Health Wonk Review is up at InsureBlog

Check out the latest edition of the Health Wonk Review at InsureBlog, where Hank Stern is our able host.


Clinical registry solution market heads toward $2 billion


Specialty medical societies such as the American College of Cardiology and American College of Surgeons sponsor clinical registries that collect observational data on patients with specific conditions or procedures, such as heart failure or joint replacement. This “real world” evidence helps hospitals improve quality of care, meet state and federal reporting requirements, and achieve pay-for-performance bonuses.

Q-Centrix, which provides technology and services that enable hospitals to participate in registries, commissioned Health Business Group to conduct a market sizing and growth study. We found that the market will reach almost $2 billion over the next five years. Q-Centrix is offering a complimentary download of the findings.

Clinical registries have been around for decades, but in recent years they have become central to achieving quality in healthcare delivery. Registries have proved their superiority over other approaches such as electronic medical records and traditional clinical trials, and are being embraced by accrediting organizations, commercial health plans and federal agencies such as FDA and CDC.

Hospitals continue to gain experience with registries and are deriving more and more value from them over time. However, in a digital, automated world, participating in registries is still a remarkably manual and time consuming process. Each patient record for the registry must be “abstracted” according to the specific requirements of that registry and then submitted securely and accurately. Some registries provide software tools to help, but even then the tool is only useful for a specific registry. That’s cumbersome for hospitals that participate in multiple registries, a big issue since hospitals often participate in 10 or more.

Hospitals have rationalized other manual, labor intensive administrative processes by outsourcing. Medical transcription is a good example, where the use of outsourcing and automation are now the norm.  The same approach is being taken in the registry world, which is why companies such as Q-Centrix are thriving.

At Health Business Group, we were excited to conduct research into this dynamic and growing market, especially since there was very little information published about the topic. To formulate our projections we reviewed secondary data sources, leveraged the Health Business Group knowledge base, and conducted interviews with dozens of hospitals, specialty societies, market experts, and industry participants. We also fielded an online survey of hospitals to develop a detailed understanding of industry trends and their root causes.

Health Business Group specializes in the assessment of healthcare markets and development of growth and M&A strategies for healthcare companies and investors. To learn more, contact us or visit our website.

By healthcare business consultant David E. Williams, president of Health Business Group.


Nutrition for cancer patients: Podcast interview with Savor CEO Susan Bratton

Susan Bratton

Savor Health CEO, Susan Bratton

Nutrition is important for everyone, but for cancer patients it’s especially critical. Many cancer patients struggle with appetite and weight loss; nutrition challenges affect patients’ ability to tolerate treatment and contribute to mortality.

Savor Health provides oncology-related nutritional solutions. I spoke with founder and CEO Susan Bratton to learn more.

  • (0:14) Why is nutrition so important for cancer patients?
  • (1:30) How common is malnutrition among cancer patients?
  • (2:12) How well understood is this problem? Is awareness increasing?
  • (5:24) Do patients understand just how serious the consequences of malnutrition are, beyond a general awareness of the importance of nutrition?
  • (6:32) How do nutritional issues vary by type of cancer?
  • (9:35) How did you become interested in this field?
  • (12:13) What are some of the approaches being used to address nutrition among cancer patients?
  • (14:15) Is there an overlap between nutritional counseling and behavioral health? Is depression taken into account?
  • (15:16) What does Savor Health do?
  • (19:30) How will the company evolve?

By healthcare business consultant David E. Williams, president of Health Business Group.

Single payer debate heats up: Don’t say I didn’t warn you


Why is single payer popping up now?

The Affordable Care Act (aka Obamacare) was a sincere attempt by Democrats to write a bipartisan bill that would attract the support of moderate Republicans. It preserved the employer-based system of private insurance, added market-based approaches such as the insurance exchanges, and enforced personal responsibility through the individual mandate. The Republican leadership made a political decision to attack the bill rather than to support it, and the GOP-led Congress and now a GOP-led Administration have tried their best to undermine the law by spreading misinformation (death panels, government takeovers), defunding key aspects such as the risk corridors, and creating uncertainty (e.g., not committing to funding cost-sharing reductions). States have done their part by suing over the law’s constitutionality.

I’ve warned since 2014 that if Obamacare fails or is repealed it will make single payer more likely. (See If Obamacare fails are we on to single payer? and One more way Obamacare may lead to single payer and Goodbye Obamacare? More like hello single payer!)

Suddenly the political ground is shifting as leading Democrats embrace single payer. The Washington Post (The dam is breaking on Democrats’ embrace of single-payer) reports that there are four co-sponsors of a single-payer bill in the Senate. Max Baucus, former chairman of the Senate Finance Committee and an Obamacare architect, has also come out in favor –something that was unfathomable until recently.

There a few reasons this is happening right now:

  • After seven years of shouting “repeal and replace” Republicans have revealed that they actually don’t have a plan for addressing problems in the healthcare system and that their real intention is to cut Medicaid and throw millions off of coverage
  • President Trump has called Republicans on their subterfuge, so now everyone is aware that there never was a plan
  • Experience with the Affordable Care Act has changed the conversation. For example, no one wants to go back to worrying about whether pre-existing conditions will keep them from getting coverage or that they’ll hit an annual or lifetime cap on benefits

Most importantly from a political standpoint, Democrats realize that the complexity of the ACA –which was needed in order to keep it a moderate bill that built on the complexity of the existing system– has worked against them. I’m a healthcare expert and I don’t understand every aspect of Obamacare. How can the average citizen be expected to do so?

“Medicare for All” is a simple and powerful rallying cry. Everyone knows what Medicare is. Those who have Medicare like it and want to keep it. There is no stigma attached to it. Unlike the ACA, a Medicare for All bill could be simple and elegant. And it wouldn’t require an individual mandate to function.

The health wonk in me says that Medicaid would actually be a much better vehicle for universal coverage than Medicare. (See Could Medicaid for all be the answer?) It would do a better job of bending the cost curve and addressing drug pricing, and would give the states more freedom to innovate. But it might be less appealing politically.

Those who want to preserve capitalism and private innovation in healthcare –and I put myself in that category– should embrace the Affordable Care Act and look for ways to improve it. The alternative is to fight a rear guard action against single payer.

By healthcare business consultant David E. Williams, president of Health Business Group.


Natural Language Processing: Podcast with Wired Informatics


Murali Minnah, co-founder and chief strategy officer of Wired Informatics

Natural language processing (NLP) is a fascinating segment of Artificial Intelligence that draws on a variety of emerging scientific fields.   Wired Informatics is developing and commercializing NLP within the healthcare industry.

I met co-founder and chief strategy officer, Murali Minnah last year and we have been exploring  applications for NLP within Health Business Group’s client base. I admire the company and its approach, so asked Murali to share his insights in this podcast:

  • (0:11) You are involved with a lot of the hot buzzwords: big data, natural language processing, and machine learning. What do those words actually mean to you?
  • (4:59) Are there aspects of healthcare that lend themselves well to natural language processing?
  • (7:18) How well does NLP actually work today? What’s the trajectory for its development?
  • (8:42) How do you work with a technology that is good and improving but not perfect? In healthcare it seems we’d be concerned about something that isn’t perfectly accurate.
  • (10:59) If you do get to 100 percent accuracy, how do you contend with problems in the underlying data?
  • (12:50) You mentioned operational use cases as the first places to start. What are some of the most compelling use cases today and down the road?
  • (15:35) Where is your company getting traction? What use cases? What customers?

By healthcare business consultant David E. Williams, president of Health Business Group.

Hospice: Another sad sector of the opioid crisis


Help yourself?

A person addicted to drugs might do anything to get their hands on the next dose. Whether that means ‘borrowing’ painkillers from a relative who had their wisdom teeth extracted, breaking into cars to grab small bills and coins, or stealing their mother’s jewelry –all things I’ve seen myself– there are no real limits. So I was saddened but not surprised to read Dying At Home In An Opioid Crisis: Hospices Grapple With Stolen Meds, which highlights the trouble dying patients face in keeping hold of their painkillers.

The Kaiser Health News examples are only anecdotal, but the combination of high quantities of opioids and homebound patients unable to fend for themselves is an ideal setting for diversion. The problem is two-fold: theft of drugs while the patient is alive, and diversion once the patient passes away. Since many patients die within days or weeks of beginning hospice, the second problem is a major one.

The examples offered in the article are heartbreaking:

  • In Mobile, Ala., a hospice nurse found a man at home in tears, holding his abdomen, complaining of pain at the top of a 10-point scale. The patient was dying of cancer, and his neighbors were stealing his opioid painkillers, day after day.

  • In Monroe, Mich., parents kept “losing” medications for a child dying at home of brain cancer, including a bottle of the painkiller methadone.

  • In Clinton, Mo., a woman at home on hospice began vomiting from anxiety from a tense family conflict: Her son had to physically fight off her daughter, who was stealing her medications. Her son implored the hospice to move his mom to a nursing home to escape the situation.

Some hospices are trying to do something about the problem, but it’s not easy. After all, their primary goal is to ease the pain of dying patients. It’s not really their job to keep track of and control everyone else. Some of the ideas being tried include:

  • Screening families for a history of drug addiction
  • Limiting the amount of meds delivered at any one time
  • Drafting agreements with families about consequences for drugs that disappear
  • Encouraging the destruction and disposal of drugs after the patient dies

None of these approaches is likely to succeed on its own. The country will have to address the broader opioid crisis in order to bring this part of it under control. However, there are a couple additional steps that could be taken now:

  • A few states let hospice employees destroy drugs once a patient dies. That should be expanded nationwide and made mandatory. There is no conflict here with the patient’s needs
  • Some patients, who would otherwise be eligible for home hospice, should be moved to facilities such as nursing homes, where controls can be tighter. (Much as I hate to argue against home care this needs to be part of the discussion)

By healthcare business consultant David E. Williams, president of Health Business Group.