Why High Performance Health Care Remains Elusive

By Brian Klepper

Published 3/31/16 in Employee Benefits Advisor

Do you know about a high-value healthcare program that wildly exceeded your expectations by delivering provably better health outcomes at dramatically lower cost? If so, I want to know about it.

High performance healthcare services are available in virtually every costly healthcare clinical and financial niche: e.g., musculo-skeletal care, cardio-metabolic care, cancer, surgery, hospital bills, out-of-network claims, dialysis, large case management, imaging. Generally, these programs have deconstructed problems that consume large percentages of the healthcare dollar, and then developed solutions that are unconventional but more effective. They win, not by exploiting conventional healthcare’s perverse incentives as the mainstream does, but by exploiting market vacuums, like crazy pricing for mediocre health outcomes.

If benefit plan sponsors and unions go outside their health plans to favor these better services, their patients typically will fare better and they will achieve significant savings. But they’ll also disrupt the current excessive-care-and-cost-is-fine paradigm, and help bring things back to rights.

Advocates may gush about a particular program’s performance but, in my experience, high performance is rare. Few programs can provide hard data or credible testimonials showing that they solidly improve health outcomes or cost. Few can show that they can scale from performance at one location to another, or that their impact is enduring. Most telling, many vendors are unwilling to put part of their fees at financial risk against the bet that they’ll hit performance targets. More often, they want you to go at risk for their performance instead. So caveat emptor.

High performance healthcare is one answer to America’s healthcare cost and quality crisis. Are you in or do you know a high performance healthcare organization? Can you/they demonstrate it with data and testimonials? If so, let me know. As a working definition, we are searching for vendors that consistently achieve >20% improvement in either key health outcomes or cost. Thirty percent is better. The greater the impact, the more likely that purchasers will be willing to disrupt conventional processes.

Meaningful change won’t happen in healthcare until purchasers, including plan sponsors, work together to favor organizations that deliver better value and, equally important, start withholding favor from those that don’t.

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A Personal History of the Weiss Family

January 10, 2016

A couple weeks ago my cousin Craig Blattner sent me a family newsletter from 1987 that featured this long family memoir, written by my Mother, Doris Klepper, who as you’ll see is a wonderfully expressive and succinct writer. While I normally would be abashed to urge others, particularly those outside my family, to dive in, my Mom’s prose clearly describes a different time, filled with the joy and irony and heartache of life. 




Doris Weiss Klepper

December, 1987

Doris Klepper ObituaryI will try to write down as much background on our family as I can recall for the enlightenment of anyone who may be interested.

My mother was born literally at the turn of the century, in April, 1900, to Joseph and Esther Rosenfeld Shostak, in New York City.  I know very little about my grandfather, a native of Russia.  Although my mother spoke a great deal about other relatives, she seemed to conspicuously avoid mentioning her father. I can only surmise that the circumstances surrounding his absence were unpleasant.

Esther raised her two children, Anna and Lillian, on her own. The only Shostak relative whom I ever knew was Anna’s first cousin, Fanny Shostak Shandalow, who was a year or so older. The two girls were very close and remained in touch for most of their lives.

Anna and Lilly had a very deprived, difficult childhood with a hardworking mother. Esther was a talented Hungarian cook and baker and she supported her family by catering for brisses, weddings and Bar Mitzvahs. Of course, in those days the affairs were much simpler than they are today, usually held in the apartments of the families.   Also, she worked as housekeeper and baby nurse for new mothers. At that time women were kept in bed for weeks after childbirth, and those who could afford it hired help to run their homes during their “confinements.” This worked a sad hardship on the Shostak children, who were left alone for long periods of time. Anna had to assume responsibility at a very early age, for herself and Lilly, who was 6-1/2 years younger. I don’t know how they survived. They seemed to move around a lot as they lived in Elizabeth, NJ. at one time and on 4th Street in the lower east side of N.Y. at another. Often they spent time with Esther’s sister and her family in Kenilworth, NJ.

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The Goose and the Elephant


Brian-KlepperAmerica’s drug and biotech industries are no doubt alarmed by the national firestorm that erupted when Turing Pharmaceuticals raised the price 55 times of its 62 year old lifesaving drug, daraprim. They must worry that CEO Martin Shkreli’s tone-deaf reactions to the public’s scorn could precipitate close scrutiny of broader drug industry dynamics. The last thing pharma wants is a vigorous, in-depth national discussion of pricing, value, what we can afford and how other advanced countries handle drug spending. All this could kill the golden goose.

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The Case for High Performance Health Care

Brian Klepper

Posted 9/25/15 on The Employee Benefit News Blog

BK PhotoNote to would-be health care reformers: don’t bother trying to drive change through policy, because you’re vastly outgunned. The industry you would reform owns Congress and the legislatures.

Nearly every substantial health care organization spends lavishly to ensure that regulation favors them. In 2009, the year the Affordable Care Act was formulated, Congress accepted more than $1.2 billion in campaign contributions presumably in exchange for influence over the shape of the law. Given that the context is currently a $4 trillion (and skyrocketing) annual health care spend and that the impacts of their lobbying will resonate for decades, the  costs were nominal and the potential for return high. Unless we can galvanize the much larger non-health care business community to act in its (and our) interests, we don’t have a prayer. Continue reading

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Will Specialty Drug Pricing Be The Straw?

Published 5/27/15 in Employee Benefit News

ALP_H_BK_0010Over the next few years, drug manufacturers will release a host of new drugs that are more complex and, in many cases, more effective than we’ve had access to in the past. There will be better solutions for common problems, and new solutions for uncommon ones. Specialty drugs, many of them “precision therapies,” will offer tremendous promise for better health outcomes across the breadth of human health and treatment.

Not surprisingly, most of these drugs will have breathtaking price tags, often a high multiple of conventional drugs. Specialty drugs are an exploding growth industry, with spending rising almost 20 times as fast as conventional drugs. Unless something changes, in just another five years we’ll likely spend more on specialty than non-specialty drugs. Or, for that matter, on doctors.

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Elaine Waples-Klepper (September 3, 1946 – November 22, 2014)

SmilingThree weeks ago today, my precious wife Elaine finally succumbed to a long, protracted battle with  cancer. Below is her obituary.  I’ll also re-run several wonderful health care articles that she wrote over the past few years.

Elaine Waples-Klepper was lost to us on the morning of November 22nd after a 55 month struggle against primary peritoneal (ovarian) cancer. Never, in the marathon of living with this disease, was she pessimistic, self-pitying or given to false hopes. She was reliably pragmatic and believed that living well created the most favorable environment for her care. She remained unfailingly buoyant, witty, graceful and fully engaged in life.

Disciplined and accomplished, she was a gifted pianist, painter and writer and focused on excellence in everything she applied herself to.  She loved reading, travel, cooking, yoga, and treasured quiet contemplation. Continue reading

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Will Employers Favor Private Exchanges Over Coverage Sponsorship?

Brian Klepper

Posted 10/17/14 on The Health Affairs Blog

BK 711Over the past couple years, health care exchanges probably have consumed more of corporate benefits managers’ time and psychic energy than any other topic. An outstanding question is whether the rank and file of American businesses will drop the hassle that employer-sponsored coverage represents, or default to private exchanges.

Private exchange offerings typically move employees from their companies’ previous self-funded health plans to fully-insured individual arrangements, purporting to offer more flexibility and choice that can adapt to the wide-ranging needs of employees and employers, while creating a more competitive health plan marketplace.

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