review their clinical decision support. That could be order sets, it could be plans of care, it could be alerts, it could be structured documentation to make sure they have fully baked in all of the clinical processes that will impact key outcomes.

Williams:            How are the Zynx order sets and clinical decision support rules developed? To what extent are they really evidence based?

Weingarten:            We carefully review the literature and have a systematic, reproducible process with a defined methodology that is similar to the evidence based practice centers of the Agency for Health Care Research and Quality. There is a systematic approach to including and excluding articles, grading the articles and expressing the information in the article.  This is a key part of Zynx clinical decision support, which has been refined based on feedback over the last 14 years. But with that being said not all of medicine is can be evidence based.

There are things that we do in health care that are more experience based.  An example might be for treating patients with community acquired pneumonia. There’s very good evidence related to which antibiotics will lead to the best outcomes but the evidence is not strong regarding whether the blood test, for example, should be ordered upon initial hospitalization.  Should a complete blood count be ordered?  What about electrolytes?  What about liver function tests?

There really isn’t good evidence to point a clinician one way or another.  We have client customized order sets and plans of care, in fact about 140,000 of them. We can review this information in an aggregate format and identify the best experiences related to those elements of care that cannot be evidence based.

Many of our order sets and plans of care may be on their 20^th iteration, 30^th iteration, 35^th iteration based on this assessment and evaluation of the information.  When an order sentence in an order set is evidence based we note it as being evidence based and include an evidence link to allow clinicians to rapidly access the evidence. When an item is informed by evidence we include the link but when it’s experience based we indicate that as well by not having an evidence link.

Williams:            Is it possible for your clients to calculate an actual return on investment for what you provide? If so –or even if not– as payment reform comes in and as ACOs are established will that become easier to do? Will the basis for the calculation change?

Weingarten:            There are a number of ways that our clients assess return on investment.  The first way is that we have these forecasters to calculate financial and clinical return on investment.

A hospital or physician organization looks at existing practice. Often they subscribe to a comparative clinical database; virtually all hospitals subscribe to one or another.  The information resides in those comparative clinical databases and then our customers plug in the information if certain improvements in care are made.

For example in patients with heart failure, if more patients were treated with certain medications –it might be ACE inhibitors, it might be ARBs, it might be beta blockers, it might be aldosterone antagonist– how many lives could be saved, how many readmissions could be avoided and how much cost could be saved? That’s one way that organizations project a clinical and financial return.

Another way is Zynx Measurement, a measurement framework where clients look at cost and quality outcome information before deploying certain order sets or plans of care or alerts and then afterwards. They look at differences and benefits. Many will compare that to a control population to try to isolate the impact of the clinical decision support versus any secular trends that might have been going on in the hospital. We’ve had a number of clients publish those findings in the peer reviewed medical literature. We also have a conference each year.  Last year we had over 300 attendees and a number of them report the impact on quality and clinical outcomes.

Williams:            I’ve been speaking today with Dr. Scott Weingarten, CEO of Zynx Health.  Scott thanks very much.

Weingarten:            Thank you David.

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I decided to issue a press release about my predictions for 2011.

MedPharma Partners’ David E. Williams: 2011 to Bring Health Care Transparency, Mobile Apps, Patient Safety and Reform Implementation

Health care strategy consultant, blogger and speaker David E. Williams leverages Twitter followers to forecast four main health care trends for 2011

BOSTON, Dec. 21, 2010 /PRNewswire/ — David E. Williams, co-founder of MedPharma Partners – http://www.mppllc.com – and author of the Health Business Blog – http://www.healthbusinessblog.com – predicts transparency, mobile health, patient safety and the implementation of health reform will be the big health care stories of 2011. The four predictions are based on his own insights and the views of his Twitter followers including prominent health care executives and entrepreneurs.

“The passage of the Affordable Care Act made 2010 a memorable year in health care, but 2011 is shaping up to be equally significant,” said Williams. “No one can master it all so I asked my Twitter followers -  – including AOL co-founder Steve Case, Beth Israel CEO Paul Levy, and Castlight Health CEO Giovanni Colella to help me think through what lies ahead.”

1. Transparency. The health care industry is tremendously opaque. Patients and doctors don’t know the price of medical services, while pharmaceutical and medical device makers maintain secret financial arrangements with physicians. That will change next year as employers and consumers embrace online price transparency tools, companies begin reporting payments to doctors, and WikiLeaks exposes questionable dealings in the pharmaceutical industry.

2. Information technology. Mobile health will enjoy strong growth as new apps, smartphones and tablets enable consumers to prevent and manage chronic diseases. Meanwhile, physicians, hospitals and vendors will continue to make slow, uneven strides on electronic health record implementation in the quest to meet Meaningful Use requirements that qualify them for federal stimulus funds.

3. Patient safety. Hospitals will make significant progress building a culture of patient safety, spurred by strong executive and clinician leadership and enabled by eLearning tools and simulation. FDA and patient demands for drug safety will be met by advanced analytic tools that help pharmaceutical companies demonstrate safety and efficacy without driving up drug development costs.

4. Health reform implementation. Republicans will attempt to obstruct health reform at the federal and state level but the rollout of the Accountable Care Act will proceed, if bumpily. By year-end, a general economic recovery will take hold, giving the Obama Administration greater leverage in the health care debate and momentum heading into the 2012 elections.

The full set of health care predictions for 2011, including quotes from Case, Levy, Colella and others, is available on the Health Business Blog.

About David E. Williams

David E. Williams has over 20 years of experience as a health care strategy consultant, blogger and public speaker.

He is co-founder of health care strategy consulting firm MedPharma Partners and author of the Health Business Blog, where he has written about health care business and policy every day since early 2005. He is Chairman of Advanced Practice Strategies and the Hearts & Noses Hospital Clown Troupe and a board member of iCardiac Technologies, Candescent Healing and the Center for the Evaluation of Value and Risk in Health.

He has acted as an instructor in MIT’s graduate-level Dynamics of Biomedical Technologies course in the Biomedical Enterprise Program and served on the Office of the National Coordinator for Health Information Technology’s Objective Review panels for Regional Health Information Technology Extension Centers and Beacon Community Programs.

Before MedPharma Partners he worked for ten years in the health care practice of the Boston Consulting Group (BCG) and as an independent consultant. He began his career at the LEK Partnership, where he was a strategy consultant and mergers and acquisitions advisor.

David holds a BA in Economics from Wesleyan University, where he was elected to Phi Beta Kappa, and an MBA from Harvard Business School, with First Year Honors.

About MedPharma Partners

MedPharma Partners LLC is a boutique strategy consulting firm serving clients in health care services, pharmaceuticals, biotech, and medical devices in North America, Europe and Asia. Clients range from Fortune 100 companies to start-ups.

The company was founded in 2003 and has offices in Boston, MA and Bridgewater, NJ. MedPharma Partners’ professionals have an average of 15 years of consulting and corporate experience.

SOURCE MedPharma Partners LLC

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