This is worth a read!

Kaiser Health News' article today

Mass. Aims To Set First-In-Nation Health Care Spending Target 

is well worth the read.  It is interestingly juxtaposed with the article on how little consumers like the idea of expanding Medicaid budgets in their own states.  The absolute notion that leaders have to get their hands around is how quickly the game is changing from how do I squeeze out a margin on what I am now doing to how fast can I handle a global fee and still make a margin.  As the dollars continue to be constrained at the State levels, the message gets louder and louder: the federal constraints are going to come and they will stick...even in the current "leaderless" election cycles.

The perfect storm of aging babyboomers, slowing retirement accounts and slowing government spending really points to more and more risk based and data driven spending.  Massachusett's focus on global payments and data is by necessity going to hit all states and then the feds for those states that can't get their hands around it.

Check it out.

I have participated in my 10th (do I really know how many) on line debates on healthcare because a neighbor of mine loves to rile up his Republican colleagues and his Democratic neighbors and to watch the sparks fly.

It has been one of the few places that I have actually seen intelligent data being quoted with a few barbs thrown in, so I keep returning to the scene of the crime and get baited into participating.    Most discussions of healthcare, or Obamacare or ACA, are mostly barbs so this is kind of enlightening.  I have yet though to see anyone convince the other that they are right....isn't it interesting, no one believes anymore that facts are facts.  They believe that they can toss out an opinion (not their own but someone elses) as a fact, and because they know their facts are often wobbly, they challenge the facts of everyone else.  Its hilarious for adults to be throwing major reference data on a facebook discussion!  Or maybe not so hilarious....I really miss the days when facts were facts and you needed a professionally critiqued replicable study to dispute the facts.  Now all we need is one loony who says it just ain't so.

The only fact that I know is that everyone needs a doctor, or possibly surgeon or midwife or orthopedic specialist or trauma surgeon at some point in their lives.  They need them for immunizations (a nurse can give it I know), ear infections, stomach bugs, terrifying febrile seizures in 4 year olds, and broken hips in your 70s.  These are not life style or choice, these are terrifying or painful moments that affect all humans and the choices are to seek medical and other health attention or to suffer and possibly die.  That makes healthcare no more a commodity than the person who receives it and the person who gives it.  It is not a market but a need.  It is not a want but a necessity.  It is a requirement of most religions to provide it and its a mark of a civilized society to provide it equally to all citizens and visitors.  The good samaritan didn't ask for papers as you might recall.

Today healthcare is about money.  Huge whopping piles of money.  Money coming in and money going out.  Money paying for nurses to valiantly stand by your bedside all night long and hold your hand and money going in boatloads to pay for administrative rules and crazy systems.  Money that lines the retirement account of senior executives to the tune of the whole budget for a town of people and money that keeps some doctors squarely in the 1%.  Money to pay off ridiculously high costs of medical education and money to pay for overmedicating of children and seniors.  Nuns talking about margin. Millionaires talking about mission.  Money, money.  Everyone has a stake.  Do I get less or more.  Do I pay less or more.  Why do I pay for someone else.  Why do they expect to have what I get but don't pay for.  Its all about money and its so broken. 

I am not naive about money and the cost of healthcare.  Its the priority it has and the imbedded vested interest that is so difficult to move.  I have seen organizations put their best interest aside only to be slammed by their constituents.  We really don't understand what is at stake as a country.

So I keep jumping into the debate because it is about the foot that was lost to poor diabetic management or the women who decided living isn't so great when you're poor so she ignores pain. Its about the body, stupid, and that body just might belong to someone you know.

Twenty CCE/MCCN Projects submitted

The State of Illinois is reviewing 20 Care Coordination Entity project bids this summer to care for the most challenging Medicaid clients - the aged and disabled. 

I had the privilege of working with a great team to design and implement a health home network for these patients that is centered on a chronic disease management model as opposed to a family practice model.  This exciting approach to systemic change and patient management - patient partnership and patient engagement - could improve the value of care for thousands of patients.

Implementation that focuses on transition management and structural improvements is underway now.  This model has value for all patients.  Congrats to a great team.

Moving to ACO

The Move to Accountable Care begins with the creation of state of the art medical or health homes.  Based on years of research at major integrated systems like Kaiser and Group Health Cooperative, the medical/health home is very different in structure, fully supported with unique roles and HIT, to create a new model of approaching the management of patient care and outcomes.   The creation of health homes is foundational but is only one  of the process and structure changes that allow an organization to manage both financial risk as well and more importantly, quality outcomes.No longer are leaders asked to tweek a system here or there or cut costs around the edges; this process change requires a wholesale refocusing on the metrics by which all entities are evaluated and compensated. 

Working with Clients to achieve structures to do this work is creative, challenging and culturally wrenching!  Everyone knows that culture trumps strategy. 

Clients need to embed in their cultures the recognition that is not an experiment or an option.  The change that is required is fundamental because the system is fundamentally unsustainable at its current cost and value (outcomes).  Patients will find that its not the options that are available to them that make quality but knowing that the right option for their health and lifestyle is available to them and will have an outcome that they expect.  These value changes are occurring and will be supported by payors whether our cultures accept them or not.  The key to success is to embrace the paradigm shift and begin the build, balancing the "now" with the future in terms of revenue stream.

Moving to Standard Work Elements in a Medical Home

I have found that the most compelling and simple tool in use for the change in moving a practice from medical practice to health home are the elements of standard work from Group Health Cooperative of Puget Sound.  These elements including call management and outreach work cell define core traits of a value based practice.  Clearly a more aggressive model than hospital clinic medicine or private practice offices these elements lead to a trade-off with unnecessary hospital use.  We are using this model with Community Health Centers as they expand their role from a medical and case management outpatient site to one that bridges the transitions with other providers and manages chronic disease.

The Standard Work Elements are available on line at Group Health's website.

If you believed what you hear in the news, you would think that all change in healthcare will cease with a negative supreme court decision.   And if you are leading a healthcare agency and believe that then you are being left behind.  There is radical change occurring from community clinics to hospitals to insurers.  Insurers testified last week before the Senate Finance Committee to the enormous progress their integrated and coordinated models are making in regions throughout country.

As providers attempt to find their niche, those that hoped their niche was in merging or being acquired are rapidly finding out that that is just the beginning. Others are creating unique and experimental partnerships.

I have had a remarkable journey led by a community clinic and partnering with hospitals to rethink the spaces in between them.  The joint responsibility for patient transitions, for navigation, for coaching patients is not only seen in the HIT expansion but in new care coordination roles and RN roles.  Joint venture approaches to afterhours and urgent care are exciting.  Joint efforts to avoid duplication of testing between hospitals based on shared quality standards could produce real savings.

The automation of risk triggers and patient monitoring will drive down unnecessary hospital visits for a significant population of chronically ill patients.  The model embraced by these partners is wholistic and flexible; focused on the strengths of the past and the opportunities to look at care differently and more broadly; less really is more!

Building the Innovative Care Coordination Model

The State of Illinois' solicitation for Innovative Care Coordination Models is a view into the path to accelerating care management and bending the cost curve with bottom up solutions.   This path is really an opportunity for disparate organizations to begin to identify and define their future, not just for chronically ill Medicaid patients but for all patients.

The focus on care coordination strategies, partnerships and leveraging existing strengths creates a must do exercise for all organizations large and small.  The ability to articulate a path for the future, identifying real strategies around measurable outcomes with the right set of partners is a call to begin to move if you haven't already.

Still I worry that there are many out there who are not using this opportunity to think through the best of their organization and to shine a spotlight on the missing links in care delivery and coordination.  Even if the Medicaid population in need of services is not a local concern or target market, the questions asked and outcomes required are a view into the soon to be rapidly changing health care landscape.  The planning by Blue Cross with large partners, the internal focus on health outcomes by Aetna will impact those not currently engaged.  The State solicitation is one opportunity to move the planning to a real, concrete level. 

I am thrilled to be working with clients on this compelling challenge.