10 thoughts on the healthcare business

1. The insurer-hospital relationship has eroded dramatically over the last five years as insurers increasingly compete with health systems.

2. Telehealth may be the canary in the coal mine as to the bricks and mortar hospital and health system.

3. Urgent care is the great awakening of "care when you want it and where you want it."

4. Hospitals and health systems and ASCs may be in a long-term period of stabilization and, in some places, slow erosion.

5. For hospitals, health systems and ASCs, think revenue and income neutral.

6. Oakland, Calif.-based Kaiser Permanente's model is the easiest means to really embrace lower costs of care, because it takes on full insurance risk. I.e., it can fully deploy remote care and telehealth and reduce bricks and mortar care. UnitedHealth Group seems to be coming to this as well. For many systems that started as regionally dominant systems, they need to double down on market position, but it's very hard to become insurers and fully embrace remote care.

7. The movement toward a public option may come from the middle of the electorate and pressure from right leaning voters who will pressure the Republican party to take this seriously, as their constituents can't get coverage at good prices.

8. Price transparency is not here yet.

9. The FDA is driving more regulation like a group possessed. HHS and CMS are in a very relaxed regulatory state.

10. The insurers, device companies and pharma companies are still thriving. 

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