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With the government-wide spending cuts known as the sequester underway since March 1, 2013, members of the Blue Cottage team recently prepared an infographic that illustrates the impact the cuts will have on healthcare. The sequester adds to the urgency to transform healthcare, which is what industry leadership needs to commit to across the board.
Infographic Credits: Caylee Raber; Imen Alem, MHSA; and Christine M. Stead, MHSA
One of the more recent requirements of the Affordable Care Act (ACA) is the release of charge data from Centers for Medicare and Medicaid Services (CMS). This data differs by organization. Each sets its own “charges,” which are used to bill CMS. There is much gamesmanship that goes into setting charges and very little is related to the actual cost of supplies and services. During each negotiation with an insurance company, a provider organization will often increase charges prior to negotiations in order to claim that costs have increased. Hence, reimbursement should increase. This kind of gamesmanship is part of what drives up the cost of health care, but that is not the main point, or benefit, of releasing the charge data.
Benefits of Pricing Data Transparency
The benefits of releasing provider charge data are multiple and include at least the following:
Awareness
One of the main benefits is having a much better understanding of the cost of healthcare. This kind of transparency will likely cause healthcare providers to tell us how the charges do not reflect costs. In my review of comments made by Marianne Udow-Phillips quoted in an AnnArbor.Com article, ”U-M Health System has some of the highest charges in the state, but patients rarely face them,” I must disagree with her statements about charges not mattering. Udow-Phillips states, “if you have health insurance, you’re not going to face charges or even the total payment.” This is an unfortunate response if this is reflective at all of what healthcare leaders believe is happening, which highlights the disconnect that the pricing transparency initiative will help to correct.
Most People Expeirenced Provider Charges in 2012
Most people DO feel these charges in one way or another – including those with insurance. Charges matter for anyone that has to satisfy a deductible as part of their health care insurance. Increasingly, health insurance plans include a deductible as part of the plan, and those deductibles are increasing. Plans with deductibles bill patients for charges. When a patient has incurred enough charges to exceed their deductible, their insurance coverage kicks in for that year.
The average deductible in the private insurance market in 2011 was $3,962, according to a recent Commonwealth Fund report, “State Trends in Premiums and Deductibles,2003–2011: Eroding Protection and Rising Costs Underscore Need for Action.” In the same report, it is noted that deductible rates are increasing quickly, more than 20-percent from 2010 to 2011 in 12 states. We may have to wait a bit for 2012 data, but it is anticipated that deductibles will continue to increase across the board. Deductibles increased over 100-percent in all scenarios from 2003 to 2011. The scenarios were based on the size of employers and their health plan deductibles for single-person and family plans. Small firms had the highest increases, with an average deductible in 2011 of $3,324. This is important since small employers, firms with less than 50 employees make up the majority of employers in the U.S.
Another group that has to pay provider charges is the underinsured and uninsured. In 2012, nearly half of U.S. adults were either uninsured or underinsured at some point during the year or 84,000,000 adults, according to “Insuring the Future: Current Trends in Health Coverage and the Effects of Implementing the Affordable Care Act,” a Commonwealth Fund report released in April 2013. In addition to those that are uninsured or underinsured, another 13,500,000 adults had high deductible health plans (HDHPs), according to an America’s Health Insurance Plans (AHIP) insurance census report using released in May 2012.
The total population that experiences hospital charges at some point comprises almost 51-percent of adults, or almost 100,000,000 adults - and growing.
Comparing Prices
Consumers, which increasingly are patients themselves, will be able to compare provider charges across provider organizations. The charge database allows for direct-to-consumer marketing in that those with lower prices may be able to gain more market share, to the extent that consumers can choose where they seek care, based on what they can afford – at least until they exceed their deductible. In the case of UMHS referenced earlier, they charge 51-percent more than the next highest priced provider for ventilator-assisted care for 96 hours in the state. While ventilator-assisted care will exceed almost everyone’s deductible, the higher charges are likely to be a trend across other services that may be in the deductible-sensitive range. Providers may want to consider new pricing strategies for services that are in the $6,000 or less range – below most deductibles.
Provider Response
Providers that are at the relatively higher end of charges will have to explain why. The explanation will increasingly need to be done in a manner that is clear and obvious to the average person, who will increasingly be the consumer. I expect that many providers will be compelled to suggest that they are taking care of more complicated, sicker patients, which may be true for academic medical centers like UMHS. Academic medicine has not done a great job expressing the value of the academic mission. It is one of the biggest opportunities that academic centers have in the next few years.
Frances Collins, Director of the National Institute of Health, went to great lengths to estimate the value of federally funded research in terms of its economic contribution and other measures. The NIH now tracks its impact across several different categories: Our Health, Our Economy, Our Communities and Our Knowledge.
Similarly, successful providers will make a compelling case for their charges based on value. The academics that do the best job of this will have a competitive advantage – not only among their peers, but also in their local and regional markets. This is an important piece of the puzzle to put in place, especially for academic providers that have relatively higher charges, which we can expect will be increasingly scrutinized by the increasing number of consumers subject to these charges.
Decreasing Costs
Personally, I think the impact of releasing charge data to the public will ignite a demand for value – from the patients footing the bill in addition to the traditional sources (employers, payors). This is a critical data component that will help patients and families make better decisions. As ACA is implemented, people will increasingly be placed in the role of consumer. Their options will include private insurance through their employer, through a health exchange, or foregoing coverage for a known cost to them personally. All of these ‘markets’ will make provider charges meaningful for the consumer. Prices ultimately will need to decrease to be more in line with a value equation that makes sense to the average consumer.
Let’s hope the response from most organizations moves in a direction that both decreases costs AND provides a very clear outcomes-based value proposition.
Attending TEDMED has been on my bucket list for several years. I was selected as a delegate and last week, I packed my bags, headed to Washington, D.C., and jumped in.
The first evening featured Kishi Bashi, who graced the stage with a fantastic and inspiring violin performance that was unique, beautiful, and created a palpable connection between music and the work ahead at TEDMED. Using improvisational techniques, Kishi demonstrated the impact and the power of being able to be fully present. It was memorable and remarkable and wonderful way to open the event.
Immediately following that bold grand opening, TEDMED’s signature speakers took the stage, one-by-one, with 18-minute monologues designed to challenge, inspire, teach, entertain, and share. Although I had watched hundreds of TED talks in the past, being present changed everything. On the first night, I found myself hanging on each and every word and looking for the meaning, the lesson, and the “so what?” in everything the speakers said. Admittedly, I felt disappointed and the thoughts running through my head were judgmental, argumentative, and aggressive. I wanted to argue their points, offer counter examples, and ask questions. I didn’t think that the speakers were original, their ideas new, or their points thought-provoking enough. I watched as others cheered and wondered what I was missing and why I had invested so much money in attending ($5,000 to participate as a delegate). I felt ripped off and disillusioned as I left the Kennedy Center that night.
Walking away, I called a good friend and shared my unfiltered thoughts with her, complaining, whining, and showering her with my negativity. She let me go on and on about how I can’t believe that we are still talking about the same things that we were talking about when I was in grad school – the same problems, the same solutions, just different catch phrases and different players. We hung up and I instantly regretted sharing my first impressions, knowing that often comes back to bite me. During the long walk back to my hotel near Union Station, I calmed down and began to reflect on the day. I slowly took stock of my reaction. My frustration turned to guilt. I felt guilty for being so judgmental and so closed minded. I questioned the source of my arrogance and the root of my dissatisfaction.
In an effort to ensure that I got “a return on my investment,” I went back to the Kennedy Center the next day with a simple goal: to meet at least 20 TEDMED delegates, that’s what the participants at the live event are called. One by one, I met scientists, medical students, public health advocates, engineers, artists, and writers. With each new contact, I inquired about his or her journey to TEDMED asking, “What are you looking for here?” I learned about their work and their passions – the organizations they run or serve, the patients they help, the students they teach. They told me their stories. And because they did, everything changed.
As I listened to each speaker’s 18 minutes of courage – it’s a huge stage in front of a huge audience – I was able to hear it differently than the day before. The topics, the ideas, the stories – suddenly, I understood where they fit. I connected each speaker’s message with the work that my fellow delegates were doing and the constraints within which many are working. I thought about my own work and how it connects, or doesn’t, to the opportunities that were shared from the stage. I worked hard to listen without judgment, to consider without challenging, and to allow all ideas to wash over me without feeling pressured to take action, form an opinion, or make progress in some way.
One by one, each speaker opened our eyes to new ideas about how to begin to thinking about doing health and healthcare differently; about embracing wellbeing and building our communities thoughtfully and deliberately with the backdrop of reality, struggle, and juxtaposition notwithstanding. Gary Slutkin, MD, Founder of Cure Violence, shared the dramatic results of his organization’s program to curb gun violence in America’s most dangerous cities, while the Senate was simultaneously voting against seven gun control amendments that the majority of Americans supported. Jonathan Bush, Founder of Athena Health, explained how entrepreneurs, not bureaucrats, are the key to the future of healthcare and so eloquently offering his call to action to regulators stating, “If you really care, get out of the government, get onto the field, and start a company.” I couldn’t help but think of all the organizations, including Parkland Health & Hospital System, who have to dedicate excessive time and resources to responding to regulators while doing the best they can to serve a seemingly ever-expanding population in need of safety net care. TEDMED speakers aren’t just talking about change – they are living it, pushing it, demanding it.
During each break at the Hive, an amazing, high-energy space designed to marry highly innovative technology with social connection and hands-on activities, I met new delegates and made more connections. The diversity of opinions was astounding. Each person had a different “favorite” speaker and the messages that were most meaningful were as varied as the attendees themselves. Many delegates seemed to resonate with the big data ideas – liberating the data that the 3G/4G carriers collect about us (our “digital breadcrumbs”) so that we can benefit from the insight it provides into our behaviors, our habits, and ultimately, our health. Others were blown away by the personal stories of physicians in the field who shared regrets about judging patients, not knowing enough, or not having the right answer at the right time. My personal favorite was a writer for The New Yorker, Andrew Solomon, who courageously shared his contemplations on richness of difference, the changing relationship of illness and identity, and the boundless nature of a parent’s love and acceptance of a child. The common thread among all of the conversations though, was that there is so much to learn in telling stories, in coming together, in sharing successes, and even more importantly, sharing our failures, frustrations, wishes, and that solution that just might be closer than we think.
Each session on the main stage in the Opera House was more meaningful than the previous one. The sessions were funny, emotionally draining, brain-straining, and smart. The entertainment that separated the sessions was phenomenal, provided a much needed shift in focus, and in several cases, was more unique than anything any of us had ever seen. In a quiet moment, I realized that TEDMED had somehow changed dramatically for me. I was present, engaged, and suddenly impressed with everyone and everything. One thing soon became clear. TEDMED didn’t change this past week. I did.
Admittedly, I’ve struggled this year. I have struggled to maintain boundless energy and the relentless pursuit of excellence and innovation in the healthcare space that has become my trademark in recent years. I am not a very patient person and when I started this company I explained to anyone who would listen that the goal was to transform healthcare, one project or one client at a time. We have succeeded in building an amazing base of intelligent, top-tier healthcare clients who allow us the privilege of working with them to achieve their goals and improve the care that they deliver. We have succeeded in building an arsenal of creative tools for facilitation and innovation, for driving progress and changing the culture. Meanwhile, the healthcare crisis has continued to spiral out of control, segments of our population continue to get left out of any progress that is being made, and costs continue to escalate while quality remains stagnant. Admittedly, what we are doing individually and collectively does not seem to be working – at least not fast enough.
I thought I was going to TEDMED to find new answers to problems old and new alike. I thought I was going to TEDMED to meet the movers and shakers, the innovators, the inventors, the brave people who push the envelope, who aren’t afraid to fail, and when they fall, they get right back up and try again. This week I found some people who fit that description, but more importantly, learned that when we are all together, each of us is more likely to exhibit those characteristics than we might be when we are alone.
On the last day, I couldn’t help but reflect upon my bad attitude and negativity from that first night. With a heavy head, I admitted to myself that the judgment, disappointment, and disillusion that I directed at those speakers was really how I was feeling about myself. The frustration with the lack of new ideas, with the absence of solutions – that frustration was with myself. Ironically, I didn’t need to go to TEDMED to find others – I needed to go to TEDMED to find the creative, passionate, enthusiastic, and visionary parts of myself that I seem to have lost in the recent months. In the end, I found just that, but not through the sessions, or the music, or the interactions in the Hive, but through the magic in the intersection of all of those things. I now understand this is the magic of TEDMED. In order to move the needle, make progress, truly transform healthcare and bring needed quality, care, and efficiency to the forefront, we need to have real conversations and include far more people than those currently participating. We need to come together and challenge the status quo in a more meaningful way – we need to reject the idea that incremental improvements will get us where we need to go. It’s time to consider new models – new ways of thinking, new leaders, new ways of educating care givers, patients, and communities about what an inclusive and functional healthcare system looks like.
So was TEDMED worth $5,000? On a personal level, the boundless energy and the drive to relentlessly pursue excellence and innovation in the healthcare space that I lost is recent months has returned with a vengeance. Can you put a price on finding yourself and rediscovering your passion?
Juliet L. Rogers, PhD, MPH, is President & CEO of Blue Cottage Consulting.
2013 Health Management and Policy Case Competition | First Place Winners | Andy Mychkovsky, Lili Ferguson, and Jason Buxbaum
In order to truly transform healthcare, we must invest in preparing the next generation of healthcare professionals to deal with the challenges that the industry currently faces. It is important that students have an opportunity outside the classroom to apply their knowledge, learn to work under pressure and think through a range of complex issues. In an effort to further its mission and to continue to create change, Blue Cottage Consulting, Griffith Leadership Center in Healthcare Management & Policy, and University Of Michigan School Of Public Health (UMSPH), recently took part in the inaugural Health Management and Policy Case Competition.
The event was an opportunity for UMSPH students to apply their coursework to real world situations. Students were assigned a problem to approach methodically, using analytics and research skills to formulate an achievable solution. They worked together in a team setting and presented their findings to a panel of judges, which included professionals from the industry.
The case required the students to put together an innovative healthcare delivery strategy for a struggling public hospital that emphasized population health as well as increased patient market share. Students were encouraged to take into consideration current physician supply levels and population health trends – based on age, ethnicity, and location.
Eleven teams with more than 50 students competed for first, second, and third place, along with other prizes that awarded analytics, innovation, and policy analysis. Among the recommendations from the top three teams, students proposed solutions involving patient or family centered medical homes and leveraging existing community providers to reach areas without access. Some groups proposed that the hospital expand its current healthcare plan to compete in larger markets in order to increase patient share and revenue.
More than 15 judges, many of them alumni of the program, participated in the deliberations throughout the day. Their backgrounds were diverse, with professionals from consulting organizations, policy experts, executive leadership from health systems and insurance companies, and public health professionals.
Feedback from the competition was positive, with many participants and judges asking for similar events in the future. Professionals from across the industry recognize the need for more real-world training. As healthcare continues to undergo major transformations, it will be important that graduating students are equipped with the necessary knowledge to make positive contributions to move the changes forward.
Below are the complete results from this year’s competition.
2013 Health Management and Policy Case Competition Results
First Place: Andy Mychkovsky, Jason Buxbaum, Lili Ferguson
Second Place: Swathi Varahabhatla, Rachel Kleinman, Sanjeev Kumar, Stephen Krutko, Tiffany Huang
Third Place: Cameron Glenn, Daniel Bae, Joshua Bogus, Bradley Hoath, Vivian Yu
Best Analytics: Shanna Kirshenblatt, Rebecca Plesser, Michelle Jablons, Connie Yau, Meredith Chapekis
Best Presentation Style: Laura McDonough, Nana Sefa, Bijal Shah, Kathryn Fischer, Sana Syal
Best Policy Incorporated: Sarah Richardson, Leslie Anderson, Lukasz Orzelski, William Tyson
Most Innovative Solution: Amena Qureshi, Vicki Burack, Lizzy Brouwer, Maha Salah-Ud-Din, Stacey Lee
Team Spirit: Sophia Duong, Rayva Virginkar, Olivia Alford, Danielle Nelson, Megan Passman
Other Participating Teams:
Jay Thaker, Lincoln Haycock, Rick McKellar, Andrew Vidikan, Peter Vogelsberg
Joe East, Talya Gates-Monasch, Meredith Neff, Jackie Rau, Cydni Smith
Elana Mosecova, Katherine Autin, Patricia Mencia, Sarah Mott, Shakina Russell
Imen Alem, MHSA, is a Healthcare Analyst at Blue Cottage Consulting.
Introduction
This two part blog series focuses on photo journals (Part 1) and storyboards (Part 2), which are tools that are commonly used in a human-centered design process. According to IDEO, a leader in design and innovation consulting, this design approach is called “human-centered” because it begins by examining the needs, dreams, and behaviors of the people who will be affected by the solution. A human-centered design approach is very applicable when designing a new healthcare facility or working to improve hospital operations. Photo journals and storyboards are two of these tools that put users at the forefront and allow us to gain insight into an experience from their perspective. These two powerful, visual reporting tools improve the way we do healthcare consulting work and ultimately optimize the way we deliver care.
Storyboards
Storyboards are a valuable design tool with great applicability to healthcare consulting. A storyboard is typically a comic strip that has been drawn by a user to describe their experience. They usually include thought or speech bubbles to communicate what the user thinks and feels throughout the experience. Like with photo journals, they are a great tool to help better understand the user experience. They provide an emotional and personal portrayal of an experience and can help to identify key gaps and opportunities. A storyboarding activity can be done with all sorts of users, though they are particularly valuable when created by a patient or family member because they capture a very specific, personal experience and the true associated emotions.
When developing the functional program for a new NICU, Blue Cottage held a meeting with several families whose children had been patients in the current NICU. We asked families to draw a storyboard to describe their experience. Families were given 20 to 30 minutes to draw their storyboards and were then encouraged to share their story with the group.
Storyboard: NICU Experience
This activity encouraged the families to think deeply about their experience and helped them to generate ideas for how to improve the NICU. After some discussion, families were encouraged to go back to their storyboard and for each step, add a sentence or idea about how it could’ve been improved. For example, one parent said that they felt very confused and lost during their first day. They suggested that it would be nice to have a guide to help them on their first day. Another key insight that came out of the activity was the desire for a Wall of Hope within the space. The families agreed that it was very inspiring and helpful to be able to read stories about other children that were born in the NICU and who were now thriving.
Both of these tools have great value in gaining key insights from stakeholders and for inspiring deeper conversations about operational and space needs. Kerry Hart, the Neonatal NICU Manager at Alberta Children’s hospital found these activities to be extremely useful in engaging frontline staff and families.
“I think the staff and families were happy to participate and it was a fun and interactive way of giving their feedback,” Hart said. “The pictures easily provided some self-explanatory rationale so that the individual staff or parent did not have to write a lot to get their point across. I would definitely recommend this to other clients as a fun and interesting way of getting input. Sometimes shaking things up engages people in the process better than just the boring writing out of comments.”
Be sure to check out part one of Visual Reporting for Operational Planning: Photo Journals and Storyboards, which highlights valuable uses of photo journals.
