The winter Olympics are complete and we are now able to reflect on some of the key performances at the event. As I reflect on the many events I watched, I was amazed at the slim margin that separated the first place from second place.
The March 11th issue of the New York Times had a chart entitled "Fractions of a Second: The Margin Between Gold and Also-Ran." In this chart it highlights that in the blink of an eye a person can go from getting the gold medal to coming in second. Some examples:
| Event |
Winning Time |
Seconds behind first place |
| Men's Downhill |
1:54.31 |
less than 0.25 seconds |
| Women's Giant slalom |
2:27.11 |
less than 0.25 seconds |
| Women's 1,000M speed skating |
1:16.56 |
less than 0.25 seconds |
The chart in the Times has many other events listed with the same time difference. When I read this I have to stop and wonder, what separated the gold medal winner from second place? Did they train harder, work longer, work smarter in the four years leading up to the Olympics? Was it their equipment, their coaching, their diet, etc? As I watched the Olympics these questions continued to circle in my mind and what I keep coming back to is how to answer these questions is with a simple YES! To get the gold medal requires you to work longer, harder and smarter. To constantly be looking for the best coaching techniques, the best equipment to push them to be the best is the heart and soul of an Olympic champion.
This same intensity can apply to business. Who are those leaders in the market? What keeps them on top or pushes them to displace the "gold medal winners of the past?" It comes down to doing the little things well. Daily looking at ways to improve or see what your competitors are doing and figuring out ways to differentiate yourselves. It's constantly looking at ways to reinvent your business as the market changes and knowing where you can be successful. It's the little things that add up to the big wins. I came across this video a few months ago that I think highlights the gold medal winners in business from those who finish second. Take a look. I would love to hear your thoughts.
Emergency room visits are going up. In fact, in a recent survey published in Health Leaders magazine and Thomson Reuters, it showed that between 2007 and 2009 emergent visit rates increased at more than 12% annually.
However, it is also important to note that in today's medical schools less than 5% of the graduating class are going into primary care. If we are going to expand coverage to an additional 30 million individuals, who is going to treat these patients? In simple economics we have a supply and demand situation.
As politicians discuss healthcare, we often hear the word "quality" used as a way to reward or eliminate waste from the system. I think we all agree that quality is key for healthcare, however, the challenge is agreeing on what "quality" of care looks like.
What measurement criteria will be used? Will it be based on outcomes or the patient experience, or both? For years, the quality discussion has been part of the debate and how things will be paid based on quality. We need to define what that means.
Yesterday, we began a bipartisan discussion to revamp nearly 1/5 of the US economy. We heard arguments for and against certain parts of the proposed bill. There was a lot of posturing during the discussions and strong arguments made by both sides. However, there are certain nonnegotiable that I believe need to be agreed to.
For any change to truly impact the rising costs of healthcare, we must have transparency. What does transparency mean as it relates to healthcare? Simple. All providers must publish their pricing for services. A simple idea but a key element to in taking the first step to saving money. We must get transparency into the discussion and from that, allow consumers to take a more active role in their healthcare purchasing.
Healthcare is one of the few remaining areas of purchasing where a consumer enters the system with little to no knowledge of what the charges will be. To truly get costs under control, the consumer will have to play a more active role in what the charges will be.
On Thursday, February 25, President Barack Obama is calling on lawmakers, in a bipartisan meeting to present their best ideas on healthcare reform. Leading up to the summit, the Center for Health Transformation (CHT) is hosting the "
American People's Online Health Summit," an online dialogue and live blog. I am one of the participating members presenting our ideas on constructive and meaningful payment reform that brings about true transparency and payment rationality in the market and would encourage each of you to go online to
http://www.healthtransformation.net/ and participate in this discussion.
With the recent announcement by some of the largest insurance carriers in the United States regarding rate increases and the continual issue of budget shortfalls of states to support Medicaid cost, we are at crossroads of having to make tough choices. We all desire greater access to quality healthcare for all Americans but in doing so we must develop a payment approach that is supportive to the consumer, provider and plan sponsor.
As I see it, in the coming weeks we will have three potential outcomes of the healthcare debate:
- A healthcare bill is passed no matter what. What the bill contains or the cost of the bill itself is secondary to the main issue of just "pass something." The stakes are high for both Democrats and Republicans if a healthcare bill is passed - no matter what the bill is.
- No healthcare bill is passed. In this case we start from scratch. In some ways this is good and in other ways will we end up in the same position today of having two polarized positioned on healthcare.
- Baby steps accomplished. In my mind the best scenario is for rational bipartisan thinking to take hold and work on those items we all can agree on. There are many components of the current healthcare bill that both Democrats and Republicans can agree on and we should focus on those items and work toward resolution.
We can no longer wait and assume Washington will figure this out. It will require all of us to participate and make our opinions know. Please join the discussion occurring on the Center for Health Transformation blog.
Over the last few months we have been bombarded by numbers. We can't escape numbers being quoted in the 24-hour news cycles. If you are like me, after a certain amount of "number discussion" I start to get immune to the enormity of the numbers. A quote that was originally attributed to the late Illinois Senator, Everett Dirksen (1896-1969) which he denied saying, "A billion here, a billion there, and pretty soon you're talking real money." This phrase about government expenditures has been resurrected as we debate the validity of government bailouts and proposed healthcare reform.
As I was reading the January 2010 issue of "Managed Healthcare Executive" there was an article by Julie Miller titled, "Healthcare's big numbers difficult to put in perspective"
The phrase attributed to the late Senator Dirksen echoed in my mind. Ms. Miller quoted the following statistics in her article:
- Healthcare accounts for a dramatic portion of the national economy - 16% of GDP
- U.S. Census Bureau, 2008 revenue totals for healthcare services, not including pharmaceuticals, reached $1.75 trillion, up from $1.66 trillion in 2007. That's a 5.7% gain.
- Physicians' offices earned $185 billion from private insurance, $74 billion from Medicare and $18 billion from Medicaid.
- Hospitals earned $307 billion from private insurance, $184 billion from Medicare, and $70 billion from Medicaid.
- In 2008, the American Hospital Assn. reported that Medicare and Medicaid underpaid hospitals and physicians by $88.8 billion.
- In the insured population, 14.3% were enrolled in Medicare, and 14.1% were enrolled in Medicaid.
- Based on these numbers, roughly one-third of the insurance payment received by providers in 2008 came from sources that underpay.
So what happens to the $88.8 billion that is underpaid to providers? (Remember it's BILLION, not million). You're right, it gets shifted to employers and private pay patients. Think of it as a hidden tax.
As our elected officials continue to discuss how to provide access to all Americans, (remember a key funding element for this access is through cuts to Medicare and Medicaid) deductibles and coinsurance continue to rise for individuals.
A billion here, a billion there and pretty soon there is no money left.
During my college football playing days I had a coach who would repeatedly say during the week of practice, "Men, failing to prepare is preparing to fail." This short pithy statement gets to the heart of doing what is necessary to win against your competition.
I recently attended the HCAA Executive Forum and was impressed with the speakers and emphasis on how to prepare for the ever-changing environment of healthcare. Today's market is requiring payers and their vendors to be flexible and more strategic in their approach.
One particular speaker I enjoyed hearing was Rich Horwath, who is president of Strategic Thinking Institute. The title of his presentation was "Deep Dive: Strategic Thinking for Competitive Advantage." In his presentation he shared how most organizations today have no strategy to effectively compete. Failing to prepare for the oncoming competition is preparing to fail.
Mr. Horwath is also the author of the book "Deep Dive" and I had a chance to read the book on my flight back to Dallas. In one of his chapters he has a quote that jumped out at me by former Coca-Cola CEO, Roberto Goizueta. "If you take risks, you may still fail. If you do not take risks, you will surely fail. The greatest risk of all is to do nothing."
If we in this industry are to effectively "prepare" for the future we must take risks. We are at a tipping point in healthcare. Employers are near breaking point in having access to affordable health coverage for their employees. Employees are near breaking point in being able to afford the insurance their employer provides. New programs will need to be implemented where costs are brought under control. To do this, new and innovative approaches will need to be tried. Some will be successful and some may fail. We can no longer wait. Just talking about giving everyone access to healthcare without dealing with the cost and affordability of healthcare is leading us down the path of failure. Failing to prepare is preparing to fail.
Recently Steve Jobs, CEO of Apple, made headlines again with the release of the iPad. Apple continues to "push the envelope" of new product innovation by providing consumers with breakthrough technology that assists in organizing and making their lives easier to manage. As I was reviewing all the headlines around the release of the iPad and how Steve Jobs continues to make a "dent in the universe" with innovative products and solutions, it made me think, what is the most innovative thing that has been released in the world of employee benefits? Think for a minute...I'll wait. It's hard isn't it? What really can be considered "breakthrough"? The list that I could come up with is small and outdated:
-
PPO's
-
Consumer Directed Health Plans
-
Health Savings Accounts
When I try to think of innovation in benefit design, I feel like I'm staring at an open box of 8 track tapes (for those who don't know what 8 track tapes are, just count your blessings).
I remember reading a commentary by a friend of mine, Maddy Bowling in Risk and Insurance dealing with this issue of innovation in healthcare, specifically as it related to worker comp. She reached the same conclusion. Innovation is sorely lacking. As consumers we are bombarded by innovation day-in and day-out. Our cell phones, TV's and computers continue to open a new world of possibilities. However, when you access the healthcare setting, you and I are confronted by a clipboards, paper and fax machines.
Picture this, as you are driving up to your doctor's office, you are on your cell phone emailing a proposal to your office, accessing the Internet to handle your banking and paying bills. You then walk into your doctor's office and are confronted with a clipboard filled with papers to fill out, faxing documents (yes faxing) and more papers to fill out.
We are at a tipping point in healthcare. We have raised our deductibles as high as we can. Our coinsurance is at maximums. Our PPO's are no longer "preferred" they are simply a list of all providers giving phantom discounts disguised as being "preferred."
Truly changing the industry requires us to take risks. Without taking risk, there will never be change. I'm proud of the innovation and risk taking we have taken at NCN to change the industry.
If healthcare is to survive, we must start thinking in terms of revolutionary ideas. We neither have the time or financial resources to continue in this evolutionary track we are on today. Fax machines, clipboards and paper....the clock is ticking.
Last week we had the honor and privilege of former Speaker of the House of Representatives, Newt Gingrich in our office. It was a great time to interact with Mr. Gingrich and his team. Our time together centered on how our organization is changing the face of how providers are reimbursed and value we bring in sharing this information is a fully transparent way. By focusing on a rational payment approach, we help create an environment where the sustainability of our healthcare delivery is achievable.
Mr. Gingrich gave us some valuable insights regarding the current views of healthcare reform in Washington and how our approach can have a broader application within the state and federal government. With the national discussion focused on access to healthcare, the need to have an equally important plan to effectively control cost is necessary for the sustainability of healthcare as we know it today. We are well positioned to have significant discussions with key leaders on a local and national basis to help bring a defensible, sustainable and rational approach to healthcare costs. We will be having many more meetings with Mr. Gingrich and his team from the Center for Health Transformation as we identify solutions for payment reform.
Many of us are familiar with the phrase, "the shot heard ‘round the world." The phrase originates in Ralph Waldo Emerson's
Concord Hymn, 1837 and relates to the start of the American Revolutionary War:
By the rude bridge that arched the flood,
Their flag to April's breeze unfurled;
Here once the embattled farmers stood;
And fired the shot heard 'round the world.
On April 19th, 1775, on Lexington Square the British Major John Pitcairn and his six light Infantry companies faced about seventy colonial militiamen. The details of the fight, and who fired the first shot, are disputed. What is clear is that this was "the shot heard 'round the world."
On Tuesday, Jan. 19th 2010, almost 235 years later in the same state where the phrase was coined, votes were cast that changed the landscape of politics (at least for this election cycle). I know it's extreme to say that this election had the same seismic effect as the battle that occurred in 1775 but what is clear:
- People are frustrated and feel government is not listening to them
- Healthcare although an important issue, cannot be viewed as one big massive spending bill, with over 2,000 pages and no one yet able to articulate what it actually will cost or mean to the average American
- With bailouts and a never-ending sea of debt, our economic ship is taking on more water making the public feel very uncomfortable.
What has been set in motion in Massachusetts is sending a strong signal to the rest of our elected officials. Healthcare reform is now on hold, the current administration is retooling and the American public is struggling to get their "sea legs" about them in the never ending economic merry go round we are on. We live in interesting times that requires great thought and perseverance.
Just as the "shot heard ‘round the world" set in motion tremendous change in our country. The voters in Massachusetts have set in motion an interesting political environment for us observe and participate in. We live in the most uncertain times, and it requires all of us to engage in problem solving.