Category: Integrated Healthcare Delivery Networks

On the “Bay State Boondoggle”

The Boston Globe recently ran an article discussing layoffs at Baystate Health, a large health system in Western Massachusetts.  The system is planing to lay off 300 employees to try to close a $75M deficit.  According to the Globe, the deficits are mainly driven by declining Medicaid reimbursement, but, more interestingly, by a $23M hit to Medicare revenue ...

How Big is too Big? On “Diseconomies” in Large Healthcare

With healthcare mergers now announced seemingly every week, I’ve been giving some thought to scale:  How big can/ should health systems be?   Anecdotally, I’m struck that the most impressive healthcare companies in America are super- regional players:  Geissinger, Cleveland Clinic, UPMC, etc.  They seem to get a lot more attention than the national players with hundreds of facilities. ...

Consolidating Surgery: Another Example of Balancing Population-Level Improvements with Poignant Individual Loss

In healthcare quality circles it’s become a truism that high surgical volume is linked to improved outcomes.  If you want to have the best surgical result, the thought goes, find the surgeon who has done the most cases like yours… Harvard’s Ashish Jha outlines the case in a recent JAMA Forum: We have always known that volume ...

Healthcare’s Friendly Societies: What Would a Healthcare Mutual Look Like?

For a few years I’ve been fantasizing about what a healthcare insurance/ delivery mutual would look like.  I’ve yet to see one but I like the idea a lot. Here’s the idea behind a mutual:  A mutual structure means that the company is owned by its clients or policyholders.  Since a mutual’s customers are also its owners, ...

Humanizing the Healthcare Machine: On Not Getting Lost in the Warehouse

One summer afternoon, when I was eight or nine, I impulsively chose to ride my bike down a steep hill near my childhood home.   From the top of the hill my bike accelerated at a frightening rate and I remember for brief moments somehow being airborne before landing in a pile of bent metal and bloody asphalt.  My adventure ended with ...

Pricing Risk: What Margin Should Risk-Bearing Healthsystems Reasonably Expect?

There is an old adage in the business world: reward follows risk. In other words, in an ideal market, investors are supposed to balance the potential returns of an investment against the possibility that they’ll lose their money. I’ve thinking a lot about risk recently as our organization came to the end of our budget ...

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Consumers are Linking Budget Airline Itineraries: Will They “Virtual Interline” Medical Services Too?

A few weeks ago, WOW Air, an Icelandic budget airline, announced that they would be flying Boston-Reykjavik at an introductory fare of $99.  Despite the growth of budget airlines in both Europe and the US, WOW is apparently the first airline to try to make a margin on trans-Atlantic routes. WOW argues that smaller planes (made possible ...