Reform- Going Forward

The way health care is delivered and financed in this country is going to change as a result of the legislation passed in the House last Sunday and signed into law today. We now have the opportunity to listen to the analysis of what it all means, the stories behind how it happened, and predictions of the consequences. In reality, no one has a clue.

What we do know is the approach that we are going to use to reform the health care system is very expensive, administratively complex, and has an unknown level of support from the stakeholders who are going to be needed to put it all into place. We know that millions of new customers (“customers” is the buzz-word) will be injected into the system. Health plans – in the private sector- see this as an opportunity. Aetna’s and United HealthGroup’s stock prices are up 80% and 60% respectively over the past twelve months. While health plans were made the “poster-child” of the debate, most are doing just fine, thank-you. We also know that with this influx of new customers there may likely be an increased demand placed on the system itself. Some don’t think this will cause any additional stress on an already strained system (primary care and hospitals)- we think it will.

We have all learned more about the parliamentary rules that are part of our legislative process through this debate than we would care to know. We have learned more about how Congress really works through this debate than we would care to know. And, we are likely to see and learn more new and interesting things as the efforts to stop the legislation continue to unfold.

We agree that more individuals will now be a part of the health care system than ever before and that is good. But, we believe that the ultimate costs are going to be much, much, more than projected (Medicare blew-through its projections in less than two years). While those supporting the legislation are touting the CBO numbers, quite frankly, we think the assumptions are optimistic at-best. And assuming the best is risky for our economy right now.

No matter which side you are on, Sunday’s vote and today’s enactment were historic events for this country. Whether you agree or disagree with the legislation itself we at least have a foundation to use to plan our business approaches for the future. This foundation will certainly change, but at least we have a footprint to follow.

The path we were on was unsustainable. The process we went through was quite ugly. I hope the path we’ve chosen doesn’t break-the-bank before it fixes the problems that need to be fixed. Time will tell.

We're Creating A Herd of Unhappy Elephants

The Institute for Healthcare Improvement (IHI) produces some interesting webinars on some “non-traditional” topics that can be applied to health care. You can listen to their programs by going to www.ihi.org and then going to the WIHI section on the site. Look in the Archive section for past programs.

Yesterday, IHI had Chip Heath, the Stanford professor who, along with his brother Dan, a Harvard MBA, produced the bestselling business book “Made to Stick.” Made to Stick discusses why some ideas seem to create lives of their own, and others die a quick death in both business and in our lives.

Their new book, “Switch- How to Change When Change Is Hard” discusses why it is so hard for us to change even when we know that change is the right thing to do.

Everything in our lives is changing right now whether we like it or not. The fundamental way we interact as a society is changing as technology, globalization, and the foundation of how our economy operates sets the stage for continued change in the future.

Our health care system is changing and is going to change even more when whatever comes out of Congress starts to become reality. While these external forces may dictate the changes we will need to make we don’t always go along willingly even though we know change is necessary.

In Switch, the Health brothers use the metaphor of The Rider, The Elephant, and the Path to visually describe why change is hard and why many good ideas fall to the wayside because we didn’t understand that we need to address both the intellectual and emotional aspects of making changes when they need to occur.

“The Rider” is our intellectual side. The Rider is our rational thoughts and all of the statistics, research, PowerPoint presentations, academics, etc. that knows changing the way our health care system operates is the right thing to do. We all know the way our health care is financed and delivered today is unsustainable for the future. In all of the research we’ve seen 75%-80% of Americans believe we need to reform the system.

“The Elephant” is our emotional side, and, as you visualize the metaphor, the more powerful of the two. The Elephant is more comfortable just plodding along in its comfort-zone but can be motivated and directed by The Rider if handled appropriately. The Elephant in health care can be seen with the reactions in the Town Hall meetings last summer, the Tea Party movement, and the response to what is taking place in Congress today. The Elephant in health care is being directed by the whip instead of following the direction of The Rider by the light tug of the reigns.

“The Path” recognizes the need to create the right environment to create lasting change. Here, the Health boys utilize the ideas of Stanford professor Lee Ross stating “people have a tendency to ignore the situational forces that shape other people”. You need to clear The Path to create real change. The Path for change in health care is being cleared by Congress since the free-market has not been able to get it done. It’s not a pretty path and certainly has many potholes, but it’s the path we have today.

As we look at our healthcare system The Elephant is reluctantly traveling down a bumpy path. The Rider is furiously using the whip to make The Elephant obey. When Congress passes the reform legislation that is on the table we don’t know if more obstacles will be thrown on the path or if obstacles will be cleared. We don’t know if The Elephant will finally follow the direction of The Rider or will rear on its hind legs, throw The Rider off and run back into the jungle.

But, we do know that lasting change using the approaches in place today will be difficult and ugly. Using the whip as the way to implement health care reform is going to create a herd of unhappy Elephants.

Employee Wellness?

No matter what final result transpires from the health care reform debacle, the process has already cost the health care system the last sliver of a valuable asset that is going to be required to make it all work- trust. Now, I’m not saying that there has ever been much trust in the system we have today. But, the process we have just witnessed drained whatever remaining trust there may have been.

Consider some of the numbers:

Only 40% of us trust hospitals as a source of healthcare information.

Most of us rely on our physicians for trusted health information, but over half look to other sources to make health decisions

Over half of us think since “managed care” was introduced in the 70’s, it is a bad thing that sacrifices quality of care for profits (and I am sure with the Administration’s current tirade against insurance companies this number is going to plummet further. We do not trust insurance companies).

Just 21% of us believe the federal government enjoys the consent/trust of the governed. According to Rasmussen Reports, Congressional job disapproval jumped 10% from just last month to over 71%.

Over 80% believe Congress is more interested in their own careers rather than serving the people.

Only 1/3 of us trust or have confidence in the employers we work for.

And, these are the groups we’re going to rely on to get us “engaged” and “actively participate” in our health and the health care system?

I don’t think it’s going to happen unless something changes dramatically.

When you think about it, if you break down all of the complexities we have created in health care you are dealing with four basic groups: the consumers- who receive the care when needed; the providers- deliver the care and help the population stay healthy; the intermediaries- process the transactions and coordinate the finances; and the government- to oversee the social interests of the system (and in the current cases of Medicare, Medicaid, etc. to act as an intermediary).

Yes, there are also employers, medical devices, pharmaceuticals, and thousands of sub-segments that are all part of the system as well, but they can be placed into one of the four basic categories above. Let’s keep it simple.

In our utopian world, these four segments are equally important and rely on a significant amount of trust between each other to optimize opportunities and maximize results individually and collectively. Consumers are engaged, and providers, intermediaries, and the government work together to support and organize care delivery.

That is not what is happening.

We all know these numbers as well:

80% of the costs are chronic, and well over half of these costs are related to the lifestyles we lead- they could be avoided:

Nearly 40% of us participate in no leisure-time physical activity

Only 12% exercise at least 5 times per week

60% are overweight

Well over half are stressed

Employers and health plans (in the intermediary segment) are offering more wellness-related programs and “wellness” (in a broad governmental sense) is at least being discussed as part of reform legislation. Despite all of this, according to Forrester Research only 11% of employees are engaged in any wellness activity offered through an employer. Some of us are trying to stay healthy on our own, but most of us are not.

Consumers (those creating the costs) do not trust the system we have. We don’t trust the intermediaries and we don’t trust the government. We will trust our providers some of the time but that is about it.

The government can enact all of the legislation that it wants. Employers and health plans can throw all of the new wellness gimmicks they can think of to try to “incent” us to do the right things. But, until the system (intermediaries, providers, and government) starts to regain the trust it has lost, it is just not going to happen. We will be looking elsewhere for health and wellness support, if we look at all. In the meantime, health care continues to get more expensive.

In his book, “The Trust Crisis in Health Care”, Harvard professor David Shore, PhD. states, “Trust, in short, is the bedrock- the very foundation- of healthcare.”

If that is the case, we are on very shaky footing with the foundation we have created today.

Changing the Health Care Paradigm

The health care system lives in its own little world. It has its list of acronyms and if you ever get a group of health care organizations or health care professionals sitting together in a room they start to talk in a language most of us can’t even begin to understand. They talk about HIPAA, HMO, PPO, HRA, comparative effectiveness, medical homes, EMR, PHI, FFS, FEHBP, MedPAC, and the list goes on. Those in the health care industry seem to understand the terms, some in government make it sound like they understand the terms, and the rest of us have no clue.

Therein is the problem.

We have made this patchwork health care system so confusing and so complex that most of us feel helpless to do anything about it. We have delegated the responsibility for fixing the mess we have to those who understand it- those that created the mess in the first place. We’ve created a Paradigm of Paralysis in health care.

We don’t need to be paralyzed. We can do something about it. We simply need to start to change the paradigm.

In late 2008-2009 Towers Watson and the National Business Group on Health completed a survey of 489 large and small companies throughout the country. They were wondering if anybody was having any success in managing health care costs within their companies.

What they found was not surprising. The best performing organizations (those that experienced less than the 6% average health care cost increase experienced by employers) were taking a broad approach, a strategic approach, to invest in programs and tactics to address the challenges facing their employees and their organizations.

These organizations didn’t just throw-out a health risk assessment to their employees and call it a day. These organizations created the culture, the strategies, the tactics, and provided the investment in resources to make a difference. They didn’t buy-in to the paralysis complex- they took action and changed the paradigm.

We all need to break through the Paradigm of Paralysis and realize we can make a difference- and understand that it’s not the government or the health plans that will ultimately solve the problems we have.

In a recent edition of the Employee Benefit News, Contributing Editor Michael Puck, SPHR compared the psychological barriers we have created in health care to the barriers that existed in the 1950’s with regard to running a sub-four-minute mile. Back then, we all knew it just couldn’t be done. Within 3 years of Roger Bannister breaking the sub-four minute barriers, over 30 other runners accomplished the same thing. The barrier wasn’t physiological, it was psychological.

We need to change the psychological paradigm in health care.

Puck outlines 4 basic components we all need to embrace to break through the Paradigm of Paralysis that exists in health care today:

Commitment- we need to define the vision and mission and gather the will-power to make it happen.

Culture- we need to create and support the environment we will need to accomplish our goals.

Structures- we need to organize the fragmented delivery processes we have today into a system we can understand and provide the results we expect

Resources- we need to effectively provide the resources necessary to accomplish the goals in a fiscally responsible manner.

While those in the health care industry and the government can continue to debate and discuss solutions to our health care crisis they are only contributing to the Paradigm of Paralysis we have today. Those innovative providers, consumers, employers, and entrepreneurs that don’t buy-in to it can do something about it, because they have the commitment to make it happen.

The Paradigm of Paralysis in health care is psychological for most but can be changed. Just look at what Roger Bannister started.