Health Care Strategist

Have a problem to solve?  Maybe you'd like to reduce expensive readmissions? Or better control drug expenditures? Need a best-in-class solution? An idea or a toolkit?   Protocols and turnkey guidelines? Try MX.com from Medimetrix Solutions EXchange , billed as "...a source for both free and licensed Solutions developed and tested by leading medical institutions...(a) pragmatic alternative to the high costs associated with creating in-house materials or hiring consultants...a new revenue stream for hospital leaders who seek to market their intellectual property to benefit other healthcare providers." Among the 200+ solutions are: The Glycemia Management Solution by Adventist Health System including Florida Hospital. A High-Cost Drug Guidelines Solution from Partners HealthCare, founded by Brigham and Women's Hospital and Massachusetts General Hospital. An Employee Engagement Survey by Benefis Health System. The Emergency Department Toolkit from Banner ...

From the StarTribune, citing research from UnitedHealth Group: "Residents of rural areas in Minnesota and across the nation are more likely to have chronic diseases and face hurdles to getting quality care, according to a UnitedHealth Group report that calls for new approaches to rural care." Compared to urban centers, rural America's problems include: A disproportionate share of people with chronic health conditions. An average travel distance of 60 miles to see a specialist. More patients with diabetes and high blood pressure. More caregivers naming teen pregnancy and drug abuse as top concerns. Solutions are multi-faceted and include: Expanding the nation's broadband network and handling more illnesses over the internet. Allowing broader roles for NPs and PAs to deal with a shortage of rural doctors. Addressing the reimbursement issues making rural practice less lucrative than urban settings. Says the study: "About 50 million Americans live in rur...

From The Town Talk : "...health-care spending keeps growing faster than the economy because of high cost of medical innovations and an aging society that consumes increasing levels of service." Case in point from RedOrbit: Chicago's Resurrection Medical Center is the first in its area - 8th in the world - to offer a 128-slice PET/CT scanner. The "premium imaging system" does many wondrous things - detecting, diagnosing and staging various types of diseases, enhancing patient comfort, decreasing scan times, etc.   I call it "competing on shiny gadgets."  Decreased costs?  Improved efficiency?  Lower prices?  Savings passed on to consumers?  Nowhere in the press release.

From Cosmic Log at MSNBC.com: The National Science Foundation is setting up a public-private program to help researchers make the leap into entrepreneurship by putting them through a boot camp for startups. NSF's Innovation Corps , or I-Corps, aims to offer 100 grants a year at $50,000 each (putting) NSF-funded scientists together with mentors and entrepreneurs to turn their ideas into marketable ventures.

Jeffrey Phillips, blogging at "Innovate On Purpose" asks "When will the innovation fad end?"    A fad's staying power is measured in months.  True innovation never ends. "...the individuals who believe innovation is a fad will pay some lip service to innovation, attempt a project or two to demonstrate their bona fides, and wait patiently for the fad to end. Don't get me wrong - many of the hucksters who thrive on a fast buck will fall away as their inability to deliver value will be exposed. But that doesn't mean that innovation is unnecessary or a fad. No, because the underlying drivers that increase the need for innovation aren't short-term and aren't based on passing fashion or whim. The drivers for innovation are factors that are simply accelerating: growing consumer demand, an expectation of new products and services, rising global trade and the increasing knowledge of consumers. These factors reduce expected product life and incr...

From my friend Paul Roemer, blogging at Healthcare IT: How good is your strategy?   "The web. Social networking. A great tool if you’re one the outside searching, deadly in the hands of your customers. "If your (hospital) is targeted, you are pretty much defenseless. Each patient is capable of creating their own digital perception of your hospital. True or false, makes no difference. Patients are like little thunderstorms popping up everywhere. Healthcare providers scurry around like frightened mice passing out umbrellas and pretending it’s not raining. They’re late, their patients are wet, and they are telling everyone. Very few...have learned that they can’t put the rain back into the clouds. "Sort of reminds me of the line in the movie Young Frankenstein, “Could be worse, could be raining.” It’s raining, and even the best firms have run out of umbrellas. What is your firm doing about it?"

How I'd fix the economy, part #4,278:  Were it up to me, I'd invite 25 million young, skilled, educated, high-earning immigrants to become immediate US citizens if they agreed to: (1) buy a house, (2) start a business employing at least 5 people and (3) pay slightly-higher than normal state and federal taxes for, say, 10 yrs. Housing market: fixed.  Job creation: fixed.  Deficit: fixed. Typically, Washington tries to solve the cost vise of Medicare and Social Security with benefits cuts (Republicans) and tax increases (Democrats.)  That's the "...deck chairs on the Titanic" approach.  Shouldn't it be obvious that the only permanent solution is demographic?   I.e. more young taxpayers paying in as more Baby Boomers take benefits out ?  And where do young taxpayers come from?  Well, you can grow them, procreating furiously and waiting 25 years for the results to mature (hopefully) into taxpaying wage earners and not "spongers off Mom ...

Answers Danielle Ofri, M.D., writing in the NY Times : "I cringe when I think about what it would mean for patients if doctors walked away from medicine because of the frustrations. "On top of that, I have to wonder about the alternatives if I gave up clinical medicine — pushing papers, sitting in endless PowerPoint meetings, crunching numbers — and realize that I am lucky and immensely privileged to be able to work directly with patients. "When I close the door to the exam room and it’s just the patient and me, with all the bureaucracy safely barricaded outside, the power of human connection becomes palpable. I can’t always make my patients feel better, but the opportunity to try cannot be underestimated." I think that's what we'd all like - more hours in the day for the fulfilling stuff and way less - maybe none - of the bad stuff.  How much better would life be without forms, committees and the PowerPoint that fuels it all?  Wouldn't it be nice...

Can technology lower health care costs?  Yes, says Mindy Tucker Fletcher and she wants you to think West Wireless Health Institute and San Diego when you say that.

"It's a great time for new ideas..." Having first put their lives on the line, entrepreneurs are hard at work changing Egypt's future.  I'll bet they're hard at work in your organization too, though further underground, more's the pity. How many of your key strategic leaders, those you're counting on to secure your future, are under 30? Most? I'll buy it. A few? I'm a seller. None? Say your prayers and polish your resume.

Yesterday's post quotes Neil Versel saying that Apple Computer's iPad has captured the imagination - and the dollars - of perhaps a quarter of all physicians in the U.S. I can't confirm the percentage but it sounds about right to me.  The iPad business unit did $6 billion in revenue LAST QUARTER alone, more than twice Dell's entire PC business! One quarter of all physicians. In just about a year. It's time for health care veterans to stop with the shopworn metaphors about physicians.  Ever heard "Working with physicians is like herding cats?"  Or the less common "...loading dogs into a wheelbarrow?"  Of course you have. It turns out getting physicians to take action en masse is pretty easy.  Just offer something in return - a benefit, an improvement, an efficiency gain, better access, connected information, a sense of delight or just plain cool.  Maybe they've had it right all along. A thought for today: "What helps luck ...

Singapore's health system places (great) emphasis on personal responsibility and economic incentives. "(And) what is most impressive about Singapore’s health care system is that the country spends about one-fifth as much per person on health care compared to the U.S., yet has better health outcomes." Personal responsibility? Economic incentives?  Do those terms still have a place in today's America?

From Neil Versel, writing in MobiHealthNews: "Silicon Valley often misses the point of healthcare." "There are few places with such a high concentration of conceited, arrogant know-it-alls than Washington, D.C., but Silicon Valley may best even the Beltway gang. I’ve seen a lot of bluster, a lot of unearned publicity, plenty of buzzwords and, in many cases, little actual success in winning over customers or addressing a real problem in healthcare. "Sure, there are exceptions. With the iPad, Cupertino, Calif.-based Apple has captured the imagination—and the dollars—of perhaps a quarter of all physicians in the U.S. (OK, sorry!  I just HAD to highlight that sentence!)  Practice Fusion, of San Francisco, has shaken up the ambulatory EMR market by offering a free, advertising-supported product that has successfully targeted a badly underserved segment, namely small physician practices. And Epocrates, based in San Mateo, Calif., claims 1.3 million users for its mobi...

An item from yesterday's Wall Street Journal caught my wandering eye. Though the economy's sad state continues to depress healthcare utilization, the effect is markedly different depending on your place in the food chain. UnitedHealthcare's earnings are up as declining utilization has not (yet) resulted in declining premiums (though come to think of it, when has it ever?)  It's no surprise that payers benefit when utilization drops.  The difference here is that the economy's doing their dirty work for them. On the other hand, Johnson & Johnson's earnings are down as consumers decide they can live without Band-Aids and Tylenol, and cash-strapped hospitals clamp down on expensive artificial joints.  Getting paid "per-click" is great when volume heats up, not so much fun when the movie runs backwards. And, no, this is not what providers mean when they mention "downside risk."  That's an entirely DIFFERENT way to lose a ton of m...

As 347-bed St. John’s Regional Medical Center in Joplin, MO begins to contemplate rebuilding, many issues come to the fore.  I’m sure there will be no shortage of advice-giving pundits and consultants. One hopes that out of that miasma emerges a clear-eyed vision of hospital demand going forward. Parent organization Sisters of Mercy Health System, Chesterfield, MO, has vowed to rebuild with an array of services. Lynn Britton, president and CEO of Sisters of Mercy Health System calls it “…a wonderful opportunity to re-imagine” health care in Joplin. A once-in-an-executive’s-lifetime opportunity, really. But what is that talking? Pride? The “Show Me” state’s resilience above all? Steadfast loyalty to employees and physicians?  All necessary and, for now, a healthy tonic for a shocked community. But rebuild what? Where? The givens: rebuilding requires capital.  Lots of capital,  the possibility that the ‘new’ Joplin will have fewer residents, and  lowe...

From Dr. Westby Fisher via MedCity News: "Hospitals expand for future patients… who may not be able to afford care." "It doesn’t take many Betz cells to know what will happen when employers who presently pay $8,000-$9,000 per employee for health care benefits suddenly get the opportunity to pay a $2,000-per-employee “fine.” Do the math: for an employer with 3,000 employees, they pay about $65.5 million for the health care benefits they’re currently providing compared to a $6 million dollar “fine.” Seems like a nearly 10-fold savings to me! Now THAT, ladies and gentlemen, is one heck of a beneficial fine!" I can hear the Board chair now: "You mean that $200 million bed tower, justified on the thinnest of research about consumers preferring private rooms, might actually open to...NO demand?"

To see the future of facility design, I tell my hospital CEO friends, they should spend substantially more time in an Apple store than in some hospital lobby. Why is it, do you think, that 30 minutes after a mall opens for business, the Apple store is packed and rocking while a dozen thrown bowling balls would not conk a single customer in the mall's more pedestrian stores? And if YOU, dear health care leader, think you have nothing to learn from Apple's retail presence YOU'VE not been paying attention...or reading all the wrong blogs.  Now it's your problem to determine which.  Can the ideas translate beyond Apple? We're about to find out as Ron Johnson, engineer of Apple's winning retail strategy, takes the CEO role at J.C. Penny's. But translate as far as healthcare?  Egads! At Apple, Johnson designed a "...retail experience that was consistent with the products and delivered lots of information. The focus was on discovery, entertainment, ...

The Lancet:  "Smoking cessation support delivered via mobile phone text messaging doubles quit rates at 6 months. The intervention is effective in all socioeconomic groups and in younger and older smokers."

Omaha.com: the 20-something math, economics and neuroscience whizzes at Contemporary Analysis make analytics affordable. "Their products are designed to yield results in about a month, and average contracts are about $5,000, Stanley said. The company's analytics tools use data to solve sales, marketing, customer retention, employee management and planning problems." Imagine being able to predict, within a small margin of error, next week's ER volumes.  Would that knowledge improve your staffing decisions? For healthcare specific applications, try the folks at Agile Healthcare .  Tell Chris Looby I sent you.

  Maybe, says Bloomberg Business Week , especially if... It isn't based on an insightful, meaningful market need, It isn't a new product or service meeting that need, and/or  It doesn't offer a communication strategy connecting the two, i.e. connecting a market need with a product or service. Ideally we work for organizations that seldom say 'No, buzz off!' to a new idea, just 'Great idea, we'll keep it alive, but now's not the right time.'   Alternatively, we can follow a certain wise person's dictum: "Never try to teach a pig to sing. It wastes your time and annoys the pig." A dictum with SO many applications, but I digress.  In the meantime, let's be REALLY careful out there!

In my last post I said some nasty things about health IT vendors, all richly deserved.  Now, from the NY Times, so it's health, it's innovative and it's digital.   Big deal. Without standards it's likely chaos. Unfortunately, IT vendors are mostly interested in 'locking-in' their customers.  Other benefits are mostly incidental. Disagree?  Re-read the last IT contract you signed...

“Strategic insanity is doing the same things as everybody else and expecting better results.” (A paraphrase of Albert Einstein.) A recent Harvard Business Review article talked about overcoming hidden cognitive limitations.  “Strategic leaders must be practitioner psychologists who expertly analyze and manage their own and others’ thought processes…identifying successful strategies that are different, unique and distant from the status quo.” Amen.  But not always a comfortable place to be is it?  Telling your organization that thought processes need to change, that they're outdated and predictable.   That the status quo should be avoided because of its limitations, not prized for its stability. So the job of a strategist is to reframe thought processes and mental models.    Let's do a deep dive into the weeds of health care thinking and modeling to see what shakes out.   And let's assume that you, dear reader, are serious about creatin...

MedCity News: Healthcare innovation has a speed-to-market, speed-to-acceptance problem.

Bob Lutz attributes the auto industry's decline to the pervasive influence of 'bean counters' - MBAs who know the price of everything and the value of nothing.  From a review of his new book "Car Guys vs. Bean Counters:" "The only time Apple ever lost the plot was when it put the M.B.A.s in charge. As long as college dropout Steve Jobs is in the driver's seat, customers (and shareholders) are happy. The reason is clearly the one Lutz puts forward in his book: 'Shoemakers should be run by shoe guys, and software firms by software guys.'" And car companies by car guys and, dare we say, hospitals by health care guys and gals.  But which health care guys and gals, exactly?  We may know the answer to that thanks to Amanda Goodall PhD, a senior researcher at the Institute for the Study of Labor (IZA) in Bonn, Germany, and author of a study of top-performing health care organizations. Goodall's research finds that top-performers are more lik...