Read Sen. Dave Durenberger’s latest Op-Ed piece in Minneapolis’ StarTribune.
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.
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.
“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.
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.
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).
This post was originally published on NIHP.org.
For more than the 33 years since I was elected to the U.S. Senate, members of Congress have been working to bend the national health care cost curve. Mainly by changing how the Medicare program pays health care providers. In 1993, President Clinton focused both on Medicare and on other policies to reduce the impact of cost drivers in health care. For example, he sought to expand insurance coverage to every American. He was defeated in this effort by Republicans, led principally by House GOP leader Newt Gingrich who went on to become Speaker when Republicans won the House in the 1994 election.
Democrats in Congress and President Obama were more successful in 2010. They passed the ACA which, besides targeting the cost drivers in health care and accountability in Medicare payment policy, expanded coverage and set important national policy goals of healthy people, healthy communities and a reformed health care payment and delivery system. As they did in 1993, Republicans opposed the ACA and have unanimously sworn to repeal and replace it should they win the presidency in 2012.
So it’s news that a House Republican and Senate Democrat, who are both health policy aficionados, have agreed to work jointly on a plan to privatize the Medicare program and to limit the amount of federal spending on Medicare,
This article was originally published in the spring 2012 issue of B. Magazine.
In 2001, the Institute of Medicine published Crossing the Quality Chasm, a seminal work identifying the chasm between what is known about providing high-quality health care and what actually is being delivered. Ten years later, this chasm still exists and was a key factor leading to the publication of Make It Happen: Effective Execution in Healthcare Leadership, a book published by Health Administration Press, a division of the Foundation of the American College of Healthcare Executives.
As director of the Center for Health and Medical Affairs at the Opus College of Business, I long have been engaged in the health care delivery system throughout the Midwest and the nation. The focus of the center is to “support improvements in the leadership and management of health care systems through research, community outreach and the collaborative development of innovative professional and executive education programs.” Conducting research for and writing this book not only furthered the goals of the center but can, as a member of HAP’s editorial board notes, “advance health care leaders from developing a plan and letting it sit on the shelf to full and robust execution.”
The failure to execute is a common problem in many organizations but more so in health care. Barriers include an incredibly complex system, splintered leadership, strategies that vacillate between financial goals and patient care, and no external pressure strong enough to force change.
Effective execution, however, is the key to high performance for most of America’s successful corporations. Executing strategies effectively and quickly is well-known in the general business world, but it appears not to have crossed the chasm into the health care field. One way to bridge this gulf is to provide more effective education and training to health care leaders nationwide in the area of practical and efficient execution.
In 2009, during the Health Care UST MBA Washington, D.C., seminar, I had the opportunity to meet Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality. A primary goal of AHRQ is to improve the processes needed to effectively move major clinical research findings from scientific literature to widespread use by the clinician.
AHRQ agreed to provide funding to the Opus College of Business to develop a new, effective execution curriculum for health care leaders and managers. For more than a year, I consulted with OCB faculty members on best business practices outside of health care and also visited some of the leading health care delivery organizations in the Midwest, including HealthPartners, Essential Health – Duluth, Marshfield Clinic in Marshfield, Wis., and Twin Cities Orthopedics to examine their systems for execution.