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.
President Bush gave his final State of the Union address Monday evening (although there is precedent of past Presidents delivering an address days before a new President takes office–got that?).
Anyway, health care was covered, but Bob Laszewski at Health Care Policy and Marketplace Review indicates we should not expect much in the way of change and has the details here.
Failure, per say, is subjective to each individual’s definition. Even so, reasons for their possible failure are at opposite ends of the spectrum. One doesn’t have enough resources, the other uses too much. But this article in the The Atlantic made the connection for me. How similar does this sound to the current debate in health care?
The United States spends more than nearly every other nation on schools, but out of 29 developed countries in a 2003 assessment, we ranked 24th in math and in problem-solving, 18th in science, and 15th in reading. Half of all black and Latino students in the U.S. don’t graduate on time (or ever) from high school. As of 2005, about 70 percent of eighth-graders were not proficient in reading. By the end of eighth grade, what passes for a math curriculum in America is two years behind that of other countries.
I asked Marc Tucker, the head of the New Commission on the Skills of the American Workforce (a 2006 bipartisan panel that called for an overhaul of the education system), how he convinces people that local control is hobbling our schools. He said he asks a simple question: If we have the second-most-expensive K–12 system of all those measured by the Organization for Economic Cooperation and Development, but consistently perform between the middle and the bottom of the pack, shouldn’t we examine the systems of countries that spend less and get better results? “I then point out that the system of local control that we have is almost unique,” Tucker says. “One then has to defend a practice that is uncharacteristic of the countries with the best performance.
Nationalizing our schools even a little goes against every cultural tradition we have, save the one that matters most: our capacity to renew ourselves to meet new challenges. Once upon a time a national role in retirement funding was anathema; then suddenly, after the Depression, we had Social Security. Once, a federal role in health care would have been rejected as socialism; now, federal money accounts for half of what we spend on health care. We started down this road on schooling a long time ago. Time now to finish the journey.
Maybe we could learn from education? At least in what not to do. But some places get education very right, let’s explore why.
“The significant problems we have cannot be solved at the same level of thinking with which we created them.”
- Albert Einstein (attributed)
On an eve, not so very long ago, a couple of health care amateurs set out to change the world…
…and then we realized that we didn’t know anything.
And rather succinctly I’ve arrived at my point: one must be smarter than Einstein to really change our system and bring about an era of sustainable health care.
So we’ve returned to school for more education (obviously we have taken getting rich off of our lives’ to-do lists, we acknowledge intrinsic motivation for setting our sails toward this career path) and quickly realized that the classroom is a great place to understand concepts (and we appreciate the tutelage we have received thus far–for it would be much more difficult without our professors’ great insight) but time constraints placed a limit on our discussions. And for those of you who have studied health care know how impossibly difficult it can be to understand that many people consider health care a real business (they do what!?) (hold on, hold on, hold on, hospitals get paid how!?) (so you’re telling me that doctors don’t work for health systems? well, right, most of the time. what!?) (it is…a business I mean, one that seems to operate very differently at almost every turn). And this can all become very frustrating, so we started spending our free time (”you have to be nuts”) talking about health care. Questions (tons of them) were raised while answers (probably even more) were tougher to come by based upon our limited experience.
Solution? Solution: our own system.
What better way to fix the health care system in this country by just starting over and starting anew (Second Life is for real). OK, not exactly plausible in a service industry that provides tangible care (you never know!). But we can talk (write!) about a virtual system. So we started a blog to serve as the internet home of our community. We’d be happy if our writing just improves our understanding of what actually goes on. But I envision much more (patience is a virtue). And we’d be happy to entertain (in fact, we encourage) the thought of other health care amateurs joining us here and providing valuable thought diversity and insight.
OK, so what is sustainable health care? I don’t have a clue (finding that answer is the mission of this here blog). Through community exploration and interaction we will:
- question the way things are in this system (seriously, because we don’t know)
- wonder (write, is probably more truthful) aloud the reasoning behind all we do
- and hopefully, along the way, by just conversing about the many conversational points there are sure to be, propose audacious (deep breath), bodacious (oh my!), and practical/useful/implementable changes
We’re not naive enough to think we have the ability to solve the (kajillion) problems in health care (yet!) but we are smart enough to realize that sometimes fresh perspectives are (pardon this awful expression) exactly what the doctor ordered. We haven’t been around long enough for the system to eat up our appetite for changing the world or diffuse our excitement for doing good. It has not consumed us yet (and I pray everyday that it will not).
This is at its very core a learning exercise aimed at making us all more knowledgeable.
So with that, we break the customary bottle of champagne over the bow of our own system, welcome.
