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Where's The Value?

We're coming up on an anniversary of sorts, an anniversary of the day I attended a charrette and nearly caused a riot.

See, I was representing my then-employer at a two-day planning retreat (also called a charrette) on the subject of building a statewide health information network, known generically as a CHIN or a RHIO. More than 100 leaders had gathered from hospitals, physician groups, payers, the ranks of tech and IT gurus and various levels of government, all with the purpose of moving the discussions from concept to something implementable.

As the festivities drew to a close, despite the group's best efforts, no compelling value proposition existed for the network. No statement of clear benefit emerged.  There was certainly no hint of how life could be improved for the end user (i.e. the patient.)  Even worse, the group's only funding plan consisted of the relatively few hospitals in the room each writing a big check.

Aspirations were running high.  Specifics were in desperately short supply.

At which point the local Blue Cross rep looked over at me and said "You know, if you hospitals would fund this system, we at Blue Cross could pay you sooner."

"You could pay us sooner NOW if you wanted to," I responded. "You just choose not to because you like money in YOUR bank account better than you like it in ours. A CHIN won't change that!"

Oops. If looks could kill I'd be writing this from whatever zip code contains Forest Lawn.  After some reflection, I could have been more judicious in my word choice, could have asked for more specifics on just how building a private-label version of the internet would accelerate hospital cash flow.  Woulda, coulda, shoulda.  I didn't.

But years later, several things are still clear as crystal:
  1. Health care's value propositions are frequently anything but.
  2. When you spend 2 days of 100 people's time trying to create a value proposition and FAIL, it's either bad facilitation or, maybe, there isn't any value to be created.  (And I might add that on this particular day the facilitators (not me) were pretty good.)
  3. Given half a chance and lots of someone else's money, groups will do their best to reinvent the wheel, or, in this case, the internet.
  4. Large doses of hospital funding won't change #1 or #2 and will only worsen #3.
  5. Suspicion is the correct stance when a payer wants a hospital to spend lots of money so they, the payer, can do their job promptly and correctly.
So say it proudly;

Charrettes are cool!
CHINs are neat!
But when value leads,
Your day is complete!

Thanks for reading.  Join the conversation.  Leave a comment.  Spark an argument.  Send me a message (  And about Blue Cross?  I'm still right.


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