IBM released a white paper (Healthcare 2015: Win-win or lose-lose?, pdf) some time ago outlining their prescription for health care reform. As (could be) expected IBM focuses on a consumer-driven transformation. The executive summary is an interesting read—most (probably all) has been talked/written about before, but it is nice to see it outlined in one place.

A major component of the transformation will be an introduction of accountability and call for action:

Action and accountability are the basic ingredients of change. To successfully transform their healthcare systems, we believe countries will undertake the following actions:

• Focus on value – Consumers, providers, and payers will agree upon the definition and measures of healthcare value and then, direct healthcare purchasing, the delivery of healthcare services, and reimbursement accordingly.

• Develop better consumers – Consumers will make sound lifestyle choices and become astute purchasers of healthcare services.

• Create better options for promoting health and providing care – Consumers, payers, and providers will seek out more convenient, effective, and efficient means, channels, and settings for health promotion and care delivery.

Asymmetric information is a problem we often speak of during discussions of why market functions break down in health care. This next idea has been floated to combat this problem—it will be interesting to see what develops:

Health infomediaries, who will help patients identify the information required to make sound choices, interpret medical information, choose between care alternatives and channels, and interact with the providers they choose, will become fixtures in the healthcare landscape for both the well and the chronically ill, and for a much broader socioeconomic segment of the population.

The company recently launched a health care island in the virtual world SecondLife:

IBM debuted at HIMSS®08 its newest island in Second Life: IBM Virtual Healthcare Island. The island is a unique, three-dimensional representation of the challenges facing today’s healthcare industry and the role information technology will play in transforming global healthcare delivery to meet patient needs.

The island supports the strategic healthcare vision that IBM released in October 2006, entitled, Healthcare 2015: Win-Win or Lose-Lose, A Portrait and a Path to Successful Transformation. The paper paints a picture of a Healthcare Industry in crisis — of health systems in the United States and many other countries that will become unsustainable by the year 2015. To avoid “lose-lose” scenarios in which global healthcare systems “hit the wall” and require immediate and forced restructuring, IBM calls for what it defines as a “win-win” option: new levels of accountability, tough decisions, hard work and focus on the consumer.

The IBM Virtual Healthcare Island is designed with a futuristic atmosphere and provides visitors with an interactive demonstration of IBM’s open-standards-based Health Information Exchange (HIE) architecture. Working with project leads in the U.S., the island was designed and built by an all-IBM-India team.

Corporate America will have much to say about the direction of health care reform in this country (IBM’s interests are two-fold: defining that direction and then helping health care organizations and companies move in that direction).  Corporate concerns have much to say about this looming change.  It is all just so interesting.

A gathering of the web’s good health care (related) stuff…

If we could just figure out the communication thing we would solve most of our issues. Here’s the piece (via Jay Parkinson) and a snippet:

Communication in medicine grows worse by the day. What should be a pillar of quality health care is instead a resounding failure.

Patients are rushed through office visits and often leave without having their questions answered. Labyrinthine barriers have to be overcome before speaking with a physician. Reaching a medical provider via the Internet is an impossibly daunting task. Doctors rarely talk to each other to coordinate treatment plans.

The Wall Street Journal reported a slow-down in retail clinic expansion this week. I’m not expecting that to mean the beginning of the end for retail clinics. The model is still viable and will prove valuable in helping our health care situation. From Kaiser Daily Health Policy Report:

The “boom” of walk-in health clinics at pharmacies, supermarkets and retailers “is showing signs of slowing,” the Wall Street Journal reports. As of May 1, there were 963 retail clinics in the U.S., compared with 125 three years ago. However, some retail clinic operators recently have closed 69 clinics in 15 states, and others, including CVS Caremark, have announced their intentions to scale back clinic expansion plans.

My belief of the connections between health care and education have been noted here previously. Richard Florida has provided something further to consider.  My point is that we can’t expect health care to continue to operate in the vacuum that it has (it won’t).  All possibilities (that we can think of) for the future must be considered.

I have often wondered what the efficient scale of a university is and, in particular, whether it would be better to create a second Harvard with the university’s wealth than to expand the first one. Maybe the Massachusetts state legislature will give the powers-that-be at Harvard an incentive to consider more radical expansion plans.

And if states and cities are willing to pony up billions for convention centers and stadia, and hundreds of millions in industrial incentives for factories, how much do you think they much come up with for a Harvard, or MIT, or Stanford, or Oxford relocation. Universities are already setting up foreign campuses. Trust me, it’s just a matter of time until this game gets big.

We’ve all heard of the impact the Baby Boomers will have on the future of America. To that end, it could be considered surprising that more hospitals haven’t focused on the health care needs of a to-be retiring population. Medicare won’t the highest payer. But they will provide volume. Shoot, the way things are going, health care organizations may become completely dependent upon government payers for sustainability.

As health systems become more competitive, tailoring services to the needs of specific subsets of the population is appropriate. No better population to start with than one that will push 75 million + through the system.

our own system will not open a “Center for the Aging” or classes to learn how to age gracefully or anything else remotely insulting. These years for this cohort will be the first time that an entire population has lived so long. And they aren’t just existing, they’re enjoying, experiencing, and exciting.

Tom Peters has been knocking on this door for a few years now. Here is the latest post in his 100 Ways to Succeed series (#116):

Boomers! Geezers! Now!

Before the week [day?] ends, somehow or other begin a serious conversation about your attitude toward and approach to the Boomer-Geezer market.

(Like race in the world of politics, try to examine your implicit biases—eventually with the help of an outside facilitator.)

If at all applicable, consider Very Radical Alternatives—e.g., re-aligning strategy around Boomers-Geezers.

Big idea/s:

(1) It is a big idea.
(2) Stir the pot. Now.
(3) The opportunities are enormous; the response so far is pitiful.
(4) Don’t be an idiot.

Sticking with the Tom Peters theme, the preceding blog post to that above had this quote from the head of the AARP, Bill Novelli, “People turning 50 today have more than half of their adult life ahead of them.”

Wow.  Mr. Peters continuing on Boomers:

“We are the Aussies & Kiwis & Americans & Canadians. We are the Western Europeans & Japanese. We are the fastest growing, the biggest, the wealthiest, the boldest, the most (yes) ambitious, the most experimental & exploratory, the most different, the most indulgent, the most difficult & demanding, the most service & experience obsessed, the most vigorous, (the least vigorous,) the most health conscious, the most female, the most profoundly important commercial market in the history of the world—and we will be the Center of your universe for the next twenty-five years. We have arrived!”

We.
Have.
Arrived.

(Pause: read the above paragraph, until you understand)

our own system is late.  But we’re ahead of most.  Starting now, we are tailoring services for Boomers.  Period.  How?  Not so sure.  Those decisions will be left for Boomers to make.  We obviously have some work ahead.

And the best part?  It won’t take a considerable investment to get in line.  Steady growth over the next few years will allow us to successfully add and customize services as they are needed.  From the Health Beat Blog:

“In truth, the aging of the population is not a big problem,” Uwe Reinhardt says. We really don’t have to worry about greedy geezers suddenly clamoring for more care than we can afford. For one, they won’t grow old all at once. They’ll grow old just as they were born—over a period of many years.

Principle #17:  The Boomers are coming.  The Boomers are here.  The Boomers are still coming.  Theeir impact on local health care systems will be large.  And in a competitive health care world (to be), we want them at our own system.  The customization of health care services will allow us to tailor the experiences for this huge (read: important) population.

A new hospital in the Henry Ford Health System has taken hotealthcare to the ultimate:

In addition to national-class clinical services, the 300-bed hospital is to offer amenities ranging from homelike private rooms with couches where relatives can sleep comfortably overnight to relaxing in-room whirlpool tubs for mothers in labor.

Wellness services include health coaches, holistic therapies and personal trainers — part of an emerging national trend to help people control or prevent chronic conditions that lead to expensive hospital stays.

But one of the hospital’s most innovative elements is its culinary program, which involves a trio of partners: prominent metro Detroit restaurateur Matt Prentice, the nationally known culinary department at Schoolcraft College in Livonia and Chef’s Garden, an elite organic farm in Ohio that sells exclusively to America’s most famous restaurants.

Here is the best part from System President and Chief Executive Officer Nancy Schlichting:

But those customer-oriented features and services won’t cost consumers more or raise health care costs.

I have been reading a lot about economic bubbles lately. There may be a commodities bubble. There may be an agriculture bubble. We all know about the housing bubble that burst (it’s spreading around the globe now).

Well, that got me wondering. Could there be a health care bubble?

Not being an economic whiz, I turned to some online resources.

The Financial Dictionary says: “A temporary market condition created through excessive buying, and an unfounded run-up in prices occurs.”

Some have argued that we buy too much health care. The foundations of rising prices are not clear cut.

Next to the trusty Wikipedia to find a foolproof system to determine when a market is bubbly. Turns out there are no hard and fast rules. Excerpts follow:

The cause of bubbles remains a challenge to economic theory. While many explanations have been suggested, it has been recently shown that bubbles appear even without uncertainty, speculation, or bounded rationality.

OK, good to know.

Most recently, it has been suggested that bubbles might ultimately be caused by processes of price coordination or institutionalization.

We have laws in place to discourage price coordination, but a true market has little impact in determining health care prices. Institutionalization: health care is highly regulated.

Because it is often difficult to observe intrinsic values in real-life markets, bubbles are often identified only in retrospect, when a sudden drop in prices appears. Such drop is known as a crash or a bubble burst.

So we won’t know until afterward.

Not extremely helpful. But take into consideration some of the issues we’re dealing with: building boom, worker shortages, Medicare’s trust fund issues, drug costs (up), labor costs (up), expensive new technology (the efficacy is debatable in some products)…care to add more?

Very little in health care is governed by real market incentives (that could be good or bad, depending on your thoughts). The problem remains: it all just keeps going up. The spending may be able to continue; it may not; but reality is that health care continues to become more expensive. Because we try to sustain all parties (and try to keep them happy) in the health care industry, the requirement (like, when we have no choice) for change is quickly arriving.

If we get to that point (when reform is not by choice, but by necessity), some party(s) must lose. That is when the health care bubble will bust.

This may have some interesting effects on our health.

Signal vs. Noise has a good post on incremental innovation (yes, even in the airline industry):

It’s a good reminder that while big changes can have a big impact (like American Airlines grounding some of their Super 80 gas guzzlers), sometimes little tweaks (like flying slower) can have a big impact too. Always keep an eye out for the little things. There’s usually a lot of low hanging fruit.

And then: one more reason why health care doesn’t want to be metaphored to airlines.  Read this first.  And then if you feel up to it here is the article (ed: it’s not a pleasant realization).

Continuing to explore new methods of care delivery. Lots of buzz on American Well a few weeks ago. Basically a patient is able to access an array of physicians instantaneously through web communication tools. Some are still quite skeptical on care provided over the internet, but this model has some legs.

Here’s a detailed explanation (insight provided) from the World Health Care Blog.

Some more on virtual visits.

Obesity rates are climbing. Its impact is worsening. The issue is quite troubling.

Americans’ eating habits have much to do with obesity. Our sedentary lifestyle (little walking, avoidance of stairs, no exercise) is also a big factor.

But there is lots to discover within these two major factors. That information will help us target preventive/health care for addressing the obesity issue.

Freakonomics reports a study which “found that neighborhoods with dramatically more fast-food restaurants and convenience stores than supermarkets also have significantly elevated rates of obesity and diabetes.”

A program in Philadelphia is targeting this problem.

We know that our environment and lifestyles have a major impact on our health, even more so than medical care.

Obesity, and its ramifications, will be the largest health issue we deal with in the very near future. The role of the health system needs to become more community collaborative as our society becomes focused on “health.” Fighting obesity is very much a public health issue—and is encouraging a move toward preventive medicine. The health system’s role could be transformed by becoming part public health agency, part individual medical care deliverer. Call it individual public health. The larger the role a health system plays in a person’s health, the more sustainable these organizations will be.

Hello Health has a very cool concept.  Read about it here.

A more conservative approach to a new (er, recycled) delivery concept (call it a hearkening to the past).