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Showing posts from April, 2009

Health Care Costs Stifle Innovation

I can name you any number of friends and business associates who would love to strike out on their own but are afraid or unable to leave jobs they loathe. Why? Where would they find affordable health insurance?

And so they stay, handcuffed to a desk, working "for the benefits." Dispirited, their talents languishing and under-utilized.

So I support efforts to dramatically reform health care and the health insurance market. I believe that there are millions of entrepreneurs-in-waiting out there, ready to re-make large swaths of our economy, just waiting for common sense to prevail and for the threat of personal bankruptcy due to health care costs to be removed before they make the jump.

Who knows what they'll produce once they're free? I don't know, exactly. I do know they've had plenty of time to ponder. Unleashing their ideas and energies is a huge but unaccounted-for benefit of remaking American health care. So let's get to it.


A Digital Sixth Sense

Still unpersuaded that, as I said below, students are pointing the way to our future? Try this on for size and watch the presentation (thanks to the Experience Economist for the heads-up):
"Students at the MIT Media Lab have developed a wearable computing system that turns any surface into an interactive display screen. The wearer can summon virtual gadgets and internet data at will, then dispel them like smoke when they're done. Pattie Maes of the lab's Fluid Interfaces group said the research is aimed at creating a new digital "sixth sense" for humans.

"In the tactile world, we use our five senses to take in information about our environment and respond to it, Maes explained. But a lot of the information that helps us understand and respond to the world doesn't come from these senses. Instead, it comes from computers and the internet. Maes' goal is to harness computers to feed us information in an organic fashion, like our existing senses.

"…

See Health Care's Future Being Invented

"On Friday, May 1, some 150 University of Wisconsin-Madison biomedical engineering students will showcase 34 novel devices that address myriad real-world medical challenges.

"The biomedical engineering (BME) students' inventions include a phonetics-based communication device for children with significant communication disorders; a patient-transfer table for magnetic resonance imaging-guided liver-cancer treatment; and a low-cost spirometer for diagnosing pulmonary diseases in third-world countries." The Takeaway: I've said before that you can get an early peak at health care's likely future by monitoring venture capital trends. You should pay attention to students, too. They don't (yet) know what they don't know, haven't had 'can't,' 'don't,' 'shouldn't,' 'mustn't...' drummed into their heads, and so operate with far fewer conceptual limitations than the rest of us.


"An Affordable Fix For Modernizing Medical Records"

...from the Veterans Health Administration and Midland (TX) Memorial Hospital.

I know enough about my own strengths and weaknesses to know that I'm no IT expert. But I am acutely interested in examples of people and teams thinking differently to solve long-standing, intractable problems and, for better or worse, there are lots of those to be found in the IT realm.

Yesterday, it was a story about a team adding iPhone portability to MEDITECH functionality, delivering to harried physicians better access to clinical data and more productive hours in every work day. (Wow. Apple in the boardroom AND the physician lounge. Has to be an IT traditionalist's worst nightmare. But I digress...)

Today, the Wall Street Journal features a story about Midland (TX) Memorial Hospital finding an affordable, open-source alternative to proprietary EMR systems:
"In the push to digitize America's hospitals, Midland Memorial faced an all-too-common dilemma: a crying need for information tech…

Does Marketing Need Changing?

Silly question. Of course it does. A better question may be "Will marketers change for the good of customers and organizations, or simply out of self-preservation as the 'interruption-driven' edifice they've grown used to crashes around them?"

From FutureLab's Marketing & Strategy Innovation Blog,
"...the heart of the new marketing model (is) in the presentation below. A marketing reality which lets go of the “product push” mentality, and focuses on relevance, engagement and reputation."Change Marketing v01View more presentations from Alain Thys.
The Takeaway: So much of health care marketing is little more than mindless carpet-bombing - akin to flying over a town, kicking bundles of brochures and newsletters out the plane's door, hoping they'll conk someone who happens to give a damn. It's time for leaders to demand more from their marketing teams.And it's time for those teams to step up, accept the challenge and acknowledge …

The Doctor of the Future...

...is being developed today. From Fast Company magazine,
The Myca platform, a Facebook-like platform uses technology, from IM to video chat, to restore the traditional doctor-patient relationship that has been lost in today's high-pressure, high-volume, eight-minute-appointment practice model.The da Vinci Surgical System, surgical robots delivering improved outcomes for patients suffering from mitral valve disease.SimulConsult, a diagnostic crowdsourcing application producing a richer, more valuable diagnostic tool.The RP-7, a 5-foot tall "remote presence" diagnostic robot bringing sorely-needed specialist expertise to rural areas."Like the Myca Platform, the robots are just one example of an advanced technology that seems impersonal but actually enables doctors to be more hands-on; in a Twitter and Facebook world, screen-to-screen face time can build relationships with patients. And like SimulConsult and the robotic college's remote learning, they encourage pr…

Now That I Have Your Attention...

What The F**K is Social Media?View more presentations from Marta Kagan.
(Thanks to Chris Spagnuolo’s EdgeHopper for the heads-up.)

The Takeaway: Markets are conversations. Consumers trust each other more than they trust you or your ads. And they're talking about you right now, whether you know it or not. So participate. Get involved. Engage. Join the conversation.



MEDITECH Meets Apple's iPhone

The Takeaway: OK, you've got your IT systems nailed and humming. Now combine some fresh thinking and off-the-shelf tools for those still-elusive improvements in clinical care, productivity and satisfaction. Stumped? Ask the "kids" in your organization for ideas. They're pointing the way.

Question: what happens when you combine MEDITECH Client/Server 6.0 and Apple's iPhone 3G?

Answer: according to Doylestown (PA) Hospital,
"Moving to iPhone (offered) immediate time-savings benefits and productivity gains. Physicians no longer have to rely solely on patient charts or hospital computers to access information; instead, they can use iPhone to retrieve the data wherever they are. “iPhone offers a major workflow improvement for our physicians,” says Rick Lang, Doylestown’s Vice President and Chief Information Officer.

"Using iPhone and MEDITECH, doctors can see everything needed for patient care, including vital signs, medications, lab results, allergies, n…

"It's Like A Food Co-op." Dr. Ores said...

"...(e)xcept it’s health care." From today's New York Times;
"Dr. David Ores is also a physician who runs a nonprofit health care cooperative for city restaurant workers that he sees as a model for how national health care could work.

"Under the plan, he charges each restaurant a dollar each month for every seat in the establishment and pools the money. In return, any employee from those restaurants can visit him free of charge, whether for a cut finger or the flu."The Takeaway: Think about being given a completely blank slate and no preconditions, with nothing off-limits. How would you create a brand-new health system - affordable, humane, appropriate, accessible?

Would Dr. Ores' model fit? Let's see...along with keeping my salads free of coughs and germs, it's inexpensive, uncomplicated, timely and easy to implement. Nah. It'll never make it into a national model.

Frankly, I'm surprised he hasn't yet run afoul of New York's I…

What's Your Share of Customer?

THE TAKEAWAY: A Share of Customer analysis is easy to do (with the help of an actuary) and may just point the way to significant, overlooked revenue opportunities.

Take 20,000 random accounts from your revenue files. To each account, append the appropriate demographic variables, diagnosis and treatment codes, and the charges for it all. Bundle it up into a suitably-scrubbed data file (so as to avoid the HIPAA police) and send it off to your favorite actuary.

Ask the actuary to estimate the total charges of that 20,000 person cohort (i.e. how much they’re estimated to spend ANYWHERE on all types of health care) and your “Share of Customer” (i.e. how much of that total they spent with you.)

Reporting on my first SoC analysis, the actuary pronounced that we were the beneficiary of roughly 86% of the cohort’s estimated total spending on inpatient and outpatient care. I didn’t think that was too bad. We were leaving a few million dollars on the table but there’s always things like out-of-…

Reforming Health Care

THE TAKEAWAY: Be consistent! If you spend decades "de-marketing" the segments you don't want, don't complain when someone else finds a way to serve them. Otherwise you just look petty and stupid.

A great summary of health care reform, here, from the NEJM.

Basics for the Massachusetts-like plan include a mandate for everyone to purchase health insurance, and a government-sponsored option for those who can't find private coverage.

Major insurers are now in full roar about a government-sponsored option, calling it "unfair competition" - an interesting position coming from an industry with a decades-long track record of denying coverage, "underwriting out" applicants presenting with so much as a hangnail and studiously avoiding ANY risk that might cost them a farthing.

And now the Feds propose to give options to those stonewalled out of the insurance market. Unfair competition? You be the judge.


We Finished In Last Place So...

...after firing everyone responsible, we're designing a new logo.

Yep, that'll work.

THE TAKEAWAY: Whatever your organization's problems, they weren't caused by your logo. Whatever the solutions, a new logo is usually an expensive, unnecessary distraction.

Are you going to drink more Pepsi or Pepsi products now that the logo has morphed into some weird emoticon?

Were I Pepsi's marketing guru, I would have found a way to distribute Gatorade Endurance Formula to stores, well, ANYWHERE, thus pleasing us triathletes who think their current eye-dropper-like distribution strategy is resoundingly idiotic.

And raise your hand if you think the Detroit Lions' new logo will pull them out of last place. Or make their fans forget 2008. Oh, I know, it's part of the revival of a great brand, bringing new passion and energy...blah blah.

Heck, I call myself a "brand-builder" and even I don't believe that stuff. Brands are not logos and symbols, they're simp…

"Groundhog Day" In Health Care

THE TAKEAWAY: Don't try to create strategic separation by informing your marketplace that you’re JUST NOW offering something that’s been commonplace for decades in the rest of the world.

So...I was driving to Chicago’s O’Hare Airport yesterday evening, when I hear a radio ad for a local hospital, one I competed with for two decades (at least when we weren’t doing joint ventures together. But I digress...) Said ad spent 60 breezy, breathless seconds praising the facility’s “new” wireless IT infrastructure.

Wow! Think about it! Wireless ANYWHERE! So visitors can GET ONLINE! And doctors and nurses can COMMUNICATE WIRELESSLY!

A fairly expensive campaign, I’m assuming, given Chicago’s media costs and the drive time placement on the biggest, baddest station of ‘em all.

And a great campaign...for 1995. And for the exactly three people on the planet who’ve never been to Starbuck’s.

Maybe the campaign’s next ad will tell me all about how they’re connected to the electrical power gri…

A Rant, But A Short One

This short rant goes out to all of my friends laboring in consumer products companies, shoveling out the crap I lug home from the grocery store.

More frequently these days I'm choosing products based on packaging. The less of it I have to throw away or recycle the better. And I'm sick of packaging that requires scissors or other implements of destruction to open. Don't you ever try to open your own packages? What's your problem anyway?


What I Do When I'm Not Working?

Triathlons. Thanks to my Linkedin network and colleague Amy Rabinovitz writing for the San Jose Fitness Examiner, my "other career" as a middle of the pack triathlete gained some Bay Area pub. Amy is a copywriter and marketer. Her bio says, “despite being fiftyish, well-worn, and no one's idea of a fitness guru, living in south bay can inspire anyone to be fit."

That's me too, except without the south bay location. And now that my 10 minutes of fame have come and gone, I can stop worrying about it.


It's Like An ER Reservation, Only...

...better. The average emergency room waiting time is now estimated to be 3.2 hours. From Springwise, here's a service that secures you a place in line, before you get there.
"...Atlanta-based InQuickER announced the launch of a new service that allows patients with non life-threatening conditions to reduce their waiting time by calling ahead or signing in online. "After preregistering for the service, patients inform their hospital about their injury or illness in order to reserve the first available time slot. In 75 percent of cases, InQuickER users will be seen immediately upon arrival, but if a patient is not seen by a doctor within 15 minutes, InQuickER and the hospital won't charge for the ER visit, diagnostic services, professional fees or supplies. The 'hold-your-place-in-line' service is currently available at three hospitals.Of course you're doing what you can to reduce that ridiculous 3.2 hour wait. Failing that, maybe InQuickER is your be…

Eschew Obfuscation

What? Keep it simple, in other words.

Health care providers spend lots of time and money convincing their customers to care about complexity. They fail, usually. Customers don't care about organizational complexity. They refuse to add someone else's problems to their own. And they'll never care about all the ways providers shoot themselves in the proverbial foot, layering complexity upon disorder on top of inward-focused decision-making.

Like big signs everywhere, proclaiming that, in most cases, your physicians are really not YOUR physicians but merely independent contractors needing a place to sit while charting. Signs that say (not so) subtly "...nyah nyah, don't sue us because you won't get anywhere!" Quite a welcome.Thank you, lawyers everywhere.

Or like health care's powerful and omnipresent "guilds" insisting that it be called "pathology" when most customers still look for "the lab." Or "diagnostic ima…

The Next X PRIZE Is For...

...affordable, quality health care. Now's your chance to assemble your team's great ideas and see if they actually work in a real-world experiment.
"The $10 million Healthcare X PRIZE, organized in collaboration with the WellPoint Foundation and health benefits company WellPoint Inc., asks entrants to generate a 50% improvement in health value in a community of 10,000 people over a three-year period. "Health value" is defined as the combination of total cost and a community health index that measures factors like improved ability to climb stairs and reduction in emergency room visits.

"Teams will have 18 months to plan their proposals. At the end of the planning period, five finalists will be selected to test their models in U.S. communities of 10,000 people. WellPoint and its affiliated health plans will collaborate with employers and health-care providers to set up test communities, and the finalists' results will be compared against a control group.&…

Improving Patient Satisfaction Surveys

If you ask identical patient satisfaction questions of a 30 year-old woman and an 85 year-old man, you aren't segmenting, you aren't learning and you're probably not satisfying anyone either.

OK, let's set up a hypothetical here. Imagine a 30 year-old woman, an executive at a major Internet company, fracturing a leg falling off the mountain she was climbing. Further, imagine an 85 year-old farmer fracturing a leg falling off the tractor he was driving. Let's say their injuries are severe enough to require surgery at your hospital and so it transpires that both patients are admitted to adjacent rooms on your ortho/surgery floor.

Two patients more different than alike save for the admitting diagnosis. With me so far?

Yet perhaps during their stay - and certainly after - as occupants of the same nursing unit, they'll be asked nearly-identical survey questions designed to elicit their satisfaction as patients and customers. Questions about "responsiveness&q…

"...and stay away from Oprah."

"It's Not the Recession, You Just Suck." A Saturday-morning ass-kicking from Lisa Barone.
"Entrepreneurs are ruling this recession."Why? Because they’re hungry and they’re motivated. That means they can’t spend their whole day getting caught in the fame game or in office politics. It means when they go to a conference or a networking event, they’re not there for the booze. They’re grabbing handfuls of business cards, talking to people, and then following up. And they don’t just say they’ll email you after the show. They really do. Actually, they email you as soon as they get home. They’re nurturing leads and finding clients and creating opportunities. They’re marketing themselves. They’re not tuning in to Oprah this afternoon to get Twitter tips from Ashton Kutcher."Learn something new. Work harder than everyone else. Do the leg work. Surround yourself with fighters. Take risks. Shut up.

OK, I will.


Social Media Explorers

I'm working with two clients, both wonderful writers, on social media and networking strategies. Each writes books and magazine articles, looking for audiences in all the traditional places, occasionally finding them, sometimes not.

My philosophy regarding intellectual and written content has always been "write once, use many." Although editing for new formats and audiences is usually necessary, content is content and a good idea is a good idea.

How to re-shape and re-purpose is the challenge. I'm lucky to have a great starting point - authors with authentic passion and a drive to search for new connections.


Strategic Planning In Challenging Times

More than 80 percent of executives responding to a recent McKinsey Quarterly survey say their strategic planning process looks different this year compared to last. Major changes include more rigorous scrutiny of capital projects and spending, wider adoption of scenario planning and more frequent monitoring of performance against plan.

The article ends on a cautionary note:
"In short, many strategists seem to be rapidly adjusting their planning processes to cope with the changed economic environment. Important as these adjustments may be, their nature also raise a major question in the minds of many strategists: is the crisis atmosphere undermining focus on all but the immediate future? More than 50 percent of executives, in fact, express worry about not striking the right balance between near-term challenges and long-term strategic priorities." I would ask the question slightly differently: if a strategic planning process changes year-to-year according to external influences…

"Novel...Health Plans Gain Traction"

Today's Wall Street Journal spotlights what I call hospital-sponsored "health insurance lite;"
"The programs typically involve collaboration between business owners, nonprofit groups and local hospitals, which offer enrollees a range of medical services at a reduced rate. The plans keep costs down partly by bypassing the extra costs that come with traditional insurance. That can be a big help for small-business employees who can't afford traditional insurance. But for patients with costly chronic diseases or catastrophic illnesses, the coverage would likely be inadequate.

In Galveston, Texas, the University of Texas Medical Branch hospital recently began providing coverage to more than 430 employees of small businesses at a cost to individuals of $60 a month, plus copayments -- far less than many traditional insurance plans. Nonprofit groups, including ones in Duluth, Minn., and Pueblo, Colo., have started similar programs. In Muskegon, Mich., one such program cal…

GE Creates New Value In Health Care

Current difficulties aside, General Electric is a fascinating company, recently announcing an alliance with Intel to develop and sell technology to help care for the elderly and chronically ill in their homes, and a development partnership with the CDC and Johns Hopkins for a rapid-response public health alert system designed to nip epidemics in the bud.

Cool ideas, both, and seemingly targeted at two sweet spots in health care's future. And good for Johns Hopkins for being part of the venture equation. But, depressingly, too many health care providers are watching from the sidelines as other more-innovative organizations build the next generation's value streams.

Except for inertial drift, there's no particular reason it must be that way. A theme of mine (and of this blog, to the extent there is one...) is that providers have ring-side seats to the health care system's myriad defects, a position which, if approached with the right mindset, provides endless raw ma…

A Truer Estimate of Your Market Share

What if...you removed your own employees' utilization from the numerator in your market share calculations?

Health care providers track market share as obsessively as any other industry I know of. Boardrooms ring with 'Huzzahs' whenever quarterly results show even the smallest uptick.

At the same time, many providers heavily incent their workforce's use of their own facilities, offering lower deductibles, co-pays or other incentives to keep it all in the family, so to speak. It makes sense from an HR perspective. You're essentially paying variable cost for your health plan's utilization instead of some multiple at the hospital down the road.

Yes, "captive arrangements" are nice, and the more you can devise with external customers, the larger and more stable is your revenue base. But don't kid yourself. Your employee health plan's spending is not really business you competed for and won. The fact that your employees choose you under financ…

What Is Health Care's Ideology?

What's that saying? Evidence of ideology is not an ideology of evidence? Something like that...

In today's New York Times, emergency room physician Dr. David H. Newman discusses our deeply entrenched beliefs in treatments that, demonstrably, DO NOT WORK. Surgeries for back pain (a $20 billion per year business.) Beta-blockers for heart attacks. Antibiotics for ear infections. Dr. Newman reminds us that, intellectually, these things SHOULD work. They don't;
"Treatment based on ideology is alluring. Surgeries to repair the knee should work. A syrup to reduce cough should help. Calming the straining heart should save lives. But the uncomfortable truth is that many expensive, invasive interventions are of little or no benefit and cause potentially uncomfortable, costly, and dangerous side effects and complications.

"The critical question that looms for health care reform is whether patients, doctors and experts are prepared to set aside ideology in the face o…

Core Competencies; Not What You Think

What are your organization's core competencies? The typical, superficial - and wrong - answer is something like "Oh, we're really good at cardiology and neurology."

Think about it. If you asked Toyota the same question, would you expect the answer to be "We're really good at the Camry"? I doubt it. So ask deeper questions: WHAT is Toyota competent at that makes the Camry a great car? WHY are you good at cardiology and neurology, assuming you are?

Do you...hire only great people? Are you adept at identifying and deploying value-adding technology? Are you maniacal about process improvement? Are you quick to acquire new knowledge? Do you learn faster than the marketplace? Are you a rockstar at engaging team members around a clinical outcome?

Find out WHY you're good at an episode of clinical care, and you'll be much closer to understanding core competencies and using them to drive strategic separation.