Budget Boutique Hospitals? Will The Search for Value Lead to Market-Segmentation in American Healthcare?

Years ago, a professor in a healthcare economics course introduced a healthcare adage: never forget, he said, that the way we pay for healthcare—through insurance premiums– distorts the consumer’s perception of value per dollar in healthcare. He meant that the insured pay into the system over time and are indemnified from sticker shock when it ...

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Medical Decisions by Gestalt. A Half-Trillion Dollar Bill and the Vexing Problem of Physician Practice Variation

It’s common that the same patient seeing two doctors for the same condition will walk away with conflicting recommendations. I recently spent time with a patient who had a bad back. One doctor had recommended a conservative approach (watch it, take ibuprofen, use ice) while another recommend an MRI and possibly an epidural steroid injection.

Getting the Doctor’s Skin in the Game: “Accountable” Healthcare… A Quick Primer– and What it Means For You.

The term “accountable healthcare” has been in the media a lot over the past few years. But what exactly is “accountable care” and what does it mean for you as a patient? In about 600 words, here is the short answer. Some background: Experts generally agree that US healthcare has become unaffordable  at a rapid rate. Health ...

Will Physician “Trust Platforms” Make System Affiliation Less Important? Considering Airbnb and Holiday Inn

In this week’s New York Times, columnist Thomas Friedman makes a great observation regarding the emergence of what he calls the “sharing economy.”  This is the peer-to-peer, internet enabled economy where ordinary citizens rent car trips and unused rooms.  It’s an area that has exploded in recent years, a trend fueled by the 80 million members of Generation Y– many who prefer ...

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Downed Airliners, the GM Debacle and the Real Danger of Groupthink in Large Organizations

The scenario plays out something like this:  an organization pulls together a team of people to work in a stressful environment.  The team coalesces and after some time a shared set of norms emerges. Everyone begins to do things the same way.  When narratives outside this shared experience emerge, the group closes its ears and marginalizes the outside ...

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A “Certificate of Not-Needed” Process: The Solution to Hospital Bed Surpluses?

Imagine that you were the “state administrator for hospitals” and were given the unenviable task of shuttering 30% of the hospital beds in your state.  How would you decide which beds to keep, and where?  Would you shutter a handful of hospitals entirely, or would you reduce capacity at every hospital across your state?  Would you be ...

Healthcare Mergers are the End of the Beginning: Some Lessons From the US Airline Business

There has been a lot of recent discussion about the value of large healthcare mergers, such as Partners ongoing acquisitions in the Boston area and the recent large merger between Baylor and Scott & White in Texas.  Supporters argue that these create better integration of care and economies of scale.  Opponents argue that these deals ultimately drive up costs, ...

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