“Three corporate behemoths — Amazon, Berkshire Hathaway and JPMorgan Chase — announced…that they would form an independent health care company for their employees in the United States.
The alliance was a sign of just how frustrated American businesses are with the state of the nation’s health care system and the rapidly spiraling cost of medical treatment. It also caused further turmoil in an industry reeling from attempts by new players to attack a notoriously inefficient, intractable web of doctors, hospitals, insurers and pharmaceutical companies.
It was unclear how extensively the three partners would overhaul their employees’ existing health coverage — whether they would simply help workers find a local doctor, steer employees to online medical advice or use their muscle to negotiate lower prices for drugs and procedures. While the alliance will apply only to their employees, these corporations are so closely watched that whatever successes they have could become models for other businesses.” (A)

“The companies said their project will focus on technology that provides simplified and transparent care. Based on the executives who have been named to top roles at the new company, Jefferies & Co. analyst Brian Tanquilut said there is a good chance it will eventually try to negotiate prices directly with health care providers like hospitals, bypassing companies that act as middlemen. That could reduce costs in the medical and pharmaceutical supply chains.
“The initial plan for the new entity will be on partnering with and/or acquiring various consumer-orientated health care technology capabilities (i.e. a venture capital strategy) and eventually using them to influence and incentivize health care cost-reducing behavior,” he said, basing his speculation on the executives picked to shepherd the new company along.” (B)

“Techno-utopian visions of algorithm-driven health-care apps and artificial medical intelligence robots aside, the most important components of the still-theoretical project are actually deeply rooted in the history of health care, both in the United States and around the world. This history illustrates the potential promise of the new initiative: It might provide cheaper, better care for all Americans while facing fewer political hurdles and requiring fewer jarring changes to the system.
Notably light on details, the announcement offered two specific components beyond its emphasis on technology. (Amazon chief executive Jeffrey P. Bezos also owns The Washington Post.) First, the new company would be “free from profit-making incentives and constraints.” Second, the overall goal would be “improving employee satisfaction and reducing costs.”
This first component is the more newsworthy one, as well as the one most likely to revolutionize American health care. Abandoning the profit motive in health insurance would be a notable break — by three of America’s leading companies no less — from nearly a half-century of corporate and conservative ideology that has maintained that free-market profit incentives are the best means of achieving efficiency and cost reductions in health care (and most other economic spheres).” (C)

“Clearly the cost of care has produced a tipping point. It might be just becoming too much—costs are so onerous and unsustainable that they can’t look the other way,” Gartner analyst Barry Runyon said. “We can’t afford healthcare. Normal middle-class people go into bankruptcy with one bad illness.”
Experts agree that the accelerated attempts to disrupt the industry by slashing costs are noble and innovative. But they disagree as to whether the companies—be it Amazon and friends or CVS and Aetna—can succeed in influencing healthcare pricing.
While acknowledging that costs need to be reined in, healthcare leaders point to larger societal problems that often end up on their front doors and have a ripple effect across the system.
“It’s important to keep in mind that the bulk of healthcare problems—and costs—stem from lifestyle behaviors and social circumstances,” Michael Dowling, CEO of Northwell Health, said in an email responding to questions about the Amazon-JPMorgan-Berkshire venture. “I would like to see some of these companies go into poor neighborhoods and try to figure out how to address health issues stemming from poverty, lack of jobs and all the negative social circumstances that contribute to chronic illness, substance abuse and health disparities in this country. That’s the biggest challenge. ” “ (D)

“Those who’ve been engaged in the struggle to find the true cost of healthcare have been working for years with limited success. Oftentimes, they have difficulty getting data from health plans or medical care providers.
“Resistance to transparency in healthcare remains high,” says Network for Regional Healthcare Improvement CEO Elizabeth Mitchell, who welcomes Amazon, Berkshire and JPMorgan’s new company. “Employers who pay for this care still don’t have insight into the relative value of what they are buying. They are looking for a way to have assurance that they are paying a fair price for a high-quality service.”
The Network for Regional Healthcare Improvement has long said any health reform effort needs to look closely at transparency because data that reveals the total and true cost of care is difficult to find. In a report last year, NRHI said health spending by U.S. commercial insurers can vary by $1,000 or more per year per patient, depending on where enrollees live.
The potential for the Amazon-Berkshire healthcare company to disrupt the way health plans do business is one reason shares of many healthcare companies tumbled Tuesday after the partnership was announced.” (E)

“The U.S. health care industry might be seeing the early signs of major shifts such as employers exerting pricing power to rein in costs; the aggressive use of technology such as drones and databases to predict, diagnose and treat diseases; and, consequently, an upending of the bargaining power of providers such as hospitals, physicians and pharmaceutical companies. All those and more are expected to come from a health care alliance announced last week by three heavyweights – Amazon, Berkshire Hathaway and JPMorgan Chase, led by their respective CEOs, Jeff Bezos, Warren Buffett and Jamie Dimon.
“They are acting as customers of health care on behalf of their employees and they are saying, ‘We finally have to get our act together and do something serious,’” said Robert Field, Wharton lecturer in health care management who is also professor of health management and policy at Drexel University. “[However,] the big question is: Will they develop something that’s scalable and transportable? If not, they will undoubtedly accomplish great things for their employees. But it will pretty much stop at that.”
Field predicted the alliance will use technology to dramatically change the way health care is delivered. “This is going to move us closer to more technologically focused health care, from drones dropping our prescriptions at our door to artificial intelligence algorithms spotting disease trends and large databases helping to diagnose you and treat you,” he said. “We’re going to lose the personal touch in health care, but perhaps we need to be going in this direction. We don’t have the corner bookshop the way we used to, and we don’t have a corner pharmacy the way we used to. Health care is going to go there one way or another.”
Wharton management professor John R. Kimberly said he wasn’t sure if the new company the trio plans to set up would be successful in lowering health care costs. “In theory, it could potentially [lower costs and improve access] for their employees,” he said. “[But] in practice, [those effects are] not so clear, even for their employees.” The three companies have a combined workforce of a million employees.
According to Kimberly, the big question is the likely impact on the larger health care industry. He identified at least two avenues of potential impact. “First is the impact of whatever models/arrangements the troika is able to develop, implement and spread to the larger market. Second is the kinds of second- and third- order effects the troika might have on the industry as a whole.” (F)

“This latest move has engendered robust debate. Proponents liberally term it “disruptive,” seeing a natural diversification opportunity for the company that has aspired to be “earth’s most customer-centric company.” Meanwhile, skeptics highlight Amazon’s lack of expertise in health care, a sector that many deem curiously resistant to the competitive forces that characterize the retail and web services markets in which Amazon has thrived. Given this state of affairs, it is worth thinking about Amazon’s efforts in a conditional manner: If Amazon succeeds in changing health care, how might it do so? (Disclosure: I own a very small number of Amazon shares.)
While Amazon’s collaboration with Berkshire Hathaway and JP Morgan Chase would obviously leverage the purchasing power of three massive employers and could lead to innovative insurance models, it seems that the bigger opportunity would be in improving how care is delivered to patients. At its root, health care is a service that needs to be delivered to a customer. For existing health care companies, the operative words in that mandate have been “health care”; for Amazon, the operative words likely are “service that needs to be delivered to a customer.” To the extent that Amazon’s perspective is correct, it is worth considering the types of experience the company could apply to health care.” (G)

“One viewpoint, published yesterday by Harvard Business School professor Robert Huckman, explored ways Amazon’s strengths might help it become a health care power. You can read Huckman’s essay in full on the Harvard Business Review’s site; here’s a summary of some of his points:
• The company that brought you one-click ordering could streamline health care processes too, bringing its reach and focus on convenience to the marketplace: Its “expertise could be used to improve health care delivery by addressing the administrative hassle and scheduling challenges faced by patients seeking routine services in a one-stop setting,” he wrote.
• Its work on frictionless commerce could greatly reduce overhead in an industry known for massive and complex data entry requirements. Some hospitals, Huckman noted, are already investing real-time patient tracking that could give them useful information about patients.
“These pieces of information, all of which are collected by the simple movement of people and equipment through established workflows, can be helpful in improving operational execution for the complex services provided in many health care settings,” wrote Huckman.
• Amazon already knows a ton about consumer purchasing decisions. Could it turn its analytical expertise to patient information? It might, for example, plumb a “wealth of integrated data that links an individual’s medical record with their overall purchasing patterns, genetic information (particularly if Amazon eventually does blood draws in convenient settings), and activity patterns,” he wrote.” (H)

“With all of its technology and unique advancements, the United States sucks at healthcare. The real problem with Obamacare is that it does not fix the “suck” part or the cost part — it just shifts where the bill goes.
So, a whole bunch of U.S. citizens, myself included, now are paying more and getting less coverage. That is neither any way to get re-elected nor any way to run a country. Typically screwing your constituents does not work well for elections, and that played a much bigger role in the last election than most realize (or want to admit).
I think Jeff Bezos gets this — it’s not rocket science. He likely understands that if the government really is not going to step up (it still is arguing over who pays, not the amount on the bill) then a heavy-hitting corporation must.
Amazon has the reach and capability to reduce healthcare costs massively through better records management; implementation of aggressive artificial intelligence-based diagnoses or diagnosis validation; ability to negotiate better drug prices; scalable AI-based patent monitoring; and policies that could address abuses, such as the overuse of painkillers, more effectively.
Individual benefits would include better and more comprehensive access to medical records; programmatic analysis of those records, triggering proactive medical procedures; more aggressive health monitoring; and far broader access to emerging medical technology and drugs.
Amazon has the capability both to lower healthcare costs and raise performance, so that Americans no longer would be paying the most for healthcare while being outranked in performance by 72 countries whose citizens pay less, often far less.” (I)

“A new report from the financial research firm Leerink, which has been closely covering Amazon’s moves in health care, says Amazon is expanding the team that’s exploring a move into the pharmacy business.
Researchers at Leerink interviewed an anonymous former senior Amazon employee, who described an exploratory team at Amazon that was once 7 to 8 people, and is now 30 to 40.
The goal appears to be to ensure its customers stay loyal and that all their needs, including health and medical, are serviced on Amazon.com.
Amazon’s entry into the pharmaceutical business seems inevitable to many in the health sector, particularly in light of the $3 billion market opportunity, and Leerink thinks it’s a matter of “when,” not “if.”
“Ultimately, Amazon is looking to bolster its Prime membership program, which by signing up for a subscription provides customers with benefits including free shipping, expedited delivery, and other perks,” the report states.
“Amazon saw the inclusion of pharmaceutical drugs as a natural add-on to its existing product offerings.”
Amazon CEO Jeff Bezos has eyed the pharmacy business for years, dating back to an investment in the startup Drugstore.com in the 1990s. That business was eventually acquired by Walgreens, and later shuttered.
“The specialist indicated that Amazon’s decision to enter pharmacy has been in the works for some time,” the report reads.
As CNBC has reported, Amazon has been busy in the last year meeting with folks across the industry, including generic drug makers, to figure out how it can break into the space.
The consumables team, led by Eric French, initially kicked off the research process. That team also includes the company’s groceries product. In May, the company started interviewing for a pharmacy general manager to lead the team, and it has been looking to recruit health experts for months — most recently, a health privacy lead. Amazon held exploratory talks in November with generic-drug makers like Sandoz and Mylan.” (J)

“While it appears Amazon’s plans to create a healthcare company aren’t fully formed, the use of data and digital tools are two likely priorities moving forward, according a Wall Street Journal report.
The news outlet obtained a document from December that outlined an initial proposal for a joint venture between Amazon, JPMorgan Chase and Berkshire Hathaway that was officially announced by the three companies on Tuesday. Although industry experts speculate the new business would take over health insurance and pharmacy benefits for employees of those companies, one source told the Wall Street Journal that idea is no longer on the table.
But the document does spell out a clear interest in data and new digital health gadgets. Part of the plan includes an initiative to create a healthcare data warehouse. The companies also want to partner with healthcare systems to use technology to care for patients outside of the hospital, along with digital tools that facilitate data sharing.
Those aren’t particularly innovative concepts in the healthcare world. Telemedicine adoption is on the rise and health systems are already investing in digital tools to streamline patient care. But Amazon’s market power, combined with its tech prowess, could be a driving force for more widespread adoption—similar to the way Apple’s foray into medical records is viewed by some as a sea change for better patient access to health data.
Greg Caressi, transformational health senior vice president at Frost & Sullivan, sees this as an initial step that could lead to broader participation in the healthcare market.
“Companies who are financially responsible for their employee’s healthcare and need a healthy and productive workforce to remain competitive, are searching for answers and looking to innovate beyond the current health system approaches,” he said in an email to FierceHealthcare. “This is an example of innovative companies combining to create new models to address health care and health system issues that impact their business. They are disrupting the system to meet broader goals, which will advance change in a slow moving ecosystem.” (K)

“Large employers have the resources to hire human resources professionals and benefits consultants to shop for their health plans. At least theoretically, those people should know more about how to pick a good health insurance plan that will serve the needs of the company’s workers. And the bigger the companies, the more they can pay to hire people really good to do that work, since their salary gets split many times over.
Have employers used these advantages to find huge savings? Not over all. Employer health insurance tends to be more expensive than public insurance, and its growth has traditionally followed the trajectory of other parts of the health industry. Some employers simply select from standard offerings, essentially outsourcing any innovation potential to notoriously risk-averse insurance companies.
But there is also a robust history of employer experimentation. Some employer ideas have paid off — and spread. Others have flopped. Amazon and friends would be building on this tradition.
Arnold Milstein, a professor at Stanford Medical School, spent several years with the benefits consulting firm Mercer developing unconventional benefit products with companies.
There is a segment of them that is willing to take the same risk tolerance that characterizes their core business and move it into the health benefit space,” he said, noting that many employers “are pretty wary, but there is a subset that has been more bold.”
There have been less successful innovations. Workplace “wellness” programs, which provide financial incentives for lifestyle changes, were initially built and bought by employers. But a growing body of evidence suggests they haven’t delivered much in the way of results.
Amazon, Chase and Berkshire Hathaway have said they’re experimenting with new health care models for their workers. If they crack the notoriously hard nut of high health care costs, we can thank the country’s weird and unloved employer health system for their discovery.” (L)

“Last week’s announcement that Amazon, Berkshire Hathaway and JPMorgan Chase will collaborate on a new venture to provide simplified, low-cost, high-quality health and wellness care for their more than 1 million employees caused a sell-off for many healthcare stocks and captured the imagination of pundits.
However, this new company is just the latest in a series of mergers and collaborations that many believe could disrupt healthcare in the United States. And the industry has for years seemed ripe for disruption. In 2017, $2.7 billion was invested in healthcare equity deals to develop tools to remake health and wellness for consumers, providers, hospitals, insurers, post-acute care settings and medical researchers, according to the New York Times.
These new alignments have included organizations like the Cleveland Clinic and Oscar, Humana and Kindred Healthcare, and a consortium of health systems that are forming their own nonprofit drug manufacturer.
Proponents of such initiatives believe that blurring the lines between what traditionally have been distinct sectors (providers, health plans, retail pharmacy and employers) will allow innovative approaches to emerge that will ease the transition from fee-for-service to value-based healthcare.
However, other healthcare leaders caution that many well-known companies have attempted to disrupt the American clinical delivery system and failed, according to another Times article. They also point out that most disruption in other industries occurs with lower-value, lower-cost products, and note that consumers don’t want to settle for low-value healthcare.
Still, that doesn’t mean healthcare organizations should ignore the winds of change. Consider the fact that since 2000, 52% of the companies listed on the Fortune 500 have gone bankrupt, been acquired, or ceased to exist, according to Constellation Research.
Indeed, the same forces that have affected other industries in the United States also apply to hospitals, and yet many hospital executives continue to lead as though nothing has changed. At a time when the core inpatient business for hospitals is declining and technology offers the ability to migrate care away from centralized hospitals, hospital executives must make sure that there is a place for their organization in the new world order of clinical care delivery.
The proposed vertical merger of CVS and Aetna represents a major challenge for all hospitals located in cities where CVS has its 9,700 retail pharmacies and 1,100 walk-in clinics. By combining organizations from different parts of the healthcare industry, the new company can realign incentives to benefit the consumer. If the new CVS can use its pharmacy benefit manager to lower prescription prices and encourage the use of less expensive drugs, the health insurance division could lower premiums so that enrollees could afford to visit their walk-in clinics to access care.
This development poses a challenge to competing hospitals because they have been making up for declines in inpatient reimbursements by raising prices in the outpatient clinic. It is hard to see how community hospitals will be able to compete with the likes of CVS and Amazon when Medicare, Medicaid and commercial health plans are cutting rates for outpatient care…
Hospital leaders must seriously consider how they will respond to competition from the innovative organizations that will emerge from mergers and collaborations. Following the same old playbook will not suffice. Executives must make hard decisions about what services they will no longer offer and how they will convince their communities that they offer value that can be measured in a rapidly changing health and wellness environment.” (M)

“The unanswered questions: There are a lot.
Will this involve new experiments, or rely on ideas — like direct contracting with hospital systems, or reference pricing — that already exist?
Are they just trying to cut out the middlemen? Most companies this large already are self-insured — meaning the companies pay for their employees’ medical costs on their own and hire health insurers to carry out the back-end work.
How will this company be different from the numerous other employer coalitions that try to band together for better deals? Amazon and JPMorgan are already part of the National Business Group on Health, and one of Buffett’s companies, BNSF Railway, is part of the Health Transformation Alliance — which so far hasn’t done a whole lot.
“We’ve seen so many employer coalitions trying to leverage their purchasing power,” Levitt said. “Those tend to go nowhere in really addressing the fundamental health care cost growth.”
What technology is actually involved? Amazon reportedly has interest in distributing prescription drugs. Will JPMorgan want to get in on the fees from managing health savings accounts? How do Buffett’s companies fit in?
Health care is literally a matter of life and death, and therefore is heavily regulated. Any new company looking to make a dent in health care costs will have to navigate a thicket of state and federal rules.
Will this end up like another Kaiser Permanente, a health insurer that uses its own closed system of hospitals and doctors? This is doubtful for now, but Kaiser Permanente started out as a workers’ comp program for shipyard and construction workers.” (N)

“Cigna CEO David Cordani said he’s confident the insurer will get a piece of Amazon, Berkshire Hathaway and J.P. Morgan’s new health initiative to tackle health costs, but investors aren’t convinced.
Cigna shares fell as much as 4 percent in trading Thursday and were recently down more than 2.5 percent for the day and about 10 percent for the week.
On Tuesday, J.P. Morgan and its partners announced plans to form a venture aimed at lowering its employee health costs. Since then, investors have been concerned that Cigna will be squeezed on pricing for its services or lose business. The company currently insures about 20 percent of J.P. Morgan’s employees.
“We’re one of J.P. Morgan’s service partners, so we have ongoing dialogue with J.P. Morgan on a regular basis,” including this week, said Cordani in an interview on CNBC’s “Squawk Box.”
“We do see this as an opportunity, and we’re in the middle of that conversation, as you would expect,” he said.
The three large employers said this week that they are hoping to form a separate entity to handle benefits “free from profitmaking incentives,” in order to lower health costs and improve service for their workers. Cordani pushed back on the profit implications on the company’s earnings conference call.
“We should not view that an industry with medical cost trend (growth) of 5-6-7 percent as sustainable,” said Cordani, while pushing back on the notion that insurer profits drive those increases.
“Our industry is capital intensive … This is not going to get solved with extracting a couple of points out of the (profit) margin,” he said.” (O)

“Given all this, surely the combined efforts of these three behemoths should yield some interesting innovations, right? Actually, don’t hold your breath, responds Harvard health care policy expert Bob Laszewski on his blog.
Why is longtime industry insider Laszewski so skeptical of the companies’ efforts? First and most basically, because this is far, far from the first time big companies have promised to finally bring some sense to America’s crazy health care situation.
“I have seen this movie before. Dozens of times over the last 25 years,” Laszewski writes. “The first time was when the leading employers in the Minneapolis-St. Paul market began the same effort in the early 1990s. That, and any other such initiative I have seen over the decades, went essentially nowhere.”
But it’s not simply that Laszewski is a jaded, been-there-done-that industry veteran. He’s also got specific reasons to be skeptical of Amazon and friends’ efforts. Their approach, he explains, is to use data to give patients and providers more information and reduce the amount of medical care people consume, or, in the lingo of the industry, “utilization.”
It’s an approach experts have been pursuing for years, Laszewski explains in his jargon-heavy post, but it’s yet to yield significant returns.
Why? Because despite the hype (and my father’s endless grumbling about unnecessary tests and scans every time he sees a doctor), the main trouble with American health care isn’t how much we consume. That’s not significantly different from other wealthy countries. The problem is how much we pay for that health care.” (P)

“The moves by these new entrants signal the continuing desire of large companies — many from outside health care — to transform the U.S. health industry, which most view as rife with inefficiencies, unsustainable costs and unhappy customers…
The U.S. health industry is in the midst of a slow but seismic shift fueled by consumerism, a move toward paying for value instead of volume, technological advances, care decentralization and growing interest in wellness…
Employers, consumers and the market in general appear to be losing patience with traditional players, which have largely continued to tread their well-worn paths.
And the more significant question may be: Will any of this result in a less expensive health system? Put another way, when you invest to create a new health model, will the model have less expensive inputs and components or just re-create the existing system and costs?…
Challenges surely lie ahead for these companies’ ambitious projects, whether they are new entrants or legacy healthcare companies building new partnerships. But the industry seems to have reached a tipping point. We are likely to continue to see powerful players taking serious actions to try to fix a system that has so far failed to do much more than tinker around the edges.” (Q)

“Jeff Bezos’ Amazon delivers stuff to your door. Jamie Dimon’s JPMorgan Chase makes money by investing. Warren Buffett’s Berkshire Hathaway sells everything from Dairy Queen dip cones to Helzberg diamonds. They’ve also rattled Washington and the country’s health care industry by declaring they would form an independent health care company for their employees.
But what makes these three titans of American industry and ingenuity think they can do better than the current players to deliver health care efficiently and affordably to more Americans? Don’t we have government to engineer health care? Oh, wait, Obamacare, with its soaring costs, shrinking networks and unkept promises.
The three business leaders have no experience in the complex health care sector. So what? We’ve learned from a decade of wrangling over Obamacare that Washington isn’t proficient at making health care accessible and affordable.
We hope the three executives and their companies deliver something that government doesn’t: innovation that works on time and within budget. Nimble strategy tailored to individual needs. Efficient execution.
Bezos and Friends join an increasingly crowded field of entrepreneurs and execs trying to figure out ways to deliver what government hasn’t or can’t”…. (R)

“The announcement on Tuesday that Amazon, JPMorgan Chase and Berkshire Hathaway would be joining forces to create a health care company moved stock markets and prompted optimistic predictions of major reform in a notoriously complex industry.
But while the three companies bring successful management, technological expertise and substantial capital to the venture, many health industry experts expressed doubts about whether their results would match their ambition.
Here are a few reasons that experts suggest we temper expectations.
It has been tried before
None of these players have expertise in health care
These are really different companies, with different priorities
There is not a clear strategic incentive to sell whatever they learn.” (S)

THE past decade has seen the smartphone become a portal for managing daily life. Consumers use their pocket computers to bank, buy and befriend. Now this array of activities is expanding into an even more vital sphere. Apple has spent three years preparing its devices and software to process medical data, offering products to researchers and clinical-care teams. On January 24th it announced the result. The next big software update for its iPhone will include a feature, Health Records, to allow users to view, manage and share their medical records. Embedded in Apple’s Health app, the new feature will bring together medical data from participating hospitals and clinics, as well as from the iPhone itself, giving millions of Americans direct digital control of their own health information for the first time.
Alphabet, Google’s parent, has just launched a third health-care firm, Cityblock Health, to operate alongside Verily, a subsidiary based in San Francisco, and DeepMind Health, an arm of its London-based artificial-intelligence (AI) firm (a fourth company, Calico, is working to extend human lifespans, but does not provide health-care services). Alphabet already claims to be able to use AI to predict possible deaths of hospitalised patients two days earlier than current methods, for instance, allowing more time for doctors to intervene. Facebook and Microsoft are preparing to add health care to their core businesses of social networking and software.
Until now the tech giants’ foray into health care has not gone much beyond wearable devices to track fitness or the provision of cloud-computing services to incumbent providers. In future they aim to deliver real medical services that directly affect individual patients. All five firms have secretive health-care skunk works, are hiring medical talent and are buying or backing external health-care startups. Undeterred by recent claims that their own products may be harmful to mental health, they want not only to be indispensable in customers’ lives but to prolong them, too….
It is worth remembering that the prospect of technology firms transforming health care has been heralded in the past, only to disappoint. Google started a health-records initiative in 2008, but shut it down by 2011, citing poor adoption. Microsoft made similar efforts with similarly low take-up. Yet ten years on, the centrality of the smartphone, with its potential to give patients access to their data whenever they want and wherever they are, changes the game.
So too does the inexorable logic of the data economy. Data sets that contain information about human health are hugely valuable. At a time when health-care budgets around the world are stretched, payers are desperate for insights that might enable them to cut costs while maintaining quality. The more data the tech firms can handle, the more they will learn about human health, and the better the services they can offer will become.” (T)

(A) Amazon, Berkshire Hathaway and JPMorgan Team Up to Try to Disrupt Health Care by By NICK WINGFIELD, KATIE THOMAS and REED ABELSON, https://www.nytimes.com/2018/01/30/technology/amazon-berkshire-hathaway-jpmorgan-health-care.html
(B) Can 3 business titans cure the US health care system?, by MARLEY JAY, http://abcnews.go.com/Technology/wireStory/health-cares-amigos-big-names-push-52732342
(C) Have they stumbled upon the solution to America’s health-care woes?, by Guian McKee, https://www.washingtonpost.com/news/made-by-history/wp/2018/02/08/how-three-of-americas-biggest-companies-might-undo-decades-of-conservative-health-care-policy/?utm_term=.0f81128f8835
(D) Disrupted: American healthcare has reached its tipping point, by Alex Kacik and Shelby Livingston, http://www.modernhealthcare.com/article/20180203/NEWS/180209961
(E) If Amazon And Buffett Lift Veil On Health Prices, Insurers Are In Trouble, by Bruce Japsen, https://www.forbes.com/sites/brucejapsen/2018/01/31/if-amazon-and-buffett-lift-veil-on-health-prices-insurers-are-in-trouble/#37662f1141c0
(F) Will Amazon, Berkshire Hathaway and JPMorgan Reinvent Health Care?, by Robert Field and Guian McKee, http://knowledge.wharton.upenn.edu/article/will-amazon-berkshire-hathaway-and-jpmorgan-change-the-game-for-health-care/
(G) What Could Amazon’s Approach to Health Care Look Like?, by Robert S. Huckman, https://hbr.org/2018/02/what-could-amazons-approach-to-health-care-look-like
(H) Amazon: How Its Strengths Could Help It in Health Care, by David Marino-Nachison, https://www.barrons.com/articles/amazon-how-its-strengths-could-help-it-in-healthcare-1518012088
(I) Amazon’s Soaring Healthcare Ambition: The Promise and the Problem, by Rob Enderle, https://www.technewsworld.com/story/85106.html?rss=1
(J) Amazon’s exploratory pharmacy team has ballooned to more than 30 people, says research firm, by Christina Farr and Meg Tirrell, https://www.cnbc.com/2018/01/24/amazon-pharmacy-team-expanded-to-more-than-30-leerink.html
(K) Report: Amazon’s healthcare plans could include a data warehouse, emphasis on digital tools, by Evan Sweeney, https://www.fiercehealthcare.com/mobile/amazon-digital-tools-technology-health-data-warehouse-telemedicine
(L) Employer Health Insurance: Often-Hated, Sometimes Pioneering, and Now on Amazon’s Radar, by Margot Sanger-Katz, https://www.nytimes.com/2018/02/01/upshot/employer-health-insurance-amazon-berkshire-hathaway.html
(M) Hospital Impact—Amazon, Berkshire Hathaway and JPMorgan venture a wake-up call for healthcare leaders, by Kent Bottles, https://www.fiercehealthcare.com/hospitals/hospital-impact-amazon-berkshire-hathaway-and-jpmorgan-venture-should-be-a-wake-up-call
(N) The fog around the new health care mega-venture, by Bob Herman, https://www.axios.com/bezos-buffett-dimon-health-care-hype-c5390c6e-61f5-4dbf-8c9f-66d5946c37ba.html
(O) Cigna CEO sees Amazon-led employee health initiative as an ‘opportunity’, by Bertha Coombs, https://www.cnbc.com/2018/02/01/cigna-ceo-sees-amazon-led-employee-health-initiative-as-an-opportunity.html
(P) Excited Amazon Will Fix Health Care? Don’t Hold Your Breath, Says Harvard Expert, by Jessica Stillman, https://www.inc.com/jessica-stillman/harvard-healthcare-analyst-amazons-healthcare-efforts-are-going-exactly-nowhere.html
(Q) Is the Amazon health-care venture enough to make a big enough splash?, by KELLY BARNES, http://thehill.com/opinion/healthcare/372988-is-the-amazon-health-care-venture-enough-to-make-a-big-enough-splash
(R) Editorial: Can Bezos, Buffett and Dimon revolutionize American health care?, http://www.chicagotribune.com/news/opinion/editorials/ct-edit-dimon-amazon-health-care-20180205-story.html
(S) Can Amazon and Friends Handle Health Care? There’s Reason for Doubt, by MARGOT SANGER-KATZ and REED ABELSON, https://www.nytimes.com/2018/01/30/upshot/can-amazon-and-friends-handle-health-care-theres-reason-for-doubt.html?ribbon-ad-idx=4&rref=world&module=ArrowsNav&contentCollection=The%20Upshot&action=swipe&region=FixedRight&pgtype=article
(T) Apple and Amazon’s moves in health signal a coming transformation, https://www.economist.com/news/business/21736193-worlds-biggest-tech-firms-see-opportunity-health-care-which-could-mean-empowered

Novel strategies often “appear” full blown. Sometimes they appear to be counterintuitive. Often there seem to be conflicting ideas out there. New players enter the competition. There is no continuum within which to place different initiatives.
So DOCTOR is taking a break to try to learn more and perhaps might come back “disruptively”!
Here are some examples I have found in the past few weeks to get myself started.
Jonathan

“What I hear is providing insights into what issues will be top of mind with healthcare leaders in 2018. Thus, here’s a short list of delivery trends to watch for in the coming year:
1. Efficiency will become a top priority. Revenues are flat while expenses continue to rise for most medical providers, so medical groups and health systems must continue to make their practices more efficient…
2. Physician burnout will be a strategic imperative. Addressing physician burnout will become a priority in the boardroom as leaders will demand initiatives to stem this epidemic. Many will add burnout metrics to their dashboards…
3. Competition for convenience will heat up. Patients—especially millennials—will continue to drive the demand for quicker, more accessible options to receive care..
4. Scope-of-practice issues will become more acute. The underutilization of many healthcare professionals―including pharmacists, nurses, physician assistants or behavioral health specialists―will lead to increased demands to expand their ability to treat patients more autonomously…
5. Practices will form more community partnerships. The move to value-based payment systems and the accountability for an attributed population means that healthcare systems will need to work with community partners to address some of the root causes of poor outcomes and resultant higher costs…” (A)

“Medicine currently follows the capitalistic model of other American industries: A fee is paid whenever a service or good is delivered. This incentive-based approach works well in most every industry, but not in health care. Fee-for-service encourages more tests and treatments, some of which are completely unnecessary. More health care does not mean better health care.
Instead of volume, we need to incentivize value by rewarding better health outcomes resulting from efficiently delivered, proactive care that keeps patients healthy.
When providers are incentivized to maintain health rather than respond to illness, they treat patients earlier in low-cost environments, like neighborhood clinics, before health problems become serious and require expensive care in a hospital setting. Those who can deliver more value by keeping patients healthy should be able to share in the savings of the health-care expenditures they have reduced.
Providers who spend more than would normally be expected for a given patient should receive no incentive payments. Furthermore, in this shift to value, there is appropriate fiscal support and incentive for the care that needs to happen in between physician visits (for example, disease education, health coaching and other ongoing care-management work). In this kind of system, the interests of payers, providers and patients become aligned.
Keeping patients healthy and out of the hospital
It can be done. Kaiser Permanente, which serves patients in eight states and the District of Columbia, combines hospitals and outpatient clinics with its own nonprofit insurance plan. Kaiser has a fixed annual amount to care for each member, so there is an inherent incentive to keep patients healthy and out of the hospital, where care is most expensive. Because its structure aligns the interests of payers, providers and patients, Kaiser operates efficiently and they are not alone. In fact, many other health systems, including the Mount Sinai Health System, are creating the same incentive model in partnership with private health plans.
By integrating the mobile and digital technology that is part of our everyday lives, medicine will be able to lower the number of hospital admissions….
Taken one step further, the Hospital at Home concept, which Mount Sinai Health System began in 2014, allows patients to be monitored closely from their own bedrooms and receive daily visits from a doctor or nurse practitioner, as well as home nursing care, lab services and medical equipment in their home, which is far less costly than remaining in the hospital…” (B)

“Oscar Health said its partnership with the Cleveland Clinic to offer individual coverage in Ohio under the Affordable Care Act has greater market share than anticipated in its first year.
The New York-based startup, which has expanded Obamacare offerings this year to more states, said it enrolled more than 11,000 members in its co-branded health plans with the Cleveland Clinic. Executives said the enrollment was higher than expected and accounts for about 15% of the individual health insurance market in the five-county northeast Ohio area. Oscar Health’s total enrollment is up 150% , or more than 250,000, after expanding into several new markets including the Cleveland area.
The enrollment is significant in part because individual health plans need enough customers for their risk pools, paying claims of sick patients and leaving enough to turn a profit and invest in product offerings. Bigger carriers including Anthem, Aetna and UnitedHealth Group scaled back their Obamacare offerings for 2018 after being unable to manage the rising costs of sick patients purchasing coverage.
The Cleveland Clinic-Oscar Health partnership is being watched closely as providers take on more financial risk in forming closer ties with insurance companies. CVS Health and Aetna are expected to offer more co-branded health plans once their deal closes later this year while Blue Cross and Blue Shield plans are also offering an increasing number of plans branded with providers in local markets.
Cleveland Clinic and Oscar describe their partnership as “a true 50/50 profit sharing of premium revenue.” Though early in their first year of operation, executives said one out of three Oscar health plan members have “already chosen a Cleveland Clinic primary care physician through Oscar health’s onboarding platform online.” (C)

“For years, hospital executives have expressed frustration when essential drugs like heart medicines have become scarce, or when prices have skyrocketed because investors manipulated the market.
Now, some of the country’s largest hospital systems are taking an aggressive step to combat the problem: They plan to go into the drug business themselves, in a move that appears to be the first on this scale.
“This is a shot across the bow of the bad guys,” said Dr. Marc Harrison, the chief executive of Intermountain Healthcare, the nonprofit Salt Lake City hospital group that is spearheading the effort. “We are not going to lay down. We are going to go ahead and try and fix it.”
While Intermountain executives would not name the drugs they intend to make, hospitals have long experienced shortages of drugs like morphine or encountered sudden price increases for old, off-patent products like the heart medicine Nitropress. Hospitals have also come under criticism for overcharging for their services, including for some drugs.
Several major hospital systems, including Ascension, a Catholic system that is the nation’s largest nonprofit hospital group, plan to form a new nonprofit company, that will provide a number of generic drugs to the hospitals. The Department of Veterans Affairs is also expressing interest in participating.
In all, about 300 hospitals are now included in the group. Other hospitals are expected to join.
Dr. Harrison said they planned to focus only on certain drugs. “There are individual places where there are problems,” he said. “We are not indicting an entire industry.”
Dr. Kevin A. Schulman, a professor of medicine at the Duke University School of Medicine who has studied the generic drug market and is advising the effort, said: “If they all agree to buy enough to sustain this effort, you will have a huge threat to people that are trying to manipulate the generic drug market. They will want to think twice.”
The idea is to directly challenge the host of industry players who have capitalized on certain markets, buying up monopolies of old, off-patent drugs and then sharply raising prices, stoking public outrage and prompting a series of Congressional hearings and federal investigations. The most notorious example is of Martin Shkreli, the former hedge fund manager who raised the price of a decades-old drug, Daraprim, to $750 a tablet in 2015, from $13.50…”(D)

“The shift toward consumerization in health insurance got rolling with passage of the Affordable Care Act in 2009 and has been gradually gaining speed since then. Now, retail giant CVS’s $69 billion agreement to buy Aetna has put a brick on the accelerator of consumerization in this space.
One driving force behind the CVS-Aetna deal may be the fear that Amazon, the e-commerce juggernaut from Seattle, is plotting a conquest of the pharmacy business. Whatever CVS’s motivations, its entry into the health insurance marketplace will force the industry to become more consumer friendly. That means injecting a huge dose of technology — especially data-analytics technology — along with marketing know-how into a business that has traditionally resisted change and innovation.
CVS will bring Aetna not only a wealth of consumer experience and relationships but also a level of technological savvy that the health insurance industry has never seen. The combined entity will possess massive amounts of data about Aetna’s members. It shouldn’t take long before CVS brings technology to bear that can help Aetna members better manage their prescription medicines, steer them toward CVS’s in-store care clinics, and offer vastly improved tools for managing their care and insurance online.
The deal will leave competing health insurance executives with no choice but to modernize their offerings and provide a user experience that approaches the standards set in the retail and consumer worlds….” (E)

“In that burst of activity, three transactions are of particular note: CVS Health’s (CVS) proposed acquisition of insurance giant Aetna (AET); Humana’s (HUM) intention to take a minority stake in Kindred (KND), a home health and hospice company; and UnitedHealth Group’s (UNH) plan to acquire Colorado-based DaVita’s (DVA) primary and urgent care business.
Interestingly, all of these combinations have a common goal: Keep patients out of high-cost hospitals by providing alternative care settings.
To understand the most recent wave of health care deals and the effect they may have on consumers, it’s important to understand the backdrop, explained Andrea Harris, senior healthcare analyst at Height Securities and a former staffer at the U.S. Department of Health and Human Services. For years, hospitals have been consolidating across the country, and the trend continued with a slew of big regional deals announced in 2017. In many areas, hospitals are now concentrated enough to dictate prices to even the biggest insurance company payers, said Harris
In part to fight back, insurers tried, unsuccessfully, to undergo their own wave of consolidation back in 2016. That’s when mega-insurers Aetna and Humana and Cigna (CI) and Anthem (ANTM) proposed merging, but both deals were blocked by the Department of Justice.
Now the trend has turned toward integrating other types of health care providers and systems in an effort to provide relief from high-cost hospital care, Harris explained. These deals are less likely to face regulatory scrutiny because insurers are expanding their businesses into areas that cause little overlap in services.
The most dramatic example is the $69 billion CVS-Aetna transaction. The hope is the merged companies would provide a willing group of patients to use CVS’ local clinics and disease management services to avoid hospital visits. By the same token, Humana wants a piece of Kindred so it can provide home health services to customers who might otherwise go to the hospital. And UnitedHealth’s alliance with DaVita will add 300 clinics in six states to UnitedHealth’s network of urgent care centers….” (F)

The renovation and expansion of Lucile Packard Children’s Hospital Stanford has been in the works for more than a decade, and this month it moved patients into the new facility for the first time.
The goal of the redesign was to create a facility with patients—and caregivers—in mind, said CMO Dennis Lund, M.D., the hospital’s chief medical officer, in an interview with FierceHealthcare. The hospital has gardens for patients and families alongside balconies and quiet spaces for clinical workers to take a breather.
“That’s especially important,” Lund said. “We can’t have successful patient care if we don’t have happy and satisfied staff.”
When the hospital first opened in 1991, it was designed to serve as a space where children could recover from care, not necessarily as a destination for pediatric care, Lund said. The original facility did not offer imaging services or have any operating rooms, so patients were sent to the adjacent Stanford University Medical Center.
As Lucile Packard began to expand its portfolio, adding complex procedures like transplantation and advanced cancer care, the need for a larger and more advanced space become evident. The new hospital is 521,000 square feet, more than double the previous children’s and obstetrics facility, and has added 149 beds for a total of 361 on the Palo Alto campus.
Alongside spaces designed to ease the stress of the care experience, Lucile Packard has expanded and modernized its imaging and treatment centers. Some elements, like new surgical suites and a neuro-interventional lab, are still under construction and set to open next year, the hospital recently announced.
Lund said the new suites will streamline the care process for certain procedures. Having adjoining spaces for different steps along the care journey will make the process faster and requires less anesthesia for the children, he said.
The investment in imaging includes a new positron emission tomography (PET) and MRI machine. The equipment allows clinicians to better craft care plans to a patient’s needs and can allow them to better monitor the spread of disease. It’s the only PET/MRI dedicated to pediatric care in the northern part of California, the hospital said….” (G)

“Dr. Mitchell H. Katz, the new president of NYC Health & Hospitals, is the system’s third leader in four years. Credit NYC Health & Hospitals
The incoming president of NYC Health & Hospitals wants to turn the nation’s largest public health care network into an agency that focuses less on hospitalized care and more on primary care, similar to initiatives carried out nationwide.
The new president, Dr. Mitchell H. Katz, who begins his job on Monday, also said he would expand the use of eConsult, an electronic health management system to streamline care and reduce wait times for specialty appointments, evaluate staff allocation and consider decreasing administrative services such as “unnecessary consultant expenses” to increase savings and revenue.
“I’m all about trying to strengthen public hospitals,” Dr. Katz, the former director of the Los Angeles County Health Agency, said in a recent phone interview. “Public hospitals are incredibly precious. If you don’t look out for them, they’ll disappear.”
Health & Hospitals, a sprawling system of 11 hospitals, five nursing facilities and more than 70 community-based health care centers and extension clinics, faces many challenges: shrinking state and federal funds, a decline in patient population, a large uninsured and underinsured patient population and a funding gap that is expected to balloon to $1.8 billion by the 2020 fiscal year.
In fact, Mayor Bill de Blasio’s administration warned in a report two years ago that the system was “on the edge of a financial cliff” and proposed restructuring and increased city subsidies.
“This is a deficit operation,” said Stanley Brezenoff, the system’s former interim chief executive. “You’re finding ways to close gaps.”
But more needs to be done to “reinvent and remodel the delivery system of Health & Hospitals,” Mr. Brezenoff said. “We have a long way to go.”” (H

“New Jersey is now home to two mega health care systems, which account for nearly half of all acute care hospitals in the state.
But declaring one the biggest in the state is difficult.
Hackensack Meridian Health said it was in the top spot after officially announcing JFK Health has joined the system last Wednesday.
But it is difficult to determine what numbers back that claim up.
HMH, with JFK joining its network, will have a total of 16 hospitals, 4,520 beds and employs nearly 33,000, including 6,500 staff physicians.
RWJBarnabas Health, which was previously touted as the largest system in the state, also has a total of 16 hospitals, 5,066 beds, 33,000 employees, plus 9,000 physicians.
HMH now has a total of 160 locations of all kinds in New Jersey. RWJBarnabas said it has 242 licensed patient care locations.
Both are claiming annual revenues at or near $5.5 billion…” (I)

“The City Council is attempting to recuperate millions of dollars from tax-exempt property owned by the Hackensack University Medical Center.
The city has filed an omitted assessment appeal for the non-profit hospital and its properties. By filing the appeal, the city wants to prompt negotiations with Hackensack Meridian Health, which owns the city hospital. City officials want to have the company pay some of the estimated $19 million in tax dollars it would owe the city if its land was not exempt from property taxes.
“There’s a lot of pressure on these hospitals at this time to make some payment of taxes to the host communities,” said Art Carlson, the city’s tax assessor. “We realize that the hospital is a great asset to the city, but that doesn’t preclude it from some kind of payments in lieu of taxes being assessed.”
Mayor John Labrosse declined to comment on the city’s appeal, citing his employment as a safety specialist at the hospital. Nancy Radwin, a Hackensack Meridian Health spokeswoman, declined to comment.
The appeal comes in the wake of a landmark tax court decision against the Morristown Medical Center in 2015. In a years-long case, Morristown council sought payments from tax appeals it filed against the hospital as far back as 2006. The hospital’s designation as a tax-exempt, charitable institution had shielded it from paying taxes on the properties it owned in town.
Ultimately, Judge Vito Bianco ruled that the medical center ran more like a for-profit corporation than a non-profit, charitable institution.
In a 2016 settlement, the hospital agreed to pay Morristown $15.5 million for 10 years of taxes and interest. The hospital also agreed to pay additional taxes for 10 years on spaces leased to restaurants, shops and private doctors. (J)

“Fairview Health Services CEO James Hereford called Epic Systems Corp. an “impediment to innovation” and said there is an opportunity for health care executives to exert more influence over the Wisconsin-based electronic-medical-records giant.
Epic, a privately held company with about $2.5 billion in annual revenue, is a dominant player in the EMR business and counts most major Twin Cities health systems among its clients. (Outside the metro area, Mayo Clinic is spending more than $1 billion to migrate all its medical records onto Epic’s platform.)
“I will submit that one of the biggest impediments to innovation in health care is Epic, because the way that Epic thinks about their [intellectual property] and the IP of others that develop on that platform,” Hereford said at a panel discussion hosted by the Business Journal last week. “There are literally billions of dollars in the Silicon Valley chasing innovation in health care. And Yet Epic has architected an organization that has its belief that all good ideas are from Madison, Wisconsin. And on the off chance that one of us think of a good idea, it’s still owned by Madison, Wisconsin.”
Epic is headquartered in Verona, which is about 10 miles from Madison.
Hereford spoke on a panel made up of CEOs from Twin Cities health care organizations such as HealthPartners Inc., Medica and Summit Orthopedics. He said health care executives collectively could do more to encourage Epic to change its approach.
“There is an opportunity for us to go to Epic and say, ‘Look, you have to open up this platform,’ ” he said. “It’s for our benefit in terms of having an innovative platform where all these bright, amazing entrepreneurs can actually have access to what is essentially 80 percent of the U.S. population that is cared for within an Epic environment. I would love for us to get together to see how we march on Madison.”
Critics have long argued that Epic takes an overly closed-off approach to its software, hindering the sharing of data to outside organizations and patients, as well as between health care providers…” (K)

“Amazon is looking to hire an expert in a set of health privacy regulations known as HIPAA, according to a new job listing.
The company is looking for a professional who can “own and operate” the security and compliance aspects of a new initiative. The person will also ensure that it meets HIPAA business associate agreement requirements, meaning Amazon intends to work with outside partners that manage personal health information.
It is also hoping the new hire will provide a consultative resource for all health-care regulatory issues.
Amazon is the latest technology company, after Apple and Alphabet, to make moves in health care. As CNBC reported in spring 2017, the company strategized how it could carve out a slice of the multibillion-dollar pharmacy market. It also has a health-care team at Amazon.com in Seattle, known by many names including “1492.”
One more immediate reason that Amazon might be looking for a health privacy expert is to augment its efforts to bring its Alexa voice assistant to health care.
The technology is not yet HIPAA compliant, which means developers aren’t able to record patients’ lab results or other types of health information in a clinical setting.
Amazon Web Services’ health lead acknowledged the gap in September at an event to promote Alexa in hospitals. “While Alexa and Lex (the technology powering Alexa) are not HIPAA-eligible, this (challenge) has provided us an opportunity to envision what is possible,” she said.
In the summer, Amazon hired Missy Krasner, herself an expert in health policy, who formerly ran Box’s health care initiatives.” (L)

“If you’ve ever struggled to access your medical information, like a lab test or immunization, Apple is trying to make your life easier.
On Wednesday, the company is releasing the test version of a new product that lets users download their health records, store them safely and show them to a doctor, caregiver or friend.
“We view the future as consumers owning their own health data,” Apple Chief Operating Officer Jeff Williams said in an interview with CNBC.
It all works when a user opens the iPhone’s health app, navigates to the health record section, and, on the new tool, adds a health provider. From there, the user taps to connect to Apple’s software system and data start streaming into the service. Patients will get notified via an alert if new information becomes available.
In June, CNBC first reported on Apple’s plans, including early discussions with top U.S. hospitals. The company confirmed that it has contracts with about a dozen hospitals across the country, including Cedars-Sinai, Johns Hopkins Medicine, Penn Medicine and the University of California, San Diego.
The medical information available will include allergies, conditions, immunizations, lab results, medications, procedures and vitals. The information is encrypted and protected through a user’s iPhone passcode.”…(M)

“Google CEO Sundar Pichai believes artificial intelligence could have “more profound” implications for humanity than electricity or fire, according to recent comments.
Pichai also warned that the development of artificial intelligence could pose as much risk as that of fire if its potential is not harnessed correctly.
“AI is one of the most important things humanity is working on,” Pichai said in an interview with MSNBC and Recode, set to air on Friday, January 26. “It’s more profound than, I don’t know, electricity or fire.”
Pichai went on to warn of the potential dangers associated with developing advanced AI, saying that developers need to learn to harness its benefits in the same way humanity did with fire.
“My point is AI is really important, but we have to be concerned about it,” Pichai said. “It’s fair to be worried about it—I wouldn’t say we’re just being optimistic about it— we want to be thoughtful about it. AI holds the potential for some of the biggest advances we’re going to see.
“Whenever I see the news of a young person dying of cancer, you realize AI is going to play a role in solving that in the future. So I think we owe it to make progress too.”” (N)

“Reducing diagnostic errors is a crucial component of improving care quality, but current methods of monitoring such mistakes may be time consuming. Now, researchers at Johns Hopkins have developed a strategy that uses big data to speed up the process.
David Newman-Toker, M.D., director of the Center for Diagnostic Excellence at Johns Hopkins’ Armstrong Institute for Patient Safety and Quality, and his team developed a new approach called SPADE (Symptom-Disease Pair Analysis of Diagnostic Error) to allow providers to harness databases instead of having staff members comb medical records for more information, according to a study published in BMJ Quality & Safety.
SPADE uses statistical analyses to find and flag patterns that can predict diagnostic errors. It mines available databases for common symptoms that lead patients to visit a doctor and then compares those data with diseases that are often misdiagnosed.
For example, SPADE would illustrate how frequently patients who visit a provider with dizziness are sent home because doctors believe the condition is minor, when they had actually suffered a stroke, Newman-Toker said in an announcement. Having these data available would improve outcomes and could refine quality measures to better reflect patients’ concerns.
“Being able to do that using big data is an important innovation for diagnostic quality and safety,” he said.
Diagnostic errors are an industry-wide issue. A recent Mayo Clinic study suggested that more than 20% of patients are misdiagnosed by their primary care doctors. Physicians can mitigate the risk by seeking out a second opinion or taking a “time out” prior to surgery to ensure the correct patient is on the operating table.
SPADE’s approach is likely to be most effective with acute or subacute conditions for which a misdiagnosis could have serious consequences: hospitalization, disability or death within six months. Newman-Toker said it would likely be effective for the “big three” conditions that lead to death or disability after a diagnostic error: infections, cancer or vascular events.” (O)

Consolidation is one of the most important trends shaping the healthcare industry today, but hospital and health system leaders rarely approach these ambitious actions with a clear sense of what makes an effective deal. Though partnerships, affiliations and joint ventures have become increasingly prevalent, as well as the acquisition of ambulatory service centers and other outpatient facilities, this article will focus on the mechanics of hospital acquisition.”
As president and CEO of Northwell Health, I have seen our health system expand to 23 hospitals. From my experience, I can say there are four essential factors to consider before pursuing a hospital acquisition.
Is the mission of the hospital you are in discussions with consistent with yours?
Would the acquisition add value to your organization?
What is the relative health of the hospital you are targeting? That encompasses not only financial health, but its reputation for clinical quality, its standing in the community, and the political dynamics of the hospital’s governing board and leadership team. Understanding a hospital from a holistic standpoint requires a full diagnostic analysis.
Does the deal help you competitively? And what are the repercussions if one of your competitors acquires the hospital instead?
Three red flags
There are three red flags we always examine when looking to acquire a hospital.
Lack of transparency. If leaders are not fully transparent with you, they are trying to hide something.
Micromanagement by the governing board. If the board doesn’t allow its management team to oversee day-to-day operations without interference, you could have major problems. Ask yourself if you can change that culture, and if so, how difficult would it be? How can you make a board understand its responsibility to hold management accountable but not insert itself in day-to-day management?
Long-term contracts with physicians and administrators. If contracts with clinical and administrative leaders are long and unbreakable, you could have trouble making changes and recruiting a new team if problems arise.
If you go back 10 years and look at the C-suites of hospitals Northwell has acquired, few of the same leaders are around today. Sometimes you need to make leadership changes quickly because the incumbents may be poisonous to the transition process. Other times, we have found leaders of newly acquired facilities to be very adaptable and open to change. The same standards must also be applied to physician leadership…
Consolidation is an essential and beneficial move if you want to provide broad-based, holistic, coordinated care. If your main priority is improving patient outcomes, the advantages of consolidation outweigh its disadvantages. However, organizations that simply collect hospitals without properly integrating them or coordinating care are destined for failure. There are many health systems that are simply a collection of points on a map — freestanding silos independent of each other. The concept behind effective acquisition should be preventing duplication and enhancing efficiency, because if your only aim is to make yourself look big, employees and patients will be the ones to suffer.” (P)

Sanford Health is expanding its presence in international health care by extending services to seven countries. This year, Sanford Health will enter New Zealand, Ireland, Vietnam, Costa Rica and South Africa and increase its presence in China and Ghana. This expansion follows last year’s acquisition of a minority stake in ISAR Klinikum, a hospital leader in stem cell therapies, located in Munich, Germany.
Sanford Health’s international health care arm, Sanford World Clinic, will now be in nine countries with more than 30 locations. Supported by philanthropy and launched in 2007, the initiative is designed to foster partnership with health care leaders in the development of sustainable services around the world.
“With these partnerships, we are creating unique opportunities for shared learning,” said Kelby Krabbenhoft, president and CEO of Sanford Health. “This is not something we are pursuing for financial gain, but we believe this type of collaboration will help further our mission of health and healing.”
Each partnership is unique in terms of scope of service and type of agreement. The focus of the collaborations range from primary and pediatric care to research and health system operations.
“We want to go where we can be impactful and create partnerships that will stand the test of time,” said Dan Blue, M.D., executive vice president of Sanford World Clinic. “We have outstanding partners in each of these countries who share a common goal – to advance health care around the world.”… (Q)

“When most hospitals close, it’s plain to see. Equipment and fixtures are hauled out and carted away. Doctors and nurses leave and buildings are shuttered, maybe demolished.
But another fate befalling U.S. hospitals is almost invisible. Across the country, conglomerates that control an increasing share of the market are changing their business models, consolidating services in one regional “hub” hospital and cutting them from others.
In recent years, hospitals across the country have seen their entire inpatient departments closed — no patients staying the night, no nursery, no place for the sickest of the sick to recover. These facilities become, in essence, outpatient clinics.
Hospital executives see these cuts as sound business decisions, and say they are the inevitable consequence of changes in how people are using medical services. But to patients and local leaders who joined forces with these larger health networks just years ago, they feel more like broken promises: Not only are they losing convenient access to care, their local hospitals are also getting drained of revenue and jobs that sustain their communities.
“It’s not even just betrayal. It’s disgust, frankly,” said Mariah Lynne, a resident of Albert Lea, Minn., where Mayo Clinic is removing most inpatient care and the birthing unit from one of its hospitals. “Never would I have expected a brand of this caliber to be so callous.”
In 2015, the most recent year of data, these service reductions accounted for nearly half of the hospital closures recorded around the country, according to the Medicare Payment Advisory Commission. (By MedPac’s definition, the loss of inpatient wards is equivalent to closure.) These data do not capture more discreet closures of surgical and maternity units that are also happening at local hospitals.
And the trend doesn’t just affect nearby residents. It represents a slow-moving but seismic shift in the idea of the community hospital — the place down the street where you could go at any hour, and for any need. Does the need for that hospital still exist, or is it a nostalgic holdover? And if it is still needed, is it economically viable?”…(R)

(A) Hospital Impact―Ear to the ground: 5 healthcare delivery trends to watch in 2018, by Jerry Penso, https://www.fiercehealthcare.com/hospitals/hospital-impact-5-healthcare-delivery-trends-to-watch-2018?mkt_tok=eyJpIjoiWm1OaFptWmtOVFF5TjJFMiIsInQiOiJyd1FIakxTZ1lONWJzU3FpVjBHdUFnWHhBR0EwdEdkNllGMDlSUEl4bVFQazBNVGsya2V3cGpiMlRlak4ydHdqWFBPNFQ0U0VrbDc1a1dSZDNwdGY0YUFlTW00UWxNblpXODNvQ2g4bHBmT0pxNk1adVQ3VXlJc0ZiUDM2a2RvWCJ9&mrkid=654508
(B) The real reason health care is bankrupting America, by Kenneth L. Davis, https://www.cnbc.com/2018/01/11/the-real-reason-health-care-is-bankrupting-america.html
(C) Oscar Health Grabs Share With Cleveland Clinic Branded Obamacare Plan, by Bruce Japsen, https://www.forbes.com/sites/brucejapsen/2018/01/19/oscar-health-grabs-share-with-cleveland-clinic-branded-obamacare-plan/#7d9334f4f468
(D) Fed Up With Drug Companies, Hospitals Decide to Start Their Own, by REED ABELSON and KATIE THOMAS, https://www.nytimes.com/2018/01/18/health/drug-prices-hospitals.html
(E) Innovative health insurers must learn to think like Amazon, by MARK NATHAN, https://www.statnews.com/2018/01/10/health-insurance-amazon/?utm_source=STAT+Newsletters&utm_campaign=b3b9ddbb62-On_Call&utm_medium=email&utm_term=0_8cab1d7961-b3b9ddbb62-150519373
(F) What health care companies are doing for their health, by WALECIA KONRAD, https://www.cbsnews.com/news/what-health-care-companies-are-doing-for-their-health/
(G) A look inside Lucile Packard’s new 521K-square-foot ‘patient-centered’ hospital, by Paige Minemyer, https://www.fiercehealthcare.com/healthcare/lucile-packard-children-s-hospital-stanford-renovation-new-facility-pediatrics-imaging?mkt_tok=eyJpIjoiWm1OaFptWmtOVFF5TjJFMiIsInQiOiJyd1FIakxTZ1lONWJzU3FpVjBHdUFnWHhBR0EwdEdkNllGMDlSUEl4bVFQazBNVGsya2V3cGpiMlRlak4ydHdqWFBPNFQ0U0VrbDc1a1dSZDNwdGY0YUFlTW00UWxNblpXODNvQ2g4bHBmT0pxNk1adVQ3VXlJc0ZiUDM2a2RvWCJ9&mrkid=654508
(H) City’s New Public Hospitals Chief Will Focus on Primary Care, by JAN RANSOM, https://www.nytimes.com/2018/01/07/nyregion/mitchell-katz-nyc-health-hospitals.html
(I) HMH and RWJBH: 2 big systems, but which is bigger?, by Anjalee Khemlani, http://www.roi-nj.com/2018/01/08/healthcare/hmh-rwjbh-two-big-systems-one-bigger/
(J) Hackensack University Medical Center’s tax exemption appealed by City Council, by Rodrigo Torrejon, https://www.northjersey.com/story/news/bergen/hackensack/2018/01/18/hackensack-university-medical-center-tax-exemption-appealed-city-council/1041144001/
(K) Fairview CEO says Epic an ‘impediment’ to innovation, calls for ‘march on Madison’, by Katharine Grayson, https://www.bizjournals.com/twincities/news/2018/01/16/fairview-ceo-says-epic-an-impediment-to.html
(L) Amazon is hiring a health privacy expert for ‘new initiative’, by Christina Farr, https://www.cnbc.com/2018/01/16/amazon-hiring-hipaa-expert.html
(M) Apple will let you keep your medical records on your iPhone or Apple Watch, by Christina Farr, https://www.cnbc.com/2018/01/24/apple-coo-williams-says-new-health-record-beta-is-right-thing-to-do.html
(N) WHAT’S BIGGER THAN FIRE AND ELECTRICITY? ARTIFICIAL INTELLIGENCE, SAYS GOOGLE BOSS, by ANTHONY CUTHBERTSON, http://www.newsweek.com/artificial-intelligence-more-profound-electricity-or-fire-says-google-boss-786531
(O) Johns Hopkins researchers use big data analytics to target diagnostic errors, improve quality, by Paige Minemyer, https://www.fiercehealthcare.com/healthcare/johns-hopkins-armstrong-institute-diagnostic-errors-spade-big-data?mkt_tok=eyJpIjoiWldReE4yUmtObU14TXpKaiIsInQiOiJaQ2NRZnFzdlwvRDVKYmV2Y2h2UDRnWTArbUxicCszKzlJVDg0TDJDWU53a21CMW9PdGlscm9aN1VEVDJmdEJMdWlXZHVRVkl5UXlJdGVXdXJXUjVmZEpjR1wvV2ltWVwvK2I5b2xGd2ZtSERZRzJBMDJBOVBveHNRSU9vUXlFQVwvVWcifQ%3D%3D&mrkid=654508
(P) Michael Dowling: The prizes and pitfalls of hospital acquisitions, by Michael J. Dowling, https://www.beckershospitalreview.com/hospital-management-administration/michael-dowling-the-prizes-and-pitfalls-of-hospital-acquisitions.html
(Q) Sanford Health increases global presence with expansion in seven countries, http://www.sanfordhealth.org/newsroom/2018/01/sanford-health-increases-global-presence-with-expansion-in-seven-countries
(R) Paying more and getting less: As hospital chains grow, local services shrink, CASEY ROSS, https://www.statnews.com/2018/01/24/hospital-chains-services-consolidation/