Collaboration Station

Where CMI, Compas, Singularity, InfoCures, & MEDtrak Come Together!

The Scoop – Provider & Payer Consolidation | Docs & YouTube | Bikinis & Insulin Pumps July 21, 2014

Filed under: Corporate — CMI/Compas @ 4:13 pm

VP Interactive Marketing Marketing Taryn Tarantino and Manager, Strategic Marketing & Corporate Communications Amanda Kopec Preto attended “A Tale of Two Cities: Wharton Professor Discussion on Provider & Payer Consolidation” and below are their combined takeaways:
This lecture discussed the healthcare landscape in Boston, with their dominant provider community, called PartnersHealth, taking the leadership role, compared to Philadelphia, where the payer community takes charge. Interesting to note was the teaching aspect of these healthcare cities, with Harvard in Boston having much more clout than Penn.

While Massachusetts, with the first government-legislated healthcare (also known as RomneyCare), has nearly complete access to healthcare, the cost is significantly higher than anywhere in the country, and the extensive Partners health system is the most costly. Because PartnersHealth owns the two biggest hospitals in Boston, Brigham Women’s Hospital and Mass General, along with many community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health related services, they can dictate the cost of their services, and payers (and patients) have to comply.

In Philadelphia, the situation is similar, however it is the payers, mostly Independence Blue Cross, that control what is paid to the providers. In Philadelphia, there is a trend that will put a premium on co-pays for access to “elite” hospitals (for example, $500 per stay at Penn vs. $100 per stay at a lower-tier community hospital).

While consolidation may be more profitable for the providers and payers, there seems to be little benefit to patients. There are no increased efficiencies or reduced costs. There is no easy or consistent way to measure improved health. And access is often diminished since smaller community hospitals in poorer areas are quickly disappearing due to bankruptcy. “Adam Smith was right,” one of the speakers said. “Competition lowers cost, spurs innovation, and encourages growth.”

The government is monitoring the consolidation trend for potential anti-trust issues. However, these cases are very hard to prove. Ultimately with the healthcare landscape undergoing radical shifts due to the Affordable Care Act and the rise of Accountable Care Organizations, this consolidation trend is one more to keep an eye on.

The key lesson is this: We are trying to find the balance within our healthcare system. The belief exists that consolidations will provide better options for consumers, and ACOs are continuing to encourage mergers, but we are not yet seeing any real efficiencies or better pricing, nor are we able to really define what is “quality” care. And the “trillion dollar question” remains: what will this mean for pharma?

Media story of the day: an essay by a primary care doc may have you sitting up in your chair as you plan your next NPP approach. He uses a YouTube video created by another doctor to help drive home the importance of a key treatment option to his patients. Docs aren’t just digital, they’re multi-media!

Type 1 Diabetic Sierra Sandison made international headlines this weekend as she wore her insulin pump while competing as Miss Idaho in the swimsuit competition portion of Miss America. More can be seen by searching #ShowMeYourPump.

The first wearable EHR, Drchrono (mentioned in Scoop last month), has launched. It is an app developed for Google Glass that also utilizes document storage tool Box. (Thanks to Alya Sherman, SVP Alliance Management, for this story.)

AIDS researchers and activists are mourning 6 colleagues who died aboard Malaysia Airlines flight 17 en route to an international AIDS conference.

A new law in Missouri will allow med school graduates to act as assistant physicians to help underserved areas.

-Carly Kuper, VP, Strategic Marketing & Corporate Communications
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