Monday, April 13, 2015

Becoming Consumer Friendly In Five Easy Steps...Or Not

An article at hhnmag.com offers hospitals 5 steps to becoming more consumer friendly.

If you still think there's a secret sauce to your hospital becoming more "consumer friendly," these 5 steps are as good a place to start as any.  Unfortunately, it's a little like that old Steve Martin comedy bit where he says he'll teach you how to be rich. The first step is to go find a million dollars.

The article's step 1 is realizing that "...a Medicare beneficiary with chronic conditions is different from a young mom who brings her kids in for an annual check-up." This is market segmentation for beginners, and, yes, one size decidedly does not fit all. Hospital execs would've known this long ago had they paid attention to their marketing team's advice. Better late than never, I guess.

Steps 2-5: have a strategy, metrics, a champion and resources. OK. Hard to argue with any of those.

But segmentation, metrics and bigger budgets can't overcome culture. They're important components to be sure, but insufficient without a dash of cold water to your organizational face.


My advice: begin with culture. 


Broken cultures prize nothing more than stasis. Metrics proving the dysfunction won't help. Research-driven segmentation schemes will fall on deaf ears.  As a lone voice, will that newly-appointed champion stick around? And how often, really, does more money cure culture? Doubtful, on all counts.

I'd submit that better first steps are honestly acknowledging that you've got work to do, that consumers are not stupid, and then challenging the culture that treats them as if they are. What do I mean? Well, when did consumers EVER win in your organization? 

Name one time. Go ahead. I'll wait.

It's no accident that there's NO hospital branding itself as "the easiest with which to do business."

Name one. Go ahead. I'll wait.

Which is easier for your board to approve: a $100 million bed tower or a $1 million investment in the digital connections that your customers have come to expect from every other organization in their lives? Did you even have that conversation? Yes, you have a consumer portal but, absent Meaningful Use dollars, would you?


If your consumers wanted early morning urgent care hours and your doctors didn't want to provide them, who won?  I can hear the excuses: "Well, yes, but the doctors refuse to...and we can't force them to..." 

Consumer-friendly organizations don't let excuses drive the conversation.

When consumers wanted easy, convenient registration but your revenue cycle team wanted more forms, more boxes checked and increasingly complex processes, who won?  More excuses: "Well, yes, but the days in AR might..." 


Consumer-friendly organizations don't let AR metrics drive the conversation.

Do physician appointments run on time? Or do you explain away delays, or, worse, say nothing to an increasingly irritated waiting room?  Excuse du jour: "Consumers just don't understand how difficult this scheduling thing really is. And our docs are so great you should be happy to wait..." 


Consumer-friendly organizations run on time and are honest and transparent about those FEW times when they don't. Period. End of conversation.

Admit your culture has a problem. For a change, make decisions in FAVOR of consumers. Fix little problems as practice, but then fix big, difficult problems. Make things easy and fast, not complicated and failure-prone. And don't expect 5 steps to overcome 50 years of active indifference.


Alternatively, make it easy on yourself. Just change your branding to "We're no worse than anyone else." After all, brutal honesty is often the first step in cultural change.

Friday, April 3, 2015

Is Healthcare Exploitative And Extractive?

I've had this post sitting around in draft form for far too long and it's time to get it off my chest.

Several years ago, MSNBC commentator Dylan Ratigan interviewed Umair Haque, author of The New Capitalist Manifesto: Building a Disruptively Better Business, founder of Bubblegeneration, Director of the Havas Media Lab and blogger at the Harvard Business Review. Though the topic wasn't healthcare, there was much for healthcare leaders to ponder.

Haque draws a clear contrast between productive wealth and destructive wealth.  Both count toward Gross Domestic Product (GDP) but only the former really contributes.

Says Umair,
"It’s easier to make money in the short-term through exploitation and the extraction and much more labor intensive with a higher failure rate and a much greater degree of challenge to actually advance and create something that is new and different and differentiates in its creation of value. “So to me, this is a crisis that is about failing to create real value, but it is a crisis of our institutions. And it’s a crisis that is of things like GDP and corporate profits, and the ways in which we measure and conceive of income. And so to really get to grips with this crisis, I think we have to begin by taking a cold hard look at those things,”
A 'cold hard look' at income and value-creation in health care is likely to be all of that AND a little bit uncomfortable. The short-term thinking. The fee for service-driven decision making.  The inward-looking, edifice-focused ways we define terms like 'health' and 'success.'

Maybe you don't think of health care as "exploitative" or "extractive?"  What else would you call a willingness to amputate a diabetic's foot while letting the underlying disease process continue apace?

Yeah I know, we're really, finally, truly getting serious about fixing stuff like that.  And though it's been part of every community needs assessment and strategic plan and QI/QA/PI target since, oh, 1965, things have changed. No more business as usual. This time it's different. We mean it. Really.

Or at least we mean it so long as Medicare guarantees us extra payment for meaning it.  Or the payers give us part of their risk pools for doing it. Ahhh, the sweet smell of success.

Does Your Strategy Account For the Future?

"Your rearview mirror is so small and your windshield is so large because what lies ahead is much more important than the past." (@CHRISVOSS)

What can we say about the future? 
  • It's uncertain and the end is always near. (Jim Morrison) 
  • The future is much like the present, only longer.  (Dan Quisenberry) 
  • The future is here.  It's just not widely distributed yet. (William Gibson) 
Uncertain. As near as tomorrow. Long duration.  Limited (and uneven) distribution.

Think about how hospital strategic plans account for future competitor decisions.   If they do at all,  it's little more than simple extrapolation of past performance, a technique which, though understandable since that's where the data reside, is nothing more than crafting strategy in a vacuum.
It's much easier to track competitor performance retrospectively than to forecast future decisions.

Volume trends, market share, patient satisfaction, quality indicators, financial performance, major capital investments are all in the public domain if one knows where to look.  A strategist's job is to synthesize all that data so that a few important, future-oriented questions receive sustained attention:

1. The Benchmark Question: 
What is our competitive position relative to the competition?

2. The Trendline Question:
Are we improving? I.e. what's the slope of our trend line? How do we know?

3. The Speed To Market Question:
Are we improving as rapidly as those around us? Are our improvement cycle times fast enough?

4. The Marketplace Expectations Question:
Are we improving as rapidly as the market demands, now and in the future? I.e. is our projected performance sufficient to succeed as customer expectations grow and evolve?


Tuesday, March 31, 2015

Behind Every Resume Is A Potential Customer...and Karma.

I recently heard from an executive colleague who, thanks to a merger, found herself looking for her next opportunity. Her story, probably depressingly familiar to many of you, was all about the big black hole of rudeness and non-responsiveness that so often sums up employers' attitudes toward candidates.

This colleague, thinking she'd see the healthcare world from a new vantage point, pursued opportunities with consultants, IT vendors, architects and other suppliers who, far from appreciating her solid resume, were like the 3 Stooges of clueless.

So back to a senior health system role she went, WHERE SHE NOW INITIATES AND MANAGES RFPs FOR SOME OF THE VERY SAME COMPANIES who wouldn't talk to her as a candidate, but profess their LOVE for her now that she's got money to spend on their services.

Not gonna happen. Any guesses who's off the RFP list?

I smiled when I heard her story, imagining the BusDev people working hard to grow the revenue pipeline, all the while being quietly sabotaged by their HR team.  Sure, you can't hire everybody, nor should you.  But karma is real and, when given an opportunity, why not make a new friend instead of an enemy?

From the New York Times comes a modest proposal: treat job-hunters like, well, customers!
"...in the whirlwind of daily activity, a business can lose sight that there are real people behind all those résumés. And how the company treats those people, well before any of them become employees, says a lot about it, its brand and its values.

"In the current labor market, where there is a glut of supply, perhaps some companies think they have the upper hand and can afford to skimp on the niceties. They are mistaken, though, because every economic cycle eventually turns, and there is always competition for the best talent, regardless of economic conditions.

"It’s for this reason that human-resources professionals and company leaders need to treat job candidates like customers."
Pay attention to job-hunters? Treat candidates like customers? They're a dime a dozen, so where's the benefit in that, you ask? "Oh but we're terribly busy HR professionals..." you say? Sure, go ahead and kiss that brand promise goodbye, along with the last remaining thimble-full of your business model's growth potential.
"A Stanford Business School case study found that some companies get (the concept of treating job hunters like customers) and capitalize on it. Southwest Airlines, for one, recognizes that employment candidates are not only career customers — but that they could also be, or become, customers of the airline.

"Southwest’s core principles of respect permeate its recruiting, where there is a focus on making sure that no applicant feels inferior or rejected. Many Southwest job applicants have a better experience being rejected by Southwest than they have being hired by other companies. As a result, Southwest gets the best people, and it shows in its superior financial results.

"Another example comes from the food industry, where I recently heard a story about a manager from Nabisco who was attending a human-resources industry conference. When he declared that his company responded to every résumé it received — solicited and unsolicited — he was met with incredulous stares from his peers.

'“Why respond to every résumé when that’s clearly not necessary?” someone asked.

"The Nabisco manager smiled and replied, “ Because — everyone eats cookies."
I love that: "...because everyone eats cookies." And they always remember how you made them feel.

The Takeaway: Has your growth trajectory flattened out? Nosedived? Check how your organization treats job-seekers. Go online and try out your HR Department's "application engine." Investigate how (or, if) you communicate with applicants. Undoubtedly, it's no better than how you treat customers...more's the pity. How can your organization surpass HR's performance when it's THEM supplying the talent? Wouldn't they be the lowest common denominator?

Regrettably, I don't foresee it changing until a generation of HR "professionals" and recruiters spend a few months themselves searching for a new job, sending resumes into the black hole, dealing with recalcitrant web sites. At that point they may figure it out. Until then, as Depeche Mode might have said it, Enjoy the Silence.

More on my feelings about HR, here.



Monday, March 30, 2015

"We decided in 2005 that no hospital executive could apply to work in this (ambulatory) company. We wanted entrepreneurs who were more open to a different way of providing healthcare services. That has been very, very successful."

--Dan Wolterman, president and CEO of Houston-based Memorial Hermann Healthcare System, Texas' largest not-for-profit health system, from an interview in Modern Healthcare.

The Answer For Lower Healthcare Costs Is...

...Customer Service.

From the New York Times: Seattle's Iora Primary Care is a new model of primary care, seeking national scale and venture capital funding.  Though the ambition may be outsize, the concepts are not new. Daily team huddles. Health coaches. Taking satisfaction surveys seriously and mining results for actionable insights. Employer and payer partnerships. Pay-for-performance not volumes. Loose-tight operations (wellness options are "loose" - i.e. varying from site to
site, while EHR alignment is "tight" and non-negotiable.)

According to the article:
"...small change(s) can make a big difference in a patient’s health — what good is the perfect drug if the patient can’t swallow it? — but the extra-mile work it took to get there can be a challenge for the typical primary care practice in the United States. Harried by busy schedules and paid on a piecework model, many doctors rush from visit to visit, avoid phone calls and emails that don’t generate payments, and often fail to address the complex social issues that hamper people’s health.
"This misalignment of financial incentives is a huge problem for patients, who often can’t get the care they need. But it’s also a big economic problem. The United States has the costliest health care system in the world, even as many patients suffer from preventable illnesses and die younger than their peers in other countries. The system is so full of inefficiencies that Americans are often sicker even as everyone — patients, insurers, the government — ends up spending more money on care.
"Iora thinks it may be able to solve both problems and make money doing so. Its business model is meant to keep patients...out of the hospital by improving service while earning a dividend on the expensive care it was able to avoid."

Still, despite the intuitive appeal and some preliminary research, hard data on results are scant:
"Iora has little published research on the cost savings it has achieved for its partners. The company’s small size makes it hard to produce data with statistical significance. Asked about current evidence of the model’s success, the company provided numbers about one of its sites, where researchers have compared Iora patients with similar patients elsewhere: Total spending was down 12 percent, with hospitalizations down 37 percent, compared with the control group. That may have been a practice with healthy patients, like Dartmouth, or one of the higher-risk patient groups; an Iora spokeswoman said she could not say which practice it was because of a confidentiality agreement with the sponsor.
"Many of the basic elements of the Iora primary care approach — longer hours, more support staff and additional per patient funding — have been tried in other settings, especially in so-called patient-centered medical homes. So far, the results for those types of practices have not been promising. Few have shown real reductions in spending or in the frequency of patients entering hospitals.
Many healthcare organizations are chasing the same vision, betting that all the "We Love Customers" talk will finally start to put some results on the bottom line.  As a healthcare strategist AND an occasional patient, let's hope they're right and the data begin to show it.

Thursday, February 26, 2015

The FCC, Net Neutrality and Hell

It's difficult to see the FCC's Net Neutrality decision as anything other than an anti-Comcast vote. Maybe I'm unique, but I side with companies making my life easier and better - Google, Amazon, NetFlix, e.g., and against companies making my life a living hell.

What consumers want from Comcast, in no particular order are (1) fast connections, (2) fair prices and (3) problem-solving customer service. Welcome to hell, Comcast style.

It's a good lesson for CEOs everywhere: suck badly enough and publicly enough, for long enough, and nobody will take your side when big decisions are made on the national stage. And it doesn't matter who might benefit.  What's important is revenge and YOU LOSE, Comcast.

Yes, this means siding with the FCC and a gaggle of collectivist nitwits, but my distaste for them and their nitwittery pales against my utter loathing for Comcast.

Tuesday, July 23, 2013

How Do Innovations Spread?

From Atul Gawande, writing in the New Yorker:
In the era of the iPhone, Facebook, and Twitter, we’ve become enamored of ideas that spread as effortlessly as ether. We want frictionless, “turnkey” solutions to the major difficulties of the world—hunger, disease, poverty. We prefer instructional videos to teachers, drones to troops, incentives to institutions. People and institutions can feel messy and anachronistic. They introduce, as the engineers put it, uncontrolled variability.

But technology and incentive programs are not enough. “Diffusion is essentially a social process through which people talking to people spread an innovation,” wrote Everett Rogers, the great scholar of how new ideas are communicated and spread. Mass media can introduce a new idea to people. But, Rogers showed, people follow the lead of other people they know and trust when they decide whether to take it up. Every change requires effort, and the decision to make that effort is a social process. (emphasis mine)
Read the entire article, here.

Friday, June 7, 2013

"Stop Blaming the Patient!"

From MedCityNews.com: "Mayo doc: Stop blaming patients. Healthcare industry’s take on non-compliance is all wrong."

Dr. Victor Montori offers some great riffs on engagement:
Non-compliance is frequently talked about as a cost and a burden put on the healthcare system by patients. But Montori’s theory is that really, it’s the healthcare system over-burdening the patient.
“We have to be very careful not to blame the patients,” Montori said during his closing keynote at MedCity’s ENGAGE on Thursday. “A lot of the conversation (around patient engagement) has been, how do we get them to do stuff? To me, that’s not engagement."
[...]
Montori closed by asserting that the U.S. healthcare system will be the best in the world only when it begins to shrink. “Healthcare right now is all about itself. Healthcare right now is about how do we get bigger, more market share,” he said. “That means that patients have to take more medicine, have to monitor themselves more often [...] We will have the best healthcare system in the world when it becomes the first healthcare system that shrinks.”

Thursday, June 6, 2013

Hanging Up On Honda

My phone rang last night, with the caller ID showing an unfamiliar number from Fremont, MI.  A quick Google search hinted that it was Honda calling, probably to determine my satisfaction with a recent oil change at one of their dealers.

I'm not answering their calls.  Not now, not ever.  Why?

Several months ago, after a similiar service visit led to a similar call, I told the researcher I was unhappy with the dealer for recommending what I thought were unecessary service items in an attempt to inflate my bill.  (So what else is new, right? Whodathunk?)

Not twenty minutes later said dealer's service manager calls, unhappy that I'd given him and his department less than perfect marks and downright angry that I'd aired my suspicions in the survey.

So I gave their customer satisfaction researchers honest feedback and they ratted me out to the locals.  Seriously?

Let's make a new deal.  Mark down that I said "Honda's service is PERFECT in all respects" and stop calling me.

And that $1,400 of "recommended" service items?  Bite me.  Next time I'm going to Jiffy Lube.

Thursday, May 30, 2013

CBS Calls Out UPMC

From CBS This Morning: University of Pittsburgh Medical Center (UPMC) "made $948 million in profits from 2011-2012."  And tax returns show UPMC spending just 2% of its annual budget on charity care.  And UPMC's CEO, Jeffrey Romoff, makes almost $6 million a year.  And Romoff also has more than a dozen administrators that take in annual salaries of over $1 million a year.  And now Pittsburgh Mayor Luke Ravenstahl is suing to revoke UPMC's nonprofit status.  Good.  I hope he wins.

From the article:
Professor Martin Gaynor of Carnegie Mellon has published papers on hospitals that enjoy nonprofit status but do not always function like charities.
"There's a lot of concern here in the community," Gaynor told "CBS This Morning."
"They've taken some actions that don't appear to be consistent with an organization whose mission is to benefit the community."
Some of UPMC's funds are directed at facility improvement, but Gaynor has concerns about even some of that spending. He likened the new, state-of-the-art pediatric center to a palace.

"It's a tremendous asset to the community," he said. "On the other hand...one has to ask whether it was so important to make it so beautiful, or whether some of those dollars could've been used to better purpose -- to offer lower prices to members of the community, to offer more charity care."

Hard to argue with the Gaynor, isn't it?  I've worked in and around not-for-profit healthcare for most of my career and it's not that difficult to distinguish community benefit-centered organizations from the edifice-centered.  I know which I prefer.  And I wish the others would stop kidding themselves, the IRS and us.

More of my thoughts on hospitals' tax exemption, in this post about the politics of tax exemption in Illinois.

Friday, May 10, 2013

The ACA's Effect On Entrepreneurs Will Be...?

An article in yesterday's Wall Street Journal asked "Will Health-Care Law Beget Entrepreneurs?"

Will the availability of reasonably-priced insurance through public marketplaces or "exchanges" cause entrepreneurs to strike out on their own, leaving behind the comfort of big company benefits?

It's a good question, albeit one with no clear-cut answer at the moment. It all depends, I guess, on one's definition of "high-functioning exchanges" and "reasonable prices."

Still, it's a question to which large companies ought to be paying close attention. How many people work at jobs simply for the health insurance, jobs they'd leave in a heartbeat to follow their passion if insurance wasn't an obstacle? I don't know for sure, but I'd bet the answer is somewhere between "more than a few" and "a whole heckavu lot."

And those leaving are likely to be those the company wishes would stay - the innovators, the passionistas, those with entrepreneurial drive and burning competitive fires.

They leave and who stays?  The timid, the risk-adverse and the "Yes, but..." crowd.  I guess you can always hope that your competitors are as bad at retaining talent as you are.

Wednesday, May 8, 2013

Should An Employer Pay You For Interviewing?

Asks Nick Corcodilos, writing for PBS NewsHour.  It's a great question.  The answer might shape up your HR department in a hurry.

From the article:
A job applicant treated with disrespect can do as much -- if not more -- damage to a company's business as a dissatisfied customer. Do employers really think word doesn't get around?
Maybe hiring managers assume that their HR departments handle all the necessary niceties with applicants. But just how accountable are HR departments? Does this company's public relations department realize that while it's spending millions on good press, the HR department is scuttling it? If you're a hiring manager, and you're not sure how job candidates are treated after they leave your office, please read "Respecting The Candidate."
Your HR department might explain that processing applicants, job offers, hires, and rejection letters is cumbersome. Tell that to your customer who cancels the order that's a month late, or to the prospect who's waiting for a sales rep to return her call.
The technology to keep candidates informed is here. The will isn't. Why? Because job candidates don't cost anything. Companies can get all your professional time they want, for free, without any obligation to you whatsoever.
The article even contains a sample letter requesting payment. Let me know if you try it.

Friday, April 26, 2013

"...a social strategy doesn’t mean doctors on Facebook"

How's your patient engagement strategy working out for you?  This article might help:  Engagement is a Strategy IV: 10 Reasons Value-based Health Care Orgs Need A Social Strategy.

If you want to influence behavior (which you do or will), you really can’t ignore a social strategy. We’ll need to get really good at engagement and behavior change on a massive scale. Social media strategies may be our best bet at influencing behavior on a massive scale. Not to push behavior in a direction, but to provide systems that let behavior naturally migrate toward the health people already seek."

Friday, March 15, 2013

What Tech Trends Do CIOs See As Overrated?



From Chris Murphy, Editor at InformationWeek.com: "7 Tech Trends CIOs Call Overrated."

Trend #4: "Big data over small data."
(Says) Ken Harris, Shaklee CIO: "I'm not convinced that big data for most companies is a promising investment right now. We haven't learned how to handle small data well, let alone throw big data on there. That isn't to say there aren't some companies for whom big data could be a game changer, but most companies don't even effectively handle small data."
Harris is entirely correct, especially regarding healthcare's provider organizations - hospitals and physician groups - who, despite much talk about evidence-based practice, remain too often stuck in patterns of deliberate, consensus-to-a-fault decision-making. 

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Shared on Google+. creativecommons.org.au
Think that's harsh?  One AHRQ study found that "...(t)ranslation of research findings into sustainable improvements in clinical outcomes and patient outcomes remains a substantial obstacle to improving the quality of care. Up to two decades may pass before the findings of original research becomes part of routine clinical practice."

It's not for lack of data, big or otherwise, that this pattern remains.  No, it's culture trumping data. 

What happens when your Chief of Cardiology says "Nah.  I disagree with those research findings.  That's not what I learned in medical school and I'm not gonna do it."  Who wins?  Her or the data?  I think we've all been around hospitals (and cardiologists) long enough to know the answer.

So work on that culture thing first.  In fact, get the culture right and the rest follows.  Otherwise you're just writing big checks to big IT companies, expecting big things and setting youself up for big disappointments.

Thursday, March 14, 2013

The Patients Speak!

Andrea J. Simon writing at HospitalImpact.org:  "What Do Patients Really Want and Do Docs Care?"
With high deductibles, consumers all expressed how they are less likely to go to the doctor unless they are really sick. A number of them spoke about preempting the healthcare system altogether and instead, using their personal network to speak with friends who are nurses about their situation or that of their child before going to the physicians.

Most interesting was the degree to which these consumers--all of whom were between 25 and 54 in age--were anxious to get mobile applications that they could use themselves to help diagnose and manage their conditions. DIY healthcare is going to be very hot if we can get it right.

Wednesday, February 6, 2013

10 Ways to Stay On Top Of the Innovation Heap

The authors of Booz & Company's "Global Innovation 1,000 Report" offer their Top 10 things innovative companies do right (via Business Insider.com)
  1. At innovative companies, everybody is an innovator.
  2. Innovative companies measure their idea-generation success.
  3. Innovative companies change the idea a lot before it becomes a product.
  4. Innovative companies test their idea with customers.
  5. Innovative companies have an internal "idea czar."
  6. Innovative companies talk to customers and other partners.
  7. Innovative companies find ideas everywhere.
  8. Innovative companies generate ideas in three basic ways:
    1. Need seekers: what do customers want?
    2. Market readers: quickly create improvements on market trends.
    3. Technology drivers: letting their tech experts experiment.
  9. Innovative companies spend R&D money thoughtfully, not profligately.
  10. Innovative companies systematically create new ideas.
Though healthcare (big pharma, mostly) is heavily represented, healthcare providers are not.   Not unexpectedly, few of these 10 activities play to providers' strengths or fit naturally into a typical hospital culture.  Outside of a few organizations like Cleveland Clinic, there's a lot more innovation 'talking' than innovation 'doing.'  Maybe it's the first step in a journey of recovery - admitting you have a problem, er, opportunity.

Read the entire article, here.

Monday, January 28, 2013

"...I was fully planning to quit in protest. I’d even started writing op-ed articles. I was going to resign pretty noisily, I’m afraid."

 Richard S. Foster is retiring this week after 18 years as the chief actuary for the Centers for Medicare and Medicaid Services. From an interview in KaiserHealthNews.org:

Q: How do we control health care costs in Medicare, Medicaid and the private sector?

A: Years ago, we thought that converting from cost-based reimbursement to prospective payment systems (a set payment that covers the entire cost of the admission) was the magic answer, and it helped a lot. Then, back in the early 1990s, everybody thought managed care was the magic answer. And that helped some, too, although most of their success was in negotiating lower payment rates, which you can only take so far.

We’ve had other instances -- pay-for-performance and consumer-driven health care -- that people had hoped would be the magic answer. Right now, there’s a great deal of hope that further integration of care, greater bundling of payments and other innovations like that will be the answer. I’m not optimistic that these things will, in fact, be any more successful than the best ideas of the past. I think they can all help.

All the insurers and payers tend to adopt and pay for just about any new technology that comes along -- even in instances where the value of the new technology is nowhere near its higher cost. So we could be a lot more prudent in how we adopt new technology. But that’s controversial. We saw in the Affordable Care Act the pushback on comparative effectiveness. If you do comparative effectiveness right, I think it could be very helpful.

Q: How would you adopt technology more prudently?

A: If you have something that is 10 times as expensive as the technology it would replace, and it really is not any more effective, why should we bother adopting that? And yet we do it all the time.

Friday, January 4, 2013

Tensions In Innovation, 2013

Forbes:  "...it’s hard not to worry that if medicine goes in the direction of the Cheesecake Factory, where care is administered on the cheap by customer-service technologists plugging data into an algorithm, then an ancient and noble profession will face extinction because of an inability (some might say a haughty unwillingness) to adequately contemplate and communicate its essential value proposition." 

Monday, December 31, 2012

Innovating Education In Chicago

Interesting summary of the innovators and incubators reforming education in Chicago: Smart Cities: Chicago's Collaborative and Chaotic Reform Record
"For over a generation, Chicago has served as the epicenter of for-profit, technology-enabled education entrepreneurship and investment."
"According to Patrick Haugh, The Chicago Public Education Fund, "Chicago sports not only an impressive set of ed investors (Sterling, GSV Advisors), established industry leaders, and an emerging cohort of promising edtech startups, it also possesses a vital network of innovative ed organizations with great local leadership, and creative funders."
Understatement of the waning year:  "...Chicago kids would benefit from coherent state policies aimed at equity, options, and innovation." 





Saturday, December 22, 2012

NJ Hospital Closures May be Offset by Incentives

From HealthLeaders: NJ Hospital Closures May be Offset by Incentives

This is what happens when hospital CEOs cling too long to, and borrow too much in support of, an outdated business model: somebody comes along, grabs a few state incentives and turns the place into a medical mall.  I'll bet the community's health improves, too.


Tuesday, December 18, 2012

Jobs Available: VP - Health Care Management Services & VP - Provider Relations

For more details about these opportunities, contact Katie Coleman, Solutions Delivery Coordinator at Catalyst Solutions.  Candidate identification closes in a few days, so don't delay!

Main: 1-800-903-9574 | Office: 303-603-3211 | Website: www.catalystsolutions.com

VP of Health Care Management Services (Virginia Beach, VA)

Responsible for understanding functional area of responsibility and how the functional areas interrelate, gathering requirements, performing analysis, supporting the development and testing processes, and understanding the applications, data, and associated technologies for supported areas. Support departmental methodologies and provide input for improvement to tools and processes. Provide leadership within the team, department, and organization by chairing meetings, writing and executing test plans, and coordinating with business owners.
The preferred candidate will have the following experience:
  • Perform detailed requirements gathering, analysis, and process and data flow diagramming for processes of moderate complexity
  • Exhibits Project Management skills including development, maintenance and management of a detailed project plan, RACI matrices, resource leveling and budget management
  • Understands and considers the relationship between processes
  • Able to identify risks and multiple solutions
  • Can contribute to analysis standards
  • Utilize appropriate methods to resolve moderately complex design issues
  • Able to perform complex SQL queries
  • Understands data modeling concepts and their application: entities and tables, relations and constraints, attribute data types and column data types
  • Working knowledge of moderately complex database design
  • Writes, revises, and verifies test plans for complex systems
  • Evaluate and test complex new/modified programs and applications
  • Monitor system functionality and performance to ensure standards are met
  • Document and track product defects
  • Coordinate problem resolution with development and/or product vendors
  • Requires little assistance and supervision
  • Demonstrates an understanding of moderately complex license and support agreements to ensure compliance and requirements are met
  • Uses SDLC development methods or industry best practices under limited supervision
  • Demonstrates the ability to validate proposed contracts meet requirements
  • Managed care experience with in-depth knowledge of claims, provider, and member files

The Preferred Candidate Demonstrates:
  • Familiarity with Functional Decomposition and/or Object Oriented analysis techniques and related diagrams (Use case/Context/Process Decomposition/Sequence/etc.).
  • Previous experience with system conversion including transaction system conversion
  • A basic knowledge of current technology trends
  • Provides software testing assistance and training to less experienced team members
  • Skills in reviewing and guiding analysis efforts of others
  • Ability to assist in setting analysis standards
  • An understanding of financial arrangements and impact as it applies to the budget
  • Ability to develop creative strategies and tap the creative potential of individuals and groups.
  • Ability to continually assess needs and implement measures to ensure customer expectations are met or exceeded.
  • Ability to turn problems into opportunities for change.
  • Advanced proficiency with all applicable company supported software applications.
  • An ability to apply configuration knowledge to resolve basic to moderate business issues, identify alternatives, determine impact, and recommend optimal configuration solutions.
  • A comprehensive understanding of how each department/health plan relates to the organization as a whole.
  • Able to direct, lead, and coach a team. Able to resolve team conflicts.
  • Able to develop and manage multiple projects with minimal direction and supervision.
  • Manage small project related budgets.
  • Motivate others and provide innovative ideas and solutions, and promote the department vision for improvement and integrate that vision with others in the organization
  • Develop short range plans to accomplish specific goals given a set amount of resources and set timeframes .
VP of Provider Relations (Virginia Beach, VA)

Responsible for providing the Health Plan with an overall expertise in physician, physician group, hospital and ancillary healthcare contracting and provider reimbursement methodologies, taking the lead on Provider Relations projects in existing, expansion and new markets. Responsible for developing contracting and financial strategies, executing strategies, and maintaining positive provider relationships while advancing the goals of the Health Plan. Responsible for oversight of all Provider Relations staff and all provider contracting and servicing activities, including resolution of complex operational issues impacting provider relationships.
PRIMARY RESPONSIBILITIES:
  • Effectively represent client in interaction and negotiation with the most senior clinical and administrative executives.
  • Collaborate with the CEO/COO and other Health Plan senior management to determine the Plan’s provider contracting needs.
  • Lead the development of provider network business plans, strategies and goals as they relate to network expansion and provider contracting, education, communication, policies, procedures and servicing.
  • Lead the development of provider network related earnings improvement initiatives as well as network growth and expansion initiatives.
  • Develop and implement Provider Relations projects or assignments in support of Health Plan goals and the Home Office.
The successful candidate will be managing 25 people total including the AVP of Hospital Contracting along with several directors. The VP will own Provider Contracting, will strategize around hospital contracts. They should have a Medicaid background as Amerigroup is a Medicaid plan. In addition to contracting responsibility, they will need to deliver on a service model to providers. They will be running operations (ex: investigating why a provider is not getting paid). They will also be teaching the staff how to service providers (including hospitals, physician groups, and ancillaries). They should be familiar with key reimbursement methodologies including Capitation, DRG, Fee-For-Service (FFS), and medical homes. The challenges for this role is putting together a tight team for physician contracting, they will also be preparing for a big bid on Medicaid business in Florida in 2013.

The fine print: I post interesting executive-level and strategy-related job opportunities as they come to my attention. These are not my searches. I am not a recruiter and have no stake, financial or otherwise, in filling the position, just a hope that, in some small way, I can assist you, dear reader, in finding your dream opportunity.

Connect with me on Twitter.  I'm @whatifwhynot

Wednesday, November 21, 2012

What's the Finance Function's ROI?

"Ads proliferate across St. Louis as hospitals push services, name-recognition" is the headline above this interesting article from the St. Louis Post-Dispatch's website.  Featuring all sides of the debate, the article includes this from Samuel Steinberg, decribed as a Florida-based hospital finance consultant who "...remains skeptical about the benefit of advertising."

“It’s very difficult to be able to demonstrate that these things are worth the investment,” he said. “Hospitals and health systems that put a lot of money into advertising say it is beneficial. But when you ask them to prove it, there’s a real shortage of good research that verifies that it’s worth it.”
Yes, hospital marketers are frequently remiss in not building more value-driven metrics into their work.  Too many of these marketers (those with limited job prospects) devolve from saying that measuring marketing is difficult to concluding it's a waste of time to try.  And in my experience, far too few say "We're going to do MORE of what we CAN measure and LESS (or NONE) of what we CAN'T," even at the cost of annoying a CEO's favorite physician or two.

Yet as uncomfortable as it may be for the Finance side of the house to hear, they and marketing have a lot in common, as BOTH functions sometimes do things based more on faith than on solid evidence of results.

Don't believe me?  I'll bet you have CPA after your name.  But I digress...

Take the internal audit function for example, people and processes designed to keep the organization compliant and fraud-free.  But how do you measure "frauds avoided" - misadventures that would've happened but didn't thanks to the IA boffins' work?  Tough to do.  At some point one must believe - there's that pesky 'faith' thing again - that organizations WITH a strong IA function are more successful than those without (a point with which I happen to agree by the way.) 

There's an entire superstructure of intuition and supposition built around that idea, just as with the idea that a healthy and well-communicated brand is an important organizational asset (even though not everything about it can be measured.)  But intuition and supposition are not facts, and saying that without IA we'd have more Enrons and Worldcoms is wishing and hoping, not evidence.

So bring data to the argument when you can.  But next time you hear Mr. Steinberg echoed by YOUR finance team, ask them for the cost justification on what THEY do.  And watch 'faith' suddenly rise up the priority list.

Tuesday, November 20, 2012

An Industry Bankrupting Its Own Customers Cannot Thrive

Wonder why you haven't gotten a raise recently?  Does it seem your income goes less far than in years past?  Blame healthcare inflation.  Or, as one economist said recently, "...healthcare stole your raise."

 , blogging at KevinMD.com predicts that healthcare is in for a new organizational structure.

At our first meeting years ago, Tom Emerick, Walmart’s then VP of Global Benefits, told me, “No industry can grow continuously at a multiple of general inflation. It will eventually become so expensive that purchasers will simply abandon it.”
He said it casually, as though it was obvious and indisputable.
Health care is playing out this way. From 1999 to 2011, health care premium inflation grew steadily at 4 times the general inflation rate. During that same period, the percentage of non-elderly Americans with employer-sponsored health coverage fell from 69.2 to 58.6 percent, a 15.3 percent erosion rate.
Health care’s boosters like to argue that it has buttressed the economy, and that it means more jobs and economic prosperity within a community. A February 2011 Altarum Institute report estimated that private sector health care jobs now account for nearly 11 percent of total employment. Since the recession began in December 2007, health care employment has risen by 6.3 percent while employment in other industry sectors fell by 6.8 percent.
[I love this next paragraph...]
But there’s a darker side. Health care’s ever-increasing revenue growth has come at the expense of individuals and firms that pay its bills, directly, through health plan premiums and through taxes, often instead of buying other goods and services. It transfers wealth to health care from everyone else. Like the finance services industry, health care has become a disproportionate “taker” industry, sapping economic vitality of America’s communities.
[Yep.  And it's time for state hospital associations everywhere to change the basis for their "economic benefit" calculations - calculations that still trumpet employment and purchasing data when it's clear the marginal benefit is negative.  Locally and nationally, we'd be better off spending more on education, infrastructure and innovation than on more health care.]
And it is also clear that a sizable part of health care cost is inappropriate and unjustified. It is related to procedures that are done unnecessarily, markups that are hidden, and a thousand ruses to make it cost more. The prestigious National Academy of Sciences Institute of Medicine recently estimated this waste at 30 percent of total health care expenditures, or about $765 billion/year. But any number of health care professionals I’ve spoken with agree that, based on their experience, the number must be significantly higher. Other estimates have suggested this. In 2008, the consulting firm PwC issued The Price of Excess, which calculated that about 54.5 percent of health care cost, or nearly $1.5 trillion annually, focused in every sector – supply chain, health information technology, care delivery and finance – provides no value.
Read the whole thing, here.

Friday, November 16, 2012

Social Media's Biggest Pitfall May Be All Those Missed Opportunities

Says Bryan Vartabedian, MD in this Healthleadersmedia.com article:
Speaking to the great responsibility point, Vartabedian contends physicians are complicit in the controversy surrounding the unproven, but social media-fueled association between the MMR vaccine and autism. "There are 65,000 pediatricians in the American Academy of Pediatrics," he says.

"If all of us just once a year had created a small piece of content, be it a blog post, even a comment, we would have ruled the search engines, and none of this really ever would have happened."
"When we think about social media, and when your institution talks to you about social media, almost invariably it will be viewed from the perspective of risk. All we see is the risk associated with it, and all your orientation and your programs, everything will center on risk and nothing will center on opportunity."

Why Can't Healthcare Solve Its Own Problems?

An interesting question posed at HealthLeadersMedia.com. 4 health leaders offer wide-ranging suggestions, including building trust and collaboration, reducing the number of stakeholders yet finding ways to work together, and reforming the tort liability system.

Hard to argue against 'more trust' isn't it? Yet it's axiomatic in healthcare that one person's 'waste' is another person's 'income stream.' You mess with my income stream and I may have a problem trusting you.

"Go get some trust..." sounds a little like comedian Steve Martin's promise to teach us how to be rich. Says Martin, "First, go find $1 million dollars!" Umm, OK. I'll go find some trust while I'm at it and fix healthcare's problems too.

Maybe it's fair to consider the requirements for more trust. What preceeds trust? What creates the right conditions for trust to occur? There's no tried-and-true formula, no "add two parts water, stir and presto! Trust!"

No, but a strong sense of leadership COURAGE is my personal formula.

As a herd-driven industry, healthcare suffers from an acute lack of courage. We're more comfortable doing things once they've been validated by a Modern Healthcare cover story (think most of what passes for healthcare strategy) or the Federal government bribes us to do them (think EMRs.)

(As an aside, I've always wanted to conduct an experiment with the strategic plans of 50 randomly-selected healthcare organizations, I'd rip off all the covers, mix up the plans and then challenge the assembled executives to pick THEIR plan out of the pile. I'd offer an award to the few who could and free consulting to the rest. But I digress...)

Yes, trust is in the problem-solving mix. But instead of an initial condition, might trust be an outcome of courageous problem-solving? Of courageously and correctly identifying the problem? Positing strong if initially unpopular countermeasures? Stepping out, taking action? Of showing courage in acting on a compelling "...make no small plans" vision, a vision with which others can enthusiastically engage?

Nobody trusts who or what they don't respect, somebody who minimizes the challenges in favor of business as usual. Nobody trusts the Captain saying "We're taking on a little water" when all the passengers know the iceberg tore a huge gash in the hull and the ship's listing 30 degrees to port.

Say what you want about lemmings and 'Fraidy Cats, fuzzy, lovable critters all. But would you trust one sufficiently to follow?

Friday, November 9, 2012

An App That Tries to Predict the Future of Cities

From TheAtlanticCities  "The Harvard Graduate School of Design released the new Ecological Urbanism app last month. The interactive app, available at the iTunes store, adapts content from the GSD book of the same name, which explores how designers can unite urbanism with environmentalism. Combining data from around the world, the app "reveals and locates current practices, emerging trends, and opportunities for new initiatives" in regard to the future of cities." Imagine something like this for predicting the future of health systems and hospitals, combining measures of community health, strategic trends, financial viability, with experts from around the world adding data and context. Hmmm.

Friday, October 26, 2012

Most Hospital M&A Transactions Are Financially Unsuccessful

From Healthcarefinancenews.com:  "Most hospital M&A transactions are financially unsuccessful, study says."

"According to a recent study, a majority of hospital and health system merger and acquisition transactions have not been financially successful.

"Booz & Company, a global management consulting firm, analyzed a sample of 220 hospitals with pre- and post-transaction performance data over a 10-year period (between 1998 and 2008) and found that less than half (41 percent) of all acquired hospitals outperformed their market.

[...]

"Sanjay suggested that it’s important for hospitals to merge with other hospitals that have like-minded views about the future and culture, as well as shared views around their positioning in the market.
"So, for example, a merger between an academic medical center and a small, community hospital in an underserved area may not be ideal."

Friday, October 5, 2012

Steve Jobs On Process Vs. Innovation


“The system is that there is no system. That doesn’t mean we don’t have process. Apple is a very disciplined company, and we have great processes. But that’s not what it’s about. Process makes you more efficient.
“But innovation comes from people meeting up in the hallways or calling each other at 10:30 at night with a new idea, or because they realized something that shoots holes in how we’ve been thinking about a problem. It’s ad hoc meetings of six people called by someone who thinks he has figured out the coolest new thing ever and who wants to know what other people think of his idea.
“And it comes from saying no to 1,000 things to make sure we don’t get on the wrong track or try to do too much. We’re always thinking about new markets we could enter, but it’s only by saying no that you can concentrate on the things that are really important." [BusinessWeek, Oct. 12, 2004]



Tuesday, October 2, 2012

Is There An App for Patient Engagement?

No, says Steve Wilkins, MPH, writing at KevinMD.com. 

Physicians, hospitals and other providers are being misled by  industry pundits claiming that more health information technology (as in EMRs, PHRs, smartphone apps, and web portals) is the key to greater patient engagement.   It’s not.

Part of the misunderstanding concerning the role of HIT comes from how the discussion about patient engagement is being framed.  According to the pundits, patient engagement is the physician or hospital’s responsibility.  And like everything else these days, we can fix it if we just throw more technology at the problem. Can anyone say Stage 2 Meaningful Use requirements?
[...]

 The role of physicians, hospitals and other providers is not so much one of needing to engage patients in their care.  Rather, providers need to “be more engaging” to patients who are already actively engaged in their health.

Take the simple act of a trip to the doctor’s office.  Before a person shows up at the doctor’s office they have to 1) have a reason or need (symptoms, a concern, chronic condition), 2) believe that the need or reason merits seeing the doctor vs. taking care of it at home themselves – this generally implies cognition and doing research, i.e., talking with friends, going on line, etc., 3) make the appointment (by calling or going online), 4) show up for the appointment, and 5) think about what they want to say to the doctor.  The point here is that by definition, people who show up for a doctor’s appointment are already engaged.
Read the whole thing, here.

Wednesday, August 22, 2012

Let's Gather Some Data, Shall We?

The story goes that, upon hearing of Richard Nixon's election triumph, a resident of New York's tony Upper East Side exclaimed "But how could that happen?  Everybody I know voted for McGovern!"

Usually attributed to film critic Pauline Kael, it's an example of the logical fallacy known as hasty generalization: drawing an overbroad conclusion based on a statistically insufficient sample. 

From the Wall Street Journal:

"In reality, Kael was more self-aware than that. What she actually said, as reported by the Times in December 1972, was: "I live in a rather special world. I only know one person who voted for Nixon." But you see how the fallacy works: By her own account, Kael led a parochial life, seldom venturing outside her "special world." If she had mistaken her circle of acquaintances for a representative sample of Americans, she would have been mystified by the election outcome."


To a certain extent, we all live "parochial lives."  We can't do everything, see everything or know everyone.  But successful marketers and strategists maintain the self-awareness to recognize the trap and say "Hmm.  Maybe we need to gather some data here."

Friday, August 17, 2012

NFP Hospitals Hit the Wall



Have nonprofit healthcare providers' improvement efforts hit a wall?  Standard & Poor's Rating Services seems to think so, in this story (via Reuters.)   From the story:

"Adding to pressures, inpatient volumes are dropping.
"With pending budget sequestration at the federal level, health reform implementation, and continuing pressure on state budgets, we believe the next several years will be difficult for most providers," said S&P. "Furthermore, we believe that the improvements of the past several years may be reaching their limit and thus will not be able to keep pace with longer-term revenue pressures, especially in light of weaker volumes."

"S&P says more rating downgrades are possible for not-for-profit healthcare systems over the next two years. It noted that the proportion of systems with positive or stable outlooks is shrinking, which "supports our opinion the multiyear trend of improved financial ratios is unlikely to continue."
Sooner or later providers, notoriously risk adverse, will be forced to admit that cautious incrementalism is little more than death by a thousand cuts - a slow death, but death nevertheless.

Many see salvation in mergers and/or acquisition.  Putting a bunch of soon-to-be-crummy balance sheets together doesn't make the collective any less crummy.  And, usually, the consultants, lawyers and integration costs eat up the first 5 years of savings from any so-called "synergies."

Many see salvation in shiny new buildings with private rooms and in-lobby waterfalls.  Few will find the new business volumes to justify more balance sheet leverage (see "crummy" - above.)

And many see salvation in massive IT investments- Big Data, EMRs, portals, etc.  I hope they're right.  I fear they're not, but it'll take five years to really know how soundly these systems were reviewed, acquired and implemented.  Sitting here it's easy to predict more failures than successes.

In the meantime, under either fee for service or risk-based reimbursement, a "low delivered cost" position looks better and better.  It's the only strategy offering a possibility of success regardless of scenario.  But here providers have been far too timid, scrabbling in the dirt for a few percentage points of margin improvement instead of challenging themselves to find 30%, 40%, even 50% savings on an episode of care.

They're not going to achieve that by cutting the marketing budget (again) or designing buildings offering more of the same.

No, it won't happen until providers finally do hit that wall.  Maybe then they'll realize that the only path to survival requires getting radical about lots of things -  including ditching that leadership box in which they find themselves.

(Photo credit: Magdalena Gmur, Creative Commons)

Thursday, August 16, 2012

What Does Culture Eat For Breakfast?

Photo by: Cillian Storm Creative Commons
Not strategy.  Leaders, more likely, at least those managing by catchphrase, as Dan Beckham suggests.

From the article:

"The Problem of Buying into the Catchphrase


"One proponent of the "culture eats strategy" catchphrase, Shawn Parr, an innovation and design consultancy CEO, made his case in a Jan. 24, 2012, Fast Company article holding out shoe company Zappos as an example. In response, Bob Frisch, a strategy expert with experience at the Boston Consulting Group, had this to say in the same publication a month later:

"Parr attributes the success of Zappos to a culture that is inclusionary, encouraging, and empowering.' Customer service representatives write zany emails and company leaders have often affirmed their belief that if you get culture right, success follows. But Zappos also has fast delivery, deep inventory, a 365-day return policy and free shipping both ways. That's a strategy — not a culture — and if Zappos weren't competitive with catalog sellers and mall shoe stores, all the culture in the world would make little difference. … In the business world, it's easy to take a handful of current winners, give them a backstory about their cultures and conclude, like Parr, that authenticity and values always win out.' Always? Walmart is the winner in retail. McDonald's serves more meals than anyone else. And yet they're hardly praised as paragons of superior culture."

Read the whole thing, here.

Tuesday, August 14, 2012

ClickZ Webinar: Privacy As A Brand Asset

Photo credit: philosophyblog.com.au (Creative Commons)
Though you'll never hear them say so publicly, many health care organizations view privacy as just another costly bureaucratic mandate, not a strategic differentiator.  Have you ever seen a hospital or medical practice compete as "the organization best equipped to protect your privacy?"  I thought not.

And I can't explain why this is so.  Certainly the "protect my privacy" segment is, numerically, substantial enough to gain an astute marketer's attention.

Perhaps some marketers underestimate their customers' privacy concerns.  Or it could be that, when push comes to shove, health care consumers value other things in their health care experience more than they value privacy, in which case those marketers are making a smart decision about priorities.

It could be that health care organizations are (rightly) terrified of making a brand promise they can't keep.  Perhaps 'privacy' lacks the sex appeal of  brands built around 'high-tech' or 'high-touch' (though you'd think the appeal of such mental gyrations would have worn off long ago.)   

Or, maybe, to health care organizations, privacy is just not a branding issue.  Compliance maybe, but not branding.  I think that's a mistake.  Great brands are built around what people care about...a lot.  The evidence is that people care about privacy...a lot.  So...

This webinar from ClickZ Academy is not specifically devoted to issues of health care privacy but might offer some useful insights to health care strategists looking to embed "privacy-by-design" in marketing campaigns.

Making Privacy a Brand Asset; August 28, 2012 @ 2:00 PM EDT.  Session length: 60 minutes

"With the emergence of "Big Data", marketers are now equipped with an unparalleled ability to target and convert key audiences online. While companies are concerned over how to effectively leverage massive databases of personal information, consumers are concerned more than ever about the privacy of their data in corporate hands. Did you know that 60% of consumers are more concerned today about their online privacy than they were a year ago?"

More information, here.

"These Aren't Your Typical Loos..."

From Seattlepi.com:

"These aren't your typical loos. One uses microwave energy to transform human waste into electricity. Another captures urine and uses it for flushing. And still another turns excrement into charcoal."

Read more, here.

Friday, August 10, 2012

Going Rogue: A Fable, But True

Lest you think my last post overstated the case FOR "rogue" employees and AGAINST all you IT traditionalists, let me tell you a story.

Recently, my team and I searched for a way to connect ourselves and a dozen or so vendors - designers, agencies, printers and consultants.  Something like Dropbox or Google Drive.  "No go" said IT.  Not secure enough.
What alternative(s) were we offered?   SharePoint of course, assuming that my modest little corner of the empire would fund the expense (ranging anywhere from a few tens of thousands to the low six figures.)  I countered with a fast "No thanks.  At that price point, I'd have to sell a kidney or something."
But without knowing it at the time, IT's response was a blessing in disguise.

Now I'm (quietly) using iDoneThis (free) to track projects and team and vendor accomplishments,  IdeaScale (free) to generate engagement around innovative ideas and strategies,  Evernote (free) to organize snippets of information, and Delicious (free) to create and share my very own knowledge base about important issues and trends.

Notice anything?  Well, yes, I'm using FREE versions of all four.  I bet that got your attention.  But more than that, none took more than 10 minutes to set up and less time to learn.  I didn't waste months with RFPs, pilot projects or controlled roll-outs.  A short discussion, decide, do it.

Decide this morning, implement this afternoon.  Repeat.

Could someone hack me?  Sure, but I don't traffic in PHI and I doubt my cryptic project summaries, creative work plans and budget discussions would be of much interest to anybody.  Heck, sometimes even MY eyes glaze over!  

Maybe hearing "NO" from IT is the best answer you can get.  Maybe it means, TIME TO THINK DIFFERENT, as the man once said.

"Enterprise IT has plenty of room for improvement..."

"Rogue IT" is about to wreak havoc at work" is Fortune's headline.  Not a moment too soon, I might add. 
From the article:

"Rogue IT is the name given to the informal, ad hoc software and devices brought by employees into the workplace. If you've ever taken your own iPad to work or used cloud-based software like Evernote or Dropbox in the office, you may well be an offender. And you're not alone. Some 43% of businesses report that their employees are using cloud services independently of the IT department, according to a recent survey of 500 IT decision makers.

"In the past, these enterprise software and hardware decisions were often the exclusive domain of a company's chief information officer or CIO, the senior executive in charge of information technology and computer systems. "Sitting in his high chair in a grey suit barking orders, [the CIO would make] product decisions for big companies with even larger user bases," explains Peter Fenton of tech investors Benchmark Capital. Rogue IT turns that model on its head, effectively crowdsourcing IT choices to employees. So where does this leave the venerable CIO? And what does it mean for the future of IT at the world's largest enterprises?
"The good news is that enterprise IT has plenty of room for improvement. "[Traditional IT] carries connotations of interminable rollouts, bewildering interfaces, obscure functionality and high prices," writes CIO.com's Bernard Golden. Security, compliance and back-end compatibility have traditionally topped CIO wish lists, not usability. As a result, employees have sometimes been left with programs that are anything but intuitive. This exacted a heavy toll in terms of time, money and organizational well-being.

[...]

"Bloated, enterprise software no longer cuts it. Seduced by Facebook (FB) and similarly intuitive platforms at home, millennials balk at staring down monster spreadsheets or decoding web 1.0 UIs at work, writes Fast Company contributor Marcia Conner. Increasingly, they expect their work suites and software to be just as user-friendly as the apps they know and love in their personal lives, a trend known as the consumerization of IT. And they're willing to go outside company walls to find products that work best for them."

So do we still need a CIO?  Apparently we do, but with employees and customers doing the heavy lifting, voting with their feet (to mix a bunch of metaphors,) the CIO will finally have time for the big, important, profitable stuff.  OK.

But if you think it's just your employees (and maybe a few physicians) going rogue, well, your customers went over that wall a long time ago.  You probably didn't notice or care until that first iPad appeared in your waiting room.


Read the whole thing, here.

And, here, from HootSource, HootSuite's blog.

Thursday, August 9, 2012

Wearable technology market to exceed $6B by 2016

Computerworld - Demand for real-time data, including personal health information, is driving the market for wearable, wireless devices that will grow from 14 million items this year to as many as 171 million in 2016.

In four years, the market for wearable wireless devices is expected to achieve minimum revenues of $6 billion, according to new research from IMS Research, a subsidiary of IHS.



Health Systems Have Been Slow To Innovate...

And Canada's 'My Healthcare Innovation' hopes to bend the innovation curve upward.
"My Healthcare Innovation is a spin-off of the Innovation Cell, a non-profit think tank at the University of Toronto. Incubated since 2009, MHI is a private and secure global platform configured specifically for healthcare workers to more effectively collaborate and share timely, locally relevant solutions. "
[...]
"Health systems have been very slow to innovate and we under-realize our return from our investment in medical research and human resources. What we need is a health system that can distill and articulate its high priority problems, share them to the innovation community (internally and externally), reward innovators and facilitate rapid implementation of "disruptive" technologies. HTX is interested in My Healthcare Innovation as a way of creating and interconnecting communities of interest to share problems and best practices, while maintaining a safe and secure environment for frank discussion," said John Soloninka, CEO of the Health Technology Exchange.
Read more: http://www.digitaljournal.com/pr/480752#ixzz1dDb9P7CH


Friday, July 27, 2012

Tracking Afib On Your iPhone

From Dr. Westby G. Fisher, writing at MedCity News:  "Patient illustrates how the iPhone and $1.99 could disrupt the medical device industry."

"Today in my clinic, a patient brought me her atrial fibrillation burden history on her iPhone and it cost her less than a $10 co-pay. For $1.99 US, she downloaded the iPhone app Cardiograph to her iPhone.

[...]

"I got a relative picture of how often she was having afib and she got the opportunity to help me with her care.

"Was this a medical device? No, it was an iPhone app. Was it perfect? No it wasn’t. I certainly couldn’t differentiate frequent PAC’s or PVC’s from atrial fibrillation reliably. It was NOT an EKG after all. But we were past that point in her evaluation. I just needed to know how often she was having her known paroxysmal atrial fibrillation and she wanted to keep a convenient record of her episodes.

"Was it helpful in this case? Absolutely.

"More importantly, she just saved herself and the health care system a ton of money. "

Tuesday, July 24, 2012

Healthcare's Biggest Problem Is...

...too much money.  Wait.  What?

Interesting opinion yesterday from the blogosphere, that healthcare's biggest problem is too much money.  Too many resources, leading to too many people, too much time spent deliberating and too few imperatives toward action.

That's why, in our best leisurely fashion, we approve capital budgets just once a year.  Miss the cycle and it's 'wait 'til next year.'  And that's OK; it's not like it's life & death or anything.

Making the cycle, especially in IT, means launching RFP processes lasting another year and pilot projects lasting one more.  And system-wide rollouts lasting two more...assuming everything goes as planned, which it seldom does.  (Can you count to five?)

That's why off-the-shelf solutions costing 'a little' are rejected in favor of customized (yet corporate-approved) offerings costing twice as much and taking thrice as long.

That's why $8.99 iPhone apps are pooh-poohed as "not serious" and "risky" while the entry-level price for "real" software seemingly starts at $250k, rising rapidly after that.  (Ask me sometime about Voxie vs. the IT geeks.)

That's why our systems for cancer care are confusing messes yet our answer is to add yet another layer of staffing and expense - "Nurse Navigators" they're called.  I guess we'll start on that whole cost reduction and process simplification thing sometime tomorrow. 

And so we have armies of bureaucrats and analysts and process sponsors, technicians, project managers, coordinators and specialists.  We need them all to churn the system...and still we think of ourselves as understaffed.

And thus committees proliferate, PowerPoint becomes the organization's lingua franca, and, typically, the "back of the house" systems (Finance, IT, HR) are far more modern than "front of the house," customer-facing offerings.  When did YOU start offering patients an on-line portal and how many revenue cycle systems came and went before the portal's go-live?

Take away that money, most of the people and all of the committees.  Remove the luxury of time.  What's left? A startup mentality where cheap is better than expensive and free is best of all.  Where costs avoided mean making payroll...or not.  Where new customers this afternoon are better than impressive forecasts two years out.  Where a bias to action always trumps endless discussion.

What's Out: big checks to license Microsoft's crappy software (oops, is my bias showing?)  What's In: free Google apps.

What's Out: elaborate performance monitoring and benchmarking systems.  What's in: free daily tracking from iDoneThis.

Money gives you the luxury of time and lessens the pressure of deliberation.  That's not always a good thing.  And it's why a million little, ankle-biting startups are about to eat hospitals for lunch.  I'm just sayin.'

UPDATE:  Don't believe me?  Read "What We Can Learn From Third-World Health Care" by Pauline W. Chen, M.D., writing in the New York Times:

"The key to their success is an unabashed disregard for some of our most cherished assumptions about what constitutes good care. Instead of providing antibiotics, CT scans and high-tech interventions, Partners in Health considers basic necessities like food and housing as critical components of the group’s medical work. Instead of asking patients to travel miles to the only clinic and see only the doctor or nurse, they train cadres of community health workers who can monitor, administer and advise in the heart of local villages and in people’s homes.
"Applied to organizations in the United States, this approach has proved startlingly effective, as the Prevention and Access to Care and Treatment, or PACT, program has demonstrated. PACT targets some of the poorest and sickest patients with H.I.V. and other chronic illnesses in the greater Boston area. Just like Partners in Health, PACT relies extensively on community health workers who are trained in tasks like helping patients take their medications and make it to clinic appointments as well as reviewing their pantries and teaching them to prepare healthy meals. Applying these broad definitions of care, PACT has significantly decreased the number of emergency room visits and life-threatening opportunistic infections, cut hospitalization rates by 60 percent and yielded a 16 percent savings for Medicaid."