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Business Models | JPowers.IN3.ORG
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Building a Multimedia Operation in China

China Staffing
For a visiting group of media executives from China, I’m giving a talk on building a new media team inside an existing print publishing operation. Not only do you have to train your staff to create innovative interactive products, you also have to train your customers in what’s possible and why it’s better than print.

Here are the slides.

Convergence of Digital Multimedia for Publishers
November 29-30 and December 1-2, 2016

A Management Seminar organized for the State Administration of Press, Publications, Radio, Film and Television in cooperation with the
SUNY Global Center

Top Healthcare Conversations of 2008

Many of the great healthcare thinkers and bloggers wrapped up 2008 with end-of-year considerations of the important developments in their fields, and some looked ahead with predictions for 2009.

Google Health 2018: Best — and Worst — Case Scenarios

We went brainstorming to see how open architecture might affect wellness, sex, eldercare, insurance and other health concerns.

U.S. Healthcare Spending: Good News/Bad News

The good news is that U.S. healthcare spending growth slowed in 2005 to 6.9% annually. The bad news is that total spending reached $2 trillion per year, 16% of the Gross Domestic Product (GDP), almost $6,700 per person for each of the 300 million Americans.

Walmart’s Loss Leaders: First Beyonce, Now Prozac (fluoxetine hydrochloride)

Walmart’s ability to drive down the cost of genercic drugs is a good thing. But in the pharmaceutical context, questions arise…

Disgruntled Docs Go Out of Network

Hundreds of pissed off MDs gathered at a seminar in New York recently to find a way to beat the healthcare system that they say underpays, overmanages and cheats both doctors and patients.

Mustargen: A Bad Case for a Nasty Old Drug

Joyce Elkins of Georgetown, Texas saw her $77.50 cancer medication Mustargen jump to $548.01 within two weeks. Merck, the drug’s original manufacturer, sold the rights to Ovation Pharmaceuticals which promptly raised the wholesale price “roughly tenfold.”

The Coming Shortage of Dead People


Demography is destiny, and the destiny of the developed world is to have more old people. The two charts above (click to enlarge) from the U.S. Census Bureau report 65+ in the United States [PDF] show two snapshots of the U.S. population in 1940 and 2000. On the left, starting at the bottom, most young people live to adulthood and then start dying off evenly at each age until very few people are left alive at the top of the spear, ages 80 and over.

The last half-century’s advances in medicine automation and world peace make the age needle flatten out. As a proportion of the population, twice as many people live past 65 today, and five time as many live past 85. Folks who would have been dead otherwise now live on to spend their children’s inheritance, collect social security and demand free drugs from the government.

Slate’s William Saletan covered the impact of all this destiny in a weekend article "Bygone Era: Old Age is changing. So should Social Security." His opening line: "The bad news is, we’re living longer."  The solution: Work longer (like past 70), curb early retirements, and needs-test Social Security.

(The title of this item comes from last year’s Atlantic Monthly article "The Coming Death Shortage" by Charles C. Mann. [$$])

Wal-Mart Medical Clinics

At yesterday’s National Governors Association Winter Meeting in Washington, Wal-Mart president Lee Scott (at right) announced the opening of 50 new in-store clinics adding to the handful now run by RediClinic, a division of Interfit Health, a Houston-based firm. Interfit is backed by Revolution Health Group, the post-Time Warner venture of AOL founder Steve Case with a stellar board of tech-savvy directors.

As we wrote in Wal-Mart’s Tough Choices last December, the biggest employer in America faces the biggest employee healthcare problem, and Scott says he’s dedicating himself to getting state governments focused on realistic solutions — instead of the employer mandates they’ve been contemplating. But the most disruptive line from the speech is: “We’re making health care more affordable and accessible to our
associates.  And with the clinics, we’re using our business strengths
to do the same for our customers and our communities

When Wal-Mart starts competing with ol’ Doc Welby, things will start changing.

MinuteClinic Retail Care: “You’re sick. We’re quick.”

The sign on the wall at Minneapolis-based MinuteClinic presents the price list for common medical procedures: $49 for a Sinus Infection, $59 for Wart Removal, $39 for a Pregnancy Test. Office hours are 8 to 8 weekdays, 8 to 4 weekends, no appointment necessary. The 90 square foot clinics are located in high traffic retail locations like Target, CVS and CUB Foods stores, usually with free parking. A nurse practitioner backed up by a proprietary evidence-based diagnosis and treatment system gets you in and out in 15 minutes, faxes your primary care physician a report, and accepts most insurance plans. If you have a medical problem not on the list — about 7% of walk-ins, says MinuteClinic — you’re referred to a primary care physician, urgent care center or emergency room.

Like a JiffyLube, the MinuteClinic does a few things, and does them efficiently and well. The company says that a Sore Throat visit — including prescription medication — costs about $62 and 30 minutes versus a primary care physician’s $109 and 90 minutes versus an emergency room’s $325 and God-know-how-many hours waiting time. Patients are satisfied: 50% are referred by friends, 40% to 45% are regulars, and the firm claims 4 complaints per 10,000 visits. Employers are satisfied: many companies actively promote MinuteClinics and even discount co-pays for employees.

Price transparency. Careful quality measurement. Evidence-based practices. Electronic medical records. 21st Century customer service. You know it’s a disruptive innovation when the first item on the agenda for the NAFAC urgent care physicians conference in April is:
"Are you threatened by the recent openings of clinics inside big-box retailers or chain drug stores in your community?"