Health Business Blog

My consulting firm is hiring. Please see job description below. Applications are accepted via email.

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Job Title:            Strategy Consultant

Reports to:         David Williams, Co-founder and Principal

Location:            Boston, MA

Status:                Full-time

Summary:

MedPharma Partners LLC is a boutique strategy consulting firm based in Boston, MA, serving the health care and life sciences sectors. Clients include large, medium and small companies and a variety of non-profit and multi-stakeholder organizations. The firm was founded in 2003 by senior professionals from The Boston Consulting Group, Deloitte, AT Kearney and LEK Consulting.

We are differentiated from competitors in multiple ways:

• Team members average many years of professional experience
• We span the business and non-profit sectors
• We work very closely with clients. For example, in some cases we even serve on their boards of directors
• We are advanced in our use of social media, including publishing the Health Business Blog every business day since 2005

As the firm continues its expansion we are recruiting a Strategy Consultant, who will work on client–facing and internal projects as a full member of our professional team.

Responsibilities:

• Member of 2-5 person MedPharma Partners client case teams; may be assigned to 2-3 teams simultaneously
• Primary and secondary data gathering –including market interviews and database searches
• Quantitative analysis –including statistical and financial modeling
• Preparation of presentations, including outlining, drafting and producing PowerPoint materials
• Research and writing on health care policy and business issues for the Health Business Blog and other publications
• Providing support for business development

Qualifications:

Educational

• Masters in Public Health, Masters in Business Administration or equivalent
• Strong academic record

Professional and technical

• Approximately 2-5 years of work experience, preferably in a professional services firm
• Passion for and knowledge of health care business and policy issues
• Facility with advanced features of Excel, Access, along with good knowledge of statistical methods
• Good knowledge of PowerPoint
• Strong writing skills

Personal characteristics

• Analytical mindset
• Tolerance for ambiguity
• Tenacity and perseverance
• Ability to work independently and as an effective team member
• Concise, efficient communication style
• Empathy for clients and colleagues with diverse backgrounds and mindsets
• Drive for excellence

Application process:

Candidates should email their resume and cover letter.

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Reducing readmissions is becoming increasingly important for hospitals. In the olden days (and still to some extent now) a readmission was simply a new opportunity to earn revenue on the same patient. But as payment models evolve toward refusing payment for preventable readmissions and as readmission rates are used as publicly reported quality measures, this is changing.

Today’s Hospitalist has a fascinating article on the topic: Think you can predict readmissions? Thing again; Doctors are clueless when it comes to guessing which patients will bounce back. It reports on a Journal of General Internal Medicine paper (Inability of Providers to Predict Unplanned Readmissions) that documents attempts to improve on readmission prediction models. The authors’ hypothesis was that physicians, case managers and nurses would take into account  a wider array of factors, e.g., socieconomics, health literacy, unmeasured clinical variables –compared with the fairly simplistic and modestly accurate algorithms in place today.

As the authors demonstrated, the experts were even worse than the model at predicting who would bounce back, and were completely useless in predicting the reasons that specific patients would be readmitted. The study brings to mind some interesting points:

• Since no one can tell who will be readmitted, programs that focus on patients that are supposedly high-risk are unlikely to be successful
• If no one can predict who’s coming back, perhaps the causes of readmission are not the specific patient’s situation but more systemic factors related to how the hospital is run
• At least in the institution profiled in the study, no one seems to be closing the loop on who’s readmitted and why. Therefore there is no learning opportunity for doctors, nurses, and case managers. I raised this point in my podcast interview yesterday with Paul Brient, who replied that PatientKeeper helps to address this problem

Perhaps the most important line in the whole paper is the following:

All groups underestimated the degree to which patients would be readmitted for adverse effects of therapy

From a patient perspective, this is a critical finding and reinforces my skepticism of clinical practice patterns in the US. Physicians hear so much about what works –often directly from drug or device companies and if not then indirectly– which tends to create a bias toward prescribing these therapies. When patients don’t follow their therapies the medical profession often couches the issue in terms of patient “compliance” or “adherence” whereas the problem may be the therapy rather than the patient. It would be very good for providers to get feedback on this topic, both at the level of specific patients as well as through broader studies.

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Hospitals and other providers that are planning to form Accountable Care Organizations (ACOs) must make sure to put a robust information infrastructure in place to enable them to manage patient care and expenses effectively. In this podcast interview, PatientKeeper CEO Paul Brient comments on the ACO draft regulations and discusses the interaction between ACO activities and Meaningful Use requirements for health information technology.

ACOs have many of the characteristics of the capitated provider organizations that emerged in the 1990s. And while many of them have fallen by the wayside, capitation has endured in some places, especially California, where groups such as HealthCare Partners use PatientKeeper tools in a capitated environment.

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David Williams interviews PatientKeeper CEO Paul Brient [ 16:24 ] Play Now | Play in Popup | Download

I’ve been a board member and financial supporter of the Hearts & Noses Hospital Clown Troupe for ten years, but always struggle to convey in words exactly what the troupe does and how special it is. The clown aspect people think they get, but it’s hard to explain how empowering the professionally trained, dedicated volunteers are to the thousands of children and families they serve. I’ve accompanied the clowns in the hospital so I understand it. I’m thankful that a donor has funded this wonderful video that lays it out for those who can’t see them in person.

To learn more, please visit the website or Facebook page and consider making a donation online.

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Political Calculations hosts a totally tabular edition of the Cavalcade of Risk blog carnival, the first time I’ve seen such a format. The blog has mitigated the risk of hard feelings by abandoning its post rating system, which must have caused some hard feelings among previous submitters.

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When I first hosted Grand Rounds six years ago, the iPhone, iPad and Twitter didn’t exist, and Facebook was not yet available to the general public. Barack Obama had not appeared on the scene and there was no discussion of the Affordable Care Act. Yet a lot of the topics in that edition would be familiar to today’s reader including firearms, RomneyCare, patient safety and Google. Two blogs (InsureBlog and Clinical Cases) that were featured in that early edition are featured here, too.

Patients first

The National Rifle Association has been flexing its muscles. The result: in Florida a new law restricts what physicians can discuss with patients about guns. Looks like someone skipped over the First Amendment in their haste to reach the Second. ACP Internist reports physicians are suing “to restore their ability to ask about guns in the home and counsel their patients to get rid of them.”

Where does the doctor’s responsibility end and the patient’s begin? Mind the Gap relates the sad story of his elderly mother, whose internist never bothered to tell her that her spine was fragile due to osteoarthritis. We don’t have all the facts here, but from where I sit the doc has some explaining to do.

Chronic illness can put marital vows to the test, as you can read in the various entries at In Sickness and In Health: A Place for Couples Dealing with Illness.  Read the thoughtful post on “how to claim your alone time without giving the impression you are rejecting your partner.”

Trudy Lieberman turns 65. Thankfully 20+ years of health care journalism prepare her to handle 4 deceptive practices used by Medicare Advantage and Medigap plans marketing to her: 1) the Trojan horse, 2) scare tactics, 3) the supposedly friendly advisor and 4) faux official documents. Journey to Moneyland for more.

A Healthy Piece of My Mind warns postmenopausal women to tread carefully in their quest to prevent breast cancer through pharmaceuticals. Side effects the medical profession considers “not serious” may be judged more significant by those experiencing them.

Speaking of drugs, Pfizer is trying a direct to consumer approach for trials of bladder-drug Detrol. The Blog That Ate Manhattan critiques specific elements of Pfizer’s approach, but is ultimately supportive of the idea of using the web to facilitate research.

As my father once told me, “surgeons like to cut.” They’re also not squeamish about showing images of open heart procedures to prospective aortic valve surgery patients. I give Columbia Surgery credit for being a lot more explicit about the situation than Mind the Gap’s doctor.

Wonks second

Health wonks must have caught the scent when it was announced I was hosting. How else to explain the cavalcade of quality policy posts?

My favorite is from Healthcare Recon, which analyzes Blue Shield of California’s decision to cap its profits. The most perceptive point comes last: BSC may be declaring a price war in order to enhance its long-term position in the individual market.

There’s a lot of whining about the draft rules for Accountable Care Organizations (ACOs). Goodness gracious, opines HealthBlawg. First, Marshfield Clinic, the prototypical ACO did just fine in the demo project. Second, ACOs aren’t the only way for providers to participate in health reform.

The Covert Rationing Blog is all hot and bothered about the government’s heavy handed attempt to take away our salt shakers. I’m a big-time fan of DrRich so I hope he’ll take it the right way when I say I think he’s been looking at a few too many black helicopters this week. Still it’s a good read and perhaps his opening reference to Mussolini is an allusion to the Roman Empire’s purported compensation policy for its armed forces and anticipates ACP Internist’s entry.

Pizaazz is seeking –but not finding– women in the health care IT world. He shares several theories and a dozen footnotes to flesh out the issue. Perhaps Judith Faulkner, founder and CEO of Epic, to my mind the most successful of all the health IT companies is too aloof or intimidating to inspire.

Colorado Health Insurance Insider would like to see Medicare include drugs under basic coverage rather than the separate Part D, but acknowledges some of the challenges.

InsureBlog explains why health plans and hospitals are in bed together to oppose California legislation that would stop “unreasonable” health insurance increases. I can’t be the only one who isn’t surprised by this alliance.

Technology third

An ER doc at Healthline reviews Superfocus glasses that give back the vision of his youth with a slider that allows him to adjust the shape of the flexible lenses. The only issue is when has to “break scrub” to move the slider. Still, he calls the product “remarkable.”

Prepared Patient explains Why Angry Birds Gets More Play Than Health Apps and offers developers pointers on creating apps for people with chronic conditions. One suggestion: test apps on older people with multiple chronic conditions who have the most to gain from them.

Diabetes Mine attracted over 100 entries to its 2011 Design Challenge. The best: Pancreum (a “wearable artificial pancreas”), BLOB (a portable insulin delivery device with its own coolant for warm climes), and diaPETIC (bringing elements of gaming to the diabetes world).

If you are one of the many who regard hospital websites as authoritative, responsible voices, then it’s time to wise up. At least when it comes to robotic surgery, hospitals seem to have abdicated their responsibility to educate by turning their web real estate over to the marketing departments of the robot makers. Gary Schwitzer’s HealthNewsReview Blog has the story.

Doctors next

Medaholic celebrates a Golden Weekend (i.e., the rare Saturday and Sunday with no work) then realizes that most people take this kind of thing for granted.

Time for docs to get those 10 e-prescriptions filed or face a Medicare “payment adjustment.” Manage My Practice has some tips for those who are struggling.

Allergy Notes reveals why asthma is not optimally controlled despite effective medications. The issue: overlooked comorbidities.

Medical Lessons teaches that while Niaspan may let you down in heart attack prevention, oatmeal, skim milk and fruit are still a good bet.

Happy Hospitalist confirms physicians are not above a bit of toilet humor, at least when nurses are involved.

If you haven’t had a chance to think about your use of hyperbole, exaggerations and dichotomous language lately, Will Meek, PhD from Vancouver will give you a chance. Ease up, fellow Bruins fans, he’s from the good Vancouver (in Washington) not the bad one up North.

Twitter’s last

Twitter is an interesting place to start a journal club, but the format has some serious limitations. Clinical Cases describes the first journal club on Twitter (going way back to 2008) while Laika’s MedLibLog informs us of a newer one.

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Shrink Rap hosts next week.

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Today’s Hospitalist (Ready to let patients hit the panic button?) describes the experience of St. Joseph’s Hospital in Orange, CA, which has implemented a “Condition H” (as in “Help”) system that allows patients and family members to activate the hospital’s rapid response team on their own as a last resort. Staff were concerned it would be overused for non-emergencies and by chronic complainers, but if anything there has been too little use. After three years, there have only been 70 Condition H calls at the 525 bed center. That equates to less than two per month for the whole hospital, or one call per bed every 22 years!

It’s a little hard to understand from the article why utilization is so low. The system has been well publicized, with posters in the halls, info in all admission packets, promotion on the hospital TV station and bilingual flyers in every room. And among the 70 calls are examples that seem to prove the relevance of the system: patients unable to reconcile conflicting advice from different clinicians, people who aren’t satisfied with their pain control, and others wondering about unexplained delays in care or testing. Those are all issues that come up frequently in hospitals, so to give the benefit of the doubt perhaps nurses and other staff are doing a great job responding to these issues and Condition H just isn’t needed. Or maybe just the existence of Condition H causes staff to be more responsive.

But it also seems that part of the challenge could be staff attitudes and vibes they give off about patients who use the system:

But patients and families aren’t the only ones who need regular education about the program. Ms. Bogert says that doctors, nurses and other providers have to learn that their concept of a crisis or emergency may not be the same as a patient’s. Nurses need to be reassured, for instance, that a patient’s call is not a direct criticism of them.

“Working in health care, our emergency factor is really high because we see so much,” says [program coordinator Soudi Bogert, RN. CCRN]. She reminds staff to respect how patients and families interpret the program. “You have to put yourselves in their shoes. In their eyes, it was an emergency.”

While Condition H team members as well as managers used to think some calls weren’t warranted, “in consistent debriefing, we discuss each event,” Ms. Bogert says. “The team has come to realize that each event is unique, as is each caller.”

The line “nurses need to be reassured, for instance, that a patient’s call is not a direct criticism of them,” caught my eye. I’ll bet plenty of patients are worried about retribution from angry nurses if they reach for Condition H.

I like the concept of Condition H, but the low level of utilization makes me skeptical of its value. If I were a hospital I would think twice before emulating this system.

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I’m amazed at just how quickly physician employment has swung from small independent practices to hospital-based employment. I’ve heard about it anecdotally from medical societies and malpractice carriers who are seeing their constituents shift, and have certainly observed the shift from individual physicians, but I’m still surprised how fast it’s occurring. A new report from recruiter Merritt Hawkins tells the clearest story I’ve seen:

• In the last 12 months, 56% of physician search assignments have been for hospital jobs, whereas 5 years ago it was just 23%
• Just 2% of assignments were for independent, solo practice docs compared with 17% 5 years ago

Doctors are becoming more like regular wage earners, albeit high paid ones. There are some strong drivers of this trend including the need to support health information technology, comply with regulations and deal with health plans. There’s also a desire on the part of a younger, increasingly female physician workforce to have a better balance between work and home life. If anything the forces pulling physicians into hospital employment will strengthen in the near term with the arrival of Accountable Care Organizations and other forms of deep integration.

Yet when a pendulum swings it tends to swing too far. Especially considering how quickly things have moved, I do expect that there will be some backlash to the rush into employment. It’s really not all that much fun having a boss, especially when that boss is a big, bureaucratic hospital with other things on its priority list besides MD satisfaction and career development. Patients may not like it so much either. I know I’d rather see a physician who’s not too tightly tied to a hospital.

So what will the reversal look like? I don’t think it’s going to be doctors rushing to put up their own shingles or buy practices of retiring docs like in the old days. Instead I expect to see a new breed of physician employers who recognize what’s needed to make docs happy, treat patients well, manage compliance, and still make money. One example is so-called direct primary care practices such as Qliance. Time will tell what other forms develop.

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OrganizedWisdom has announced Startup Health, a strategic initiative to help health and wellness entrepreneurs tap into capital, education, mentorship and other resources to develop sustainable new companies. Startup Health will be chaired by Jerry Levin, former chairman and CEO of Time Warner Inc. The organization is joining the White House’s Startup America Partnership, which is designed to spur entrepreneurship.

In this podcast, OrganizedWisdom CEO Steve Krein explains the initiative and asks all who are interested to visit Startup Health in order to “take the pledge,” which involves committing to support of the startup ecosystem and providing name, email and specifying the type of stakeholder you are, e.g., entrepreneur, investor, journalist.

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David Williams interviews OrganizedWisdom's Steve Krein [ 11:37 ] Play Now | Play in Popup | Download

Check out the latest edition of the Health Wonk Review at the Health Care Blog.

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