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.

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Anna-Lisa_SilvestreCancerGeekuscaspecialistJohn IrvinePerry Recent comment authors
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Anna-Lisa_Silvestre
Member

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… Read more »

uscaspecialist
Member

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… Read more »

Peter
Member
Peter

“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”?

Peter
Member
Peter

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

John Irvine
Member

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

Peter
Member
Peter

Navel gazing comment by Mr. Delao? Where is the leadership in that?

John Irvine
Member

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… Read more »

CancerGeek
Member

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

Scale is done one patient at a time.

~Andy

CancerGeek
Member

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… Read more »

Peter
Member
Peter

“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… Read more »

CancerGeek
Member

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,… Read more »

Peter
Member
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.” 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… Read more »

CancerGeek
Member

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… Read more »

Paul @ Pivot ConsultingLLC
Member

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… Read more »

Peter
Member
Peter

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.

Paul @ Pivot ConsultingLLC
Member

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.

CancerGeek
Member

Paul

Yes, I write for the Mayo Innovation Labs. You can find a lot there. If you want a deep dive, please feel free to reach out to me.

Andy
@cancergeek
cancergeek@gmail.com

Paul @ Pivot ConsultingLLC
Member

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… Read more »

Perry
Member
Perry

Well said, Paul.

Peter
Member
Peter

“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.

CancerGeek
Member

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.

BobbyGvegas
Member

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