Tom Cigarran, founder of Healthways Inc., the nation's largest disease-management company, says that despite politicians' denials, some sort of healthcare rationing is inevitable and needs to be done rationally and fairly. Cigarran also offers his thoughts on health reform, saying it should be divided into three parts.
The nation spends billions of dollars a year on patients' return visits to the hospital—many of which are readmissions that could be prevented with better follow-up care, according to a study published in the New England Journal of Medicine. As many as a fifth of all Medicare patients are readmitted within a month of being discharged and a third are rehospitalized within 90 days, according to the study.
Two weeks ago, I was in my backyard here in semi-rural Vero Beach, FL, armed with a pellet spreader and locked in mortal combat with fire ants, when I heard the impact of a crash in my front yard. I ran around the corner of the house and found a young woman sprawled on her back in my front yard, conscious, but clearly frightened and in pain. A few feet away lay a Harley-Davidson motorcycle, wedged against an electrical transformer that had been knocked off its concrete foundation.
I yelled for my wife inside the house to call 9-1-1, and ran to the woman's side, told her not to move, told her that an ambulance was on its way. The first words out of her mouth were "Don't call an ambulance. I don't have insurance. I can't go to the hospital. I can't pay for it." That may not be an exact quote but it was pretty close.
The woman had been learning to ride the motorcycle on our quiet side street when she reached the corner, panicked, and hit the throttle instead of the brake. Fortunately for her, she wasn't going too fast when the motorcycle hit the transformer, throwing her over the green, three-feet-high, steel box. Otherwise, she would have hit the side of my house and sustained very serious injuries against a less-forgiving brick wall. The ambulance arrived about 10 minutes later and she was transported on a stretcher, her neck in a brace. I saw her a few days later hobbling around on crutches, her leg in a full splint.
Once the ambulance left and the neighborhood settled down, I had a chance to reflect on what that young woman said as I picked blue metallic Harley paint chips off my lawn. I was angry. I thought "what does it say about our nation if a frightened and injured accident victim's first thoughts are about her inability to pay for care?" What if I had honored her request and cancelled the ambulance? Would she have dragged herself home?
Later, upon further review, I realized the issue was more complicated. It's easy to pull a Michael Moore, shake your fist at an unjust system, and demand "free" healthcare. But I also had to wonder why the young woman didn't have health insurance. She wasn't yet 20 years old, so maybe she thought she was invincible. Maybe she couldn't get a health plan through her work, or maybe she was unemployed, or maybe she believed she couldn't afford a health plan, regardless of her job status. Here in Florida, however, they have a new, low-cost health insurance plan called Cover Florida that's received extensive publicity. Why hadn't she enrolled? Why was she riding a motorcycle if she wasn't properly insured? Turns out, she didn't have a motorcycle operating license, or auto insurance, either. Florida Power & Light Co. will send her a bill for the damaged transformer.
I thought about that minor accident and the circumstances, and extrapolated for the 47 million or so uninsured people in this country. The questions quickly overwhelmed the answers. How many Americans are uninsured because they either can't afford it or can't get it because of a dreaded "pre-existing condition?" How many are uninsured because they don't think they'll need it, or because they have no assets to protect? Can we have universal healthcare without mandatory premiums? How will those premiums be collected? Who will set the rates? Will they be deducted from paychecks like the payroll tax for Social Security? Can a deeply divided Congress reach a consensus for such reforms? Would we the people make it work?
There are larger philosophical questions too. Where does society's responsibility for the health of the individual begin? Shouldn't the individual also have a share of the responsibility to maintain his health? We talk about healthcare being a right. Shouldn't it also be a responsibility? Are we doing everything in our means to give people the tools to take care of themselves? Does universal coverage mean universal care?
Healthcare leaders themselves are divided on this question. In overall results from the HealthLeaders Media Industry Survey 2009, respondents vary on which model offers the best hope for healthcare: government-mandate universal health insurance, 25%; government-funded universal healthcare, 22%; consumer-directed healthcare, 34%; employer-sponsored healthcare, 11%; and other, 9%.
So, in that very small episode that near-literally hit home, I got an up-close-and-personal tutorial on the incredible complexities hidden in a simple term like "healthcare reform." It's a lesson that hospitals and healthcare providers review every hour of the day, and usually in far more dire circumstances.
As a columnist, you can pick an ideology on healthcare reform that suits you and run above the fray without getting your shoes bloody. It gets a lot more complicated when "the uninsured" are real people, lying on the ground in front of your house, injured and scared, broken, and broke.
John Commins is the human resources and community and rural hospitals editor withHealthLeaders Media. He can be reached atjcommins@healthleadersmedia.com.Note: You can sign up to receive HealthLeaders Media Community and Rural Hospital Weekly, a free weekly e-newsletter that provides news and information tailored to the specific needs of community hospitals.
"We planned for 4,000 and had an estimated 15,000 attend our opening event," Sara Bakken Lee said as she spoke during the ROI roundtable panel at the HealthLeaders Media Marketing Awards last November. "On Friday night there were streams of people. It was like a rock concert."
The Mayo Clinic public affairs consultant was referencing the grand opening event of the Rochester, MN, campus' Dan Abraham Healthy Living Center—a 115,000-square-foot employee health and wellness center donated by a patient and benefactor of the same name. Even before builders broke ground on the facility, hospital marketers were constructing what would become a highly successful internal marketing campaign, which won a Best in Show award among large hospitals at the 2008 HealthLeaders Media Marketing Awards.
Lee says the campaign had four objectives: to keep employees engaged during the 18-month construction process, to inspire a healthier lifestyle, to generate pride and excitement, and to celebrate the grand opening. They achieved this by launching a print campaign and by promoting the center with special events.
The print campaign consisted of direct mail and magazine ads that feature Mayo employees who are striving for personal wellness goals. This message coincides with CEO Glenn Forbes' ambition to create "the healthiest work force in America."
"What Mayo does really well is share stories. We knew that those success stories were out there, and we wanted to tell them," says Beth Warren, director of the Healthy Living Center.
Marketers also use employee testimonials to stress that fitness can be possible despite a busy work schedule. "Sometimes people may think that they've got so many other priorities that wellness falls to the bottom of their priorities," says Lee. "It's basically a way of saying you need to put yourself first. Our primary value is the needs of the patient come first, which is still very true, but you have to care for yourself before you can care for others."
Hospital employees were also invited to take hard-hat tours of the center as it was being built and visit a Web site containing updated construction information and video testimonials of employee wellness success stories.
What's more, employees are not only joining the center, but many are very active participants. Warren says an average of 3,500 people use the facility each day.
Marianne Aiello is an editor with HealthLeaders Media. Send her Campaign Spotlight ideas at maiello@healthleadersmedia.com. If you are a marketer submitting a campaign on behalf of your facility or client, please ensure you have permission before doing so.
This post on the Branding Strategy Insider blog explores the updated roles women are playing in ads and the trend toward promoting products once considered the domain of women, such as vacuum cleaners, in a gender-neutral way.
Hospital and health system marketers often hear about messaging, tactics, and tools. But they can't forget the importance of timeliness in cultivating relationships with their patients.
Testimonials are a staple in healthcare marketing efforts. But what if, along with the success stories, you had to disclose not-so-rosy outcomes? It would sure diminish the impact of the woman talking about the difference in her life after bariatric surgery, or the man who talks about how a surgeon saved his life. After all, not everyone loses a dramatic amount of weight after bariatric surgery and not every patient survives surgery.
The FTC is putting the finishing touches on a plan to strengthen rules about testimonials and celebrity endorsements, two popular tactics in healthcare marketing. And merely saying "results not typical" won't cover healthcare marketers under the new guidelines.
The FTC's proposed revisions cover consumer endorsements, expert endorsements, and endorsements by organizations. They also require disclosure of material connections between advertisers and endorsers, according to the FTC.
"On the issue of consumer endorsements, the . . . revisions state that testimonials that do not describe typical consumer experiences should be accompanied by clear and conspicuous disclosure of the results consumers can generally expect to achieve from the advertised product or program."
Celebrity television spots have featured Marlo Thomas, Jennifer Aniston, Jimmy Smits, Ray Romano, Robin Williams, and Bernie Mac since 2004. Long before that, the organization raised money and awareness with concerts featuring luminaries Frank Sinatra, Dean Martin, Elvis Presley, Sammy Davis Jr., Dinah Shore, and Jack Benny.
It's hard to imagine one of those touching ads ending with a long legal disclaimer à la drug company direct-to-consumer ads.
The final guidelines are expected to be issued later this year. Additional guidelines from the text of the Federal Register notice include the following:
Determining whether a speaker's statement is an endorsement depends solely on whether consumers believe that it represents the endorser's own view. Whether the person making the statement is speaking from a script, or giving the endorsement in his or her words, is irrelevant to the determination.
An advertisement employing endorsements by one or more consumers about the performance of a product or service will be interpreted as a representation that the product or service is effective for the purpose represented in the endorsement. Consumer endorsements convey not only that the advertised product or service worked for the consumers depicted in the advertisement, but also that it will work for others.
Advertisers are subject to liability for false or unsubstantiated statements made through endorsements, or for failing to disclose material connections between themselves and their endorsers. Endorsers may also be subject to liability for their statements..
Advertisers who use bloggers to promote their organization, and the bloggers themselves, face potential liability.
An advertiser who uses consumer endorsements must possess and rely upon adequate substantiation to support efficacy claims made through endorsements, just as the advertiser would be required to do if it had made the representation directly.
Consumer endorsements themselves do not constitute competent and reliable scientific evidence; anecdotal evidence about the individual experience of consumers is not sufficient to substantiate claims requiring scientific evidence. Even if those experiences are genuine, they may be attributable to a placebo effect or other factors unrelated to the advertised product or service, according to the FTC.
George Van Antwerp, vice president of Solutions Strategy Group, Silverlink Communications, discusses how health insurers are saving money through pharmacy programs.
Over the past few months, literally millions of words have been written or spoken about health, healthcare, the healthcare system, what we need to do to address the serious issues related to each, and why.
The White House has undertaken an unprecedented process to gather input from every stakeholder, resulting in a degree of alignment never before seen. With the imminent confirmation of Health and Human Services Secretary-designate Kathleen Sebelius and the recent appointment of healthcare veteran Nancy-Ann DeParle, the critical focus of Director of the Office of Management and Budget Peter Orszag and the President's own commitment that healthcare reform "cannot wait, must not wait, and will not wait another year," significant changes to America's healthcare landscape are almost a surety. However, even a cursory review of everything that's been written and said to date reveals a striking omission. Nowhere can we find a simple, clear, unambiguous statement of what it is that we want the reformed system to actually accomplish. This is not a minor oversight. If we don't have a common objective and a single measure to determine whether or not we're achieving it, the likelihood of our reformed system producing outcomes—clinical or financial—that are markedly different than those of the current system is small.
The requirement that a system have a purpose was clearly expressed by W. Edwards Deming, who helped Japan develop into an economic power after World War II: "A system is a network of interdependent components that work together to try to accomplish the aim of the system. A system must have an aim. Without the aim, there is no system." President Dwight Eisenhower conveyed essentially the same thought: "We succeed only as we identify in life, or in war, or in anything else, a single overriding objective, and make all other considerations bend to that one objective."
Absent that aim, absent that single overriding objective, we are left only to debate how to fix what we don't like about how the current system functions, how it's organized, and how it's paid for. And, unfortunately, that's exactly the debate we're having.
A variety of factors are driving the current discussion, not least of which is the critically unchallenged assumption that in reform, we must preserve as much of the present system as we can. But the truth is we don't have a system. We never have.
Rather, what passes for America's healthcare system is a patchwork quilt of services, modified over time by governmental or private-sector changes—often in conflict—in payment, coverage, facilities, and manpower policies, in response to the critical need of the day.
Consider, for example, the conflicting policy perspectives that led first to Hill-Burton and then, a mere 20 years later to Certificate of Need. Look at any element and similar reaction responses can be found. Unlike the weekly successes we see in the TV show House, we have an historically poor record of curing the problem by treating its symptoms.
But that's the path on which we seem to be embarking again. While well-intentioned and replete with phrases that have become iconic in the debate—quality, accessible, universal, transparent, affordable—we apparently have not realized that those terms describe principles of how we want the system to work; they lend little clarity to the question of what we want it to do. And neither does blaming any of the candidates historically held responsible for getting us into this mess in the first place. (Government, health plans, hospitals, doctors, lawyers, consumers, and virtually every other stakeholder in health and healthcare have, at one time or another, been the whipping boy for our broken system.)
History makes it pretty clear that another round of incremental "adjustments" is unlikely to yield a solution that, at the end of the day, both improves health and is sustainably affordable. As the Center for Health Transformation puts it, "Small changes or reactionary fixes to separate pieces of the current system have not and will not work. We need a system-wide transformation."
By any assessment, America's health and healthcare are poor. The last World Health Organization ranking put us at #37, despite the fact that we spend a greater percentage of GDP on health than any other developed nation.
So, what should our aim be? Over the next decade, we progress to #1, we design a system that keeps Americans as healthy as possible for as long as possible, and we create a system that all other considerations bend to that one objective.
In setting that objective—and why would we accept anything less—we need to recognize that we will not achieve it by continuing to focus on or enhance our current sick care processes or by tinkering with other elements on the supply side of the health equation. Rather, we need to be focused on assuring that the reformed system is enabled to do three things:
Keep healthy people healthy
Mitigate or eliminate health risks associated with modifiable lifestyle behavior choices
Assure optimized, evidence-based care for those who require it
If we don't address all three areas, the apparently inexorable demand for services, fueled principally by both an aging population and the epidemic-level incidence of avoidable chronic disease, will quickly overrun the system's ability to respond.
With one goal and three clear initiatives, the opportunity exists to actually structure a true system, in which each of the interdependent components do, in fact, work together to further achieving the goal. Without that goal, true reform will elude us . . . again.
Bob Stone is an executive vice president and founder of Healthways, the nation's largest health, wellness prevention, and care management company providing solutions to more than 34 million individuals domestically and internationally. A former president of DMAA: The Care Continuum Alliance, his 40-year career includes experience in both public and private hospitals, regulatory agencies, and academic medical centers.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
