- Patients & the New World of Healthcare, Part 1: PCOR
by Beth Austin
Today's turbulent healthcare environment has brought a great deal of scrutiny on insurers, provider/delivery systems, and the general business of healthcare. In a system poised for major change, America's healthcare consumers will have important new choices and an evolving need for education. In this first of a series of blogs, I'd like to start a conversation about the impacts the Affordable Care Act (ACA) and current industry trends will have on the role of the patient. This post focuses on patient-centered outcome research (PCOR), but other topics - such as Accountable Care Organizations (ACOs) and the Health Insurance Marketplace - will follow.
The ACA legislation established the Patient-Centered Outcomes Research Trust Fund, which is the primary funding source for the Patient Centered Outcomes Research Institute (PCORI). The mission and vision of PCORI are centered on helping people make more informed healthcare decisions that will improve desired healthcare outcomes. It's not hard to support these objectives in principle, since if successful, not only do paitents thrive, but providers, insurers, and payors also have the potential to reap indirect benefits. The organization funds research projects that are centered on key patient-centered questions::
"Given my personal characteristics, conditions and preferences, what should I expect will happen to me?"
"What are my options and what are the potential benefits and harms of those options?"
"What can I do to improve the outcomes that are most important to me?
"How can clinicians and the care delivery systems they work in help me make the best ...
- Doubling Down
by Scott Good
In previous blogs, I have written about Community Health Needs Assessments (CHNAs) and the challenges of meeting regulatory demands in a way that uses resources wisely – offering some methodological details and keys to success. The implementation planning mandate (and the linkage to the IRS Schedule 990H) is an opportunity to engage community leaders and reach out to address prioritized needs.
CHNAs and Implementation Plans (IPs) may meet regulatory requirements but if not conducted in order to meet the “triple aim” goals of improved population health, enhanced patient experiences, and lower costs, they are destined to fail.
By failure, I mean suboptimizing the hospital’s ability to improve community health and operate efficiently. Let’s be honest, it’s pretty easy to meet the CHNA / IP requirements, but it is more difficult, more expensive, more time consuming, and more risky to really pursue triple aim goals.
It’s time to “double down”
This blog is called “Doubling Down” because the changing healthcare environment is compelling hospitals, health systems, payers, community groups, and people with health issues (including those working to stay healthy) to think about health and healthcare differently. The CHNA / IP regulations move us in a positive direction. However, going that second step – toward a triple aim solution – is needed to develop a sustainable model to meet our goals of having healthier communities and lower health system costs.
The time has come to – as many hospitals have already realized – make the hard choice and invest in conducting a CHNA and developing an Implementation ...
- Human Rights Issues: Under-reported, Unseen, Unresolved
by Jordan Rowe
As a society, the United States has come a long way. Many civil and human rights issues have been advanced in recent history, but in some areas, we have a long way to go.
My lack of awareness of an important human rights issue came to my attention only recently, upon my noticing an increased number of people in the Portland area who are experiencing homelessness. Homelessness is a bigger issue than I thought.
My awareness was heightened while working on a client project. A healthcare facility in New England asked us to perform a needs assessment for the homeless population in their target service area. During the research, I learned that homelessness is a majorly unrecognized and often ignored issue; but it surrounds us every day. Other than the few individuals standing on busy street corners, asking for our money and our help, we often just don't see it. The issue of homelessness is multidimensional. Many people attribute homelessness to personality defects, such as laziness, but this perspective is superficial. In the research, I learned that around 70% of the homeless community that I was assessing had been diagnosed with one or more behavioral health disorders. Treatable disorders. And the numbers are expanding.
According to Neil Donovan, executive director at the National Coalition for the Homeless, homelessness is severely underreported. Point-in-time tallies (the estimation of homeless populations based on any given day) vary dramatically from estimations taken over a period of time. Not only are there almost double the amount of ...
- Health, Personal Change and My Blockbuster Drug
by Jim Kupel
Health coaches or navigators are a great idea – and one that has demonstrated results. But implicit in Scott’s recent blog is the idea of personal change. A navigator may get to know the patient’s personal and health goals, help identify barriers (e.g., childcare, transportation, family issues, and others), and help develop a realistic plan to the overcome the barriers and achieve the goals. But navigators can only help. We need to do the hard work ourselves. Patient engagement is at the center of changing the system.
So, if I have a chronic health condition and have been marginally compliant with what I know I need to do (lose weight, use less salt, etc.) what are the characteristics and activities of the navigator that will make me more likely to follow the care plan?
This is a very different approach for most of the health care system that has been reactive in nature.
While Judith Hibbard and others have been saying patient activation is central to improving healthcare for years, the idea has been rekindled by the meme that “patient engagement is the block buster drug of the century.”
“… it’s surprising that it has taken us this long to focus on patient engagement because the results we have thus far are nothing short of astounding. If patient engagement were a drug, it would be the ...
- America's Changing Healthcare Landscape: Some Basic Points
by Scott Good
The landscape of healthcare in America is changing – like it or not. There are a myriad of proscribed changes, yet many of them revolve around a few key issues. One of the issues involves the elusive tripartite goals of improving health, enhancing patient experiences, and better managing costs.
Organizations such as the Institute for Healthcare Improvement (IHI, www.ihi.org) are implementing a number of initiatives to help organizations achieve the “triple aim” goals.
To help focus the discussion, let’s look at diabetes care. Over 11% of U.S. adults age 20 and older have diabetes, and 27% of seniors. The total cost of care is approaching $200 billion annually with about two-thirds for direct care and the rest for indirect costs such as lost workdays, restricted activity, and disability due to diabetes (www.cdc.gov/diabetes/consumer/research.htm). Care models – like those for most other disease states – typically involve a fee for service approach.
Projects, such as those being utilizing the IHI approach, are encouraging organizations to revise care models and take more of a population health, proactive approach. However, there are a myriad of operational and implementation challenges. For example, one of the often used strategies is to add case managers – or “navigators” – to help higher risk patients (those using the greatest percentage of services) adhere to health regimens. Yet, there are not many established evidence-based best practices for their use – not to mention a consistent definition of their role.
In this time of inevitable change, there is an ...
- Real Need and Redoubling Our Efforts on Healthcare Reform
by Jim Kupel
Our clients are some of the most dedicated professionals in the world. They believe, as do I, that by changing processes, improving quality and reducing fraud, abuse and waste that we can change the cost curve of this important segment of our economy.
There is also an important discussion starting again about engaging consumers and the use of insurance. The idea of insurance is simple: we all pay some so that those most tragically affected are not financially ruined by a health catastrophe. Or as in the case of the following real life story, so those in need do not need to negotiate payment in the midst of a personal health crisis.
“I finally was able to see my daughter around 1:30AM in the wee hours of Sunday morning. She was hooked up to all the usual monitors in the ICU and had several IV's in her right arm as her picc line wasn't being used in case it was a source of infection. She looked at me and said she'd never been jabbed with so many needles so quickly, but it was necessary to get the fluids and three antibiotics into her immediately. What I didn't know at the time, was that her low blood pressure and high heart rate were symptoms of sepsis, which can be a deadly bacteria in the blood….
“I have to admit while sitting in the ICU, I also had moments of wondering how we got here again and thinking about how ...
- Greater Good
by Scott Good
I just saw a headline that Pope Benedict XVI is resigning. I am not Catholic but being an “armchair researcher” of the development of early religious institutions, I find his resignation particularly interesting. The previous time that a pope resigned was about 600 years ago to help resolve the “Great Schism” between the papacy established in Rome and the one in Avignon, France. Without going into a lot of detail, I prefer to stay at about 30,000 feet. To me, regardless of any other factors, the pope who resigned in 1417 (Gregory XII), probably did so for the greater good of the church – most likely, as Benedict is also doing.
So why talk about this on a Crescendo blog? Well, it’s like this … More and more, we are seeing people do difficult things for the right reasons, and this gives me hope. We all know that the face of healthcare is changing (and probably education, soon too – but that will be in a future blog). Increasingly, physicians, payers, healthcare educators, and affiliated community groups are working together to improve patient care, enhance patient experiences, and better manage costs. These decisions to collaborate are difficult because they often threaten revenue streams or channels of power.
So are people making decisions like these because they are serving the greater good or because they realize that if they do not do so, they may be increasingly vulnerable to future changes? In the pope’s case, I say that it is for the greater good ...
- Getting Over It
By Beth Austin
With the new year comes new possibilities, new opportunities, and, of course, a slew of New Year's resolutions on which we will make varying degrees of progress throughout the year. People are generally used to making (and breaking) personal New Year's resolutions, but for business leaders, the list should also include goals for their organizations. One's personal and professional goals are often inter-related - and the process for successfully achieving the milestones is similar for both.
I was reminded of this once again last weekend in the midst of my efforts to make a change in my personal life. It's an important change that is long overdue and I just need to get over it already. I reflected a bit on why my particular issue had been going on so long and I realized that without conscious effort, our approach to addressing either personal or business challenges is often ineffectual. As a critical thinker who favors processes, I almost immediately got a visual in my head that looked something like this:
Cycle of a Failed New Year's Resolution
Since I'm blogging this right now, I can't gauge the reaction, but I imagine that if I shared this in a public forum it would be met with some sheepish looks and nervous laughter - along with chorus strenuous denials (see Step 1 above). So, how can this process improve?
Although one should always iterate, measure, and improve once a new process or behavior is put in place, it is ...
- The Healthcare “Reformation”
Posted by: Scott Good
The Protestant Reformation is one of the more interesting events in European history over the past thousand years - regardless of one's faith-based leanings. I was recently put in a position where I needed to know enough about the event to lead a public forum on the topic. My talk went fine, and the information - particularly after brushing up on my history a little - was fascinating. Having a somewhat unique perspective on large issues such as this (i.e., the bifurcation of a major institution), I recognize some of the parallels between bellwether events (such as the one which was the subject of my forum) and the structural changes in healthcare. Although I do not intend to draw any comparisons between Martin Luther of 1517 and the Affordable Care Act, I think that some observations may be appropriate.
Martin Luther was a German monk who had some life changing events and then - through some unintended consequences - was put into a position of making some very difficult decisions. In his case, it involved the cataclysmic decision of splitting off from the Catholic Church. Except for the "German monk" and "Catholic Church" parts, some participants in a recent healthcare-related focus group that I moderated had stories that paralleled Luther's tale. For them, the life changing events related to a life threatening illness with their son; the unintended consequences were related to a series of responses by the health plan and care providers. The difficult decision was the need to sell family business (small ...
- Discipline, Gratitude and Thankfulness
posted by Jim Kupel
Strange as it seems, there is an incredible amount of thankfulness in the latest Ken Burns special on the Dust Bowl. As I watched, I saw the essential American juxtaposition of thankfulness and discipline. Dustbowl farmers were irate at their neighbors who didn't work hard to adopt good land management. Simultaneously they were incredibly thankful that their neighbors and the federal government could offer assistance.
The other revelation is that gratitude can also change our body chemistry and actually help us through our present difficulties. The Harvard Mental Health letter explains that "in positive psychology research, gratitude is strongly and consistently associated with greater happiness. Gratitude helps people feel more positive emotions, relish good experiences, improve their health, deal with adversity, and build strong relationships."
My eldest daughter, while far removed from the dust bowl, has shown me a simple, but much appreciated connection between discipline and thankfulness. She and her friends are using Facebook to share their thankfulness during this Thanksgiving season.
It reminds me of the three-blessings exercise described in an ABC story about how thankfulness is linked to positive changes in brain and body. "One of the most well-known practices uncovered from this research is known as the Three Blessings exercise," said Renee Jain. "Each night before going to bed you write down three good things (ordinary or extraordinary) that happened to you during the day. Studies reveal those who continue this exercise for one week straight can increase their happiness and decrease depressive symptoms for up to ...
- Tell Me More
Posted By Beth Austin
It's "Trade Show Season." Marketers out there will need no explanation for this, but for the rest of you, the fall is a busy time for many of us due the preponderance of trade shows and conferences that happen in September and October. This season has been a busy one for the folks here at Crescendo, as we have been attending shows everywhere from Bangor, Maine, to West Palm Beach, Florida and a number of places in between. Over the last couple of months, I've had the opportunity to present at several conferences and, as always, I'm reminded of what a great learning opportunity it is. Although it seems somewhat counterintuitive, but the times when you'd think I'd really be doing all the talking is when I get some of the best listening in. The reason for this is because of the one-on-one conversation and information sharing that follows a talk. Regardless of the subject matter is, attendees will always approach me after a presentation and share their story about the topic at hand. I find this part of the job to be the most rewarding.
These conversations provide a great opportunity to make a connection. Sometimes the information shared is no different than what we've learned from our research or what you might be able to find on the internet, but that person-to-person networking and the opportunity to "hear it from the horse's mouth" makes it all the more powerful.
One of the topics ...
- Solving the Economic Paradox
posted by Jim Kupel
A recent New York Times headline read: "Economy still weak, but more feel secure." This is an apparent paradox to many. I'm not sure it is all that much of a paradox. There may be a simple answer to the question of why the economy is growing slowly and consumer confidence is increasing solidly.
Could it be that Americans have adjusted their expectations and are getting along with their lives without listening to the media doom & gloom or looking towards the government to solve all their problems? We're looking hard for better jobs, helping our kids with their school work, and learning to enjoy life despite substantial difficulties.
I'm sure there are larger economic changes we don't yet understand, e.g. baby boomers retiring. But there is something we do know: Americans know how to push ahead with a good attitude despite lots of difficulties.
- 10 Levers for Successfully Recruiting Physicians to Rural Areas
posted by Ron Skarka
We've all heard the statistics about physician geographic distribution away from rural areas. Yet Triple Aim achievement requires physician recruitment success. Our communities must attract care team leadership with vision, compassion, and communication skills as well as the necessary clinical diagnostic and therapeutic skills. In other words success mandates both intellectual intelligence as well as emotional intelligence. We need "value" recruiting, not just "volume" recruiting. How do we convince these superstars to join our rural communities?
Having been a healthcare executive at small community hospitals for the past 25 years, I've had to pull a few rabbits out of my hat to win the competition for physician leaders. Here are ten "levers" that can help in this process:
- Listen: Start by asking the physicians about their ideal practice setting and ideal location for their family (single physicians aren't usually enamored of rural areas but there are always exceptions). You might be surprised to hear the priorities. Many times I hear the following: "collegial environment, not cut-throat, personable colleagues, pleasant work environment, appreciative patients, opportunity to make a difference..." Regarding a place to live: "Balance of life, low crime, great schools, outdoor activities ...." Sounds like something we can provide in small towns.
- Big Fish in a Small Pond: You won't be a number here. People will look up to you.
- Educational Assets: Are your schools highly rated? A nearby college?
- Access to Culture: You can persuade those undergoing the urban-rural transition that there is access to culture (summer theatre ...
- Why Not Do Something that Changes the World?
Posted by Scott Good
Sometimes it just takes someone to put "the obvious" into a simple paradigm. Doing so catches people's attention, critical momentum is gained, and lives are changed. Life, liberty, and the pursuit of happiness" (Declaration of Independence, 1776); "Liberty, equality, brotherhood" (French Revolution, 1789); "Healthy, wealthy, and wise" (John Clarke, 1639; Ben Franklin, around 1745).
In 2007, the Institute for Healthcare Improvement (IHI) launched its "Triple Aim." Triple Aim is a simple paradigm that with three purposes: (1) improving population health outcomes, (2) improving the quality of patient experience, and, (3) reducing costs. This isn't rocket science - we all want to stay or get healthy, feel comfortable with the process, and save money for ourselves and the healthcare system - but that doesn't mean that it is easy either.
On a practical level, I compare the Triple Aim to long distance running. I am a very, very slow runner, but I can run long distance when I'm in shape. I've run five or six marathons in the past few years, and am planning to run one more in 2013 and then a seventh in Miami 2014. My problem is that I am impatient in my training. After running no more than two or three miles in nearly a year, I decided to go for a 13.6 mile run (yes ... stupid on many levels) because I really dislike the four to six weeks that it normally takes me to get up to that distance. Did this make sense in ...
- Meaningful Use of Patient Portals
Posted by Heidi Wurpel
The Health Information Technology for Economic and Clinical Health Act (HITECH) based reimbursement for certified Electronic Health Record (EHR)/Electronic Medical Record (EMR) technology on "Meaningful Use". Both Medicare and Medicaid make incentive payments under HITECH. However, "meaningful use" standards become increasingly stringent each year.
Hospitals and medical practices who have received reimbursements simply for having an EHR/EMR that includes a patient portal (even if it was turned off) will not only need to turn on their patient portals to continue receiving reimbursement but will also need to start showing that a percentage of their employee population is actively using the patient portal.
The success of meeting this requirement is likely to hinge on the strength of the medical provider's patient communications. On surveys, patients almost always express desire for telemedicine, e-mail communications with their provider, electronic prescription refill requests, and 24-hour self-scheduling abilities. However, getting patients to break old habits and utilize these new patient portal technologies will take more than just flipping a switch. How do you do this?
- Medical practices and hospitals should start identifying patient e-mail addresses - and each patient's interest level in utilizing technology - now. A database will ease the challenge of targeting patients for communications.
- Start talking to your patients about the specifics of your portal. Whether this is a formal survey conducted by an evaluator such as Crescendo, or simply ad hoc conversations in the waiting room, knowing the aspects of your portal that patients find most exciting will allow you to ...
- A New Vision
Posted by Beth Austin
"This mission, vision, and values work that organizations do is completely unproductive," the keynote speaker said.
Intrigued, but skeptical, I wondered where he would go next with this. He went on to tell the roomful of hospital executives this: "If I asked each of you to write down your mission statement on a piece of paper and give it to me, I could hand them all back out to you at random and most of you would not know whether the one you got back was yours."
Uneasy laughter rippled through the room.
However, the speaker was not negating the importance of setting clear strategic direction for an organization, but suggesting that the process needed an overhaul. An organization doesn't need a mission statement - it needs a "dream."
The idea that organizations should get away from generic and antiseptic visions certainly resonates with me. I've written before about the need for people to have passion about what they do in order to thrive or to help people simply survive the less-than-stellar days. Studies continue to demonstrate that when organizations (and the people that comprise them) are engaged and passionate about what they do, it shows. Customers know it (e.g., Zappos) and a series of articles from the Harvard Business Review and elsewhere suggest that it's also reflected on the bottom line.
The link between employee engagement and organizational success is not a new one, but human resources professionals know that how we define - and foster - employee engagement also ...
- Workplace Olympians
Posted by Jim Kupel
Just before the start of the London Olympics games, I watched a show on the Oprah network featuring 10 great Olympians from the past, e.g. Mark Spitz, Carl Lewis. I was struck by several recurring themes in the answers to Oprah's questions.
What makes Olympians? Mental toughness, training, sacrifice and focus. It is one of the few venues that is a true meritocracy.
I thought about the implications for the American workplace. Certainly competitive this is part of the formula, but it's not competitiveness alone that makes an Olympian. The common theme was that each one of these people was striving for perfection. They were striving to become the worlds best. In some cases you become the best by besting another, but in every case becoming an Olympian requires besting oneself.
This has been one of the hallmarks of American culture, but it is also the hallmark ofgreat businesses. Think Toyota and quality improvement innovations on the auto manufacturing line. Think Pixar's critique sessions every morning after a day of animation movie making. Think Jackie Joyner-Kersee 2 and Babe Didrikson Zaharias 3
Another aspect of the Olympians is a spirit of fair play mixed with competitiveness. The reason corruption, bullying and outright robbery are not good for societies is clear-none of them results in improved societal performance. As a species we need to recognize this and continue to encourage an environment of mental toughness, training and fair play that results in great innovations that can sustain a planet ...
- To Syndicate or Not to Syndicate
Posted by Heidi Wurpel
Syndicated content is often an affordable way to increase the breadth of your digital presence and add value to your website for visitors. Syndication is essentially renting a direct link into a trusted website, full of vetted content. Syndication has occurred in television for years - with cable stations renting programs that previously ran on the major broadcast networks to pull in additional viewers.
The difference between television syndication and website syndication (except for companies that are a hybrid of the two such as Hulu and Netflix) is that, while television syndication increases the viewers coming to a cable station, website syndication does not. Syndicating online content rather than writing your own (and locating it on your website) does not increase traffic or your organic search engine optimization (SEO) results as much as original content would. Instead, the purpose of online syndicated content is to add value to your already loyal visitors by providing them with a curated and typically easily searched database or library through the framework of your site.
When to Syndicate:
Writing original content and renting trustworthy content are both good solutions to separate problems.
Original Content - If you are looking to increase traffic to your site, optimize your search engine placement, give a new voice to an old or complex subject, or share information that is not readily available elsewhere on the web, then writing your own content may be a better choice for you (assuming you have the time and writing skills to do so or the money ...
- Defining a Hospital's Personality in Preparing a Community Health Needs Assessment
Posted by Scott Good
Crescendo has conducted Community Health Needs Assessments (CHNA) for many hospitals and done strategic planning, communications, marketing, and other research for scores of others. Upon establishing a relationship with the leadership, it is always fascinating to be "steeped in the personality" of the hospital. The phrase sounds almost cliché, but it is critically important when conducting a CHNA.
Community assessments are meant to do more than to take a pedantic snapshot of one's service area. They need to be done in a way that syncs with the mission and vision of the executive leadership.
Let me give you an example.
I recently went to a client site in order to conduct a focus group as part of the CHNA process. I decided to get there about an hour early and to learn more about the facility, things that employees are excited about, observe the demeanor of the patients, listen to department heads talk about "new things" they are doing, and anything else I could soak in that would help me better understand the "personality" of the place. A client project team member was able to escort me around and show me some of the things that make the hospital unique. While seeing the newly renovated auxiliary hallway (now an art gallery with about 20 paintings from local artists) and the gym (open to the public plus a section for cardiac rehab only), I could better understand the energy shown by employees. The energy level is positive even though the facility recently ...
- America Works and Innovates
Posted by Jim Kupel
Edward Hopper was accurate in his portrayal of Americans. We are a thoughtful and serious bunch and for the most part we like to work and innovate. I have been thinking about Edward Hopper's portrayal of Americans since viewing an exhibit at the Bowdoin Art Museum. If you look at many of the people in his paintings - Office at Night; Nighthawks, Automat - you would not say they are happy.
My companions suggested that Hopper saw Americans as troubled. I disagreed and suggested that his paintings are realistic view of what we look like going about our lives. Part of their realism involves catching Americans off guard. In other words, it is as if Hopper captured our private moments in a number of settings and in doing so captured our countenance at the time. I suggested that most people don't go through their lives with a smile on their face, but that does not mean they are troubled.
To test my hypothesis I've been watching people in airports as I travel largely for work. Certainly there are exceptions - families on vacation and obviously having fun; travelers who are having a problem with their connections who are clearly upset. But for the most part people in American airports look serious and thoughtful regardless of whether they are traveling for work or pleasure or working in the airport itself as pilots, food service workers or gate personnel.
Hopper captured an essential component of the American psyche-we work. In a way it was ...