Healthcare Disruption: Big Bang or Tipping Point?

The debate how to improve access to American healthcare has brought about some grand and complex schemes.  But, what if the eventual disruption of the health sector comes about as result of a series of small changes that eventually become significant enough to bring about a tipping point?

Ripe for Disruption?

Americans are familiar with the competing government visions for disrupting healthcare. The ACA focused on increasing insurance coverage and decreasing healthcare costs over time.  The first version of the ACHA focused on repealing ACA taxes and increasing insurance policy choices.  The conservative think-tank  Heritage Foundation favors a fully market based health system with access to doctors and treatments tied to whatever the market set, a scenario which would see more rural and low performing hospitals closing and insurers paying less for ‘low performing’ doctors.

The American Congress has healthcare reform / disruption on hold for now. Meanwhile, the American hospital system is financially strained and downsizing, in spite of taking in nearly a third of the $3 Trillion healthcare pie. Both rural and urban hospitals are dealing with decreasing operating budgets which they attribute to increased technology costs, pharma, bad debt, labor costs, decreasing patient services and shrinking reimbursement rates. Speculation has been going on for some time that the American health care sector, which is three times larger than the banking industry and comprises more than 17% of the United States GDP, is ripe for disruption.

But, which parts of the healthcare sector are disruptable?  Who will the players be?  How will costs for treating expensive chronic conditions be contained? Will the sector be disrupted by 1 big change or through a series of smaller changes? Let’s take a quick look at just three possible forces in a ‘tipping point’ path to healthcare reform.

Better Income through Better Patient Services

Last week Mount Sinai reported an overall increase in revenue largely due to increased patient services.  Other hospitals are losing money on patient services, what makes Mount Sinai different? Mount Sinai expanded access to its services including opening a full service primary care center in Brooklyn and a partnership to use predictive analytics to identify high-risk patients.

Mount Sinai’s expansion to make its services more accessible reflects a national trend to provide services in areas and at times that are convenient to consumers. Retail and satellite clinics (aka Doc in a Box) are popular because they are convenient, have longer hours of operation, are transparent about costs, and are affordable. In other words, they provide value to the customer.

A recent panel discussion at the Healthcare IT Marketing and PR Conference (#HITMC) in Las Vegas NV speculated that the future of healthcare could hold even further ‘commoditization’ of healthcare beyond satellite clinics. What other areas of healthcare could provide better patient value while improving the healthcare bottom line? Artificial intelligence likely will have a role in providing a more standardized system of care.  As health IT products such as population health tools, EHRs, and more improve, it’s not difficult to envision the path to additional consistency and standardization or ‘commoditization’ of care.

New Money

If Hospitals do not have the funding to transform healthcare, who does? Despite saying that they said they’d never become a healthcare company, Google appears to be moving in a life-science direction. A Google Alphabet subsidiary Sidewalk Labs called Care Labs posted a ‘big picture’ of how healthcare delivery could look in the future. The community health project post addresses improving access but also achieving cost savings through prevention.

Eye brows raised recently as three Google Alphabet subsidiaries began hiring life science talent.  Even sidewalk labs which aims to use technology to solve urban problems is hiring health care positions including a chief health officer and a head of community health.

A Globally Scalable Platform for a Pricey Health Issue

Most of us have heard of the promise that blockchain has for healthcare from access to EHRs to combatting fraud.  But, did you imagine that it might be used to improve diabetes management? Last month at the CoinAgenda conference in Puerto Rico a startup named Healthcoin won an award for best private blockchain. Still in its prelaunch, Healthcoin incentivizes improving patient’s biomarkers for diabetes.  When measurements for information related to A1c, blood pressure, and HDL cholesterol improve, the blockchain issues them a token. When launched, the company envisions employers and insurance companies paying pre-set rewards for tokens. In addition, they will be building a biomarker database which can be mined by pharmaceutical companies for help in drug discovery.

A blockchain solution for diabetes management and a new big data source to boot? Wonder if Google is interested?

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Forces for Change

Forces for Change

High drug prices, a failing public image, generics-friendly legislation, and a dearth of innovation are forcing M&As, outsourcing, and radical thinking for Pharma.  PBMs are being called to the table for their drug pricing margins. And, get out your glow sticks, because SXSW is the new frontier for Pharma and Tech match-making.

That innovative industry that played a huge role in lengthening our life spans has become the one everyone loves to hate.  According to a recent Gallup poll, pharma and healthcare are at the bottom of the barrel when it comes to public opinion.  Rounding out the bottom three is the Federal Government, which has joined in on the Pharma finger pointing.  Our health care systems are losing money and insurance is becoming unaffordable.  Both are in part due to the high cost of pharmaceuticals.

In some ways, we are the victims of our own life spans.  More of us are living longer. The percentage of people over age 65 is 8.5% and projected to grow to 17% by 2050. With age come chronic and expensive health problems. That dynamic, in concert with the pharmaceutical industry’s struggles and a broken drug pricing system have created the perfect storm. Effective strategies for decreasing health care and pharmaceutical costs while the population ages will require more than cost shifting.  It will require careful examination of the causes of escalating prices, targeted solutions, and innovation that requires pharma to think differently.

Too Many Expenses, Too Little Innovation

A recent analysis of 13 historically big pharma companies found that R & D expenses that are not off-set by sales of new products; an over reliance on off-patent drugs, price increases and marketing strategy; and a lack of focus on innovation from leadership on down. In short, there is too much focus on the status quo, too little risk-taking without the promise of a quick pay-off, and too few bold thinkers (trouble-makers).

‘Thus, the conundrum of big pharma is as follows: most companies are not innovative enough to live solely from their innovation. Eight (out of 13) depend upon off-patent drugs for one-third to two-third of their revenues. That in turn has slanted their leadership toward processed-focused leaders, who are deft at offsetting their innovation deficit with legacy sales, but not so good at boosting innovation to sustainable levels. It’s a vicious circle that has been tough to break.’ Bernard Munos,

American Consumers and Politicians are Angry

Some in the U.S. Congress are counting on the free-market as the best solution to spur innovation and bring drug prices down. They paint pharma as an industry in fear of being out-innovated and desperate to maintain control over drug markets. Recent testimony to the House Oversight Committee on Health Care, Benefits, and Administrative Rules pointed to pharma abuses of the regulatory process and other acts to maintain monopolistic prices. Ted Cruz (R-Texas) recently introduced a bill to permit drug importation as a means of forcing pharma to price competitively.  Mike Lee (R – Utah) will soon introduce the CREATES Act, which will make it easier for generic drug manufacturers to get the formulae for off-patent drugs.

Historically Huge Price Increases in the U.S are NOT from All Pharmaceutical Companies

Several companies have voluntarily signed a pledge to limit price hikes including: AbbVie, Merck, Novo Nordisk, Takeda, Johnson and Johnson, and Allergan. Chicago-based pharmaceutical company AbbVie joined the price hike pledge at the J.P. Morgan Healthcare conference. Apparently, there was quite a bit of pricing talk at the conference with some mocking the 10% limit as still above the rate of inflation.  Others are just not fans at all. Notably, Mylan CEO Heather Bresch said that a 10% increase is not the answer.

Also at JP Morgan, then head of Novo Nordisk’s North American operations, Jakob Riis called out the drug supply chain that routes drug purchases through pharmacy benefit managers, other payers, wholesalers, and pharmacies for their roles in higher drug prices.

Pharmacy Benefit Managers Role in Price Hikes

While drug makers are the most often blamed for escalating drug costs in America, the middle men, the Pharmacy Benefit Managers (PBM) are increasingly in the cross hairs of investigators for their role in excessively high drug prices. An analysis of drug expenditures in 2015 commissioned by PhRMA found that non-manufacturing stakeholders, which includes PBMs took in 31% of the total, approximately $142.8 billion dollars. PBMs negotiate discounts with manufacturers, contract with pharmacies, and process prescription drug claims.   Over time, many believe that PBMs have morphed from a focus on cost containment to operations that harm American pharmacies, payers and consumers. Competition has decreased over the years and there are currently just 3 PBMs that control approximately 80 – 85% of the American market.

Express Scripts, recently purchased by CVS Health, has had several law suits filed by pharmacies alleging they were deprived of access to markets.  Recently there have been multiple allegations that Express Scripts, CVS Health, Optum RX and Prime Therapeutics have colluded to drive certain pharmacies out of business. More telling than the flurry of lawsuits are indications that drug prices are better for companies that don’t use the big PBMs. Ten years ago, Caterpiller moved away from Pharmacy Benefit Managers and has seen a decrease in drug costs while the rest of us have seen spiraling costs. Last year, Anthem sued Express Scripts when the payer realized that they were not getting competitive pricing. Leary of the big 3 PBMs, some companies are switching to smaller, more transparent companies that charge a flat fee.

While the big PBMs deny the allegations against them, when DIY and boutique PBMs outperform big companies, something is off. One thing seems clear; the American drug pricing system is broken and high prices cannot just be blamed on big pharma greed. A bi-partisan bill introduced by Congressman Doug Collins (R-GA) this month requires greater transparency from PBMs.

Pharma Evolving

Returns on R & D for the biggest companies have fallen to the lowest level in 6 years and are expected to fall further. To offset the cost of R & D and increase successful innovation many companies have opted for mergers, acquisitions and partnerships. Pharmaceutical M & A have focused on intellectual property, sales force efficiency, streamlining R & D, and reorganizing. Companies are expected to continue to downsize R & D and purchase rights to potential blockbuster drugs. Outsourcing partnerships, particularly for clinical trials which account for the largest chunk of R & D costs, are expected to grow to somewhere between 55% – 70% over the next ten years. Additional trends include increased and better use of analytics, data-centered tools to improve protocol design.

Some companies have begun to address what they have identified as internal obstacles to innovation including incentives to prolong dubious drug development programs. They are further shaking things up by recruiting scientists who rebel against bureaucracy, and placing nonscientists into drug development roles to come up with fresh ideas.

The Most Innovative Companies

According to a recent analysis of 2015 sales from newly approved drugs by Forbes Magazine Johnson & Johnson and Bristol-Myers Squibb are leading innovators. The overall picture though, is of an industry that is still struggling. Another analysis by IDEA Pharma noted that 7 of the 13 historically big pharma companies who received 14 FDA approvals in 2015, received none in 2016. Innovation, they note may be increasingly driven by smaller, more agile companies such as those that received 14 of the 22 FDA approvals in 2016.

Going Boldly Where No Pharma Has Gone Before.

Pharma’s next mission is to seek out new cost efficiencies and innovation so it’s not surprising that pharma companies are partnering with tech companies as another area for growth. Many companies partner with startups as well as large tech companies.

The Pharma ranks were a noticeable presence at this month.  Whether digiceuticals or beyond the pill tech to enhance the effectiveness of their products, partnership and investment opportunities at SXSW make the conference a good fit for pharma.

Collaboration was also evident in the speakers.  For example, representatives from the Dell Medical School at UT Austin, IBM Corp, and Johnson and Johnson were on a panel with the topic: Collaborative Innovation in the Digital Age.

Pharma stepping outside the box at conferences like SXSW will fuel innovation not just for their industry but for those they collaborate with.  People need to learn about each other and their businesses.  The silos need to come down but it will take work because this is real life.

A post by Janelle Starr at illustrates this issue nicely. She was listening to an investor describe how he’d met with 100 start-ups and funded none of them because they had assumptions about the market forces that were false. So, it was a surprise to her when she realized that the investor himself demonstrated a knowledge of healthcare that was no better than those he was criticizing.

Going boldly can be embarrassing when you already think you know it all.

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To HIMSS or Not To HIMSS? Find the Answer With 5 Questions

What’s reality vs perception?

The decision to exhibit at HIMSS or any other large trade show is usually made a year in advance. Do companies really know how to work a large show to get the most ROI? Is it really just about deep pockets? Are there other less expensive ways to have a competitive edge? This blog outlines the 5 questions to answer to HIMSS or not to HIMSS.

What is so magical about HIMSS? Does it really produce results? What’s reality vs perception?

With an estimated 40,000 attendees, the Healthcare Information Management Systems Society (HIMSS) Annual Meeting is among the largest trade shows focused on healthcare information technology.  This year HIMSS will take over the Orlando Convention Center from February 19-23.

In many ways, HIMSS is no different than any other massive trade show. But, is HIMSS really the mecca for making HIT deals happen? Let’s look at the numbers.

There are over 1,200 exhibitors scheduled for this year’s exhibit floor. But, …

  • only 50% of the exhibitors are returning from 2016
  • only 25% of the exhibitors exhibited in 2015 and 2016
  • only 80 of the exhibitors go back to 2014
Based on the Lodescore Analytics database, HIMSS has churned through 3,000 exhibitors on its exhibit floor in the past three years.

Is HIMSS a bad trade show?

Why do companies decide not to exhibit at HIMSS? What does the churn really represent?

Not enough return on investment
Companies invest millions of dollars on concrete floor space, booths, and entertainment for 4 days of HIMSS exhibit time. It would be very difficult to justify this kind of expense without measurable return on investment from new partnerships and measurable new revenue.
Companies are flaming out
Healthcare is slow to evolve and change. It’s a $7 Trillion market. Huge opportunities for innovation and technology. Many start-ups run for the prize, but flame out before they get beyond the Valley of Death.
Not the right trade show or do not do the pre-work
HIMSS might not be the right event for a company. Even with 40k attendees, they may not fit the customer profile or have the decision authority to buy. Also, the exhibit floor is massive and many first timers are not prepared, don’t pre-seed or pull traffic to their booths, and drown in the sea of logos on the exhibit floor.

So, do you HIMSS or not? Here are the 5 questions to inform your HIMSS decision:

1. Are you a true start-up that is looking for its first customers?
You will get lost at HIMSS. You could get a badge and go guerrilla, but it probably would be best to find other smaller, more targeted HIT events that will cost less time and money.
2. Are you a start-up with tech partners?
See if your partner will allow you to hang and use their booth for demos and potential client meetings. If not, go guerrilla at HIMSS and focus on other smaller, more targeted HIT events. NOTE – Not all pavilions are the same. The Intelligent Health Pavilion does a phenomenal job showcasing tangible use cases and qualified HIT solutions. It doesn’t matter where it is on the show floor – just go. Then, there are pavilions filled with kiosks and are the lowest level entry for start-ups. I have never seen them get good foot traffic and  they usually turn into ghost towns by end of Day 2.
3. Are you a start-up with customers?
Go guerilla. Pack your schedule with customer meetings/dinners. Analyze the education program. Identify speakers that match your customer profile and then plant yourself in the front row during their presentation. Be prepared to recognize something specific about their interests when you introduce yourself following their presentation.
4. Are you a company between $1M-$15M?
DO NOT EXHIBIT. I know that it is so tempting and your marketing company will be chomping at the bit. But, you will be a small fish. You will be located on the side walls and will not get the traffic that you hoped for. Save up until you can get into the middle and/or the aisles to run with the big companies. Invest your money towards guerrilla tactics – send more employees and work the show beyond the exhibit floor. Work the educational programs, plan customer meetings and dinners, entertain like a King. You’ll probably spend as much, but if your tactics are focused and customer-centric, it will deliver the ROI that you need to grow revenue.
5. Are you a company >$15M?
Do a 20×20 foot booth (or bigger) and hand out Jelly Belly’s, Starbuck’s, or branded bottled water (my favorite!). Location matters; use the McDonald’s vs Burger King strategy and try to get near a cluster of your competitors. Their traffic becomes your traffic. Just think of that qualified lead visiting the booth next door and you lure them as they are leaving. Pre-plan meetings and find ways to show off your C-Suite executives through off-site events and dinners. Finally, make sure that you actually do something with all of your badge scan data. It’s unbelievable statistic but a reputable badge company shared with me that 80% of badge data is never touched post event. How’s that for effective pull-through tactics?

The reality is that HIMSS is what you make of it. Your success and decisions will depend on many factors. Ultimately, businesses need to be smarter about where, when, and how much they invest. They need to critically assess customer and competitor activities and tie them to quantifiable ROI. Lodestone Logic is the only company that provides a suite of productivity tools, data tools, and consulting services to simplify these processes and help you to have a competitive edge.

If you are heading to HIMSS and want to learn more about our Conference Optimization Services, let’s meet up in person. Send me an email at

Here’s to happy HIMSS-ing!

Is Digital Health Living up to the Hype?

The Digital Health Summit at CES 2017, some new industry reports, and the likelihood of large scale changes to the ACA in the very near future, make now a good time to ask: “Is digital health living up to the hype?”

Digital Health is Still Growing

No doubt digital health is big business. The global market, according to a recent report, is valued at $11.47 billion in 2014 and is projected to grow to $102 billion by 2022.  Blood pressure monitors and blood glucose meters have the largest share of the market which includes pulse oximeters, multi-parameter trackers, sleep & apnea monitors, fitness sensors, neurological monitors, heart rate meters, EKG monitors, cardiac monitors, and more.

No Real Clinical Utility for Pricey Conditions

While there has been a sharp increase in consumer adoption of both mHealth and telemedicine the majority of mhealth users are still people who are in good health. More than half of those who report using a wearable are not doing so to monitor a health condition. An Accenture report found that only 2 percent of the patients at the 100 largest hospitals are using mobile health apps even though 66 of those hospitals offer them.

While the digital health market is growing, it has not established itself (or begun to do so) as effective in treating the chronic conditions that drive-up healthcare costs. A recent analysis of spending by disease identified diabetes as the most expensive condition accounting for $101 billion in diagnosis and treatment costs in 2013 and its cost is growing 36 times the second most pricey condition, ischemic heart disease. Real clinical utility for these chronic conditions is not yet at hand. Brian Kalis, managing director in Accenture’s Health practice says that apps are not engaging patients.

MHealth experts: Healthcare Providers need to take Digital Health Seriously

While some say that the apps are not good enough, others say that healthcare is not taking them seriously enough. In fact, healthcare is beginning to move toward serious adoption of mhealth but have continuing concerns about efficacy, privacy, and safety.

Last month, the AMA adopted a set of principles on mHealth apps. Among the guidelines for incorporating digital tools into their practices were effectiveness, data protection, and safety. The AMA recommends that physicians consult lawyers to ensure that privacy and security laws are met.  However, the recently passed 21st Century Cures act limited the FDA’s ability to regulate apps and devices and this could reduce the clarity about safety and effectiveness.

Patients share their physician’s concerns about privacy.  No doubt privacy concerns are fueled by ongoing hacks of healthcare data. A recent poll of consumers found that patient concerns about data privacy are climbing. Interestingly, this feeling also involves their assessment of their physician’s tech abilities.  69% of patients confirm their belief that their current primary care physician does not demonstrate enough technology prowess for them to trust divulging all their personal information.

Healthcare providers are beginning to show up at CES. The 2017 Health Care Summit at CES includes executives from Phillips, UnitedHealth Group, Harvard Medical School, the Cedars-Sinai Health System, the Mount Sinai Health System and more. Topics on the agenda include gamification in diabetes management, digital tech and obesity, the opioid epidemic, precision medicine and more. Additionally, this year, Dr. Mehmet Oz & ResMed are expected to release the results of a national sleep study. Interestingly, it could be that apps that promote our sleep health may also have an impact on diabetes costs because our sleep health appears to be tied to risks for both obesity and type 2 diabetes.