By Matthew Holt

A few weeks back we welcomed John Goodman as a contributor at THCB. His first column was more than a tad critical of me for impugning the ethics of Harvard Business School Prof Regina Herzlinger. Herzlinger, you may recall made a boatload of money off her position on the board of directors of Wellcare. Wellcare was operating a Medicaid and Medicare HMO in Florida, while basically using that not-too-sacred trust as an excuse to defraud the taxpayer.

Due to the demands of reality cutting into my work-life, my blow-by-blow analysis of Wellcare’s bad behavior has waned a little, but here I instead commend to you the consistently great work of Roy Poses over at Health Care Renewal. Earlier this month Roy took a look at the latest chapter in the tawdry tale. I encourage you to read his article for the full tale, but essentially even despite the settling of the criminal and civil charges for theft of around $46m, there’s a brand new set of charges from the same period—this time theft is alleged of up to $600 million. This new set of allegations were collected by (FBI informant & Wellcare financial analyst) Sean Hellein who wore a wire for more than a year, and probably stands to make a packet in the qui tam suit.

And not that I’d further besmirch the reputation of Prof. Herzlinger, but the time period all this happened was while she was still on the board, and none of these were given as her expressed reasons for leaving. Then it struck me, is Regi in on the qui tam suit too? That would be the way to make serious money out of her insider knowledge.

By Matthew Holt

I get emails from PR companies all the time pimping this or that client, but they don’t get a lot stranger than this one. (I‘ve hidden the names to protect the guilty):

Subject: Top 3 Reasons Why Health Insurers Are On Your Side…

Hi Matthew,

Health plans are typically portrayed as the evil empire, bent on raising premiums and squeezing every shred of patience out of their members. But, what if I told you that in reality, that isn’t the case?

Here are the top 3 reasons why your health plan really is in your corner and why it is in their best interest to keep you healthy:

1. The healthier you are, the more profitable it is for your insurance provider. Therefore they should go out of their way to keep you healthy with preventative care recommendations.

2. Your health insurer is in a position to get you access to the providers and specialists you want, when you want them. A plan biggest differentiator and selling point is its provider network. It benefits both the plan and the member to have the most skilled, sought after providers a part of the network.

3. Health plans have a 360 degree view of every member’s care. Unlike individual healthcare professionals, plans know every touch point their members have with providers and can make care recommendations.

How about a story that looks at why plans get a bad rap, and actions they are taking that are in their members’ best interests that aren’t typically publicized?

I can put you in touch with REDACTED of HEALTH IT VENDOR who can elaborate on the top 3 reasons and discuss steps that plans are taking to improve the flow of information between plans and providers and plans and members leading to more efficient and effective care.

What do you think?

Regards,
REDACTED

I thought that the careful THCB reader might come up with some interesting analysis about whether health plans are actually doing what this PR maven thinks they’re doing. And I’m sure one or two other THCB readers may not be convinced that insurers are “on your side”

By Matthew Holt

I don’t often write about Footy any more on THCB, but England is out of the World Cup today, stuffed 4–1 by Germany. So I thought I’d give my opinion, and for the moment I’m dropping my dual nationality and writing as an Englishman!

Why did we lose? Realistically England doesn’t have enough good players because England’s population is too small (50m vs 80m Germans) and—as pointed out in Soccernomics—the working class ethos against middle & upper class kids limits our potential pool of players even more—as England’s working class population is falling relatively as more kids go to college. In general England could improve our football team by changing its economy to match the slums of Argentina’s or Brazil’s but I wouldn’t take that as a fair trade. After all, the US dominates international sport (except its fifth most important sport soccer) because it has a huge urban underclass with a great feeder system (that’s colleges!) to getting them into basketball/American Football/Track etc. And it may well be that with more and more kids from the big urban centers getting into soccer, America can only improve. It’s a decent prediction that the US will win the World Cup in the next 50 years or so. Unlikely that England ever will again.

Continue reading…

By Matthew Holt

I (and a few THCB friends like Brian Klepper, Maggie Mahar, Michael Millenson & Barbara Ficarra) have been doing quick spots on KOMO a talk radio station in Seattle. We’re on every Tuesday & Friday at about 10.25 EST. Usually I forget to record it but today I captured my 60 seconds of joc(k)ular wisdom on the topic of whether late goals in the World Cup are bad for your health?

Here’s the interview…(only 90 seconds!)

Soccer bad for your health?

By Matthew Holt

At the AHIP conference in Vegas earlier this month I sat down with the CEO of Alere, Tom Underwood, and long-time friend of The Health Care Blog, Gordon Norman (Alere’s SVP of Innovation). I asked Tom about the services they provide within personal health support and their recent acquisition of RMD Networks. 

Gordon got the big question: does disease management program really work? Tom got the easy questions about the future of the business.

By Matthew Holt

Queen of shoes Inga at HISTalk got ahead of the news (she tweeted about 2 hours before the announcement—not sure if that led to the news being moved up—but the Eclipsys stock showed no sign of word getting out in advance and the website they’ve put up looks very thrown together!).  Inga also has the best summary.

The deal is that Allscripts is going to buy out Misys (which owned a majority stake following Allscripts buying the former Medic practice management system but was always trying to get out of the US HIT business) at about it’s rough current market price, and pay it a spiff on top of over $117m. I’m up with insomnia, so the US market isn’t open and we can’t know how it’ll like it. But the UK is open and Misys is trading 20% higher. So my guess is that Allscripts will take a hit for that. Meanwhile it’s paying about a 20% premium for Eclipsys. In the end Eclipsys shareholders will have 37% of the combined entity, Misys will keep a chunk of about 10% that Allscripts can buy out post closing. Allscripts CEO Glen Tullman will stay CEO, and Eclipsys’ CEO Phil Pead will be Chairman with a list of tasks that suggests that he’ll have more time on the golf course than Glen.

Does it make sense? Other than the financial deal, this is a moderate size bet from Allscripts, which is about double the market cap of Eclipsys. The bet is that there are enough hospitals who (like it’s star client North Shore-Long Island Jewish) will buy both an inpatient system and an integrated outpatient system for their affiliated physicians. They claim that it’s about 35% of the market.

But that remains to be seen. Most of the hospitals who are big enough to be “hubs” have already made a bet on an inpatient vendor, and in general that hasn’t been Eclipsys. (Calling them a “leader” in hospital IT is somewhat redefining the term) Whether enough of them are reconsidering their whole approach I doubt. But on the other hand Allscripts has shown that it can integrate diverse product lines with several of its acquisitions and make good business decisions about it (although not always thrilling customers who thought they were buying an ongoing product). And Eclipsys is profitable, so the downside risk doesn’t seem too high.

I guess the only real question is raised in a separate NY Times article yesterday which suggested that meaningful use criteria were so impossible that no one could possibly get the government’s money. Of course the expectation that EMR use will dramatically grow is the main justification behind Allscripts’ merger driven growth the last few years.

BTW checkout slide 21 on the slide deck of the announcement. Glen still can’t resist taking a crack at a certain CEO in Madison, Wisconsin.

By Matthew Holt

One of my favorite people has the (first of) her (several) 15 minutes of fame in the NY Times today. Alex Drane tells all about growing a small business into a pretty big one (although it’s in the NY Times art of running a small business section as I guess Eliza isn’t General Motors). Most interesting thing they print is that she recruited her team by stealing them from her competitors. Her technique was to call them up and ask the person they wanted if anyone they knew needed a new job! And apparently she wants all her employees to leave and run their company (or maybe she was misquoted!)

But don’t forget that besides her day job Alex is the force behind Engage with Grace which she’s taking to TedMed this Fall (yes we know the TedMedsters are two years behind Health 2.0, but we’ll forgive them in this case).

But most importantly, look at that smile….

And you’ll see Alex at Health 2.0 Goes to Washington if we can just wrestle her to get her demo in order later this week!

CODA–And as an added bonus I got to record a podcast with Alex this very afternoon! (Click on the dark bar below and it turns into a player)

Alex Drane interview