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Monday Morning Update 6/24/19

June 23, 2019 News 16 Comments

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Phreesia files for a $125 million IPO, hoping to list shares on the NYSE under ticker symbol PHR.

The company – whose platform offers online appointment scheduling, revenue cycle, health risk screening,  and check-in kiosks — lost $15 million on $100 million of total revenue in its most recent fiscal year.

Reader Comments


From HISInside: “Re: Change Healthcare. Large-scale pre-IPO layoffs over the past few days. They also announced internally that they are selling the analytics business unit, including RelayHealth products.” Unverified, although reported on some of the layoff sites. Anonymous posters there attached a purported company email that said jobs were eliminated in the Software and Analytics business unit. I would be surprised if they are dealing off RelayHealth since it was the closest thing to a jewel in the McKesson HIT crown, but perhaps the potential payoff is too great to pass up.

From Max the Fax: “Re: fax machines. See this article. It’s embarrassing to be so far behind.” I’ll take your side if you show me documented proof that getting rid of fax machines improves outcomes or cost. Fax machines are an admittedly humorous example of “being behind,” but healthcare is also guilty of chasing the latest and greatest shiny objects (imaging machines, drugs, IT, architect-arousing buildings) that don’t move the health needle one bit. We need to become more critical consumers of resources of unproven value for which patients and insured consumers are forced to pay, especially given that big healthcare systems feel little competitive pressure to spend patient money wisely.

From Kabob: “Re: Slack. Wondering if you’ve used it?” I haven’t, but my curiosity has been piqued by all the pre-IPO coverage. I would be interested in hearing from anyone who has used it in a hospital setting and what benefits it provided. The most common criticism is that it sucks up time and saps creativity as users move their mental goalpost to never-ending but often pointless interaction, plus it leaves them in a social media-like dopamine frenzy to check it constantly for fearing of being one-upped while offline. Things I learned today: the name Slack came from the contrived acronym “Searchable Log of All Communication and Knowledge.” There’s a free trial for anyone interested. I played around with the free version of Microsoft Teams and wasn’t impressed.

HIStalk Announcements and Requests


PCPs of an encouraging two-thirds of poll respondents had the records of their most recent hospital encounter at their next appointment. David says his PCP had his records and CT scans, while Monica reports that the notes, but not the x-rays, were sent to her specialist within three weeks. Peggy says her PCP had everything, while Proficient Patient and Flyonthewall said it was a snap because the hospital and PCP both use Epic.

New poll to your right or here: For those employed by others: what is the #1 reason that you don’t work for yourself?


Welcome to new HIStalk Platinum Sponsor Greenway Health. The Tampa-based company offers the award-winning, cloud-based Intergy EHR/PM that delivers reduced clicks and personalized user experience; revenue cycle management solutions that decrease A/R days by an average of 32%;  practice analytics; patient engagement; care coordination; and interoperability options that include CommonWell and Greenway Exchange, a cloud-based health information network that has connected 1,400 vendor products in delivering 22 million messages per month. The company summarizes its areas of focus as: (a) delighting the caregiver; (b) inspiring practice transformation; and (c) restoring the “care” in “healthcare.” Thanks to Greenway Health for supporting HIStalk.

It’s almost July 1, when a fresh batch of scared (and scarily young) medical residents learn to answer to being called “doctor” in the hospital as they ply their chosen career for the first time, fueled by panic-induced adrenaline, low-quality but free cafeteria food, the pressure to please their attendings, and sleep deprivation. For the rest of us, it’s like a restaurant’s soft opening or a play’s first performance – you’ll be happier if you can hold off being a customer for a few weeks until routines replace reaction.


July 25 (Thursday) 2:00 ET. “Meeting patient needs across the continuum of care.” Sponsor: Philips Population Health Management. Presenters: Cindy Gaines, chief nursing officer, Philips Population Health Management; Cynthia Burghard, research director of value-based healthcare IT transformation strategies, IDC. Traditional care management approaches are not sufficient to deliver value-based healthcare. Supplementing EHRs with advanced PHM technology and a scalable care management approach gives health systems proactive and longitudinal insights that optimize scarce resources in meeting the needs of multiple types of patients. This webinar will address the key characteristics of a digital platform for value-based care management, cover the planning and deployment of a scalable care management strategy, and review patient experience scenarios for CHF and diabetes.

Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock


UnitedHealth Group will acquire healthcare payments firm Equian LLC from its private equity owner for $3.2 billion. New Mountain Capital acquired the company in late 2015 for just $225 million. Industry long-timer Scott Mingee joined Equian in early 2013 in his first CEO job.


Recently retired McKesson Chairman and CEO John Hammergren will receive a $114 million one-time pension payout, $10.5 million in stock vesting, lifetime medical benefits, lifetime financial counseling, and an office and secretary for the rest of his life. The total cost the company is around $141 million. He’ll also be paid $900,000 per year as chairman of Change Healthcare. The $10,000 worth of MCK shares you bought the day Hammergren started as CEO (February 1, 2001) were worth $42,500 the day he quit, although that’s barely better performance than the Nasdaq as a whole. In addition to his parting gift, Hammergren made more than $500 million in a 13-year span with McKesson, with a record one-year compensation of $145 million. The American healthcare system and its sick patients who paid those sums have thus thanked you for your service.

Three New York City hospitals (Montefiore, Mount Sinai, and Maimonides) sell the professional liability insurance firm they own (Hospitals Insurance Company) for $650 million to The Doctors Company. The hospitals admitted in 2017 to breaking state law in failing to disclose that they, like other hospitals, had formed a Cayman Islands-based insurance company that collected premiums that were used to buy less-expensive policies, generating more than $200 million in investment income. That practice is legal as long as hospitals disclose it. The Doctors Company says it is aware of the company’s history and will rename it Healthcare Risk Advisors. Mount Sinai will spend its $325 million of the proceeds on construction, while Montefiore will use its $163 million to buy software for cost management and value-based care.



Megan Schmidt (CompuGroup Medical) joins PierianDx as SVP of product.

Announcements and Implementations


Johns Hopkins All Children’s Hospital (FL) will replace Cerner with Epic, which is used throughout Hopkins Medicine. The 15-month project will kick off on July 1. Hopkins took ownership of the 259-bed hospital in 2011, its first expansion outside of Maryland. The hospital reported $50 million in profit on $469 million in revenue in its most recent tax year.

Government and Politics

President Trump will issue an executive order Monday that will require hospitals, doctors, and insurers to disclose their negotiated contract prices. This is great news if you are an attorney since the legal wrangling will take years before anyone sees confidential contract pricing, if indeed they ever do.


Politico reports that Mark Roche, MD, MSMI has resigned as CMS’s first chief health informatics officer after taking the job just four months ago.



Modern Healthcare lists the 25 highest-paid executives of non-profit health systems for 2017. Topping the list is Kaiser Permanente Chairman and CEO Bernard Tyson at $16 million. The lowest guy on the list (and I say “guy” because all 25 are male) still made $5.3 million. The one that leaps out, though, is electrophysiologist Joseph Levine, MD of St. Francis Hospital (NY), whose $6.5 million payday represented 1.68% of the hospital’s entire payroll.

Hospital operator Universal Health Services says 26 of its facilities were taken offline for two hours Friday due to Cerner data center problems.

GoFundMe says it is running $10 million worth of campaigns by people who need help affording insulin. Why you would want to be running a drug company rather than being diabetic: a vial of insulin costs $2-6 to manufacture and you can charge 7 million Americans — who would die without using up to several vials per month – $250 or more per vial, multiples of what people in all other countries pay. Sweet. 

Sponsor Updates

  • Diameter Health is attending Qualipalooza in Orlando this week and will sponsor NCQA’s Digital Quality Summit in Boston July 16-18.
  • Live Process creates a CMS Emergency Preparedness Rule self-assessment quiz.
  • Waystar, Flywire Health, Experian Health, Recondo Technology, Relatient, and Sansoro Health will exhibit at HFMA June 23-26 in Orlando.
  • NextGate responds to the CMS FY20 IPPS proposed rule.
  • With help from AWHONN attendees, Clinical Computer Systems, developer of the Obix Perinatal Data System, donates $3,125 to AWHONN’s Every Woman, Every Baby effort.
  • OmniSys will exhibit at McKesson IdeaShare June 27-30 in Orlando.
  • PatientBond publishes a new white paper, “Psychographic Segmentation and its Practical Application in Patient Engagement and Behavior Change.”
  • Surescripts will exhibit at the ASAP Mid Year Conference 2019 June 26-28 in Washington, DC.
  • SymphonyRM will present at AAPL June 27 in Salt Lake City.
  • Voalte will exhibit at the AzONL 2019 Summer Forum for Nurse Leaders June 28 in Scottsdale, AZ.
  • Visage Imaging will exhibit at SIIM19 June 26-28 in Denver.

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Currently there are "16 comments" on this Article:

  1. Would be interesting to see the gap, perhaps chasm, between what Mark Roche thought the CMS chief health informatics job was going to be and what it actually turned out to be. Or perhaps the position is going to be relocated to Kansas City with the research scientists from the Department of Agriculture. We are certainly living in interesting times.

  2. …affording insulin. Walmart sells $20 vials of R and N insulin, also cheap-o test devices that use low-cost test strips. (retail $ less than insurance copay… no script needed).

      • Not a big fan of social media, and your article extrapolates how $1,000 prescription hamburgers are best, once burgers are properly nuanced.
        But trash science supported by edge-case extrapolation to populations is the wp’s argument, perhaps the FDA has a firmer grip on what insulin “is”.
        Here’s one attributable value: a 98% cost difference, deal with it like you know something or dislike that individuals in the USA can maintain viability without having to rely on go-fund-me beg-a-thons.
        $1,000+ or $24, these are numbers, regardless of any nonsensical social or wp bias.

        • I thought about it for an afternoon and I think we likely don’t disagree about the facts about insulin. I think the disagreement likely lies on the lines regarding what quality of medical care should be provided to the poor and what amount of profit is appropriate for the 3 companies that make insulin analogues.

          • I was not expecting professionalism and am humbled to see someone who’s good at this. I’m not that good, only good enough to see it in others. It gives me a happiness seeing professionals act.
            And… just to fess up, I might know people (I had a dream once) who worked in pharma having a keen sense of the expenditures of NDA through approval, and how adhering to GLPs, GMPs and GCPs (I think these mean something important) is just serious business, while money is the least of concerns when safety and efficacy matter.
            That you would offer a simple comment sort of blew my persona away. Hope to work with you soon.

    • Richie,

      Like many areas of medicine, the standard of care – of therapy – have advanced significantly.

      Better insulins allow better control with fewer injections; Better test strips reduce the size of each sample by a factor of approx ~15.

      The improved glycemic control made possible by these improved tools may not be appreciated by the Insurance company bean counters – they typically place them in a 3rd tier formulary.

      There are no generic options for a rapid insulin that was made possible by recombinant DNA work and brought to market in the 90’s.

      My point is that “its complicated” – more complicated than a Google search of Walmart pricing.

      • (snark alert) Gosh, I never looked at it that way, you’re absolutely right. Even if someone is dying – don’t give them Walmart insulin – and beggars get a great deal because it is so worth it. Got it, thanks for the opportunity to learn what smart people think.
        I gotta go, seems being talked-past gives me a sense it’d be more efficient to get information from a shady used car lot. (I’d say Walmart, but hearing the obligatory scorn seemed so worn-out the first time.) Did the WP article mention it’s related, if not a reprint, of a facebook post, did ya even check? Deal with it on your own time, I try to avoid poorly formed arguments based on social media – even when the spasmodic thrashing of soft-handed social-media cyclops (Nietzsche) seems so titillating.

        • Richie,

          I was starting to follow your line of thinking and then you continued the spiral into an angry, self serving jerk and now I don’t even care about your argument//position, even if valid. I wonder if anyone does.


          • Hi lmnop, friendliness only hurts the ball club. (bull durham).
            Hope you never meet me, you seem nice. I “liked” your post and click dislike on all of mine. Just to be nice.

  3. It’s 941AM and I’ve seen no comments regarding Hammergren’s compensation.

    I suddenly feel disappointed with my 1- 2% exceeds expectations performance, yet-to-be-seen, raise.

    • I love the savagery from Mr. Histalk re: Hammergren. “The American healthcare system and its sick patients who paid those sums have thus thanked you for your service.”

      I wish the executives of corporate America would take more ownership of their comically high compensation ($500+ million over 14 years???) and the impact it has on their organization’s health. That’s a direct wealth transfer to a single person. That could easily fund all of the healthcare costs of entire counties over the same period of time. I have a hard time believing that whatever value he added to MCK is worth that.

  4. Group messaging is heavily used in software Engineering. typically start ups use it so that the entrepreneur can keep a eye on all communication channels. The micro manager entrupruner uses it like a remote control to manage engineering teams. It kills productivity and software teams begin to service the entrupruner rather than the customer.

    On the upside Dr Devi Shetty hospital uses in-built group messaging tool to keep everyone on the same page wrt a specific case.

    Similarly swiggy uses in-built group messaging tool to connect supplier , delivery personnel and customer support ops wrt to a single food order only.

    If used properly it can help in near term targets.
    Retrospective searchable log is not useful as short range food delivery outlier cases are unique and rarely is the root cause generic.
    With the market changing so quickly past communication log does not help to solve future problems. agile companies do not have time to ponder over past mistakes. They just fix and power ahead.

  5. I enjoy hearing the comments about Hammergren as well. He’s the poster boy for the disgusting excesses of corporate America. Many of those years McKesson was laying off employees making far less than him so he could show the board and shareholders a gain. I have never seen Hammergren name associated with any philanthropic pursuit. I find it ironic, or something more serious that both Hammergren and George Barrett, CEO of Cardinal both retired…. could it have anything to do with the opioid crisis?

  6. Interesting combo of news this week. Cerner encourages investors with their plans to boost earnings by selling patient data. Amazon’s PillPack and Surescripts scrap over access to patient medication data. Cerner announces partnership with Amazon’s AWS for hosting their customers’ systems. Hmmm, I wonder where my patient data is going to end up when I entrust it to a Cerner hospital…

    • NextGen engaged in the practice of selling patient data last year about this same time. I don’t think it worked as expected. Interestingly, NextGen is also partnered with AWS.

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