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, ...

Swiss Flight 188, the Normalization of Deviance and a Better Way to Communicate: Lessons for Healthcare Leaders

I recently came across some captivating footage of a Swiss Airlines flight crew dealing with the unexpected loss of an engine.  Watch this- you won’t be able to take your eyes off this smooth, competent crew.  

Express Scripts Undoes Turing Pharmaceuticals: Witness the Rise of the “Activist” PBM

Everyone knows the recent story of “rapscallion” Martin Shkreli: the ethically depleted CEO of Turing Pharmaceuticals who bought the rights to Daraprim, a generic anti-parasitic medicine and marked up the price of a tablet from $13.50 to $750 overnight.   As disgusting as Shkreli’s story is–  the more important and interesting tale is how Turing was subsequently undone by ...

Administrative Bloat in Healthcare is a Land of Opportunity: On Direct to Consumer Price Transparency

I was recently connect with two smart entrepreneurs (James Millaway and Stan Schwartz, MD) who run a company called The Zero Card.  Their business is a platform where consumers and employers have access to transparent “cash” prices for a range of medical services.  Providers display their best non-insurance rates and offer a fixed price for an episode of care. Individuals (or ideally self-insured ...

Once A Sail, Now an Anchor: Medicare Incentive Programs are Making Safety-Net Hospitals Unaffordable

Here is an interesting exercise and an unfortunate lesson in the law of unexpected consequences: Pop Quiz: Your elderly Granny comes from overseas without insurance and suddenly needs her gallbladder taken out.  You call around the hospitals in town and they agree to extend to you the same rates as they would charge Medicare.  (This is hypothetical, of ...

Transitioning to Risk- Getting Over the Straddle

This week I gave a presentation on “transitioning to risk” at a great meeting with a large group of seasoned healthcare executives in Nebraska. One of the points I made was this:  it is important to remember that when transitioning to risk from fee-for-service, a healthcare organization has to expect a period of poor financial performance before the financial ...

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