In a letter to the editor to the Mankato Free Press, Dave Durenberger talks about how the ACA is an important part of the journey of health reform.
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. Read the rest of this entry »
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:
- What are the characteristics of the new reality?
- Who will be the key influencers in purchasing decisions?
- How can suppliers effectively demonstrate value and thrive in the new decision-making environment?
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. Read the rest of this entry »
“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.
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. Read the rest of this entry »
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.
By Stephanie Hegland
What started as a health care policy class last spring for Health Care UST MBA students Laura Templin-Howk and Tina Morey, culminated September 28, 2012, in the Healthy Minnesota: Communities in Action Poster Session and Forum, featuring closing remarks by U.S. Surgeon General Dr. Regina Benjamin. Inspired while being in Washington D.C. during the arguments before the Supreme Court on the legality of the Affordable Care Act (ACA), and encouraged by the legislation’s financial support for proactive, preventive measures (Title IV, Subsection D, “Creating Healthier Communities”), Templin-Howk and Morey sought to showcase Minnesota’s trailblazing community-driven initiatives. And showcase they did, by pulling together 40 examples of why Minnesota continues to lead the nation in healthcare innovation.
Community-led projects throughout the state highlighted the work already being done to improve the health of our communities. Each poster presenter spoke to their projects’ individual mission, success and lessons learned. A PDF of the program which contains descriptions and contact information for each project can be found on the event page: http://www.stthomas.edu/business/degrees/ustmba/healthcaremba/events/2012-09-28_Healthy_MN.html. These projects frequently showcased partnerships between communities, healthcare providers and systems, ancillary providers, community agencies and school districts. Let’s face it; it’s not a secret that greater physical activity, eating more fruits and vegetables, regular health screenings, and increased collaboration between providers leads to improved health outcomes for the state’s population. But how to accomplish these improvements? Therein lies the challenge. And further, how will policies, systems and environmental changes be modified to sustain these improvements?
In addition to the posters, a panel of presenters, moderated by Minnesota Commissioner of Health Dr. Edward Ehlinger, discussed what was learned while implementing the community-led initiatives of Allina’s Healthy Communities Partnership, Blue Cross Blue Shield’s do.town, Hennepin County’s Hennepin Health and New Ulm’s Hearts Beat Back. Dr. Ehlinger kicked off the discussion by calling for a need to balance healthcare investment between treatment and prevention, and to create healthier communities that make it easy for individuals to (make the healthy choice the easy choice. According to Dr. Ehlinger, 40% of behavior that impacts health occurs where we live, work, play, learn and pray. It is these types of initiatives, occurring in the community, which set the stage to change the policies that will lead to improved health outcomes for all citizens.
Some key discussion points addressed by the panel:
- Push for continued public investment, as provided through the Minnesota Department of Health Statewide Health Improvement Program (SHIP) grants. Government funding allowed projects to experiment with new ideas, share resources/materials developed with interested parties, expand initiatives to worksites and drive community engagement.
- Encourage collaboration among health care providers that were once perceived as competitors. When providers join together, patients experience comprehensive health care, less duplication of efforts, and improved outcomes at less cost.
- Move prevention upstream (from a financial perspective). Frequently, the current health care model funds crisis – people enter the health care system through an acute care setting, often when they are ill. Rather, the health care model needs to evolve to greater investment in prevention and community engagement prior to illness. Additionally, the model needs to reward providers for keeping patients healthy, rather than treating the sick.
- Engage community members – allow them to drive change, rather than be passive recipients. Success was nearly guaranteed when project teams asked community members what changes they wanted to see, what changes they needed in their neighborhoods, and how to achieve sustainable improvements (both financial and tactical).
- Change social norms around what constitutes healthy behavior – encouraging communities to be accountable for themselves and each other.
- Recognize roadblocks – time, a health care system that’s based on payment for sick people, prioritizing multiple expensive interventions, and “changing behavior in mid-air while needing to still fly the plane.”
Senator Dave Durenberger concluded the discussion by saying “these projects bring out the ‘we’ instead of me”, and introduced Dr. Regina Benjamin. She complimented the panel and poster presenters for representing many of the strategies outlined by the National Prevention Council. And she congratulated Templin-Howk and Morey for demonstrating the leadership needed to engage all communities toward improved health.
In March of this year, the Health Care UST MBA cohort 18 experienced an opportunity of a lifetime. We were in Washington, D.C., as the opening arguments for the legality of the Affordable Care Act (ACA) were presented to the United States Supreme Court. Whether we agreed or disagreed with the content, the ACA was the most significant health care legislation to leave a president’s desk since the passing of Medicare in 1965. Through the influences of Senator Dave Durenberger, we were introduced to more than 25 political players who were all candid about their ACA opinions and their predictions of the Supreme Court ruling.
Fellow student Tina Morey and I left Washington, D.C., with a revived sense of hope that a paradigm shift in health care is on the horizon. Title IV of the ACA, “Prevention of Chronic Disease and Improvement of Public Health,” was the first legislation to place financial support for proactive, preventative measures. Title IV Subsection D, “Creating Healthier Communities,” provides an outline to encourage the funding of local projects that are created with the intent of population-based prevention programs through Community Transformation Plans. The beauty of this section is to encourage bottom-up, localized creativity in addressing community health concerns. Healthier schools, healthier food options, physical activity opportunities, promotion of healthy lifestyles, emotional wellness, prevention curricula, activities to prevent chronic diseases, infrastructure creation, racial and ethnic disparities reduction are all possible components of Community Transformation Plans.
We did not have to look farther than our backyards to see active examples of healthy community initiatives; in my case, the golden nugget was in my hometown of New Ulm, MN. Read the rest of this entry »
There is a great deal of discussion regarding the issues that exist in health care, and even more speculation around how the upcoming election will impact the full implementation of health care reform. However, there does not appear to be clear direction or definition around the type of work force needed to lead the transformation.
A recent presentation [i] about Minnesota’s health care workforce presented the following facts:
- health care sector accounts for 13% of all employment in the state
- health care and social assistance sector represents nearly 1 in 5 job openings in Minnesota
- health care jobs continued to grow during the recent recession, while total employment fell
- health care sector is, and will continue to be, the leading area for job creation through 2020.
And last week’s press release [ii] by the Minnesota Department of Employment and Economic Development, stating job vacancies are up 15.1% in Q2 2012 compared to Q2 2011, confirmed that the health care and social assistance sector accounted for the largest number of job vacancies (16.5%) in the state.
There is familiarity with the drivers that are demanding more health care workers: Technology (IT, EHRs), Medicine and Care (telemedicine, virtual care, Triple Aim), People and Wellbeing (aging population, retirement, consumer empowerment), Economics and Finance (cost of care, reimbursement models), and Policy and Regulations (health care reform, quality measures, ACOs).
However, there seems to be less knowledge of the needed roles and required competencies. Read the rest of this entry »