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In this health care podcast, I\u2019m interviewing John Marchica, who is the CEO at Darwin Research Group.

Starting last year in the middle of the worst of the COVID pandemic, Darwin Research Group conducted a study about what was going on at health systems or integrated delivery networks (IDNs), and they\u2019ve updated it every quarter since then. The goal was to try to stay on top of the effects of COVID-19 on care management and the business of care delivery.

I loved having this opportunity to quiz John about what health systems are saying about how they are doing and what they are doing, both strategically and reactively, coming out of the pandemic and in response to the pandemic.

Now this is a half-hour conversation about an extensive research report, so we\u2019re kind of aggregating all of the health systems in one big bucket. Said another way, we\u2019re obviously not going to play the deep cuts here. No worries\u2014the insights that John lays out are fascinating and give an insider\u2019s look into what\u2019s going on at these really powerful institutions.

By the way, when I say powerful institutions, I just was looking at some stats the other day. Something like 50% of all prescriptions these days run through IDNs (that was in 2020). And also in 2020, aggregate IDN market size was $1 trillion. And by 2027, their anticipated combined revenues may exceed $2 trillion. That\u2019s double. (I know, that was some quick math by me. You\u2019re welcome.)

We\u2019ll see, though, what the recent Executive Order yields\u2014the one to look into the market power that some of these consolidated IDNs wield. Regardless of who you are, it is tough to deny the mountain of evidence showing that IDN health system consolidation considerably jacks up prices that patients, employers, and taxpayers pay in any geography where consolidated IDNs, otherwise known as monopolies, have destroyed all competition.

Probably the most striking takeaway I had from this conversation was how much there is to read between the lines. At the end of the day, IDNs are, and are run, like businesses; and regardless of whether they have a nonprofit on the door or not, that is still true.

Before I get into this, let me just clearly say that my heart goes out to the frontline workers\u2014doctors, nurses, everybody else\u2014and all they have done and continue to do for us, and I mean that with three underlines. While I really admire and support some of the rural and urban truly safety net hospitals who are trying to cobble together positive net revenue against all odds, I am far less sympathetic to some of the huge institutions who will engineer an \u201cit\u2019s good for patients, honestly\u201d cover story for any and all endeavors which all seem to have one thing in common: their profitability. Like, nobody mentioned 340B revenue opportunities or how much money there is in specialty pharmacy when explaining the rationale for standing up specialty pharmacies within some health systems\u2019 walls. Maybe it goes without saying.

Here\u2019s my conversation with John Marchica, CEO of Darwin Research Group and host of the Health Care Rounds podcast, by the way. You should check that out.

John Marchica is a veteran health care strategist and CEO of Darwin Research Group, a health care market intelligence firm specializing in health care delivery systems. He\u2019s a two-time health care entrepreneur, and his first company, FaxWatch, was listed twice on the Inc. 500 list of fastest-growing American companies. John is the author of The Accountable Organization and has advised senior management on strategy and organizational change for more than a decade.

John did his undergraduate work in economics at Knox College, has an MBA and MA in public policy from the University of Chicago, and completed his PhD coursework at The Dartmouth Institute. He is a faculty associate in the WP Carey School of Business and the College of Health Solutions at Arizona State University and is an active member of the American College of Healthcare Executives.

03:50 What were John\u2019s top three health system findings during COVID?
05:24 What is priority for integrated delivery network health systems right now?
08:57 Why do health systems have a renewed focus in primary care?
10:07 How did infusion centers manage throughout the pandemic?
13:58 \u201cIt\u2019s not just in cancer, people not getting screened and being diagnosed; it\u2019s in other areas as well.\u201d
14:17 Which of these telemedicine changes are permanent?
19:39 \u201cA visit is a visit \u2026 so why would you reimburse at a lower rate?\u201d
19:57 \u201cTelemedicine \u2026 is, by its nature, more efficient \u2026 and they should be able to figure out how to make money.\u201d
27:17 What are health system plans that own their specialty pharmacy groups doing right now?
29:57 What does Darwin Research Group focus on?

@johnmarchica of @DarwinHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

What were John\u2019s top three health system findings during COVID? @johnmarchica of @DarwinHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

What is priority for integrated delivery network health systems right now? @johnmarchica of @DarwinHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

Why do health systems have a renewed focus in primary care? @johnmarchica of @DarwinHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

How did infusion centers manage throughout the pandemic? @johnmarchica of @DarwinHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

\u201cIt\u2019s not just in cancer, people not getting screened and being diagnosed; it\u2019s in other areas as well.\u201d @johnmarchica of @DarwinHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

Which of these telemedicine changes are permanent? @johnmarchica of @DarwinHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

\u201cA visit is a visit \u2026 so why would you reimburse at a lower rate?\u201d @johnmarchica of @DarwinHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

\u201cTelemedicine \u2026 is, by its nature, more efficient \u2026 and they should be able to figure out how to make money.\u201d @johnmarchica of @DarwinHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions

What are health system plans that own their specialty pharmacy groups doing right now? @johnmarchica of @DarwinHealth discusses #virtualhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #virtualfirst #healthcaresolutions