A new study has found surprising evidence of delays in getting women with heart trouble to the hospital. Researchers at Tufts Medical Center examined 5,887 emergency calls about suspected cardiac symptoms in Dallas County, TX. About half of the calls were made by women, and about 11% were delayed, spending 45 minutes or longer in the care of emergency workers. Women were 52% more likely than men to be among the delayed, said Thomas W. Concannon, an assistant professor of medicine at Tufts University.
A growing number of workers in 2009 will pay more for health benefits, and in some cases receive less coverage, as their employers grapple with the financial fallout of rising medical expenses and diminished revenue and profits, recent surveys of human resource officials show. The Corporate Executive Board found in a survey that a quarter of officials from 350 large corporations said they had increased deductibles an average of 9% in 2008. But 30% of the employers said they expected to raise deductibles an average of 14% in 2009.
There is plenty of discussion among the consumer-driven health crowd about where one's "medical home" resides these days. Is it part of an integrated delivery system or an institutional entity, such as a mission-driven community hospital? Is it a local doc in the box or urgent care center? Some even think a health information Web site, like WebMD, or an extended social network of family, friends, and experienced patients, could function as a medical home.
So what makes us, as consumers, seek out and want to have different solutions to meet our healthcare needs and provide that medical home? It could be our level of experience, lack of standards, or belief—based on the variability in the delivery of care—that there is no system in healthcare.
Or it could be that the current leaders in healthcare are not who you think. The "real" health leaders are not C-suite executives at your local hospital or physicians and caregivers—they are empowered consumers.
Today's health leaders are the moms and dads who are struggling to navigate the healthcare system. These consumers are doing their best to lead their family through crisis, chronic condition, and routine cold and flu without the benefit of a healthcare provider taking the lead to coordinate their family's care.
But is it really about coordination of care, or is about the lack of confidence that we as consumers have in the system? As consumers, we understand convenience, service levels, quality, price, and satisfaction of experience. We call this "value for money", and it's ingrained in everyone who makes purchases.The new C-suite—healthcare consumers—is searching for value in the care that they buy.
In the book, Redefining Health Care, authors Michael E. Porter and Elizabeth Olmsted Teisberg define healthcare value as "outcomes per dollar." Even though people can debate whether an outcome is experience, satisfaction, death, or a safety event, we can all agree that the "per dollar" part is really clear.
Everyday consumers make value judgments based upon what matters most to them. They do this with calling plans, travel destinations, and service ratings that help them make decisions. These new empowered consumers are the ones creating value by defining value. Today, absent anyone noticing, consumers will draw their own conclusions and vote with their feet and wallet.
Institutional healthcare leaders should get off the "quality is king" bandwagon and realize that enormous volumes of care are given daily that have minimal impact on quality or outcomes. It's not just about quality; it's about convenience, experience, satisfaction, preference, perception, and yes, it's about the out-of-pocket price consumers pay. When healthcare leaders get on the track and begin to follow the warnings from the Centers for Medicare & Medicaid Services that value-based purchasing is just around the corner, we'll finally start to hear how they are helping consumers find value. That is a community benefit that you can sink your teeth into.
So, how can institutional healthcare leaders better serve the new C-Suite (or consumers)?
Transparency: Develop a philosophy of transparency for performance reporting.
Value: Understand your value equation (outcomes per dollar) and publish it!
Metrics: Measure differences in price, convenience, perception, satisfaction, and outcomes. Adjust your service offerings based on what works.
Communication: Formulate a communication strategy that helps consumers understand the complexity of your offerings; then, streamline the message and publish it.
Be a Consumer: Spend a day as a consumer in your own facility—take public transportation to get there; walk into the emergency room and ask for care; ask the admissions department about the cost of basic services; analyze how helpful your employees really are, and poll other patients in the waiting room about their wait time and levels of confusion.
Delivering value is about the big picture—not just quality or good food or friendly staff. And if you don't think the current economy will put new pressures on your facility's value equation, think again.
John Morrow is a health ratings innovator who has spent his career helping hospitals, consumers and payers improve their value proposition by benchmarking performance. He most recently created the Hospital Value Index® with Data Advantage and was the founder of 100 Top Hospitals: Benchmarks for Success® while at HCIA (now Thomson-Reuters).
I still wish my husband and I could take back the decision to purchase that 1986 Oldsmobile. Its transmission died a month after we bought it, so it ended up sitting in our driveway with grass growing up around the tires. Fourteen years later, it's still a sensitive subject to discuss (or write about).
While that decision dinged our pocket book and was a major inconvenience, it was still just a car. When a hospital CEO makes a poor decision, the repercussions can affect employees, patients, and the community at large. I certainly don't envy their position or some of the decisions they'll need to make this year. For example, no CEO wants to downsize 50 people. And the realization eight months down the road that you need 10 of those positions back because they really were vital to the operation of the organization only makes that decision tougher to bear.
Usually CEOs have exhausted all of the alternatives when deciding to cut a service or lay off employees or close a facility. But perhaps the even more challenging decisions are the strategic choices made throughout the year. According to a survey by McKinsey & Co. that evaluated which decision-making processes yield the best results, only 23% of decisions were made in response to an immediate threat. The report, which surveyed 2,327 executives from various industries and regions, also found that decisions made without a strategic planning process were twice as likely to generate extremely poor results—more than a fifth generated revenue 75% or more below expectations.
CEOs tend to have a large role in both the most and least successful decisions, the report says. Given the current financial climate, I'd say there's no denying that CEOs are facing extraordinary pressure to make sound strategic decisions.
Pete Knox, the executive vice president of Bellin Health in Green Bay, WI, recently told me that one of the key reasons some healthcare organizations struggle is because they fail to view their core strategic missions like service, quality, growth, people, and finances as a collective group of strategies that require the same resources. "They tend to fragment that," he says. Unfortunately, that means each group is focused on their own priorities and driving that agenda. For example, the financial people want resources for financial priorities, quality people want to focus on regulations, marketers want to expand services, and so on. CEOs are getting hit from different angles and sources, Knox explains. "You have to make high-level decisions on where to focus time."
Knox says Bellin Health has five strategies that align with its mission and vision, and all five compete for the same resource pool. Even though the organization focuses some energy in each of the five categories, how much it allocates relies on a very high-level discussion. "We make some strategic decision about where we are as an organization, how we want to position ourselves, and where we need to focus energy," he says. "It is a very deliberate prioritization and allocation process."
Based on its findings, the McKinsey report offered three best practices organizations can use to improve their decision making.
Define the risk. Organizations should examine decisions through a detailed financial model that compares those risks to the risks of other projects in the organization's portfolio. Looking back and learning from past situations that are comparable is also advised.
Discussion is key. The report found that decisions initiated and approved by the same person generated the worst financial results. There was also a strong correlation linking financial success with clarity about who is responsible for the project and the involvement of that individual in the decision-making process. Other participants in the discussion should be included based on skills and experience, and that decision criteria should be transparent. Lastly, the decision should be discussed in relation to other strategic initiatives.
The organization should come first. Organizational goals should be placed above the business goals of individual units. Leaders should spend time building consensus among the different units of the organization.
There are many external factors that healthcare CEOs can't control, like government reimbursement, the new administration's policies, and the speed of the economy's recovery. But CEOs can ensure that all decisions have the proper analysis, resource allocation, management oversight, and strategic alignment with the organization as a whole.
Having those tools in place can help CEOs avoid the fallout of a poor decision—and the sting of regret.
Carrie Vaughan is leadership editor with HealthLeaders magazine. She can be reached at cvaughan@healthleadersmedia.com.
Note: You can sign up to receive HealthLeaders Media Corner Office, a free weekly e-newsletter that reports on key management trends and strategies that affect healthcare CEOs and senior leaders.
Minnesota Attorney General Lori Swanson has accused Allina Hospitals and Clinics of charging patients unlawfully high interest rates on unpaid medical bills and filed a lawsuit that could affect the bills of thousands of consumers. Allina charged patients interest rates as high as 18% on medical debt, even though, Swanson asserted, Minnesota law caps rates on such debt at 8%. Swanson said she wants Allina to reduce interest rates charged by its MedCredit Financial Services unit and make refunds to patients who were charged high rates in the past. She is also pursuing civil penalties of up to $25,000 per violation.
Massachusetts Attorney General Martha Coakley has launched an investigation into whether the state's largest health insurance company and its largest healthcare provider may have illegally colluded to increase the price of health insurance statewide over the last nine years. Caokley sent formal demands for information to Blue Cross and Blue Shield of Massachusetts and Partners HealthCare, calling for a detailed account of their contract negotiations in recent years. Since 2000, Blue Cross has boosted the rate it pays for medical care by Partners doctors and hospitals by 75%, dramatically more than the increases given to most other Massachusetts hospitals. Blue Cross now pays $2 billion a year to Partners.
Tenet Healthcare Corp. surprised Wall Street by predicting a fourth-quarter profit, but its lack of further earnings visibility highlights the toll an ailing U.S. economy and tough credit markets are taking on the hospital industry. Tenet's preliminary report may ease some of Wall Street's concerns about the final quarter of 2008, but the overall prognosis for the industry isn't encouraging, experts say. "We definitely are hearing from the field that as this economic slowdown gets longer and deeper, that hospitals are hurting," said Caroline Steinberg, vice president for trends analysis at the American Hospital Association.
The Joint Commission has announced that Washington DC-based United Medical Center, formerly known as Greater Southeast Community Hospital, has earned accreditation slightly more than a year after losing it in December 2007. A spokeswoman for the commission said that United Medical Center passed a surprise inspection and that its accreditation became effective Jan. 14. In a statement, the hospital's board chairman and president, Eric Rieseberg, called the accreditation "a milestone" that affirmed the efforts of "thousands of people who have worked hard to restore the community's faith in our hospital."
Consolidating two Pennsylvania Blues plans would have reduced competition, hurt providers, and meant fewer options for consumers, according to Pennsylvania Insurance Commissioner Joel Ario.
Knowing that Ario planned to reject their merger on January 27, Philadelphia-based Independence Blue Cross and Pittsburgh-based Highmark, Inc., withdrew their applications on Wednesday. The two insurers filed the proposed consolidation nearly two years ago and it was the topic of public hearings in which competitors, physicians, and consumers questioned the merger's affect on healthcare in Pennsylvania.
"Our conclusions were based on the fact that the consolidation of these two companies at this time would have worsened what already is a highly concentrated market for health insurance in this state," said Ario during a press conference Thursday. "In other words, we already have an anti-competitive dynamic at play here and the consolidation would make that dynamic worse."
Independence and Highmark are two of four Blues plans operating in Pennsylvania. Independence covers the Philadelphia area, Highmark has Pittsburgh and the middle portion of the Keystone State, Blue Cross of Northeastern Pennsylvania covers the northeast, and Capital BlueCross serves the central region.
The sticking points for the Insurance Department were the merger's adverse impact on competition and the health insurers' refusal to relinquish the use of either the Blue Cross or Blue Shield brand. (Highmark is a Blue Cross and Blue Shield company while Independence is a Blue Cross plan.) If the merged company relinquished one brand name, a competitor could have entered the Pennsylvania market under the Blues umbrella, which would have brought more competition.)
In announcing their withdrawal of the consolidation, Kenneth R. Melani, MD, president and chief executive officer of Highmark, and Joseph A. Frick, Independent's president and chief executive officer, said in a joint statement Wednesday, "Throughout the review process, we have stated repeatedly that we would not give up one of our brands. We have spent more than 70 years developing our brands' value in our marketing and they are an integral part of our corporate identities and reputation."
Though the merger would have benefited healthcare, the executives said, relinquishing one of its brands would "preclude the new company from delivering to our customers, communities, and the Commonwealth the full results we had projected."
At his press conference Thursday, Ario said a merged Independence/Highmark insurer would have received $17.4 billion in premiums and become the sixth largest health insurer in the country with a 51% market share in the state. The $17.4 billion figure would have followed only Kaiser Permanente in California for direct premiums in one state and it would have been fifth in market share percentage in one state.
The new company would have enjoyed a "more dominant position" in Pennsylvania than any national competitor has in any other state, he said.
Ario added the merged company would have given Highmark/Independence "undue leverage over providers to the detriment of the insurance buying public."
"The consolidation would have undermined competition. The proposed consolidation would have been likely to have a long-term anti-competitive effect, especially when combined with the limited presence of the national competitors in Pennsylvania. We would not tolerate this type of consolidation in any other line of business—imagine the auto or life markets without the significant presence of other leading national insurers," said Ario.
Ario said the state explored various conditions to "reform the transaction into a pro-competitive one," such as expanding Blue on Blue competition beyond central Pennsylvania, sharing efficiency benefits from the merger with the state, and limit anti-competitive practices in the areas of contracting and other market practices.
One of the opponents of the proposed merger was Capital BlueCross of Harrisburg, PA. Michael J. Merenda, executive vice president of Capital BlueCross, said Capital hopes state policymakers learn from the process.
"Commissioner Ario's hearings shined a stark light on numerous structural challenges in the Pennsylvania health insurance marketplace, and it is important those challenges continue to be considered, debated, and addressed," said Merenda.
Ario said policymakers should review new health insurance regulations proposed by the Pennsylvania Senate Banking and Insurance Committee, which would prohibit unfair contract terms, enhance transparency, and eliminate medical underwriting, to create a better health insurance system.
"The applicants' withdrawal will prevent the competitive environment from getting worse, but the fact is that the current market is not as competitive as it should be," said Ario.
Architects for the U.S. Department of Veterans Affairs and the Louisiana State University System have unveiled preliminary plans Thursday for medical complexes in New Orleans. The architects showed stakeholders various options with a common result: distinctly independent hospitals that appear to lack much of the "synergy" the participating institutions once touted. Speaking to preservationists and planners, separate design teams emphasized that the schematic designs are "preliminary," but some in the audience expressed surprise when comparing the early renderings.
