Category Archives: Amazon, Berkshire Hathaway, Walmart and Uber

What Single Payer Healthcare Would Do For American Families; and Do We Need Medicare for All?

medicare360Lizzy Francis of Fatherly noted that Every Democratic frontrunner in the 2020 election has some sort of universal health care plan akin to Medicare for All. While all of their plans “possibly” answer a real question — how to fix a health insurance system that is expensive, confusing, and mired in bureaucracy — they differ in many ways. Meanwhile, pundits and moderate politicians have called single-payer unrealistic and expensive, while arguing that many people really like their private insurance and don’t want to be kicked off of it. Others worry about what it would do to the private health care system, which would be gutted. But the costs of considering single-payer are too big to ignore including the cost of establishing and running a system such as what the Democrats advertise as their solutions.

Today, individually insured middle class families spend about 15.5 percent of their income on health care — not counting what their employees cover in premiums before their pay even hits their paycheck. Meanwhile, the wealthiest Americans actually receive such great tax exemptions for their health care spending that they receive a surplus of .1 percent to .9 percent on top of their income.

“Overall health expenditures throughout the whole economy will go down, due to the efficiencies of a single-payer system,” says Matt Bruenig, lawyer, policy analyst, and founder of the People’s Policy Project, a think tank that studies single-payer healthcare. “And the distribution of those expenditures and who pays for those expenditures will be shifted up the income ladder. Middle class families can expect at least thousands of dollars of savings a year from not having to pay premiums or co-pays,” he says.

Today, families that make about $60,000 a year spend about $10,000 of their pay on health care. Under universal health care, they would pay less than $1,000 in taxes (really??) and no longer have to pay deductibles, deal with surprise billing, or contend with the fact that a major medical event could bankrupt them.

Aside from costs, there are more reasons our current healthcare system is failing families. For example, even someone on employer-sponsored health insurance who might like their health insurance has a one in four chance of getting kicked off of it over the course of any given year. And given that today the average worker has about 11 jobs from age 18 to 50, per Bruenig, health insurance turnover is all but inevitable for the modern worker.

The numbers on insurance turnover are alarming, starting with the fact that about 28 million Americans have no insurance at all. All of these people likely got kicked off of their insurance: the 3.7 million people who turned 65 in 2017, the 22 million people who were fired in 2018, the 40.1 million people who quit their jobs in 2018, and the employees who work at 15 percent of companies with employer-sponsored health insurance that switched carriers, the latter of which changes the providers that employees can see and causes a lot of paperwork. Then one must consider the 1.5 million people who got divorced in 2015 and 7.4 million people who moved states and the 35 percent of people on Medicaid had their income increase to the point where they were too well off for Medicaid but not well off enough to afford other insurance plans.

Beyond that, insurers are constantly changing what providers they work with, which means the doctor that someone sees in April might not be on their plan three months later. Employees and families often feel stuck to their jobs that may have a bad work-life balance, pay poorly, or otherwise not be a good fit because the costs of trying to get on another health care plan or the risks of leaving a job due to the health care plan it offers are far too high when kids are in the mix.

“Having consistency is key, even for people who have jobs,” says Bruenig. “That job will only last so long before they’re off to another one. They could get fired, the company could close down. Being in the labor force and having the security that [your insurance will] follow you no matter which job you go to is useful,” says Bruenig.

It’s especially useful for parents, who have more than their own health to worry about. And even people who have health insurance through their private plan or employer go bankrupt with alarming frequency. Out of pocket spending for people with employer-provided health insurance has increased by more than 50 percent in the last 10 years; half of all insurance policyholders have a deductible of at least $1,000; and most deductibles for families near $3,000. When more than 40 percent of Americans say they cannot afford an emergency expense of $400 or more, it’s a wonder to think how they could ever meet that deductible before their health insurance coverage kicks in. About one in four Americans in a 2015 poll said they could not afford medical bills, and another poll showed that half of those polled had received a medical bill that they could not afford to pay. Medical debt affects 79 million Americans or about half of working-age people.

Two thirds of people who file for bankruptcy say that their inability to pay their medical bills is why they are doing so. These are often people who are insured. These are people who should be protected. They pay into an insurance program — sometimes 20 percent of their income — in order to protect them and their families from this, but insurance companies do not protect them.

One reason is that in medical emergencies, ambulances often take people to the nearest possible hospital. That hospital might not be in their network. Or it might be, but the attending doctor might not be in their network. When the bill comes due, Americans are gutted. That would never happen under a single-payer system.

The average American middle class family spends about 15-20 percent of their income on health care each year. That would shrink to just around 5 percent under many versions of the payment plan, with out-of-pocket costs completely eliminated from the equation and no deductible to discourage families from getting the medical help they need. They could continue to see the providers they like without worrying that their provider will stop working with their insurer. People don’t like to wade through the bureaucracy of their employer sponsored or private insurance plans: they like their doctors. They like having relationships with them. They like to be able to see them without being surprise billed or being told their insurance only covers half of their visits.

But what about business? What single-payer would do to the overall economy is hard to say. Retirement portfolios would surely be affected by the change. The stock market would be affected. People in the health insurance industry could lose their jobs. But many of the companies, which still sell medications and medical tech, would survive, even if the scope of their business would radically change. And for businesses that spend money to insure their employees, there would either be a slight reduction in the cost of business or very little change in cost at all, says Bruenig.

Today, businesses, which help insure 155 million Americans, spend about $1 trillion in premiums to the private health insurance industry. That actually probably wouldn’t change under a single-payer system, per Bruenig.

“The question of the bottom line for businesses, money-wise, is a little bit uncertain. But the idea is not to necessarily save them money — it’s more of a question of flexibility. The objective savings that employers would realize in terms of not having to hire staff to talk to insurers and enroll people in insurance go down a lot. But in general, we want to keep them [paying into the system] instead of trying to shift them off to some other person.”

That’s how employer-sponsored insurance basically works today. What many people don’t realize is that part of the premiums that employers pay for their employees is set aside as part of their salary when they are hired. So, per Bruenig, if someone makes $50,000 a year, that means that about $15,000 on average is set aside from the employer perspective (that employees don’t know about) to pay into the health insurance system while employees cover about 30 percent of that premium cost through their paycheck, not including deductibles and out-of-pocket costs.

While that wouldn’t change under Medicare for All, instead of paying premiums to private insurers, employers would pay those premiums to the government. In the meantime, their costs associated with HR, payroll, and the time spent poring over health care plans would be eliminated.

There are a few ways this can be handled: one is called a ‘maintenance of effort approach,’ which is where employers pay what they were paying under private insurance to the government every year, accounting for inflation.

Another oft-cited method of payment is through an increase in the payroll tax — a tax employers already pay — to the government to help fund government-sponsored health care. Other plans include making the federal income tax more progressive and raising the marginal tax rate to 70 percent to those who make more than $10 million a year and establishing an extreme wealth tax like that proposed by Elizabeth Warren.

Estimates show that Bernie Sanders’ Medicare For All plan would save $5.1 trillion of taxpayer and business money over a decade while cutting out-of-pocket spending on health care. While total health care spending will indeed need to increase as more people will be covered by health care, the overall savings in expenses would bring that cost back down so much that the government only needs to raise about 1 trillion dollars to fund Medicare for All when met with taxpayer money and private business investment. This number has been proven incorrect. The cost is about $40 trillion over 10 years.

But the reasons that it would help employers often go beyond the strictly financial, much how the reasons for universal health care being so great for families to go beyond the financial benefits as well.

“In the current system, mandates trigger based on if someone is a full-time employee. To the extent that that goes away, you would expect that you won’t have a big employer making sure people only work 29 hours so that [they don’t get benefits.],” argues Bruenig. “Essentially, those “cliffs,” where if you take one extra step, and work 30 hours [instead of 29], the cost goes way up at the margin. Those would get eliminated, and would give businesses more flexibility, and would seemingly help workers at the same time who might want more hours.”

Families could switch jobs without worrying about what they would do during a probationary period at their new job before their health benefits kick in, and people with chronic medical conditions wouldn’t have to spend hours a day on the phone haggling with their health insurance providers to get essential services covered by them. From a cost perspective, yes, a single-payer system is cheaper than what we operate today. But from a time-saved perspective, from worrying-about-money-perspective, and from a can-I-take-my-kid-to-the-pediatrician? perspective, this works better. The time spent poring over confusing health care documents? Gone. Deductibles? Gone. What’s simpler is simpler — and for businesses and families, a seamless single-payer-system would lessen a lot of headaches and prevent a lot of pain.

Majority of U.S. doctors believe ACA has improved access to care

Sixty percent of U.S. physicians believe that the Affordable Care Act (ACA) has improved access to care and insurance after five years of implementation, according to a report published in the September issue of Health Affairs.

Lindsay Riordan, from the Mayo Clinic Alix School of Medicine in Rochester, Minnesota, and colleagues readministered elements of a previous survey to U.S. physicians to examine how their opinions of the ACA may have changed during the five-year implementation period (2012 to 2017). Responses were compared across surveys. A total of 489 physicians responded to the 2017 survey.

The researchers found that 60 percent of respondents believed that the ACA had improved access to care and insurance, but 43 percent felt that it had reduced coverage affordability. Despite reporting perceived worsening in several practice conditions, in 2017, more physicians agreed that the ACA “would turn the United States health care in the right direction” compared with 2012 (53 versus 42 percent). In the 2017 results, only political party affiliation was a significant predictor of support for the ACA after adjustment for potential confounding variables.

“A slight majority of U.S. physicians, after experiencing the ACA’s implementation, believed that it is a net positive for U.S. health care,” the authors write. “Their favorable impressions increased, despite their reports of declining affordability of insurance, increased administrative burdens, and other challenges they and their patients faced.”

And remember my suggestion was to improve the failures in the Affordable Care Act/Obamacare instead of this Medicare for All solution which is so short-sighted if anybody out there is on Medicare realizes….and it is not FREE!!

Walmart, CVS, Walgreen health clinics can fill a need, but there’s a hitch: Dr. Marc Siegel

Matthew Wisner reported that Walmart is opening its first health clinic in Georgia with plans to offer everything from shots to X-rays, dental and even eye care.

“You go to Walmart and you’re going to be able to get psychotherapy now. Labs, X-rays as you mentioned, immunizations, medications, there are nurses there, doctors there. They’re opening up in Texas, Georgia, and South Carolina,” Fox News medical correspondent Dr. Marc Siegel told the FOX Business Network’s “Varney & Co.”

According to Siegel, Walmart is trying to compete against the big pharmacy chains heading in the same direction.

“It’s also to compete with CVS/Aetna right, who is going to be opening 1,500 of these locations around the country. And, Walgreens as well, with Humana and United Healthcare. So all of these big pharmacy chains are getting into the stand-alone health-care model,” Siegel said.

Siegel says these types of clinics will offer access to health care that some consumers may not have, but he said there is a downside.

“But what happens to the results? Where is the follow-up? I don’t really want a Walmart doing all of the, or CVS, or Walgreens doing all of the follow-ups. I’m worried about someone coming in for one-stop shopping and not having follow up,” explained Siegel.

Lindsay Riordan, from the Mayo Clinic Alix School of Medicine in Rochester, Minnesota, and colleagues readministered elements of a previous survey to U.S. physicians to examine how their opinions of the ACA may have changed during the five-year implementation period (2012 to 2017). Responses were compared across surveys. A total of 489 physicians responded to the 2017 survey.

The researchers found that 60 percent of respondents believed that the ACA had improved access to care and insurance, but 43 percent felt that it had reduced coverage affordability. Despite reporting perceived worsening in several practice conditions, in 2017, more physicians agreed that the ACA “would turn the United States health care in the right direction” compared with 2012 (53 versus 42 percent). In the 2017 results, only political party affiliation was a significant predictor of support for the ACA after adjustment for potential confounding variables.

“A slight majority of U.S. physicians, after experiencing the ACA’s implementation, believed that it is a net positive for U.S. health care,” the authors write. “Their favorable impressions increased, despite their reports of declining affordability of insurance, increased administrative burdens, and other challenges they and their patients faced.”

Opinion: The U.S. can slash health-care costs 75% with 2 fundamental changes — and without ‘Medicare for All’. Dr. Ben Carson suggested using HSA’s to solve the health care problem and this article looks at funding the HSA deductible, as Indiana and Whole Foods do, and put real prices on everything

Sean Masaki Flynn noted that as the Democratic presidential candidates argue about “Medicare for All” versus a “public option,” two simple policy changes could slash U.S. health-care costs by 75% while increasing access and improving the quality of care.

These policies have been proven to work by ingenious companies like Whole Foods and innovative governments like the state of Indiana and Singapore. If they were rolled out nationally, the United States would save $2.4 trillion per year across individuals, businesses, and the government.

The first policy—price tags—is a necessary prerequisite for competition and efficiency. Under our current system, it’s nearly impossible for people with health insurance to find out in advance what anything covered by their insurance will end up costing. Patients have no way to comparison shop for procedures covered by insurance, and providers are under little pressure to lower costs.

By contrast, there is intense competition among the providers of medical services like LASIK eye surgery that aren’t covered by health insurance. For those procedures, providers must compete for market share and profits by figuring out ways to improve efficiency and lower prices. They must also advertise to get customers in the door and must ensure high quality to generate customer loyalty and benefit from word of mouth.

That’s why the price of LASIK eye surgery, as just one example, has fallen so dramatically even as quality has soared. Adjusted for inflation, LASIK cost nearly $4,000 per eye when it made its debut in the 1990s. These days, the average price is around $2,000 per eye and you can get it done for as little as $1,000 on sale.

By contrast, ask yourself what a colonoscopy or knee replacement will cost you. There’s no way to tell.

Price tags also insure that everybody pays the same amount. We currently have a health-care system in which providers charge patients wildly different prices depending on their insurance. That injustice will end if we insist on legally mandated price tags and require that every patient be charged at the same price.

As a side benefit, we will also see massively lower administrative costs. They are currently extremely high because once a doctor submits a bill to an insurance company, the insurance company works hard to deny or discount the claim. Thus begins a hideously costly and drawn-out negotiation that eventually yields the dollar amount that the doctor will get reimbursed. If you have price tags for every procedure and require that every patient be charged the same price, all of that bickering and chicanery goes away. As does the need for gargantuan bureaucracies to process claims.

What happened in Indiana?

The second policy—deductible security—pairs an insurance policy that has an annual deductible with a health savings account (HSA) that the policy’s sponsor funds each year with an amount equal to the annual deductible.

The policy’s sponsor can be either a private employer like Whole Foods (now part of Amazon.AMZN, -0.39%), which has been doing this since 2002 or a government entity like the state of Indiana, which has been offering deductible security to its employees since 2007.

While Indiana offers its workers a variety of health-care plans, the vast majority opt for the deductible security plan, under which the state covers the premium and then gifts $2,850 into each employee’s HSA every year.

Since that amount is equal to the annual deductible, participants have money to pay for out-of-pocket expenses. But the annual gifts do more than ensure that participants are financially secure; they give people skin in the game. Participants spend prudently because they know that any unspent HSA balances are theirs to keep. The result? Massively lower health-care spending without any decrement to health outcomes.

We know this because Indiana Gov. Mitch Daniels ordered a study that tracked health-care spending and outcomes for state employees during the 2007-to-2009 period when deductible security was first offered. Employees choosing this plan were, for example, 67% less likely to go to high-cost emergency rooms (rather than low-cost urgent care centers.) They also spent $18 less per prescription because they were vastly more likely to opt for generic equivalents rather than brand-name medicines.

Those behavioral changes resulted in 35% lower health-care spending than when the same employees were enrolled in traditional health insurance. Even better, the study found that employees enrolled in the deductible security plan were going in for mammograms, annual check-ups, and other forms of preventive medicine at the same rate as when they were enrolled in traditional insurance. Thus, these cost savings are real and not due to people delaying necessary care in order to hoard their HSA balances.

By contrast, the single-payer “Medicare for All” proposal that is being pushed by Bernie Sanders and Kamala Harris would create a health-care system in which consumers never have skin in the game and in which prices are hidden for every procedure.

That lack of skin in the game will generate an expenditure explosion. We know this because when Oregon randomized 10,000 previously uninsured people into single-payer health insurance starting in 2008, the recipients’ annual health-care spending jumped 36% without any statistically significant improvements in health outcomes.

Look at Singapore

By contrast, if we were to require price tags in addition to deductible security, the combined savings would amount to about 75% of what we are paying now for health care.

We know this to be true because while price tags and deductible security were invented in the United States, only one country has had the good sense to roll them out nationwide. By doing so, Singapore is able to deliver universal coverage and the best health outcomes in the world while spending 77% less per capita than the United States and about 60% less per capita than the United Kingdom, Canada, Japan, and other advanced industrial economies.

Providers post prices in Singapore, and people have plenty of money in their HSA balances to cover out-of-pocket expenses. As in the United States, regulators set coverage standards for private insurance companies, which then accept premiums and pay for costs in excess of the annual deductible. The government also directly pays for health care for the indigent.

The result is a system in which government spending constitutes about half of all health-care spending, as is the case in the United States. But because prices are so much lower, the Singapore government spends only about 2.4% of GDP on health care. By contrast, government health-care spending in the United States runs at 8% of GDP.

With Singapore’s citizenry empowered by deductible security and price tags, competition has worked its magic, forcing providers to constantly figure out ways to lower costs and improve quality. The result is not only 77% less spending than the United States but also, as Bloomberg Businessweek reports, one of the healthiest populations in the world.

If we are going to be serious about squashing health-care costs and improving the quality of care, we need to foster intense competition among health-care providers to win business from consumers who are informed, empowered and protected from financial surprises. Price tags and deductible security are the only policies that accomplish all of these goals.

I hope that politicians on both sides of the aisle will get behind these proven solutions. But realize that all these programs are missing a number of important parts of the equation to make the programs work: tort reform, the cost of medical education and the cost of drugs. These issues need to be included in the final solution and the eventual program. Washington should not be a place where good ideas go to die.

Uber, Walmart, Amazon and Berkshire Hathaway Get into Healthcare; And Now Uber Launches Service To Get People To The Doctor’s Office!



28059229_1452381504891504_6986021347674518630_nUber wants to get you from your home to your doctor’s office — and you won’t even need to open the Uber app. The company announced Thursday that it’s teaming up with healthcare organizations to provide transportation for patients going to and from medical appointments.

Receptionists or other staffers can schedule the rides for patients through doctor’s offices. And they can be booked for immediate pickup or up to 30 days in advance. That means patients without a smartphone — who wouldn’t be able to use Uber otherwise — can become Uber customers.

Instead of operating through an app, Uber Health will send its passengers’ ride information through an SMS text message. The company also plans to introduce the option for passengers to receive a call with trip details to their landline instead. Drivers will still use the Uber smartphone app to pick up these passengers.

“Transportation barriers are the greatest for vulnerable populations,” says Chris Weber, the general manager of Uber Health. “This service will provide reliable, comfortable transportation for patients.”

Transportation is, indeed, a barrier to good health care. Affordable access to a vehicle is consistently associated with increased access to medical care, according to a study. Around 3.6 million Americans miss doctor’s appointments or delay medical care due to a lack of transportation every year, according to the National Conference of State Legislatures.

To meet the medical privacy standards outlined in the federal HIPAA law, drivers won’t know which of their passengers are using Uber Health. Like a typical Uber ride, only a passenger’s name, pickup and drop-off addresses will be given to the driver. So Uber drivers won’t be able to opt into the health service the same way that they opt into Uber Eats, a food delivery service.

Peter Whorley, who drives a Honda Odyssey minivan for Uber in Fort Lauderdale, Fla., often picks up passengers who need the extra space, including patients traveling to and from doctor’s offices.

“I just picked up someone with back surgery the other day,” he says. “I like to help people, if they need extra assistance, I personally don’t have that problem. But some people might be squeamish, and not want to.”

Whorley, who has been driving for Uber for more than two years, is more skeptical about picking up people without smartphones. He thinks location tracking on smartphones is vital to the efficiency of the ride-hailing service. “When you’re a good passenger, you should be able to have your phone out to communicate with your driver,” he says.

Uber’s Weber says that because health care providers will use their best discretion in scheduling the rides, they won’t call Ubers for people in need of urgent medical attention. “It’s not a replacement for ambulances,” he says, but a reliable means of transportation to non-urgent medical services that he hopes will curb missed appointments.

One hundred healthcare organizations in the U.S., including hospitals, clinics, rehab centers, senior care facilities, home care centers, and physical therapy centers have already used Uber Health’s test program. The service will be rolled out to healthcare organizations gradually. The only part of this program is that they plan on billing the physicians and their organizations. I can’t agree with this concept, especially with the discounted insurance reimbursements.

And Here Comes The Uber Of Healthcare. CONCIERGE KEY Health is the first mobile app to provide healthcare consumers with on-demand access to elite physician specialists, urgent care clinics, and hospitals. Founder Robert Grant thinks that app-based healthcare is about to take off, digital journal.

The aim of CONCIERGE KEY Health is to eliminate excessive appointment and in-office wait times in the U.S. health system, through a consumer subscription-based membership. The app is based on concierge medicine model and it includes elite providers in all fields, from general practitioners to dentists.

The model enables patients to expedite the process of connecting to and consulting with elite top-tier doctors across the healthcare spectrum. Speed, convenience, and connecting with elite medical providers are the basis of the business model.

To find out more about this different approach to securing medical services, Digital Journal spoke with the founder, Robert Grant. Grant has previously had tenures at the ALPHAEON Corporation, Bausch+Lomb Surgical, and Allergan Medical.

We began by asking about the state of U.S. healthcare.

Digital Journal: What are the major challenges facing healthcare?

Robert Grant: “Healthcare has been upside down for a long time now because it has forgotten who the ultimate customer is: the patient.

“The overly complex and highly opaque healthcare third-party based ecosystem of today prioritize in the following order: payors (insurance companies), pharma, physicians, and finally, patients. This is due in part to the well-organized lobby and narrative of the industrial complex of healthcare, which is made up largely of payors and pharma corporations.

“We believe the healthcare ecosystem should be prioritized in exactly the opposite way of how it is structured today: first, patients; second, physicians providing care; third, products and finally payors.

“Because today’s industrial complex prioritizes the benefit of payors and pharma above physicians and patients, the entire analysis begins and ends with the ‘see-saw’ and the purported zero-sum game of cost versus quality of care. Forgetting that the ultimate customer of healthcare is the patient, today’s ecosystem is not focused on the patients/customer experience.

DJ: Why has health care become so bureaucratic?

Grant: “Because it is not clear who the customer is. When your doctor writes a prescription for medication to you, who exactly is the customer of that pharmaceutical product? Is it the pharmacy that inventories it? Or, is it the patient that picks it up from the pharmacy? Or, is it actually the third-party payor (insurance company) that pays for it? Or, is it really the doctor who wrote the prescription in the first place? Or, is it actually the patient who pays the premiums to the payors in the first place?

“It is an extraordinarily complex and opaque ecosystem, with all parties self-interested to maximize returns, and it isn’t clear that the patient is actually the customer. That way there is so much dissatisfaction in healthcare among patients.”

DJ: How can digital technology and automation help?

Grant: “Technology empowers consumers and further clarifies and magnifies the link and balance between vendors and customer. Vendors must serve the needs and demands of their customers.

“In virtually every other non-monopolized industry, vendors who fail to adequately serve their customers cease to exist. Cost and quality are not the only measures of performance. Customer experience and satisfaction play a major role in the so-called ‘Experience-Economy,’ which has penetrated every industry with widespread adoption by vendors and customers alike. Healthy competition sustains this balance between vendor and customer. Healthcare has been and continues to be the exception thus far.”

DJ: Please explain your new app and how it aids the patient.

Grant: “The CONCIERGE KEY Health app upgrades the healthcare experience for consumers. It provides personalized and on-demand access to the world’s elite physicians, including specialists, urgent care facilities and hospitals.”

DJ: What are the advantages with the app for healthcare institutions?

Grant: “Institutions will benefit from the CONCIERGE KEY Health app as it will reduce their financial dependence on payors and improve the healthcare experience for their customers, the patients. It will also provide a new service and revenue source that consumers want and are willing to pay for.”

DJ: What has the interest been from the medical community?

Grant: “The interest for CONCIERGE KEY’s “on-demand” service has been very high from the medical community. It appeals equally to patients and doctors alike. Longer doctor wait times, a better process to inform doctor selection than paid advertising and Yelp provide and the desire for a distinctive and personalized health experience are the major drivers of consumer demand.”

DJ: Which demographic groups do you think the app will appeal to most?

Grant: “Recent third-party surveys of approximately 900 consumers across 11 metro areas nationwide revealed a very high demand among 25 to 50-year-old consumers. There is a strong bias in the data toward family participation in CONCIERGE KEY.”

DJ: How have you addressed data security concerns?

Grant: “Our CONCIERGE KEY on-demand app includes state-of-the-art security protections and is HIPAA compliant.”

DJ: What else are you working on?

Grant: “We are laser-focused on perfecting our on-demand service. The market potential for this first patient-centric service is massive. Once we achieve our initial goals of widespread adoption of our on-demand service here and abroad, we see CONCIERGE KEY as an innovative platform for patient-centered and simple solutions to other healthcare needs, where we can help untangle unnecessary complexity and upgrade the overall healthcare experience for our subscription members.

DJ: How else do you envisage healthcare technology evolving?

Grant: “The entire healthcare debate has focused solely on the see-saw of cost versus quality of care. To us, these are simply the hygiene factors of healthcare. No company has embedded a truly keen focus and understanding of the patient experience. Healthcare is the largest industry in the United States, representing almost one of every five dollars spent by Americans every year. No other industry is so late to emphasize the motivators for consumers related to the customer experience as healthcare is.

“While new technologies to treat our various ailments emerge every year by gaining FDA approval, we believe the next leap of technology expansion will address the personalization and overall experience of patients within the healthcare economy and we intend to lead that effort.”

While CONCIERGE KEY Health is the first mobile app that provides on-demand access to specialists, urgent care clinics and hospitals for U.S. patients, it will be intriguing to see if an Uber-like model can develop in the healthcare space.

Uber Cofounder’s ‘Uber For Healthcare’ Startup Raises $14 Million.

While dozens of startups today look to Uber as a template for how to bring on-demand convenience to a long-standing market, one “Uber for healthcare” startup has an advantage. Its co-founder Oscar Salazar, who helped build the first Uber prototype, knows a thing or two about the $46 billion-plus valuation company first-hand.

Pager announced Tuesday it had raised $14 million from Ashton Kutcher’s Sound Ventures and New Enterprise Associates, with existing investors Goodwater Capital, Lux Capital, and Montage Ventures rejoining. The money’s aimed at expanding the New York City-focused service to new markets including San Francisco and Los Angeles and building out the product.

While services like ZocDoc and Doctors On Demand have made it possible for customers to find and book doctors more easily by computer or phone, Pager tries to take the process further by making your appointment instant and for a flat fee. A first-time urgent care visit is $50, and $200 after that. A physical is $100 and a phone consultation $25.

The parallels to Uber are peppered throughout Pager’s product. The service finds and verifies doctors for its network and bills you automatically over a linked credit card. There’s a $10 cancellation fee if you bail on an appointment after more than 5 minutes. And because the service is out of network, for now, it favors those for whom convenience can come at a premium to healthcare network costs.

That’s why it’s no surprise that Salazar is involved. Since building the prototype of the Uber app with billionaires Garrett Camp and Travis Kalanick, Salazar’s become something of an on-demand Uber exporter. He’s got a co-founder title with Ride, an app to bring Uber-like convenience to carpooling. Last month he linked up with another startup to work on an “Uber for trash.” Salazar doesn’t work full-time or daily at any of these startups.

“I don’t build companies, I help people build companies,” says Salazar. “It’s part of my strategy to work with companies like Uber because I can do my job faster and I want to have value to add.”

As Salazar helps with high-level product issues and builds out technical teams, it’s up to operators lesser known than Kalanick to execute at each one. At Pager, that’s the job of CEO Gaspard de Dreuzy. “Pager is focused on delivering a broader range of care options on demand” that exist today, de Dreuzy says. “It could be a tele-consult via phone or messaging, or an in-person visit in the home, or a referral to the right specialist. We like to think of ourselves as the Amazon for healthcare.”

Eventually, Pager will build partnerships with national providers to improve their own customer reach, says new investor and NEA partner Mohamed Makhzoumi. That’s where Pager’s vision may translate into large numbers of users, as its technology helps push the rest of the industry to improve its tech. Otherwise, Pager’s pricing and pitch could come off—as Uber once did—as a service of convenience for the well-heeled Donotpaginate

The influence of Salazar’s background helped with investors and with the product. It also helps Pager stand out among a dozen of startups striving for attention. But Salazar himself makes it plain that he’s not helping any of his startups score major Uber partnerships trading off his reputation at Uber HQ.

Salazar’s already got a new area where he’s looking for an “Uber for X”: education. “ They all share a narrative, Salazar says. “All the projects I’m involved in have a social impact. That’s where startups can change the world faster.”

Amazon, Berkshire Hathaway, And JPMorgan Chase Launch New Health Care Company. Health care costs are “a hungry tapeworm on the American economy,” Berkshire Hathaway Chairman and CEO Warren Buffett says, and now his firm is teaming up with Amazon and JPMorgan Chase to create a new company with the goal of providing high-quality health care for their U.S. employees at a lower cost.

The new company will be “free from profit-making incentives and constraints” as it tries to find ways to cut costs and boost satisfaction with the health care plan for employees of Amazon, Berkshire Hathaway, and JPMorgan Chase. The trio unveiled their new venture in a news release.

“The initial focus of the new company will be on technology solutions that will provide U.S. employees and their families with simplified, high-quality and transparent healthcare at a reasonable cost,” the companies said.

The enterprise unites three of the largest and most envied companies in their respective sectors — from retail to banking, and including Berkshire’s wide portfolio of companies such as Geico and Fruit of the Loom. And in Buffett, Amazon’s Jeff Bezos and JPMorgan’s Jamie Dimon, the companies also have veteran leaders who have shown an ability to solve vexing business problems.

According to recent annual reports, taken together the three companies employ more than 950,000 people worldwide. The three CEOs say they’re aware of the enormous challenges they face. “The health care system is complex, and we enter into this challenge open-eyed about the degree of difficulty,” said Jeff Bezos, Amazon founder, and CEO. “Hard as it might be, reducing health care’s burden on the economy while improving outcomes for employees and their families would be worth the effort.”

Responding to the announcement Tuesday morning, White House economic adviser Gary Cohn told CNBC “we agree in that philosophy. We think that individual workers should have to pay less for health care.”

Still, the Trump administration already “created association health-care plans, which is the exact same thing that those companies did,” Cohn said, referring to an executive order last October that sought to make it easier for employers to combine efforts in offering insurance. That order also opened the possibility some groups could get coverage across state lines — “a move that Republicans have long advocated as a way to lower costs,” NPR’s Scott Horsley explained at the time.

“Smaller businesses could pool their employees together to get more purchasing power,” Cohn added Tuesday, “so they could save money on health care.” NPR’s Scott Hensley tells Morning Edition there is a precedent for the case of a non-health care company wading into the healthcare business — “in fact, it has happened repeatedly.”

“One of the most prominent examples is what is now Kaiser Permanente, a big provider of health care in this country. It started with the Kaiser shipyards and providing, first, workers comp kind of care and, later, more integrated health care for employees,” Scott explains. “So it is possible.”

The particulars remain scarce at the moment, though. Details such as the company’s name, a base of operations and long-term leadership weren’t included in a joint news release about the new company that was sent out Tuesday morning.

At the start, the new company will be led by executives from each of the troika of giant firms: Marvelle Sullivan Berchtold, a managing director of JPMorgan Chase; Todd Combs, an investment officer of Berkshire Hathaway; and Beth Galetti, a senior vice president at Amazon.

JPMorgan’s Dimon said, “The three of our companies have extraordinary resources, and our goal is to create solutions that benefit our U.S. employees, their families and, potentially, all Americans.”

Everyone seems to want to get the market for health care and thinks that they know what the solution is to the healthcare crisis. Remember that in 2014 Walmart decided to get into Primary care. Walmart’s New Primary Care Clinics Shake up Healthcare Market

Walmart has recently launched half a dozen primary care clinics across South Carolina and Texas, with plans to open six more before January. Staffed by nurse practitioners, in a partnership with QuadMed, these clinics are fully owned by the company and branded explicitly as one-stop shops for primary care.

Prior to this, Walmart’s 100-plus retail clinics were hosted through leases with local hospitals. With a walk-in visit price of a mere $40 (and $4 if you are a Walmart employee), Walmart’s goal for these clinics is to be a low-cost alternative to traditional options.  Additionally, the clinics will also stand out from competitors as they will be open for 12 hour days on the week and 8 hours (per day) on the weekend.

The rollout of clinics is beginning in rural areas, where doctors are scarce.  When comparing the number of hospitals in urban versus rural areas, Definitive Healthcare’s hospital database’s search accounts for 2,228 hospitals located in rural areas, but 3,871 hospitals located in an urban geographic location.

Previously, Walmart only offered what is known as “convenient-care-clinics” or “retail clinics,” which treat uncomplicated minor illnesses and provide preventative health care services.  Besides Walmart, CVS offers their Minute Clinic through this model, as well as Target’s Target Clinic.  With their new clinics, Walmart will be able to support a broader range of services such as chronic disease management.

The New York Times examines this news on Walmart, by also comparing their model to Walgreens.  In 2013 Walgreens also began offering primary care services in their 400 clinics across the country.  They were the first-ever chain retailer to become a direct provider of primary care services.  Walgreens, however, differs in that they are still reluctant to call their facilities primary care clinics, while Walmart put that label front and center.

Additionally, Walgreens differs because also last year, they became the first mover when they began partnerships with ACOs.  Their partnership with three providers, Advocare Walgreens Well Network (New Jersey), Diagnostic Clinic Walgreens Well Network (Florida), and Scott & White Healthcare Walgreens Well Network (Texas), was aimed at participation in the Medicare Shared Savings Program (MSSP).  This was the first retailer/provider partnership that will try and improve care and reduce costs of Medicare.

Definitive Healthcare’s healthcare database tracks intelligence on 600+ accountable care organizations (ACOs), including those affiliated with Walgreens. In addition to the three MSSP ACOs, Walgreen is also in collaboration with four other ACOs, such as Centura ACO Health of Colorado.  Definitive Healthcare’s database provides intelligence on 34 members of that ACO, as well as tracks their technology modules of HIE and EHR/EMR.

Instead of replacing one’s primary care physician, as what is intended with Walmart’s goal, Walgreens instead stresses that their collaboration will provide a comprehensive experience for the consumer.  They still want the majority of care coming from the patient’s physician group or health system, but Walgreens would just add distinct value to the ambulatory network, etc.

While it still is a bit too early to tell, The Advisory Board Company has already written on how the Walgreens’ ACO partnership is on the right track. As Walmart continues to roll out these physician centers, it will be interesting to track the success of these new clinics. Walmart’s clinics will accept Medicare but currently does not accept third-party insurance.  The timing of these new clinics could benefit greatly from the changes resulting from the Affordable Care Act.

And as another article reported Thomas M. Loarie Walmart To Put MRI Scanners In Stores and Will Charge $400/Scan. The US Healthcare System is Anti-Middle Class Says Healthcare Executive /  Middle-Class Friendly Walmart to Place MRI Units in its 3000 Stores by 2018. James Orlikoff, President of Orlikoff and Associates (Chicago), outlined the economic pressures related to healthcare that are going break the middle-class if we “do not break rather than bend the healthcare cost curve.” His comments were made during a pre-meeting workshop, “Something Disruptive This Way Comes: Preparing for Consumerism in Healthcare” at last week’s 23rd Annual Health Forum and American Hospital Association Leadership Summit in San Francisco.

“Rapidly increasing deductibles and co-pays along with means testing by Medicare are pushing healthcare financial risk to the patient.” And with a slow growth economy, personal income growth is being more than offset by healthcare expenses.

Orlikoff went on to say that despite the enactment of the Accountable Care Act (Obamacare), healthcare spending is forecasted to accelerate this year and continue for the foreseeable future.  The modest increase in healthcare spending over the last few years was due largely to the recession.

He went on to say “We have known this train wreck has been coming but we did nothing about it.” Its effects extend beyond healthcare to the general economy as healthcare continues to take a big bite out at 18% of GDP. We are at a significant competitive disadvantage with emerging economies where healthcare represents only 3-5% of GDP. He added that competitiveness is critical. Without it, we will be unable to create the jobs and income critical for the middle class that pays for healthcare.

“Even healthcare systems cannot afford to buy their own product for their employees.”

These economic factors are attracting consumer companies to the healthcare services market. CVS, Walgreens, Rite-Aid, Target, Walmart, Apple, and others eye the $30 trillion to be spent on healthcare over the next decade as an opportunity and see the consumer as the new decision-maker.  The retail pharmacies and rapidly growing urgent care centers are improving access, quality, and convenience while reducing cost.

As healthcare moves from wholesale to retail, cost-based pricing is being transformed to price-based costing. Walmart today offers a “truss” for those who have inguinal hernias in lieu of having surgery – $50 versus $5800-$10,000. Walmart has announced it will put MRI’s (diagnostic imaging) in all of its stores by 2018.Orlikoff said Walmart plans to price an MRI at $400.

Can they, the Walmarts, the Ubers, Amazon and Berkshire Hathaway know anything about healthcare or the solutions to health care?

Back to the discussion of a Single payer healthcare system!