The Powers Report Podcast

This is the first in a two-part series about price transparency. In this episode, I will discuss price transparency as it relates to hospitals and other providers. In Part II, I will discuss the drug industry. In both podcasts, I will talk about efforts underway by the government to provide better information to consumers. The hope is that better access to pricing will increase competition and reduce prices. While I support this free market idea, it has its limitations. In each show, I will provide additional initiatives that should be pursued to not only increase access to better pricing but also to push prices down to realistic levels.

Key Citations

* Requirement to post chargemaster pricing: Modern Healthcare

* Proposal to post hospital and insurer negotiated rates: The Wall Street Journal

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Welcome to The Powers Report Podcast. I am your host, Janis Powers. The show brings you candid, unique and data-driven perspectives on the health care industry. I believe that any solution that is going to positively impact the American health care system has to satisfy two major criteria: financial viability and behavioral incentive alignment. In other words, access to high quality care can only be achieved if we can afford it, and if we behave in ways that optimize our health. Please subscribe to our show on iTunes or on your preferred podcasting platform and connect with us on social media. Again, this is Janis Powers, and welcome to The Powers Report Podcast.

Americans have become increasingly frustrated with the health care system, and pricing is a big part of the problem. We’re upset about drug pricing and we’re upset about those pesky nonsensical hospital bills that no one understands. Over a half a million people who file for bankruptcy each year do so because of medical bills. They’re un or under-insured and probably are sitting on a pile of statements that make absolutely no sense to them. It’s outrageous.

The price transparency movement is taking hold as a means to address this problem. Legislators, patient advocates, pundits and even I have been pushing for more price transparency. In this show I am going to talk about the different ways to achieve it because I don’t think the initiatives being undertaken right now are going to get us where we need to be.

This show is the first in a two-part series about price transparency. In this episode, I will focus on price transparency as it relates to hospitals and other providers. In Part II, I will address drug pricing. I think drug pricing gets more media play, but the dollars associated with it are about a third of what is spent by hospitals. From an order of magnitude perspective, dealing with price transparency in the provider system can positively impact more patients and more dollars.

Price transparency has become an increasingly important issue because health care costs have been going up and health insurance is covering a lot less. Some Americans (9% of the population in 2017) don’t even have health insurance. For those who do have it, about half of those covered by their employer have a high deductible health plan. That means that they have to pay, typically, several thousand dollars out of pocket before their insurance will cover their costs. More and more patients are getting slapped with charges that they didn’t expect, that they don’t understand and that they cannot pay. Hence the bankruptcy problem.

Much debate pits a government-run health care system against the private insurance system. I believe we are seeing the development of a third option: The Market Option. More and more health care costs are being shifted to consumers in the form of High Deductible Health Plans and Health Savings Accounts. These options are terrific for selected constituents. But we must ensure that as we give consumers more spending power, we also provide them with the education they need to use it properly. Preventive and necessary medical care must be utilized. We must also focus on patient wellness so consumers wind up paying less of their own money for their own health care.

Key Citations

* Definition of High Deductible Health Plan (HDHP): gov

* New ruling shifting chronic diseases costs to insurers for HDHP enrollees: WSJ

* Definition of Health Savings Account (HSA): gov

* Information about the Health Savings Account Expansion Act of 2019: Bill Track 50

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Welcome to The Powers Report Podcast. I am your host, Janis Powers. The show brings you candid, unique and data-driven perspectives on the health care industry. I believe that any solution that is going to positively impact the American health care system has to satisfy two major criteria: financial viability and behavioral incentive alignment. In other words, access to high quality care can only be achieved if we can afford it, and if we behave in ways that optimize our health. Please subscribe to our show on i-Tunes or on your preferred podcasting platform and connect with us on social media. Again, this is Janis Powers, and welcome to The Powers Report Podcast.

I can’t think of any American who likes dealing with a health insurance company. I could spend an entire show talking about how maddening it is to pay so much and get so little back – even when certain drugs or surgeries are covered. The insurance industry literally makes people sick because for all the good it’s supposed to provide us, we somehow always feel screwed.

Maybe that’s because health insurers make so much money. UnitedHealthcare Group, the country’s largest health insurer, earned $17.3 billion from operations in 2018. That’s about half the GDP of the entire state of Vermont. One company.

Alas, if you beat up on the insurance industry in favor of public health, there are a few things to know. First off, the government underpays providers for care. Medicare payments don’t cover the cost of care for most hospitals, which means that a hospital loses money every time a Medicare patient walks through the door. Given that Medicare is the largest payer for most hospitals, that’s a problem.

Reimbursement from Medicaid isn’t any better.

This is a major reason why over 100 rural hospitals have closed since 2010. Populations continue to move to urban areas making it harder for small hospitals to fill up their beds – and when they have patients, more often than not they’re on government programs which don’t pay enough to cover costs.

Some in the health care industry argue that the cost structure in hospitals is simply too high, and that hospitals should do a better job of reducing expenses so they can stay in business. In part, I agree with this, especially with regards to the high fixed costs and overhead that characterize many hospitals.

Lots of talk is underway about breaking up the big tech companies because of their influence and size. Companies like Alphabet (parent company to Google and YouTube) and Facebook have an outsized impact on social media. The same is true in heath care, except that the influential organization is not a for-profit company, it’s the U.S. government. Facebook’s 2018 revenues were $56 billion. Alphabet’s were $137 billion. And Medicare…the program spent $706 billion in 2017. If we’re talking about breaking up social media companies because of their influence and size, shouldn’t we consider breaking up CMS, the Centers for Medicare and Medicaid Services, too?

Key Citations

* European Union’s rules on data collection: EU General Data Protection Regulation (GDPR)

* Study about the payback of investing in safety net programs: WSJ

* CMS Administrator’s editorial against Medicare-for-All: WSJ

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Welcome to The Powers Report Podcast. I am your host, Janis Powers. The show brings you candid, unique and data-driven perspectives on the health care industry. I believe that any solution that is going to positively impact the American health care system has to satisfy two major criteria: financial viability and behavioral incentive alignment. In other words, access to high quality care can only be achieved if we can afford it, and if we behave in ways that optimize our health. Please subscribe to our show on iTunes or on your preferred podcasting platform and connect with us on social media. Again, this is Janis Powers, and welcome to The Powers Report Podcast.

This podcast is about doing the unthinkable: breaking up CMS. Yes, CMS, the organization that oversees Medicare and Medicaid. Many people want to expand Medicare with different permutations of Medicare-for-All. I think we need to do the exact opposite. And we should look at what’s going on in the tech world for some guidance.

Anti-trust talk is sweeping the corridors in Washington with regard to the big tech companies. Facebook, Google and Twitter are under scrutiny because of their dominance in the social media world. What you post, what you like, what you are curious about…all of that is saved, sorted and sometimes, sold. There are legitimate concerns over how these and other companies use data and about their inability to control content on their platforms.

The European Union has already taken action. The General Data Protection Regulation, GDPR, outlines a series of regulations about how companies can collect and use your data in the EU. The companies must follow rules related to deleting information, having people opt in instead of opt out, allowing users to correct personal information, etc. It’s great for consumers but a massive headache for the companies. There’s concern that GDPR-type rules will find their way across the pond to the U.S.

That, or we could just break up the companies.

Facebook is the largest social media platform in the world. It has about 2.4 billion active users. It also owns Instagram, the popular image-intensive platform, and WhatsApp, a messaging service used predominantly internationally. Sometimes by terrorists. Alphabet is the parent company for Google and YouTube. Google is by far the largest search engine in the U.S., with about two-thirds market share. Five billion videos are watched on YouTube every day, with an average viewing time on the platform of 40 m...

The health care industry needs an activism movement. It needs outspoken, courageous individuals who will act with their words and their wallets to bring about behavioral change. Given how unhealthy our population is – 70% of us are overweight, for one – it’s going to take some tough love to get us to where we need to be. This podcast explores ways we can act individually, as well as a call to celebrities and influencers, so we can course-correct our behaviors, setting us on a positive path to good health.

Key Citations

* Performance of health insurance companies in the bull market: CNBC

* Millennials: the most obese generation in history: Healthline

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Welcome to The Powers Report Podcast. I am your host, Janis Powers. The show brings you candid, unique and data-driven perspectives on the health care industry. I believe that any solution that is going to positively impact the American health care system has to satisfy two major criteria: financial viability and behavioral incentive alignment. In other words, access to high quality care can only be achieved if we can afford it, and if we behave in ways that optimize our health. Please subscribe to our show on iTunes or on your preferred podcasting platform and connect with us on social media. Again, this is Janis Powers, and welcome to The Powers Report Podcast.

In this show, I am going to talk about some different ways that we can change the conversation about living a healthy life in America. Our health care system is so bungled that it’s going to take a variety of solutions that attack different problems to get us where we need to be. We need smart policy solutions that keep patients safe, improve price transparency, eliminate devastating financial exposure to patients and cut out the negative incentives that drive up unnecessary cost utilization. We need technology solutions that encourage us to be healthier, make the system more efficient and bring us new products and ideas to improve the industry.

But we also need an attitude adjustment. A big one. One of health care’s major and under- discussed problems is that we have cultural challenges that must be overcome in order to fix the system. These cultural problems manifest in our behaviors, many of which are negative and contribute to the industry’s high cost/poor outcomes situation.

We are an unhealthy lot. We’re overweight. We take too many pills. We don’t exercise enough. We don’t sleep enough. Our diets aren’t what they should be. We’re stressed because of work, financial problems and many of us think that the sky is falling.

There are solutions out there right now that try to address our behavioral problems. We need to continue to pursue them because, as I said, there will not be one solution that does it all. So it’s great that we have employer-based wellness programs. Yes to public health programs that promote education about health in the community. Yes to grocery stores that offer more fresh, healthy food options. Major props to the individuals who encourage their friends and family and co-workers to make smart choices.

Yet we need more. What we need is a health activism movement. This movement needs multiple dimensions where people use their mouths and their money, their words and their wallets to candidly and aggressively correct our behavioral problems.

When we use our money to influence behavior and culture, it’s a form of socially-responsible investing.

Americans have long rhapsodized over our nation’s defining characteristics: freedom and equality. Yet these two ideas are actually contradictory when it comes to the design of health care policy. In this podcast, Powers discusses how creating a health system that promotes equality impedes on individual freedoms. She also highlights the problems with allowing too much freedom of choice in health care. New developments, from genetic testing to amazing drug treatments, are exacerbating the ability to create a system that balances equality and freedom. Powers offers up an alternative and also outlines which of these important considerations – freedom or equality – should be prioritized in the American health care system.

Key Citations

* Kamala Harris and the elimination of private insurance: CNN

* Prioritizing private pay patients at the Mayo Clinic: Modern Healthcare

Transcript

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Welcome to The Powers Report Podcast. I am your host, Janis Powers. The show brings you candid, unique and data-driven perspectives on the health care industry. I believe that any solution that is going to positively impact the American health care system has to satisfy two major criteria: financial viability and behavioral incentive alignment. In other words, access to high quality care can only be achieved if we can afford it, and if we behave in ways that optimize our health. Please subscribe to our show on iTunes or on your preferred podcasting platform and connect with us on social media. Again, this is Janis Powers, and welcome to The Powers Report Podcast.

As the 2020 presidential election approaches, we will be hearing some familiar terms on the campaign trail. We’ll hear politicians mention one of my favorites, the American Dream. I’m partial to this one, because my book that proposes an overhaul of the health care system is called Health Care: Meet the American Dream. But we’ll also hear a lot about freedom and a lot about equality – two values intrinsic to the American spirit.

In this podcast, I will talk about freedom and equality in the health care system. What does it mean to have freedom in health care? To have equality in health care?

This is critical to discuss because I believe that freedom and equality cannot co-exist in our health care system. Yet we, as Americans, support both freedom and equality. We’re going to have trouble figuring out a way forward for health care if we don’t start considering this rarely discussed contradiction. Which is more important? Do we really understand the ramifications of striving for either freedom or equality in health care?

So let’s get into it.

We Americans love, and better yet, expect, freedom of choice. When the Affordable Care Act was designed, there was hope that buyers on the health insurance exchanges would have choices. The exchanges were called marketplaces for a reason. People were expected to shop for their insurance, and the marketplaces were supposed to make it easy to compare prices.

We’ve subsequently learned that shopping just on price for health insurance doesn’t allow consumers to make informed choices because the products vary considerably by coverage and access. One plan may offer the same pricing as another, but your doctor may not be included in one of them. So the products aren’t equal, even if the pricing implies that they are.

In fact, our love of choice is creating a conflict with regard to support for a s...

Health care is one of the most important issues to Americans in the upcoming election cycle. The majority of Democratic candidates for president have been rallying around a Medicare-for-All idea. Does this mean they’ve abandoned the Affordable Care Act? In this episode, Powers discusses some of the positive aspects of the ACA, particularly the prohibition of insurers to deny coverage based on pre-existing conditions. She then outlines ten steps that can be pursued to replace the ACA as an alternative to walking away from the program in pursuit of Medicare-for-All.

Key Citations

* Policy definition of pre-existing condition: Centers for Medicare and Medicaid Services

* Tax benefits of taxing employer-sponsored health insurance subsidies: Urban Institute and Brookings Institution

* Higher cost to subsidize ACA insurance than pay for Medicaid enrollment: Modern Healthcare

Transcript

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Welcome to The Powers Report Podcast. I am your host, Janis Powers. The show brings you candid, unique and data-driven perspectives on the health care industry. I believe that any solution that is going to positively impact the American health care system has to satisfy two major criteria: financial viability and behavioral incentive alignment. In other words, access to high quality care can only be achieved if we can afford it, and if we behave in ways that optimize our health. Please subscribe to our show on iTunes or on your preferred podcasting platform and connect with us on social media. Again, this is Janis Powers, and welcome to The Powers Report Podcast.

If you’re a Democrat running for the presidential nomination – and at this point, there are over 20 of them – then you have to have an opinion about Medicare for All. You’ll need a response. Are you for a total government take-over? Do you want to eliminate private insurance? Or maybe you just want people to have the option to buy into the current Medicare program?

One of the biggest challenges with positioning yourself on Medicare-for-All is that no one’s agreed exactly what it is. But one thing is for sure. It’s not the Affordable Care Act. Which brings up an interesting situation for the Democrats. The ACA was the Dems’ signature legislation, the Obama-era program that was supposed to provide all Americans will affordable health insurance. It was passed in 2010. Here we are, about a decade later in a different election cycle, and the party has ostensibly abandoned it.

One interpretation of the abandonment, and it’s a position I think is legitimate, is that the Democratic candidates don’t want to touch the ACA because it didn’t come close to fulfilling the promises of bringing affordable health insurance to everyone. About 10% of Americans still don’t have health insurance and the insurance that is offered on the marketplace isn’t affordable.

Now, for those of you who’ve been listening to this show, you’re probably aware that I don’t like waste. My professional goal has always been to find the most efficient way to get people the best health care experience possible. In my view, there’s nothing more wasteful than campaigning for, lobbying for, developing and implementing a multi-billion-dollar program and then ditching it less than ten years later for something else. Especially when that something else – Medicare-for-All – ...

Billionaire Robert F. Smith’s commitment to pay off the student loans for the graduating class of Morehead College was a bold philanthropic gesture because it was direct and efficient. Yet as magnanimous as Smith’s gift is, it fails to address the reason why students graduate with so much debt in the first place: rising administrative costs in the higher education sector. Powers explores what the health care industry can learn from Smith’s gift to Morehouse College given that health care is also plagued with high costs and inefficiencies. How can donors to health care get the most bang for their buck when they give money to a system that is so operationally flawed? Powers discusses her approach to transforming the health care system and how it will require novel, creative models of philanthropic support.

Key Citations

* Robert F. Smith’s pledge to pay off student debt at Morehouse College: The Washington Post

* Rise in the cost of tuition at colleges: College Board

* Percent of Population in Relation to Health Care Costs: Peterson-Kaiser Health System Tracker

* How China is using crowdfunding for health care: The Wall Street Journal

Transcript

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Welcome to The Powers Report Podcast. I am your host, Janis Powers. The show brings you candid, unique and data-driven perspectives on the health care industry. I believe that any solution that is going to positively impact the American health care system has to satisfy two major criteria: financial viability and behavioral incentive alignment. In other words, access to high quality care can only be achieved if we can afford it, and if we behave in ways that optimize our health. Please subscribe to our show on iTunes or on your preferred podcasting platform and connect with us on social media. Again, this is Janis Powers, and welcome to The Powers Report Podcast.

A funny thing happened at Morehouse College in May. A billionaire promised to pay off the student loans of the graduating class. While the rest of us are tinkering into summer, the recent graduates of Morehouse College and their families are probably still reeling from the surprise announcement. It has inspired me to think more about how philanthropy is changing, not just in education, but also in other fields. In this podcast, I will talk about the need to embrace new modes of philanthropy in health care, and how this Morehouse model can serve as a catalyst to make giving more targeted and more efficient.

Here’s the re-cap. Austin-based billionaire Robert F. Smith delivered a commencement speech at Morehead College. Smith is the founder of Vista Equity Partners and is one of the wealthiest African Americans in the country. He’s not a graduate of Morehouse, which has historically been a black, male college. Yet Smith is a proponent of using his wealth to support African American causes. He pledged $50 million to his alma mater, Cornell University, to support African Americans and women in chemical and biomolecular engineering programs.

Talking about hospitals doesn’t have the pizzazz of cutting-edge concepts like blockchain or artificial intelligence. But we have to talk more about hospitals because they spend a lot of money. About one out of every three dollars in health care is spent by hospitals. The issue is so important that Powers has dedicated two episodes to the subject. The previous podcast, Part I, covered her experience with hospitals and the challenges they face related to reductions in reimbursement and the evolution of care delivery. In this episode, Part II, Powers talks about how hospitals have responded to these changes and offers up suggestions about how they should position themselves in the coming decade.

Key Citations

* Facts about U.S. Hospitals: American Hospital Association

* 2018 Annual Report: Catholic Health Initiatives

* 2017 and 2018 Financial Statements: Dignity Health

* 2017 Annual Report to Shareholders: Hospital Corporation of America

* Study about administrative costs in healthcare: Health Affairs

* Healthcare-associated infections: Centers for Disease Control

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Welcome to The Powers Report Podcast. I am your host, Janis Powers. The show brings you candid, unique and data-driven perspectives on the health care industry. I believe that any solution that is going to positively impact the American health care system has to satisfy two major criteria: financial viability and behavioral incentive alignment. In other words, access to high quality care can only be achieved if we can afford it, and if we behave in ways that optimize our health. Please subscribe to our show on iTunes or on your preferred podcasting platform and connect with us on social media. Again, this is Janis Powers, and welcome to The Powers Report Podcast.

This show is the second of a two-part series about a critical aspect of the health care system that seems to fly under the radar: hospitals. It’s an aspect of the industry that needs significant change but is probably the most resistant to it. As I mentioned in the previous show, we have to talk about hospitals because they spend a lot of money. In 2017, the US spent $3.5 trillion on health care (1). A third of those dollars, over 1.1 trillion of them, was spent by hospitals. In comparison, only about 10% of the spend went towards drugs. We hear a lot more in the news about drugs because most Americans take at least one prescription medication a day. But big money is spent by hospitals and given the cost pressures in the industry, we need to focus on making sure the big spenders are operating as efficiently as possible.

In the previous podcast I talked about some of the reimbursement issues and operational challenges that hospitals are facing. Here’s a brief summary. Medicare and Medicaid provide hospitals with 60% of their payments (2). As a result of the cost crunch in health care, the Centers for Medicare & Medicaid Services (CMS) has been coming up with programs and tactics to reduce payments to hospitals. Hospitals have been struggling to abide by the ...

Talking about hospitals doesn’t have the pizzazz of cutting-edge concepts like blockchain or artificial intelligence. But we have to talk more about hospitals because they spend a lot of money. About one out of every three dollars in health care is spent by hospitals. The issue is so important that Powers has dedicated two episodes to the subject. This first podcast, Part I, covers her experience with hospitals and the challenges they face related to reductions in reimbursement and the evolution of care delivery. In Part II, Powers will talk about how hospitals have responded to these changes and offers up suggestions about how they should position themselves in the coming decade.

Key Citations:

* Hospital Value-Based Purchasing Program: Centers for Medicare & Medicaid Services

* Hospital Readmissions Reduction Program: Centers for Medicare & Medicaid Services

Transcript

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Welcome to The Powers Report Podcast. I am your host, Janis Powers. The show brings you candid, unique and data-driven perspectives on the health care industry. I believe that any solution that is going to positively impact the American health care system has to satisfy two major criteria: financial viability and behavioral incentive alignment. In other words, access to high quality care can only be achieved if we can afford it, and if we behave in ways that optimize our health. Please subscribe to our show on iTunes or on your preferred podcasting platform and connect with us on social media. Again, this is Janis Powers, and welcome to The Powers Report Podcast.

This show is the first of a two-part series about a critical aspect of the health care system that seems to fly under the radar: hospitals. It’s an aspect of the industry that needs significant change but is probably the most resistant to it. I know the subject of hospitals isn’t the “sexiest” topic in health care. It doesn’t have the zing that blockchain or AI or IOT has, that is for sure.

But we have to talk about hospitals because they spend a lot of money. In 2017, the US spent $3.5 trillion on health care (1). A third of those dollars, over 1.1 trillion of them, was spent by hospitals. In comparison, only about 10% of the spend went towards drugs. We hear a lot more in the news about drugs because most Americans take at least one prescription medication a day. But big money is spent by hospitals and given the cost pressures in the industry, we need to focus on making sure the big spenders are operating as efficiently as possible.

The issue is so important, that I am dedicating two shows to on the topic. In this podcast, I’ll outline my experience with hospitals, and talk about some of the reimbursement and operational challenges they’re facing. In the second half of the series, I’ll talk about how hospitals are reacting to these changes and then offer up some suggestions about what I think they should be doing.

I like talking about hospitals because I’ve spent my career consulting to hospitals and other providers, particularly ambulatory surgery centers (ASCs). I started as a strategy and operations consultant with Deloitte in 1995. I have worked all around the country and have served pretty much every type of hospital and hospital system, including integrated delivery systems, for-profit systems, not-for-profit systems, academic medical centers, rural hospitals, etc.

My work related to delivery system optimization.

Genetic testing has exploded on the consumer market, and advancements in genetic science are offering seismic changes to how we view our health status. But just how accurate are genetic tests? What are the pitfalls to commercializing this relatively new science? Powers discusses these issues as well as concerns over privacy and ethical conundrums related to gene editing.

Key Citations

* Different types of genetic tests: National Genome Research Institute

* Article about limits of genetic testing: MIT Technology Review

* Longitudinal study about heart disease: Framingham Heart Study

* NIH program to study genetics of 1 million Americans: All of Us Research Program

* Primer on CRISPR-Cas9 technology: U.S. National Library of Medicine

* Unintended consequences of gene editing: The Wall Street Journal

Transcript

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Welcome to The Powers Report Podcast. I am your host, Janis Powers. The show brings you candid, unique and data-driven perspectives on the health care industry. I believe that any solution that is going to positively impact the American health care system has to satisfy two major criteria: financial viability and behavioral incentive alignment. In other words, access to high quality care can only be achieved if we can afford it, and if we behave in ways that optimize our health. Please subscribe to our show on iTunes or on your preferred podcasting platform and connect with us on social media. Again, this is Janis Powers, and welcome to The Powers Report Podcast.

Genetic testing is all over the news these days and for good reason. It’s an exciting area of health care that leverages technology to find out information about our unique profiles in a way we’ve never seen before. In this show, I will talk about genetic testing and some of the latest technological advancements in genetic science. I’ll also talk about how the study and commercialization of genetic science can best help patients help themselves.

The public’s amplified fascination with genetic testing dates back to an event that occurred…less than a generation ago. The human genome was sequenced in 2003. It was a massive scientific breakthrough, led by the National Human Genome Research Institute, the Department of Energy, and partners with International Human Genome Sequencing Institute. By “sequenced” it means that researchers were able to identify the order of the pairs of DNA that make up our genes. The order that the genes are in is critical, because there are relationships between the pairs of DNA, based on where they are. Scientists are just scratching the surface on understanding this part of the human gene. But sequencing has enabled an incredible volume of research, therapies, drugs and, most recently, consumer products, to be brought to market.

Genetic testing covers a broad spectrum of study. The National Human Genome Research Institute has a great summary of the different types of tests that are available. Predictive genetic tests are some of the tests done by consumer companies like 23andMe and AncestryDNA. These tests can tell you the likelihood that you may develop a disease. Diagnostic testing is different.