Monday, January 30, 2023
ISSN 2765-8767
  • Survey
  • Podcast
  • Write for Us
Daily Remedy
  • Home
  • Articles
  • Podcasts
    A conversation with Dr. Selwyn O. Rogers, trauma surgeon and gun policy expert

    A conversation with Dr. Selwyn O. Rogers, trauma surgeon and gun policy expert

    November 25, 2022
    A conversation with Dr. Kyle Fischer, policy director for the Health Alliance for Violence Intervention

    A conversation with Dr. Kyle Fischer, policy director for the Health Alliance for Violence Intervention

    November 25, 2022
    A conversation with Dr. Edwin Leap, physician writer and emergency medicine physician

    A conversation with Dr. Edwin Leap, writer and emergency medicine physician

    November 8, 2022
    A conversation with Mr. Omar M Khateeb, innovator in medical device sales

    A conversation with Mr. Omar M Khateeb, innovator in medical device sales

    October 31, 2022
    A conversation with Miss Smriti Kirubanandan, passionate healthcare strategist

    A conversation with Miss Smriti Kirubanandan, passionate healthcare strategist

    October 23, 2022
    A conversation with Mr. Michael Johnson, legal expert in physician contracts

    A conversation with Mr. Michael Johnson, legal expert in physician contracts

    October 23, 2022
  • Surveys

    Surveys

    Does inflation affect how you use your deductible?

    Does inflation affect how you use your deductible?

    by Jay K Joshi
    December 12, 2022

    Survey Resutls

    How strongly do you believe that you can tell when your provider does not trust you?

    How strongly do you believe that you can tell when your provider does not trust you?

    October 16, 2022
  • About Us
  • Contact us
  • Support Us
No Result
View All Result
  • Home
  • Articles
  • Podcasts
    A conversation with Dr. Selwyn O. Rogers, trauma surgeon and gun policy expert

    A conversation with Dr. Selwyn O. Rogers, trauma surgeon and gun policy expert

    November 25, 2022
    A conversation with Dr. Kyle Fischer, policy director for the Health Alliance for Violence Intervention

    A conversation with Dr. Kyle Fischer, policy director for the Health Alliance for Violence Intervention

    November 25, 2022
    A conversation with Dr. Edwin Leap, physician writer and emergency medicine physician

    A conversation with Dr. Edwin Leap, writer and emergency medicine physician

    November 8, 2022
    A conversation with Mr. Omar M Khateeb, innovator in medical device sales

    A conversation with Mr. Omar M Khateeb, innovator in medical device sales

    October 31, 2022
    A conversation with Miss Smriti Kirubanandan, passionate healthcare strategist

    A conversation with Miss Smriti Kirubanandan, passionate healthcare strategist

    October 23, 2022
    A conversation with Mr. Michael Johnson, legal expert in physician contracts

    A conversation with Mr. Michael Johnson, legal expert in physician contracts

    October 23, 2022
  • Surveys

    Surveys

    Does inflation affect how you use your deductible?

    Does inflation affect how you use your deductible?

    by Jay K Joshi
    December 12, 2022

    Survey Resutls

    How strongly do you believe that you can tell when your provider does not trust you?

    How strongly do you believe that you can tell when your provider does not trust you?

    October 16, 2022
  • About Us
  • Contact us
  • Support Us
No Result
View All Result
Daily Remedy
No Result
View All Result
Home Innovations & Investing

Healthcare is Irrational

Jay K Joshi by Jay K Joshi
August 8, 2021
in Innovations & Investing
0

One Medical acquired Iora Health.

A company defined by direct pay memberships acquired a company defined by risk-based insurance plans. At first blush it makes no sense, until you understand the environment in which the acquisition was made.

A few months ago the Centers for Medicare and Medicaid Services (CMS) established Medicare Direct Contracting and issued specific risk contracts to a select number of entities. Iora Health was one of them. One Medical was not.

Additionally, CMS determined that only those companies initially selected would be re-eligible for the program the following year – which means no new entrants.

The market closed just as quickly as it opened – with one quick whisk of CMS’s regulatory wand.

The details of the program are much like other risk-based payment models, continuing the government’s push to tie financial remuneration of clinical services with the outcome of those services. Vague on details and heavy on platitudes, stating on the website:

“The risk-sharing options are anticipated to appeal to a broad range of physician practices and other organizations because they are expected to reduce burden, support a focus on beneficiaries with complex, chronic conditions, and encourage participation from organizations that have not typically participated in Medicare FFS or CMS Innovation Center models.”

But more than any tangible goal or metric of measurement, the exclusivity of the program is the value driver. And explains why a company notorious for direct payments would suddenly shift into the risk contracting market.

Scarcity always breeds demand, and the exclusivity of the entities selected into the Medicare Direct Contracting suddenly made every entity selected much more valuable.

Whether One Medical would have purchased Iora Health absent any exclusivity provision in the contracting will never be known. One Medical has not admitted this outright.

But the explanation for the acquisition will come in how One Medical integrates – or does not integrate – Iora Health into their existing business line.

One Medical provides premium, exclusive care for upper class populations. Iora Health focuses on high-risk patient populations, which tend to be the diametric opposite of One Medical’s population.

The two companies have different populations and different models of patient care.

One Medical has clinics in premium, urbane locations across elite metropolitans, charging a premium to its customers, netting a significant profit in the process.

Iora Health targets elderly patients with multiple chronic conditions and co-morbidities affecting their quality of life, investing time into indigent patients, sacrificing profit in the name of care coordination.

They cannot be more different.

But the shifting regulatory world, and the exclusivity offered, changed the value of Iora Health to the point that, despite not being profitable, it was acquired under a multi-billion dollar valuation.

Implying that value in healthcare comes not from the services provided, not from the unit economics, but from the regulatory policies coming from high above.

Which can change in unpredictable ways, leading two healthcare service providers, with two different populations, to merge into one entity.

Which seems quiet irrational.

ShareTweet
Jay K Joshi

Jay K Joshi

Dr. Jay K Joshi serves as the editor-in-chief of Daily Remedy. He is a serial entrepreneur and sought after thought-leader for matters related to healthcare innovation and medical jurisprudence. He has published articles on a variety of healthcare topics in both peer-reviewed journals and trade publications. His legal writings include amicus curiae briefs prepared for prominent federal healthcare cases.

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Videos

YouTube Video VVUxUDVQenU5RTFjUVFKNDY2ZlBmdFB3LmdVUm55WVpqRmNn This is a video about Elemental/Essential Frameworks of Healthcare Law

00:00 Elemental/Essential Frameworks of Healthcare Law
Load More... Subscribe

Expert vs. Lay Testimony

Visuals

NADAC (National Average Drug Acquisition Cost)

NADAC (National Average Drug Acquisition Cost)

by Jay K Joshi
January 29, 2023
0

We list the acquisition price of drugs that are covered under the Medicaid Drug Rebate Program - effectively, how much does the government pay for common drugs utilized by patients on Medicaid. Drugs listed are from A-CH.  

Read more

Twitter Updates

Tweets by DailyRemedy1

Newsletter

Start your Daily Remedy journey

Cultivate your knowledge of current healthcare events and ensure you receive the most accurate, insightful healthcare news and editorials.

*we hate spam as much as you do

Popular

  • Letter to the Alabama Board of Medical Examiners

    Letter to the Alabama Board of Medical Examiners

    0 shares
    Share 0 Tweet 0
  • Prosecuting Doctors as Drug Dealers

    0 shares
    Share 0 Tweet 0
  • Why Our Prescribing were for Patients’ Best Interests

    0 shares
    Share 0 Tweet 0
  • Malicious Prosecution and Fabrication of Evidence

    0 shares
    Share 0 Tweet 0
  • My Respect for the Law

    0 shares
    Share 0 Tweet 0

Daily Remedy

Daily Remedy offers the best in healthcare information and healthcare editorial content. We take pride in consistently delivering only the highest quality of insight and analysis to ensure our audience is well-informed about current healthcare topics - beyond the traditional headlines.

Daily Remedy website services, content, and products are for informational purposes only. We do not provide medical advice, diagnosis, or treatment. All rights reserved.

Important Links

  • Support Us
  • About Us
  • Contact us
  • Privacy Policy
  • Terms and Conditions

Newsletter

Start your Daily Remedy journey

Cultivate your knowledge of current healthcare events and ensure you receive the most accurate, insightful healthcare news and editorials.

*we hate spam as much as you do

  • Survey
  • Podcast
  • About Us
  • Contact us

© 2023 Daily Remedy

No Result
View All Result
  • Home
  • Articles
    • Contrarian
    • Financial Markets
    • Innovations & Investing
    • Perspectives
    • Politics & Law
    • Trends
    • Uncertainty & Complexity
  • Podcasts
  • Surveys
    • Survey Results
  • About Us
  • Contact us
  • Support Us

© 2023 Daily Remedy

Start your Daily Remedy journey

Cultivate your knowledge of current healthcare events and ensure you receive the most accurate, insightful healthcare news and editorials.

*we hate spam as much as you do