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Health Issue Online

Most of Jeff Goldsmith’s writings- ranging from health policy analysis to market trends- have appeared in diverse online publications, including Harvard Business Review, Health Affairs and The Healthcare Blog.

Selected writings appear in chronological order, listed below with links.

Health Issues Online

Feb 2023: Last in Line Hospitals saved hundreds of thousands of lives in the US during COVID, but at an horrendous cost in burnout both among its clinical and management staffs. As the country struggles to tame inflation post-COVID, hospitals find themselves losing tens of billions of dollars on operations, and will be “last in line” to readjust their rates to the exploding people and material cost of care. Hospitals have also been targets of unrelenting criticisms from academic, the press and policymakers. How can they regain their financial footing in this hostile atmosphere, and demonstrate the value they create for society. Feb 23, 2023

Oct 2022: Has “Disruption” Reached its Sell-by Date? In 1997, Harvard Business School’s Clayton Christiansen published an influential treatise on industry economics entitled The Innovator’s Dilemma. In it, he discussed how technical and business model innovation works to overthrow entire industries. Released at the peak of the late 1990’s Internet boom, Christiansen’s book had widespread influence and enshrined the notion of “disruptive innovation” at the core of business strategy in healthcare. Twenty-five years on, the “disruption” meme is showing signs of aging, and decreasing usefulness in guiding investment in healthcare. How do we think constructively about innovation in healthcare? Oct 12, 2022

Oct 2022: The Future of Practicing Physicians in a Corporate World The past two decades have seen a marked decline in physicians’ economic and political power. Private medical practice has withered, and as many as one-third of physicians are now employed by hospitals in the US. More than a hundred thousand more physicians are employed by corporations, health insurers and private equity firms. As the baby boom generation retires, however, physicians will become increasingly scarce, driving up not only their incomes but also their professional power. How will they use their increasing power? Oct 14, 2022

May 2022: United Healthcare Anatomy of a Behemoth On May 25, Jeff Goldsmith posted on Medium a detailed analysis of the business model and strategy of UnitedHealth Group, a $300 billion integrated health insurer. In addition to being the US largest health insurance enterprise, United has greater assets and earnings than Exxon Mobil. It is the also largest employer of physicians in the US, and second only to the British National Health Service in the world. Yet this vast enterprise, which is within reach of being 10% of total US health spending, is poorly understood and appreciated in the industry. May 23, 2022

May 2022: The Reckoning: What Happens to Digital Health After COVIDWith Advisory Board President Eric Larsen, Jeff Goldsmith laid out the root causes of the crash in digital health company valuations in 2021-22 and explored how customer needs will determine the size and shape of this promising field. It is wrong to think of digital health in isolation from the existing care system; it is not a new care system, but rather a force multiplier of the core relationships that are at the heart of medicine. What forces will govern the consolidation of the digital heatlh sector? May 9, 2022.

Feb 2022: After the CrashAfter an astonishing run during COVID, digital health and tech stocks withered in a broader collapse of NASDAQ companies in early 2022. What do past industry cycles teach us about how important innovations recover from initial challenges and become essential to our lives? How will health tech recover from the crash and what do innovative companies have to do to power through the downturn? Feb 3, 2022.

Jan 2022: Trusting Relations are the Core of Medicine: Can Telehealth Support Them?The rise of telehealth in the midst of COVID has challenged the conventional wisdom about clinical medicine and opened channels of access, particularly for mental health care, that will be vitally important beyond the pandemic. How will patients use these tools? Is digital health a new sector of medicine, or a powerful tool for strengthening existing relationships, or both? Jan 12, 2022.

Jan 2021: Digital Health: How to Avoid a Second TechLash Digital health offerings have dramatically expanded during COVID, catalyzing tens of billions of venture and private equity funding for new ventures. And yet digital health enthusiasts are making many of the same mistakes that proponents of the electronic health record made two decades ago. How can digital health offerings fit into and improve US healthcare, while improving communication, co-ordination of care and patient/consumer safety. Jan 8, 2021

Nov 2020: An American Disgrace Jeff Goldsmith reviews Anne Case and Angus Deaton’s “Deaths of Despair” for Health Affairs. Nov, 2020

Jul 21, 2020: Managed Care 3.0: Rise of the Robots Much is being made of the potential of artificial intelligence (AI) in healthcare. Little did care providers know that it is already affecting their cash flow! Managed Care 3.0 explores how AI assisted robotic process automation is being used by large and little known healthcare revenue cycle vendors to scrub (and reject) medical claims. Care systems are fighting back with their own AI-assisted systems. Read about this rapidly emerging sector and its risks to care providers Jul 21, 2020

Feb 10, 2020: Jeff Goldsmith looked at seven trends in medicine that were likely to dominate the decade of the 2020s. It was posted a month before the COVID pandemic surfaced in the US, which he did not predict. Despite the ensuing carnage, Jeff Goldsmith stands by this forecast. Feb 10, 2020

Jan 24, 2019: What A Health System Is and Isn't This term is grossly overused in health care delivery. The key to “system-ness” is consistent and effective management- motivating and guiding clinical care, delivering measurable value to patients and affirmatively controlling the delivered cost of care. Jan 24, 2019

Nov 15, 2018: Health systems Need to Completely Reassess How They Manage Costs. In this Harvard Business Review online posting, Jeff Goldsmith says that health care executives frequently tell him that, in response to recent financial pressures, that “they have done all the easy stuff”. This article explores what they will need to do to actually get control over their costs. If they believe they have picked all the “low hanging fruit”, this article argues that “it is time to get a ladder”. Nov 15, 2018

May 29, 2018: Do Hospitals Benefit from Employing Physicians? Over the last decade, hospitals have employed more than a hundred thousand physicians, many formerly in private practice. Recent evidence suggests that each practice generates direct losses of nearly $200 thousand per year, before considering incremental hospital market share gains. How should hospitals think constructively about the complex challenges surrounding physician employment, and create value both for patients and their physicians? This Harvard Business Review article, with Navigant colleagues Alex Hunter and Amy Strauss, frames and answers these questions. Oct 5, 2017

Mar 30, 2018: Fix the EHR! The so-called Electronic Health Record has become a major source of professional dissatisfaction in healthcare. With Dr. Robert Wachter, Chair of Medicine at the University of California at San Francisco and author of Digital Doctors, Jeff discusses what has gone wrong with the design of this complex tool, and lays out the major changes that need to be made in EHRs for them to achieve their potential in improving both care and the patient experience. Mar 30, 2018

Nov 10, 2017: What to Do About Hospitals’ Medicare Financial Losses. This Harvard Business Review blog posting is a follow up to the October blog, and explores why losses in treating Medicare patients have soared (to more than triple the losses from Medicaid patients!), and how hospitals can work with their clinicians to improve care processes, eliminate needless variation in use of the hospital’s services and reduce those losses. Nov 10, 2017

Oct 5, 2017: What Hospitals Can Do to Reverse their Sliding Financial Performance. This Harvard Business Review blog posting examine the causes of the sharp deterioration in hospital operating earnings during 2016 and early 2017, and outlines essential strategies managements should pursue to reverse those declines. Oct 5, 2017

Aug 22, 2017: Confessions of a SuperUser This posting explores what Jeff Goldsmith learned about the health system he has worked in for over forty years as a patient. It examines his experience of five complex surgical episodes in four different health systems, and how theories of how the health system works match up against the patient experience. Aug 22, 2017

May 9, 2017: To Profit from Uncertainty, Hospitals Must Become Anti-Fragile This Modern Healthcare OpEd discusses Nasim Taleb’s book Anti-Fragile: Things that Gain from Disorder and its relevance to healthcare management. In particular, health systems actually become more difficult to manage and their business risks increase as they become larger, and diversify into unrelated businesses. How hospital managements can manage uncertainty is an increasing challenge as the industry consolidates. May 9, 2017

Mar 8, 2017: “Repeal and Replace ObamaCare” was one of the slogans that powered Donald Trump’s upset victory in the November 2016 Presidential election. How ironic, then, that the actual proposals would have badly damaged both the states and working class voters that put the President in office. Read about the cruel paradox of Repeal and Replace and why it ultimately failed. Mar 8, 2017

Mar 8, 2017: Geisinger’s Transformation: Balancing Risk and Growth This posting in Health Affairs blog examines the unconventional turnaround Strategy which Glenn Steele pursued as CEO of the Geisinger Health System that led both to financial success and a remarkable clinical transformation that made Geisinger one of the national leaders in healthcare redesign. Mar 8, 2017

Sept 29, 2016: Fail to Scale In winemaking, some wines only grow in highly defined localities. The concept is terroir. In US health policy, multiple examples of the same phenomenon exist: Kaiser, physician sponsored independent practice associations, hospital system sponsored health plans thrive in some parts of the US and wither in others. Why is this? Why do great ideas in healthcare repeatedly fail to scale up nationally? Read Fail to Scale: Sept 29, 2016

June 16, 2016: All Risk is Local We all knew how this was going to go, or thought we did. Healthcare payment is moving from volume to value, led by the Medicare program’s historic ACO program, and private markets are going to be fundamentally restructured by ObamaCare. Well, it didn’t work out as we expected, and the shift to value is HIGHLY dependent not on the federal government, but rather state Medicaid programs, some of which pay at 65 cents on the dollar relative to cost. Private insurance markets are in turmoil as a result of ACA, and new payment models are taking a back seat to major underwriting losses. What difference does it make? Read All Risk is Local and find out. June 16, 2016

May 9, 2016: The Tangled Hospital Physician Relationship Hospitals have employed tens of thousands of physicians in the past decade, a sixty percent increase from 2003 to 2014. Tens of thousands more depend on hospital subsidies of various kinds. And yet the private practice of medicine is far from dead, as single specialty physician groups increasingly dominate lucrative medical and surgical specialty markets. Power is shifting between hospitals and physicians with the growth in new payment models, but in which direction? How to make sense of this troubled and tangled relationship is discussed in The Tangled Hospital Physician Relationship. May 9, 2016

The C Word: Why Calling Patients "Consumers" Is an Insulting Caricature: That patients are becoming consumers of healthcare implies both discretionary purchasing power and leverage that, in most real world situations does not accurately reflect either their powerlessness or their priorities. Why we need to find better language to describe the patient role in the health system. April, 2016

Why the Health System's Performance is Improving: Death rates for the three major killers of Americans has plummeted in the past thirty years, despite the fact that we have cured none of them. How has professional collaboration and continuous improvements both in technology and care processes has made the health system safer and more effective. March, 2016

2014 Health Spending: The Great Moderation is Likely Not Over: Health spending growth spiked upward in 2014, after a decade of moderation.
In this posting, Jeff Goldsmith argues that the factors leading to the 2014 spike are one time costs related to the Affordable Care Act's implementation and does not alter the trajectory of core costs. December, 2015

October, 2015: In attempting to explain the seemingly endless rise in health costs, politicians and the health policy community have evolved two explanations of the root cause: moral failure by either care providers or by patients. Read why both conservative and progressive policy narratives are flawed, and should be replaced by a broader and more nuanced explanation, leading to different remedies. Read Moral Failure and Health Costs: Two Simplistic Spending Narratives October 27, 2015

July 26, 2015: Healthcare executives and clinicians seem to spend half their lives in meetings of questionable productive effect. Read why this is likely to change as younger people replace boomers in key positions and new technology makes better decisionmaking possible in: Death by Meeting

July, 2015: Population health-based payment (e.g. capitation) is expected by many in the health industry to replace the current fee-for-service methods of paying doctors and per admission or per procedure payment of hospitals. Read why this is unlikely to happen: Shift to Population-health payment unlikely to come anytime soon July 18, 2015

March, 2015: Is it inevitable that most care in the US will be delivered by so-called Integrated Delivery Networks, that span hospital, physician and post-acute services and offer these services through their own health plans? This model of care organization was felt to offer less expensive care at higher quality than less integrated enterprises. In a comprehensive review of the economics literature as well as a preliminary look at new data, Jeff Goldsmith and Rob Burns of the Wharton School of Finance at the University of Pennsylvania found no evidence either of savings or improved quality from these complex care models. Read Integrated Delivery Networks: Is the Whole Less than the Sum of the Parts? March 7, 2015

November, 2014: In this essay, Jeff Goldsmith surveys the US healthcare landscape and finds a remarkable amount of good news: subsiding health cost growth, an honest societal conversation about value rather than merely cost, improving hospital/physician relations, declining mortality rates from major diseases and other developments. Why isn’t all good news fully appreciated by those who organize and deliver care? When It Comes To Healthcare, The Glass is Half Full November 11, 2014

October, 2014: In this article, Jeff Goldsmith and James Orlikoff ask the question: when considering a merger, do hospital trustees honestly separate the future of the hospital from their own future as leaders? Are many mergers simply a reflection of a failure of succession planning, both for the Board and its management, or the actual prospects for their institution? The authors urge trustees to consider their own legacies and to plan effectively for leadership succession. Mergers as a Substitute for a Strategy October 15, 2014

September, 2014: In this interview, Jeff Goldsmith talks with the recently retired CEO of the $60 billion Kaiser Permanente Health Plan about his turnaround strategy at Kaiser, his activism during the 2008-2010 health reform debate, the health system’s unfinished business and his future plans as an advocate for reducing healthcare disparities. Interview with George Halvorson September 30, 2014

June, 2014: Hospital systems like Boston’s Partners Healthcare and Northern California’s Sutter Health are supposed to exert virtually unchecked economic power in their local health insurance markets. Many health policy experts believe they have enough clout with health insurers to charge what they wish for their own services. So why did these and other high quality health systems suffer sharp economic reversals at the end of 2013? See How Much Market Power Do Hospital Systems Have: June 12, 2014

May, 2014: Physicians are spending more than a day a week on paperwork, and nearly $85 thousand a year on administrative costs related to billing and “quality reporting”. Administrative costs are drowning independent physicians and driving them to sell their practices. Jeff Goldsmith proposes a solution: Charting Day May 10, 2014

March, 2014: Hospitals all over the United States are seeing fewer inpatients and their revenues have basically ceased growing, despite five years of economic recovery. Traditional strategies such as merging to get market power with health insurers and acquiring physician practices don’t seem to be working. What is happening to the nation’s hospital industry and what do boards and managements need to do to cope with a rapidly worsening economic outlook? Can Hospitals Survive, Part II: March 14, 2014

August, 2013: Health costs are slowed to a near standstill. What caused it? What does it mean? Is the pause durable or transient? Read: Health Cost Inflation at Historic Low. August 1, 2013

May, 2013: The US hospital of 2013 is remarkably similar in technology and services to the US hospital of 1998. Have hospitals entered a 21st Century Time Warp? May 21, 2013

March, 2013: The largest problem the health system faces in the next decade is the retirement of the baby boom primary care physicians, just in time for boomers enrolling in Medicare and millions of newly covered by health reform. Younger physicians are not entering primary care because it pays so poorly. Can we design new primary care models to alleviate the impending shortage, or is something more fundamental required? March 28, 2013

January, 2013: For the third year in a row, health spending continues at pre-Medicare rates of cost growth. Is this new and welcome trend sustainable? Where is health spending headed? January 31, 2013

January, 2013: n December,2012, Jeff Goldsmith journeyed to Thailand, and visited the storied Bumrungrad Hospital. He was really impressed with what he saw. Read about why in The Accidental Tourist. January 24, 2013

August, 2012: While the US economy continues to labor to create new jobs, the health system has added over a million jobs since the beginning of the recession, despite falling physician office visits, hospitalizations, etc. What gives? Is health care an alternate economic universe? August 29, 2012

May, 2012: US health cost growth has reached a fifty year low. What does this mean for health policy? The key problem: nearly half the country cannot afford to use the health system without massive public subsidy. Why affordability, not cost growth, is the major health policy challenge. May 8, 2012

November, 2011: In a failed Congressional experiment with "global spending caps" on physician services, US physicians ended up owing Congress and the Medicare program over $300 billion. The Congressional advisory panel MedPac issues a flawed proposal for cleaning up the so-called Sustainable Growth Rate (SGR) mess. November 16, 2011

August, 2011: Continued economic troubles may be bringing healthcare’s three decade long run to an end. Can the health system adjust to scarcity? August 10, 2011

July, 2010: The US economy languishes while the health system continues adding jobs. Are the two phenomena related? Is America marooned in the horse latitudes? July 6, 2010

October, 2008: The world economy crashes, and comes within a hairs’ breadth of a catastrophic worldwide depression. For those of us genetically incapable of pessimism, the crash presented a dilemma. This, my sole posting on Huffington Post, proposed a new support group, called Optimists Anonymous. October 10, 2008

October, 2007: Health costs, which have risen at double digit rates for decades, began slowing down in the mid-2000’s, and no-one believed it. This posting, my first, discusses the politics of the perpetual health care crisis, and generated a lot of angry responses. October 3, 2007