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Jan 01 2013

2013: The Year of Healthcare Emancipation?

By e-patients, healthcare industry, healthcare price transparency, participatory medicine

Hang on to your hats – this one might wade into controversy.

django lincoln caduceus imageAs I write this (3:30pm EST on January 1, 2013), I’m listening to a conversation on NPR about the Emancipation Proclamation, which was signed into law by Abraham Lincoln 150 years ago today. I’m also reflecting on a couple of movies I’ve seen in the last 45 days: Lincoln (over Thanksgiving weekend) and Django Unchained (on Christmas Day).

Is it time for an emancipation proclamation for patients? Or should we just saddle up and have a shootout at the plantation … um, hospital instead?

Too many healthcare transactions are still conducted over the patient’s supine form. Doctors, hospitals, and other entities in the “provider” column horse-trade with health insurers, including Medicare, in the “payer” column. That means that the patient winds up shackled. No say in how much something costs, no real voice (yet) in what happens next, little interest on the part of the two trading entities in clueing us in to what’s happening.

Some of my connections in the participatory medicine/e-patients movement use a driver-rider metaphor for transforming healthcare, with the patient moving from passenger to driver in healthcare. It’s a less controversial/confrontational metaphor than referring to patients as chattel on the medical plantation. However, I’m sticking with that plantation metaphor for the moment, because too many in the provider and payer camps are still viewing patients as meat puppets, not as full participants.

Does healthcare need an emancipation proclamation? Yes. Here’s where the metaphor shifts: let’s not wait for someone to proclaim us (patients) emancipated. Let’s break our own chains, and be our own liberators.

Let’s demand that the providers and the payers give us an equal seat at the table, and then let’s …

LEARN EVERYTHING WE CAN TO BE PRODUCTIVE CONTRIBUTORS TO THE HEALTHCARE SYSTEM.

That last statement is the core of what will emancipate healthcare: patients, providers, payers, caregivers, everyone. Shared decision making – along with “patient-centered”, that’s the new hot phrase in healthcare – can only exist if all parties are able to participate in sharing the decision-making. We must learn how to understand the language of medicine, including research statistics (by the way, many doctors aren’t great at that, either). We must learn to apply critical reasoning to what we see/hear/read in the media about risks and trends in health and disease. We need to work on getting a seat at the research table to give a hard shove in the direction of making clinical research less ivory-tower and more boots-on-the-ground.

Some recommended reading for those who’d like to emancipate themselves:

Society for Participatory Medicine blog

ePatient Dave

Susannah Fox

Dr. Ted Eytan

and our movement’s own Rosa Parks (or, dare I say it, our own Django?):

Regina Holliday

Let’s liberate ourselves, shall we?

Jan 01 2013

2013 Manifesto: short and salty-sweet

By healthcare industry, technology

Last year’s look-ahead for 2012 was a 5-point manifesto. Reviewing progress against that list, I see that I did pretty well, with only #2 falling a little short – which is not a bad track record.

This year, I’m keeping it tight. I’m going with a 2-rule manifesto.

Rule #1: Be accountable

We’ve all got metrics to measure ourselves against. Revenue, connections, sales, errors, accomplishments – all of those are important. The trouble comes when you focus too much on one area, which usually means that other important metrics wind up taking a back seat.

If you focus exclusively on incoming revenue, you might miss some mistakes that will cost you at least some of that revenue. If you concentrate only on building more connections in the industry, you might lose some long-term relationships that are just starting to ripen.

For me, accountability this year will be tied to two metrics: raising the revenue gained from the speaking side of my business, and widening my marketing net beyond the mid-Atlantic region. Tracking both will be easy, and each will challenge me to focus very tightly on activities and outreach that will move my game-plan forward. Accountability – at least here at Mighty Casey Media – will be baked in to the spreadsheet I’ll use to track that game-plan.

What accountability will you bake in to your 2013 goals? How will you track your progress? Who will you report to? That last one is a challenge for me, since I’m a solo-preneur. Stay tuned, since one of my accountability check-boxes will be reporting progress here, on the Mighty Mouth Blog.

Rule #2: Laugh more, bark less

That’s a purposeful scrambling of the “wag more, bark less” bumper sticker I see … everywhere. My version of wagging is laughter. If I’m laughing, there’s less risk that I’ll be screaming. Given that one of my core purposes in life is working to effect positive change in the healthcare industry, I can wind up screaming pretty easily if I don’t keep myself in check.

Barking = screaming in my world. We’re all about avoiding the screaming wherever possible. That does not mean that I’ll dampen my ferocity. Hell to the no. What it does mean is that I’ll find ways to wrap the bitter medicine in a big lump of maple sugar. “Bitter medicine” is hard truth about how healthcare has to shift from paternalism and a gold-rush mentality; the lump of maple sugar (and my biggest challenge) is finding the humor that will make that medicine go down … without resorting to barking.

Those are my Simple Rules for 2013.

Happy New Year.

Jun 13 2012

The black box that caused the crash (of healthcare)

By healthcare industry, politics
healthcare money image

This week, NPR’s Marketplace aired a piece on what I have taken to calling the “black box of healthcare” – pricing. There is a committee, called the RUC, set up and run by the American Medical Association, that reports to CMS (the federal unit that runs Medicare and Medicaid) on relative value numbers for the thousands of medical procedures that wind up as billing codes in Medicare and your health insurer.

Those relative value numbers = PRICES. This isn’t considered price-fixing under anti-trust rules because the RUC reports to CMS, which then publishes the numbers on the Medicare reimbursement rate schedule. So the AMA isn’t publishing the prices, CMS is.

Fox, meet henhouse. Or, stated in another way: airplane, meet the black box that is making you crash and burn. The Marketplace page linked in the 1st graf has plenty of linkage to additional context for this issue. Read them, and weep.

How is it that an industry whose aggregate cost is now at close to 20% of US GDP gets to set its own prices, and then have them published by the federal government as The Official Price List?

It’s called effective lobbying, and it’s so effective that it’s essentially kept access to the pricing committee process a secret for decades. Which makes it pretty clear why so much of our GDP goes to healthcare, doesn’t it?

The sound bite in the story that I found the most hilarious was from Charlie Baker, the former CEO of the Harvard Pilgrim health plan in Massachusetts. His quote:

By having a process that for all intensive [sic] purposes isn’t a public process, and doesn’t appear to actually be accountable to much of anybody, I think that’s kind of un-American!

I find this hilarious because Harvard Pilgrim is a member of America’s Health Insurance Plans, the industry group that advocates (translation: lobbies) for health insurers, who also have their hands on the levers of healthcare pricing via reimbursement rates (granted, based on CMS’s published rates, which are based on the RUC’s relative value numbers). Which means that the very-American health insurance industry is a co-conspirator in this price-setting (-fixing?) game.

Healthcare pricing is such a black box that if a patient attempts to find out what something will cost before s/he has a medical procedure, s/he will be met with a blank stare, “I don’t know”, “nobody knows how to figure that out”, or some other version of “what?” that gets you no answer.

e-Patient Dave deBronkart has a terrific example of how shopping for healthcare can be done, even in the face of “what?” – click the link for the full story there. Patients acting on their own behalf to determine their economic exposure before they get medical care might begin to bend the healthcare cost curve IF they can get the price information.

Dave isn’t the only customer of the healthcare industry who’s looking for pricing, and answers to the variance in said pricing depending on who you ask. The LA Times had a piece in their May 27, 2012 business pages on how patients could negotiate cash prices at the hospital or in the doctor’s office that were far below insurance reimbursement rates IF they didn’t use their insurance.

As an industry, healthcare is deeply broken. Since the industry has been supported for decades by an economic model that hides pricing from its consumers – employer-based health insurance – the end users, patients, have no clear path to making informed choices based on quality and cost.

If you ran your business that way, you’d be out of business pretty quickly. It’s time to break the healthcare industry’s economic model – if ever there was a sector ripe for creative economic destruction, healthcare is that sector.

Jul 27 2011

Data, Data, Who’s Got My Data?

By e-patients, EHR, health records, healthcare industry, medical records

 I’ll totally get one. Srsly.

I confess that I’d happily get a barcode tattooed on my neck if it meant I’d never have to fill out another ****ing health history form in a doctor’s office.

I’m totally serious.

Paper records are so … 19th century. With the advent of the current iteration of “health care reform” (which is really “health INSURANCE reform,” but that’s a blog post for another day), much has been made of the importance of Electronic Medical Record (EMR) systems in building a national Health Information Exchange (HIE).

Medicine = Acronym World. The Pentagon are pikers when it comes to fogging the battlefield with impenetrable letter-fication.

21st century health care certainly must involve a lot of easily-shared data, with health history and diagnostic information traveling literally at light speed between doctor’s offices, hospitals, and clinics. Not only does it speed care, it can ensure safety: the right record, with the right patient, makes the right care clear.

The thorny-issue part is this: whose data is it, anyway? Doctors certainly need to have full access to all the data on patients they’ve treated. Hospitals have to keep records on the people they’ve treated on their wards, in their clinics, and in their ORs. Payers (insurers, Medicare, Medicaid, et al) need data access to pay claims, track demographics, and create statistical and financial forecasts. And patients must have access to their own data, at minimum to vet it for errors, at best to own a full copy of their health history since birth to share with providers and care-givers.

I spent 8 months trying to correct an error on the report for the breast MRI I had in 2008 as preparation for my cancer surgery. The report said “family history of breast cancer.” NO. I was Patient Zero, there was NO family history of breast cancer. I fought for eight months, and I’m still only about 90% convinced the error is completely expunged. Patients need access, and we also need easy recourse to error-correction.

Back to EMRs and data exchange: access to patient data must be completely available to all concerned parties. That means doctors, healthcare facilities (hospitals, clinics, et al), and PATIENTS. However, the discussion about healthcare technology almost never includes patients. We’re considered, at best, bystanders; at worst, annoying insects.

E-Patient Dave DeBronkart – Mr. Gimme My Damn Data himself – was the 1st person I heard use the term “e-patient”. The E stands for empowered, engaged, enabled, equipped, equal – not electronic, although that’s certainly a supporting foundation for the e-patient movement. E-patients are usually placed in the “annoying insect” category by healthcare providers who don’t want to share – which can include payers, who can turn a simple record request into a Bleak-House level of bureaucracy. The most epic story in recent history, IMO at least, is Regina Holliday’s now-famous 73 Cents post (and the painting it talks about) – charging patients for access to their own data (at 73 cents a page) borders on the immoral, if not the criminal.

In the long slog through working groups, committees, implementations, and reports-to-the-board that is EMR and HIE development, don’t let the healthcare system leave us – the patients – out of the conversation.

It might be their data, too – but at root, and always, it starts with us. It’s theirs, yours … ours.

Data, Data, Who’s Got My Data?
Nov 19 2010

The Story on Healthcare Reform…After 11/2/2010

By healthcare industry

I attended a great Disruptive Women in Health Care event last week: Health Reform After the 2010 Election – Assessing the Viability of Health Insurance in the Aftermath of the Mid-Term Elections.

A big title, but it’s a big topic.

In a series of panel discussions, a varied group of healthcare policy wonks and a smattering of journalists offered their perspectives on what the future of healthcare payment & health insurance reform is, given that control of the House is now in Republican hands, and the Senate super-majority won by the Democrats in 2008 is history.

With the economy in the tank since before the 2008 election, and little to show for the massive injection of federal money to bail out the financial markets and the auto industry (other than a continuing 9+% national unemployment rate), it still seems quixotic that the Obama administration picked healthcare reform as its first big policy project.

Dan Gerstein, a Forbes columnist and former legislative aide to Senator Joe Lieberman, said during the first panel discussion, “this was a perfect storm of bad execution on the part of the Democrats.” With the economy and jobs a much larger, and more personal, issue to most of the electorate, the 9 months it took to push the healthcare reform act through Congress took a big toll on the public’s perception of the Obama administration.

Which, in turn, took a big toll on the Democratic Party’s results on Nov. 2.

Now, whither healthcare reform? It seems that the watchword will be replace, not repeal.

Nancy Johnson, who served 24 years representing Connecticut in the US House and is now a public policy advisor at Baker Donelson, said, “people are beyond parties now. Two things have gone fundamentally wrong: endless use of credit, which has led to fiscal collapse.” That translates to an unwillingness, particularly on the part of the states, to fund healthcare reform as it currently stands.

Now that the President will have to deal with a much less amenable Congress, Jim Slattery, a six-term Congressman from Kansas and now a partner at law firm Wiley Rein, said, “the President has a tough choice to make, and only a few weeks to make it. Confrontation or cooperation?” He noted that in a democracy, “compromise is a great substitute for violence,” but I wonder how much of a figurative beating the desire for systemic healthcare reform will take in the name of compromise.

Stay tuned on that one.

The second panel discussion spoke directly about the issue of health insurance: access/availability and affordability. One of the central issues facing the health insurance market is this: if the government is mandating insurance coverage, redefining the role of insurance agents and brokers will be an interesting battleground.

David Reynolds, President & CEO of Coventry Health Care in Maryland and Delaware, thinks that those agents and brokers would be ideal navigators of the new system. But how will they be remunerated for serving as navigators, particularly on the lower end of the market?

Slattery said that moving healthcare toward a utility model, where public utilities are private companies operating under public regulation on price and access, might be the right answer. Add to that the idea of moving the healthcare delivery system from an illness-treatment to an illness-prevention model and we might see some actual bending of the cost curve.

The session wound up with a discussion of what the insurance market might look like with the new Congressional landscape. Janet Trautwein, CEO of the National Association of Health Underwriters (NAHU), which represents more than 100,000 employee benefits and health plan management professionals across the US,  echoed Reynold’s statement that agents and brokers were valuable advisors to companies working to understand the impact of the healthcare reform act. She also noted that the staggering $1Trillion-with-a-T price tag of reform was just the government share of the financial impact of healthcare reform.

Leslie V. Norwalk, who served as Acting Administrator for the Centers for Medicare & Medicaid Services (CMS) in the George W. Bush adminstration, observed that companies might elect to pay the $2,000-per-employee fine for not offering healthcare coverage to their workers, since coverage typically costs between $3,000-$8,000 per employee per year. Even if they pay the fine, and offer their workers $1,000 each toward buying their own insurance, they’d at least break even – and they might save a significant amount of money.

Think of it from the perspective of a Fortune 50 who employs more than 100,000 people – get my drift?

Did the folks drafting the legislation even think of that possibility when structuring it? Were their calculators broken?

My take-away from the morning’s discussion – which I have to say I was delighted to have been in the room for – was that both sides of the aisle believe that the healthcare payment system in the US has fallen, and it can’t get up. The issue at hand now, with the new Congressional balance of power, is how to tweak/replace/re-tool needed reform without increasing the federal debt, and while simultaneously creating a system that truly offers access to all.

I’m a believer in the consumer-driven model, with HSAs for everybody. Encourage people to be active consumers, not passive meat puppets, when it comes to their health and healthcare. Will Congress agree? Stay tuned.

That’s my story, and I’m stickin’ to it….

Here’s some video of the morning’s events:

Disruptive Women Panel #1 – November 3, 2010 from Amplify Public Affairs on Vimeo.

Nov 04 2010

The Story on Healthcare IT: Creating Connections

By healthcare industry, technology

The highest and best use of IT in healthcare is to create strong, healthy connections between doctors and their patients. One of the most critical pieces of that is giving patients access – both to their health data, and to their healthcare providers – along with permission to engage.

I wear two hats in the healthcare space: patient activist/advocate, and healthcare communications/media consultant. My healthcare-focused company WellCentrix is building a reputation for understanding both the business (doctors & other providers) and the customer (that would be the patients, not the insurers) side of healthcare.

I attended the Virginia chapter of the Health Information & Management Systems Society’s annual conference last week, and posted a wrap-up report of what I heard there over two days of sessions.

If you’re a patient – and we’re all patients, even doctors are patients – you might want to get some intel on what healthcare IT leaders are doing, thinking, and planning.

Click HERE to find out!

Sep 21 2010

HACKED: The Douche Is Out There

By Uncategorized

This site – the main presence on the web for my business – was hacked by a group of losers who fly under the banner h4ck-y0u. They replaced my deathless prose (well, some of it is, at least IMO) with a handprint graphic and the theme from the X Files.

Jeez, kids, bored much?

I have to give both myself and GoDaddy some props – me for figuring out the MySQL fix via the WP Codex (speaking of hackers…); GoDaddy for actually providing real tech support, and it only took two calls to reach a dude named Brian who, to my utter surprise, really did help. Brian: new BFF. Srsly.

Bottom line? I’m working hard over the next couple of days to further harden my WP security.

Be warned: the douche is out there…

Sep 03 2010

When Jet Blue’s Ship Came In, They Were At the Airport

By Uncategorized

Well, of course they were at the airport. They’re an airline.

My point is that by not responding quickly to the Steven Slater Beer-Slide incident, they’ve really missed the boat on kicking off a great conversation about and among an entire industry and its customers. The conversation is kicked off, and JetBlue is a major part of the story, but they screwed up a huge opportunity to manage a crisis well.

It took them TWO DAYS to formulate a response on their blog. In hiding behind the “we don’t comment on individuals” curtain, they missed a chance to become the Great & Powerful Oz of the air travel industry, at least in the customer-cabin-crew-connection-and-convo category.

What would I recommend to a company who finds themselves in the position that Jet Blue was in on Monday?

  • Offer a comment along the lines of “today’s events are offering us an opportunity to start a conversation across our industry about customer service and workplace conditions. If you’d like to share your views with us, [blog/email/Facebook/Twitter] – we welcome the chance to explore how we can improve our relationships with our customers AND our employees.” That doesn’t assess or assume blame, but it says you’re paying attention.
  • Monitor traffic, engage in conversations with heart but not an excess of passion (IOW, don’t pull a Slater).
  • Monitor commentary about your brand, and the individual who set off the situation. Respond only to direct queries by pointing them at your crisis-comms traffic cops mentioned in Bullet 1.

Jet Blue wasn’t completely silent. Unfortunately, the cries and whispers of the guy who manages their corporate comms Twitter feed got into a Twit-fight with Andy Borowitz (@BorowitzReport). In a battle of wits with a comedian, Jet Blue’s guy is an unarmed combatant. And he forgot the 1st rule of crisis communications: don’t say anything that will make the crisis worse.

You could wind up Dipstick Du Jour on Gawker.

I hope both Jet Blue and Steven Slater find their way through, and past, this slide down the barbed-wire fence of corporate celebrity. I also hope that other individuals, and the companies who employ them, find better ways to manage workplace stress.

That’s my story, and I’m stickin’ to it…

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