Leadership, Operations Improvement

What the Science of Motivation Can Teach You about High Performance


Daniel Pink

By Cindy Lorah

The opening keynote address of the American Medical Group Association (AMGA) meeting in Orlando, March 15, featured Daniel Pink, author of A Whole New Mind and Drive, who shared his insight on the science of motivation and some of its implications for health care.

First, he looks at our “intrinsic” knowledge of motivation – what people generally believe and act on regularly. Namely, that rewarding a behavior gives you more of it and punishment for a behavior gives you less.  Social scientists have basically been testing this “hypothesis” for years, and the result is that “sometimes” this holds true, but not nearly as often as we generally think…and this can lead to big mistakes.

This type of “IF – THEN” motivation (IF this action happens, THEN you will get this reward/punishment) has been shown to be great for simple and short-term tasks. However, it is not great for complex, long-term situations. One key study showed that as long as a task involves only mechanical skills, bonuses work as expected. However, once the task calls for “even rudimentary cognitive skills,” a larger reward led to poorer performance. Although this may seem wrong on a profound level, it is not surprising to social scientists. People love rewards and tend to focus intently on achieving them. However, if people need to think creatively and multi-dimensionally, you do not want to motivate single-minded focus.

An example pertaining to health care are studies looking at pay-for-performance initiatives. One study showed there “is not evidence that financial incentives can improve patient outcomes,” and a second showed that there is no evidence that pay-for-performance in hospitals led to a decrease in 30 day mortality.

To be clear, it is a fact that money is a motivator. It matters a lot, but its effects are nuanced. People are exquisitely tuned to norms of fairness. People need to be paid enough to “take money off the table” and to be perceived as being paid fairly.

Assuming “fair” compensation exists, there are 3 motivators for enduring performance:  Autonomy, Mastery, and Purpose.  Continue Reading


The Value Imperative: The Impact of Value-Based Care on Medical Products Marketing

By Cindy Lorah

Recently, the Health Care UST MBA at the University of St. Thomas convened a discussion on the changing landscape of purchasing decisions as care delivery systems evolve to value-based, population models such as ACO’s. This event was part of the MN Chapter of the American Marketing Association’s Health Care Special Interest Group series. The panel included:

  • LeAnn R. Born, vice president – supply chain, Fairview Health Services
  • Pat Courneya, M.D., health plan medical director, HealthPartners
  • Steve Swanson, M.D., president, John Nasseff Neuroscience Institute, Allina Health
  • Moderated by Mark Morse, principal, MORSEKODE agency.

The program provided a valuable perspective for medical products organizations struggling to understand the new reality and its implications for their market and development strategies.  The conversation broadly addressed three questions:

  1. What are the characteristics of the new reality?
  2. Who will be the key influencers in purchasing decisions?
  3. How can suppliers effectively demonstrate value and thrive in the new decision-making environment?

Continue Reading

Financing, Health Policy, Leadership, Operations Improvement

Improved Economic and Employee Health is Goal of Blue Zones Strategies

37740635By Stephanie Hegland, MBA

In this age of health care reform, corporations are looking to innovative care delivery models – such as accountable care organizations and patient-centered medical homes — to bend the proverbial cost curve by improving the health and well-being of their employees. Recently, Kare 11 News profiled a different approach to improving employee health by implementing Blue Zones principles.

Salo, Oberon and NumberWorks – three affiliated Minneapolis contract staffing companies – became the first organizations to seek a Blue Zones Certified designation. “Workplaces with greater well-being have fewer health care costs and are among the best places to work,” said Dan Buettner, founder of Blue Zones, when he introduced the six-month initiative last September. The Blue Zones Certified Workplace designation is his effort to systematically create an environment of health by focusing on four optimal behaviors: move naturally, have the right outlook, eat wisely, and connect with family and friends.

Collectively, Blue Zones principles represent what Buettner has discovered during his global research to identify communities where more people reach the age of 100 than anywhere else, communities which he termed Blue Zones. Continue Reading

Health Policy, Leadership

Checking the vitals of health reform


“But in Washington, political polarization now stands in the way of what must be the next leg of the health care journey: making improved health and reduced health spending part of our nation’s fiscal strategy.

I am not talking about balancing federal budgets by shifting costs to consumers, providers or the private sector.

I am talking about real reform.”

What does “real reform” look like? Dave Durenberger explains in an opinion piece published at Politico.com.

Financing, Health Policy, Leadership, Operations Improvement

Optum’s strategy for ACO development

docsMinnesota is proud to be the home town of UnitedHealth Group (UHG), the largest health insurance and health services company in the United States. UHG provides services to over 97 million Americans.

On January 31, 2013, Chris Pricco, senior vice president of accountable care solutions at Optum, presented the UHG perspective on accountable care organization (ACO) development over the next 5 years. This event was co-sponsored by the Minnesota Chapter of the American College of Healthcare Executives.

If you were to attend one event that would encapsulate the future of the American health care system – this was the event. Here are some key points from Mr. Pricco’s presentation.

The most important trends in health care delivery today:

  • Providers are under market share, profitability and consolidations pressures
  • Cost shifting is rising to unsustainable levels
  • CMS is radically revising its payment methodologies
  • Commercial providers are implementing aggressive pay for performance systems
  • Providers are beginning to take and manage risk

As providers move into the ACO and quality payment environment, several key strategies must be effectively executed:

  • Redesign the organization’s care delivery model to be attractive to the market
  • Develop methods to manage risk
  • Optimize contracts with payers and providers in the system
  • Effectively integrate all providers into the system
  • Measure and improved consumer engagement
  • Increase effective branding and marketing at the retail level

The need to move from a fee-for-service environment to a value-based payment system is challenging for most delivery systems. However, Optum’s experience is that this shift is happening to all systems today.  Continue Reading


The Challenge and Opportunity with Big Data in Health Care

By: Daniel McLaughlin, M.H.A.

The expansion of Electronic Health Records is presenting an unprecedented opportunity to make significant improvements in the American health care system. However, for this opportunity to be realized, new methods of data management and analysis that are uncommon in health care will need to be deployed.

Organizations that have mature electronic health records have conquered the challenge of moving data from operating systems into data warehouses and are using them for substantial improvements. For example, a question that had challenged researchers for many years was whether traditional low-priced blood pressure control was as effective as newer, more expensive drugs. To answer this question, NIH conducted an extensive trial that took eight years and cost $120 million. The results indicated that: the oldest and cheapest of the drugs, known as thiazide-type diuretics, were more effective at reducing hypertension than the newer, more expensive ones.

However, some patients did not respond to these drugs and needed to use the newer drugs – but which ones? Unfortunately, NIH did not have the funds to conduct a follow up study. By the time the NIH study was complete, however, Kaiser Permanente had an extensive electronic health record and data warehouse. By using real patient data in their warehouse and traditional statistical methods, the researchers had the answer in 18 months for $200,000.

Although traditional scientific methods and statistical tools work well for some health care questions, they cannot be easily applied to many interesting questions such as:


  • Which doctors have the most cost effective risk adjusted care patterns based on actual cost of care – not charges?
  • What are the characteristics of patients that can predict the level of non-compliance with discharge orders and the probability of re-admissions?

The challenge of answering these questions is best illustrated by the complexity of the data bases. A standard electronic health record for a patient will have over 2,700 fields. A charge master for a hospital can easily contain 20,000 separate services and prices. Traditional statistical methods flounder in this environment.

Fortunately, data mining professionals (particularly in retail) have developed new tools such as market basket analysis, classification algorithms, association rules, cluster analysis and neural networks to understand these massive data bases. Hopefully, these techniques will soon migrate to health care to support substantial improvements in care delivery.

To learn more about how the new tools of data mining and other technologies are changing the business of health care, attend the UST Executive Conference on the Future of Health Care on Friday, November 9, 2012 at the University of St. Thomas Minneapolis campus.