Heathcare

Automation + Motivation

Learn what you should be doing now as automation changes the way people work and get rewarded.

Last week I read about a recent Bain & Company report estimating the automation of 40 million jobs [25-30% of US jobs] within the next decade. White color jobs are not immune from outsourcing or automation.

That’s eye opening but technology has made the world feel a lot smaller since the dot-com boom. When I first started my online training business in 2000, a healthcare CEO asked me where my colleagues were located. Everyone was scattered around the US. It seemed to make him feel uncomfortable, but even then high speed internet access enabled my development team to communicate and collaborate in real time.

The tools are better now but technology is also getting smarter. In 2009, I closed my online training business for two reasons:

1/ Much of the revenue cycle work and financial reporting in healthcare could be automated.

2/ The companies that needed a training program were more focused on extrinsic rewards.

Algorithmic Work:
Revenue Cycle work for the most part is algorithmic work or in other words, work that requires routine processing. At least 90% of revenue related transactions can be automated now if companies have invested in their systems. Old patient accounting systems that relied heavily on data entry as a source of information are now the problem because much of the information contained in them is dated and incorrect. There are better ways to obtain, use and store the patient data needed for transacting business.

Heuristic Work:
Automating revenue cycle transactions also changes the skillsets needed to manage the systems and do the remaining 10%. The work becomes less about routine processing and more about creative and analytical problem solving also referred to as heuristic work. Given the nature of the work, heuristic work typically cannot be outsourced or automated.

Motivation:
Many healthcare companies still rely on incentive based reward structures to motivate people to work. Productivity goals made sense when much of the work involved routine processing. Unfortunately, it doesn’t work the same way for people intrinsically motivated by the work itself. In fact, “if then” rewards are often counter productive because it turns something that people enjoy doing into the drudgery of work. Worse yet, decreases in intrinsic motivation can lead to destructive behaviors.

Goals may cause systematic problems for organizations due to narrowed focus, unethical behavior, increased risk taking, decreased cooperation and decreased intrinsic motivation. ~Drive by Daniel Pink

 

Referring back to #2 of my reasons, companies led by people who are driven by immediate extrinsic rewards underperform over the long term simply because they underinvest in training, systems, research and development. Same is true for publicly traded companies who provide the most earnings guidance to Wall Street analysts.

Drive
Drive by Daniel Pink is a book about Motivation that does a good job of connecting the dots of several leaders in modern behavioral research.

Extrinsic rewards are addictive particularly for type A personalities but at a certain point, they don’t make people happier. In fact, people driven by extrinsic rewards are more likely to feel anxious and depressed than intrinsically motivated people.

Three Ingredients of Motivation:

1/ Autonomy: According to Tony Hsieh, founder and CEO of Zappos and author of Delivering Happiness, perceived control is an important component of one’s happiness. When performance goals are tied to compensation it become more about the money and less about the work. Plus when performance metrics are varied they are harder to finagle.

2/ Mastery: Tony Robins recently posted on LinkedIn “All my past failure and frustration were actually laying the foundation for the understandings that have created the new level of living I now enjoy.” That’s mastery. It’s a lifelong period of effort to improve performance in a specific domain. According to Carol Dweck author of Mindset, the effort that it takes to master something meaningful [aka: pain] is what gives meaning to life.

3/ Purpose: The most deeply motivated people – not to mention those who are most productive and satisfied – hitch their desires to a cause larger than themselves.” There are some good examples in Drive of companies leading with purpose. One of which is Toms shoes and another good example not in the book is Patagonia.

For me, our online training program was about giving our students a career path to better job opportunities and a brighter future. That’s why I remained so passionate about it for so long.

So what do you need to do now:

1/ Figure out what type of work motivates you.

2/ Invest in your skillset rather than relying on your employer for training.

3/ Deliberately practice so that you improve.

4/ Identify your Why or in other words, your purpose.

About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

 

Learn the three Ds

Use the three Ds from the process of “Get Stuff Done” to make good decisions and be more successful at work and in life.

The three Ds are Discussion, Debate and Decision from the process of “Get Stuff Done” described in Radical Candor. I happen to be reading the book this week and used the three Ds as a framework for explaining my process for flushing out the problems, generating ideas and developing the right course of action from a project.

My application of the framework isn’t an exact textbook example. However, it has served as a good way to frame the complexity of the project and balance the complexity with the drive to get the project done.

Discussion:

According to the book, discussion is supposed to take place in 1:1 meetings. Meetings between managers and direct reports are supposed to provide a safe and constructive environment for discussing new ideas, challenges and other issues.

The discussion phase for me happens with a small group of subject matter expertise. It’s a low key discussion to flush out the details of the problem and constraints so that we can generate new ideas for how best to address the need. We basically spend the time thinking about what’s possible. Afterwards I send out a recap of our discussion and capture any additional thoughts on the matter. The recap ensures that we all left the discussion with the same understanding.

Debate:

Debates are bigger meetings to present the ideas so that others can raise their questions and concerns before a decision is reached. Keeping people in debate rather than decision mode is tricky when you have debaters and deciders in the room. Debate can be almost painful for those who already know what they want and/or want a quick decision. If you have ever felt like you got shut down too early during a debate meeting it’s a clear indication that you have debaters and deciders in the room.

The best thing you can do based on my own experience is to communicate your expectation for the meeting and what you want to get from it. If the ideas aren’t flowing, directly challenge the group on a specific problem or idea to spur further debate. The book has some techniques for making sure everyone is in the mind space for a debate meeting and for making it a fun process.

Decide:

People who have a strong grasp of the facts need to make the decisions. Those people are usually closest to the work. That’s why leading edge companies have a process for decision making and why many use the process for Getting Things Done. All of the meetings to discuss, clarify and debate the issues facilitate the decision making process.

The three Ds also help me respect the boundaries of my role as a consultant which is to help flush out the problem, generate ideas and facilitate the decision making process – and not make decisions no matter how tempting.

Application in life

You could apply the three Ds to other relationships as well. Think about the 1:1 meeting framework. When friends and family have problems, they often just want to someone to listen and to ask questions that help them clarify their issues and ideas. They don’t want to be told what to do and definitely don’t want to be judged.

Debate is necessary when decisions affect others. It gives everyone an opportunity to ask questions and raise their concerns so that they can be addressed before a decision is made. Debate often ends too early in the process and unfortunately, the relationships suffer. So keep the debate going until you can make a good decision.

About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

Single Payer System

A Single Payer System will help “Make America Great Again”.

I am convinced healthcare in American needs to become a single payer system with an option to purchase private insurance. Why?

Many American are still slipping through the cracks of the current system because it’s so fragmented. With health insurers pulling out of the exchanges and the uncertainty of CHIP, even more Americans are likely going to slip through the cracks in 2018.

While reading Option B this weekend, I learned that 46% of Americans cannot afford to pay $400 in the event of an emergency. It’s no wonder hospitals are seeing an increase in bad debt. The average deductible in 2016 was just shy of $1500. With more Americans trying to lower their premiums, it’s reasonable to expect deductibles will continue to increase. Higher deductibles and out-of-pocket maximums means many Americans are underinsured and exposed to excessive financial risk.

Illness is a factor in more than 40% of bankruptcies and there is evidence that people with cancer are more than 2.5 times as likely to file for bankruptcy. Even relatively small unexpected expenses can have disastrous consequences: 46% of Americans are unable to pay for an emergency bill of $400. ~Option B by Sheryl Sandberg and Adam Grant

People need a certain level of support to shift into growth mindset which is essential to return America to greatness. Healthcare is an essential part of that support. As Sheryl acknowledged in Option B, paid family leave, quality healthcare and mental health coverage make the difference between people falling off and hanging on. In other words, they are essential to life.

Many leaders are acknowledging now that capitalism is not working for the vast majority of Americans. The fundamental goals of business and the welfare of Americans are misaligned.

I fully agree that the capitalist system as we know it with regards to compensation is severely out of balance when you compare the growth of executive level compensation with that of labor….The U.S. Middle Class is shrinking compared to the base of 1962 and is now about 47% of the population from about 62%… These are the kinds of trends that lead to social and political upheaval. ~ Fortune, CEO Daily

What’s clear is that we’ve tried to make universal healthcare coverage work and we’ve allowed things to get so far off track that we need to do something dramatically different. It’s time for Option B in healthcare.

We should consider a single payer system as the base of the American system. Access to healthcare should not depend on where people live or who they work for because it’s an essential service for the health and welfare of all Americans.

A single payer system is going to be expensive but to “make America great again” we need to reinvest in all people rather than just lining the pockets of the 1%. Warren Buffet one of the wealthiest people in American is onboard.

 

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About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

 

No Easy Answers

There are no easy answers when it comes to healthcare.

Healthcare is something everyone wants because it’s an essential service for sustaining a healthy life. However, the cost of healthcare is what makes it a difficult service to provide to all Americans. Politicians are continuing to struggle with what to do.

Changes to the ACA are still up in the air …“the president has no interest in bailing out insurance companies.”

Proposals to sure up the insurance options available on the exchanges require subsidies for low-income consumers. The GOP is willing to authorize the subsidies but there is a catch. Republicans want states to have more control over the implementation of the ACA – which essentially means health insurance available to Americans will vary state to state. Consequently, Democrats have expressed their concern for the consumer protections which were a fundamental part of the ACA.

Insurers are threatening to pull out of the exchanges if the funds for subsidies disappear. Lindsay Graham is suggesting block grants to states if all else fails which no one seems to like either because some Americans will get generous benefits and others not enough.

There is one thing they agree on:

Either way you slice it both Republicans and Democrats seems to be pointing to the complexity of the current healthcare system as a problem.

Republicans are making a case for a free market system that makes patients behave as healthcare consumers. The thought behind it is that consumers will only pay for what they need if they know the price. In theory, healthcare becomes a cash business which negates the need for the complexities of the current healthcare billing and collection industry. The problem is healthcare consumers may not have the cash for needed care.

Democrats on the other hand are making a case for a Single Payer system which will place the financial burden on the tax payer. A single payer system would provide a basic level of coverage to all Americans regardless of their ability to pay. The challenge is in defining the basic level of coverage because when someone else is paying most people think more always seems better – even if it isn’t. Bernie Sanders plan will be presented on Wednesday.

Healthcare billing and collection cost providers approximately $52 billion/year. Either strategy will put pressure on the Revenue Cycle industry providing billing and collection services because the healthcare payment processes will likely be simplified.

Bernie’s Plan

Labeled “Medicare for All” but is really “ACA Coverage for All” paid for by the tax payer. Hence a non-starter plan even though it is backed by 15 Democratic representatives.

The cost would likely exceed any cost savings even if the government “negotiates” all the prices with providers and drug companies. But let’s wait for the white paper that explains the savings and funding before we judge.

Fair Price for Healthcare

Getting a fair price for healthcare is tricky because it’s not an apples to apples comparison.

Benefit season is starting soon. I’ve compiled some of my recent posts to help you get your arms around the latest strategies being offered to establish a fair price for healthcare services and to help you manage your total cost of healthcare.

Charges [aka List Price]:

Healthcare charges still seem to be a bit of a mystery to everyone. So let me start by explaining how most providers develop their list price and why.

The charge for most services in healthcare is based on a multiple of the Medicare fee schedule — at least initially. There are so many billing codes that it would be really hard for providers to keep up with the cost of each one which is why most base their charges on Medicare.

The tricky part is the multiple because every payer has their own methodology for payment. To capture the full amount due, the provider has to establish a charge that is sufficient to capture any outlier payer. Unfortunately, the multiple [aka: the markup] can make the charges seem unreasonable.

The charge for new services usually captures part of the cost savings so that providers are incentivized to adopt new technology. It helps them cover the cost of doing so. The charge and the price [contracted rates] consumers pay usually go down over time assuming the provider updates their chargemaster.

Then there are what I will refer to as the “fraudsters” who will keep increasing their charges to capture more and more from insurers as benefit loopholes close, such as out-of-network coverage. Their charges defy all logic and unfortunately, create an aura of mistrust.

Tip: The best way to protect yourself from fraudsters is to ask for an detailed estimate prior to service. Have them explain it to you.

Ambulatory Surgery Centers (ASCs):

ASCs offer a lower cost alternative to hospital based services and are a good option for surgeries and other service for the low acuity population. For those with increased medical risks [obesity, heart disease etc.] hospitals are a safer option.

The Ambulatory Surgery Center (ASC) industry grew rapidly from 2000–2008 largely because it provided surgeons a way to make more money from something they already do. It also gave them more say in and in some cases, more control over their work environment in terms of support staff, supplies and business practices.

Unfortunately, many were more focused on making a fast buck from the out-of-network strategy [aka: fraudsters] rather than providing an efficient service to lower the cost of healthcare. That’s changing.

Economical Credentialing and Narrow Networks:

Some health plans have been developing narrow networks that are economically credentialing some providers [aka: the fraudsters] out of their networks for past behaviors. It’s one way to lower cost but many not be a win for those that value choice.

Unfortunately, penalizing providers usually forces more consolidation which drives up price. Many ASCs are being sold to hospitals and healthcare systems that have more leverage with the payers to negotiate higher prices for their services. Pricing transparency tools that use historical claims data may not reflect the new higher prices.

Bundled Payments:

Bundled payments are catching on as a new reimbursement model in healthcare but not all bundles are the same.

Bundles are a flat fee paid to a healthcare provider for a full episode of care. By limiting the payment, it forces the provider to reduce the cost of care for the defined service and guarantee a certain outcome.

If you’re considering using bundles as a way to control your healthcare costs, there are several questions that you should be asking, such as:

1. Who are the providers included in the network? Not all providers are included in every network or selected the the same way.

2. What is the scope of service included? The services and amount of service included in the flat rate will vary bundle-to-bundle.

3. How is a quality outcome defined? Is the patient returned to pre-injury condition or returned to a basic ambulatory state or returned to work?

4. How much control do employees/patients get? Can they select all their providers or just some, the location, the time, the supplies and implants used or is that the tradeoff for a lower cost?

5. What is the expected cost savings over standard contracted rates? What level of savings makes it worth it to you?

Understand what you’re getting and trading off for a lower cost of healthcare. Bundles can pose problems is they are not Administered well because there are always some who will game the system. You have to think through these deals carefully.

Change is Hard Won

Changing the healthcare system takes time. Everyone needs to do their part to lower the cost of healthcare.

1. Healthcare Consumers: Many Americans don’t change their unhealthy habits until they have a major life event like a heart attack, cancer scare or some other health related crisis. The cost of all those unhealthy habits plus the life events drive up healthcare costs for everyone and no one wants to foot the bill.

2. Healthcare Providers: Healthcare providers don’t change until there is a financial benefit for doing so. Many providers didn’t adopt technology that costs maybe 1–2% of their revenue until the government incentivized them to do it. Why? Because they were focused on their top line rather than their bottom line.

3. Health Plans: Health Insurers don’t change their coverage and payment practices until they understand how something impacts their medical loss ratio. Untimely payment decisions make it hard for providers to change how they serve and delight patients. As you know, not many people are willing to work for free.

There are no silver bullets to fix healthcare. Americans need to take a good look in the mirror and own their part, providers need to focus more on the bottom line and insurers need to do more timely financial modeling to fix the incentives for providers.

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About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

Join us on Hello Workout for help covering the weekly minimum requirements for good health, telehealth appointments with Sports Medicine experts and other tips to help you achieve more success in work and life.

Moral Obligation?

Is it a moral obligation to provide healthcare to all Americans – or not?

That is the question that as Americans we need to answer. It’s clear now that many voters did not understand that it was the question they needed to answer for themselves before voting to “repeal and replace ObamaCare” when voting for Trump. In fact, Trump himself may not have even understood that given his comment about the Republican healthcare bill being “mean”.

If you haven’t been following the development of the latest Republican healthcare bill, here is a simple explanation of the differences between ObamaCare and TrumpCare. You’ll get a good idea how it affects you as well as why at least some consider the policy to be mean.

The policy problem became crystal clear to me this week when I listened to an interview given by the former CEO of Aetna. He spoke briefly about how ObamaCare is based on incompatible policies. On the one hand, the Democrats wanting to provide everyone with “good insurance” similar to the policies provided to our elected officials. On the other hand, the Republicans wanting everyone to behave as healthcare consumers which is a cornerstone of their free market economic philosophy.

The Republican policies already in ObamaCare are the marketplaces created to sell health insurance, the high deductibles to ensure individuals have more “skin in the game” [that means more money from their own pockets], the marketplaces to sell healthcare services and enable “shopping” etc. Many of these consumer initiatives have failed to engage Americans as healthcare consumers or reduce total healthcare spending. That’s essentially why we are having the healthcare debate all over again.

What’s different about TrumpCare now?

The changes in coverage requirements for employers, the penalties for not having insurance and coverage reductions for pre-existing conditions. Forcing people to pay for something that doesn’t meet their needs is a tax.

From my perspective it is time to start calling it a tax and treat it as such especially if you believe healthcare is a moral obligation. There are more costs that can be rung out of the healthcare industry if we simplify it.

Single Payer

What I have also discovered recently is that many Americans don’t understand what a Single Payer system is or how it could help them. We don’t need to look to Canada or elsewhere for a good example. Our best example is Medicare. A lot of thought and work goes into that program and in many respects it is used by the private sector as a coverage and payment framework. The core of Medicare has 2 parts: Medicare Part A (Hospital Coverage) and Medicare Part B (Medical Coverage). Part A is covered with tax dollars and Part B is paid with premiums.

A national framework similar to Medicare that is paid with a blend of tax dollars for medically necessary services [i.e. no Viagra coverage] and premiums for services that increase quality of life [i.e. Viagra coverage] would work for Americans and the healthcare industry. People are being needlessly scared by the thought of rationing and long lines for healthcare if America moves to a single payer system.

Why now?

A single payer system is the one change that can make the biggest impact for Americans now. It would give all Americans peace of mind that they will be cared for when they are injured or sick.

Basic Income

Silicon Valley leaders are recognizing the need to provide people with a “basic income” as more jobs are automated. Basic income means that industry leaders are expecting more Americans to drop in socioeconomic class. The working class [low and middle income Americans] will be impacted the most by the Republican healthcare bill. So over time it could mean that even more Americans may not have healthcare coverage or access to healthcare services.

Hospitals are required to stabilize everyone who enter their doors regardless of their ability to pay and often in good conscious provide more service than that now. If there is not enough people who can pay, the cost goes up for those who can pay or those who can’t pay go without. That’s the reality of a free market system.

Pricing Regulation

California AB 72 has been signed into law. It limits the amount patients can be billed when treated by a non-contracted provider in a contracted facility.

For example: Let’s say you have surgery at your local hospital. Your surgeon and the hospital is in your health plan’s network. The fees are reasonable for the services being provided because they are discounted to the contracted rates. However, after services are provided you discover the anesthesiologist was not in-network. Now, unless the anesthesiologist has made an agreement with you prior to service, your liability will be limited to an estimate of a contracted rate. The bill limits the total amount due from you and your health plan to the greater of the average contracted rate or 125% of the Medicare fee schedule.

For healthcare providers, it impairs their ability to negotiate contract rates that reflect the “fair market value” of their services. It’s effectively like a company adopting a pay scale that has no exceptions for knowledge, skill, experience and performance. Everyone gets the same pay. That’s a step toward developing a single payer system.

Medical Risk

I attended a Designing for Behavior Change event recently. The one statistic presented that really shocked me was that 90% of the people at risk for chronic health conditions like heart disease and diabetes related to obesity don’t know it. One third [33.3%] of the American population is obese which means their BMI > 30. How is that possible after having an increased focus on wellness? It makes you wonder what exactly gets communicated to patients about their health status.

I have spoken with clinicians [doctors and nurses] as well as health plan administrators and most have little faith that they can change the obesity trend. Most feel that their words of warning are falling on deaf ears. It’s sad because when you combine that trend with America’s aging population Medical Risk has the potential to skyrocket.

That’s probably why budget conscious Republicans [also referred to as the far right] want to pull back on Medicaid funding and why we all as Americans need to make the decision about whether healthcare is a moral obligation or not. All of us — even those currently covered by employer based insurance — will be directly impacted by your decision.

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About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

Join us on Hello Workout for help covering the weekly minimum requirements for good health, telehealth appointments with Sports Medicine experts and other tips to help you achieve more success in work and life.

 

New Healthcare Services

New healthcare services that are user-friendly and cost effective for when you’re in pain.

Judging whether a medical issue is “emergency room worthy” isn’t always easy. A bad tummy ache could be gas or something more urgent such as appendicitis. Your pain level is usually a pretty good indicator of whether it’s something that needs immediate medical attention or a home remedy. If your pain level is off the charts, it’s best to go to your local emergency room and get checked out. It may cost a pretty penny or two but it’s better to be safe than sorry. If your pain level is tolerable, you’ve got some time to triage your situation.

Now there are several new healthcare services available to you that are user-friendly and cost-effective.

Telehealth

Rather than calling your mom for advice or searching the web for answers, you can now chat with a licensed physician on demand via phone, teleconference or a mobile app about your medical issue and get professional advice on what to do next. The cost runs about $50 per appointment and may be covered by your insurance.

If you’re new to working out, a weekend warrior or an athlete, having on demand access to a Sports Medicine physician is not a bad idea. Chances are you will have more aches and pains than the average person. It’s good to know what’s causing the issue and whether it’s something that needs medical attention, modification or just recovery time. Injury prevention is key to improving performance and your health.

Home Visit

Physicians are making house calls again. If you or someone you love has a medical condition that makes it difficult to leave the house than a home visit might be just the ticket. Home health visits for people who are older, handicapped and/or really sick are usually covered by Medicare and/or Medicaid.

Cheer up if you’re too young and healthy to qualify for home health! There are also concierge services offering house calls for anyone feeling too sick to get out of bed [think bad cough or flu] or too busy to squeeze in a check up or annual flu shot. The cost runs about $99 which is about the same as an office visit and may be covered by your insurance.

Urgent Care

Urgent care centers are popping up in every neighborhood and are a great resource to help you rule out more serious medical issues or confirm a potential diagnosis. Rapid tests, exams and x-rays are performed on the spot to help diagnosis contagious things like strep throat and pink eye, evaluate tummy and chest pain and test for and splint broken bones. From there, healthcare professionals will direct you for any needed follow up care. The base cost starts at $250 and goes up with each test, exam, x-ray and/or service performed.

Now you know when and how to use the new healthcare services and roughly how much they will cost. The exact prices depends on who owns and operates the services, geographical location and whether or not discounts are offered by insurers and to patients who pay at time of service.

 

Subscribe for Healthcare Gal posts to get your arms around healthcare in America and/or Follow Healthcare Gal on Facebook.

About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

Join us on Hello Workout for help covering the weekly minimum requirements for good health, telehealth appointments with Sports Medicine experts and other tips to help you achieve more success in work and life.

Save on Healthcare

Shopping for healthcare takes a little research and know how but there is real money to be saved.

No one likes to pay more than they have to for anything.

Did you know you can buy car parts on Amazon? I didn’t until someone broke one of my tail lights and it looked like an easy DIY [Do It Yourself] project. I was able to find the exact part and as a Prime member got it shipped to me FREE. It was so easy that I couldn’t help but do a little more shopping.

Why am I telling you about shopping for car parts?

No one ever pegged me as someone who would buy car parts or attempt a DIY project on my car. Like many people, I have a trusted relationship with my mechanic and whatever repairs he recommends, I approve and pay him to do.

Similarly many Americans put their full trust in their doctors and approve their recommendations regardless of cost. However, that could change. My DIY project wasn’t as easy as it looked on YouTube. After breaking 3 finger nails and 2 screw drivers, I gave up and made an appointment with my mechanic. While there I decided to have a few more minor repairs done. This time I was speechless when I saw the quote. My mechanic quoted me 4 times [4x] the cost for the parts. How do I know? I remembered seeing the parts on Amazon.

A 4x markup is comparable to the markup routinely charged on high dollar supplies and implants in healthcare. The difference is healthcare consumers only pay a small portion of the marked up cost after the insurance discount and payment. I didn’t say anything to my mechanic at the time, but it made me realize that pricing transparency is a game changer.

Amazon for healthcare

Amazon has already announced plans to start selling prescription drugs. It’s going to take some work before they are ready to fill their first prescription but when they do, it could be a big cost saver for many Americans. There is currently no way to compare the cost of drugs at different pharmacies or covered by different health plans. Amazon could make it as easy as shopping for car parts by providing a marketplace for pharmaceutical companies.

Amazon already sells medical supplies.

Imagine how surprised my mechanic was when I drove into his garage with a trunk filled with parts. I had also purchased new lenses and seals to replace my cloudy headlight covers and was surprised when my mechanic refused to do the work. What I didn’t understand when purchasing the lenses was that changing only the lens would impair the integrity of the light and cause bigger problems later. He recommended a body shop if I absolutely wanted to do it. His refusal to do the repair requested may have been upsetting for some, but for me it spoke to his integrity as a trusted advisor. I returned the lenses and seals.

Can you see that scenario playing out if healthcare consumers start buying their own supplies and implants? Using the Amazon filters to narrow the options that are right for your make and model of car is easy enough but the process is still lacking the intelligence and judgement that you get from a highly trained professional. Let’s try not to imagine a medical DIY project guided by a YouTube video for now.

Amazon-like services available now

Pharmacy:

There are online pharmacies available now. If you do plan to purchase your prescription drugs make sure you buy from one of the Verified Internet Pharmacy Practice Sites [VIPPS] otherwise you might not get a quality drug. To save money now, talk with your doctors about generics and bio-similar drugs that can save you money and ensure you get the right medication. You may also be able to qualify for patient assistance from a pharmaceutical company.

Healthcare Services:

There are also web-sites that can give you “fair prices” for healthcare services including surgery. Fair prices are generated from historical claims data collected from participating companies, providers and payers.

Healthcare Bluebook is one of the sites available to consumers FREE and a good place to start your shopping. If you use the site, be sure to enter your Zip Code to get the prices for healthcare services offered near you and click on the Details to learn what’s included in the price. For surgery, the fair price on Healthcare Bluebook includes the fees for the facility [hospital or Ambulatory Surgery Center], surgeon and anesthesiologist plus all the supplies and implants. When the fees of different service providers are included in one price, it’s referred to as a bundle.

If you call a hospital or an ASC for a quote, ask them for a bundled price too. Chances are they have one that could save you money and make it easier for you to get your arms around the total cost and the billing.

Labs:

You can also order many of your own lab tests through HealthcheckUSA.com or Quest Diagnostics to check your cholesterol, diabetes, colon cancer, prostate etc. without a physician order. The rates are comparable to cash rates which are often significantly less than the full price because the labs get their money from you at time of service.

Subscribe for Healthcare Gal posts to get your arms around healthcare in America and/or Follow Healthcare Gal on Facebook.

About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

Join us on Hello Workout for help covering the weekly minimum requirements for good health, advice from professionals and other tips to help you achieve more success in work and life.

 

 

 

Power of Habits

Your habits are the key to your success in business and life.

A habit is something you do when triggered by something that only you know when you crave the reward.

The Anatomy of a Habit:

A habit has four (4) parts. Once you understand the parts, you can change any habits that is limiting your success.

Cue: The cue is the trigger which can be a feeling, time of day, specific event or anything else that makes you start a specific routine.

Routine: The routine is the action or series of actions you take when triggered. The routine is specific to the trigger and is almost an automatic response.

Reward: The reward is something you get at the end of the routine such as a sense of calm, satisfaction, connection, belonging, completeness, control or whatever you feel from completing the routine.

Craving: The craving is your need for the reward.

 

The Problem:

The routine is the problem. It’s the action or series of actions that you take when you crave the reward that is limiting your ability to achieve your goal. To change the routine and your outcome, you have to identify the cue and the reward so that you can replace the routine with something equally rewarding.

We all have some habits that may not be serving our wellbeing or limiting our success. I have been referring to my need for innovation as a “nasty innovation habit” for the last several years. Like other bad habits, my innovation habit affects my wellbeing in a number of ways and it’s hard for me to break the cycle because it’s so automatic. Let me explain why…

Cue: What drives me to innovate?

It all starts with a problem or at least something that seems harder than it needs to be [cue]. I crave the challenge of adventuring into something new, something that challenges my thinking and the status quo. I’m not as satisfied by the nuance of refining one skill over the lifetime of a career as many others do.

Routine: Develop a solution to solve the problem

I ventured into e-learning during the dot com boom because it seemed like the best way to make a big impact on the industry. I didn’t know anything about the technology or methodologies for developing courses at the time. However, I hired consultants to collaborate with me.

At the time we launched, Health South missed their numbers by more than $2 billion which materially misstated their financials and caused the dissolution of the company. Unlike the other CFOs who had unintentionally misstated their numbers, Health South executives intended to deceive investors and succeeded for a long time. Several of them ended up in jail.

The contractual write-offs are still a big problem for most healthcare companies because the system is fragmented, the contract terms for payment vary from payer to payer, systems lack the needed sophistication to administer the payment permutations and the people doing the day-to-day work and reporting the numbers rarely get the needed training.

Outsourcing only solves part of the problem. Every step of the process and very transaction posted into the billing system makes a difference to the accuracy of the numbers. Rather than fixing the problem, the industry added more solutions to address the consequences and shift the blame. The revenue cycle industry generates more than $52 billion annually and is still not satisfying any of the stakeholders – especially patients.

My first solution addressed the training deficit of the people doing the work and reporting the numbers. I thought it would be kind of like writing a book in that it takes an upfront investment of time and effort but then pays off over time. Like Starbucks, our courses provided professional credits that could be used for college courses. With a 10% initial pass rate, I worked harder than I ever imagined. It wasn’t like a book at all because clients transferred performance expectation to me. I tried to be really inspirational during virtual meetings and relatable in our marketing collateral. Our messaging was on the right track but we missed the need for teaching basic life skills.

Starbucks’ program reportedly teaches skills such as “how to live, how to focus, how to get to work on time and how to master emotions”. My sister who is a psychologist identified that her clients at the time were similar to my students. She was just trying to get them through life whereas I was trying to turn them into star performers. I connected the dots, but still couldn’t close the gap.

It was a missed opportunity because we’ve created more problems since then. Offering people a way forward in life empowers them with keystone habits that makes it easier to change other habits to improve their lifestyle and live their best life. In short, education has the power to change lives.

Reward: What do I get for solving the problem?

I often joke with people that I got the whole employment equation all wrong. When you innovate with your own money it often requires significant sacrifice and for some, it seems like unnecessary hardship.

The reward while on the journey are all the “small wins” that reinforce the belief that the goal is achievable. I can actually feel the pleasure center of my brain light up with a win. Another entrepreneur who I met early in my career used to talk to me about progress. The concept of progress stuck but I didn’t fully appreciate the value of it then.

It took experience for the value of progress to really resonate. As with any big goal it takes months or even years to achieve and there are many setbacks that make you question whether you can get through another week or month. I have a sticky note on my monitor with the words “Do whatever it takes”. I move it to eye level on those days when I need a constant reminder to get out of my comfort zone. Of course there are some ethical limits to the “whatever” but I have had to do things and have had conversations that were way beyond my comfort zone. It’s something that needed to be done. Everyone has the power to bust through their self imposed limits.

Carving: What makes me keep going?

My friends and family wonder what drives me to keep innovating. I do well as a consultant and consulting without personal projects provides for a more balanced life. Truth be told, there are times when I crave more balance. Some days I can even hear my subconscious saying “I want my old life back” as though a pouting child. However, the craving to feel the “rush” of solving a bigger problem is more compelling. So I just keep going.

Goals: What are your goals?

I have always wanted to have a “positive impact” on healthcare. Those words alone have served as a guiding force for the type of work that I do as a consultant, the way that I conduct myself within the industry and the types of problems that I tackle on my own. It’s kind of like Google’s “do no evil” mantra.

When Paul O’Neil became CEO of Alcoa, he focused the company on safety. When he spoke about safety at his first annual meeting, investors thought he had lost the typical Republican plot of “synergy, rightsizing and co-opetition”. However, what the investors didn’t understand was that by focusing on safety he united the company around a common goal. As safety improved, productivity and profit improved.

We need a common goal to unit the healthcare industry. The triple aim lacks identity and is hard to remember. I like Patient Wellbeing because it encompasses safety, outcomes, experience, cost and wellness. I’d love to hear your thoughts.

Power of Habit

If you haven’t read the Power of Habit by Charles Duhigg yet, I encourage you to do so. It was enlightening for me on many levels and provided food for thought about how I want to approach my work and life going forward.

If you’re struggling to loose a few pounds, I’ll leave you with the two most important things from the book that you can do everyday:

Eat Breakfast — It will help to keep you full throughout the day and eat less.

Weigh yourself Everyday — It will help inform you which foods make you gain weight and which foods make you loose weight.

Of course, if I was to add a third it would be exercise.

About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

Join us on Hello Workout for help covering the weekly minimum requirements for good health, advice from professionals and other tips to help you achieve more success in work and life.

Lean In for Healthcare

We need to “Lean In together” to solve the biggest challenge facing healthcare now.

One of my sisters asked me when Lean In was first published if I had read the book. Even though it was getting great reviews, I had no desire to read about another women’s struggles in business and life — no matter who wrote it. However, I checked the book out of the library last week when none of the other books on my list were immediately available.

Lean In made me laugh out loud and cry because it validated so much of what I had felt and experienced over the course of my professional career and life. Some of Sheryl’s personal stories are funny but the book is also filled with some good information and stats for those struggling with the idea or the reality of balancing their careers with family life. It is a book that both men and women should read to inform their perspective and behavior towards one another.

Ironically, I was at home reading Lean In while millions of others all over the world were marching for equal rights. I didn’t join the Women’s March in San Francisco mainly because large crowds make me anxious. To some degree, I regret it now. Opportunities to make our voices heard matter even if they are deflected by those who need to hear them. They will eventually have to listen.

It will come as no surprise to those who know me well that I was also a little mentally preoccupied. I was thinking about the expected changes in healthcare, my HBA mentoring group and recent conversation with others in the industry.

Healthcare:

When I was working for one of the California based payers years ago, I said to the then VP of Strategy that everyone involved in healthcare needed a voice at the table to solve the problems. It wasn’t anything that I had read or heard, but rather what I really felt after working on both sides of the industry for about five years. When the ACA was drafted, everyone involved in healthcare had a voice at the table.

Like any other strategy, the plan for the ACA was hatched with the best information available at the time. Parts of it worked as expected and as with any other strategy, other parts need to be adjusted now that we have more information. It should come as no surprise to any of us especially those involved in healthcare. Repeal and replace sounds more dramatic but “the replacement” is likely to have many of the same elements as the ACA.

The biggest issue that remains is the rising cost of healthcare. There may be some fat left to be squeezed from insurers and prescription drugs. However, healthcare providers seem to be tapped out. For me it’s evident by the level of tension between physicians and administrations.

I don’t believe that we can financially engineer our way out of the rising cost of healthcare because the medical risk for the country is too high. Like the banking industry leading up to the financial crisis, the medical risk is spread across the industry with some verticals better capitalized than others to absorb it. As the screws get tightened, parts of the system will be squeezed to the breaking point. Unfortunately, it’s likely to be the parts serving the most vulnerable Americans.

Mentoring Group:

I participated in the inaugural HBA mentoring group around the time of the financial crisis. It was a great opportunity to meet other women in the industry and gain the perspective of those working in different fields. What’s more interesting to me now having read Lean In are the limiting beliefs that are holding some of the women back.

We did an exercise to help one another prepare for their next job. As part of the exercise, we reviewed the description for a desired job and resume for each person in the group. One of the women in the group is a highly trained scientist working in quality assurance for a biotech company. When she reviewed my resume and the job that I had selected, she told me that she didn’t see the exact qualifications for the job on my resume. She was looking for an exact match. When I selected the job, I was looking at it with a skills and competency lens. I didn’t need to have the exact experience to know that I could do the job as described. I chalked up her feedback as that of a scientist. However, now I understand that her perspective is how most women think which can be limiting to not only her but others including me. Reportedly, men don’t look for an exact match when they select and apply for jobs. My guess is that they may not hire that way either.

Communication was another problem raised by the group. The quality scientist was upset that her manager was always late to meetings. The group concocted this very elaborate plan for her to address the issue. I suggested to her that she just tell her manager “your tardiness isn’t working for me”. No one in the group believed that it could be that simple and dismissed my suggestion. However, Sheryl relays a story about Mark Zuckerberg joining a group at the office to learn Mandarin. When one of the women in the group was talking in Mandarin about one of their managers, Mark kept asking her to simplify so that he could understand what she was saying. Finally, she blurted out “my manager sucks.” Now that is something simple enough that everyone can understand and work to fix.

Mentors and mentoring groups are good because they open us up to different perspectives and challenge the beliefs that are holding us back. We need to get out of our comfort zones and if we are going to rise to the challenges ahead.

Recent Conversations:

Last week, I was able to meet with other executives working in different verticals of the industry. We discovered some shared experiences and mutual interests but what I appreciated most was being able to say “what do you think?” No one person has all the answers and it serves us all to do a reality check on your own perspective and role. Some of us are carpenters fixing problems within the existing system as we go and others are disrupters looking to turn healthcare upside down. We need both to solve the biggest challenges facing healthcare.

With that said, I initiated a new circle for healthcare professionals on the Lean In web-site so that we can meet, share, learn and challenge one another. I don’t have specific goals for the circle other than to give everyone a seat at the “table” who wants one.

About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

Join us on Hello Workout for help covering the weekly minimum requirements for good health, advice from professionals and other tips to help you achieve more success in work and life.