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. 

Autonomy

“Management” is a brilliant “technology” that has enabled a lot of growth, but it has a single focus – compliance. Increasingly, organizations are looking for engagement, not compliance. People don’t get engaged by being managed – they need to “get there by their own steam.” Great bosses are characterized by those who have high standards and provide a high level of autonomy.  When people are given an amount of sovereignty over 4 T’s – Time, Technique, Team & Tasks – they will perform at a higher level.

A good example is Facebook’s hiring practices. The organization hires talent, but follows this by internal interviews that allow the teams to decide which group is the best fit for each new hire.

Other examples include the creation of “islands of autonomy” in which employees are encouraged to carve out regularly scheduled times (an hour or two per week, for example) to specifically focus on innovation, ways to better serve clients, or (in the case of Mayo Clinic) to do whatever they WANT. These initiatives have been shown to increase engagement, increase the number breakthrough ideas, and decrease burn-out.

Mastery

People like to do things they can get better at. This is a widely ignored phenomenon, but explains our interest in sports, playing musical instruments, etc. A Harvard study did an extensive study of daily work motivation and found that the biggest motivator is “…making progress in meaningful work.” This involves feedback, which most organizations are not set-up to provide well! Younger workers, especially, have grown up in a technological world that provides rich, regular, robust feedback. Compare this to the annual review process that provides irregular, untimely, usually unhelpful feedback. We need to work on increasing the “metabolism of feedback” in organizations and can start with encouraging people to “own” their own performance reviews by keeping track of their daily accomplishments and goals. He recommends the free version of iDoneThis, which will send you an email at the end of each day asking you what you accomplished and chronicling it for future reference.

Purpose

People have a strong desire to feel a sense of purpose. Many hospitals, for example, have struggled with how to get clinicians to wash/sanitize their hands. In a study that compared the effectiveness of different messages encouraging hand hygiene, only the one that emphasized the benefits to the patient was effective. Managers typically spend a lot of time on how things should be done and give short-shrift to why they should be done. Bringing the why to the surface (especially in health care, where the why is so critical) is a powerful motivator.

Pink encourages checking out the resources and “autonomy audit” at his website: www.danpink.com

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?

What are the characteristics of the new reality?

• Focus on the Triple Aim. Work to 1) maximize the health of the population, 2) improve patient experience, and 3) do so at a lower cost. This focus has implications for all sectors of health care.
• Evidence and transparency. As providers get more comfortable with measures, they are demanding it from their partners as well. In this part of the country, there’s a clear goal of seamlessly blending health records and claim records to support data-driven decision making throughout the system.
• Total cost of care. Focus on maximizing value throughout the continuum of care, which is broadening to include population health starting with prevention (when possible), incorporating chronic disease management, reduced hospitalizations, home health, etc…all the way through end-of-life care. MN Community Measurement is now moving forward with a Total Cost of Care measure to provide transparent ways to compare full episodes of care across provider systems.
• Wellness and prevention. Throughout the industry, there is a shift from an interventional message to a wellness and prevention message. When there is conflicting data, which do you trust? Many stakeholders are looking for ways to develop authenticity and connect all sources of patients’ health information & influence.
• Experimentation and uncertainty: Provider organizations are struggling with how to move away from fee-for-service models to value-based models, incorporating shared savings, care delivery model innovation, new partnerships and new value propositions. Most are still being paid in large part as fee-for-service and being held accountable to historic profitability measures. Former profit centers will quickly become cost centers if they don’t adapt quickly to their evolving payment structures.

Who will be the key influencers in purchasing decisions?

• In health care systems, those with the data to understand quality outcomes and long-term value will be key influencers. Integrating EHR data, plan information, and spend information to make better decisions is the goal. Specific decisions will depend on the type of product:
  • When purchasing commodities, systems will no longer automatically buy from group purchasing contract lists, but will evaluate the data for best long-term value.
  • Specialized decisions are (or will soon be) no longer made solely by physicians, but will be influenced by quality committees, data analysts, supply chain departments, professional associations, etc. One of most powerful tools is doing doctor to doctor comparisons showing best practice outcomes within an organization and across a profession.
  • New products. It is very hard to prove with data that a new technology is really worth the increased cost. Triple Aim considerations must be built into the entire design and development process, but at this point most systems can only assess short- to mid-term economic impact.
  • Patients are increasingly influencing treatment decisions. In Minnesota, approximately 30% of health plans are high deductible, so patients are demanding more information about options, cost, quality, and outcomes.  “Shared decision making” between patients and clinicians that takes into account the patient’s personal health goals and focuses on better educating patients about what will truly lead to better outcomes has shown that patients make more conservative, less expensive decisions, with more satisfaction and faster recovery because they are engaged and have buy-in to the decisions and outcomes. New players (such as Consumer Reports) and new technologies are creating tools similar to those found in other industries to educate consumers.
  • Employers are demanding value for their employees to hold down premiums and promote a healthy, productive workforce.
  • Government continues to be a big decision maker, controlling Medicare and Medicaid reimbursement.

How can suppliers effectively demonstrate value and thrive in the new decision-making environment?

• FDA approval is not enough – it is a very low bar from a reimbursement perspective. From the outset, Triple Aim objectives must guide product design to address not just that it works, but that it’s necessary and adds value to the system.
• Flexible strategies. Manufacturers need to create strategies that are flexible enough to address global market differences. This region is very data-driven, but each region of the country and the world will have different needs and expectations.
• Long-term vs. short-term economic impact is still difficult for payers and providers to assess. Most in this region are currently looking at “mid-term” impact. They are looking beyond an episode of care (such as a single surgical procedure) to total cost of care a few months to a year out, including infection rates, hospital readmission rates, etc. Long-term costs are still hard to measure. Data analytics are not where they need to be and there is a lot of mobility in the system, so longitudinal data is hard to track. Kaiser Permanente has been doing this for long enough that they are now demonstrating effective life cycle value analysis. This is the long-term goal and the more expensive the treatment, the more it will be looked at. Well-organized groups will be able to see what products / treatments are really working. From a marketing perspective, partnering on this on-going analysis to help create valuable long-term data will be important.
• Support transition to new payment models. The current transition between traditional fee-for-service payment models and evolving value-based models is difficult for the operational leaders of hospitals and specialty practices. Budgetary responsibilities still lead to misaligned incentives. For example, oncology groups earn a lot of their profit administering oncology drugs. HealthPartners’ health plan is now off-setting the differential, so groups are not incented to prescribe higher margin drugs. US Oncology is opening up their best practice guidelines to support value-based decision making.
• Comparative effectiveness. Often new products have incremental benefits for a subset of a population.  Suppliers can add value by helping providers understand how to best match alternatives to realize the best advantage for each population.

Take away: No one will be able to sell anything without the data to show value and support of the Triple Aim.

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. The nine lifestyle characteristics common to Blue Zones residents were profiled in his book, The Blue Zones:  Lessons for Living Longer from the People Who’ve Lived the Longest (2008). Following  a five-year study of the happiest people in the world, Buettner published Thrive: Finding Happiness the Blue Zones Way (2010), which catalogues the six dimensions of life which most influence authentic happiness.

Many of the behaviors exhibited by those living healthier, happier and longer lives are not unlike those promoted by physicians in Western medical clinics: eat more fruits and vegetables, move more, sit less, decrease stress, and surround yourself with supportive, encouraging, and healthy friends. Additionally, Buettner’s research found the longest-living people also have a life purpose, stop eating at 80% full, drink alcohol moderately, belong to a faith-based community, and put family first.

The Blue Zones Community initiative, in partnership with AARP, the University of Minnesota’s School of Public Health and the United Health Foundation, applied the same tenets found in the Blue Zones book to residents of Albert Lea, Minnesota. During a year-long pilot, participants made small lifestyle and environmental changes to improve eating habits, increase activity, create greater social connection and establish a clear sense of purpose. Residents lost a combined 12,000 pounds, increased life expectancy 3.1 years, reduced absenteeism by 21%, and showed a 40% decrease in health care costs. Subsequent Blue Zones Communities were launched in California and Iowa, and continue to deliver similar results.

Buettner is internationally recognized as a researcher, explorer and best-selling author, who founded Blue Zones to implement the best practices discovered in his travels into the everyday lives of people everywhere. In addition to presenting, writing, and blogging about his findings, Buettner has developed educational curriculum to challenge youth to explore, question and act in ways that promote health and happiness. His website features checklists to score and offer improvements in your home environment and social network.

References:

http://www.kare11.com/news/article/1007602/391/Minnesota-company-reaches
-for-Blue-Zone

http://www.bluezones.com/about/

http://www.sph.umn.edu/outreach/engagement/bluezones/

http://www.aarp.org/health/brain-health/info-01-2013/finding-happiness-blue-zones.html

http://www.multivu.com/mnr/58201-salo-first-blue-zones-certified-workplace-employee-health-wellness

“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.  Those systems that move quickly into this new reality are the most successful.

UHG has comprehensive data on care delivery performance and costs throughout the United States. The difference between market leaders and typical providers is remarkable.  If all providers performed as well as the market leaders the cost of healthcare  in the United State could be reduced by 15 to 20%.

Today there are approximately 200 ACOs currently operating in the United State in both the commercial and Medicare markets. It is interesting to note that more than 5 million Medicare beneficiaries now receive their health care in ACOs. Optum projects that there will be between 700 and 1000 ACOs in 2016. They also project that many of these organizations will add certain insurance features, become certified health plans and will be offered in the state-based health insurance exchanges (now called marketplaces).

The health care industry may be at a tipping point. Consider the dramatic change that may occur when ACOs come to the health exchanges with superior quality and 20% lower cost. As market shares shift dramatically, those organizations that are slow to respond to the ACO trend will either merge or cease operation.

Although these forces may be painful for some organizations, an optimist can foresee a future American health care system that consumes only 12 to 15% of the GDP and delivers high quality care to highly motivated and engaged patients.

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.

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. Two years prior to the Accountable Care Act of 2010, the city of New Ulm, population of 13,500, became the target of a community prevention project called Hearts Beat Back: The Heart of New Ulm Project. The 10 year goal of the project is to reduce the number of heart attacks in the community of New Ulm through the collaboration of the community. Once again, Minnesota rises to the challenge of such community health ahead of the curve.

As I learned more about the Hearts Beat Back initiative, I realized I wanted to capitalize on the connections Senator Durenberger provided us by inviting Regina Benjamin, M.D., M.B.A., the United States Surgeon General, to visit Minneapolis and New Ulm. Her presence would heighten national attention to the trailblazing efforts in Minnesota.

Tina agreed to co-chair the planning committee with me. Tina and I believe health care is local. Creating a healthier culture within a community is vital to empowering individuals to actively manage their own health and well‐being. Together with Cindy Lorah and Sandy Bauer of the University of St. Thomas, we embarked on an adventure to discover more community-led health initiatives from around the state of Minnesota. A two-day event was the result of our efforts.

On September 28 and 29, University of St Thomas will sponsor the Healthy Minnesota: Communities in Action event along with the Minnesota Public Health Association (MPHA) and the New Ulm Day of Play with the Hearts Beat Back: The Heart of New Ulm project.

On Friday, September 28 from 3 pm to 6:30 p.m., a poster session and interactive discussion will be held in coordination with the MPHA annual meeting. The purpose of the poster session is to highlight some of the best examples of community-led health initiatives from throughout the state. Grassroots community health and wellness projects are encouraged to participate.

A panel discussion on “Healthy Minnesota: Getting Communities into Action” will be held from 4 p.m. to 5:30 p.m. Representatives from the Hearts Beat Back (Heart of New Ulm Project), Do.town (Blue Cross Blue Shield of MN), Healthy Hennepin (Hennepin County), and Community Health Partnership (Allina Health) projects will discuss challenges of engaging and creating stronger, healthier communities. It will be moderated by Commissioner of Health, Dr. Ed Ehlinger. The panel discussion will be followed by comments from former U.S. Senator Dave Durenberger. Closing remarks are expected to be made by the Surgeon General of the United States, Regina Benjamin, M.D.

On Saturday, September 29, Dr. Benjamin is expected to travel to New Ulm, accompanied by me and Senator Durenberger. She will make opening statements for the New Ulm Day of Play, held on the campus of Martin Luther College (MLC). The Day of Play is a worldwide event created by Nickelodeon in 2004 to encourage parents and children to turn off the television and get physically active. In New Ulm, the Day of Play will consist of 20 different activities for families to experience together. Kite flying, double-dutch, folk and Zumba dancing, horseshoe pitching are examples of family activities that will be available.

The significance of prevention and the role of community in creating a healthier culture are vital to empowering individuals to actively manage their own health and well-being. Please join the students of University of St Thomas’ Health Care UST MBA program as they showcase the accomplishments of Minnesotan communities.

Laura Templin-Howk is the Laboratory Supervisor for St Francis Regional Medical Center in Shakopee, MN. She is currently a student in Cohort 18 of the University of St Thomas Health Care UST MBA program.

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. One emerging role in the reform environment is that of patient advocate or integration specialist – individuals who can help patients navigate the complex system called health care; individuals who assist the whole person with coordination of care efforts, act as the leader of a patient’s integrated health care team, and understand how to improve patient quality of care while driving down overall cost of care.

An increasing demand exists for expertise in the area of data collection and analysis – first to gather, mine, and provide structure to all the data the new technology has provided; next to evaluate, translate, forecast, predict and communicate trends found in the data. This includes understanding and dissecting data from a clinical, financial, technical, policy and business perspective.

Another significant area of job growth is the emerging role of wellness coach – individuals who can help patients close the gap between where they want to be (from a health and lifestyle perspective) compared to where they are today. A recent article [iii] on WebMD profiled a Minneapolis physician and clinic that has embraced the practice of referring patients to wellness coaches. As the article suggests, physicians are tasked with helping patients’ live longer, healthier lives, but 98% of the responsibility is owned by the patient. Wellness coaches encourage and support efforts to improve diet, increase exercise, and address emotional health, all of which move patients along the continuum toward improved health.

The key competencies identified as critical for future healthcare workers are: an understanding of bodies of knowledge, possessing emotional/social intelligence, critical thinking skills and enterprise intelligence. Successful health care professionals will need a broader understanding of the many issues involved in developing an integrated approach to health care delivery; they will need to analyze the abundance of data now available and spot trends that lead to improving quality, and they will need to understand the breadth of the enterprise to hone in on cost drivers. Those professionals that created the health care system of today may not necessarily be the same individuals with the necessary skill sets to pave the path of tomorrow.

Stephanie Hegland is a principal product consultant at BlueCross BlueShield Minnesota. Hegland’s health care experience includes two years in health & wellness program management at Blue Cross, and over 13 years in medical sales. Prior to entering the field of health care, Hegland spent four years in corporate communications. Hegland is passionate about combining her communication expertise and health care insight to distill, decipher and report upon important developments and activities within the health care industry. Hegland holds an M.B.A. degree from the Health Care UST MBA program.

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, the health insurance program on which 46 million aged and disabled Americans have come to depend because they have been taxed to prepay a part of the premium costs all their working lives.

Proposals to privatize Medicare are not new. With authority from Congress, Medicare piloted them successfully with risk-bearing HMOs starting in 1985. In regions of the country with integrated care systems the HMO was successful in substantially reducing Medicare spending – from 15% to 17% in Minneapolis-St. Paul and Rochester in just two years. Because there was intense competition among private HMOs, and because nearly every doctor had to belong to one or the other of them, the result was bending the cost curve for non-Medicare patients as well.

Unfortunately, much of the country didn’t know what an HMO was. Doctors, hospitals and insurers were doing just fine under traditional Medicare’s fee-for-service system, so they resisted the opportunity to be part of an HMO. Fact is, the AMA had been fighting HMOs for decades in their historic battle against “corporate medicine.” Private HMOs like Physicians Health Plan in Minneapolis “went public for-profit,” began acquiring HMOs in other parts of the country, and is now UnitedHealth Group. BCBC non-profits converted and more than half of them nationally are now Wellpoint or other for-profit companies.

These companies supported privatization of Medicare (like Medicare Advantage today) but insisted on getting paid more than traditional Medicare or they wouldn’t compete. In 1998, the managed care plans fought efforts by a Republican House in the Balanced Budget Act of 1997 to require them to bid competitively for Medicare business. Republicans in Congress caved to their entreaties “to protect medical insurance markets.” And health care costs measured by insurance premiums and uncontrolled by any sensible payment policy, went right back up.

Read more about Senator Durenberger’s analysis of the Ryan/Wyden Medicare reform proposal.