OP-ED

The Writing Is On the (Healthcare) Wall

flying cadeuciiFor the past few months I have been traveling around the globe. In my travels I have been talking to “leaders” from Ministries’ of Health, Insurance Companies, Hospitals, Physicians, and Professional Societies.

In many of the conversations I continue to hear more of the same story:

In order for change to happen, the incentives need to be in place.

Things such as, “…in order for physicians to adopt, the incentives need to support the actions.”

“…until incentives align it is difficult for hospitals to adopt changes in care models.”

“…in order for me to spend more time with patients the payment models need to align accordingly.”

Repeatedly I hear that in order for people to make changes inside of healthcare,that the money trail needs to lead the charge.

Yes, that worked so well with the adoption of EHR/EMR.

Leaders followed the dollars only to adopt and implement data archives that do not talk, interact, or share knowledge across the care continuum for patients.

Since when do “leaders” follow?

Really?

At what point did leaders take the stance that in order to make a change it has to be easy and the dollars need to exist?

Well the writing is on the wall….

Wall

You can wait for payments, incentives, and the current model to be optimized.  You can wait for the payers of today, insurance and government, to decide on how you will be paid tomorrow. Wait for them to define “value” for you, and the “worth” you provide.

You can be a follower.

I ask why?

Why wait for someone else to define the time, manner, and the change we make?

It takes time, work, and effort in defining the challenge(s).

It takes even more time and effort to understand those definitions.

When you have a deep understanding of those challenges you can leverage them to create a different world view. A new model.

I prefer to lead and create a new model that makes the other models obsolete.

I prefer to learn from the venture capitalists. First in, first out.

Creating and designing a new model is risky. It takes time and effort. It is challenging. It requires me to be comfortable with things that are uncomfortable. It forces me to live on the edges. It pushes me to enjoy the white space.

It makes us ask, “People like us, do things like….”

This is where the incentive exists.

The incentive to be a leader.

Will you lead with me?

Or will you follow?

Andy DeLaO, aka Cancergeek, is a healthcare professional with 15 years of experience leading and developing healthcare service lines, marketing, and challenging the status quo of healthcare delivery to improve connecting patients and the world of healthcare.

Livongo’s Post Ad Banner 728*90
Spread the love

Categories: OP-ED, THCB

Tagged as:

22 replies »

  1. Regarding incentives for change: the very practical day to day reality for primary care physicians (and other specialties) is an immense amount of inbox items, pressure to meet regulations, quality program metrics and see enough patients to meet income requirements for mortgage, kids, etc.
    It isn’t that providers don’t want to change, but most efforts fail to recognize the day to day work life and specify how changes will improve their work day. The larger and wonderful concepts for a better health care system sound good but in the end people focus on what is in front of them. The job for leaders is to bridge that gap, provide incentives where possible and at very least, don’t make the work day harder. By working alongside providers and continually asking for their perspective, change can happen.

  2. All sounds good Andy, from the outside, and now I have a better understanding of the patient focus. Are all six hospitals participating, and does this reduce the need for 6 hospitals?

    I’m a cynical sceptic, especially for health care as so much of it churns the bottom line with opaqness.

  3. I’m not familiar with a broad swath of the publications about Medicine and patient care, but from what I have read this patient centered approach is very rare. Most of the in fashion reforms view the patient as too dumb to play a key role in his or her care and doctors are too greedy to trust. Nortin Hadler’s work (Citizen Patient, The Last Well Person etc) and some of his co authors on this blog site are the main things I’ve seen that counter this trend. Your description of your work to reduce cycle time from dx to tx and to listen to the patient is extremely refreshing! Thank you!

  4. Peter-

    I will do my best to address your additional questions and thoughts, but please feel free to reach out. I think you would benefit in a live discussion and dialogue.

    1. Rate limiting steps: we mapped this out to understand the current design. We then created a metric we wanted to meet as a metric. We started with 5 days. In testing we discovered we could push the system, so we moved the metric.

    2. Lung Cancer: In many instances lung cancer patients get lost in the mix, up to 65 days. Which from an outcome perspective means that if median survival is 10 months for late stage disease, you have now just “wasted” 20% of patients “time.”

    3. When one of your loved ones is told, “You have cancer” the only thing that matters is time and the right answers. 55″ TV’s have no bearing, especially in this discussion. That is the problem with “patient experience” no one takes the time to stop, listen, and understand patients. Each market needs to understand the #MyIdealPtExp

    4. Conditions of Participation (COP) came out of the NCCCP-NCI grants and recommendations specific to MDC’s. You may still be able to find the matrix on NCI, although it has now moved to NCORP. (I was one of the people managing several of the arms)

    5. The reality is that not all physicians want to practice as a team. Surgeons like to operate, so asking them to wait, when it is the right thing for the patient, takes a commitment from the surgeon as well as the rest of the team to ensure that you get all of the information, to the entire team, shared transparently with the patient, in written (or video) form, to drive the dialogue and allow the patient to set their expectations, and allow them to choose the best option to meet their expectations.

    6. Our data showed that Total Cost to System was lower. It varied by diagnosis. Example, for breast and prostate it was reduced by 40%. Higher for other diagnosis, lower for others.

    7. That cost savings was passed on to the patient.

    8. Risk sharing model was created between Health System and Payers.

    9. I select projects that allow me to deliver the 4T’s. (https://youtu.be/-8H4MZwtEIk)

    Yes I get paid for the work I co-create, but that is not my driving force. My driving force is to remind all of us, that we need to stop thinking in terms of incentives, whether revenue generating or cost savings, in driving our decisions.

    It hasn’t worked for us to this point in time.

    My driving force is impacting the lives of patients.

    Impact is performed one patient at a time. Quit scaling mediocrity (which in my opinion is most of what cost out and revenue generation encourages) and start co-creating opportunities to facilitate connecting on the 4T’s.

    Andy
    @cancergeek
    cancergeek@gmail.com

  5. “The 6 hospitals are fighting over a smaller number of patients because the service line and program I co-created are the brand of choice by patients in that service area.”

    First, I appreciate the expanded explanation, second, I’m still trying to digest the concept to see if it’s a unique disruptive design or just better marketing to attract customers. I don’t think you reduced the need for care, it sounds like you branded a better competitive edge, a strategy a venture capitalist would use to recoup their investment.

    I’m not sure the wait time for patients is the proper beneficial metric to lower. Yes, it’s attractive for the patient, as is palatial marbled foyers and 55″ flat screens in rooms, but should that be the metric you’d be trying to solve? I’m not there yet.

    “The physicians that are willing to work with that program, follow the program guidelines, can sign the code of participation and be in the program.”

    Sounds like a threat to either sign up or die.

    “Costs are lowered because we are working together, proactively, on behalf of the patient need: getting the right answer at the right time.”

    I think reducing the billable hours used to diagnose and treat patients is a good goal, I’m not sure your outcome actually accomplished that? Did it benefit the overall system?

    “My world view is different. My metrics are different than yours.
    I didn’t co-create the program to unite physicians, divide money, and lower costs. I co-created the program to meet the unmet needs of patients. That was my metric.”

    Well that’s where the money is for you, but not necessarily where the focus needs to be if we are truly going to control overall costs and lower patient insurance premiums and co-pays. Were your “cost savings and higher reimbursements” passed on the premium payers – I don’t think so as it’s about capturing more revenue, which is at the heart of our cost problem.

  6. Andy,
    “We developed a program that could deliver (if patients wanted to go this fast) a diagnosis to treatment in 3 days or less, for all cancers.” …..great stuff, what a refreshing perspective. Where can I learn more (websites, articles, blog postings?)
    Thanks,
    Paul…….Never mind…think I just found it….Mayo.

  7. Peter

    The 6 hospitals are fighting over a smaller number of patients because the service line and program I co-created are the brand of choice by patients in that service area.

    The physicians that are willing to work with that program, follow the program guidelines, can sign the code of participation and be in the program.

    Costs are lowered because we are working together, proactively, on behalf of the patient need: getting the right answer at the right time.

    My world view is different. My metrics are different than yours.

    I didn’t co-create the program to unite physicians, divide money, and lower costs.

    I co-created the program to meet the unmet needs of patients. That was my metric.

    Your metrics are a byproduct that just happen when you solve for the “why.”

    Again, this is only my world view, and my work is not for the masses.

    My work is for those that want to put the #MeInMedicine and understand the #MyIdealPtExp

    ~Andy
    cancergeek@gmail.com
    @cancergeek

  8. “6 hospitals fighting for the same patients. Hospitals and programs are competing or “differentiating” with technology. Independent physicians are not “incentivized” to work together, proactively discuss cases, and deliver summaries to patients prior to treatment decisions. We developed a program that could deliver (if patients wanted to go this fast) a diagnosis to treatment in 3 days or less, for all cancers. This differentiation drove patient choice because we delivered on their needs, not the payers. We delivered on the 4T’s from their view first, and met other stakeholders needs as well.”

    Andy,

    So are the 6 hospitals still fighting for the same patients and are physicians now working together, proactively? If so how is the money divided?

    Were your “stakeholders” all six hospitals?

    Did this lower costs?

  9. My philosophy is simple: listen to patients, understand their unmet needs, co-create the output.

    Scale is done one patient at a time.

    ~Andy

  10. Paul
    Great response and addition. I am in complete agreement that there are many nuances that happen locally that once understood, allow for new models and methods.

  11. Peter-
    I am not suggesting that there is only a single answer that healthcare can use as a “best practice” and scale. That is part of the problem. 80% of these best practices and the scale we seek is mediocre at best. Healthcare tends to optimize incrementally, not actually innovate. More mediocrity.

    I have been asked to help in defining problems in various parts of globe. I have taken the time to understand the field we are playing on and the rules of the game. In doing so, I have not limited the “program” to only meeting those metrics. I have been able to create new games.

    Example: Turn around time from diagnosis to treatment in cancer is on average 10 days in the patient service area. As high as 45-60 for certain cancer types. The patients defined their problems around the 4T’s: Time, Trust, Transparency, and Transitions. 6 hospitals fighting for the same patients. Hospitals and programs are competing or “differentiating” with technology. Independent physicians are not “incentivized” to work together, proactively discuss cases, and deliver summaries to patients prior to treatment decisions. We developed a program that could deliver (if patients wanted to go this fast) a diagnosis to treatment in 3 days or less, for all cancers. This differentiation drove patient choice because we delivered on their needs, not the payers. We delivered on the 4T’s from their view first, and met other stakeholders needs as well. Over time, the transparency in our data and repackaging it to payers, we were awarded increased reimbursement and preferred status.

    Again, this is not a one size fits all.

    My “leadership” is that I see patients as experts. Majority of healthcare “leaders” see patients as patients. As numbers. As dollars and cents. As part of the problem.

    The reason why we are all here is only because there is a need created by a patient. I define the problem or challenge in their terms, through their world view, with patients, first. I co-create. I listen.

    My style is not for everyone. I create opportunities for patients-providers-payers-politicians to connect. I believe we all have a choice. We can work to put the #MeInMedicine and understand the #MyIdealPtExp or we can generate more mediocrity.

    We can choose to be Jackson Pollack or Charles Pollack. I prefer Jackson.

    I am not recommending you to join my tribe and follow me.

    I am urging you to be a leader.

    Remember: “Change the game, don’t let the game change you.” ~Macklemore

    Andy

  12. “So maybe it’s time to crawl back into the box and do what was done best in the past, a focus on patient care; not EMR’s, not reformed payment structures, not making healthcare more difficult to deliver.”

    uscaspecialist, sounds like you are a provider doc. You can fix the above by going off-the-grid with cash only payment – are you one of the “leaders”?

  13. Andy truly is a dreamer and believer who has impacted many lives throughout his career. He continues to think outside of the box and challenging the norm. The point here is it takes more than just one dreamer and believer to fix the system.
    Incentives as was discussed fail due to improper thought and process put behind them. Use an EMR/EHR system to improve patient and provider communication, check boxes and get paid for box checking, not for improving direct patient care. Providers are following a mandate, not leading the charge.
    For change to happen, it does have to start with the leaders and providers in healthcare, to stand up to the payers and our government, and say enough is enough. The leaders who dictate patient care are those that have financial incentive behind to limit access and choice to care. As providers of care, we continue to follow out of fear and lack of choice. We have reliquinshed our rights for the future of our profession.
    There is one thing to consider though; we spend so much time ‘thinking outside of the box’ we have failed to maintain what is “inside of the box”. This perhaps has led us to the point where we are today, thinking of new technology and healthcare models to fix a system that perhaps wasn’t as broken as we thought it was. We claimed out of control expenses, failed communication between provider to patient and provider to provider.
    So maybe it’s time to crawl back into the box and do what was done best in the past, a focus on patient care; not EMR’s, not reformed payment structures, not making healthcare more difficult to deliver.

  14. Well …

    Peter, you seem like a fairly astute observer of the healthcare scene. Haven’t you noticed this trend in your encounters with industry “leaders?” Here’s his conditional statement:

    If you do ____________________ (whatever it is my organization does ) __________ then ____________ (healthcare will be saved / a billion dollars will be saved / 100,000 lives will be saved)

    I’d say calling this out on qualifies as a not half bad idea

    I’m not sure if it technically counts as “leadership” but Andy gets points on the board for sure

    Or does he have a concrete policy proposal to count as a leader?

    I’ll email him.
    / j

  15. I think the point is a broader anthropologic one about how healthcare organizations behave

  16. “The real leaders are those innovating the counter movements….concierge and direct primary care…trying to preserve the best traditions of medicine.”

    Those two aspects of alternative billing methods outside of insurance may disrupt primary care, but primary care is not where our major problems are in health care. Come up with an affordable, accessible disruptive hospital system – that will be truly innovating.

  17. “Will you lead with me?”
    Haven’t seen any details of what we are leading with. Got any specifics?

  18. Provocative! All of the current fashionable reforms and their buzzwords…..ACO’s, Medical Homes, big data mining, and EHR’s (as a required tool) were concocted by non practicing think tankers, government bureaucrats and other social engineers and other power brokers who foist their concoction upon the practicing doctors….these are not leaders as you define it…these are tinkerers who bear no risk as they forcibly experiment with the medical system.

    This top-down approach defies the normal new technology adoption process (think computers and cell phones for example) where early adopters voluntarily use the product and by their risk taking end up refining it so that it is usable by the broader set of possible customers…and the vendors are anxious to make it attractive to a broader audience so they keep making the products easier to use.

    The real leaders are those innovating the counter movements….concierge and direct primary care…trying to preserve the best traditions of medicine.

  19. Sounds sort of like “Supply Side Theory.” Or, “Build It and They Will Come.”

Leave a Reply

Your email address will not be published. Required fields are marked *