2018 September

Post: Values

Salesforce is one company that truly walks their talk.

Here’s what I inferred about their values and culture from just one day at Dreamforce:

1/ Environment: Be Mindful. All the nomenclature and products used referenced the environment reminding us all to tread lightly and reduce our impact.

2/ Transparency: Build trust. Customers asked for greater pricing transparency so what are they getting….published rates! Transparency is used to build trust within the organization and with customers.

3/ Inclusion: Be Open. The diversity of the people attending, speaking and customer involvement spoke to their commitment to inclusion and the value of sharing of ideas and lessons learned.

4/ Community: Empower. Community leaders are recognized and empowered to help everyone thrive. After all, big initiatives take a village to do well.

BTW – they are doing some pretty amazing things with their technology too that will help us all blaze new trails. We’ll share more about that in future posts.

Post: Despair

Should wellness programs include an unrestricted education benefit to stem the tide of despair?

Have you heard the term Diseases of Despair? I hadn’t until today but couldn’t help but think at least some of the drug abuse problem was a function of the fact that life just sucks for some Americans.

How do we make it better?

1/ If you think about Maslow’s hierarchy of needs, the foundation includes the basic things people need to sustain life [housing, food and water etc.] and feel safe.

2/ If you think about how to move people up the hierarchy, they need education, job training and coaching to develop the life skills needed to be independent and successful.

The problem is two fold. 

1/ Many Americans have been without a foundation for a long time. They need healthcare and in many cases, lots of healthcare to restore their health.

2/ The other problem is that the foundation is still eroding for many Americans. If foundations continue to fail, more will suffer Diseases of Despair. It’s likely stressful for employees at the breaking point.

Americans need to address the problem with social programs and stem the tide by investing in people.

Extending wellness programs to include an unrestricted benefit for online education might help stem the tide. It’s an affordable offering for employers to consider.

Post: Rules

Not all rules are made to be broken.

The healthcare industry has always struggled with patient compliance. Many patients stop taking a prescription or adhering to a care plan as soon as they starting feeling better.

It’s a huge problem for physicians trying to adopt value based care models because non-compliant behavior often results in the need for more healthcare. Under value based care that additional care is provided at the physician’s expense. No wonder physicians are not keen on the new risk models.

Ideally every American should understand how they respond to rules.  However, it’s likely another thing that physicians need to address with patients to increase compliance.

There are 4 responses to rules:

1. Upholders: Uphold all rules both outer and inner.

2. Questioners: Questions all rules and uphold only the rules that make sense to them.

3. Rebels: As the name implies, they resist all rules.

4. Obligators: They are motivated by outer rules but not inner rules.

EMR companies should consider updating Patient Registration screens to capture patient’s rule behavior and to identify the Questioners and Rebels who are less likely to comply with meds and care plans. Rule behavior should also be factored into reporting and payment to avoid penalizing physicians.

 

Post: Fixing Problems

Go slow to go fast.

Most people call us when they have a problem and they are having trouble fixing it. Reflecting back on completed projects, the underlying issues are one or more of the following:

1/ Flawed assumptions: Assumptions are made about what’s causing a problem without checking all the facts.

2/ Timeline: Deadlines to get the project done and the need to get it done overshadows whether it’s the best solution or not.

3/ Perception: People outside the department or discipline don’t understand or don’t care enough to prioritize your needs.

Taking a step back to reassess things is hard but it’s worth taking the time to get it right.

What we know to be true:

1/ People might not understand your needs but that doesn’t mean they don’t care.

2/ Often systems and processes just need to be fine tuned. Fine tuning requires less work than starting a new for your limited resources such as engineers.

3/ Deadlines are sometimes arbitrary. Know whether the deadline is someone’s ideal deadline or a real one and why.

Best Advice: Take the time you need to understand the problem. Developing and implementing the solution will go much smoother and faster.

Post: Networking

How often are you networking with intention?

Why do I ask? New opportunities often come from the people you know and who know what you do.

I started thinking about this after meeting with another small business owner who told me his entire business comes from referrals.

I couldn’t help but do a little research into networking and how people are getting referrals. I’ll share a few things that I’ve learned so far about networking with intention.

Tips for Intentional Networking:

1/ Networking Groups. Find a business group serving the same industry or types of people that you would like to meet. Regular attendance matters.

2/ Schedule 1:1’s. Schedule a one hour meeting with everyone in the group to develop a more meaningful connection. During the meeting, share your name, what you do, the types of clients you serve and the types of connections that would be meaningful to you.

3/ Connect people. Some people make connections naturally and others have to be prompted. Don’t be scared to ask for a referral.

Social Networks:

LinkedIn is a great way to research people and build a network. It’s pretty meaningless if you don’t use the connections.

Start with a message about why you want to connect as part of your request and follow up with a call or meeting. If you don’t know why you want to connect, don’t send the request.

Follow them to get insight into who they are and what they do. Then if you think it would be valuable to connect with them, send the request to start the conversation.

Health and Fitness: Hello Workout is another good way to network if you’re in the business of treating and caring for others. Get more information or sign up Free.

Post: Self-Care

What do you do afterwork to decompress and recharge your batteries?

It was a ice-breaker question that members of a business group needed to answer as part of their introduction. Almost everyone in the group started with something along the lines of “well I know that I should be exercising” but what I really do is …. guess what they said.

As some of you know, I’ve been trying to get more people working out and living a healthier lifestyle [aka: Hello Workout]. My introduction was last so there was no bias in the responses for what I do or anything that I said.

After hearing everyone’s “confessions”, I almost felt bad introducing myself and sharing a bit about my lifestyle. If you’re wondering, I am a strong believer in regular maintenance whether it’s my car or my body. Both work better when they are cared for properly.

Inspiring, nudging and telling people to workout might not be the right approach. It makes people feel ashamed and it makes people initiating the conversation feel bad. It’s awkward all the way around.

Many in the business group talked about caring for others. There is no shame in caring for others. So maybe the better question is “How do you care for yourself?“.

Words are powerful. Simple changes can make a big impact.

Shame steers people into a life of silence, inactivity, lying and hiding.

~ Harriet Lerner

 

Post: Balance Billing

More regulations or should we fix the payment system?

Years ago, I attended a ABA conference and asked “why don’t we just fix the payment system” rather than add more regulation. I am reminded of that event this morning in reading the KHN proposed options for addressing balance billing.

The proposed solutions are a bunch of new federal and state laws addressing charges and billing practices. Regulation is an important part of protecting individual Americans against corporate wrong doing. However when regulation is used as a bandaid, regulations become part of the problem.

In the case of healthcare, additional cost. High cost is one of the big issues that the industry needs to address in order to make healthcare more affordable.

The problems that need to be addressed are:

1/ Fragmentation: Makes it difficult for patients to navigate and costly to administer.

2/ Network: Not all providers participate in commercial networks which means some patients are exposed to balance billing.

3/ Transparency: Insurers and healthcare providers don’t want their contracted rates shared to enable the consumer.

4/ Current Billing Regs: Healthcare services and products are marked up because everyone needs to be charged the same and there is variability in the contracted rates.

The problems require a more fundamental change.

Universal healthcare

Is it the end of employer-sponsored healthcare or the beginning of employer-driven healthcare?

When I posed this question to my Linked In network, many people viewed the post, some followed up for links to sources but no one commented even though healthcare is top of mind right now for many Americans.

Healthcare is an emotional topic. It’s something that everyone wants and needs but most Americans are struggling to pay for it. The healthcare jobs boom is still going strong which means the total cost of healthcare is continuing to increase. While there doesn’t seem to be a rolling average cost of healthcare per GDP publicly available to see the impact, the math is pretty simple  – more jobs means there is more healthcare being delivered which means more cost.

The total cost of healthcare will not decrease until we curb demand. 

Consumer Driven Healthcare initiatives failed.

Consumer driven healthcare initiatives such as high deductible health plans curbed demand in the short run but resulted in more costly healthcare outcomes. Americans simply couldn’t afford to pay their premiums and the patient portion of healthcare services under those plans. Consequently, they didn’t seek treatment until their health issue became a big problem. In simple terms, big problems cost more to treat. Other consumer initiatives such as pricing transparency never really saw the light of day.

Employer-Driven Healthcare

Employer-Driven healthcare is a new theory and consistent with the Republican trickle down economic policies. The assumption is that if the Republicans can tweak policies enough to get the economy to full employment, every American or at least nearly all Americans will get a job with healthcare benefits. In theory, all employers will offer benefits that are rich enough to ensure timely access to healthcare services.

Some employers are taking initiative to implement on-site and near site clinics, lower deductibles and implement wellness initiatives even though there is a perception that wellness doesn’t work.

There are ways to make wellness programs work better but the key words for an employer-driven healthcare system to work is ALL and SOME. If only some employers offer rich benefits, many Americans will continue to be underinsured or uninsured.

Medicare for All

The idea of “Medicare for All” was endorsed this weekend by former President Barak Obama. The initiative is gaining traction due to the economics and financial condition of Americans.

1/ Healthcare is becoming a bigger portion of the take home pay of low and middle income Americans which means they have less money to spend on housing, food, clothing and other life essentials that affect their health and wellbeing.

2/ The middle class is eroding to the point that it needs to be supported with social wealth-fare spending. Reportedly, $1 in every $7 is now spent to subsidize the middle class.

3/ Republicans are working to privatize Medicare. More health plans are getting into the Medicare and Medicaid business. According to the press release for Oscar Health, it is a more “lucrative” segment. Oscar [co-founded by Jared Kushner’s brother, Joshua] historically sold individual and family plans on the exchanges. Many of the people purchasing policies on the exchanges were sicker and needed more healthcare than expected.

4/ New Medicare Advantage plans are now addressing social determinants and covering many basic living costs. Bankruptcy filings are increasing in the senior population.

5/ Koch brother sponsored study reports “Medicare for All” saves $2 Trillion.

What does this mean for healthcare?

If we just look at the economic condition of many Americans and how the financial strain is impacting their health, it’s clear that we need a new universal healthcare system.

If we consider the changes underway to Medicare and the momentum of the “Medicare for All” movement, it looks like Medicare will be the underpinning of the new universal system. It’s a good thing for you because all or nearly all healthcare providers participate in Medicare, it has well established coverage standards for medical care along with a fee schedule and excludes bad actors from participation.

If we factor in everyone’s deep seated emotions about healthcare, we need a system that offers choice.

What we end up with is a two tiered system offering basic coverage for all Americans and enhanced benefits for those who choose and can afford to purchase additional coverage.

Simplicity wins:

There are plenty of models in other first world countries that can serve as a framework. The key is choosing a framework that simplifies the healthcare system for all to navigate and understand. Not only will it make it easier for all Americans to access care when they need it rather than when they can afford it. It will also reduce the cost. The administrative burden of the current system alone is estimated at 30% of the total healthcare burden in America.