Tag: Cost

On the Tragedy of the Commons: the Toxic Effects of Drug Co-Pay Coupons

Last week I was driving through Phoenix when I saw this sign at an intersection: It struck me that this was a perfect example of what happens when clever business folks figure out a way to short circuit the normal laws of consumer behavior.    How’s it work?  Bring your car in and the glass shop bills ...

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 ...

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 ...

On Getting Burned by Population Health Thinking: (Why has a Decade of Intervention not Prevented More Deaths From Brain Aneurysms?)

In our house we take a lot of fizzy vitamin C to prevent colds in the winter. As doctors, my wife and I both know that science doesn’t support our decision… We take it anyway. We shouldn’t. After all, the well respected Cochrane group (which grades and distills multiple studies into a single “meta-analysis”) clearly ...

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Academic Medical Centers Are Under Siege. Is the Best Strategy to Go Small or to Go Big and Own the Continuum?

The university hospital at my alma mater recently announced an intriguing deal. Jefferson University Hospital, around since 1825, signed a deal with an upstart company called American Well to provide “virtual ED” visits to patients who would otherwise have come to the hospital’s emergency department. A recent article in Becker’s noted: The American Well technology will ...

Squeeze the Consumer or Squeeze the Prescriber? Conflicting Ideologies and the Rise of High Deductible Health Plans

If you were designing a program to lower healthcare costs, would you direct your efforts at the medical consumer, or the medical prescriber?  Do you create a system where an informed and empowered consumer drives the market, or one which regulates providers and holds them accountable for the services they deliver? The answer, I think, would depend on ...

Another Domino Starting to Fall- The Narrowing of Physician Networks

In previous posts, I’ve discussed the inevitable squeeze that high cost/ low quality physicians will feel from payers as the system becomes more discriminating about paying more “reasonable” rates and only for performance. There now seems to be evidence that we are seeing the largest health insurers get tough by trimming their networks of the physician value ...