The demise of personal responsbility and the necessity of reinvention

A few months ago I visited my primary care doctor.  Fortunately (or not) he knows that I’m pursuing a career in health care administration and so I receive the longer than the (less than) standard 10-minute primary care visit.  That extra time is spent discussing health care reform, not my health (still, very valuable, especially since listening to insight provided by physicians like himself will be important to my future financial health).

We got to talking about pay for performance and physician incentives.  His (very accurate) contention is that payers cannot only hold physicians accountable for better outcomes, they must also (very accurately) hold patients accountable for personal decisions affecting those outcomes.  While measures are beginning to do just that, we have a very long, long way to go.

The problem is one of culture.  Long a nation of personal responsibility (“pull yourself up by the bootstraps”), we’ve (the U.S. of A) recently (it’s probably been a long trend downward) entered an era of diffusing responsibility that is having an extraordinary impact on our health.  Whether or not you are a proponent/evangelist of the consumerist movement in the health care industry, agreement must be reached on this point: personal responsibility in daily decisions of health must improve (greatly!).  It is becoming clear that increasing the financial burden on patients to incent more healthful decision making isn’t creating the dramatic improvements necessary.

We’re obese (and getting larger).  We don’t do well with preventative physician visits.  Our eating habits are atrocious.  We exercise dramatically less than we watch television.  We’re becoming more dependent on drugs to correct the problem.  It’s getting really, really bad.  Modern medicine has been the saving grace of many, many patients.

Current events are only decreasing the notion of personal responsibility.

Our banking system will (hopefully, hopefully) be made all better by a government cash infusion of billions of dollars (one that cost more than the Marshall Plan, Louisiana Purchase, trip to the moon, savings and loan bailout, Korean War, New Deal, Iraq War, Vietnam War, and NASA’s entire lifetime budget COMBINED!) after many people made bad, bad decisions.

The (not-so) Big Three are asking for money, too.  This one is going to cost significantly less than the above (reportedly only $10 billion…for now, the charade that was flying on private jets and then driving to D.C. was obviously realized) for companies that badly managed the move toward fuel-efficient vehicles (not to mention their only very recent introduction to good design) in an industry that some say won’t survive (that’s capitalism, by the way).

Our local governments are in trouble, too.  States across the nation are preparing for record-setting shortfalls.  Some mayors have even asked for bailout assistance.  Philadelphia mayor Michael Nutter said, “I want to make sure that cities and metro areas are at the table, that their voices are being heard, that our challenges and problems are well understood, so that we can get relief.”

Many people are looking for relief.  It must be one of those “do as I say, not as I do” moments.

The problem here is that a cash infusion into our personal health can’t fix our health problems.  While the government can try like heck to fix the economic problems we currently face by printing more money, we can’t create more years of life when we reach the unhealthy point of no return.

We need nationwide behavior change.

Even bariatric surgery patients must change their diets; for even after a surgery if a patient returns to eating habits of old, the weight will come back.  A heart bypass surgery patient must change food intake and exercise habits.  The same can be said for any number of current health care procedures.  But the point is, as our collective health worsens, we must start taking action before we have to undergo medical/surgical treatment.

But how, one might ask?

Invest in primary care.  Seriously invest in primary care.  Whether it is done through loan forgiveness or more closely aligning specialist and primary care physician salaries or some other tool (the debate can be had), it must be done.  That less than 10-minute face time with a primary doctor, inexcusable.  People listen to doctors.  Look at me, I’m writing about it after conversing with my primary care doctor.  Start the behavior change in the exam room.  Obviously we need to invest in a personal responsibility campaign, too.  We also need to properly incent patients to follow marching orders (trips to Hawaii? shopping sprees? money off premiums/co-pays/deductibles? community recognition? it’s obvious reduced life expectancy isn’t a big enough stick…).  I look forward to hearing about what other ideas you may have.

Let’s get back to personal responsbility.  It truly is the only tool that will save us.  Diatribe over.

Season’s Greetings: Happy Health Care!

My roommates and I have been planning on having a holiday party in the coming weeks to celebrate the season.  It was to be a best-of-your-closet-Christmas sweater get-together.  Until this morning.

When one roommate hung this article on the bathroom mirror (we’re all health administration students, health care consumes the majority of our attention) we knew we had a new theme.  As it happens, our social circles seem to intertwine with other health care students (medicine, dentistry, administration, public health, health information; for it what it’s worth this limited worldview is one of the reasons our system is in its current state and one more reason to get out of health care) so the guest list will be appropriately represented (synchronistic happenstance considering the new theme).

Reported Health and Human Services secretary nominee Tom Daschle has suggested that Americans hold holiday-season parties to brainstorm solutions for the American health care system (covered here by the WSJ Health Blog).  Mr. Daschle said Friday:

Our long-term fiscal prospects will have a hard time improving as long as sky-rocketing health care costs are holding us all down.  These health care community discussions are a great way for the American people to have a direct say in our health care reform efforts.

We plan on participating and have made our intentions known to the Obama administration team through their transition website as Mr. Daschle is planning to attend one group’s event.  You should consider doing the same.

This all got me thinking about past holiday parties with friends and family and how often health care is a topic of discussion.  We’re not usually discussing how to solve our health care problems, of course.  Amidst the catching-up/political banter/good-nature ribbing with fellow attendees, the health care conversations usually entail listening to complaints and success stories of health care travails during the previous year.  Which is all well and good since an astute health care transformer should be able to pull change ideas from a laundry list of complaints.

Whether or not you host an official health reform ideas holiday party, bring your favorite note taking device to your holiday season festivities and jot down what you hear.  Our participatory democracy wants to hear about it.

Of course Christmas sweaters (the uglier the better) are still welcome, they just won’t be the featured entertainment for the evening.

The successful innovation agenda

Jim Carroll had a very intriguing post at World Health Care Blog last week on health care innovation.  The post is a keynote at a conference in 2020.  His reflections provide insight to the ten biggest changes in health care since 2008.  The changes are drastic.  They’re innovative.  They’re also exactly where we need to go.

Coming back to the present, the changes Carroll writes of can form a very interesting innovation agenda:

  1. Move to a system of preventative care.
  2. Enable virtual care through bio-connectivity.
  3. Embrace Health 2.0.
  4. Improve the management of change within the health care organization.
  5. Provide service in the health care environment.
  6. Connect every device.
  7. Utilize the cloud and its power.
  8. Deliver medical knowledge to providers as needed.
  9. Ensure the system can handle ever-increasing scientific velocity.
  10. Build optimism, always optimism.

Does your organization have an innovation agenda?  Has your organization made innovation a foundational pillar for future success?  Does your organization’s definition of innovation include more than buying the latest and greatest technology?

A faltering economy makes now a wow time to get started.  After all, the pressure is on to get the ship in order.  It’s not just a time to drastically cut costs, it’s also a time to find opportunity.

Daniel Roth at Wired writes:

With the world’s economies apparently snowballing into a deep recession, it feels uncomfortably Pollyannish to see signs of hope. But for the bravest inventors and entrepreneurs, conditions are ideal to pounce on a business opportunity. In periods of economic turmoil, people are hungry and work cheap, and entrenched companies often concentrate on in-house cost-cutting instead of exploring new markets, which can explode with the next turn of the business cycle.

Here is why:

This doesn’t mean that big new ideas emerge because of turmoil—in fact, the data shows no relationship between major breakthroughs and economic conditions. But the benefit of a global money drought is that competition tends to vaporize (ed: in hospitals, vaporize should read contract). And for some, the stress of tough times has an amazing way of concentrating the mind on the way forward.

But the opportunity-seeking organization can’t enter the innovation game willy-nilly.  It must be a concerted effort with defined measures of success.  Measuring innovation can be difficult.  As PSFK recently highlighted, the Boston Consulting Group has published a report seeking to answer the question, “(H)ow effective is the push to innovate when there are no real measures of its rewards?”

From BCG:

Companies undermeasure, measure the wrong things, or, in some cases, don’t measure at all, because they are under the mistaken impression that innovation is somehow different from other business processes and can’t or shouldn’t be measured. The potential cost of this error – in terms of poorly allocated resources, squandered opportunities, and bad decision making generally – is substantial.

BCG recommends implementing an “innovation-to-cash” process to ensure success (read about it here, pdf).

The key, as with other initiatives, is accountability.  BGG:

Make innovation a central concern to your top people by tying a substantial part of their compensation to it. Don’t pretend that people will make innovations, by definition a long-term pursuit, a priority when virtually all of their pay is tied to meeting either next quarter’s numbers or some vague and far-off target they can barely influence.

It’s an innovator’s market.  Approach it deliberately.  Do so intelligently.