Asthma: U.S. and Globally

Asthma is a chronic lung disease that inflames and narrows the airways, causing recurring periods of wheezing, chest tightness, shortness of breath, and coughing.  According to the National Institutes of Health (NIH), in the United States, more than 25 million people are known to have asthma; about 7 million of these people are children.  The Centers for Disease Control and Prevention (CDC) has similar numbers, stating that 24 million Americans have asthma and that annually, asthma attacks result in 1.8 million emergency department visits and 3,400 deaths.

The World Health Organization (WHO) reports that asthma currently affects 235 million people around the globe.   It is estimated that the number of people with asthma will grow by more than 100 million by 2025.  A 2014 report by the Global Asthma Network suggests that as many as 334 million people have asthma.  The report notes that the highest burden of the disease is found in Australia and New Zealand, some countries in Africa, the Middle East and South America, and North-Western Europe.  The report concludes with:

“Little is known about asthma in the many countries where it has not been studied, and little information is available about asthma in adults over the age of 45.”

The 2015 Drug Trend Report by Express Scripts conveyed a number of interesting statistics.  Regarding asthma in the United States, a few highlights are:

Asthma drugs are among the top three most expensive traditional therapy classes for Medicaid patients.

Medicaid per member per year payments increased 2.6% between 2014 and 2015 on asthma drugs.

Spending on asthma drugs is anticipated to increase in 2016 and 2017, but remain flat in 2018.

Additionally, the U.S. government notes that while Asthma medication spending decreased 1.6% between 2014 and 2015, costs are still extremely high.  In fact, the annual costs related to asthma are $56 billion ($50 billion is attributable to direct costs such as hospital stays; $6 billion is attributable to indirect costs such as lost pay from illness or death).


Contact ABISA for healthcare consultancy support or speaking engagements.

Physician Entrepreneurs Drive Innovation and Change

Physician leaders must be innovators to navigate their practices into and through the era of healthcare reform.  True physician entrepreneurs take charge of change and continuously scan the outside environment for new and fresh ideas.  They search for opportunities for ways to do what has never been done before.

The history of modern healthcare will continue to be filled by practices that no longer exist because their leadership refused to adapt and change until it was too late.  Consequently, you must always be actively looking and listening to what is going on around you for even the most remote signal that there is something new on the horizon because today’s innovations can come from just about anywhere.

Good is rarely good enough, and opportunities for improvement are never lacking.  Physician entrepreneurs should expect and accept disruption and resistance to change, and never lose sight of the fact that costs are high when change efforts go wrong.  Even the most groundbreaking practices can get stuck and fail to see the possibilities in evolving, because success is comfortable and often too connected to the past.  Physician entrepreneurs can be characterized by having an attitude of wanting to change the business-as-usual environment.  They recognize that there is no single solution to any problem and accept that not everyone will see their vision.  They keep focus and balance as they push to change, understanding that there is no “one size fits all” approach.

To be a true innovating physician entrepreneur means you must be in a constant state of awareness.  No one can survive without focusing in their own way on what matters and drives their medical practice.  Therefore, you must relentlessly focus that ownership on what drives your practice, create a culture that reflects who you are and stay grounded as you make things happen.  Too often we focus on what matters to survive now, because those are the highest-value targets.  As you push to evolve your practice, remember that nothing is ever going to be perfect, so don’t be embarrassed about the mistakes you make or the actions you take.  Losses may hurt but they won’t kill the practice.  You can recover as long as you have a plan.  Failing to stay connected and see things from all angles though, is a clear sign that you are losing perspective.

Medical practices must constantly change in order to survive in today’s competitive healthcare arena.  Practices should never settle for something that is considered completed; all things can improve with change.  While success is important, it is equally important to recognize that in the healthcare industry success will generally not come easily or quickly.  Highly effective physician entrepreneurs emphasize that success in the healthcare arena requires the planning and conduct of operations based on two imperatives: adaptability, and perseverance.   In an era when the future of healthcare may not be predictable, physicians must avoid overreliance on pre-existing assumptions.

A physician entrepreneur’s strategy is a vision for the practice, owned by the practice. And to succeed the whole practice must engage with it and live and breathe it.  That strategy should be the pillar against which the physician entrepreneur assesses priorities, actions and performance.  It’s from here that great leaps in growth and productivity can be achieved.


Contact ABISA for healthcare consultancy support or speaking engagements.

Global Health Insurers

As consumers and providers increasing engage in medical tourism and global telehealth initiatives, many wade through the waters of insurance.  Does it have to be cash only?  What insurance is available throughout the world?  Consumers may also choose to purchase international health insurance when travelling abroad.  While there are numerous options out there, here is a list (in decreasing order of size) of some of the largest insurers around the globe.

Zurich Insurance Group, based in Switzerland, is the largest global insurer.  Founded 144 years ago, they have a presence in 170 countries.

Express Scripts, based in the United States, is essentially a complex PBM (pharmacy benefit management company), providing a host of related services for health plans, employers, and government agencies.

United Healthcare, based in the United States, is the largest health insurer in the U.S. covering more than 70 million individuals.  Over the past couple of years, the company has merged with Amil Participações S.A., which was one of Brazil’s largest health insurance companies.

Aviva, based in the United Kingdom, services over 33 million customers in 16 countries, including Europe, Canada, and Asia.  They are the second-largest insurer in Canada and one of the top foreign insurers in China.

Axa, based in France, is a well-known global brand.  Regarding the company’s health insurance arm, the largest footprint is in the United Kingdom where they operate the brand AXA PPP Healthcare with a headquarters in Kent, England.

Blue Cross Blue Shield, based in the United States, is actually a federation of 36 different health insurance companies.  All combined, they service over 100 million Americans.

Aetna, based in the United States, services over 35 million Americans and recently has announced its plans to acquire insurer Humana (see below).

AIA, based in Hong Kong, has a presence in 18 markets in Asia-Pacific and proudly proclaims that the company is “100% Focused on Asia-Pacific”.

Allianz, based in Germany, has over 85 million customers in 70 countries.

Humana, based in the United States, services over 13 million consumers.  As mentioned above, Aetna is currently in the process of acquiring Humana, pending approval by the U.S. government.

Regardless of where these insurers are based, we see that many have expansive international operations.  Their plans vary throughout the world as they take into consideration different lifestyles and needs of consumers.  These are just a few of the companies you may want to review when considering building out your medical tourism program and/or your global telehealth initiatives.


Contact ABISA for healthcare consultancy support or speaking engagements.

Consolidation ≠ Efficiency

As the United States began implementing the Patient Protection and Affordable Care Act (aka “Obamacare”), many in the healthcare industry focused on the law’s initiatives which pushed for provider consolidation.  In fact, there are tenants in the law that actually incentivize hospitals to acquire physician practices.  Some of the primary stated intents of such measures were to increase efficiency, increase value, and decrease costs.  A recent study in the Journal of the American Medical Association (JAMA) shed light on these consolidations and the result is the government’s misaligned incentives have actually led to negative consequences.  The lead author of the study, Hannah Neprash of Harvard Medical School, demonstrated that indeed these negative consequences are happening in the outpatient setting.

The JAMA study reviewed the impact of physician-hospital integrations on 240 metropolitan statistical areas.  In looking at the concurrent changes in spending, the data proved that financial integration between physicians and hospitals has been associated with higher commercial prices and spending for outpatient care.  As physicians’ market power increases, so does outpatient spending.  To be clear, that spending is almost exclusively a result of price increases, and not a consequence in higher utilization.  In one of my prior posts on the price-quality link, we see some data pointing to the notion that most consumers do not see an association between price and quality.

Along the same lines, a recent Forbes article declared the hopes of these planned benefits of physician-hospital integrations as “probably wishful thinking.”  The author of the article is Peter Ubel, a physician and behavioral scientist at Duke University.  Dr. Ubel correctly notes that physicians feel pressured to align with hospitals in order to gain negotiating leverage with insurance companies.  With his experience of being trained at the Mayo Clinic, he expounded upon the increase in physician-hospital integrations:

“Joining forces with hospitals may or may not improve the quality or efficiency of medical care.  But it sure as heck gives doctors a fighting chance to negotiate better terms with insurers.”

President Obama’s sweeping healthcare legislation has had a profound impact on physicians in addition to increasing healthcare coverage for millions of Americans.  The data is in on the financial impact thus far as well as on some initiatives such as Accountable Care Organizations.  What we are beginning to shed more light on now is the efficacy of some of the law’s major pillars and the consequences those pillars have on the private practice segment of the physician community.


Contact ABISA for healthcare consultancy support or speaking engagements.