Living Well Journal

Ready to Dump Your Health Insurance?

It is becoming increasingly apparent to me that the future of cash-based healthcare services is brighter than many people might think.

I know a man, a very successful entrepreneur, who got fed up with his $900+ monthly premium on his $10,000 deductible health plan for himself and his wife.  So he said, "I'm out."

He dropped his health plan and joined a Christian healthcare cooperative instead.  Because he lives a life free of substance abuse and unsafe lifestyles, he pays $300 a month as a donation to the co-op.  His donations pay for the healthcare expenses incurred by other co-op members.  It is not insurance (but the Accountable Care Act provides an exclusion for membership in such co-ops).

It sounded flakey to me until he told me what happened when he needed cervical spine surgery.  

The projected cost of the surgery was $45,000.  He negotiated with his preferred surgeon, the hospital and the anesthesiologist and got a total cash price of $14,000.  He had the surgery, submitted the bill to the co-op and they paid it.  And all he paid was his monthly $300 co-op donation - - no deductibe, no copay.

Now stop and think:  everyone was happy with this arrangement!  The hospital and the physicians voluntarily accepted this deal - - which can only mean it was a better deal than they would have gotten from Aetna.  And with no delay in payment, no denials, no EOBs, no collections efforts.  Just cash.

So, as the classic question goes, "What's wrong with this picture?"  The answer is, "Nothing!"

This insight was affirmed in a must-read Op-Ed article in today's Wall Street Journal entitled, "Jeffrey Singer:  The Man Who Was Treated for $17,000 Less."  If health plan premiums rise as precipitously as some are projecting under ObamaCare, a lot of people will be dumping their insurance like this!

If Airlines Worked Like Healthcare

As we struggle through the transformation from the Old to the New World of healthcare in the US, this is a (painfully) funny way to see ourselves from another perspective ... Laughter makes the heart healthy!

If Healthcare Worked Like Airlines

Overpaying for Healthcare? How do you know?

Transparency of pricing data is needed for consumers of healthcare to make rational choices.

Today that data is hard to come by.  But a bill being sponsored by Senators Charles Grasley (R-IA) and Ron Wyden (D-OR) proposes to publicly share the purchasing data of the nation's largest purchaser of healthcare:  Medicare.

Give the Public Access to the Medicare Database

"For no compelling reason, a commanding tool for trying to contain health care costs is lying unused. That sidelined powerhouse is the Medicare claims database, which holds a record of all payments from taxpayers to physicians and other providers for seniors’ health care."

"If bipartisan legislation now before the Senate becomes law, this information would be made available to all Americans through a free, searchable online database. It would instantly position Americans to secure more value for the $2.7 trillion being spent this year on health services. That’s because the publication of the Medicare data will become health care’s new financial baseline; the measure of what America’s largest and most powerful buyer of health care gets for nearly $600 billion a year."

Because US healthcare has been paid through intermediaries for the last 50 years, consumers have little sense of healthcare prices and there is virtually NO relationship remaining between cost and price in healthcare.  This isn't due to doctors and hospitals gouging the public, but simply rational people working within an irrational, Rube Goldberg-type system.

Some healthcare providers may oppose this bill.  But the only innovations that have actually WORKED to reduce healthcare spending have involved individual consumers having "skin in the game" and making rational economic choices for their own care.  To do so, consumers need price data.

The MEDPAR data base is the most complete database out there.  If it were opened to the public, there would be a surge in data-mining firms that would slice and dice it for easy consumer consumption. 

Medicare is already the baseline against which health plans and providers negotiate managed care contracts.  The fact is that hospitals and physicians lose money on Medicaid and often times on Medicare - - they make up those losses by negotiating better-than-Medicare rates on their commercial insurance contracts.  But all those are on the decline, inexorably headed for parity with Medicare. 

The uninsured/self-pay patient is paying the "rack rate" unless he negotiates a discount in exchange for cash payment -- typically 40% discounts are avaiable for prompt payment.  Having access to Medicare price data would introduce significant negotiating information for consumers.

We find ourselves in a transitional chasm between two worlds: the Old World of fee for service based healthcare paid through intermediaries and the brave New World of capitated, value based health care.  But it is not clear that the Old World will go away entirely with everyone buying insurance through exchanges (or defaulting to a single payer system.)  If individuals are to retain their ability to negotiate their own purchases for healthcare, the MEDPAR database could be a powerful tool in their hands.

Can Great Physicians also be Great Leaders?

We all know that physicians view the world differently than healthcare executives. Here's a story that explains why.

I vividly recall a speech by a physician leader given to a hundred of his colleagues.  His topic was why physicians and hospital executives seem to be so often at odds with one another.

He told the story of his two twin sons who had graduated from college and were both starting grad school:  one in an MBA program and the other in medical school.

Both sons left home on a Saturday morning, and each called home the following Saturday morning to tell Dad about their first week in grad school.

The son who went to an MBA program was excited about his first week in grad school.  "On the first morning, I was introduced to 6 other members of my class who would be my Study Group.  We will be doing projects together as a team for a single grade.  We spent the first week learning about ourselves and each other, taking personality assessments and doing various team-building exercises."

An hour later, the son from med school called home.  "This was a fascinating first week in med school.  On the first morning of the program, I was introduced to my cadaver..."  (medical students dissect a cadaver - - a dead body - - for months in their first year to study anatomy.)

The implications of how we socialize and educate leaders in each profession couldn't be clearer. 

Business leaders are taught that they cannot be successful without others.  Therefore learning to work in a team is hardwired into their minds.  They learn technical skills (strategy, finance, operations) as well as behavioral skills (motivating others, relationship building).  By the time they arrive in leadership roles, these competencies are second nature to them.

Physicians, conversely, are trained to be autonomous, fully-accountable captains of their profession.  The buck stops squarely on each physician's shoulders.  He or she cannot delegate that accountability, nor are they taught to rely upon anyone else. (And if I'm laying on the stretcher in the ED after an auto accident, I absolutely want my doctor to be confident and in-command of my treatment!)

Placing physicians in a system or team is often extremely stressful and plagued with conflict.

As healthcare struggles to change, physicians' behaviors and practice patterns must change - - moving from autonomous actors to integrated team members.  The same skills and competencies that make a truly outstanding physician can actually militate against enabling that same physician to become an effective leader.

Fortunately, recent research into physician leadership is revealing important insights that are revolutionizing the approach to finding and developing physician leaders.  I'll write more about this next.

Employed but not Engaged

A recent Gallup poll, The State of the American Workplace, reveals an important insight for leaders.

Employed, but not Engaged on the Job

Only 30% of workers are truly engaged in their work - - they are excited and invested in their work and the enterprise they work for.  Another 18%, however, are “actively disengaged” to the point they are undermining the work of others.

Here’s the insight for leaders:  geography, gender and job title have little effect on engagement, but the size of the work group does.  Smaller teams engender higher engagement.

Think of a nurse on an inpatient unit.  If she is assigned to a shift team that is not subject to being pulled to another unit, she will be more averse to calling-out:  she knows the individuals who are depending upon her and who will be carrying extra patients in her absence.  The personal sense of accountability and responsibility to real people makes a huge difference in one’s engagement on the job.

Empowering small, cohesive teams within a larger organization or department creates purpose and engagement.  People need the personal relationships of team mates to feel invested in their work.  Treating people as interchangeable cogs in a larger wheel, conversely, robs them of purpose and engagement.

Happiness is a Serious Problem for Leaders

One of my favorite thinkers is Dennis Prager, author of a compelling book: Happiness is a Serious Problem.  (See side bar Recommended Reading).  It came to mind today as I was reading a column by Chuck Lauer, long-time observer of leadership in healthcare.  Both authors zero-in on the same conclusion, but from different angles.

Prager concludes that happy people are grateful people.  His rationale is fascinating and convincing.

Gratitude

Lauer likewise offers examples of the power of gratitude expressed by leaders.  

If leaders want happy customers, they can't get it without happy, engaged employees.  And happy, engaged employees are the product of demonstrably grateful leaders.  You can't get it any other way.

Healthcare institutions are living through unprecedented change and upheaval, and the people of healthcare are laboing under the weight and uncertainty it entails.  It takes everyone pulling in the same direction to survive and thrive.  One of the most powerful tools available to a leader is to Be Grateful and express it... you can't go wrong saying thank you too much!

The Quiet Healthcare Revolution

I wrote a few days ago about insights leading to innovation, and the need to challenge sacred cows in healthcare in order to generate innovations.

Here is a remarkable example of what is possible in healthcare.

CareMore started 20 years ago as a dream by a physician who would not settle for "because we've always done it that way."  He chose instead to "tip" the sacred cow of "only physicians can 'doctor.'"  The results are truly impressive.

If you want to be encouraged that coordinated, team-based healthcare can actually produce better outcomes and happier patients at lower costs, read this.

The Quiet Healthcare Revolution

Sacred Cow-Tipping

An insight comes in that moment when two or more concepts, lingering in the back of the mind, suddenly connect to form a new, powerful idea.  And insights are the fuel for innovation.

You may have heard about "cow tipping".... some teenagers sneak into a field and tip a sleeping cow over for laughs!  Well, once again, science has robbed all the fun of another urban legend.  Turns out it would take 4.43 people -- fueled by sufficient alcohol -- to tip a cow.

Cow-tipping myth hasn't a leg to stand on

I'm involved with a lot of very smart people across the healthcare spectrum and I'm fascinated by the conventional wisdom that says, "It takes 12-15 years for a clinical innovation to become mainstream in healthcare."  My experience validates it and yet I wonder why?  It could be due to Sacred Cows.

That's why the article linked below caught my attention.  Innovative thinking requires tipping over some sacred cows.

"We can’t solve problems by using the same kind of thinking we used when we created them” is insightful advice from the great Albert Einstein. Or, as Dee Houck, the creator of the Visa Network, put it – “The problem is never how to get new, innovative thoughts into your mind, but how to get old ones out.”

Dissing Healthcare's Sacred Cows

The authors' list of “sacred cows” that are thwarting innovation in healthcare quickly grew to over 50, of which the following were their highest ranking “sacred cows”:

• EMRs fix everything

• Bigger is more efficient and cost effective

• Consumers cannot make their own healthcare decisions

• Quality measures measure quality

• The best care is delivered in the hospital

• More data leads to better decision making

• You can’t deliver quality care if you are focused on the bottom line

• Medicare is the only disruptive force in healthcare

• Only physicians can “doctor”

• Problems in our healthcare system derive from fee for service

• Physicians are best at managing patient care

• People at the end of life want life at any cost

• US healthcare is the best in the world

My point is this: any one of these, if tipped, could be the start of a new, innovative way of thinking about the problems we face.  If we continue to think that US healthcare is the best in the world, we automatically disregard any innovative ideas from elsewhere.  If we continue to think that only physicians can "doctor" we will ignore innovative ways to bring new players to the team to make it better for everyone.

I highly recommend the daily practice of looking for a sacred cow to nudge ... and see what insights emerge!

Power Corrupts, But Power Also Reveals

“Nothing discloses real character like the use of power,” wrote Robert Green Ingersoll, reflecting on the legacy of Abraham Lincoln. “Most people can bear adversity. But if you wish to know what a man really is, give him power.”

See Yes, Power Corrupts, But Power Also Reveals by Wharton professor and author, Adam Grant.

Disruptive Innovations for a Disruptive Transformation

The healthcare industry is entering the most disruptive transformation in our lifetimes, calling for equally Disruptive Innovations.

Leaders in healthcare - - both physicians and non-clinicians - - must grow their capacity for leading in uncharted territory.

This article spotlights 3 health systems whose leaders are not waiting to follow others.

Disruptive Innovations in Healthcare

"Catholic Health Initiatives, Intermountain Healthcare and ThedaCare's disruptive innovations uproot existing systems in favor of new approaches that simplify processes and reach new markets. These organizations recognized the need for a complete overhaul of healthcare delivery models instead of tweaks to the current system due to the rising cost of care. These health systems have become models of what can be accomplished through disruptive innovation."