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Elephants, middlemen, and systems – oh, my!

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I’ve been MIA here, but I’ve been loud/proud pretty much everywhere else in the last few months. Including here and here.  What follows is a rant based on what I’ve been seeing/doing since last seen on this page.

Elephants

There’s an old joke that goes like this: “What’s an elephant?” “It’s a mouse designed by a government committee.” There’s also the old “elephant in the room” bromide about topics that are not to be mentioned under any circumstances, despite their obvious impact on the issue under discussion. And the “How do you eat an elephant? One bite at a time.” motivational meme, along with the “blind guys describing an elephant” metaphor used to explain the impact of silo-ed thinking.

We’re up to our parietal bones in pachyderms in the healthcare transformation discussion. The biggest one – you can call him Jumbo, or you could call him Dumbo – is always in the room. What I call him is Huckster Nation.

elephant in the room by banksy
Image: Banksy

What do I mean? I mean the underpinning of pretty much all of American culture – the carnival barker sales guy (guy in this usage is gender neutral). We are a nation of flacks, flogging everything from Sham-Wow to space stations, and that includes our healthcare system. Hell, I’m selling myself, or at least I’m offering to rent out the contents of my cranium in exchange for coin of the realm, as are we all, in one way or another.

Americans have taken this to the level of a cultural art form, in that we’ve built our national myth around economic freedom. That it works out to be a literal myth for too many of us – income divide, I’m talking to you – is part of what I’m calling out here, but for the moment let’s focus on the carnival barkers sales guys in US healthcare, shall we?

I’m taking about the ….

Middlemen

Who are the middlemen in healthcare? Apart from the obvious ones – the health insurers, including Medicare, who administer the payment/money side of healthcare delivery – there are a metric sh*t ton of middlemen of all sorts threaded throughout the system. To use a biology metaphor, let’s call the ones that help Good Bacteria and the ones that don’t help Ebola Outbreaks. By the way, I’m defining “help” as an effort at improving something: making care more accessible, creating technology that improves care/care process, research that discovers new treatments.

Here are some examples of Good Bacteria:

  • Organizations that build health literacy tools to improve people’s access to and understanding of healthcare (click here for an example)
  • Open-access scientific journals (click here and here for examples)
  • Companies that build tech that helps patients, or clinical teams, or patients AND clinical teams (click here and here for examples)

Here are some Ebola Outbreaks:

  • Any commercial enterprise operating the healthcare sector that puts ROI above human lives (click here for an example)
  • Not-for-profit healthcare systems that treat humans solely as profit modules (click here for an example)
  • Health insurance companies that allow games of “gotcha” where their covered lives are the game pieces (click here for a Modern Healthcare piece on the issue)

Systems

Which brings me to the whole US healthcare system conundrum, which was summed up pretty well by my friend Dan Munro:

system isn't broken image
Image: Dan Munro

I attended the Population Health Alliance Forum conference recently in DC. I was surrounded by middlemen – some Good Bacteria, some Ebola Outbreaks – as I sat and listened to clinicians, analytics geeks, policy wonks, and carnival barkers sales guys talk about issues in population health. Population health is defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” Meaning that in most conversations where the phrase appears, you’re talking about Employer Sponsored Insurance (ESI), or Medicare. So the attendees were heavy on the big insurer and big health provider side, with a strong showing in the “we want to sell our stuff to big insurers and big health providers” cohort.

I was, as far as I could tell, the only person wearing the “I’m a patient here, myself” label. I guess I was the patient voice carnival barker sales guy. Hey, we’re all selling something, even if it’s only an idea.

Meanwhile, I’m surrounded by system players in a series of hotel ballrooms in DC. I found myself getting a little shouty with frustration on Twitter:

That last one – the “what’s the ROI?” thing – was fueled by rage. The US healthcare system, which sucks up $3 trillion-with-a-T every year – making it the most expensive healthcare system in the world, but 11th on the Top 10 list on health outcomes – is stuck on a “what’s the ROI?” loop, driven by the carnival barkers sales guys, while human lives sink below the metric radar. In other words, loot trumps lives.

In the metaphor I’m using in this post, Ebola Outbreaks are overwhelming the Good Bacteria. So here’s what we gotta do – we gotta call out Ebola Outbreaks when and wherever they appear. If you see one, shout it out – preferably in public, like on Twitter! – and tag me. I’ll be “Nurse with the Good Bacteria,” and whistle up both some outrage, and some common sense solutions.

Let’s not keep the insanity that is $3T+/year in exchange for “sorta OK” on a lather/rinse/repeat cycle. Who’s with me?

Smokin’ deal. Brand/Social media audit. Get 2013 started right, CHEAP!

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smoking hot stuff
make your brand smokin’ hot!

It’s almost 2013.

Want to set your brand storytelling on fire for the New Year?

Looking to get your branding on social media in sync and hotter than Christmas in July?

Longing to create some emotional heat in the hearts of your customers?

Here’s how you can get 2013 off to a smokin’ hot brand-storytelling start, at a bargain-basement price:

Brand / social audit deals from Mighty Casey Media!

Here’s how it works.

  • Want a brand audit? 
    • I do a full website copy review
    • You get a written report with specific suggestions on:
      • Brand story opportunities
        • Are you telling the best story possible?
        • Are there holes in your story?
      • Website copy improvements
        • Too many words?
        • Not enough words?
        • Words that don’t work?
      • Newsletter editorial calendar outline for 2013
        • Monthly and quarterly tips to increase your email newsletter’s open rate
  • Want a social media audit? 
    • I do a full social media platform review (including your company blog)
    • You get a written report with specific suggestions on:
      • Content creation/curation for the social platforms you use
        • What to share
        • Where to share it
        • Content sources that will amp up your social story-telling
      • Social platforms that could add brand engagement
        • Are there social opportunities you’re missing?
      • Blog editorial calendar outline for 2013
        • Tips for making your weekly posts eyeball magnets for your target audience

OK, I know you have a question:

How much is it?

That’s easy.

$250 each.

Want to get both?

$400 if you buy both.

(That’s a $100 savings, in case your calculator’s broken.)

The catch? There are only 10 of each available.

If you want to take advantage of this deal, here are the steps:

  • Decide you want to buy
  • Email me with your web and/or social links by Monday, December 31, 2012

That’s it!

You’ll get your written report by January 9, 2013, along with a PayPal invoice.

Simple.

So what are you waiting for?

GO!

 

Got succession planning?

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If you’re over 55, you’ve been getting junk mail for at least a few years advising you to think ahead about what will happen when you’re gone.

passing-it-onPlain-speaking version: after you’re dead.

That’s a topic that every business owner, and business leader, needs to examine closely, too. What will happen when you’re gone? When you retire, when you cash out, when you deploy whatever your exit strategy turns out to be?

A key part of that exit strategy is making sure your exit doesn’t flatten all the tires on the bus of the business. Or worse, knock the wheels right off that bus.

If you’re running a successful business, you have to think of it as part of your legacy. However, you can’t just write a will saying “everything goes to [insert heir here]” without helping that heir understand all the ins and outs of the enterprise.

Who will take care of your clients? Who will keep production running? How will business development continue?

What’s the plan, Stan?

I’m prompted to think about this topic after losing a friend too young recently. Well, he wasn’t years-young, but he was dreams-young, and that made me think that everyone – doesn’t matter if you’re 25, 35, or 75 – who is responsible for the continuing health of an organization must make a fully-fleshed succession plan to guarantee the organization doesn’t die when s/he does.

Who can you groom to take the reins? Have you drawn up the “what if?” map of how your team will move forward if you’re not there to lead them? Have you consulted with an expert who can draw you the full map of a succession plan?

Talk to other CEOs that you trust. Ask them how they built their legacy plan. If they look at you like you’re speaking Martian, talk to the law firm that represents your company. Or simply Google “succession planning” and your city, state, or ZIP code.

If you’re in the US mid-Atlantic region, you can just start here: Assura Consulting. (Full disclosure: not a client. Just folks whose expertise I trust.)

Otherwise, the terrific enterprise tree you grew from a seedling might wind up ground to pulp.

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

Don’t wind up on the least-wanted list

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unfortunate xmas decisionsYes, kids, it’s that time of year again.

ChristmaHanaKwanzaKah is once again in the hearts and on the minds of everyone from sea to shining sea – and beyond – so it’s time for a remedial lesson on How to Succeed in Business Without Really Lying.

Here are the Mighty Casey Media rules for surviving the holidays with your sanity – and your client list – intact:

  • Don’t be a grinch. If you’re not a big fan of the holidays, don’t trash those who are. You don’t have to go overboard and wear a pair of reindeer antlers all month, yet neither do you have to tell the office Christmas Elf that s/he is crazy for loving the holidays.
  • Be a gracious guest. If you’re invited to a holiday celebration by a client or a colleague, accept with thanks. Attend with intent to find the cheer. Bring a friend along who could be a good prospect for the business. Holiday gifts can come in the form of customers. Take it from one who knows.
  • Be a thoughtful host. If you host a holiday gathering, make sure to keep the conversation and connection flowing. Configure your party so there’s plenty of opportunity to interact, and make the rounds continually to ensure that everyone is enjoying themselves. And have a defined end-time for the party, which saves having to shovel folks out the door.
  • If you can’t deal, deal yourself out. If the holidays drive you nuts, that seems like a great excuse to take off on a vacation, a retreat, or a sabbatical. Deal yourself out of the holiday merry-go-round, and return to the game refreshed after Santa’s blown town.

Merry ChristmaHanaKwanzaKah to all, and to all a way to make the end-of-year insanity work for you!

New Golden Rule: See something? SAY SOMETHING.

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bathroom bolshevik breedingRecent events have led me to believe that the world is populated by blind people. Or at least people who are easily sold on crazy.

One of those recent developments is the unfolding drama at Penn State, where icons of college sports – both the college and the coach – have been revealed to have been, if not active perpetrators, at least willing-to-look-the-other-way co-conspirators in child sexual abuse.

I use the image on the right because (a) it’s one of my favorite ad posters ever and (b) what happened at Penn State happened in a washroom.

If you see something, SAY SOMETHING. Even if you don’t/can’t/won’t DO something, at least speak up. And don’t take “it’s just [insert utterly unacceptable excuse here], don’t worry, I’ll take care of it” as an adequate response.

SAY something to someone who can/will DO something. Not the bishop that the pedophile priest works for. Not the coach who’s the supervisor of the guy who’s raping a child in the shower.

SAY SOMETHING to the cops.

“If you see something, say something” is the tag-line for a current Dept. of Homeland Security awareness campaign, aimed at stopping terrorist activity before it becomes an actual attack.

If rape isn’t terrorism, I don’t know what is. All crimes against persons – assault, rape, mugging, et al – is terrorism on a small scale, leaving marks as deep as surviving a bus bombing. In some ways, these very personal attacks leave deeper marks, because an entire community doesn’t share the victim’s experience. The person is left to deal with the aftermath alone. Just as the Penn State victim – he’s been dealing with the aftermath since 2002, essentially alone. And now the whole world is watching.

If you see something – someone hitting a child, slapping their spouse, raping a child in a freakin’ locker room – SAY SOMETHING. If you see it in your house. If you see it on your street. If you see it in the office. If you see it at your school.

See bullying? Say something. See domestic violence? Say something. See a theft, or an assault? Say something.

Find someone with a badge and a gun – and not just a university/school cop, either – and report what you saw. Keep talking until they listen.

If you see someone with a badge or a gun perpetrating a crime, call the FBI. Use your cellphone camera, and take it to the media.

See something? SAY SOMETHING.

All that it takes for the triumph of evil is for good men (and women) to do nothing. That’s always true, and never more true than in the situation where both the Catholic church and Penn State find themselves. An institution that’s trusted with the care and education of children has no excuse: if you see something, say something. Otherwise you’re approving the act.

It’s that simple.

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

Why is business expected to pay for healthcare in the US?

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I’ve asked this question frequently over the years, starting in the ’80s, continuing to today … and I’ll keep it up until someone realizes that it’s a failed paradigm.

What we have here, kidz, is what happens when a society decides that socialism is anathema, but doesn’t empower and educate its citizens about how to take responsibility for themselves in ways that will keep them healthy, productive community members.

Business started picking up the tab for healthcare during World War II, when stiff wage controls made it impossible for defense plants to give their employees raises. In place of more money, they started to pay for health insurance – which state and federal government were more than happy to turn into mandated employee benefits over the next 20 years.

What happened then was predictable: three generations have been out of touch with the true cost of  healthcare, and the true cost of their choices about their health. If you’re a good little American consumer, you do whatever your television tells you to do: eat this. Buy that. Otherwise the terrorists win!

Three generations of disconnection from the real costs of our medical care have delivered us an epidemic of obesity – thanks to plentiful empty calories, courtesy of agri-business, and our willingness to beach ourselves on our sofas, in our SUVs, or at our computers, the better to receive more messages about what we should buy and eat.

Health insurance costs have skyrocketed as we’ve become a nation of couch potatoes. Companies are scaling back their employee health benefits as those costs continue to rise, putting more and more people in the un-insured or under-insured bucket. Is that rise in healthcare costs, which in turn drives higher premiums, combining with the federal mandate that all companies offer employees health insurance or face the wrath of Khan, er, the feds the real “job killer”? I think so.

Here’s a suggestion: sell health insurance like auto, home, and life insurance are sold. Put consumers in charge of shopping for, and purchasing, their own insurance. Let business help their employees, if they choose to do so, as a true benefit rather than a mandate. Help every consumer set up a Health Savings Account for their healthcare expenses. And stop the state-by-state divvy-up that lets health insurers essentially gerrymander the health insurance marketplace.

Put consumers fully in charge of their insurance, and their care. Turn the health insurance market into a car-insurance model. People can buy minimum levels of insurance, and assume the risk of that choice. They can opt out completely, and assume all the risk for their healthcare costs. Make it a true marketplace, rather than the giant mess that we currently call health insurance. Employers are certainly able to help their employees with HSA deductions and matching contributions; smart companies will help their teams figure out managing and negotiating for insurance as a group. But they shouldn’t be expected to foot the bill.

Radical? Perhaps. Necessary? I’d say it’s essential.

Until we’re put in touch with the costs of our healthcare, we won’t be encouraged/empowered to take control of our health. As long as we’re using other people’s money to pay for healthcare, we’re stuck where we are.

Which is a very bad place to be.

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