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.