The Regional Communities blog is “A weekly compilation of news links about and for regional communities pursuing local and regional development.”
This week our own system is lucky enough to have made the cut for the post Population Shifts, suburban slums, and hospitals. Have a regional read.
Coincidentally, a couple of relevant mafia stories…
If we’re in need of a scapegoat for any health care insurance reform, Dr. Jonathan Kellerman has found the party in a biting Wall Street Journal opinion piece:
The health insurance model is closest to the parasitic relationship imposed by the Mafia and the like. Insurance companies provide nothing other than an ambiguous, shifty notion of “protection.” But even the Mafia doesn’t stick its nose into the process; once the monthly skim is set, Don Whoever stays out of the picture, but for occasional “cost of doing business” increases. When insurance companies insinuate themselves into the system, their first step is figuring out how to increase the skim by harming the people they are allegedly protecting through reduced service.
Once they affix themselves to the host – in this case dual hosts, both doctor and patient – they systematically suck the lifeblood out of the supply chain with obstructive strategies. For that reason, the consequences of any insurance-based health-care model, be it privately run, or a government entitlement, are painfully easy to predict. There will be progressively draconian rationing using denial of authorization and steadily rising co-payments on the patient end; massive paperwork and other bureaucratic hurdles, and steadily diminishing fee-recovery on the doctor end.
He actually suggests ridding ourselves completely of insurance, it’s worth a read.
The Guardian, last week, had an intriguing story on how to do (good) business like the mafia. Despite some of the questionable tactics employed by the mafia over the years, Clare Longrigg writes there are lessons to be learned from organized crime. My favorite (of the seven):
Rule 6: Reinvention
In case of a political scandal, or a business failure, it is vital for the new boss to be able to distance himself from the whole affair. Indeed, he may find it useful to take on a new persona altogether. When Stuart Rose returned to Arcadia after three years to rescue it, he said: “What is interesting is that people here think I haven’t changed, but I have been gone three years. I am not the same Stuart Rose, I have changed a lot.”
With Provenzano’s new directives, not only did the negative headlines cease, but he managed to dissociate himself from the scandals that had gone before. Like everyone else, he had emerged from Cosa Nostra’s most violent decade with his reputation in tatters; his advisers helped him to “get his virginity back”, in Giuffrè’s interesting phrase. With the help of his PR-savvy advisers, he made sure no one associated him with the violent years, and created his image as the peacemaker.
“When I got out of prison,” Giuffrè recalled, “I found Provenzano a changed man; from the hitman he once was, now he showed signs of saintliness.”
One of the best aspects of my MHA program (and one of the reasons I chose it) is a clinical rounds class that places MHA students with a hospital service for five weeks to observe medical students, interns, residents, fellows, and attendings do rounds. I have often heard that learning on the job is the best way to learn; this experience is no different, a key to understanding others and learning about what they do is to immerse yourself in their situation.
One of the important differences that separates health care from other “business” is that most providers—who are directly responsible for admitting patients into the hospital and thus, relied upon in order for hospitals to make money—are not employees of the hospital. It is understandable why problems develop.
The age-old health care management problem involves a disconnect between providers and management—most likely to do with a lack of communication. This class, while admittedly too short, is an effort to help administration students (most with limited clinical experience) gain an understanding of the medical education process (and a general look into the provider’s decision-making process).
I’ve always respected physicians, but my respect has increased dramatically after just a few meetings with my care team. Decision making can be difficult as there is always some uncertainty in the decision making process. Limiting that uncertainty is a key to making good decisions.
Here is what I’ve come to understand well: Uncertainty rules the day in medical care. And patients expect miracles. While the competent provider (of which I have yet to meet one on the other side) often has a good idea/understanding of a patient’s medical problem, they just never know for sure. Here’s the problem: (constant!) vague and incomplete information. Besides a detective, who else deals with so much constant uncertainty? Or if that isn’t enough, how about dealing with uncertainty and knowing the decisions made could have a negative impact on another human life?
Differences between providers and administrators will always exist. The two have very different job descriptions with very different expectations. The differences create a necessary balance. While only for a short period of time, being exposed to providers doing their job is helping me visualize those differences. The hope is that this experience will translate to a better understanding of it all.
our own system makes its Health Wonk Review (”a biweekly compendium of the best of the health policy blogs”) debut at Workers’ Comp Insider.
While we leave the true wonkery to the real professionals, I think the questions we ask here can add to the debate. Have a read.
The dutiful student in me forces the usual time spent blogging to be spent studying for a final exam. In lieu of a full-fledged post, here are some links to explore…
The Atlantic has an article exploring the subprime mess and what it means to American suburbia, “A structural change is under way in the housing market—a major shift in the way many Americans want to live and work.” After years of trying to get away from the shadows of the skyscrapers downtown and moving to the cookie-cutter neighborhoods of suburban living, Americans are moving back downtown. What does this mean for hospitals—both downtown and the sprawl of medical services that occurred with the population as it moved outward?
I’m big on primary care and its role on helping us get out of the mess we are in (and the larger mess we’re going to be in in a few years). The Healthcare Economist blog has a good post on a recent study on the effect of family physicians on health improvement, “When FP supply is instrumented by age-related capitation it has markedly larger and statistically significant effects. A 10 percent increase in FP supply increases the probability of reporting very good health by 6 percent.”
Enjoy.
A couple of items dealing with welcomes…
Per usual, Beth Israel Deaconess Medical Center is doing something extraordinarily right (at least in my opinion). I’ve written before on the difficulties of navigating a large hospital, especially on first visits. While many organizations offer information desks, BIDMC is being proactive in delivering help to individuals who walk through their front door by utilizing “greeters.” Their job “is to be available to help people find their way in the hospital, including escorting them as necessary to find the right place in our 2 million square feet of space.” (Applause!)
The second item of note is a welcome of our own. When our own system started, my full intention was for it to be more than just me trying to carry this conversation (hence the our in the title, and all the we talk from the beginning). I’m excited to welcome Matt Vestal (read about him here) to our blogging team. Matt and I often have stimulating discussions on all-topics-health-care and his questions/insight/ideas will add value to this blog and contribute to our evolving search for the definition of sustainable health care.
Again, if you consider yourself a health care amateur, and feel like you have something to offer to our own system, contact me!
There’s a mess going on in California regarding the retroactive termination of insurance benefits well-covered by The Health Care Blog, so go there for the wonkery.
But what caught my attention was in the fine print of the post: “(FD I am a HealthNet individual policy holder and they haven’t “recivved” me yet. Then again I haven’t had a claim in 3 years!)”
A big push of consumer-directed health insurance and high deductible health plans is to get consumers involved in care decisions, more or less taking away the perception of free care that often arises when patients are well covered by traditional insurance policies. The ethics, along with the pros and cons, of this notion can debated later.
What struck me was the exclamation of pride of not having a claim in three years. I don’t want to spend any time in a clinic or hospital either, but when do no claims become a bad thing? Obviously we are not privy to the specifics of the individual policy, however, as some experts claim, HDHPs may prevent patients from seeking needed care.
My question is, will a period of no claims become a competition of pride amongst us? A boasting of sorts? Maybe. But is it a good thing?
This may be a bit of a digression from the usual on our own system, but some ideas are just so important…
How to present…well.
It is not an easy thing, but being a good presenter can be a powerful tool. And in this information age we live in there are countless tools available, for free. In fact, some of the best give their ideas away because they can’t stand to see any more bad presentations.
It starts with preparation, and a lot of it. Garr Reynolds gives us plenty of help in this area, here, with ten steps to guide our planning. An excerpt from step No. 7, Dakara nani?, which roughly translates into:
So what?” — always be asking yourself this very important, simple question. If you can’t really answer that question, then cut that bit of content out of your talk.
Your presence during a presentation is key. Mr. Reynolds strikes again with ten more great tips to help with delivery.
If I had only one tip to give, it would be to be passionate about your topic and let that enthusiasm come out. Yes, you need great content. Yes, you need professional, well designed visuals. But it is all for naught if you do not have a deep, heartfelt belief in your topic.
And finally, the software program which has become the crutch of most presentations–and make your presentation an instant failure even if you have prepared well and are a competent deliverer, PowerPoint.
Seth Godin has a great post titled Really Bad PowerPoint, and how to avoid it with four components of a good presentation. Mr. Reynolds provides ten more tips on this subject.
And putting it all together, Guy Kawasaki, who listens to many a presentation, works hard to evangelize the 10/20/30 Rule: “It’s quite simple: a PowerPoint presentation should have ten slides, last no more than twenty minutes, and contain no font smaller than thirty points.”
Here’s Mr. Kawasaki on the 10/20/30 Rule:
For tips on a regular basis, Mr. Reynolds’s Presentation Zen blog is great.
OK, so great presentations take a good amount of time to do. But it’s worth it. As an audience member, please, please take the time.
In class we have been talking about quality–no doubt a needed discussion as we enter the workforce.
Six Sigma, Lean, Lean Sigma, IHI, Baldridge. And the countless other programs/iterations/combinations/mash-ups in existence.
But any quality program discussion necessitates other conversations. Importantly: 1) implementation and 2) sustenance.
No doubt any health care worker has been through some sort of the “flavor of the month” experience except for maybe a select, chosen few.
Seth’s post gives it straight, “I don’t want to use a tool unless I’m going to use it really well. Doing any of these things halfway is worse than not at all. People don’t want a mediocre interaction.”
Partially implemented and poorly sustained quality programs damage the patient interaction.
Why don’t we ask, “are we fully, top-priority-like, completely committed to this?” when it comes to implementation…er, real implementation?
Long have we heard that we need to make patients more like consumers in health care. Consumer-directed health care will … (insert promise here).
Adam Hanft at FastCompany blogs the return of the “rational consumer” (go read the post here, its biting wit is worth your time)
Consumers are willing, if not anxious, to spend more for brands that transcend the narrow benefits of functional utility – see Virginia Postrel’s “The Substance of Style.” Price sensitivity is out. Sensibility sensitivity is in. Consumers seek to wrap themselves in brands that offer up a cozy, self-reinforcing blanket of hipness and coolness. It’s a co-dependency of cues and semaphores, a mutual acknowledgment that brand and user are in on the game.
Well guess what? You’ve seen what happened to Starbucks sales and its stock during the last quarter. It was more than a mere froth of bad news, bringing Howard Schultz back into the CEO position to recover the missing mojo. Meanwhile, McDonalds is getting into the pricey coffee space, with their own McBaristas. And just last week, I read that — sacre bleue – Starbucks is testing a $1 cup of Joe, a stunning capitulation.
USA Today had a story earlier this week on employers who were dropping group health insurance plans and replacing them with monthly stipends to help individuals purchase insurance on their own. Among others:
Nick Trikolas plans to drop health insurance for his employees and give them money to buy their own coverage. He says doing so will put him in the vanguard of a movement by employers searching for answers to rising health costs.
The Wall Street Journal had a story as well:
So instead of providing group insurance, Mr. Martin is offering allowances — such as contributions to health-savings accounts, or HSAs — to employees who buy their own coverage in the individual market. Other small and medium-size employers are also providing stipends to workers who buy their own coverage through similar defined contribution programs.
Most insurees still receive coverage through their employers but we have all read about rising premiums that are forcing companies to rethink their benefit offerings. Never mind that when companies drop unaffordable insurance for employees and force them into the individual insurance market, the affordability (lack-there-of) of similar benefits does not change–it’s just passed onto the employee. Regardless, (this cliche is oft and over used) it is what it is.
In this atmosphere of change, this push for change, difficult choices will have to be made. And if sustainable change is to be made, we may very well have to rethink our views on health insurance. It is likely that any drastic reform means big changes in the insurance market. And that change could mean individual insurance plans for all.
If that’s the case, I introduce to you, health services industry, the “Rational Consumer.” A consumer that asks about the prices of procedures, compares treatment options, foregos pharmaceutical cures, decides against a trip to the emergency room…the list could go on and on.
It could be a good thing. A game-changing thing.
