Spring 2019 | Volume 8 | Number 2
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The healthcare arena continues to gyrate and spin wildly, often in unanticipated and unpredictable ways! And with recent efforts resumed to revive attempts to eradicate the Affordable Care Act, including pre-existing conditions provisions, and apparently with no detailed replacement plan waiting in the wings, the anxiety of millions of Americans, both those with and without insurance converge, is palpable and growing.
The combination of (1) ongoing consolidation within healthcare, (2) the rising cost of medications that have been on the market for years (e.g., insulin) as well as (3) the high expense typically associated with specialty meds, and (4) the greater awareness of the role and impact of Pharmacy Benefit Managers (PBMs) by employers and consumers means more laser-like focus on the life cycle and patent process, and growing resistance to pricing methodologies and rebate systems employed by drug manufacturers.
With dozens of genetic tests coming to market every day and labs available to combine both pharmacokinetics and pharmacogenomics, the potential and promise of precision medicine, especially in areas like anti-depressant medication, therapies seem on the verge of a major breakthrough.
And the nascent artificial intelligence (AI) industry, whose technology is being used in an ever-broadening array of applications, has many wondering, if and how this journey can be different and lessons learned in the development and growth of the internet and social media be leveraged to help reduce the likelihood of unintended, negative consequences. Can the horse stay in the barn? Will the genie stay in the bottle? Will we manage and control AI or will it control us in the end due to a forward evolution that is unfettered? Is AI the wild, wild west of the 21st century?
The bottom line? Healthcare is never boring and often not easy, especially for patients and consumers. It is under constant flux, which appears to be the new normal. It is the story of the best of times, and, not infrequently, the worst of times. And the only ones who can tip the scales in our favor are us. So, what are you doing already or are willing to commit to right NOW to ensure the greater good is achieved for all?
Z. Colette Edwards, WG'84, MD'85
Managing Editor
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Have an article to contribute or words of wisdom for the Philosopher's Corner?
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See what our alumni have been up to.
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Access previous newsletter editions.
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I had coffee recently with an HCM alum I’d gotten to know when he was a student and I was five years out. Our conversation then was the same five years later: what’s happening in healthcare? Where will it be in five years? How do I make an impact? How do I help people? I’ve had this conversation with hundreds of HCM students and alumni over the years. I never tire of it. What a privilege it’s been to serve this community for the last five years.
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This eclectic standing column features insightful musings, words of wisdom, life lessons, and stepping stones to business success. This month's philosopher is
Chris Simpkins, WG’02
. Chris is the Vice President of Analytics at Change Health.
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Not a Freudian Slip
: The Magic of Music on Health – Part 2
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There is a solid amount of evidence demonstrating the transformational power music can have on our lives and in our communities.
Part 1
provided a brief overview of how music positively impacts all seven dimensions of well-being and has proven its educational, therapeutic, and social value. The aim with most articles is to inform, to get you thinking about the information and examining what it means to you. In these next two articles, I am hoping to go a few steps further to help you apply what you have learned about music and begin to practice and experience the positive impacts, which will hopefully reinforce your eagerness to sustain.
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Affidavit: Healthcare and the Law
- Biometric Data Collection and Storage -The Courts Weigh In
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The alignment and performance of the executive leadership team (ELT) can make or break the short-and long-term success of a healthcare organization. This is why it is crucial for CEOs to focus on accelerating the effectiveness of the ELT. Most CEOs inherit a leadership team. So how can a CEO, new or otherwise, tackle the daunting task of taking an existing group of leaders to the next level?
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Downloading Success
: CEO Primer - Accelerating Executive Team Performance
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The words “data security” can be nightmare inducing for anyone whose job responsibilities include the protection of other people’s personal data. Few areas are more sensitive than private health information—and we have all of the complexities of HIPAA and its State analogues to show for it. Some States are now taking steps to protect private individuals from having their biometric data collected and stored without meaningful consent. Generally, privacy laws will punish a company when a breach occurs—but one State has taken a more proactive approach which allows private individuals to sue a company for collecting and storing their biometric data without consent—that is, in violation of the law.
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To Your Health
: Lifestyle Changes - Make the Assist
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Coaches use the phrase, “There is no ‘I’ in team.” Long-time UNC basketball coach Dean Smith applied the ‘Point to the Passer’ rule, which meant that whichever player scored they would point out the teammate who made the pass to them. Ask yourself, when was the last time you made an assist? Or worse, did you buy the jumbo popcorn at the movies with your friend who is trying to change their diet? To whom do you point in your life who assists you?
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Policing Drug Prices in America: The Institute for Clinical and Economic Review
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The United States lags behind other industrialized nations in systematically allocating limited healthcare dollars to medications that provide the most value at the lowest cost. In fact, the very institute created by the federal government “to assist…in making informed health decisions,” the Patient-Centered Outcomes Research Institute, is legislatively prohibited from considering costs in their comparative-effectiveness studies.
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Further, the Centers for Medicare and Medicaid Services, our country’s biggest payer, is explicitly prohibited from considering a drug’s price tag in coverage determinations for the Medicare population.
2-3
Amidst increasing public scrutiny on the high cost of medications to patients, a small Boston-based research firm, the Institute for Clinical and Economic Review (ICER), is gaining influence at a time when the U.S. is poised for a drug pricing revolution.
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Radiology: A Profession in Transition - Q and A with James Whitfell, MD’94
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Learn about trends in radiology – technological advancements, private equity investment, and the changing role of the radiologist – from James Whitfill, MD, Senior Vice President and Chief Transformation Officer of HonorHealth, Chair of Society for Imaging Informatics in Medicine, and President of Lumetis, LLC, a national healthcare consulting firm. He was the first physician to complete a fellowship in Medical Informatics in the University of Pennsylvania Department of Medicine.
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Wharton Around the Globe
: Assessing Care Delivery in Assam, India
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There is a shortage of care for patients in resource-poor populations such as that which
Makunda Hospital
serves. Most healthcare is out-of-pocket, and one hospital admission can leave a family in poverty. Providing healthcare to local residents in resource-poor settings can be challenging to do in a sustainable manner. Makunda Hospital has developed a unique model, the “Makunda Model,” that allows it to provide care to many outpatients and inpatients in need of healthcare services in a remote region of northeastern India. It has developed approaches to maintain sustainability in spite of seeing patients with limited resources, and, additionally, has created educational and agricultural businesses in the local community.
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Developing Healthcare Leadership in Turbulent Times
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The challenges facing our healthcare system in the current moment are well known and widely discussed—the need to reduce costs and improve quality, the rapid changes in the business landscape through consolidation and horizontal and vertical integration, the ever-changing political landscape, emerging technologies (too many to mention), and the disruptive effects looming from new entries into the system (i.e., Amazon, J.P. Morgan, Berkshire Hathaway, Walmart, etc.). What does not get addressed as much is the need for strong leadership at multiple levels to navigate the rapid pace of change in healthcare and turn challenge to opportunity.
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Disclaimer
: The opinions expressed within are those of the authors and editors of the articles and do not necessarily reflect the views, opinions, positions or strategies of the Wharton School and/or the University of Pennsylvania, and/or their respective organizations. Publication in this e-magazine should not be considered an endorsement. The
Wharton Healthcare Quarterly
and WHCMAA make no representations as to accuracy, completeness, currentness, suitability, or validity of any information in this e-magazine and will not be liable for any errors, omissions, or delays in this information or any losses, injuries, or damages arising from its display or use.
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