Health Isn't Just About ROI

A familiar Einstein quote: "Not everything that counts can be measured. Not everything that can be measured counts."

W'ere trying to measure everything today in health care. We don't make a move unless the data is there to justify a positive "return on investment" (ROI) before we even start. We've reverted to use clinical and academic approaches to making decisions because we've been screwed so many times in the past. Data is safe. ROI is measurable. The way we make decisions today is justifiable in some cases and only holds us back in others.

Improving the health of our population is logical. When considering the costs of preventable chronic illnesses it only makes sense to help others change behaviors to prevent or minimize their effect- for the quality of life of the individual, and the costs associated with them. Yet, for any number of reasons, the health care system (employers, health plans, providers) continue to debate within itself with where the responsibility for "health and wellness" fits in the curative/sickness-focused model we have today. Who should pay for it? Will I get paid for doing this? Why should i keep someone healthy when they will only go to another employer or health plan when I'm done? What is the evidence and clinical model? With the costs of diabetes, obesity, hypertension, and other lifestyle-related chronic illnesses skyrocketing, a focus on creating a healthy population simply makes sense, we need to quit the debating, and begin to do something about it collectively.

An article in the December issue of the Harvard Business Review ("What's the Hard Return on Employee Wellness Programs?") further supports the value of wellness programs in the workplace. In typical academic fashion, the article identifies six "pillars" organizations included in the research used to create successful wellness programs in their organizations; Pillar 1: Multi-Level Leadership; Pillar 2: Alignment with organizational identities/aspirations; Pillar 3: Scope, Relevance, Quality; Pillar 4: Accessibility; Pillar 5: Partnerships; Pillar 6: Communication.

This isn't rocket-science.

I would argue these Pillars can and should be included underneath a more general platform of the need to create a "culture of health" that is trusted and embraced by the individual. The organizations included in the HBR article all had high "participation," positive ROIs, and focused approaches. But, all had also created a culture of health within their organizations that was a natural part of the organizational DNA. The health and wellness component was only an extension of the relationship these employers had created with their employees. It took time, and they all earned the trust of those participating with them.

Before relying on the 6 Pillars as the saving grace of what is required to create a healthy population of individuals we also need to focus on creating the culture of health throughout the landscape. This may take time and may not show a positive ROI for some time. Most individuals understandably do not trust the health care system we have today, some don't trust their employer relationship, and most certainly don't trust the health plans. Health care (providers, employers, health plans) need to build the trust and not simply rely on metrics or pillars to determine their success. They need to help individuals understand the relationships and provide the context they need to recognize they are part of the solution- and not simply a cog that is part of an external process. They need to be engaged.

To paraphrase Ghandi- "a (health care system's) culture resides in the hearts and soul of its people."

The culture is not determined just by the short-term ROI or other metrics that may or may not be important right now.

Fixing Health Care- Making It A Patriotic Duty Instead of a Political One

Last week we lost 18 soldiers and Marines in Iraq and Afghanistan. Unless you are family, friend, or part of a community hit by the reality of these wars (yes, they are wars) you don’t hear much about it. The country has too many other things to worry and argue about.

As we enter the Holiday Season this year, take a minute and say a prayer for the men and women half-way across the world and living in horrific conditions to protect the freedoms we enjoy today. Say a little prayer of thanks and appreciation for those who have made the ultimate sacrifice. While you’re at it, say a prayer for their families as well. These folks know what real sacrifice is all about. It’s not easy but they know their role, accept it, and make the best of a really rotten situation.

Instead of making health care a political football why don’t we think about pulling together a little to achieve a common mission in the best interest of our country. Let’s make it our patriotic duty to work together to solve one of the biggest economic challenges facing our country. We may not all necessarily agree with the rules and we may not even like those we need to work with. Mark my word, those serving in Afghanistan and Iraq face the same challenges. But, they adjust and look beyond themselves to achieve a common objective. They make things happen.

They are Americans before they are anything else. We can learn a lot from them.

Have a Safe and Happy Thanksgiving

The Brutal Reality: Health Care Today = Increased National Debt

In their book "Confronting Reality; Doing What Matters to Get Things Right," Larry Bossidy and Ram Charan put forward a statement that has implications for everyone in our country today. They state, "To confront reality is to recognize the world as it is, not as you wish it to be, and have the courage to do what must be done, not what you'd like to do." Very appropriate to describe the reality of the financial situation in our country.

Last week, Erskine Bowles and Alan Simpson, Co-Chair of the National Commission on Fiscal Responsibility and Reform submitted their "Co-Chairmen Proposal" for tackling the $13.7 trillion dollar debt facing our country. This debt is the result of the policies and entitlement expectations we have accumulated over the years (not just over the past two years) and was exacerbated by the Great Recession of 2008 experienced in the global economy. We are now facing a level of debt that jeopardizes the economic foundation of the country.

We have posted their proposal on our website at http://www.collaborationhealthcare.com/ and you can also look at it by clicking HERE.

We encourage everyone to take a look at it. It's only 50 pages and is mainly a "powerpoint on paper" highlighting the key messages. It has already been blasted for its lack of specifics. I look at it more as a starting point, not the final solution.

Those on the right have been critical because it includes tax and revenue increases. They believe there is already plenty of revenue- just not enough spending discipline.

Those on the left have been critical because it takes on some of the entitlements that have historically been off-limits; Medicare and Social Security.

The brutal reality is that we need some combination of addressing both.

Why is this topic included in my health care blog? Because health care (Medicare/Medicaid) is a major contributor to our debt and our lack of action in the past is impacting our businesses in the private sector and ultimately negatively impacting our economy. It's only going to get worse and it's time to quit arguing about the way to fix what we know needs to be fixed - and just do it. The impact of our debt is going to impact every American sooner or later. To fix our debt problem and our economy we must begin to change the way health care works whether we have laws that require it or not.

Some are still in total denial that the problem is as bad as others are making it out to be (AARP and the Natinal Committee to Perserve Social Security). On the other hand, David Cote, Chairman and CEO of Honeywell International and one of the committee members, was shocked to find out how bad our situation actually is.

The first founding principal of the Debt Reform document states, "We have a patriotic duty to come together on a plan that will make America better off tomorrow than it is today." America can come together when it wants to. Unfortunately it usually some type of crisis or catastrophe to make it happen.

The country has an opportunity to address a real issue before it is too late and becomes a catastrophe. This is beyond politics or ideology. It's time we confront the reality, become informed, and recognize it's going to take some sacrifice from everyone.

We have said before that fixing health care is critical to fixing our economy. Let's quit putting the ideology in front of the actions- as stated by Bossidy and Charan- "we need to have the courage to do what must be done, not what we'd like to do."

Republicans- It's Time For Specifics and Not Just Campaign Rhetoric

The $4 billion the country spent on this last election should be looked at as a little boom for the economy. Political consultants, media buyers, the hospitality industry, and others tied to the various campaigns got a little boost in revenue. So, that's good. You see, we can find money to spend when we want to.

While we had to suffer through the nauseating attack ads that are now part of the norm, we watched a country tell its government it wanted a change in direction. This was by no means an embracing of the Republican Party as the devout Republicans would like to think. It was the independent citizens telling the government they didn't like the direction the country was heading and wanted change. The level of trust in government is at an all-time low- for both major parties. In two years if we're in the same place, the same thing will happen- we'll have another change.

Now that the Republicans are driving the bus (or at least near the front) they now have an opportunity to step up to the plate with specifics on what they intend to do. They have been exceptional in the complaining department (and have brought up justifiable concerns). It's just they have been woefully short on the specifics of their alternatives. They now have the chance to show what they can do.

Repealing the health care reform legislation is becoming a central battle-cry for the "new government." Minnesota Governor Tim Pawlenty is leading the charge as he explores his presidential run for 2012. On CNN he once again denounced the "takeover of health care by the federal government" and instead wants to rely on the "free market" to do its magic- but there are not a lot of specifics beyond that. Michelle Bachmann (R MN) has jumped on the bus as part of the Tea Party movement commenting during her debates that she believes allowing consumers to purchase health care across state lines will solve the problems we have in health care. This is all great political-speak for the free-market purists, but, exactly what are you going to do and exactly how will it work? I guess they haven't got that far yet.

Solving our health care crisis is an economic issue, it is a debt issue. It is no longer simply a campaign debate. Health care (even before the reform legislation) was dragging our economy down. We seem to have lost this fact in all the political talking points we've heard over the past year. Medicare/Medicaid spending are the two biggest components of our growing national debt (along with Social Security) and is only going to get worse as the Baby Boomers create a tsunami within the Medicare system. The same is true for Medicaid as the rolls of recipients expand as a result of our depressed economy.

Regardless of what one thinks about the legislation that was passed earlier in the year (Pawlenty called it "the worse piece of legislation passed in modern times") it brought the issue of health care near the top of the national agenda- where it should be. Our health care system is (and has) impacted the competitive positioning of employers and thus impacts jobs- this is nothing new. It has economically wiped out average citizens and created hardships for many others with the fragmented and costly inefficiencies that are part of it today. Everyone agrees the health care system we have today is unsustainable for the future.

As Republicans assume their new role it's time they move beyond the broad generalities outlined in the Pledge to America and through the campaign rhetoric. They will likely find once again (as Democrats found in 2010 and as Republicans should have learned in 2008) that campaigning and governing are two totally different animals.

Americans are open to new ideas. Instead of focusing on the campaign message of "Repealing Obamacare" let's hear what your specific alternatives might be. The health care crisis is not going away.

Americans are listening and waiting to hear what you have to say. You've got two years.