"You have to get leadership on board." That's the first thing everybody tells you about every single marketing initiative, effort, or project, from improving internal communications to launching a patient experience initiative to trying out a new kind of marketing tactic.
But you know what? People rarely explain just how you're supposed to get those leaders on board. Sometimes it feels like C-suite leaders are gurus sitting atop a mountain in the Himalayas. You climb and climb and climb to get to them, but once you arrive you're not sure what to ask them.
Plus, these particular gurus are very skeptical.
They think open forums and relative anonymity will lead to negative comments. They think it drains resources. They don't see the potential for return on investment. And a lot of folks—including (perhaps especially) healthcare decision-makers—just don't get it, or think social media is a passing fad.
"A lot of facilities are not sure what the reward is, but they know the risk is pretty great," Reed Smith, director of project management at the Texas Hospital Association in Austin told me for an article in this month's issue of HealthLeaders magazine, "Marketing: Are Social Media's Rewards Worth the Risks?"
When it came time to convince the leaders at his organization to get on board with social media efforts, Marc Needham, director of Web technology at Scripps Health in San Diego, took action. He walked into a meeting with a stack of papers the size of a phone book that contained printouts from all the Web sites where people were talking about Scripps—including reviews on sites such as Yelp.com, blog posts, videos, news stories, and reader comments about the four-hospital system.
"Here are some examples of the conversations that are happening," he told the room. "And we need to be a part of it."
Today, Scripps is a leader in using social media effectively, with a presence on Twitter, Facebook, YouTube, and other social media sites.
Perhaps the trick is not to ask the gurus to tell you the meaning of life—but to show and tell the guru the meaning of life.
There are more pros, cons, and evidence in the article from those who are doing social media well. So if you're looking for concrete ways to "get leaders on board" at your organization, you might borrow from the advice of others.
Just don't forget to pack it along with your climbing gear.
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A look at Alabama and its small shrimp processing town, Bayou La Batre, made famous by the 1994 movie "Forrest Gump," might reveal some clues about what health issues President Obama's pick for the next U.S. Surgeon General will tackle first.
Regina Benjamin, MD, started her own practice on the south side of town nearly two decades ago, an office that is now Bayou La Batre Rural Health Clinic.
Now, many in the small shrimp town are beaming with pride that one of their own has been named to be the top physician in the U.S.
"This is the biggest thing since Bubba Gump that a person from Bajou La Batre had a moment of fame," says Jim Vann, a pharmacist who has known her for nearly two decades.
She wanted to care for a population of poor, uninsured, and often very sick people that are the end result of all that is wrong with the U.S. healthcare system, which allows diseases that could be prevented to flourish.
For Benjamin, it will probably be back to the basics of educating and encouraging Americans not to smoke, to manage their weight and their diet, and to avoid heart disease and high blood pressure, conditions that plague her community and her state, some of her acquaintances and co-workers said.
She and her small staff of fewer than 12 see about 16 patients a day, five days a week. And most of these patients have challenging health problems.
"This is a community of largely self-employed people, fishermen, who are independent minded people," says Vann.
"And there are an awful lot of them who don't have insurance because they can't afford it. I know many times people tell me they didn't go to the doctor, or they don't get this medicine they need, or won't get this test or procedure done" because they can't pay.
Benjamin, he says, "knows this. She's lived it. She touches it every day." And making sure that everyone has an option for health coverage is of paramount importance to her, he says.
Twice her clinic has been torn apart by hurricanes (Georges and Katrina) and once totally burned down by fire. Still, she has managed to overcome, find the money, restore patients' charts, and rebuild.
Many of the people in this town have neglected their care for many years. A large portion are obese, and have diabetes and hypertension, mirroring health conditions in the rest of Alabama.
They also smoke cigarettes, and eat a cultural–not necessarily a healthy–diet. And many are now unemployed, because businesses ruined by Hurricane Katrina and flooding in 2005 were torn down. The companies moved away, leaving behind their former employees, some of Benjamin's colleagues and co-workers said.
For many now living in Bayou La Batre, many illnesses would have been avoided if care had been easier to find years ago.
But now, the challenge is to manage patients' diseases and conditions the best that her clinic's budget and small staff can.
Nell Stoddard, a nurse at Benjamin's clinic for the last 19 years and whose son is being treated by Benjamin for leukemia, has tremendous confidence that if confirmed for the top doctor post, Benjamin will make an impact not just in Bayou La Batre and Alabama, but throughout the country as well.
"She is adamant about making sure people get the right care. And when our offices burned down and we lost everything, she was adamant to get computers, and put all the records on those computers."
Benjamin, her colleagues say, is driven to change the system not just because of the conditions in her town, but as a former president of the Alabama Medical Association, she is well aware the state has some of the worst healthcare measurement scores in the country. For starters, nearly one-third of its adult residents are obese, the second highest rate in the U.S. And the prevalence of obese Alabama citizens has been increasing.
A recent national population study found the state, which has 4.6 million people, ranked "weak" or "very weak" and significantly worse than the average of other states in eight of 12 healthcare categories including heart disease, preventive, maternal child health, cancer, and respiratory care.
Trying to operate a clinic in a rural setting presents issues that are a big part of that challenge.
As Obama introduced Benjamin in the Rose Garden Monday, he used the word "rural" no fewer than five times.
And many hope the obstacles to healthcare faced especially by rural communities, such as a shortage of health providers, low budgets, long-distances from homes to medical care, lack of specialist and primary care physicians, and high numbers of poor and uninsured will be a top priority for Benjamin, along with Congress and the U.S. healthcare system, to overcome.
Alan Morgan, executive director of the National Rural Health Association, applauded her nomination and called Benjamin a "role model for rural clinicians.
"Her efforts to serve her local rural community are certainly well known nationally. She fully understands that these challenges cannot be solved with a simple sound bite from our Nation's Capital. She also understands that the healthcare disparities, combined with local cultures and regional customs in rural America will need unique and localized solutions."
Robin Bugni, vice president of business innovation and development at Pittsburgh-based health insurer Highmark, Inc., speaks about how to implement real-time claims adjudication and estimation services. [Sponsored by Emdeon]
Health insurance companies are often seen as the bad guys in politics, but one industry CEO is hoping to change that perception as he makes a move to become governor of Massachusetts. Harvard Pilgrim Health Care CEO Charles Baker last week announced he is running for governor of the Bay State in 2010. His timing was not great with half of Massachusetts vacationing on the Cape and the other half in Maine last week, but his announcement pleased state Republicans.
Baker does not have name recognition now, but political insiders have expected a run for governor and the health industry knows all about him.
With his announcement, Baker, who was state secretary of administration and finance during the William Weld and Paul Cellucci administrations in the 1990s, became the second Republican to enter the race. The only other candidate at this time is Christy Mihos, a Cape Cod businessman, who ran an unsuccessful campaign as an Independent candidate in 2006. Mihos' candidacy three years ago helped sink any chance of interim Gov. Kerry Healey winning the governorship. Mihos hammered away at Healey during debates and the eventual winner, Democrat Deval Patrick, won the election easily.
Patrick rode into office with a game plan quite similar to the way Barack Obama would become president. Both men are dynamic speechmakers who painted themselves as outsiders and gave a recipe of hope and change. While Obama's slogan was "Yes We Can," Patrick led with "Together We Can."
Patrick's speeches inspired the Democratic base and he was seen as an outsider of Beacon Hill politics. Patrick's governance, however, has seen its share of missteps and now the one-term governor is facing not only a Republican challenge but likely an Independent foe—state Treasurer Tim Cahill, who recently announced he was leaving the Democratic party to become an Independent. Political insiders believe that was his first step toward a run for governor in 2010.
Patrick's unpopularity coupled with a possible challenge from a fairly popular third-party challenger points to the possibility of a Republican regaining the Corner Office. The thought of a health insurer CEO as a viable political candidate would be laughable in other parts of the country (imagine the uproar in a place like California). But, in Massachusetts, Baker has a real shot—and it goes beyond the current governor's sagging poll ratings and a third-party challenge.
Baker is a leader who took a sputtering health plan in 1999 and built it into one of the most respected insurers in the nation. In fact, U.S. News & World Report and the National Committee for Quality Assurance named Harvard Pilgrim the top commercial health plan in America last year and J.D. Power and Associates ranked Harvard Pilgrim number one in the New England region this year.
Baker also has a decent shot in 2010 because of the state's healthcare reform plan, which has struggled with costs. The chief executive has been outspoken about the current system in his blog, Let's Talk Health Care, calling attention most recently to the merged market, which blended the individual and small group markets. "As a result of the merger," he said, "the premiums paid by small businesses went up, and individual prices went down."
With rising health costs crowding out other programs and state officials raising premiums and cutting benefits to those in the public programs, Baker's experience could be seen by voters as a reason to go Republican. In his blog, Baker also has promoted the ideas of bundling payments for quality and care coordination, closing loopholes in the state's health reform program, and Medicare payment reform. He has also written about his concerns with a possible public insurance option.
Having Baker as governor would place healthcare reform in the state on a different course. One significant change that a Baker administration might make is fixing a loophole that allows individuals to buy insurance for a short amount of time, receive costly healthcare services, and be considered insured so they don't have to pay a fine.
According to Baker, about 40% of Harvard Pilgrim members who had individual insurance were covered for less than five months between April 2008 to March 2009. He added that those same people cost about $2,400 per month, which is about 600% higher than what is expected.
Baker said those costs are being transferred to small businesses and individuals that are purchasing 12 months of health insurance and it is allowing residents to game the system.
He suggested the state change its policy to remove the loophole. "That would be the simplest and easiest way to protect individuals and small businesses who are playing by the rules—and limit the very costly impact of this wrinkle in health care reform."
Electing Baker would not only help insurers in his state, but could also indirectly affect insurers across the country. Healthcare leaders are closely watching the Massachusetts experiment and any successes there will be tried in other states. With his experience in healthcare and government, plus his outsider role, Massachusetts voters might actually take a chance on a CEO of a health insurance plan.
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The commission charged with certifying health information technology is unduly influenced by legacy vendors whose concern for their own welfare is threatening the success of the national HIT initiative, a healthcare analyst told a federal workgroup Tuesday.
Brian Klepper, a panelist at Tuesday's HIT Policy Committee Certification/Adoption Workgroup hearing in Washington, DC, said the Certification Commission for Health Information Technology is led by people with strong ties to legacy software vendors and their trade group, Healthcare Information and Management Systems Society.
"CCHIT was founded by HIMSS. The executive director came from HIMSS. The chairman of the board is president of HIMSS, and it is dominated by a vendor mentality," he said. "CCHIT gives HIT legacy vendors inappropriate influence over policy and it threatens to facilitate a national HIT approach that would fall short of healthcare reform's goals. Whether or not it is actually conflicted, it certainly gives the appearance of being conflicted in a way that would not be tolerated throughout most of the private sector."
Klepper suggested that the CCHIT's role in defining certification rules be reduced, and that other certifying entities be brought in to perform those functions. He also suggested that CCHIT's executive leadership "should be replaced."
That idea didn't sit well with CCHIT Chairman Mark Leavitt, who was sitting a few feet from Klepper on the same panel.
Leavitt, the former CMO at the HIMSS, denied the assertion that legacy vendors are running the show at CCHIT. However, he said it would be unrealistic to exclude vendors from the process.
"Some people have said ‘You are certifying products. You should not allow any vendors to participate in your program or be on board,'" Leavitt said. "That is like saying ‘Let's create a system to test cars and not have anyone who's has ever designed or built cars on the board.' If you exclude the vendors, you probably exclude two-thirds or three-fourths of the people who've been involved in HIT."
He also bristled at Klepper's conflict of interest charge. "I've got 25-30 years in healthcare IT. Those who sit on public stage and impugn the integrity of an individual should at least–before they do it–talk to some people who know that person," Leavitt said.
That prompted a sharp rebuttal from Klepper. "Nobody here has impugned anyone personally. Mark, you are unfortunately inconsequential in that part of the discussion," he told Leavitt. "What matters is there is $19 billion of federal money on the table and that the eligibility criteria will be used in some way to steer that money."
Klepper said CCHIT has "dragged its feet" in several critical areas of HIT development, especially in the push toward interoperability. He said most HIT systems are at a "Level 1, text-reading stage within CCHIT. We could be doing so much more." "Interoperability, which we have heard echoed over and over, does not exist out in the marketplace," he said. "It's a priority for everything, for coordination of care, data aggregation, pricing, performance transparency, for comparative effectiveness research, decision support, patient engagement. All these issues depend critically on the ability of one system to be able to talk seamlessly with another. Those standards have not yet been developed adequately so they are in the marketplace in a significant way. That is holding our entire system hostage."
He added that Google, Microsoft, and New York Presbyterian and Beth Israel hospitals are ignoring CCHIT and swapping data on their own. "When the market begins to ignore what you are doing because what you are doing isn't keeping up, that means you are not current," he said.
CCHIT is focusing "on features and functions," rather than on standards, security, and the rapid distribution and usability of technology at a lower cost, he said.
"We have very high cost for entry, and as a result of that, a very small minority of physician practices have health IT deployed," Klepper said. "Another very large percentage of physician practices that do have it deployed have turned off many of the features and functions. If anything speaks to meaningful use, if somebody turns something off, that says that it's not."
He said CCHIT is looking backward at "very narrow conceptions of what HIT ought to be" and ignoring Web-based technologies for moving data and providing analytics. "It's cementing in old technologies and setting us back a generation," Klepper says.
House Democrats have announced a plan that would force the richest 2 million U.S. taxpayers to shoulder much of the cost of an expansion of the nation's healthcare system by imposing a surtax of as much as 5.4% on income above $350,000 a year. The House proposal aims to extend insurance coverage to 37 million Americans over the next decade. Democratic aides said the proposal would cost more than $1.2 trillion over the next 10 years, and would ensure that 97% of Americans were enrolled in a health plan by 2015.
The new state budget in Massachusetts eliminates healthcare coverage for some 30,000 legal immigrants to help close a growing deficit, reversing progress toward universal coverage. The affected immigrants, permanent residents who have had green cards for less than five years, are now covered under a subsidized insurance program for low-income residents that is central to the state's healthcare law enacted in 2006. Critics of the cut, which would save an estimated $130 million, say it unfairly targets taxpaying residents and threatens the state's healthcare experiment at a critical time.
New York Attorney General Andrew Cuomo July 8 announced the takedown of an elaborate fraud scheme that allegedly generated more than $1 million in profits, according to a Department of Justice (DOJ) release. Cuomo indicted 12 people and nine corporations implicated in the scheme.
In the release, Cuomo describes the plot, dubbed "The Levy Enterprise" as "a complex scheme that violated hospital patients' privacy and may have driven up the insurance rates of millions of New York automobile owners."
The scheme got its name from the plan's alleged mastermind Daniel Levy, 32, of Rego Park, Queens, who owned and controlled two medical clinics: Bronx Sheridan Medical P.C., and New Lite Bronx Medical, P.C. Levy and his co-conspirators allegedly took advantage of New York's Comprehensive Motor Vehicle Insurance Reparations Act, commonly referred to as the no-fault law.
The no-fault law reimburses persons who are injured in minor accidents for medically necessary medical and health services, including initial medical evaluations, physical therapy, chiropractic care, acupuncture, and diagnostic testing.
According to the DOJ, Levy allegedly paid Desmond Connell, an attorney, to drive business into Levy's clinics. Connell increased business by paying hospital employees to provide him with the information for patients who had recently been in minor vehicle accidents. Connell then allegedly gave that information to "steerers" whose job it was to contact the patients and convince them to receive unnecessary medical treatment at one of Levy's facilities.
Patients allegedly received months of unnecessary treatments, including acupuncture, physical therapy, chiropractic treatment, psychological counseling, and neurological testing. The healthcare providers involved in the Levy Enterprise billed the insurance carriers for this treatment and received millions of dollars.
The steerers allegedly told patients to make up false injuries in order to increase their chances of landing a big injury settlement. The DOJ also alleges that the steerers directed patients to Connell's preferred attorneys to handle their cases. Connell preferred those attorneys because they allegedly paid him 40% of the settlement amount, according to the DOJ.
In addition to Levy and Connell, 10 others were included in the 147-count indictment.
House Democrats have unveiled sweeping healthcare legislation that would hit all but the smallest businesses with a penalty equal to 8% of payroll if they fail to provide health insurance to workers. Under the House measure, employers with payrolls exceeding $400,000 a year would have to provide health insurance or pay the 8% penalty. Employers with payrolls between $250,000 and $400,000 a year would pay a smaller penalty, and those less than $250,000 would be exempt. Certain small firms would get tax credits to help buy coverage.
Workers who quit smoking, lose weight, and eat right could have their health insurance premiums cut by as much as half, possibly saving them thousands of dollars per year, under a measure inserted into the Senate healthcare overhaul bill. Under the plan, individuals would have a strong financial incentive for jumping on a treadmill or signing up for smoking cessation classes, moves that would not only prolong their lives but also reduce the financial burdens of behavior-related disease on the healthcare system.
