Prevention...

So what are you thinking about prevention? As an employer and potential employer of physicians, do you see the prevention side of this equation, now fully covered as an opportunity to be a win-win as an employer and provider?  Are there opportunities to make it work in your favor? Clearly the returns are nothing like a hospital stay but does a hospital stay get you ahead of the curve.

Or take a lesson from education.  Instead of cutting physical education at the Naperville public schools, some of the best in the country, the kids now have more opportunities to destress and get their brains oxygenated in the morning.  Their results on tests and their performance overall improved.  Is there an opportunity to "pay" employees to exercise during a free time or lunch time or before work?  Would there be a savings in the long term in productivity, morale, retention and cost of insurance.   Personal responsibility has not worked well in the past as the obesity rates climb.  The carrot has always seemed negative to me - it looks like the stick. 

How are you looking at your workforce - where are the incentives.  Do your policies reinforce the healthy lifestyle that you are promoting to the public.  Is the fryer still working overtime in the cafeteria?  Are your employees wearing miniskirts and high heals or are they in running shoes able to sprint the stairs.  What message are we giving the community with elevators full of unhealthy food and unhealthy staff.
Just thinking about prevention - and your most expensive resource - your people.

Are you between reform and your board?

It seems to me that more and more CEOs have woken up to realize that with the Health Reform package not only is their business model heading toward a fairly major change in a relatively short time (more change than DRGs which felt like a tsunami at the time), but that they are being criticized for going along with it.  The fact that every major healthcare organization (trade association, professional association etc) advocated for it puts the CEO in a difficult spot.  With subspecialists that do not want a change in a career and income path that they "sacrificed" alot for ( and worked 25 years for), meshed with somewhat conservative business and community leaders heading up boards, you can feel the squeeze. 

Phones are ringing.  Voices raised.  Emotions all over the place.  One leader said, "I know now why no one took this on in years past!".  What is one to do?.....

It seems to me that there is an opportunity to provide consumer ready copy for distribution by healthcare institutional leaders to help people understand the unique positives of this plan and the opportunities for the organizaiton, doctors and community.  And the hospitals need some help identifying the paradigm shift and how to mitigate the negatives while dealing with change.  No one wants to change, especially if you are in the minority that benefits.  (Ask White South Africans about change...its scary but it is also inevitable).  There is an opportunity for us to support leaders as they support terrified constituents face a new future.  It is not fair to let these folks figure it out themselves...they invested in the status quo in good faith...so let's stop labeling and start planning how to make the future work...starting in the present.

Is there a take-away here?

The headline read "WellPoint CEO Braly received a 51 percent compensation boost in 2009". Okay so she worked really hard and she got a great deal in health reform requiring everyone to essentially buy insurance and the public thinks they didn't get what they want.  So its a win-win....for her.  But where did WellPoint miss the fact that the insurance companies were called "greedy" and uncaring and unethical - essentially all in the name of profit!  How do you structure compensation in this environment to total $13 million when your rates are escalating by almost 40% for some of the insured.  I say that that multiple of salary from the lowest paid worker or the average family in the US to $13 million is beyond arrogant and "capitalistic".  It doesn't pass anyone's reasonableness test for what is fast becoming a public utility and it looks like a complete lack of fiduciary oversight in this market and a slap in the face of the public.

Okay, I get that it is hard to be an executive of a huge company; that you make sacrifices including never seeing your family; that your competitors are paying ridiculous sums and yes, that she is a woman and if its good enough for men all these years she ought to get the same private equity stock.

But put all that aside for a minute.  Do the same rules of the 1990s, and early 2000s apply here at all?  Did we not just see a recession where retirements were lost or delayed, where houses were lost and safety nets failed and many more people joined the ranks of the "uninsured" in healthcare.  None except the most minute segment of society are secure in their financial futures.  The economy isn't recovering fast because of fear.  So in this environment, a board would payout a compensation package that is mind-boggling to even more than the average American. 

My thought here is that the healthcare industry including and most importantly the not-for-profit sector (hospitals) better start to think differently about compensation going forward.  Not necessarily the small hospital in a rural location whose VPs just barely make six figures but the escalating salaries and bonuses for the top brass.  The incentives better be more obvious to the consumer of health than the Well point package is.  The value added to the community and each patient ought to be clear in the compensation since each of those customers is paying for the product.  And Boards better start to question the standard that they are using....or Senator Grassley will for you!