Too Confused to Use?

A study by GfK Custom Research of 502 private-sector employers painted a picture of where employers stand today regarding the Affordable Care Act and offering health insurance benefits to employees. Not surprisingly, most still don’t believe the Affordable Care Act will have much impact on the future costs of health care, and many believe it will actually increase the costs in the future. However, the majority of employers still don’t understand what is in the law and how it is supposed to work- so, the comments are based more on perception than fact.

Over 55% of the employers indicated they would continue to offer health insurance to their employees even after the major components of the “insurance reforms” of the Affordable Care Act are put in place. However, the responses were dependent on the size of the company. Most large companies plan to continue to provide health insurance- while smaller companies aren’t so sure. Over 30% of the companies (both large and small) are unsure whether they will continue to offer health insurance as a benefit to the employees in the future. Not surprisingly, the majority not offering health insurance now base their decision on cost (not on the Affordable Care Act).

In 2004, about 68% of the employers offered health insurance to their employees. The number stands at 60% today. By 2014 (when the theoretical “health insurance exchanges” are supposed to be operational) the number will likely be somewhere between 50-60%.

If the numbers hold, consumers are going to need to purchase health insurance different than they have in the past. They are going to need more education, more guidance, and more “transparency” than ever before. Transparency has never been a core competency of Health Care.

So, while Health Care focuses on all of the other transactional details to establish exchanges, develop new delivery models (Accountable Care Organizations), collect data, and all the rest let’s hope it doesn’t forget about the needs of those who can really have an impact on changing the trajectory we are on today- the individual/the patient.

All the new ideas won’t make much of a difference if the individual doesn’t understand how they work- or are too confused to be engaged to use them.

Transparency- Getting People To Use Information Is The Real Key

The November, 2011 publication of the American Journal of Medical Quality found 80% of the “highly findable” health care rating sites (rating doctors and hospitals) draw on anecdotal patient reports (the patient opinion and experience) more than anything else. According to the article, the sites many are using to research care providers and show highly ranked in the search engines don’t use some of the measurements Health Care would like them to use to help make informed health care decision. Only half of the highly findable sites include quality information and a third feature cost data. Forty-four percent featured performance results based on claims data or board-certification information.

Despite the effort Health Care is making to increase the amount of data and information available to the general population, a large segment remains frustrated with their inability to find what they need when they need it. Their frustration lies in three key areas: A lack of awareness of what is available, not knowing what questions they need to ask, and then finding the information once they know what they need. Individuals will likely continue to rely on family, friends, and their social networks as a more reliable source until Health Care packages and markets the information in a way that is relevant to the individual.

As Health Care continues to improve the "transparency" of how with works with the general public it will need to continue to acknowledge the “trust barrier” that exists with many individuals. Individuals will gravitate to the sources they feel they trust and provides information that is relevant to them. Collecting information is the first step, analyzing the information is the second step, packaging and communicating the information is the third step. And, it seems as if “experiential rating sites” have done a better job packaging and communicating their relevance to the general population than those that use the metrics Health Care prefers.

Maybe Health Care can learn from them.

Down to the Thanksgiving Wire

The Joint Select Committee on Deficit Reduction has until November 23 to come up with a plan to cut $1.2 trillion from the deficit. Then, Congress needs to have an up or down vote on the plan by December 23. We’re in for an interesting few more months watching the congressional version of “Survivor.”

Here’s a prediction: The plan will arrive at the very last minute and it still won’t deal with the fundamental systemic dysfunction our economy is facing today. The numbers may add up to $1.2-$1.5 trillion- but the way getting there will likely hurt a lot of people unnecessarily. The politics continues to avoid addressing the “causes” for the dysfunction instead of addressing them head-on.

The costs associated with Medicare and Medicaid need to be on the table. They are a large part of the problem and can’t be ignored. Unfortunately, the “super committee” will likely focus on the level benefits provided to beneficiaries and the costs paid to providers (“end result items”) as opposed to creating the environment to help the health care system eliminate the waste, inefficiency, and fraud (“the cause items”) that create the costs in the first place.

Eligibility will change for both Medicare and Medicaid, contributions will increase, current benefits will be scrutinized or reduced, and the amount paid to those delivering the care will be reduced as well. The “end results” will be covered.

Nothing will likely be mentioned about changing the current pay-as-you-go reimbursement methods, very little mentioned about improving consumer education and understanding to help them make better decisions, not much will be discussed about improving the coordination and communication of care decisions when inside the health care system or creating systems where health care providers in general agree with what works and what doesn’t.

I suppose the super committee will assume that the private market will simply need to adjust to the new reality- there were no other options. Many of these items are somewhat addessed in the Affordable Care Act but consumers aren’t so sure of that one either. But, there are other options. If the super committee really focused on “the cause items,” Medicare and Medicaid could contribute significantly toward the deficit reduction goal without cutting benefits or payments nearly as significantly as they are likely to propose.

I guess we’ll just have to wait and see what happens. It will be another down-to-the-wire episode.

Steve Jobs- A Role Model of What Our Country Needs Today

Our country lost one of the great innovators of our time- perhaps of all time. Steve Jobs was only 56 when he died but fundamentally changed the way we live during the short time he was with us.

Most of us never met Steve Jobs- but we all felt his creativity and passion for excellence every day. We saw the results of what can be accomplished when you dream, you believe, and you persevere. Our lives have been changed by his commitment to dream. Our world was changed by his example of believing and passionately working as a team for the accomplishment of a common good.

Perhaps health care, politics, and our country as a whole should take a break from acting the way it is today to reflect on the legacy of a true innovator and creator. We need more passionate and innovative creators to dig us out of the hole we are in. I’m sure Steve Jobs wouldn’t see the hole- but the opportunities available to dig us out.

We may have lost the dynamic presence of Steve Jobs in the world but we will forever live on with his legacy.

As Facebook creator Mark Zuckerberg wrote in a brief eulogy to Steve Jobs, “Thanks for showing that what you build can change the world.”

We need to continue to dream, create, and work together toward a common goal. It will be the best tribute to one of the most creative innovators of all time.

Armageddon Hypochondria

I attended the monthly meeting of the Association for Strategic Planning the other day. Dr. Jim Paulsen, Chief Investment Strategist for Wells Capital Management was the speaker. He topic was to provide an update on the economic and financial markets and provide some insight into this insanity that seems to be reality today. Dr. Paulsen and I grew up in two small towns about five miles apart in southeast Iowa. We both went to the same church in small rural Iowa and both of us attended Iowa State University. I hadn’t seen him in many years and I primarily went to the meeting just to see him and see if he remembered me (he vaguely remembered). And as if I really needed it, I was also interested in hearing one more perspective of what is going on in the world.

His message was different. He laid out a compelling argument and one that is not nearly as loud as the “gloom and doom” message we’re hearing from the politicians and media. Dr. Paulsen peppered his talk with a portfolio of graphs and charts comparing this recession to those in the past showing how this recovery (and he does believe we are in a recovery) is “normal.” He doesn’t ignore the challenges (housing, credit/lending levels, and health care costs) but believes the positive economic indicators (company profits, investment, and manufacturing) are moving exactly as he would expect and ahead of where we’ve been before. He also presented a clip of a 1991magazine article from Time Magazine describing the economic environment we were dealing with. You could paste the same words used back then into any article today and you wouldn’t know the difference- political paralysis, health care costs, rising debt, etc. etc.

Dr. Paulsen believes our country is a victim of “Armageddon Hypochondria.” While the recovery, from an economic perspective, is proceeding as almost every other recovery has in the past, he believes we have become victims to the politics and the media hype creating the feeling of gloom and doom and extremely low levels of confidence we are experiencing today.

The numbers in his presentation all made sense and it was nice to hear someone believe we are doing ok- not perfect, but ok.

“Armageddon Hypochondria” is a dangerous disease especially in rough economic times. The endless political-cycles in this country and the 2012 elections will very likely make the disease grow in the future- especially to the uninformed or susceptible. We also can’t confuse Armageddon Hypochondria with the Brutal Reality of what is happening in our country and in the world. Health care costs are absolutely unsustainable, unemployment levels are unacceptable, middle-class America is shaken, and the hyper-connected global economy has changed the game for everyone. Doing nothing and letting the market “self-medicate itself” (Dr. Paulsen’s prescription for Armageddon Hypochondria) is a standard free-market solution.

Using the past to predict the future is standard operating procedure and makes perfect sense. I just wonder if the world dynamics have fundamentally changed too much over the past five years to provide any reliable predictions to what will happen in the future.

I’ve concluded (self-diagnosis) I don’t have Armageddon Hypochondria- but I do believe if we continue to address critical economic , healthcare, and policy issues as we have in the recent past, we could bring ourselves closer to the edge.

I may have the symptoms- I just don’t have the disease- yet.

Remembering the Passion of 9-11-01

The clear blue skies and the crisp chill of early fall bring the memories back again. Some call it “9-11 Blue.” These are the mornings when we recall the time when most Americans lost their naivety and innocence to confront the reality of the world we live in today.

Each year we dutifully honor the lives lost in the tragedy of September 11, 2001. The pain of loss will never leave for some. For the rest of America, it pauses, it honors, and then moves on. Unfortunately, we don’t spend enough time reflecting on the magnitude of what happened on that day. There are too many other things to worry about today.

Since 9-11-01, over 6,000 American heroes have given their lives in the wars in Iraq and Afghanistan. Another 45,000 have been wounded. Thousands of families, friends, and loved-ones grieve for the losses and the sacrifices that have come about as a result of this blatant attack on America’s ideals. Countless others struggle to help those who have returned from these wars to somehow become a part of a different kind of America than existed ten years ago when all of this began. Today’s America can seem like it’s paralyzed and confused.

Yes, we have some challenges. We have some big challenges. But, let’s not forget it wasn’t the government, or politicians, or the military, or big business that pulled us together in 2001. It was the will of the American people who established the direction we wanted to follow. We were united in a cause.

As we pause once again to honor all of those who have sacrificed on 9-11 and beyond, let’s not get distracted by the “self-interest politics” that has slowly but surely become part of the fabric of our political process today. Let’s work together to solve our debt problems, support those fighting for our freedom, fix our educational system, grow our economy, create jobs, and finally fix our health care crisis in a way that can only happen in America; a unified nation of individuals with a common purpose and a passion for liberty and democracy for all. We’ve done it before and we can do it again.

Those who have already sacrificed deserve nothing less.

Participation and Engagement Are Not The Same Thing

I gave a talk to a group of businesses on the transactional side of health care the other day. My topic was to provide my perspective of approaching “consumer engagement” for the transactional side of health care from the lessons learned from the health and wellness side.

I spent a lot of time thinking about the topic. The politically correct approach would have been to provide all of the appropriate statistics to show how incentives, benefit designs, and the other “economic” approaches were improving participation in wellness programs (47% participation in completing a Health Risk Questionnaire with an incentive and 26% without) and how innovative communication/marketing strategies improve participation, and all of the other stuff. The politically correct approach would have been to say to just take what we’re doing so well on the health care side and use it in some of the other areas.

But, my topic was engagement, not participation.

Engagement, to me, is deeper. Engagement is commitment, its understanding the context, it’s taking steps beyond the minimum necessary to get by or getting paid to do it; it’s becoming part of the solution.

As I put my thoughts research together I began to realize (actually I had always assumed) that consumers aren’t engaged in health care. Seventy-five percent don’t understand it and many continue to be frustrated by it. Yes, the participation numbers may be improving for some of the wellness/preventive components (25% on average but higher for some program areas and for some organizations in general). However with such a high confusion factor and a health care literacy rate of only around 15% we could do much better. Add to that an industry “trust ranking” of Health Insurance and Managed Care only above Telecommunications, Oil, and Tobacco I concluded we might have a problem with real engagement.

My message to this transactional group ended up being that they need to be aware that they may be “branded by a brand” in health care and the health care brand with consumers right now is not all that hot (except with hospitals and doctors). I told them that they need to be aware that consumers were being asked to play many roles in health care today (Benefit Manager, Financial Manager, Care Navigator, Legal Manager, Information Manager, Personal/Family Wellness Manager) and they need to look at consumers in the total context as they develop products or strategies impacting a single one. I told them they would need to provide the appropriate guidance to consumers to help them fill their role as an Informed Health Care Consumer. And, building trust with the consumer would be a key to building engagement.

Yes, you can certainly improve the participation numbers by paying people and designing benefits to influence what they do. For most, the participation will only be short-term and dependent on continuing to pay them or maintaining the benefit structure directing them what to do. However, if you have them engaged, the participation numbers will be longer-term and the approaches you can use are more flexible. You may not even need to pay people to get them to do the right thing.

This transactional group was only interested in participation- not real engagement. They wanted to hear how incentives and economic structures could drive people to their businesses. They wanted to hear me validate what they were doing today and how participation (how many bodies) was the real indicator- not engagement. I think they wanted to hear the standard stuff. They didn’t want to hear about reality of the consumer perception of health care today.

Well, I still believe building trust in this industry is the real key to engagement. And, building trust starts with confronting the reality of where you are today and what may need to do to change. You build trust with open communication, honesty, integrity, and partnerships. You build trust with collaboration and dialogue. Building trust is more than just a software application, an incentive program, or an HRA. It’s about building a relationship with an individual.

Transactional health care may still be focused on participation. The real solution is engagement- and that’s tougher to earn.

From Minnesota- No Piling On Please!!!

I have to admit, living in Minnesota is never dull.

In addition to being the home of ten thousand lakes, beautiful communities, good people, and some innovative businesses we have created quite a collection of politicians to guide our state to where it is today including: Humphrey, Mondale, Wellstone, Ventura and more recently Pawlenty, and Bachmann. It’s quite the collection of personalities when you think about it. Minnesotan’s have become a pretty versatile people. We’re always looking for the right combination of personalities that can get something done. We’re willing to take some chances.

While historically Democrat, slowly but surely (just like the rest of the country), Minnesota has become ideologically partisan and divided. Last November, we elected a Democratic Governor, and a Republican legislature that work so well together we are now beginning the third week of a government shut-down.

What is the primary issue?; Balancing an “out-of-control” budget combining the right balance of expense reduction with revenue. The right and the left couldn't come to an agreement and is at a stalemate. Now, only the “essential services” in government are funded, the rest of the state is closed.

State parks are shut down (during the 4^th of July holiday), rest areas are closed, renewing your driver’s license or getting a fishing license (almost a requirement to live in Minnesota) is unavailable. Because the politicians could not do their jobs the rest of us are being asked to “suck it up” and live with it. In the meantime, Minnesota’s credit rating was devalued resulting in increased interest costs at a time we don’t need any additional costs.

In Washington we’re now in the midst of heated debate concerning raising the debt limit. What is the primary issue?; Addressing an “out-of-control” budget by combining the right balance of expense reduction with revenue (Sound familiar?) At this point, we’re at a similar stalemate at the federal level and we’re nearing the point that the effects could be worse than what is already being experienced in Minnesota if some resolution isn’t reached.

Since 1962, the debt limit has been increased 74 times. Many times it was increased as a part of some other legislation and never received much attention. Over the past 10 years, however, the debt limit has increased 10 times as the debt of our nation has exploded because of weak economic growth, the 2001 and 2003 tax cuts, funding two wars, and a stimulus package that was intended to prevent us falling into a bigger recession than we already experienced. Both sides need to assume some responsibility for the crisis we now face.

Unfortunately, the debt limit vote this time has become political instead of rational. Politicians are covering their asses as they protect their special interests and are already looking to use the process for leverage in the 2012 Presidential and Congressional elections. As in Minnesota, neither side is budging.

Some argue we aren’t really at any crisis point and can get through by simply juggling how we pay our bills until some resolution is reached. I would ask these people to just take a look at the fragile nature of the global markets. Whether these people want to accept it or not, August 2 is a “real date” to the markets- they will react accordingly.

So, once again (and as predicted when the federal budget was passed to avoid a federal shut-down), we’re going to go down to the wire. Because of the political reality of today, if a deal is reached it will not nearly be what is needed to address the crisis we are facing. If a deal is not reached, we will just have to wait and see what the market reaction will be- and it won’t be pretty.

Either way, once again the American people will be left living with the effects of a partisan political quagmire. We’re already going to have to live with the mess created by shutting down the government in Minnesota- we don’t need the federal government piling on.

Both sides are to blame on this one- so, get to work, put your politics aside, and do what is right for the country.

The Collaboration Health Care Elevator Speech

I’ve been asked many times over the years for the “elevator speech” for Collaboration Health Care. Honestly, I’ve sometimes been at a loss to respond because when I say, “I want to change the way the general population “thinks” about health care,” nobody cares.

Despite the different types of projects we have been involved in over the years, they seem to still boil down to the same thing- we’re still trying to change the way all of the stakeholders look at and think about health care. But still, nobody seems to look at it that way.

It’s still all about ROI, production, diagnosis, measurement, and all of the “transactional” aspects now involved with health care. It’s all about regulations and bureaucracy and following an established set of rules and processes as opposed to looking at the world a little different and trying to have a basic understanding of why all of this is necessary in the first place.

Don’t get me wrong. Measurement and accountability is important. We’re just now going to the extreme and don’t seem to be solving the problem.

Solving our health care cost crisis is not going to be solved in a partisan manner. The Affordable Care Act was a very partisan piece of legislation and needs to be modified. Repealing it is not the answer either. We need to have a basic framework in place we can all work from. We aren’t working from it together today.

And, most of the general population is confused. We’re more knowledgeable than we were before all of this health care talk started- but we’ve been informed from very partisan sources. We really don’t know who to believe.

Despite much of the population still indicating they are relatively satisfied with the way things are, there is a very rapidly growing segment saying they aren’t. More are feeling the affects the rising health care costs are having on their personal finances. And, it’s only going to get worse if something doesn’t change- and change fast.

Our health care costs eat up a substantial portion of our national budget and are a key component of our national debt. The “unfunded” liability (what isn’t paid for) for Medicare over the next several decades will reach $46 trillion. Health care costs have the real potential to be the final straw to bring down our economic foundation if they are not addressed.

So, I suppose the elevator speech should be changed; “Helping stakeholders change the way they think about health care” doesn’t seem to matter much to anyone.

How about, " Protecting our national and personal economic future by changing the way stakeholders think about and interact with the health care system- through education, information, partnerships, and dialogue.”?

It’s a little long, but maybe more folks will get it.

Newt's Comment Is Right- But He Got Creamed For Saying It

Newt Gingrich has been a guest on Meet the Press thirty-five times. He’s covered a lot of territory on the show over the years. During his visit on May 15th, host David Gregory asked Newt his opinion of Paul Ryan’s approach to address the budget deficit and ultimately addressing the unsustainable costs of Medicare. He replied, “I don’t think right-wing social engineering is any more desirable than left-wing social engineering.”

His defection from the party-line quickly reverberated throughout the conservative ranks raising a huge obstacle to his chances of becoming the Republican nomination to challenge President Obama in the 2012 presidential elections.

Despite speaking the truth, and despite being accurate in his assessment- his thirty-fifth visit cost him a lot. The reaction he received from the Republicans illustrated how far apart we are as a country to address the challenges we are facing. Unfortunately, we are being guided by the far-right or far-left politics when the real solutions are somewhere in between.

In the meantime, our health care costs continue to rise. Price Waterhouse Coopers released a new assessment of the medical cost trends for 2012 (Behind the Numbers; Medical Cost Trends for 2012). While medical cost trends increased 7.5% in 2010, they are projected to increase 8% in 2011, and 8.5% in 2012. As the economy struggles along at 2-3% growth (or less) we just continue to lose ground. Any possibilities for relief through initiatives included in the Affordable Care Act will not be felt for several more years- if at all.

The PWC assessment commented, “An interesting blend of reactions to the recession, the slow recovery, health reform, and other variables will affect the medical cost trend in 2012.” The problem is only going to get deeper the longer we wait to take real action beyond the party-lines of the politics and special interests.

Quite simply, the philosophies of the free-market purists will not solve this problem. The theories of the government-control liberals will not solve it either. We need a rational collaboration of both public and private initiatives to eliminate the waste, reduce the inefficiencies, and develop a solution that makes sense for the country.

We need to be able to talk about some of the solutions that are not necessarily “right” or “left.”

Newt’s comment on Meet the Press reflects what we need. Unfortunately he was creamed for saying it.

2011 Physician Compensation Report- An Interesting Picture

Whenever we start talking about the increase in health care costs we invariably start to think about the amount of money made by the providers. The costs of paying the providers make up 30% of the cost of care so it’s pretty easy to make them a target.

Medscape WebMD recently published their Physician Compensation Report for 2011. It paints a pretty interesting picture of the current economics of the general provider community.

Overall, the average “salary” for the 15,794 physicians across 22 specialty areas averaged somewhere around $250,000 a year. Orthopedic Surgery and Radiology did the best at around $350,000 and Primary Care and Pediatrics received the least at slightly under $200,000 per year.

About half of the respondents indicated their income “remained the same” between the years 2009-2010, but more indicated their incomes increased than decreased during this time.

Those in the North Central U.S. averaged the most ($225,000) and those in the Southwest and Northeast averaged the least ($190,000).

All respondents felt they should be earning more and less than half of the Primary Care practitioners felt they are currently fairly compensated for their efforts.

They all work a lot of hours and spend way too much time on paperwork and non-patient administration.

Almost a third are not so sure they would choose medicine as a career if they had to do it all again. They would either go into business, law, or teach.

When looking at the pure numbers we need to remember these amounts don’t include the general costs of education, general overhead, malpractice insurance, staffing, and all the other costs that we require providers to assume as a part of participating in the health care system we have created.

The question isn’t really “how much” but what is the value? That is the challenge we just haven’t been able to determine very well.

So, before we look only to putting some arbitrary limits on the fees paid to providers as the sole way to control costs we should first look at the ways we can measure and improve the value of the dollars that are being spent; more electronic technology, accessing best-practices, reducing administrative nonsense, and creating more informed consumers come to mind. And, providers need to be accountable for the value they provide, just like we’re expecting other stakeholders to be accountable in their new roles as well. Providers can’t just do whatever they want any more and expect someone else to pick up the tab.

Princeton economist Uwe Reinheardt estimated that if you cut physician income across the board by 20% you would only shave 2% off national health spending. That’s not a very big dent.

While health care spending is a problem, how we’re spending the money is an even bigger one.

Just Wind The Clock- It's Going To Happen Again

Last Friday the leadership in Congress and the Executive branch finally came to a last-minute agreement to narrowly avert a government shutdown. As expected, everyone waited until the last minute before finally showing their hand.

A soldier in Afghanistan (supporting a family back home) wondered if he was going to be paid. Some of these heroes literally live paycheck-to-paycheck. So, while dodging Taliban snipers and trying to avoid IEDs planted in the road, he now had to worry if his wife and children would have the money they needed for support while he was gone.

It's inexcusable- unfortunately this is the world of politics, partisanship, and debt we live in today.

Congress will likely pass the $38 billion in "reductions" that were part of the final agreement to create the FY2011 budget (many months late). Just to add to the confusion surrounding what was actually accomplished, the CBO posted their analysis of the deal the day before the vote stating the number isn't really $38 billion but somewhere around $350 million for FY2011 due to the maze of IOUs, transfer accounts, and other accounting gimmicks included in our federal accounting process. To add more fuel, they posted their projections indicating our deficit for the first six months of the year will be about $800 billion- over $110 billion more than the same time last year. We aren't making much progress.

The politics are getting uglier- and Americans have no idea who to believe.

While the lights remain turned on for now, these last-minute agreements are unfortunately going to be the norm. The fiasco that occurred last week is a drop in the bucket compared to what we're going to experience when the votes to raise the debt ceiling and the 2012 budget debates really get underway. Quite honestly, the stability of our economy is at stake.

Republicans want to use the scorched-earth approach, Democrats want to protect self-interests. Most of us know the right answer is somewhere in between. It's now a game of chicken- and we're all on the receiving end.

We'd better brace ourselves. The coming months are not going to be pretty. Whether we want to accept reality or not- addressing health care and entitlements (Medicare, Medicaid, and Social Security) will be or should be central to the discussion.

The world has changed and America has changed and now is the time we'll really see what we're made of. We had just better be sure we don't ask those who are already sacrificing so much while they are protecting our freedoms in hostile environments to sacrifice more just because we can't get our act together here at home.

We're better than that.

The New Proposed Rules for ACOs- Can We Make 429 Pages Understandable?

The Department of Health and Human Services just released the “proposed rules” for creating Accountable Care Organizations. Accountable Care Organizations (ACOs) were legitimized in the Affordable Care Act as a way to try to curb the unsustainable Medicare costs occurring today by organizing the way beneficiaries receive care in a different way. I believe the idea could be simplified by simply saying they change the way providers are paid by working together better than they do today. These proposed rules (requesting comment from the public) are 429 pages and will be a field day of billable hours for policy consultants, actuaries, financial analysts, and statisticians. With all of the data requirements included, technology companies and the IT departments at health care organizations are going to have some great opportunities (and a lot of work) if they play it right. You can grab the proposed rules by clicking HERE (it’s a big PDF file so hopefully your computer won’t choke).

Accountable Care Organizations are part of the Medicare Shared Savings program included in the ACA and are intended to create organizations to “expand value-based purchasing, broaden quality reporting, improve the level of performance and feedback to suppliers, create incentives to enhance quality, improve beneficiary outcomes, and increase the value of care." The idea is to reward providers for delivering high quality, efficient clinical care for Medicare beneficiaries. The rules themselves sound remarkably similar to the HMOs that everybody hated- but ACOs are supposed to be different. They are going to be primarily run by hospitals and provider groups instead of insurance companies, and supposedly will be less restrictive with the patients and allow for individuals to see providers outside the network if they want. We'll see.

I read that the health care industry tends to operate with “kind of a herd behavior, rushing to implement an idea without working through the detailed business questions of how they’ll work.” ACO’s are the new hot topic in health care and the herd is building. They sound like a good idea (and could be a survival strategy for some provider organizations and hospitals) so many folks are jumping on-board, they just don’t know how it’s all going to work.

HHS estimates 5 million Medicare beneficiaries will be enrolled in ACOs in the next few years. Somewhere between 75 and 150 ACOs are supposed to be operational over the next three years and will cost around $1.75 million each to get set up. The start-up costs are primarily going to be borne by the private market. HHS believes Medicare will save a little over $500 million over the next 3 years (median number). That’s a pretty small portion of overall Medicare spending- but it’s a start.

Once again, I wonder about the patients.

The rules spend quite a bit of time talking about the importance of being “patient centered” but nobody is talking about how to get the patients and individuals ready to be “patient centered.” What will happen when a patient wants to go outside the network impacting any bonus payment the ACO might receive? What will happen when the patient wants every possible test and procedure that the ACO may not believe is necessary? That’s going to determine the real success of ACOs. Can health care finally relate to people on an individual level?

As they are outlined today, the rules acknowledge that public and patient support is going to be required to make all of this work- but doesn’t quite define how. The rules state, “The exercise of free choice, however, can be undermined or even nullified if beneficiaries do not possess adequate information to assess the possible consequences of available choices, or to evaluate which available options are most consistent with their values and preferences concerning their own health care.”

Health care is going to need to connect with people in new ways. Brochures, pamphlets, and marketing materials are not going to cut it any more. Individuals need to be educated and informed about the basics of ACOs to be able to participate like ACOs are going to need them to participate.

Consumer education needs to be a priority and not just an exercise shoved off to the marketing department or handled like health care has handled communication and education in the past. Consumers are having a tough time trusting health care right now- 429 pages of rules may be a billable hour windfall for the consulting companies, but it doesn’t make things any easier for those who are really going to need to know what is expected and are going to be asked to participate in ways they haven’t had to in the past.

Let's hope we can start connecting.

Rep. Bachmann- Is the Tea Party Out of Touch Too?

Minnesota Representative Michele Bachmann certainly stuck to her talking points on Sunday’s Meet the Press.

Despite David Gregory’s persistent attempts, Bachmann danced around almost every question. She had a point to make and that point didn’t include responding to Gregory’s questions. She was sticking to her message and she was going to make it- no matter how embarrassing the outcome might be.

Her new “revelation” focused on the discovery of $105 billion in appropriations funding supporting the Patient Protection and Affordable Care Act passed last year. Her web site comments, “Recently, I read startling information about the funding of ObamaCare. . .” and goes on, “Because now, months after passage, we are discovering an astonishing $105,464,000,000 has already been appropriated to the Health and Human Services Secretary for ObamaCare through FY2019.”

Bachmann even sandwiched her “support card” showing the $105 billion number to all viewers in response to a totally unrelated question thinking it would provide extra emphasis.

She credits her revelation to an article she recently read- and the rest is history. She was off and running- despite the fact that these numbers have been out there since the beginning.

The numbers are true. There were a lot of appropriations made in the ACA for grants and funding in many different areas. These include funding for the health insurance exchanges, school-based health centers, expanded primary care residency programs, health care education at the community levels, and others. There were allocations made for many “oversight” organizations we could probably do without considering where we are from a fiscal perspective.

But unless you simply didn’t read the law, or are totally uninformed of what is included, this should not have been “startling information” especially for someone in Congress.

The Congressional Research Service published a report last October identifying the appropriations included in the law. There is nothing hidden. Representative Bachmann must just be getting to reading it now- or she has been waiting for another source to read it for her.

The costs of our health care system are continuing to increase and will continue to increase if nothing is done. The ACA needs a lot of work to fix if we’re going to fix it, or another approach had better be ready if we’re going to repeal it. Politics aside, we’re at a tipping point in health care.

If Representative Bachmann is going to be speaking for the Tea Party, I would recommend she get her facts straight before talking to a national audience again. If she is “shocked and surprised” at this late stage that is her fault for not being informed.

She shouldn’t assume the rest of the American people are as uninformed as she is.

Finally- A Business Case For Hospital Readmissions

A study in the New England Journal of Medicine concluded 1 in 5 elderly patients are readmitted to the hospital 30 days after leaving. This results in 2.3 million individuals being readmitted at a cost of over $17 billion to Medicare. A significant number of the readmissions are avoidable.We’ve known this has been an issue for a long time, but there was never the ability to develop the “business case” to fix it. Business cases are a big deal in healthcare. Even though we know it’s the right thing to do, if it costs in the short term or you can’t make money at it in the long term, things don’t change.

One part of The Affordable Care Act focuses on reducing avoidable hospital readmissions and will begin to penalize (reduce payment) to hospitals if their readmissions exceed certain targets. Suddenly, there is a business case and hospitals are taking steps to fix the problem and, for the most part, the initial steps to fix the problem are very simple: Make sure patients understand their responsibilities to care for themselves and get the follow-up care that is required. It may take a little more time to educate the patient or their care givers than before, but now the extra time is justified by the potential of lost revenue down the road.

While health care couldn’t make the business case before, I think about the 1 in 5 elderly patients who had to suffer being readmitted and the economic consequences that may go along with it. Somebody has to pay for it. And, I wonder why it takes threatening a reduction in what a hospital is paid to just take a little extra time to educate patients and care givers and do the right thing.

I guess that’s why it took a law to fix it. Our incentives are all screwed up.

My Journey Through The PPACA: Patient-Centered Research

Trying to read the PPACA is brutal. I've skimmed it twice and am now going through in a little more detail- reading the words. I have no intention of being an expert on this- but, I do want to be informed with what it is and what it isn't. So, I'm going to share some thoughts as I go through it on the blog.

As with any legislation (not just health care) the words and the organization (sections, titles, and all the rest) probably makes sense to the lawyers but I doubt even the politicians can explain it. That is a large part of the problem with this- it is just hard to explain what is written. Very few have tried.

I was particularly interested in the "patient-centered" stuff. Section 6301 page 609 creates the "Patient Centered Outcomes Research Institute" and a boatload of money is allocated to it.

Here's the definition/purpose:

"to assist patients, clinicians, purchasers, and policy-makers in making informed he

alth decisions by advancing the quality and relevance of evidence concerning the manner in which

disease, disorders, and other health conditions can effectively and appropriately be prevented, diagnosed, treated, monitored, and managed through research and evidence synthesis that considers variations in patient subpopulations and the dissemination of research findings with respect to the relative health outcome, clinical effectiveness, and appropriateness of medical treatments services and items--"

Whew. Take a breath.

While this diatribe probably means something to those in health care- (health care loves to use a lot of words or acronyms to say simple things)- the average person will have no clue what this is and why it may be important. How this definition of purpose even remotely relates to anything "patient centered" is beyond me.

I've found there are some good things in the law and some things that make no sense. Many times I had to work to find them. The lack of education, communication and explanation of this reform approach at a very basic consumer level remains a huge part of the problem as this debate continues.

Beginning to organize the information in the health care system is a good thing. Starting to organize system-wide "best-practices" and prevention methods is a good thing for everyone involved. Unfortunately, the consumer is never going to know why this is important because nobody is telling them and they have to try figure it out on their own with the 77 word definitions provided. Or, they just do the easiest thing and listen to the talking points of cable news or the politicians.

We all know how balanced these sources are.

A Wake-Up Call For Our Country

It’s unfortunate that sometimes it takes a significant event to force us to step back, reflect, and determine where we are. These events occur for us individually as well as collectively as a society and as a nation.

The tragic events in Tucson this past weekend is one of those.

The finger-pointing and accusations were flying within hours of the shootings even before any facts were known. We still don’t know many facts today and we never may know the real reasons for this insane act.

New York Times Nobel Prize winning columnist Paul Krugman quickly jumped to blaming the Tea Party, Glen Beck, Sarah Palin and conservatives in general. He commented, “Violent acts are what happen when you create a climate of hate.” He believes conservatives created this environment of hate.

Florida Democratic Congressman Alan Grayson didn’t help to create an environment of unity when he referred to Tea Party Challenger Daniel Webster as “Taliban Dan” during the mid-term elections. The rhetoric during these elections across-the-board was brutal.

Let’s just call it even. There is enough blame to go around on all sides. Regardless of whether the accused was politically motivated or not, we all know our political process and dialogue has grown toxic and does not help the cause of addressing the challenges we face as a country. We have serious challenges ahead of us. Whether we want to accept it or not- they will not be solved as Republicans, Democrats, or Tea Party; they will be solved as Americans.

Commentator David Gergen states it best, “This is not a moment to point fingers and make accusations. But it is a time to pray for the victims- and pledge to each other that we will struggle for a more civil and decent America.”

To honor the victims, and with prayers for Gabrielle Giffords, let’s come together to at least agree on that.