Cooperating for better care.

Robert Whitcomb

Author Archives

Steps in commercializing new healthcare tech


Steve Blank, writing in MedCity News, reports on a new class of life-science/healthcare co-working collaboration space.

He says that startups seeking to commercialize new technologies should:

  • Define ”clinical utility” before spending millions of dollars.
  • Understand who core and tertiary customers are, and the sales and marketing process ”required for initial clinical sales and downstream commercialization.”
  • Assess intellectual property and regulatory risk ”before designing and building”.
  • ”Know what data will be required by future partnerships/collaboration/purchases before doing the science.”
  • “Identify financing vehicles” before they’re needed.


Enhanced medical homes for kids seen to improve outcomes


An article in JAMA concludes:

Among high-risk children with chronic illness, an enhanced medical home that provided comprehensive care to promote prompt effective care vs usual care reduced serious illnesses and costs.”

The aim of the study was to find out “whether an enhanced medical home providing comprehensive care prevents serious illness (death, intensive care unit [ICU] admission, or hospital stay >7 days) and/or reduces costs among children with chronic illness.”

The study’s authors had noted that regular “Patient-centered medical homes have not been shown to reduce adverse outcomes or costs in adults or children with chronic illness.”



Jonathan Merril, M.D., joins Cambridge Management Group

Jonathan Merril, M.D., has joined Cambridge Management Group  ( as a senior adviser.

Dr. Merril has devoted his career to improving provider and patient education through technology. He is currently developing a “chronic care university’’ at Partners HealthCare. The new “university’’ is an online service for patients and primary-care providers meant to improve the lives of people with chronic conditions, with the first program to be focused on multiple sclerosis.

Cambridge Management Group ( has increasingly worked with providers to improve care and control costs associated with patients with chronic conditions as their numbers increase with the aging of the population. Dr. Merril and his colleagues at Cambridge Management Group recognize the growing need to manage chronic diseases with innovation in diagnostics and therapeutics.

He uses mobile and simulation technology and healthcare-education expertise to work with businesses, government and non-profit organizations to create novel opportunities to enhance care.

He is also the chief executive of Astute Technology, which streams large medical conferences, including those of the American Heart Association, the American Society for Clinical Oncology and many other organizations. Dr. Merril holds many patents in the digital capture of such gatherings.

Dr. Merril has used the Internet and App technology to build some of the most widely used online (including mobile) learning resources for physicians and patients. These systems power the Partners Healthcare Office of Continuing Professional Development and some key activities (including board reviews) of various other large non-profit healthcare organizations.

He is an expert in building and integrating platforms for continuing education, maintenance of licensure and promoting best practices for hospitals and professional societies.

Dr. Merril received his M.D. degree from The George Washington University School of Medicine and Health Sciences. He did his internship in internal medicine and then completed a fellowship in medical informatics in a joint program of George Washington and Massachusetts General Hospital. Jonathan Merril is married and has three children.

How the GOP might unite on an ACA replacement


Politico discusses how 2015 could be the year that Republicans, now in firm control of Congress, finally define how they would replace the Affordable Care Act.

The Supreme Court will  soon hear case that threatens subsidies that form a core of the Affordable Care Act. That has Republicans putting pressure on themselves to rally around their own plan, drawing on such ideas as tax credits to buy insurance, high-risk pools and letting insurance be sold across state lines.

If the justices follow the GOP plan, subsidies ”could be abruptly cut off to millions of people in states relying on the federal health exchange. That financial assistance would be available in just the 13 states running their own exchanges.”

All this would “spill over into the rest of the U.S. health insurance system. Without subsidies in two-thirds of the states, the uninsured rate would probably rise, reversing its sharp decline. Premiums could soar if only the sickest people stick with their more expensive coverage.”



The punishment of a bioethicist


Healthcare Renewal’s Roy Poses, M.D., and  the Minneapolis Star Tribune look  at the controversial case of Carl Elliott, M.D., a psychiatrist and bioethicist at the University of Minnesota who challenged the University of Minnesota’s handling of the  death of a patient in a clinical trial run by the university.



PinnacleHealth’s program to get physicians to listen more


With  vivid examples, Nirmal Joshi, M.D., chief medical officer for Pinnacle Health System, based in Harrisburg, Pa., discusses in a New York Times piece the necessity of  intense, if sometimes brief, two-way communication between physicians and patients.

Dr. Joshi notes that  the Joint Commission  has found that ”communication failure (rather than a provider’s lack of technical skill) was at the root of over 70 percent of serious adverse health outcomes in hospitals.”

”{O}ne survey found, two out of every three patients are discharged from the hospital without even knowing their diagnosis. Another study discovered that in over 60 percent of cases, patients misunderstood directions after a visit to their doctor’s office. And on average, physicians wait just 18 seconds before interrupting patients’ narratives of their symptoms.”

Dr. J0shi describes started a program  that he and his colleagues started to improve doctors’ communication with their patients at Pinnacle.

They developed a physician-training program, which, he writes in The Times, ”involved mock patient interviews and assessment from {an} actor role-playing the patient. Over 250 physicians were trained using this technique. We also arranged for a ‘physician coach’ to sit in on real patient interviews and provide feedback.”

 And it helped a lot, as his op-ed explains.

Brainstorming for federal dollars



The Washington Post reports that “federal officials are trying to create a new model for neuroscience research, one that emphasizes innovation and cooperation across specialties and institutions. To do that, they threw a two-day ‘kickoff’ for scientists fortunate enough to have received the first funding slices of what probably will be a multibillion-dollar federal pie.”



‘Repricers’ slash hospital bills


Read how a Pennsylvania company, ELAP Services, helps slash hospital bills for self-insured employees.

ELAP does cost analysis for its clients by studying hospitals’ department-by-department costs that they reported to Medicare.

The Philadelphia Inquirer reports that “For major back surgery, for example, ELAP employees, called ‘repricers,’ go through every line of what could be a 30-page hospital bill and adjust the charges based on the hospital’s actual costs, using Medicare cost data. Then ELAP adds back a predetermined percentage of the cost, typically 12 percent to 25 percent, ‘to allow a fair margin above that cost,’ (ELAP founder Stephen P.} Kelly said.”

”In a case that landed in court, a hospital billed $312,655. ELAP said its client should pay only $99,476, or 32 percent of gross charges….That determination stood up to a federal judge’s scrutiny in a 2013 court case.”

”Kelly, 60, founded ELAP as an antidote to what he saw as a lack of transparency in medical billing for employers trapped in relationships with third-party administrators who have proprietary contracts with hospital networks.”


Some California narrow networks getting even narrower


California’s biggest health insurers are sticking with their often-criticized narrow networks of doctors, and in some cases they are cutting the number of physicians even more,” reports the Los Angeles Times.

Further, the paper reports, ”the state’s insurance exchange, Covered California, still has no comprehensive directory to help consumers match doctors with health plans.”


Hospital admissions keep falling

Inpatient admissions at many hospital systems kept falling during  2014’s third quarter.  Changes tied to healthcare reform were cited, including Medicare’s “two-midnight rule,” which has shifted many patients to ”observations” from admissions. But of course, Medicare is doing other things with financial incentives to control costs by shifting patients away from hospitals.

Further explaining the decline is the increase in high-deductible health plans with hefty co-payments and co-insurance.



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