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Arbitrator awards fired Swedish Health whistleblower surgeon $17.5M

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http://www.fiercehealthcare.com/healthcare/arbitrator-awards-fired-whistleblower-17-5-million?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWWpaa1lUTXlOREU0WldReSIsInQiOiI5Zzg4Q1p0YUpoZklLQTdYRWFjOFNsTFJBM3RXdHBDdlhjT3dpXC9BUUJWWjdcLzF1QWg0NXpHWFA4bk1Oc01taUhcL3Q0YjFqdWptYmY5V2VwUjkzK2poNElYdUNOelpIUHV1RzY3Z3dTV1lDckY1SUVQRFdwUnp6amV4RTIzalEwNyJ9

Legal cases

A substantial payout for a fired whistleblower has Swedish Health crying foul. The organization will now challenge the arbitrator’s award in court.

David Newell, M.D., blew the whistle on a high-profile case involving neurosurgeons who double-booked patients for surgeries at a Swedish Health hospital in Seattle. The fallout from that case was sufficiently brutal for the CEO of Providence St. Joseph, which acquired Swedish, to take out a full-page ad in The Seattle Times apologizing to the organization’s employees and patients.

Now, The Seattle Times reports, an arbitrator has agreed with Newell’s claim that Swedish fired him in retaliation for his whistleblowing activities, and awarded him $17.5 million. The award reportedly includes $15.5 million in lost earnings and another $1 million for emotional distress.

Swedish Health contends it fired Newell after he failed to immediately disclose he had been arrested in a prostitution sting, as required by his employment agreement. The organization also protested the amount of lost earnings requested, noting that the figure represented nearly 10 times his annual compensation in 2014, and that he would have needed to perform more than 3,000 complex brain-aneurysm procedures in a year to reach such an amount.

Guy Hudson, M.D., the CEO of Swedish, blasted the ruling in a statement (PDF). “For this arbitrator to award Dr. Newell $17.5 million—at a time when many people cannot afford healthcare or fear losing their insurance, and when there is an epidemic of sex trafficking and exploitation of women—is unconscionable and outrageous,” he said.

But the newspaper reports that in a recent court filing, Newell’s attorney maintained that evidence presented showed Swedish Health’s actions “were part of a pattern of targeting and interfering with established neurosurgeons’ practices, retaliatory behavior, and a disregard for patient safety.”

In a similar case, a court recently ruled in favor of a Boston-based surgeon who lost his job at an upstate New York hospital after speaking out about concurrent surgeries performed there by another doctor. Lost wages in that case totaled $88,277.

Centrist Democrats Turn to Pragmatism, Seek Bipartisan ACA Fixes

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https://morningconsult.com/2017/09/15/centrist-dems-seek-bipartisan-aca-fixes-not-single-payer-plan/

Click to access attachment-1.pdf

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While some progressives campaigned this week for “Medicare for all,” a group of moderate House Democrats aligned themselves with a more modest push to stabilize the Affordable Care Act, arguing that it could spur broader health care reforms in the future.

Thirty-eight of the 61 members of the New Democrat Coalition sent a letterFriday urging the leaders of the Senate Health, Education, Labor and Pensions Committee to agree on a bipartisan bill to keep premiums from rising further for Obamacare enrollees next year.

The letter outlines five short-term proposals agreed to by the group — several of which are likely to be included in the Senate bill, such as the extension of key insurer payments known as cost-sharing reductions.

New Democrat Coalition Chair Rep. Jim Himes (D-Conn.) said that while some Democrats and Republicans continue to push polarizing health care plans after the July collapse of Senate Republicans’ Obamacare repeal push, some lawmakers of both parties are ready to try bipartisanship.

“There’s a pretty substantial group of Democrats and Republicans who are ready to work together and get some things done on this most politically charged of topics,” Himes said in an interview Thursday.

Only three of the 38 Democrats who signed the letter are co-sponsors of a single-payer health care bill introduced by Rep. John Conyers (D-Mich.) that has been endorsed by approximately 60 percent of the House Democratic caucus; Sen. Bernie Sanders (I-Vt.) introduced similar legislation in the Senate on Wednesday.

But the progressive single-payer legislation has almost no chance of passing the Republican-led Congress, and members of the New Democrat Coalition are taking a more pragmatic approach: While “Medicare for all” proponents support placing nearly all Americans on a government plan, the New Democrat Coalition is backing reforms to improve private health insurance coverage and reduce health care costs.

“We believe these ideas provide a framework to reduce health care costs for families and seniors, increase choices for consumers, and encourage participation by the young and healthy,” the Democrats wrote in the letter.

Some members of the New Democrat Coalition are also in the House Problem Solvers Caucus, which consists of centrist GOP and Democratic lawmakers and sent its own letter Wednesday urging the Senate HELP and Finance committees to move toward a bill as a crucial Sept. 27 deadline for insurers approaches.

HELP Committee Chairman Lamar Alexander hopes to reach an agreement on the legislation by early next week, the Tennessee Republican said at a hearing on Thursday.

 

Relevance is King, and “The Top of the Funnel” is Most Relevant to The Most People

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http://thinkrevivehealth.com/2017/09/relevance-is-king-and-the-top-of-the-funnel-is-most-relevant-to-the-most-people/

 

CVS’ recent announcement that the company is expanding its reach in chronic care management is the latest sign that the market has never been more competitive or complicated. (Are you asking yourself, “which market?”) CVS isn’t just protecting its PBM business and driving sales for its retail business. The company has plans to provide one-on-one support and coaching — in a store, via phone, or video — to people who have diabetes, asthma, hypertension, hypercholesterolemia, or high cholesterol, and depression.

This, of course, follows in the footsteps of other companies encroaching on traditional provider-territory, like Optum. OptumCare, the care delivery arm of the company, has 22,000 physicians in 30 markets and 200 surgery centers in 33 states. The combination of the two presents a formidable continuum that could provide consumers with most of the outpatient services they’ll ever need. In other words, the health system brand defined by superior service lines will continue to be less and less relevant as the “top of the funnel” becomes more competitive and more important.

Despite the fierce competition, many health systems continue to focus a large majority of marketing dollars on down-funnel service line care, such as chronic disease treatments and surgeries. There’s logic to that strategy: market and differentiate the services that are most profitable and keep you in business. The problem is that logic doesn’t work in a digital age when consumers have more choices and less patience. Their healthcare mindshare is occupied by a host of companies — like CVS Health and OptumCare — that are more relevant to their daily life than heart surgery or cancer care.

HEALTH SYSTEMS MUST ESTABLISH (AND MAINTAIN) CONTROL OVER THE TOP OF THE FUNNEL

Therein lies the problem for health systems. When Joe Public interacts with your brand, relevance is king. And as we all know, specialty care isn’t relevant to the vast majority of people most of the time. When the competitive field wasn’t as crowded and consumers weren’t showered with more than 5,000 ads every day, it was easier to make an impression that might not be relevant in the moment but could be recalled later when it mattered. That day has passed. The emphasis must shift from awareness and impressions to real engagement.

Health systems — just like any other brands — must be relevant and provide value as often as possible to stay engaged with consumers. Think about your continuum of services as a funnel (Figure 1). Primary care, urgent care, ER, and health & wellness programs sit at the top as these are the services most often used, and represent the most common entry point into your system.

They are also more subject to cost and convenience scrutiny. To maximize the path to specialty and surgical care in the middle of the funnel, health systems can’t just rely on people who go through the side of the funnel – those who did their research to determine which hospital had the best cardiovascular outcomes in the region. For most health systems, the vast majority of their down-funnel, inpatient service line volume — more than 75% — comes from prior top of the funnel activity, not from out of the blue. Health systems need to get as many people in the top of the funnel to build brand, build engagement, and feed all service lines.

Why? Because this is the best way to engage consumers and build brand loyalty. Brand loyalty develops as consumers repeatedly engage with a service over time, and they become repeat customers if they are satisfied. A good experience at the top of the funnel can lead to more profitable business in the middle of the funnel. In fact, our research and work with hundreds of health systems across the country reveals that most people who receive specialty care at a health system had at least one prior experience. And where does most engagement with the healthcare system occur? At the top of the funnel.

Back to CVS. Health systems run the risk of being expensive specialty factories if they cede control of the top of the funnel to competitors — especially competitors who are not other hospitals. The strongest relevance is at the top of the funnel, which is where prescriptions and chronic care management live along with a host of other more frequently used services. CVS Health, Optum, Walgreens, Amazon, and even Google present formidable, well-resourced companies vying for the top of the funnel in some capacity.

What’s your strategy?

Bill Gates thinks an infectious disease outbreak could kill 30 million people at some point in the next decade — here’s how worried you should be

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http://www.businessinsider.com/pandemic-risk-to-humanity-2017-9

http://www.globalgoals.org/goalkeepers/datareport/

bill gates

As hurricanes and other natural disasters ravage the world and the threat of nuclear war looms, it’s hard to assess which risks for humanity are really the scariest right now.

But one of the biggest threats out there is one of the oldest: infectious disease, which can emerge naturally or be human-made, as in a case of bioterrorism.

As Bill and Melinda Gates wrote in their recently released “Goalkeepers” report, disease — both infectious and chronic — is the biggest public health threat the world faces in the next decade. And although Gates said on a press call that “you can be pretty hopeful there’ll be big progress” on chronic disease, we are still unprepared to deal with the infectious variety.

Gates has repeatedly stated that he sees a pandemic as the greatest immediate threat to humanity on the planet.

“Whether it occurs by a quirk of nature or at the hand of a terrorist, epidemiologists say a fast-moving airborne pathogen could kill more than 30 million people in less than a year,” Gates wrote in an op-ed for Business Insider earlier this year. “And they say there is a reasonable probability the world will experience such an outbreak in the next 10-15 years.”

Gates is right about the gravity of that threat, according to experts in the field.

George Poste is an ex officio member of the Blue Ribbon Study Panel on Biodefense, a group created to assess the state of biodefense in the US,.

“We are coming up on the centenary of the 1918 influenza pandemic,” he told Business Insider. “We’ve been fortunately spared anything on that scale for the past 100 years, but it is inevitable that a pandemic strain of equal virulence will emerge.”

The 1918 pandemic killed approximately 50 million people around the globe, making it one of the deadliest events in human history.

David Rakestraw, a program manager overseeing chemical, biological and explosives security at Lawrence Livermore National Laboratory, and Tom Slezak, the laboratory’s associate program leader for bioinformatics, also agree with Gates.

“Both natural and intentional biological threats pose significant threats and merit our nation’s attention to mitigate their impact,” they told Business Insider in an email.

It’s possible that a major outbreak could be intentionally created as the result of a biological weapon, but Poste thinks a serious bioterrorism attack is unlikely due to the complexity of pulling something like that off.

It’s very likely, however, that a highly dangerous disease would naturally emerge — and the consequences of that pandemic would be just as severe.

Regardless of how a disease starts to spread, preparedness efforts for pandemics are the same, according to Poste. And the recent outbreaks of Zika and Ebola have highlighted the need for more heightened disease surveillance capabilities. We’re still getting a handle on the health effects of Zika — and it seems like the mosquito-borne disease may be even more severe than we thought.

Experts have long advocated for better ways to recognize emerging threats before they become epidemics or pandemics. Poste also said we need to improve rapid diagnostic tests and get better at developing new therapeutics and vaccines — something Gates highlighted as a weakness in the “Goalkeepers” report as well.

Until that happens, that threat remains far more real than many of us realize.

 

The Best Health Care System in the World: Which One Would You Pick?

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“Medicare for all,” or “single-payer,” is becoming a rallying cry for Democrats.

This is often accompanied by calls to match the health care coverage of “the rest of the world.” But this overlooks a crucial fact: The “rest of the world” is not all alike.

The commonality is universal coverage, but wealthy nations have taken varying approaches to it, some relying heavily on the government (as with single-payer); some relying more on private insurers; others in between.

Experts don’t agree on which is best; a lot depends on perspective. But we thought it would be fun to stage a small tournament.

We selected eight countries, representing a range of health care systems, and established a bracket by randomly assigning seeds.

To select the winner of each matchup, we gathered a small judging panel, which includes us:

  • Aaron Carroll, a health services researcher and professor of pediatrics at Indiana University School of Medicine
  • Austin Frakt, director of the Partnered Evidence-Based Policy Resource Center at the V.A. Boston Healthcare System; associate professor with Boston University’s School of Public Health; and adjunct associate professor with the Harvard T.H. Chan School of Public Health

and three economists and physician experts in health care systems:

  • Craig Garthwaite, a health economist with Northwestern University’s Kellogg School of Management
  • Uwe Reinhardt, a health economist with Princeton University’s Woodrow Wilson School of Public and International Affairs
  • Ashish Jha, a physician with the Harvard T.H. Chan School of Public Health and the director of the Harvard Global Health Institute

A summary of our worldviews on health care is at bottom.

So that you can play along at home and make your own picks, we’ll describe each system along with our choices (the experts’ selections will decide who advances). When we cite hard data, they come from the Commonwealth Fund’s International Country Comparison in 2017.

But enough talk. Let’s play.