A Choice to Live

147391Participants at this year’s LeadingAge Annual Meeting in Nashville were treated on Sunday evening to the premier showing of Glen Campbell: I’ll Be Me. A documentary of the legendary country artist’s life with Alzheimer’s disease, the venue and audience chosen for the premier could not have been more perfectly selected.

The film artistically yet with faithful realism explores the many emotions that Alzheimer’s disease evokes – in the individual afflicted, as well as those who share life with that person. It chronicles what began as a 3-week goodbye tour turned into a 151-show theatrical phenomenon that became much more about celebrating life in whatever form it humanly manifests than succumbing to the sadness and regret of disease.

Alzheimer’s disease is unique in its ability to impact loved ones of the individual having the disease while stealing away that person’s ability to understand or empathize with those feelings. Glen Campbell and his family determined in 2011 that they would use their shared experiences to help build greater awareness and understanding of the disease.

Nationwide screenings of the film are set to launch this weekend. Grab yourself a box of tissues and go see it.

  ~ Sparky

The Healthcare Value Equation

Prior to leaving for Denver and the LeadingAge Annual Meeting & Exhibition last week I posted here in the Pub several questions I was anxious to have answered by LeadingAge members.  I was not disappointed by the vibrant and impactful discussions and sharing of ideas that has come to epitomize that event.  Indeed, I learned a great deal of incredibly valuable insights, as usual.  But it was what I did not observe that – while not terribly surprising – has me nonetheless concerned about many member organizations’ futures.

Overall, I would characterize the leadership view at most organizations toward Healthcare Reform and its attendant ramifications as being acutely aware, justifiably concerned and yet still very uncertain about what types of organizational changes will be required to survive.  And where there is a greater level of certainty, the perceived changes needed tend to be of a more tactical and pragmatic nature, rather than transformational.

I realize this is to be expected because change is anathema to our human psyche.  Even changes that bring about sought after and desired results in our lives are usually disruptive, requiring adaptation, resiliency and an unplanned exertion of focus and energy.

The dynamics of organizational change are such that if you take the individual energy required to adapt to change and then multiply that by the number of individuals comprising an organization, the product will be exponentially higher.  This is primarily owing to differences in the means and speed at which individuals accept and adopt to change.  And the process by which an organization reconciles these differences is a function of effective organizational change management.

Whenever I give a presentation on Healthcare Reform I share what I have learned as a student of Michael Porter’s work on Value-Based Healthcare.  I seek to convey the singular concept that will serve as the platform upon which all future performance improvement efforts must be based.  I refer to this concept as the E = mc2 of future healthcare delivery: Value = Outcomes/Cost.   This is also the formulaic basis upon which leadership teams at organizations that provide healthcare must base their organizational change efforts.

This may seem like a simple enough concept, particularly when we compare its application in almost any other industry in which a product or service is exchanged for currency (or another product or service).  In healthcare, as we know, our delivery system has largely obfuscated the applicability and worth of this formula – first through employer-provided insurance beginning during World War II and then several decades later and subsequently through complex provider payment designs developed by Medicare, Medicaid and commercial insurers.

As Porter asserts, today healthcare providers compete on bargaining power, volume and control of the patient, rather than value.  The demographic and economic realities of this 21st century require a paradigm shift in the competitive model of healthcare delivery, where market advantages will be achieved through actual and perceptual positions of value created for the patient.  Such a shift cannot be achieved through incremental improvements in cost reduction and process improvement – however grandiose the means of pursuing such goals may be.  It requires a transformational shift in how the healthcare organization views itself.

It also requires a new way of thinking about how we understand and define Outcomes; and how we track, analyze and report on Costs.  I will write more on these topics in the future.  But for now, my message is that those senior housing and care organizations that embrace this way of thinking – and determine how to manifest an organizational strategic positioning based on value – will be much more likely to survive and even thrive in the future. 


Questions I Have for LeadingAge Members

This week I will be joining my Artower colleagues in Denver at the LeadingAge Annual Meeting & Exhibition.    We will be hanging out at Booth # 1915 during Exhibit hours.  If you are going to be out in Denver, please stop by and say hello.

My first LeadingAge (AAHSA) conference was in 1991 (San Francisco) when I was working at Ernst & Young.  A lot has changed in the senior housing & care industry over that span, and LeadingAge has been at the heart of much of that change: they are to be commended for their tireless efforts of advocacy, education and applied research on behalf of their nonprofit membership. 

And I have truly enjoyed being a sponsor, supporter and contributing author/speaker to AAHSA/LeadingAge events during that time.  The accepted quid pro quo of that business relationship has been making such contributions to LeadingAge membership in return for access to that membership (though I think the form of those contributions has been decidedly trending more heavily toward financial over in-kind, which I guess reflects the economic realities we live in today).

I have always felt, however, that the AAHSA/LeadingAge quid pro quo relationship – if approached from the proper perspective (i.e., having the ability to listen and learn) – offered a great deal more than just marketing opportunities.  And so as I do every year, in getting ready for this year’s Meeting, I have some specific areas of interest that I am hoping to learn more about.

Industry Consolidation
Industry consolidation in healthcare is in motion, and the trajectory is one of acceleration.  Economic realities mandate the achievement of increased efficiency and productivity as a condition of survival.  The importance of mission notwithstanding, nonprofit organizations providing healthcare will not avoid being affected by consolidation in one fashion or another.  I am curious to learn whether the leadership of LeadingAge members agree with me – and if so, what they are doing to prepare their organizations for the impact of industry consolidation.

Care Transitioning
How are members organizations reacting to the intense regulatory pressure to lower Medicare/Medicaid expenditures through what is believed (hoped?) will be efficiencies and better alignment of care needs with care settings? Hospitals are – finally – beginning to reach out to post-acute/long-term care providers to engage in conversations on this topic.  What are members doing to be prepared for those conversations?

Hospital Readmissions
A similar but more clinically-focused discussion has to do with Section 3025 of the Affordable Care Act, the Hospital Readmissions Reduction Program.  Care Transitioning is a critical element of that discussion, but I really want to understand what members are doing to embrace – or not – the ability to handle increasingly higher levels of patient acuity.

Defining the Boomer
For the past decade or so we have been discussing how the Boomer Generation is going to be a uniquely different market constituency: more demanding, more educated and informed, more willing (and able) to pay for personalized services and care.  We’re another decade-plus away from Boomers starting to have a really significant impact on provider demand, but with the leading edge of that demographic now entering retirement, what are we learning about the reality of the expectations we’ve formed about Boomers?

Information Technology
The silver bullet that’s supposed to pierce the rising bubble of healthcare costs, Information Technology holds great promise – and great peril for nonprofit organizations providing housing, aging services and post-acute/long-term care.  I would like to better understand how LeadingAge members are viewing IT investments and what risk management strategies they are employing to help guide such investment decisions.

Home & Community-Based Services
This is the area that I am most excited about, having been privy to the strategic initiatives of several member organizations that are currently planning, developing and providing service and care programs that will help seniors remain in their homes and communities.  And in each case those efforts are being developed in concert with market and regulatory-driven realities of Healthcare Reform.  I believe that – at least in the short run – innovation in home and community-based services offers a shorter path to achieving organizational financial sustainability than information technology.

Of course I have a lot more questions and areas of interest where I am hoping to learn as much as I usually do from attending the LeadingAge conference.  Please watch this space for after the conference.  I will share what I learned.  Until then, hope to see you in Denver,


Branding in An Era of Healthcare Reform

Larry Minnix, President & CEO of LeadingAge, recently began a video series entitled, a few minutes with Larry Minnix (I am guessing they didn’t hire Porter Novelli to help with the naming – or, maybe they did).  If you haven’t already, I encourage you to take the time to watch these.  Larry does a wonderful job sharing timely and highly relevant messages in his famously comfortable speakeasy style.

In the current episode that I’ve embedded below Larry discusses LeadingAge’s 2011 Annual Report. 

In referring to LeadingAge member organizations, Larry noted that, “we’ve had reinforced the fact that the most valuable, priceless thing that you own is your not-for-profit brand and heritage.”

I agree with Larry – today. Tomorrow – as in the next five to ten years – is a different story. The looming reality facing nonprofit senior housing and care organizations is that to remain economically viable in the future I believe their brand will have to become more synonymous with value than being nonprofit.

For those nonprofit organizations desiring to survive (and thrive) under Healthcare Reform, future brand identity and perception may need to change significantly. Consumer preferences of the Baby Boomer generation, the need to participate in integrated care delivery systems, learning to financially manage through new payment models (e.g., ACOs, managed care, payment bundling) – these are factors, which will have a greater impact on successful brand strategy than a nonprofit identity.

This is why I found that part of Larry’s message so timely and well placed. Tomorrow is not too soon to begin proactively managing your brand in lieu of Healthcare Reform. To be sure, managing a brand is a bit like herding cats: there are things you can control, things you cannot control and things you foolishly believe you can control.

I am reminded of a passage I like to quote from the book, Brand: It Ain’t the Logo: It’s what people think of you™  by Ted Matthews.

“A Brand is the sum total impression and memory of every remarkable, every so-so and every negative experience with any and all pieces of an organization. A Brand is the personality of a company, product or service and is judged and assessed a value by everyone it touches, whether inside the company (your employees) or outside (your customers, suppliers, shareholders and other stakeholders). These perceptions of value may, or may not, be what you want them to be. Which suggests a fact that may surprise you: your Brand isn’t really yours. You don’t own it – all the people thinking about you do.”

Perception is reality, isn’t it. Being able to monetize the perceptual advantage of being a nonprofit will continue to be critically important to brand awareness and positioning. I am not suggesting otherwise. But – it will not be sufficient for survival in the face of the tremendous challenges ahead, and it will be secondary to perceptually positioning your brand based upon the ability to deliver value under Healthcare Reform.

What do you think?

  ~ Sparky