Search

Entries in Other (16)

Monday
Dec102018

Four Questions for CoxHealth: Post-Webinar Interview

Recently, DNV GL Healthcare and CoxHealth participated in a Healthcare Web Summit webinar discussion on Unconventional Paths to Reducing Patient Readmissions. If you missed this informative webinar presentation, watch the On-Demand version here. After the webinar, we interviewed the CoxHealth team on four key takeaways from the webinar: 

1. Your study looked at readmission rates for congestive heart failure patients, how did you identify physicians with higher than average readmission rates? 

CoxHealth: We are currently identifying CHF patients who have readmitted for a second time and enrolling them in the Advanced Practice Paramedic Program.  Our data showed that if a person readmits once, they are more likely to readmit a second, third, etc time.  We felt our best use of resources was to stop the multiple readmitters. 

2. From a case management perspective, what were lessons learned from skilled nursing facilities? 

CoxHealth: We brought a few different skilled nursing facilities together and diet was determined to be the single largest item that helped keep readmission rates low.  Our APPs have a great focus on diet with the patient and the patient’s family when they enroll. 

3. Describe your Advanced Practice Paramedics program and key successes with this program in managing emergency department high utilizers. 

CoxHealth: We identify a high utilizer as anyone who visits the ED 5 or more times in a 12 month period.  One of our keys of success, that we learned because we didn’t start this way, is to have an APP in the ED to visit with the patients real-time and enroll them.  We started with a social worker doing this and we weren’t having the acceptance we were hoping for.  When we had the paramedic, who would then be coming into their home, visit about the program, our acceptance rate increased drastically.  

Another key to our success is our goal is to graduate patients from the program in approximately 90 days.  We continue to track the ED utilization after the enrollment period to ensure we don’t need to touch base again with the patient, but our goal is to work with them on what interventions can be implemented so they don’t have to visit the ED as often.  If our APPs didn’t graduate patients, we wouldn’t be able to enroll new patients and continue to grow our success. 

Our final keys to success is to not overly prescribe to the APP what they should be doing for the patient.  We have individualized care plans and encourage the APPs to think outside the box when providing care. 

4. Who pays for the APP program? 

CoxHealth: CoxHealth pays for the program.  We are proving the program’s worth through cost avoidance of low reimbursement patients in the ED as well as decreasing readmissions cost.  We are currently in discussions with two large payers to begin reimbursement for APP visits.

Thursday
Jun282018

Five Questions for Kelly Proctor, Physical Environment Sector Lead, DNV GL Healthcare: Post-Webinar Interview

By Claire Thayer, June 28, 2018

Recently, Kelly Proctor, Physical Environment Sector Lead, DNV GL Healthcare, participated in a Healthcare Web Summit webinar discussion on Workplace Violence, Security Vulnerability Analysis, and Ensuring Sound Security Management. If you missed this informative webinar presentation, watch the On-Demand version here. After the webinar, we interviewed Patrick on five key takeaways from the webinar:

 1. What is ISO 9001?

Kelly Proctor: ISO 9001 is a Quality Management System that ensures risk based thinking and continual improvement.

2. Why introduce ISO 9001 to hospitals and tie this to the accreditation process?

Kelly Proctor: ISO 9001 when implemented properly will ensure that the hospital considers all risks both internally and externally while building an effective Quality Management System. The Quality management system will be the infrastructure for all the other standards and requirements for the organization as well as serve as the quality improvement program forcing the hospital to consider risks, both internally and externally. A strong ISO 9001 program will improve processes and sustainability.

3. Your webinar focused on Security Management and specifically NFPA 99 2012 Chapter 13.  Can you define this for our audience?

Kelly Proctor: All CMS reimbursed hospitals are required to follow the National Fire Protection Agency (NFPA) 99 2012 Edition and NFPA 101 2012 Edition standards. CMS allows hospitals to exclude Chapters 7, 8, 12 and 13 of the NFPA 99 2012 standards however DNV-GL does not allow its client hospitals to exclude chapters 12 (Emergency Management) and Chapter 13 (Security Management). Chapter 13, has a focus on the security of the hospital and requires the hospital to identify its security risks, areas to be secured, abduction risks and security measures, Work Place Violence and more.

4. In your discussion on the value of conducting a thorough Security Vulnerability Analysis (SVA), you've indicated that this should be considered as living document.  Can you tell us more?

Kelly Proctor: The SVA should be considered a living document because as your security risks change so should your SAV. NFPA 99 requires an annual review of the SVA however if there are changes in the hospital risks the SVA should be adjusted to reflect these changes.

5. What are the 7 building blocks for developing an effective workplace violence prevention program?

Kelly Proctor: These 7 building blocks can be found in the NIAHO standards Revision 18 under the interpretive guidelines. They are as follows:

• Establishment of a Threat Assessment Team

• Hazard Assessments

• Workplace Hazard Control and Prevention

• Training and Education

• Incident Reporting, Investigation, Follow-up and Evaluation

• Recordkeeping

Wednesday
Mar292017

Disobey, Please

Untitled 1
 

By Kim Bellard, March 29, 2017

 

The M.I.T. Media Lab is taking nominations for its Disobedience Award, which was first announced last year.  As the award's site proudly quotes Joi Ito, the Director of the Lab and who came up with the idea: "You don't change the world by doing what you are told."

I love it. 

 

The site, and the award's proponents, make clear that they are not talking about disobedience for the sake of disobedience.  It's not about breaking laws.  They're promoting "responsible disobedience," rule-breaking that is for the sake of the greater good.  The site specifies: This award will go to a person or group engaged in what we believe is an extraordinary example of disobedience for the benefit of society."   

 

In Mr. Ito's original announcement, he elaborated: The disobedience that we would like to call out is the kind that seeks to change society in a positive way, and is consistent with a key set of principles. The principles include non-violence, creativity, courage, and taking responsibility for one's actions." 

 

The creators of the award are probably not thinking much about health care -- despite disavowing it is about civil disobedience, many examples they've given revolve around people resisting what they think are improper government actions -- but they should be. 

If there's a field where lots of stupid, or even bad, things happen to people , through design, indifference, or inaction, health care has to be it.

The list of disobedient acts in health care that would serve society is longer than my imagination can produce, but here are some examples:

·         The nurse who says, no, I'm not going to wake up our patients in the middle of the night for readings no one is going to look at.

·         The doctor (or nurse) who knows a doctor that they believe is incompetent and decides, I'm going to speak up about it.  I'll make sure patients know.

·         The billing expert who decides, no, I'm not going to keep up the charge master, with this set of charges that aren't based on actual costs and which almost never actually get used (except by those unfortunate people without insurance).  Instead, we'll have a set of real prices, and, if we give anyone any discounts, they will be based on ability to pay, not on type of insurance.

·         The EHR developer who realizes that, it's silly that this institution's EHR can't communicate with that institution's EHR, even though they use the same platform and/or use the same data fields.  .

·         The insurance executive who vows, I'm tired of selling products that are full of jargon, loopholes, and legalese, so that no one understands them or knows what is or isn't covered.  We're going to sell a product that can be clearly described on one page using simple language.

·         The practice administrator who understands that patients' time is valuable too, and orders that the practice will limit overbooking and will not charge patients if they have to wait longer than 15 minutes. 

·         The medical specialty that commits to being for patients, not its physician members, by developing measures, specific to patient outcomes, in order to validate ongoing competence.

 

Going back to the award's principles of non-violence, creativity, courage, and taking responsibility for one's actions -- well, the above would all seem to fit.  They're all achievable.  It only takes someone to stand up and decide to do them.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

 
Friday
Mar182016

Under the Influence

By Kim Bellard, March 18, 2016

new analysis by ProPublica found that doctors who receive money from drug companies do, in fact, tend to prescribe more brand name drugs, and that the more money they got, the more brand name prescribing they did.

ProPublica looked at prescribing patterns from five specialties -- cardiovascular, family medicine, internal medicine, ophthalmology, and psychiatry -- with the restriction that individual physicians had to have had at least 1,000 Part D prescriptions in the study period (2014).  Overall, about three-fourths of physicians took some money from a drug company, although there was wide variation by specialty and geography -- e.g., nearly 9 of 10 cardiologists took payments, just as around 90% of physicians took such payments in Nevada, Kentucky, Alabama, and South Carolina. 

Conversely, in Minnesota and Vermont the percentage was closer to 25%.

The amount of the payments appeared to have an impact.  Internists who received no payments had brand-name prescribing rates of about 20%, while those getting more than $5,000 had rates of around 30%.

The defenses from physician organizations and the drug industry make for fun reading.  Dr. Richard Baron, the president and chief executive of the America Board of Internal Medicine, protested that doctors almost have to go out of their way to avoid taking these kinds of payments.

The president of the American College of Cardiology suggested the patterns were re-enforcing; the more they learn about a drug, the more they tend to use it, and the more they use it, the more drug companies pay them to be speakers and consultants.

Seriously, these are their defenses?

We've been learning a lot more about how pervasive industry payments -- not just pharmaceutical companies but also medical device and other health care suppliers -- are since the advent of the Open Payments initiative.  We're talking about over $6.5b in payments in 2014, made to over 600,000 physicians and 1100 hospitals.  I wrote about this last summer, and the new ProPublica analysis certainly should rattle any remaining doubts anyone might have had about the potential impact of such payments. 

True to form, last fall the AMA called for a ban on DTC advertising.   That's right, they don't seem disturbed about the $6.5b physicians are getting, but they think that the ads that we see are bad.  There's a certain logic to that; it has long been suspected that these ads help drive consumer demand.

Austin Frakt, of The New York Timesrecently challenged this conventional wisdom.  For one thing, he notes that while drug ads do cause an increase in sales for the advertised drug, they also increase sales of other drugs in the same class, using Prozac as an example.  Seeing drug ads may help "normalize" the condition being treated, making getting treatment for it more acceptable, and may also help encourage patients to continue with existing prescriptions.  

Mr. Frakt points out that it is not only the drug companies who benefit from drug advertising, but also physicians.  Every $28 in drug advertising results in an additional doctor visit; someone has to do the prescribing, after all.  And, of course, the DTC spending is dwarfed by the direct-to-physician "promotions" -- Mr. Frakt estimates drug companies spend seven times more on these than on DTC advertising. 

So we're back to the ProPublica analysis. 

It simply is not plausible to maintain that these efforts are not influencing physicians' decisions, and that they may not always be in the best interests of patients.  As Bloomberg put it last summer: the payments "seek to convince doctors that second choice is OK."
 
Well, I don't know about you, but that is not OK with me. 

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Wednesday
Apr012015

Healthcare Startups Capitalizing on the Sharing Economy and More

By Clive Riddle, April 1, 2015

These five healthcare lists – courtesy of healthsprocket - should be of great interest today –addressing the sharing economy; King v Burwell; upcoming M&A transactions; headlines you might have missed; and hot innovation initiatives:

Healthcare Startups Capitalizing on the Sharing Economy and More

  1. Uberlance - provide on-demand ambulance services with your SUV
  2. Airpital - rent out your spare rooms for hospital services
  3. PatientGrades - site for doctors to rate their patients
  4. TeleCrowd - crowdsourcing telemedicine - vote on patient's diagnosis & treatment
  5. AirRx - Start a Mail Order Pharmacy with your unused prescriptions

Five Possible Outcomes for SCOTUS King v Burwell Decision

  1. To avoid split tie decision, Scalia and Ginsberg thumb wrestle to settle matter
  2. Court disallows federal funding in states using healthcare.gov, with farmer exemption allowing combined corn/healthplan subsidy
  3. Court strikes down Obamacare - Congress passes emergency band-aid bill providing monthly lottery tickets and band-aids to uninsured
  4. Court rules federal subsidies may continue, but not via healthcare.gov - strict interpretation requires actual physical marketplace with pop-up tents
  5. Court keeps Obamacare intact - Congress authorizes funding of time travel - terminator cyborg to go back to 2010 and prevent passage of ACA

Four Upcoming Blockbuster Healthcare M&A Transactions to Watch For

  1. UnitedHealthcare acquires states of Florida and Arizona to increase Medicare marketshare
  2. J&J acquires actual cloud covering east coast for cloud-based pharma initiatives - relocates cloud to reduce future employee snow days
  3. Company formerly known as WellPoint acquires copyright to Star Spangled Banner as part of re-branding company as "National Anthem"
  4. HCA acquires Carnival Cruise Lines to create new medical tourism fleet

Important Healthcare Headlines You Might Have Missed

  1. German government delays renown U.S. Clinic's expansion to Hamburg and Frankfurt - puts Mayo on hold
  2. In nod to digital age, doctor offices now feature e-versions of past magazines in patient lobbies using refurbished Apple Newton tablets
  3. Red Cross licenses use of name to Blue Cross Blue Shield plans wishing to re-brand insurance products in Republican states
  4. Concerns mount with new obesity management procedure converting unused part of brain to second stomach
  5. GAO investigation uncovers missing "M" in Centers for Medicare & Medicaid Services acronym

Hot Healthcare Innovation Initiatives

  1. Implantable chip sends you text message letting you know when your knee hurts
  2. McDonalds / CMS partnership pairing choice of Value Meal with each Value-Based payment
  3. Exercise treadmills installed in fast food line queues
  4. StubHub-like app to auction your doctor appointment time
  5. Starbucks Pharmacies dispensing your daily prescription with your latte

The lists provided in Healthsprocket’s annual April 1st edition of the SprocketRocket newsletter. If you’d like to check out similar lists from previous April 1st editions, click here

Friday
Jan302015

Ranking the Seahawk’s Seattle vs. the Patriot’s Boston in the Health Care Bowl

By Clive Riddle, January 30, 2015

Given that the contest between the Seattle Seahawks  vs. the New England Patriots in Super Bowl XLIX is a product of listing and ranking NFL teams (by wins and losses), perhaps some irrelevant insights into the outcome of that contest can be gleaned by comparing how the two cities rank in various healthcare lists.

Of course the immediate challenge is to assign a city to the Patriots. Foxboro- the site of their stadium? The entire New England region and all metro areas within? We’ll deflate their claim to a multi-state region, and go with just Boston.

Looking to healthsprocket, the site for healthcare lists, we find these eight lists posted during the past year, which include mention of Seattle or Boston.  The result is basically a tie, based on mentions – unless you deflate the Patriot’s claim to Springfield and Worcester, in which case Seattle might prevail in a sqeaker.

There is a list claiming overall healthcare rankings – that puts Boston at #2 with Seattle whiffing:

Ranking Of The Best Healthcare Cities In The U.S. (Source: iVantage Health Analytics)

  1. Washington, DC
  2. Boston
  3. Minneapolis
  4. Portland, OR
  5. Chicago
  6. Charlotte
  7. Philadelphia
  8. Atlanta
  9. New York
  10. St. Louis

On the other hand, Boston makes the Most Expense Healthcare Cities list (#9), unlike Seattle:

10 Most Expensive Cities for Healthcare (Source: Castlight Health)

  1. Sacramento, CA
  2. San Francisco, CA
  3. Dallas, TX
  4. St. Louis, MO
  5. Kansas City, MO
  6. Charlotte, NC
  7. Denver, CO
  8. Miami, FL
  9. Boston, MA
  10. Portland, OR

Seattle makes this list of lowest cost bronze plans (at #18) in 2014 public exchanges, unlike Boston

2014 Lowest Cost Bronze Plan After Subsidies by Largest City in Each State For A Single 25 Year Old (Source: Kaiser Family Foundation)

  1. Los Angeles, CA - $140
  2. Denver, CO - $142
  3. Hartford, CT - $117
  4. Washington, DC - $124
  5. Indianapolis, IN - $157
  6. Baltimore, MD - $115
  7. Portland, ME - $146
  8. Billings, MT - $152
  9. Omaha, NE - $135
  10. Albuquerque, NM - $122
  11. New York City, NY - $111
  12. Cleveland, OH - $136
  13. Portland, OR - $130
  14. Providence, RI - $127
  15. Sioux Falls, SD - $173
  16. 16.Richmond, VA - $127
  17. 17.Burlington, VT - $116
  18. 18.Seattle, WA - $138

Seattle is also the place to be if you don’t like waiting for your doctor – ranked at #1, with Boston not mentioned

Top 10 Cities With The Shortest Average Wait Times To See The Doctor (Source: Vitals)

  1. Seattle, WA- 16 minutes, 15 seconds
  2. Milwaukee, WI- 16 minutes, 17 seconds
  3. Denver, CO- 16 minutes, 25 seconds
  4. Minneapolis, MN- 16 minutes, 42 seconds
  5. Portland, OR- 17 minutes, 05 seconds
  6. Omaha, NE- 17 minutes, 23 seconds
  7. Charlotte, NC- 17 minutes, 26 seconds
  8. Austin, TX- 17 minutes, 32 seconds
  9. San Diego, CA- 17 minutes, 43 seconds
  10. Raleigh, NC- 17 minutes, 48 seconds

Boston Children’s comes in #1 in this list of best Children’s hospitals, while Seattle is ignored:

Deborah Kotz: The Honor Roll of Best Children's Hospitals 2014-15 (Source: The Boston Globe)

  1. Boston Children’s Hospital/ Children’s Hospital of Philadelphia (tied)
  2. Cincinnati Children’s Hospital Medical Center
  3. Texas Children’s Hospital, Houston
  4. Children’s Hospital Los Angeles
  5. Children’s Hospital Colorado, Aurora
  6. Nationwide Children’s Hospital, Columbus, Ohio
  7. Ann and Robert H. Lurie Children’s Hospital of Chicago
  8. Children’s Hospital of Pittsburgh of UPMC
  9. Johns Hopkins Children’s Center, Baltimore

If you use the Patriot’s inflated claim to the larger region, Springfield and and Worcester come in at #1, and #14 respectively  for best heart surgery hospitals, while Seattle has a hospital ranking #13, in the list:

Top 15 hospitals in U.S. for heart surgery (Source: Castlight Health)

  1. Baystate Medical Center, Springfield, Mass.
  2. Borgess Medical Center, Kalamazoo, Mich.
  3. Cleveland Clinic, Cleveland
  4. The Heart Hospital Baylor Plano, Plano, Texas
  5. Kaiser Permanente Sunnyside Medical Center, Clackamas, Ore.
  6. Kaleida Health (Gates Vascular Institute at Buffalo General Medical Center), Buffalo, N.Y.
  7. Mother Frances Hospital-Tyler, Tyler, Texas
  8. St. Joseph Mercy Hospital, Ypsilanti, Mich.
  9. St. Joseph's Hospital Health Center, Syracuse, N.Y.
  10. St. Vincent Heart Center of Indiana, Indianapolis
  11. Sequoia Hospital, Redwood City, Calif.
  12. Spectrum Health - Grand Rapids (Meijer Heart Center), Grand Rapids, Mich.
  13. Swedish Medical Center-Cherry Hill Campus, Seattle
  14. UMass Memorial Medical Center, Worcester, Mass.
  15. Valley Hospital, Ridgewood, N.J.

Using an access benchmark, Boston ranks #5 while Seattle doesn’t make this list:

Top 10 Cities With The Highest Per-Capita Ratio Of Both Hospitals And Primary Care Physicians Per Resident (source: Vitals)

  1. Cleveland
  2. Minneapolis
  3. Milwaukee
  4. Kansas City
  5. Boston
  6. Omaha
  7. Denver (tie)
  8. Miami (tie)
  9. Atlanta
  10. Nashville

And finally, perhaps in a bit of a stretch, Seattle placing an Executive in the this Most Influential list, while Boston is ignored:

Modern Healthcare: 10 Most Influential Physician Executives And Leaders (source: Modern Healthcare)

  1. Richard Gilfillan- President and CEO, CHE Trinity Health, Livonia, Michigan
  2. John Noseworthy- President and CEO, Mayo Clinic, Rochester, Minnesota
  3. Gary Kaplan- Chairman and CEO, Virginia Mason Health System, Seattle, Washington
  4. Margaret Hamburg- Commissioner, Food and Drug Administration, Washington
  5. Ardis Dee Hoven- President, American Medical Association, Chicago, Illinois
  6. Patrick Conway- Deputy Administrator for Innovation and Quality, CMO, CMS, Baltimore, Maryland
  7. John Kitzhaber- Governor of Oregon
  8. Glen Steele Jr.- President and CEO, Geisinger Health System, Danville, Pennsylvania
  9. Jonathan Perlin- President, Clinical Services CMO, HCA, Nashville Chairman-elect, American Hospital Association, Nashville, Tennessee
  10. Toby Cosgrove- CEO, Cleveland Clinic, Cleveland, Ohio
Monday
Jun092014

Stopping on Green 

By Laurie Gelb, June 9, 2014

The intersection greets you with a green light, but an accident blocks your lane. You brake instinctively, disregarding an official signal to proceed. Contradictory stimuli define our lives. 

Cut to health care’s adherence doctrine. “Ask your doctor. Take your medication as prescribed.” In what other subject area is it optimal for end-users to follow instructions without having internalized a rationale and therefore knowing when and how to ignore them? If you’re repairing something and the instructions say “use an inch of duck tape” and it takes two, do you stop working or use more tape?  You make a split-second decision in the moment. 

We expect to kludge. Every day, most people take action that is unprecedented for them, slightly different, under new circumstances or seen in a new light. When a wall-mounted sink falls off, most of us can imagine that we should use the main water shutoff even if we’ve never used it before. And if we came to a screeching halt at every choice about food, drink, OTC, rx, exercise, surgery, medical equipment, caregiving, parenting, safety, environmental controls, etc., we couldn’t function. Certainly, some health decisions merit more than a second for consideration, but that doesn’t mean they get it, whereas some receive more consideration than they deserve.

You might ask, why is understanding the rationale for and exceptions to instructions so important, considering that patients can consult a clinician that knows both well? But you know the answer: seldom is the clinician or the network next to patients as they make critical choices to act, avoid, deny, even everyday re-evaluation of instructions about meds, diet, exercise, procedures, lifestyle, rehab.The vast majority of decisions that drive health outcomes are unknown, unseen and uninfluenced by content and service providers. And our constituents, knowing their own context better than anyone while facing their own toppled sinks, must often take what is for them unprecedented action. 

As the green light illustrates, we haven’t abstracted information until we can act optimally when things go wrong, or when conditions differ from a perfect world. The necessity of lifelong learning applies to health care in spades, while the evidence base for preaching “follow” (along with paternalistic clinicians and arsenic cosmetics) reeks of mold.

Memorizing that 2x2=4 doesn’t mean that you understand arithmetic. When a toddler repeats words, she hasn’t yet learned the language. We should want health care choices made by reason, not rote. Since any ongoing regimen, including observation, should be re-evaluated periodically, the notion of “set it and forget it” doesn’t apply. 

Few life choices entail a greater emotional investment than your own and loved ones’ health, while typical messaging dispassionately informs you that following the rules offers the best odds.  Yet the “exceptions” are so ubiquitous as to be cliché. Long-distance runners drop dead of early MIs as grizzled sun-worshippers light up into their 80s.  The “what you get is what you follow” thesis merits growing skepticism as truisms (fats block arteries, calcium strengthens bones, exercise prolongs life) emerge as increasingly complex and non-curvilinear propositions. Moreover, today’s patients face competing risks and lifestyle choices that their ancestors never knew. 

Instead of preaching reliance on catechisms that may or may not apply to a given situation, how about skill-building in decision-making directly, including the rationale for caring at all, transcending health calculators and guidelines. Economic studies show lower costs for the “engaged.” It can’t be an innate urge to obsess about health care that engages them, since hypochondriacs entails higher costs. The truly engaged understand enough to add value to their care.

Let’s not seek “informed consumers” a la the cereal aisle, who can only consume the information and care we provide, but informed patients, caregivers, clinicians, administrators and payors, who can collectively lift all boats. Clinicians can ask better questions to optimize outcomes, while EHR designers find better ways to incorporate the answers. Payors can better align provider and patient incentives. Patients and caregivers can ask better questions as well, while acting optimally on the stimuli life presents. 

Our “best” patients are not necessarily the most compliant with our every word. Instead, they ask realistic questions and probe for the best kludges so they can best apply what they know to what they don’t. Indeed, exploring disease information on one’s own has been associated with greater adherence in the traditional sense, time and again. Our “best customers” and the caregivers that support them understand that intention is not action, there is no free ride in health care and sometimes they must preserve their own health and even lives by stopping on green. 

Last week’s Modern Healthcare piece on the Cleveland Clinic illustrates, hardly for the first time, that even marquee institutions mislay part of the achievable.  By the same token, the lives we can save or improve by helping decision-makers to do their best work are incremental to the followers who leave more to chance.

Next installment: what are quick wins for patient satisfaction [sic], disease management and e-health if/as we rethink the adherence doctrine?

Friday
Apr042014

April Fool’s Day Brings Some Humor to Healthcare

By Clive Riddle, April 4, 2014

The first of April marked the annual issuance of satirical lists from healthsprocket, zinging a range of current topics in the business of healthcare, which I can’t resist repeating.

First, let’s visit a list of predictions of future major news items, in a list entitled -  Top Healthcare Headlines from Tomorrow's News

  1. Healthcare.gov server achieves singularity, assumes control of planet
  2. Obesity Problem eliminated in United States thanks to Congressional Act to expand BMI ranges
  3. Exchange enrollment count after March 31st deadline exceeds 400 million, last minute inclusion of uncovered domestic pets credited with enrollment surge
  4. Influenza eradicated after development of oral vaccine distributed in Starbucks Coffee
  5. National consulting lobby urges Congress and states to adopt new, confusing and conflicting healthcare legislation - say lack of new laws since Affordable Care Act is stifling consultant job creation
  6. Medicare officially re-named "Johnsoncare" in keeping with Obamacare precedent
  7. Health Plan of San Mateo declared second largest plan in nation after Kaiser-BlueCrossBlueShield-UnitedHealthcare-Human-Aetna-Cigna-HealthNet-Molina-Centene merger

Here’s another list looking into the future, this time predicting what big problems lie ahead a year from now, with the Top Five Healthcare Crises Predicted for 2015:

  1. Acute Shortage of available new healthcare acronyms
  2. Global climate change causes the Cloud holding all healthcare big data to disappear
  3. Demand for health coaches exceeds supply, causing raid on NFL, NBA and MLB staffs
  4. Healthcare exchanges finally end up working smoothly, causing a wide-scale chain reaction of pundits and politicians heads to explode on national television
  5. Lack of funding causes medical homes to downsize to medical apartments

And one more list about upcoming events, this time narrowing the focus to upcoming month, as we consider Healthcare scandals that will surface later this year:

  1. The "two ferns" in the Obama -Zach Galifianakis healthcare.gov interview were secretly switched out with alternative plants provided by medical marijuana lobby
  2. Major healthcare analytics platform discovered to be vintage Magic 8-Ball
  3. Move by major Health Savings Account (HSA) administrators to convert all accounts to bitcoins proves disastrous
  4. Jointly funded XBox, Wii and Playstation study finding health benefits of exercise and fresh air to be vastly overrated, revealed to be based on SimCity and not actual data
  5. High speed disclaimers at end of prescription television ads discovered to be spoken in Klingon language

Speaking of the “Two Ferns” video, next we look at a list that addresses the White House media blitz to promote signing up in the health insurance marketplaces, with New Television Shows Created to Attract the Young Invincibles to Obamacare:

  1. How I Met Your Health Plan - A previously uninsured guy spends nine seasons explaining to his kids how he finally got coverage after years of searching
  2. CSI: Covered Singles Insurance - Each week, investigators track down an uninsured single twentysomething, and bring their health coverage to justice
  3. The Amazing Race - Young uninsured individuals hurry to sign up in a plan before the open enrollment deadline, despite obstacles placed in their path
  4. Modern Family - Different dependent coverage scenarios are explored in each episode
  5. Once Upon a Time - Evil witches try and convince the population to hold out for their fairy tale past of fee for service medicine, house calls, low costs, and happy doctors and patients

And finally, no discussion of the Affordable Care Act is complete without a few zombies thrown in the mix, as demonstrated by the healthsprocket list Upsides for the Affordable Care Act after a Zombie Apocalypse:

  1. Web traffic will not overwhelm healthcare.gov
  2. Annual ACA expenditures will come in under budget
  3. That stubborn "young invincibles" demographic won't be so important
  4. Consumer engagement strategies can be significantly simplified
  5. More of the population will be walking and less sedentary
Tuesday
Jan222013

"Faith is taking the first step even when you don’t see the whole staircase" - Martin Luther King

By Cyndy Nayer, January 22, 2013

The day before the 2nd inauguration of the President Obama, I have paused.  I’ve been thinking about the post I wrote last year at this time, with quotes of MLK and how they applied to my work, my vision, and, at the time, to the organization I had founded and built on evidence of health value innovation.  It’s no secret it’s been a tumultuous year for all of us.

This past year has been a year of conflict:  the dis-collaboration of the elected officials, the persistence of debt in the government, the modest recovery of the economy, the continuation of foreclosures, and so on.  Today, Twitter is alive with evidence of low to no health improvement from electronic medical records (EHR), the appearance of lack of remorse by Lance Armstrong, the noise of the NRA video with the Obama daughters, and so much more negativity.

On the opposite end, there was a call for Obama’s face to join Lincoln’s at Mt. Rushmore , the praise of Obamacare (ACA) [despite the unprecedented increases in insurance premiums for the 21-29 year olds], and the return of Hillary Clinton to Capitol Hill for updates on national defense.

This emotional rollercoaster is a ride this recession-weary country could well avoid.  So, today, I search for a hero who can help us refocus, that can help us restore our faith in in positive days ahead, and that will support our call to Capitol Hill and the White House to stop this battling and help us get the country back to work, get the kids healthy, and put our health system to top form and optimal outcomes.

I turn to a story, one more time, about Gabby Giffords, but not the PAC story (though, I’m so glad that she and husband Mark Kelley put their strengths into the efforts to protect our children and communities).  No, this time, it’s a message of facing demons and rebuilding on higher ground.

Gabby and Mark sat, on Nov 8, 2012, in a courtroom in Tuscon, AZ and faced her shooter.  Through her husband, Gabby told the shooter, “Today I am done thinking about you,”  and left the courtroom.  Her message to the press is that this is certainly not forgotten, but a resolution to move on.

Gabby is a true American hero.  We’ve struggled through her fight to live, her fight to walk, her fight to talk.  I’vedocumented the success of the recovery as a testament to all that the American health system does right.  The collaboration between health systems, the teamwork of the proficient care providers throughout the recovery, and her personal and very public messaging that yes, she’s getting better, and yes, she’s frustrated, and yes, it’s hard, and yes, she will persevere.

This is the message I’d like to hear from all of our elected officials.  America is a “do” country, not a “do not,” not even a “try” country.  For many years, when people tell me they are going to try something, I put a grin on my face and remind them of the famous philosopher Yoda, of Star Wars fame, who said “Do or do not, there is no try.”  America is that country, the DO country.

Need proof?  Check out this article  Apollo 40 years on:  how the moon missions changed the world for ever.  You will discover that innovation that supported the missions to the moon included (excerpt from the article):

Apollo 9 astronaut Rusty Schweickart’s ”mind-expanding view and the epiphany that it triggered led him to vividly appreciate the insanity of humans fighting over borders that were invisible to him from up there. ‘Hundreds of people in the Middle East killing each other over some imaginary line that you’re not even aware of, that you can’t see,” he recounted. ‘ And from where you see it, the thing is a whole, and it’s so beautiful,” he remembered of his view of Earth. “You wish you could take one in each hand, one from each side in the various conflicts, and say, ‘Look. Look at it from this perspective. Look at that. What’s important?’”  This later influenced astronomer Schweickart’s speech, later turned into an essay entitled “No Frames, No Boundaries,” was embraced by those at the conference, including Carl Sagan, who borrowed from for his uplifting poem Pale Blue Dot, published in his 1994 book of the same name.

The article goes on to document the increase in education funding that fueled the PhDs who developed the navigation system, the protective coverings, and so much more, all built on the faith that we could actually get a man to the moon, because President John F Kennedy declared it would be so.

Need more proof?  Stan Musial.  I have also paused today because Stan-the-Man has passed away.  I grew up in St. Louis.  I was at Stan’s last game in 1963.  I saw him often at Musial and Biggies, one of the best steak houses ever (it closed many years ago) and he never failed to give a smile, wave his hand, ask my little brothers for a handshake, or sign a napkin (or a Cardinal cap, which he more often than not was wearing).  I saw him 40 years later, still standing tall, still with that cockeyed grin, but a but stooped and a bit unsteady.  I wept today, because Stan Musial is the symbol of the Gateway to the West, of the St. Louis Cardinals, of the hope that St. Louis was in those years.  The years he played baseball were also the years of Dr. King.  I don’t think anyone would say those were collaborative years, no, but we did remarkable things, like missions to the moon, Medicare and Medicaid, and freedom to vote.  Our visions, our passions, while not always in sync, came together in sadness (the assassinations of John and Robert Kennedy, and of Dr. King) and in joy (the retirement celebrations of Stan-the-Man, the 1969 walk on the moon).

We never know how far our vision or our passion will reach.  We don’t know the depths of despair that some go thru during the frustration of reorganizing the vision, reformulating the steps, but never, ever losing hope of achievement.

I hope no one ever goes through what the parents at Newtown nor Gabby Giffords, nor the families of the now 900+ people who have been killed since the Newtown tragedy occurred must live with every day.  I hope I live to see the end of health system errors that cause needless suffering– in poor outcomes, in financial loss, and in family jobs–that we’ve all witnessed over the past years.

I say today that this is where I’m going:  to speed innovation that proves it is a solution to the gaps in care, gets people to better manage their own health, and puts the system into pro-active mode for healthier communities. At my lowest, I reach back to the heros, the Gabbys, the Marks, the Stans, the JFKs, the astronauts, the MLKs, and the many more who envision a bolder, grander, more compassionate America.  I refuse to give up my dream.  I will move forward on the faith that is my core, and I’ll take that first step, that 101st step, and I’ll hold your hand as you join me.


Lonny Dunn (@ProNetworkBuild)

1/12/13, 8:16 AM“The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires.” – William A. Ward


I share with you that tweet above that I think is so profound, and I hope it helps you, and those you love, find your way.  I pray, too, that those who guide our country find the will and the faith to solve for what is holding us back, not for personal interests, but for collective improvement. And, I include one more message below from the Twitter-sphere [apologies, I don't know who tweeted it]:

Don’t tell me the sky is the limit when I know there are footprints on the moon.

Be well, my friends, and travel with your head up and your eyes open and your passion in your hearts. Bless the USA, its leaders and its heroes.

Thursday
Aug162012

Not So Bad to Be Employed in Healthcare in this Economy

By Clive Riddle, August 17, 2012

Randstad Healthcare, one of the nation’s largest healthcare staffing firms, now maintains a “Healthcare Employee Confidence Index, a measure of overall confidence among U.S. healthcare workers” which they state “declined 4.5 points to 53.9 in the second quarter of 2012” according to the Harris Interactive quarterly survey they commissioned.

The company states “the quarterly survey of 232 workers currently employed in the healthcare industry, which included physicians, healthcare administrators, as well as other healthcare professionals, reflects a sizeable increase in those who believe the economy is getting weaker. At the same time, that sentiment did not damper workers' personal confidence, as more stated that they believe more jobs are available and they are likely to look for one in the next 12 months. “

Steve McMahan, an  executive vice president with Randstad tells us "understandably, healthcare workers are concerned about the overall economy, but at the same time, this does not seem to be hampering their personal confidence in their own abilities and attractiveness to other potential employers. In fact, when it comes to their own employability, half of healthcare workers surveyed still remain confident that they could find alternative employment if they chose to.”

Here’s some of their survey findings:

  • 43% believe the strength of the economy is weakening, an increase from 27% in first quarter 2012
  • 20% of healthcare workers believe the economy is strengthening.
  • 24% report that more jobs are available, but 49% of healthcare workers believe there are fewer opportunities available
  • 51% indicate that they are confident they could find a job (versus 58%in Q1 2012)
  • 58% of healthcare workers feel confident in the future of their company
  • 37% of healthcare workers are likely to look for a new job in the next 12 months (rising six percentage points from Q1 2012)

It’s interesting of course, to contrast the US healthcare employment picture from the economy as a whole, since the onset of the Great Recession. Here’s Bureau of Labor Statistics graphics from their Current Employment Statistics Highlights, July 2012 issued on August 3rd.

Maybe its not so bad to be employed in healthcare.

Thursday
Feb122009

Identity Crisis: What’s in a name?

By Clive Riddle, February 12, 2009

I recently watched with bemusement as a stream of e-mails progressed through my inbox from participants in the HFMA Managed Care Forum debating what to change the name of their forum to, given the evolution of the business and the negative connotations of the term ‘managed care.’

The debate isn’t new. Significant Managed Care backlash in the media, consumer and provider community started ten years ago, and calls to re-coin the term have been continual ever since. The term “Health Plan” is often now inserted where Managed Care once resided for various publications, organizations and activities, but “Health Plan” doesn’t always fit the situation.

HMO’s aren’t so much the term of choice either, compared to a decade ago, given the decline in HMO enrollment and rise of PPO enrollment and other benefit designs. Back in the day (way back in the day) before “Managed Care” was coined, in the 1970’s the movement was often referred to as “Alternative Delivery Systems.” Eventually that term took on other meanings.

Even before Managed Care really hit backlash mode, there were calls to rename the term. CMS among other made a major effort to re-label Managed Care as “Coordinated Care.” Of course, back then CMS wasn’t CMS either. The Centers for Medicare and Medicaid Services was called HCFA (Health Care Finance Administration.) While we’re digressing, what’s up with the acronym CMS anyway? Why isn’t it CMMS? And which “M” stayed in, and which “M” got dropped? Is it the same reason that the Department of Health and Human Services some time ago dropped the “D” from DHHS and now call themselves HHS? Did the missing “D” and missing “M” get together and form the acronym for “Disease Management”?

Managed Care isn’t the only term, movement or industry continuing to experience an identity crisis. Consumer driven care is also referred to as consumer-directed care, and at the start of the decade “defined contribution health plans” was the term of choice referring to account-based plans. Of course, now many simply use the term “consumerism” to more globally encompass consumer driven initiatives, including those beyond the scope of account based plans.

Health care companies as well run into identity crisis as times change and situations evolve. Almost everyone knows that Kaiser Permanente after World War II grew out of Henry J Kaiser’s prior programs to provide prepaid clinics and care to his shipyard and steel workers. Not everyone knows that AvMed Health Plan of Florida was coined from “Aviation Medicine” when the company was formed in 1969 to provide a prepaid health system for the Miami area aviation industry.

Of course, if your first name is Clive, you’re used to identity issues. I have credit cards made out to Olive, phone calls for Cleve and Clyde and receive mail for Cline and Cliff. When I was in second grade I informed my teacher on the first day of class my correct name was Edward (my middle name) causing great confusion when I brought school friends home. Eventually I embraced my inner Clive. Clive Owens has made things a little easier, but its still an issue. Perhaps I should seek a Clive Forum and start a discussion thread on renaming the Forum. Perhaps I’ll check with the HFMA Managed Care Forum and see how things worked out for them.

Sunday
Jun222008

Health Care Is Personal: In Memory of Karen

By Clive Riddle

Just a few months into my first administrative position at a hospital in 1981, just a year out of college, I remember feeling pleased with myself as I edited the Radiation Therapy Center feasibility study I had just spent countless hours and days preparing. It was a thick report full of projections, tables, charts, and narrative. Then in the background, I could year the sobbing outside my office.

My office had been converted from an admissions room, and was situated next to a quiet area for families, off the main lobby. I had never really paid attention my surroundings. I was too into my new job. But the sobbing persisted, and at some point I had to leave my office for a meeting. As I rounded the corner I spied the family, grieving for a loved one that had just passed away upstairs.

In the years to come, as I progressed in my career, becoming CEO of a regional provider owned health plan, I was typically far removed from the actual rendering of health care. Instead I was immersed in the business of it: budgets, monthly reports, department head meetings, actuarial projections, marketing campaigns, contract negotiations, board meetings, personnel issues.

Now and then, but never often enough, I tried to remind myself of that day outside my hospital office, so early in my career, when I first learned that health care is personal, and can not so lightly treated as just another business or commodity.

During my more than dozen years running that health plan, I had the great pleasure of working every day with Karen (Hutcheson) Speziale. She was the Chief Operating Officer of the plan, and she made the plan run, and run well. Karen passed away this past week, after a six and a half year battle with cancer. Karen should have been with us for at least a couple of more decades.

I remember sitting in my health plan office with Karen and our Medical Director, making decisions on proposed benefit and coinsurance levels for the coming plan year. We set a higher coinsurance level and benefit limitation for Total Parenteral Nutrition (TPN), which was at the time increasingly being used in the treatment of Crohn’s Disease. Years later, one of my children would be diagnosed with Crohn’s. We also set various new benefit parameters for several different prescription and treatment options for cancer.

Health care is personal.

After I left that health plan to start MCOL, Karen went on to take a position with Kaiser Permanente, developing and then managing their expansion in our market. Kaiser is now the dominant health plan in our area. Later, Karen moved away to San Diego, and really flourished there.

Karen volunteered significant time in elementary school classrooms. She became the advisor for the local chapter of her Sorority at the university. She spent countless hours on other civic activities. Several of her former department heads from our old health plan remained the closest of friends with her, taking really cool vacations together, and staying in constant touch. She also kept very close ties with her family. When Karen’s illness required that she fully retire from her job, she continued all her contributions to the community.

I very recently took a quick trip to visit with Karen. She had just returned from a visit to the Kindergarten class where she helped the kids learn to read. They had put on a program just for her. On the wall in her office was a plaque recently given to her by her Sorority as the national “Alumna of the Year.” The perpetual annual award will now bear her name.

Karen’s investment in community time should serve as a wake up  call to all of us working on the business side of health care, to put and keep some balance in our lives, as Karen did.

Karen shared with me how recently at the hospital she had an hour long conversation with a nurse on what was wrong with health care. Karen laughed about it, but its hard to argue that there is something significant that needs to be done with health care. We can start by remembering how personal it is.

Anyone reading this who knew Karen Speziale might be interested to know that donations in her memory can be made to San Diego Hospice at www.sdhospice.org

Friday
Jun222007

Clive Riddle's Welcome

Greetings from BlogLand:

MCOL has launched the MCOLBlog, and I'm excited to be a part of it. Actually, we've been blogging to our MCOL paid members for years, but this inaugurates our public blog for all those in the universe wishing to take part in our discussion.

I will be commenting and reporting on a wide variety of topics regarding the business of health care. By way of background, I've been running MCOL, the B2B publisher of managed care and health care business information and resources for the past twelve years. Before that, I ran a regional health plan for over a decade.

In particular, I'll be addressing issues including consumer driven care, transparency, health care reform, strategies addressing plan design and costs, convenient care, international health care issues, Medicare and Medicaid managed care, and much more.

I look forward to your comments.

Friday
Jun222007

Lindsay Resnick's Welcome

As Chief Marketing Officer of Finelight, I lead business development and strategic advisory services. In this role, I make it a point to stay currenton health care trends and innovative approaches to marketing to insure our clients success in the competitive landscape.

I am excited to be a contributor to the MCOL Blog. With 25 years of professional experience in the health care and insurance industries, I will be discussing such topics as consumer directed health plans, product branding, Medicare, direct-to-consumer selling and how to achieve a dominant position in segmented markets such as young invincibles, boomers and seniors.

There is much to talk about. I encourage you to participate in the comments section as we work together to tackle these issues.

Thank you,
Lindsay Resnick

Thursday
Jun212007

Laurie Gelb's Welcome

Welcome to the MCOL Blog. As a survey/outcomes researcher/strategist who's been on the hospital, payor, manufacturer and consultant sides of the table, I'm looking forward to some lively conversation on decision support, my particular passion. Anyone who delivers, funds, receives or regulates care these days faces an unprecedented burden of choice. How do we minimize this burden while optimizing health? Please bring your experience and insight to our discussion.

Tuesday
Jun192007

William Demarco's Welcome

Welcome:

As a contributor to the MCOLBlog, I’ll be sharing our perspectives on issues surrounding healthcare delivery system redesign and transformation, with particular respect to provider owned enterprises. Among other things, I’ll be discussing provider and employer prospective payment approaches in addressing Pay for Performance models, for purposes of developing direct employer/provider contracting entities, benchmarking collaboratives under the new value purchasing initiatives, as well as single specialty centers of excellence.

Of course, there’s lots more under the sun to talk about, and I do hope to hear from you as we continue down this path.