Healthcare Collaboration » healthcare reform

Vision for Getting It Done

Kenneth Cohn — Sat, 30 Apr 2011 19:06:13 +0000

The first blog on this site is a joyous celebration of the birth of a new book, Getting It Done: Experienced Healthcare Leaders Reveal Field-Tested Strategies for Clinical and Financial Success. Getting It Done celebrates heroes at over sixteen US healthcare organizations who braved the challenges of the status quo to break down silos and improve care for their communities.

The vision for this website is to:

build a community of like-minded professionals who feel passionately that we need to do a better job of providing more coordinated, cost-effective care
sustain the confidence we need to move forward in the face of uncertainty
help fellow healthcare professionals to reconnect with the ideals that attracted them to healthcare careers in the first place, to make a difference in patients’ and families’ lives

Please join me in moving from doing more with less to collaborating to using our existing resources more efficiently and effectively. The work that we do in the coming year can shape healthcare delivery for the next two decades.

Please visit this website frequently and notify friends and colleagues to contribute their insights as well to this discussion.

Kenneth H. Cohn

Vision for Getting It Done is an original post from Kenneth Cohn on Healthcare Collaboration - Improving Physician-Hospital Relations

Collaborative Healthcare Reform

Kenneth Cohn — Wed, 27 Apr 2011 12:44:55 +0000

Yesterday, a friend asked me, “Ken, do you feel comfortable speaking on healthcare reform?”

“Heck no,” I replied. “It is changing way too fast for anyone to feel like an expert. The word ‘Facilitator’ appears after my name, to clarify my role as someone who brings data for group discussion rather than someone who acts as the sage on the stage.”

With that purpose in mind, I traveled to Connecticut last week to speak to a group of physicians, hospital administrators, and Board members on Making Sense of Healthcare Reform: Moving Forward in the Face of Uncertainty. The Vice-President of the Medical Staff invited me to help him dispel myths, like “Healthcare reform will be overturned, it will only apply to Medicare, and it will take decades before disruptive change comes to this part of the state.”

I divided my talk into three parts:

Historical context: In 1943, facing union-led strikes during a period of wartime wage and price controls, Congress and the Internal Revenue Service agreed to allow companies to provide healthcare benefits to employees as a tax-free benefit that companies could expense as a tax deduction; so began our healthcare non-system
Organizational implications: As I mentioned in Collaborative Culture, most physicians enjoy bottom-up processes more than top-down edicts. They have told me that they much prefer being inspired to being supervised. The only way that I know to develop a common culture is to allow physicians to play a role in shaping it. A few physician champions can transform a culture once they see that they are making their time count and that they are making a difference in their patients’ lives.
Personal implications: I believe that disruptive change calls for personal reinvention; unfortunately, the pathways that are so clear for becoming a physician are anything but transparent when it comes to transitioning; as my mentor, Dr.Paul Batalden, said, “Change feels like failure when we are in the middle of it,” which can lead to feelings of isolation and despair

Two questions from the audience remain with me:

1) From the Board Chair: “What should be the role of the Board in supporting healthcare reform?”
I replied that the Board should be a convener of respectful conversations among members of the medical staff, hospital leadership, and the community. In complex times, communication based on active listening can help us act, learn, and adapt.

2) From an orthopedic surgeon: “How can we avoid reinventing the wheel? There has to be a model out there that works, and people like you need to tell us what doesn’t work.”
I empathized with his feeling that nobody wants to relive the difficult situations of the previous century occasioned by capitation and reengineering. I also mentioned that orthopedists in the 40 states where I have worked have told me, “When you have been to one hospital, you have been to one hospital.” Physicians with whom I have collaborated have preferred being active participants to having change imposed upon them. Healthcare reform involves an iterative journey, in which we accept setbacks in order to move forward. Learning is never failure.

Personal Implications of Healthcare Reform

The Collaboration Multiplier

I believe that we are in an exciting phase. The changes that we are making now may have implications for decades. We need to feel that we are not alone, that collaboration can improve clinical and financial outcomes, and that a spirit of inquiry rather than advocacy can guide us in the face of uncertainty. As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

Disclosure:

Although I was paid to speak on “Making Sense of Healthcare Reform: Moving Forward in the Face of Uncertainty,” I have not received any compensation for writing this blog post. I have no material connection to the brands, topics and/or products that are mentioned herein.

Collaborative Healthcare Reform is an original post from Kenneth Cohn on Healthcare Collaboration - Improving Physician-Hospital Relations

Collaborative Uncertainty

Kenneth Cohn — Sat, 26 Mar 2011 13:09:01 +0000

Flowering cherry trees in Georgia

Last weekend, I had an early taste of spring, as I facilitated a medical staff retreat with hospital leaders and Board members. We discussed:

- physician leaders who have improved quality, safety, and service
- building a culture of collaboration from the ground up
- career-saving strategies to prevent frustration and burnout.

We also discussed how we could move forward despite national uncertainty about the future of healthcare reform

I know that they will achieve their goal of becoming a top-tier hospital system because they have an engaged group of medical leaders, a visionary CEO and CMO, and a culture of mutual respect.

I felt proud watching the group come together on the need to make a personal commitment to improve quality and safety rather than blaming others. When discussing a model for timely implementation, we recalled from residency the process of making a daily rounds ”scut list” of the task, the deadline, and the person responsible for getting it done. As the authors of Crucial Confrontations wrote, “There is no we in accountability.”

Like many of us who were not taught communication skills in medical school, residency, or fellowship training, they welcomed the opportunity to learn how to manage conflict and confront people in a way that improved rather than threatened team cohesion, as summarized in Crucial Confrontations :

Start from a position of safety
Maintain respect
Use contrasting to reassure what is not going to happen
Establish mutual purpose
End with a question, as illustrated below:

I am concerned about a problem that is affecting all of us.

I feel that our 5% rate of hospital-acquired infections is too high. I find it hard to tell patients that one of twenty will suffer harm from being here.

This is not a witch-hunt. I value your service to the hospital. I would like to understand better what I can do to foster a safe dialogue on how to improve care for our community. I welcome your suggestions.

Is there a time in the next two weeks when we could come together to discuss this situation further?

As always, I welcome your suggestions on how we can improve healthcare collaboration and our service to patients, for whom we maintain a sacred trust.

Kenneth H. Cohn

Disclosure:

Although I received compensation for facilitating the medical staff retreat, I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

Collaborative Uncertainty is an original post from Kenneth Cohn on Healthcare Collaboration - Improving Physician-Hospital Relations

Collaborative Construction: Implications for Hospital-Physician Relations

Kenneth Cohn — Sun, 13 Jun 2010 11:51:38 +0000

Despite the stresses of moving, I am excited to buy a home that a builder built for himself. As several people in construction have told me, builders use their knowledge, experience, and leverage with their subcontractors to make sure that they are living in a home that meets and exceeds specifications.

Steel girders supporting upper floors

My grandfather, who sold commercial real estate, told me to begin a tour of a house for sale at the basement, where one can see, feel, and even smell the quality of workmanship and attention to detail. Witness the I-beams used in construction of skyscrapers that support the top two floors of my new home.

Two healthcare analogies come to mind:

1) During my residency, an attending surgeon stayed in the Operating Room until the skin incision was closed; he told me, “If patients see perfectly approximated skin edges, they assume that their surgeon paid attention to detail on the inside. First impressions count.”

2) When I help hospitals set up Physician Advisory Panels, I encourage them to pick physician co-chairs who, based on inside knowledge, are the physicians that physicians turn to for advice and care; these physician champions create a safe environment for learning and growth that builds transparency and medical staff trust from the ground up in the same way that a home builder starts construction with a solid foundation

Imagine the potential, as we design a system to deliver more collaborative cost-effective healthcare, of being builders designing a home that we are going to live in. For those of us at or nearing our mid-century mark, the timing could not be more favorable.

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

Collaborative Construction: Implications for Hospital-Physician Relations is an original post from Kenneth Cohn on Healthcare Collaboration - Improving Physician-Hospital Relations

Collaborative Congress: Post 85

Kenneth Cohn — Tue, 20 Apr 2010 17:58:57 +0000

Dr. Cohn speaking on Physician Recruiting, Contracting, and Retention Strategies

I believe that this Congress of the American College of Healthcare Executives was the best educational forum that I have ever attended. Imagine Congress passing major healthcare legislation the same week that over 4,000 healthcare executives met in Chicago to discuss implications of healthcare reform. I felt that I was part of the present, especially as Mike Fecher and I addressed over 100 people re: Field-Tested Physician Recruiting, Contracting, and Retention Strategies. I found it provocative that nearly everyone conducted exit interviews of departing physicians to ask why they were leaving, but nobody in the room asked physicians who had been with them at least five years why they stayed and what they could do to make their time more productive.

Some of the many highlights of this outstanding meeting included:

Maureen Bisognano’s Building Strong Connections Between Cost and Quality, in which she encouraged leaders to “think outside the building,” to improve safety, engage patients in improved self-management, reduce arbitrary individual variation, root out waste, and create a culture that supports the delivery of cost-effective care
Chuck Mowll’s Best Practices of High-Reliability Hospitals, in which he cited Sentara’s practices of putting red tape around medication dispensing machines to warn people not to interrupt the person using them, using simplification experts to review processes, and encouraging staff to comment on any safety issues that concern them
Nate Kaufman’s Proven Strategies to Enhance Performance Under Healthcare Reform, in which he encouraged participants to view upcoming challenges as thrills rather than threats as they approached physicians to break even on Medicare by strategic cost reduction, rebalancing payer contracts, recruiting clinical stars, improving coding, revenue cycle, and patient flow, developing an embedded medical group, selectively adding fixed costs, and auditing all financial relationships with physicians
Ruth Brinkley’s Positioning Yourself for Success, in which she summarized the six ingredients for career success: competence, confidence, courage, resilience, humor, and people
Gerry Ibay and James Higgins’ How to Succeed as an Early Careerist, in which they described the capacity for deep listening, challenging one’s own point of view to hear others’ perspectives

Although I usually do not stay through Thursday, I was glad that I did this time, to attend Kathleen Bartholomew and Joe Bujak’s Of Lions and Lambs: Transforming Physician-Nurse Communication. They dressed in costume to role-play disrespectful dialogue and its effect on clinical and financial outcomes, especially in causing people to take out frustrations on colleagues who had nothing to do with the harmful interaction.

They pointed out that depersonalization protects power and autonomy and that we need to come to know each other as people by celebrating successes rather than focusing solely on mistakes. When respected physician and nurse leaders come to consensus on behavioral expectations to which everyone is accountable, the majority of those who transgress will apologize and those who don’t will leave. Safety and clinical quality establish the moral high-ground.

What do you think?

Does the prospect of healthcare reform make you excited, fearful, or ambivalent
Can we build a strong connection between cost and quality
What physician-hospital collaboration do we need to do to break even on Medicare reimbursement
Do nurses and physicians where you work share behavioral expectations to which everyone is held accountable to improve healthcare communication

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

Collaborative Congress: Post 85 is an original post from Kenneth Cohn on Healthcare Collaboration - Improving Physician-Hospital Relations

A Massachusetts Surgeon Weighs in on the Meaning of Scott Brown’s Senate Victory: Post 81

Kenneth Cohn — Sun, 24 Jan 2010 17:30:30 +0000

Warning to readers: This post, like a previous post, Gotcha: A surgeon dissects patient-centered care, contains more rant than reason. Those who feel passionately that Congress is doing a great job dealing with the people’s healthcare should look elsewhere for confirmation of their views.

In An Interview with Stuart Altman, this distinguished healthcare economist mentioned Altman’s Law, that advocacy groups seek to preserve the status quo rather than adopt another plan that might disadvantage their interests.

January 21, 2010, in Citizens United v. Federal Election Commission, the Supreme Court voted 5-4 to remove limits on contributions from corporations and unions for “electioneering communication.” Hailed by some as a victory for the First Amendment right of free speech, to at least one skeptical surgeon, it means that free speech just became more expensive, as limitless contributions pour in to influence 535 votes.

Kudos to David Harlow for getting it right in his commentary, Holy Mackarel: Scott Brown, Health Reform Redux and What Can (Should) Happen Next: “it is time to think about other avenues towards the improvement of the health care system in this country.” Reform efforts will go on while Congress is embroiled in partisan gridlock. As David mentioned, states have become the learning laboratories.

Medicare demonstration grants in Colorado, New Mexico, Oklahoma, and Texas continue to investigate the merits of value-based purchasing of healthcare services. Patient-centered medical home projects, as described in Engaging Physicians to Adopt Healthcare Information Technology, represent a continuous, proactive, consumer-directed approach to care coordination.

In My Inadvertent Oncology Fellowship: Why I Remain Optimistic About Healthcare, I concurred with fellow Massachusetts surgeon Dr. Atul Gawande, that healthcare reform embodies an iterative journey, where we test different hypotheses in our learning laboratories, because no one has sufficient knowledge to assert that one way of delivering care will work for all our citizens. Dr. Gawande concluded in Testing, Testing:

But if we’re willing to accept an arduous, messy, and continuous process, we can come to grips with a problem even of this immensity. We’ve done it before.

As I mentioned in “Embracing Complexity,” in Better Communication For Better Care: Mastering Physician-Administrator Collaboration, face-face conversations are the only sustainable way that people can deal with complex situations in which predictability is diminished, experience does not guarantee success, and relationships are key.

Complexity facilitates interest group politics, as members on all sides struggle to convey their message in 30 seconds or less. In Collaborative Sensemaking, I described the critical role that healthcare leaders must play in interpreting and explaining disruptive marketplace changes and framing what is required for successful healthcare delivery.

Finally, I thank my mentor, Lee Kaiser, who in Collaborative Gnosticism, wrote:

Most people and most organizations see themselves at the center of the universe, which leads to egocentric, self-interested approaches that facilitate exploiting others for competitive advantage, hardly a sustainable approach to differentiation and the service of others… There is no economic, social, or political solution to the current healthcare crisis. Spirituality, based on abundance, collaboration, and sharing provides the only solution because it makes problems disappear.

As always, I welcome your input to improve healthcare collaboration, even if sometimes I feel (to paraphrase Churchill) that we embrace it only after we have exhausted all other alternatives.

Kenneth H. Cohn

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein. David Harlow is a friend, colleague, and coauthor with me of Field-tested Strategies for Physician Recruitment and Contracting. Please check out his HealthBlawg.

A Massachusetts Surgeon Weighs in on the Meaning of Scott Brown’s Senate Victory: Post 81 is an original post from Kenneth Cohn on Healthcare Collaboration - Improving Physician-Hospital Relations

Collaborative Future: Post 77

Kenneth Cohn — Mon, 12 Oct 2009 01:42:55 +0000

Dr. Cohn Introducing Dr. Taubman

I had the pleasure last weekend of attending The Future of Medicine: An Expert Diagnosis, at my alma mater, the University of Rochester. Here I am introducing Dr. Mark Taubman, the Acting CEO of the University of Rochester Medical Center.

Other Panelists included: Paul Keckley, Executive Director, Deloitte Center for Health Solutions, Daniel Sisto, President, Healthcare Association of New York State, and David Klein, CEO of The Lifetime Healthcare Companies, below.

Mr. Keckley pointed out that over 60% of our $35 trillion national debt is healthcare related. So far, the US economy has shed over 6 million jobs during our current recession, but healthcare has added approximately 300,000 jobs over the same timeframe. Decreasing healthcare costs by 1.5% per year for 10 years would save approximately $3 trillion.

Mr. Sisto, summarizing the events of last summer, defined a myth as a popular belief or tradition that serves to explain the mindset or world-view of a group. He described politics as the manipulation of people by playing into their myths. He described the maneuvering that is taking place, even though Democrats hold 256 seats in the House of Representatives, because 57 members of the Progressive Caucus, committed to the passage of the public option, are balanced by 52 Blue Dog Democrats, who resist activities that enlarge government. Furthermore, 49 House Democrats were elected from districts that voted for John McCain in the 2008 Presidential election, making them wary of appearing to overreach.

UR Future of Medicine Panel

He also explained that one reason for the difference in cost of the Senate Finance Committee Bill (approximately $829 billion) and the House bills (approximately $1.2 trillion) is that the House provides a 10-year fix to Medicare physician fee cuts, but the Senate bill addresses only the first 2 years. Without intervention, Medicare payments to physicians will be cut 21.5% in 2010. In 2007, Medicare accounted for 17% of Federal spending, and Medicaid accounted for 7% of Federal spending. To learn more about differences between the current House and Senate bills, please read Rehabilitating Healthcare in the LA Times October 14, 2009.

Mr. Klein pointed out that the current legislation before Congress does not provide significant cost containment. Approximately 3/4 of the average annual family policy cost of $12,700 is borne by employers. As Medicaid coverage expands, states face either cutbacks in other budget categories or increased income and/ or property and sales taxes to fund this expansion.

Despite the challenges, the panelists made me feel that the future of US medicine is bright, provided that we can identify and implement ways to decrease waste and inappropriate care. This panel summarized a great deal of data into actionable information. I thank the panelists for traveling to Rochester to educate us on the challenges and opportunities that we face in the coming months and apologize if I have misquoted them or left out any important information in this brief summary.

What do you think?

Do you find the current state of affairs confusing regarding healthcare reform
Do you feel that the healthcare cost pressures we face are unsustainable
Do you find that the opportunities for reform balance the current challenges

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

Collaborative Future: Post 77 is an original post from Kenneth Cohn on Healthcare Collaboration - Improving Physician-Hospital Relations

Collaborative Wishes: Post 75

Kenneth Cohn — Sat, 05 Sep 2009 23:18:36 +0000

In residency, I learned that it is a sign of strength to admit ignorance and ask for help. While writing my latest column for the Journal of Healthcare Management on Innovation in the Face of Recession, I realized that little has been written recently on that subject in healthcare.

So, I asked respected thought leaders what they were doing and what was working. I ended with the following question:

If you could be granted three wishes, what would you request?

Their responses fell into several thought-provoking clusters:

Regarding healthcare reform, over one third wished for a more efficient system that decreased red tape and made it easier for people to collaborate inside and outside their organizations. Such collaboration included sharing information about outcomes and improvement programs that worked as well as aligning incentives, so that we have a system of interdependent parts rather than a collection of cottage industries. In Collaborative Conversations, I wrote that the challenge of any meaningful healthcare reform efforts is the extent to which they engage healthcare professionals to make a difference in patients’ and families’ lives.
The above response tied into to their wish for a nationwide information network that would help providers and organizations be more accountable for outcomes and help them integrate care throughout the inpatient/outpatient continuum. As one respondent wrote, “Know more, act prudently, measure outcomes.”
Physician staffing also entered into their responses, especially primary care providers and orthopedic surgeons. As I mentioned in Field-tested Strategies for Physician Recruitment and Contracting, not only are patients aging and their care needs becoming more complex, but health care providers are aging along with them, and younger physicians tend to have different expectations about work-life balance than colleagues who were born before 1965. Of the physicians practicing in 2005, 36% were at least 55 years old and over 15% were at least 65 (Cohn KH. Harlow DC. Journal of Healthcare Management. 2009; 54(3):151-158).
Several participants wished for patients to become more cognizant of their role in improving healthcare outcomes, specifically regarding nutrition, exercise, and safe decisionmaking related to seatbelt use, alcohol, and protective barriers in those who have multiple partners. As noted in Collaborative Business, here is an area where insurance companies and large corporations are providing innovative incentives, such as a 24-hour help line, exercise facilities, smoking cessation programs, cancer screening, diabetic education, and trans-fat free cafeterias.
One person wished for targeted management and leadership training. As I wrote in Collaborative Leadership Development, summarizing Growing Leaders in Healthcare by Brett D. Lee and James W. Herring, 85% of Fortune 500 companies sponsor formalized internal leadership development programs, but only 21% of US hospitals have formal processes for identifying and developing candidates for leadership positions.
Another wished for an intellectually stimulating environment in which to work. In Collaborative Listening, I mentioned Brian Wong’s survey of over 1,500 practicing physicians, where meaningful work that makes a difference in patients’ lives ranked as the top priority.
Finally, about 10% of respondents made ”spiritual” wishes to restore a sense of mission, purpose, and professionalism, reconnect with the reasons they initially chose healthcare careers, and have the courage and wisdom to make correct decisions in difficult economic times. Not only did they seek incentives to encourage cooperation and sharing, they also sought an abundance rather than a scarcity mentality to confront our current challenges. In Collaborative Gnosticism, my mentor, Lee Kaiser, stated that most people and organizations see themselves at the center of the universe, which leads to egocentric, self-interested approaches that facilitate exploiting others for competitive advantage, hardly a sustainable approach to the service of others. He maintains that there is no economic, social, or political solution to the current healthcare crisis. Spirituality, based on abundance, collaboration, and sharing provides the only solution because it makes problems disappear.

What do you think?

Despite the strident debate over healthcare that we are witnessing in the news media, do we largely agree on the rationale for improving our clinical and financial outcomes
If we agree on the why and and the what, can the how become a lifelong iterative journey
What three wishes would you like granted

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

Addendum: Anyone wishing to take the aforementioned survey and have your responses mentioned in my upcoming column, please copy the questions below, paste them into your e-mail program, and send your responses to ken.cohn@healthcarecollaboration.com by September 11, 2009. Thank you for your input:

How are you and your organization doing in these difficult economic times?
What are your greatest concerns?
What strategies have you found to be the most useful in dealing with your concerns?
What strategies have not proven to be helpful?
If you could be granted three wishes, what would you request?

Collaborative Wishes: Post 75 is an original post from Kenneth Cohn on Healthcare Collaboration - Improving Physician-Hospital Relations

Collaborative Disruption

Kenneth Cohn — Sat, 13 Jun 2009 10:26:16 +0000

I am responding to feedback from a seminar participant who asked for summaries of books relating to healthcare.

Through Executive Book Summaries to which I subscribe, I came across a provocative recently published book, The Innovator’s Prescription: A Disruptive Solution for Health Care, by Clayton Christensen, Jerome Grossman, and Jason Hwang. Although I do not usually summarize books that I have not read in their entirety, the content motivated me to alert readers to this 441 page tome, in the hope that others will agree that perfection can be the enemy of good, to paraphrase Voltaire. I give thanks to the beeper gods and godesses who permitted me to read the summary and write a blog post while providing general surgical coverage in Maine this weekend.

Warning: something in this book is bound to upset and unnerve all of us who may not realize how invested we are in the present non-system of care. What I write should be viewed more as confessional than prescriptive.

The premise is that the need to transform expensive, complex offerings into higher-quality, lower-cost offerings is not unique to healthcare. For example, Dell’s entry into the personal computing marketplace forced IBM to reevaluate its business model and focus on providing value-added business consulting services rather than building personal computers as its primary source of revenue.

According to the authors, healthcare provides two distinct services:

Solution shop: activities that focus on diagnosing patients’ problems
Value-adding processes: activities that fix problems that have been diagnosed in solution shops

The reasons that the two services must be separate is that solution shops need to be paid on a fee-for-service basis; they require advanced technology and specialized expertise. However, value-adding processes are outcome-driven, can sell their output for a fixed price, and (for example, Geisinger Clinic’s Proven Care for heart bypass grafts and hip replacements) can warrantee results. Only when the organizational resources, processes, and business model are focused around a job-to-be-done, can they be integrated and optimized to obtain outcomes as close to perfection as possible.

Therefore, the authors recommend that hospitals build distinct facilities (or at least a hospital within a hospital) to deconstruct their activities operationally into solution shops and value-adding processes. In the future, general hospitals will no longer be able to subsidize low-volume non-standard solution-shop (diagnostic) services with high-volume value-added work (procedures).

The authors feel that only a minority of chronic diseases, such as Alzheimer’s, Parkinson’s, lupus, epilepsy, and infertility necessitate a multidisciplinary solution shop. The majority of chronic illnesses are rule-based, meaning that they can be competently managed by an individual caretaker; rule-based diseases include hypertension, osteoporosis, HIV, type I diabetes, and myopia. The rules for treating many rule-based illnesses are so widely accepted that nurse practitioners can care for these patients without compromising clinical outcomes.

We cannot count on traditional physician practices to police patients to enforce compliance with therapy. The business models that can help patients succeed are different from those that diagnose and prescribe the original treatment plan. The authors cite as examples disease management companies like OptumHealth and Healthways. That only a fraction of patients are cared for by disease management companies and integrated providers like Kaiser Permanente and Geisinger suggests an opportunity for those willing to embrace change rather than cling to familiar models.

The Patient-Centered Medical Home represents an opportunity for primary care physicians to provide systematic, patient-centered, coordinated care management processes. The Patient Centered Medical Home is a health care setting that facilitates partnerships between individual patients, their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange, and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.

The authors feel that quality results from proper integration of care and that lower costs come from focus that promotes lower overhead. Large employers are initiating disruptive change by outsourcing the care of patients to coherent solution shops for diagnosis and to integrated providers for patients’ treatment plan and compliance monitoring.

Similar technologic disruptive forces introduce patients to devices that have provider experience built into their logic circuits, which will allow patients to monitor their own health in an improved fashion, for example scales and blood pressure cuffs, that wirelessly transmit patients’ daily weight and blood pressure to nurses experienced in the management of patients with congestive heart failure, that help patients thrive outside expensive hospital settings.

I ask with anticipation, “What do you think,” because a book like this lends itself to wide-ranging discussions on a variety of topics, including:

Do we need a more coherent business model to guide 21st century US healthcare
What are the strengths, weaknesses, opportunities, and threats implicit in The Innovator’s Prescription
When is the ideal time and where is the ideal place to start

As always, I welcome your input to improve healthcare collaboration.

Collaborative Disruption is an original post from Kenneth Cohn on Healthcare Collaboration - Improving Physician-Hospital Relations

Collaborative Mother’s Day

Kenneth Cohn — Sun, 10 May 2009 11:40:05 +0000

This may be a controversial post on my favorite holiday, where we celebrate nurturing, sacrifice, and unconditional love; one day is insufficient.

I admit that in previous posts( Gotcha and Uncollaborative Insurance ) I have complained about what I felt were arbitrary regulations on physical therapy for cancer survivors like me who sustained spine injuries and back and neck pain as complications of lifesaving therapy.

I cheered the decision that sent $6.6 million from Aetna to business owners due to a violation of Maine state law that requires small-group insurers to spend at least 75% of premiums on medical claims [Modern Healthcare 39(17)16].

Yet, today, in the spirit of Mother’s Day, I have chosen to focus on what I agree with in Karen Ignani’s article [Uniquely American Solution: Collaboration, leadership required to bring change. Modern Healthcare. 39(17)20-21]. Anticipating criticism from readers who become as frustrated as I do with caring for patients amid denial codes, telephone calls, and burdensome paperwork and regulations, I disclose that I have received no money from anyone in the health insurance industry. On the contrary, I send Harvard Pilgrim Healthcare nearly $17,000 in annual premiums.

Here are points from her recent article on which I agree with Ms. Ignani:
1) Successful reform will require a comprehensive cost-containment strategy: I hope that physicians and hospital share with insurers, pharma, and device manufacturers in the sacrifices required to bring costs down considerably. I support insurers converting to a universal claim form which will save providers time and administrative staff costs. I also support regulations that increase transparency for physicians and organizations who receive payments from drug and device companies for research, consulting, and speaking.
2) Preventive care and screening reduce future catastrophic outlays. I would be willing to sign a 5-year contract with my insurance company in return for a guarantee that premium costs would not rise more than the agreed upon amount, so that they could reap the benefits of their investment in my wellness
3) Investing in anti-obesity and anti-smoking campaigns can improve the health of the nation and reduce related costs. Even though I am not overweight and do not smoke, I support these efforts.
4) Providing scholarships and loan forgiveness for physicians specializing in primary care will help provide and sustain the workforce necessary to achieve the above objectives. In the Southern Surgical Association Presidential Address, Dr. James O’Neill stated, “I believe that the reason many students are selecting so-called “lifestyle specialities” characterized by shift work, is because these fields are relatively protected in terms of reimbursement under Medicare and other insurance reimbursement. This is primarily because of enormous student debt, now averaging close to $200,000 and rising, an insidious influence… Currently, no one is taking responsibility for this and it is up to us.” [Journal of the American College of Surgeons. 208(5),659.] The sooner we institute this reform, the better.
General surgeons, especially those who work in rural settings, deserve to be included in the primary care category; without our active assistance, emergency departments, intensive care units, and medical wards cease to provide comprehensive care. General surgeons allow a hospital function as an acute-care facility that can provide life-saving care to our communities.
5) All of us can do better. Amen
6) Acting now to identify reductions in all sectors can provide significant relief to purchasers of healthcare insurance, improve the solvency of the Medicare trust fund, and free up resources to finance healthcare reform. No disagreement here either.

The following are some ways that we physicians can make it easier to reach a sustainable equilibrium:
1) Invest in interoperable electronic health record software that allows us to share data without the need to re-enter it into our computers
2) Use software displays that show us clearly the results and date of previous laboratory testing and imaging studies, so that we avoid duplication
3) Obtain palliative care consults for patients entering the intensive care unit to avoid squandering limited resources on patients at the end of their lifespan for whom there is little hope of extended survival. Questions about rationing need to give way to questions about how we can deploy scarce resources more effectively
4) Support legislation that requires patients to fill out living wills signed by their next of kin and power of attorney when they apply for/ renew their health insurance coverage. This is especially important for aging patients before significant cognitive decline occurs
5) Play a greater role in health education not only for individual patients but also in schools and public forums
6) Be more pleasant and rethink conspiracy theories to cultivate mutual respect. As I wrote in Facilitating Physician Engagement, breakthrough innovation occurred at the Pittsburgh Regional Health Initiative once participants moved from an accusatory, “Why don’t you …” approach to a more welcoming, “What if We …?”

What do you think?

What reforms do you support in the upcoming healthcare reform debate
What can we do better
As you look into the mirror, what would you like to change

As always, I welcome your input to improve healthcare collaboration.

Collaborative Mother’s Day is an original post from Kenneth Cohn on Healthcare Collaboration - Improving Physician-Hospital Relations