Since the death of Steve Jobs, many writers have tried to define and then apply his business lessons to other companies. But in our small world, much of the Jobsian commentary has focused on the futility of applying the Apple magic to healthcare. Matt Herper, for example, wrote a thoughtful column in Fortune but ended up concluding that while “hospitals could use someone to stitch all the gadgets together, and make it all perfect… there … Continue reading
Reimbursement as Environment
Who controls reimbursement? Talk to a drug company, or most pharmaceutical analysts, and the answer is payers. Talk to payers and the answer is far more complicated – and not one where they claim overall control of the process. The fact is reimbursement doesn’t come down to a decision; it’s an environment. And like any environment, its effects have multiple causes. I don’t pretend to fully understand why sales of Dendreon’s prostate cancer therapy, Provenge, … Continue reading
Healthcare's Topeka Problem
You might have heard that, for about a month, domestic abusers in Topeka roamed free. Not because the community encourages wife-beaters. But because it couldn’t afford to prosecute them. County DAs, dealing with a 10% budget cut, said they didn’t have the money to go after misdemeanors, including domestic abuse. So they sent the cases over to Topeka city prosecutors, who, suffering under similar economics, likewise claimed they couldn’t afford to prosecute under the local … Continue reading
At the Shadowy Intersection of Payers and Product Companies
I suppose it’s understandable, given the history. Payers don’t trust the cost-effectiveness information pharma and device companies provide them about their products. (It does always somehow prove the supplier’s economic value.) Manufacturers, for their part, figure that whatever decision a payer makes, it’s always going to be driven by short-term economics. In fairness, it often is. This mutual distrust isn’t particularly problematic when a healthcare economy has plenty of room for growth. Generally, both groups … Continue reading