Don't Invite Anyone From Health Care
In October 2006, the Northern Nevada Health Care Coalition decided to hold a health care conference. They made sure their community's health care leaders knew about it, but pointedly told them they weren't invited. And the attendees unanimously agreed to contribute their data into a common data repository, so that it could be mined to identify problems and opportunities. Now they're focused on addressing each problem and opportunity they've found.
Employers, as the purchasers, can drive real solutions when they decide to be decisive.
Employers, as the purchasers, can drive real solutions when they decide to be decisive.
Last year the Nevada Health Care Coalition in Reno asked me to work with them on a mid-October health care conference. They wanted to grow their coalition, and encourage their members to fund a data-mining project that would allow them to develop performance ratings on the region’s doctors (by specialty) and hospitals (by service).
Typically in meetings like this, the host group invites representatives from the different major constituencies: doctors, hospitals, health plans and employers.
I suggested an alternative. “Only invite the employers, and the C-suite executives, the corporate decision makers, at that. Don’t allow the employers to simply send their benefits managers.”
“Don’t invite anyone from health care. They’re too conflicted, and they’ll block progress. They’ll argue against transparency. They’ll claim they’re already fixing the problems. They’ll say its more complicated than the employers understand. And on and on. Draw a line in the sand. Don’t invite them.”
And so they didn’t.
I prepared background materials on the dynamics: the growth in premium cost, the erosion of private sector coverage enrollment, how that drop in health plan enrollment was in turn drying up the funds spent on health care, and how turmoil in the health care economy could disrupt other economic sectors. I described the deep drivers of cost and the health care crisis.
The Coalition sent out the materials with the invitations, and was delighted to discover that local business leaders were intrigued. The invitees forwarded the invitations to other business leaders, and so the Coalition received more acceptances than they had anticipated.
My partner in developing this meeting with the Coalition was Jerry Reeves MD, currently the National Chief Medical Officer of the Unite Here Union. Jerry, a pediatric oncologist by training, is a former Humana National Medical Director and former CEO of WorldDoc, which has developed a powerful suite of patient decision support tools. He achieved national health care celebrity when he took over the leadership of the (union-based) Culinary Fund Health Plan in Las Vegas. By carefully analyzing and acting on the data, and by developing incentives for providers and patients for every area of the health plan, he successfully drove so much money out of that plan while improving quality that all the union’s workers received a 60 cent/hour raise. It’s one of the best health care stories I know.
The day of the meeting, I arrived in the conference room and was introduced to the meeting’s sponsor, the CEO of one of the local hospitals, who was going to say a few introductory words and then leave the proceedings. We chatted, and then I said, “The problem, I think, is that despite a lot of handwriting on the wall, the health care sector is just too comfortable, too conflicted, to initiate the changes necessary to re-establish stability to health care.”
He smiled slyly. “Oh, WE SEE the handwriting. We just think it’s intended for somebody else.”
After the introductions, I was the first presenter. In about 25 minutes. I described how, in my view, there are three very deep problems that underlie the intensifying health care crisis. The first is fee-for-service reimbursement, which rewards more care, independent of quality or safety concerns, rather than the right care. Doctors and hospitals get paid for every service and product they provide, appropriate or not, so they often provide more than is necessary.
The excesses that result are exacerbated by a second problem, a lack of transparency, an inability to see inappropriateness and waste when it occurs. Of course, the fact that it is so hard to detect poor quality care, even dangerous care, has created an opportunistic culture that pervades every part of health care: the drug, device and supply sectors, the care delivery sector and the finance sector. A significant portion of many health care organizations' financial baselines depends on the money that comes from high-margin but unnecessary services, so it is unlikely that many will support reforms that eliminate waste.
A third problem is that the health care sector spends enormous sums lobbying our federal and state officials to maintain the status quo, which is partly why it has been so difficult to get meaningful reforms that can ameliorate the crisis.
I argued that, if Nevada’s business leaders wanted to do a single thing that could have maximum impact, then they should pool their claims data and mine it. As they identify problems and opportunities - like people with chronic disease who aren't getting care, high infection rates in certain facilities, unnecessary imaging procedures, prescriptions for brand drugs when generics are fine - they can prioritize and bring in programs that address them.
Then it was Jerry’s turn. He has a wonderfully clear and methodical presentation that shows an audience, step by step, how he first developed the performance information, and attacked the problems of cost and quality in his plan. He used the concepts I had described but showed exactly how they can work successfully in the real world.
The two talks burned up 50 minutes. After a quick break, I asked whether anyone disagreed with what we had said, or wanted to offer an alternate view. No hands went up.
So I said, "Then who agrees? Who would support the development of a regional health care data repository and mining effort? Everyone raised their hands. It was unanimous.
And then a man stood up. I’m paraphrasing here, but he said, “We’re glad you got the go-ahead. But I want to point out that only health care doesn’t use data. Everyone else uses it. It’s about time the health care industry becomes fluent in modern business practice. So, yes, we all agree with your plan. Get busy with it and keep us apprised. Can we go back to work now?”
And with that, about an hour and a half into a two and a half hour meeting, we were done. We got everything we asked for. The Nevada Health Care Coalition is now working through the challenges of bringing this type of project to fruition. They established a Health Care Data Collaborative and set up a 10 person oversight panel. They recruited employers to contribute data to the pool and networks willing to work with their physicians. Now they're working to select their analytics vendors. Dr. Reeves is helping as Medical Director. They seem poised for great things.
Unlike most health care executives, non-health care business leaders are positively beside themselves over unrelenting, runaway health care costs. They are perplexed why it is so difficult to turn health care around. Given an opportunity and some guidance about an industry that they know little about, they will act decisively to bring things under control.
But, to me, the meeting's deeper message was this. The health care crisis will last only as long as it takes non-health care business to unite and mobilize. Once they have accomplished that, they will use their influence over markets and policy to impose business disciplines – standards, performance transparency, and payments tied to performance – on the health care sector that many other industries adopted long ago.
The leaders of non-health care business will make this happen, not because they particularly care about health care or social justice, but because they recognize that an unhealthy work force is unproductive, and because they understand that if the nation’s largest economic sector becomes unstable, it could disrupt business within every economic sector.
In other words, America's business leaders will drive reform because it is in their own best interests.
Typically in meetings like this, the host group invites representatives from the different major constituencies: doctors, hospitals, health plans and employers.
I suggested an alternative. “Only invite the employers, and the C-suite executives, the corporate decision makers, at that. Don’t allow the employers to simply send their benefits managers.”
“Don’t invite anyone from health care. They’re too conflicted, and they’ll block progress. They’ll argue against transparency. They’ll claim they’re already fixing the problems. They’ll say its more complicated than the employers understand. And on and on. Draw a line in the sand. Don’t invite them.”
And so they didn’t.
I prepared background materials on the dynamics: the growth in premium cost, the erosion of private sector coverage enrollment, how that drop in health plan enrollment was in turn drying up the funds spent on health care, and how turmoil in the health care economy could disrupt other economic sectors. I described the deep drivers of cost and the health care crisis.
The Coalition sent out the materials with the invitations, and was delighted to discover that local business leaders were intrigued. The invitees forwarded the invitations to other business leaders, and so the Coalition received more acceptances than they had anticipated.
My partner in developing this meeting with the Coalition was Jerry Reeves MD, currently the National Chief Medical Officer of the Unite Here Union. Jerry, a pediatric oncologist by training, is a former Humana National Medical Director and former CEO of WorldDoc, which has developed a powerful suite of patient decision support tools. He achieved national health care celebrity when he took over the leadership of the (union-based) Culinary Fund Health Plan in Las Vegas. By carefully analyzing and acting on the data, and by developing incentives for providers and patients for every area of the health plan, he successfully drove so much money out of that plan while improving quality that all the union’s workers received a 60 cent/hour raise. It’s one of the best health care stories I know.
The day of the meeting, I arrived in the conference room and was introduced to the meeting’s sponsor, the CEO of one of the local hospitals, who was going to say a few introductory words and then leave the proceedings. We chatted, and then I said, “The problem, I think, is that despite a lot of handwriting on the wall, the health care sector is just too comfortable, too conflicted, to initiate the changes necessary to re-establish stability to health care.”
He smiled slyly. “Oh, WE SEE the handwriting. We just think it’s intended for somebody else.”
After the introductions, I was the first presenter. In about 25 minutes. I described how, in my view, there are three very deep problems that underlie the intensifying health care crisis. The first is fee-for-service reimbursement, which rewards more care, independent of quality or safety concerns, rather than the right care. Doctors and hospitals get paid for every service and product they provide, appropriate or not, so they often provide more than is necessary.
The excesses that result are exacerbated by a second problem, a lack of transparency, an inability to see inappropriateness and waste when it occurs. Of course, the fact that it is so hard to detect poor quality care, even dangerous care, has created an opportunistic culture that pervades every part of health care: the drug, device and supply sectors, the care delivery sector and the finance sector. A significant portion of many health care organizations' financial baselines depends on the money that comes from high-margin but unnecessary services, so it is unlikely that many will support reforms that eliminate waste.
A third problem is that the health care sector spends enormous sums lobbying our federal and state officials to maintain the status quo, which is partly why it has been so difficult to get meaningful reforms that can ameliorate the crisis.
I argued that, if Nevada’s business leaders wanted to do a single thing that could have maximum impact, then they should pool their claims data and mine it. As they identify problems and opportunities - like people with chronic disease who aren't getting care, high infection rates in certain facilities, unnecessary imaging procedures, prescriptions for brand drugs when generics are fine - they can prioritize and bring in programs that address them.
Then it was Jerry’s turn. He has a wonderfully clear and methodical presentation that shows an audience, step by step, how he first developed the performance information, and attacked the problems of cost and quality in his plan. He used the concepts I had described but showed exactly how they can work successfully in the real world.
The two talks burned up 50 minutes. After a quick break, I asked whether anyone disagreed with what we had said, or wanted to offer an alternate view. No hands went up.
So I said, "Then who agrees? Who would support the development of a regional health care data repository and mining effort? Everyone raised their hands. It was unanimous.
And then a man stood up. I’m paraphrasing here, but he said, “We’re glad you got the go-ahead. But I want to point out that only health care doesn’t use data. Everyone else uses it. It’s about time the health care industry becomes fluent in modern business practice. So, yes, we all agree with your plan. Get busy with it and keep us apprised. Can we go back to work now?”
And with that, about an hour and a half into a two and a half hour meeting, we were done. We got everything we asked for. The Nevada Health Care Coalition is now working through the challenges of bringing this type of project to fruition. They established a Health Care Data Collaborative and set up a 10 person oversight panel. They recruited employers to contribute data to the pool and networks willing to work with their physicians. Now they're working to select their analytics vendors. Dr. Reeves is helping as Medical Director. They seem poised for great things.
Unlike most health care executives, non-health care business leaders are positively beside themselves over unrelenting, runaway health care costs. They are perplexed why it is so difficult to turn health care around. Given an opportunity and some guidance about an industry that they know little about, they will act decisively to bring things under control.
But, to me, the meeting's deeper message was this. The health care crisis will last only as long as it takes non-health care business to unite and mobilize. Once they have accomplished that, they will use their influence over markets and policy to impose business disciplines – standards, performance transparency, and payments tied to performance – on the health care sector that many other industries adopted long ago.
The leaders of non-health care business will make this happen, not because they particularly care about health care or social justice, but because they recognize that an unhealthy work force is unproductive, and because they understand that if the nation’s largest economic sector becomes unstable, it could disrupt business within every economic sector.
In other words, America's business leaders will drive reform because it is in their own best interests.
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