Alba gu bràth!

Ian Morrison wrote an interesting piece today in H&HN Daily: Will Your Hospital Maintain Its Independence? Most anything that starts with, “My native c32f740dadef6f60188f14b376a76efcScotland,” attracts my attention, but Dr. Morrison makes some very interesting comparisons between nationalism and traditionalism that are especially insightful in understanding the current healthcare landscape in the US. More particularly, he offers some useful observations on the national referendum for independence in Scotland at a social level and resistance to change in the US healthcare industry at an individual level.

Scotland recently rejected a call for independence from the United Kingdom by a margin of 55% to 45%. From what I followed in The Times as a run up to the vote it was anticipated to be a lot closer. An emotionally charged issue as one might expect when contemplating the future fate of a nation, the debate over independence goes way (way) back. When I was in Edinburgh in mid 90s I met family there fervid about having such a referendum on the ballot. And, of course, if you’re familiar with Braveheart, you know the thirst for independence goes back to when battles were fought with spears and arrows and naked bums.

The point is, human commitment and passion run deep whenever and wherever the past is concerned. As a nation, it’s the cultural mores and traditions that bind together its citizenry into a common purpose that forms a society beneficial to the individuals participating in – and often fighting for – that society. At an individual level it’s the ability to associate with that purpose through reflection and introspection – memories as it were, whether real or perceived.

Though often positioned as an assertive claim to acquire, it is really most often a defensive maneuver to retain. And thus the desire for independence – at both a national and individual level – therefore also reflects an inherent resistance to change. And that is the parallel Morrison draws to the American healthcare system. An historical cast of passionate, empathetic caregivers – both individuals as well as the institutions to which those individuals have belonged – is being threatened by, “the relentless growth of large regional systems of care coming to dominate the landscape.”

The concern is genuine and real, and how it will ultimately play out is still far from being determined. Morrison shares a few thoughts on how individuals and organizations might best prepare for decisions affecting their own independence. He rightly points out that maintaining independence at all costs may not be prudent, but I direct you to his article (link at the beginning of this post) because it really is worth the read.

I would add to his thoughts the need for a true sense of urgency to create a market strategy that addresses the prospect of remaining independent – or not. Reactive thinking is never strategic. Very often necessary, unavoidable and critical to survival – but not strategic. Take the time now to ensure your organization’s leadership team is in alignment on how it will approach threats to independence – before that threat is manifested as a fete accompli.

  ~ Sparky

Why Can’t Healthcare Innovate?

Whether viewed as paradox or conundrum, the healthcare industry’s relative inability to innovate has long been a source of both fascination and frustration. In the May 8, 2014 edition of the New England Journal of Medicine,  David A. Asch, M.D., M.B.A., Christian Terwiesch, Ph.D., Kevin B. Mahoney, B.A., and Roy Rosin, M.B.A. write about this phenomenon in Insourcing Healthcare Innovation.

Describing the understandable resistance of healthcare professionals to embrace problem-solving techniques from unrelated industries because the complexity of healthcare delivery is most often not well understood, those professionals are by definition usually most interested in exploring new ideas, new approaches and the pursuit of new knowledge. This apparent irony, the authors believe, might be effectively synchronized if a different approach could be taken to reconciling innovation with contextual understanding.

The approach they share is a four-stage design process they believe can achieve this reconciliation. The four stages include: contextual inquiry (understanding the processes currently in place); problem definition (ensuring the right problem has been understood and defined); divergence (exploring alternative approaches) and rapid validation (ability to move from theory to implementation).

If these sound familiar, it is because the general direction of proceeding from understanding where you are to achieving where you would like to be in an orderly fashion is the foundation of many approaches to strategic planning. So from that vantage there isn’t anything particularly revolutionary about the process described.

But understanding the core resistance to such processes – that the way in which healthcare practitioners are educated, trained and practice is frequently counterintuitive to innovation techniques successfully utilized in other industries – is an important distinction. What this translates into is making the requisite investment to understand the unique attributes and complexity of healthcare delivery – its distinctive product offerings, its highly dependent reliance upon personal relationships, its unbelievably complicated regulatory environment – as a necessary component of any planning effort.

It takes time and effort to build the needed understanding of the unique challenges that healthcare practitioners face. You have to ask probing questions and not hesitate to admit your lack of understanding: a fair balance of humility and curiosity can go a long way to building key relationships and creating the requisite knowledgebase necessary to innovate.

In other words, individual egos often create barriers to innovation processes that are attempted to be imported from other industries. More so than representing a different way of approaching innovation in healthcare, what this article does is reinforce a tried and true means of any planning effort: listen and learn before you lead.



Big Data and Brand Management

Big Data: big opportunities or big problems?  While most of what I have read seeks to position this question in the context of anticipated investments in human resources and IT infrastructure, I have a different take.  I think the most critical and salient difference in determining whether Big Data has positive or negative implications for healthcare providers will depend primarily on whether and how effectively it is utilized and managed in organizational branding.

Part I ~ Implications of Big Data
In explaining this, let’s start with a look at just a few examples of where and how Big Data will impact healthcare organizations. 

Clinical and Epidemiological Research
Healthcare providers have long been cognizant of the important role that cutting edge clinical and epidemiological research plays in helping educate and prepare them to provide evidence-based care.  They are also aware of the tremendous burden that misguided and/or shoddy research creates on both their time and talents.

At a clinical level, Big Data means being able to utilize previously prohibitive quantities of biomolecular data to test relational hypotheses much faster, while at the epidemiological level it means being aware of social cause and effect relationships much sooner.  In either instance, the impact and expectations of what to do with more information at an accelerated rate will have a significant impact on healthcare providers, as well as patient-consumers.

Consumer Empowerment
There are already literally thousands of smart phone/tablet app’s available to help individuals manage there own care.  A quite natural focus among these has been to design applications targeting chronic disease management.  As the Boomer age wave grows, so too will that portion of the patient population that is not only adept but very conversant in using electronic data and information to be highly informed and highly motivated self-care advocates.

Though Big Data is by far not the only force driving greater transparency of financial and operational performance metrics from healthcare providers, it will be the catalyst that transforms those metrics from merely data to usable information – and unfortunately, probably a good deal of misinformation as well.  Providers will have to be both cognizant and vigilant in assessing how this emerging trend will impact their market positioning.

The common thread of these three examples is what I call the Acceleration of Digital Chaos©.  More data is always beneficial to the extent that it creates greater awareness, enhances education, expands knowledge – and most importantly, creates wisdom.  But as we know, more data does not always lead to such hopeful results.  It also often leads to more confusion, more frustration – and worst, more risk of making critical decisions based upon faulty analysis.

Part II ~ The Importance of Brand Management
Wherever there is chaos and confusion that grows out of attempts to address a basic human need like healthcare, so too exists the double-edged sword of opportunity and risk: the opportunity to bring clarity amidst the chaos in the form of high-value solutions, as well as the ever present risk of making things worse.  And there too lies the associated challenge of branding: opportunities to leverage Big Data in ways that can greatly enhance the value of your brand – or facilitate its disintegration into a pile ashes.

To make sure Big Data serves your brand rather than destroys it will require an active awareness and understanding of where and how Big Data will intersect with Brand Management.  Several examples of these intersections are offered for your consideration.

Social Media
Social Media continues to grow in importance and relevancy to the healthcare industry.  Enter Big Data and now you have a tremendously powerful vehicle for gaining valuable information and insights on patterns and behaviors – of both consumers and competitors.  

To the extent a knowledge advantage can be gained through use of Big Data, that information can be used to help position your organizational brand in concert with consumer demands and expectations – and before competitors achieve that positioning.  I cannot think of a more important market-oriented investment that healthcare providers can make at this time than exploring and understanding how Big Data will transform the way data collected through Social Media can be used to competitive advantage.

Quality and Integrity
Examples in Part I above highlight the likely potential where Big Data will generate tremendous personal anxiety, confusion and frustration.  Take the average consumer-patient looking at knee-replacement surgery in the year 2015.  Armed with 30 published research papers on the advantages and disadvantages of different techniques; over 50 web site addresses stored in the web browser with pages and pages of performance data on surgeons;  15 different self-help iPad applications downloaded to determine the most effective means of post-survey rehabilitation.  You get the idea.

So the ability of healthcare providers to be perceptually positioned as a trusted resource to cut through all of the confusion and frustration will create substantial market advantages.  But, importantly, those healthcare providers that are able to achieve a sustainable advantage will not only facilitate a more efficient and helpful pathway through the confusion – but they will do so while backing it up with consistently higher quality care than competitors.  The two must go hand in hand.

Data Security and Corporate Compliance
I saved the most important for last.  This is a hugely tremendous risk to brand value that will be attendant to using Big Data.  We read of examples every day where patient data has landed in the wrong hands.  The consequences of being at fault – whether real or perceived – for a breach of data privacy and protection could erase years of investment in building your brand overnight.

Yet it is reasonable and plausible that a breach could happen despite the most advanced and diligent efforts of prevention.  In such instance, the organizational fallback position must be a strict adherence to corporate compliance policies that clearly make the protection of personal data the highest priority – not only in theory but in practice.

Please note this post is not by a stretch intended to be an exhaustive survey and consideration of either the ways in which Big Data will impact healthcare, nor the numerous ways in which it has the potential to impact healthcare providers’ brands.  It is intended primarily to help leadership teams of such organizations begin to perform their own assessment of how and where Big Data can have a Big Impact on their future branding efforts.


Pub Chat # 3 ~ Marcia Tetterton

This edition of Pub Chat coincides with the release of a new report published by Artower Advisory Services, which summarizes findings and observations from the recently completed Organizational Readiness Assessment Survey Instrument (ORASI©).  For more information, please click on the links below: 

   ORASI© Press Release         2012 ORASI© Summary Report

With the recent decision handed down by the Supreme Court regarding the constitutionality of the Patient Protection and Affordable Care Act, the probability has increased substantially that healthcare providers will have to implement significant changes in the way they do business. To assist providers of home healthcare and hospice in determining their organizational readiness for Healthcare Reform, the Council of State Home Care Associations commissioned the adaptation of an organizational readiness self-assessment survey developed by Artower Advisory Services for use by member agencies.

Over 940 participants from member agencies of 26 state associations took part in the survey during the period April 3, 2012 through July 3, 2012. The primary purpose of this effort was to help those agencies and the state associations to which they belong better understand the areas where attention, focus and training are necessary to help prepare home healthcare and hospice agencies be successful under Healthcare Reform.

You can listen to my interview with Marcia by clicking on Larry’s microphone, below:

~ Sparky

Consumer-Driven Senior Care

In a recent article published in Beckers Hospital Review:   6 Trends in an Era of Consumer-Driven Healthcare, hospital executives were provided with the strategic implications of current and emerging trends in consumerism.  These same trends will undoubtedly impact organizations that provide senior housing, aging services and post-acute/long-term care.  Understanding, analyzing and developing strategies to address the challenges and benefits from opportunities presented by/offered as the Baby Boomer generation begins to hold sway over the healthcare delivery system will be important for both providers, as well as policymakers.  So I thought it might be useful to try and interpret the key themes presented in that article from the perspective of senior housing and care (SHC) organizations.

Key Trend 1: Transparency
The Affordable Care Act specifically focuses on two areas of transparency: the gathering, assembly, analysis and reporting of clinical and operational data by healthcare providers (e.g., provisions found in the Elder Justice Act ~ Sec. 6703 of the Affordable Care Act); and the assimilation of comparative cost/benefit – i.e., value – information and analysis, particularly relating to provider charges and third-party reimbursement of same (e.g., Health Insurance Exchanges).

With or without the constitutionality of the Affordable Care Act, the message here for SHC providers is quite simple: get used to it.  Nay, if you want to be around in another decade, embrace it.  We are accelerating toward a period of time during which provider culture will be predominantly impacted by data-driven marketing, clinical performance, operational efficiency and financial reality.  And the watchdog enforcing voluntary compliance will not be CMS, state governments or private accreditation: it will be your own stakeholders and constituents.

Key Trend 2: Social Media
People talk – and, of course, people with more time on their hands talk more.  Evidenced by the well-documented social mobilization of the 1960s and 1970s – Boomers know how to communicate.  The intriguing, albeit sometimes almost depressing, realities of electronic social networking offer a challenging conundrum to SHC organizations.  Many, if not most, healthcare providers have embraced that reality in one form or another – whether that’s physicians communicating with patients via e-mail, hospitals using online YouTube videos to promote post-discharge wellness education or organizations like MorseLife in Florida developing an iPhone app (the MorseLife All) that connects seniors in its market to their campus.

Connecting in real time, however, carries with it a variety of challenges and opportunities.  The clinical side of healthcare (the side that can save your life) requires a keen sense of discipline and objectivity – two elements largely vacant in much of social media.  But there seems to be very little standing in the way of information – and misinformation – being haphazardly propagated as proxy for clinical expertise via such media.  Consumers recognize this risk, and that will offer an opportunity for SHC providers to be positioned within social media based upon their credibility, expertise and authority.  Recognizing this has important implications for brand management.

Key Trend 3: Consumer Empowerment
The underlying objective of increased transparency, access to comparative outcome analytics and evidence-based healthcare/medicine is, of course, to help position the healthcare consumer to be in a position to better advocate for their own healthcare. The benefits of such empowerment, however, will necessarily be tempered to the extent the targeted audience is unable to take full advantage. As we know, this is often true of a senior population that may face a variety of obstacles (e.g., mobility outside the home, effects of medication, propensity toward dementia). For good or ill, it will likely fall upon SHC organizations to play a proactive advocacy role for many disenfranchised seniors.

And this will put those providers in a potentially perilous position. Being an advocate usually necessitates having a healthy dose of skepticism. It is difficult, at best, to challenge and defend at the same time. It is sort of like playing a game against yourself: you will always win – and lose. But that is what innovation is all about – finding value-added solutions where none were thought to exist. Those organizations that develop innovative approaches to consumer advocacy for the senior population in ways that add value to all stakeholders will find huge competitive advantages in the future.

Key Trend 4: Consumer Expectations
Much has been written regarding the comparative demands of the Boomer Generation relative to previous generations, but demographically we have really only begun to see this manifested where product and service offerings target the 55 – 65 age cohort (e.g., Active Adult communities, age-defying miracle cures and, of course, Harleys).  But where those Boomer consumers have begun to make their mark the evidence of their purchasing sophistication and discernment is compelling.

Boomers demand value.  And as written in this space before, value in healthcare must be understood as providing better patient experiences and outcomes at an overall lower aggregate cost.  So while value is emerging as the driving force of third-party payer expectations (whether that is from employers, private insurers or Medicare/Medicaid), it will also be the driving force of the empowered consumer.  The message for SHC providers is clear: think value first, often and always.

Key Trend 5: Consumer Outreach
The proliferation of electronic communication media offers some very compelling opportunities for SHC providers to “connect” with their targeted markets.  In doing so, however, it is important to recognize how many other sources are competing for the attention of individuals in those markets.  While I recognized that at a theoretical level, this blog has been a firsthand experience of having to reconcile your individual perceptions on the value of content produced with the actual level of interest generated.

As I have been making the point in presentations on Healthcare Reform, if we get everything else right – increasing access, improving affordability, bending the cost curve, expanding the caregiving labor force – but fail to improve upon the overall health and wellness of our society, we will have failed miserably in creating a healthcare delivery system that is sustainable.  SHC providers are very uniquely positioned to leverage the benefits and advantages that electronic media can offer to help improve the overall health and wellness of the senior population in their communities.  And such efforts will find great synergy with other strategic efforts to develop integrated care and home and community-based delivery models.

I think SHC providers have more to gain than lose by being proactive in embracing Consumer-Driven Healthcare.  What do you think?

  ~ Sparky

Being Proactive in the Face of Uncertainty

While none of the Policy Pub’s guests have provided any comments yet (I’m hoping a few more “spirited” posts will begin to wear down the  contributory inhibitions), several patrons have emailed me privately and asked whether I had any practical advice on how to approach this period of policy limbo – between before knowing how SCOTUS will decide and the outcome of the fall general election.  So I thought this might be a good opportunity to offer some advice.

Accept the Brutal Reality
Often lost in the din of popular media reporting on the Healthcare Reform debate are the irrefutable realities that underlie how and why it has become a major public policy issue in the first place.  The Internet is replete with charts and tables illustrating the debated evidence of unsustainable healthcare spending.  I think a very poignant and candid assessment that ought to resonate with business-minded individuals can be found in the January 2012 Standard & Poor’s credit report, Mounting Medical Care Spending Could Be Harmful To The G-20’s Credit Health
.  It was noted there that, “steadily rising health care spending will pull heavily on public purse strings in the coming decades. If governments do not change their social protection systems, they will likely become unsustainable, in Standard & Poor’s Ratings Services’ view.”

The will to control healthcare spending is not a Republican or Democrat phenomenon.  So holding out hope that future policy outcomes directed at the behest of either current or future elected officials, irrespective of political party, will somehow relieve the pressure is a fantasyland belief that only serves to psychologically forestall the inevitable.  Healthcare organizations that are able to accept and internalize knowing that they will have to compete on value in the future will survive – those that do not, will not.  It is really as simple (and brutal) as that.

Use this Time to Answer Some Tough Questions
If the Affordable Care Act is either partially or fully struck down – and/or the general election delivers a major shift in party majority, there will be a brand new tsunami of political opportunism in its wake.  It will take a fair amount of time (I am betting six quarters, at least) for that special interest flooding to subside to the point where any type of meaningful legislation can be passed replacing the ACA.

What impact that actually has, however, on the timing of the policy-driven financial realties that senior housing and care providers are facing is unclear because much of the ACA’s impact is not scheduled to begin until 2014 in any event.  And while we wait for the Federal government, State budgetary pressures will continue to mount.  So I think a prudent approach is not to mark the passing of time by the political winds but assume that every month going forward should reflect a quantifiable movement toward a future state vision of your organization that is more lean, more efficient – and is able to deliver more value than your competition.

To accomplish this, however, you first need to decide what that future state vision looks like.  I just finished a new whitepaper on strategic planning and positioning that discusses the importance of visioning in context.  For the purposes of this post, I think the relevant questions that need to be answered by most organizations – and very soon – are:
     What business(es) are we in?
     Who really are our constituents and stakeholders –
        and how do we bring value to them?
     Are we ready to partner with other healthcare 
        providers – and under what circumstances?

     How do we ensure that our investments create
         future option value?
     Where are the opportunities to monetize our value
        chain into revenue?

Be Ready to Negotiate
If there was one skillset I would say – on average – represents the weakest link for high quality, high value senior housing and care organizations desiring to thrive in a future world of Healthcare Reform it would be the ability to negotiate business deals.  It is just not an inherent skill that seems to be well correlated with other leadership qualities that are of paramount importance – and have historically been sufficient to achieve leadership excellence.

That is changing, and quickly.  Effective negotiation will determine whether you are  “bought by” or “merged into” another organization.  It will determine whether the acquisition you make increases or decreases the overall value of the combined organizations.  It will determine whether you drive the terms and conditions necessary to financially survive under managed care, or accept what you’re given – and hope for the best.

When the time comes to partner with other market participants (whether those are community-based organizations, physician groups operating as a medical home or  hospitals) you don’t want to be sitting there with your hand up, saying, “oh pick me, pick me!” You want to know well in advance what you bring to the table, what it is worth and what you demand for that value.

Create an Opportunity Assessment Matrix
Finally, senior housing and care organizations will have to be able to react more quickly to opportunities than they have in the past.  As Healthcare Reform – in whatever final format that takes – begins to roll forward in earnest, market dynamics will accelerate.  New – and often unexpected – partnership opportunities will emerge.  Being able to react quickly – and before the competition – will be a huge strategic advantage and key to survival.

One idea that we have found helpful is the Opportunity Assessment Matrix.  This is a concept that we have used with several senior housing and care organizations, and it is a tool that is designed to streamline the process of identifying, assessing, analyzing and prioritizing market opportunities.  It is also helpful in mitigating risks and ensuring the requisite organizational support is in place before valuable resources are invested in pursuit of alternative opportunities.

The concept is basic: discuss, agree upon and document the various elements that any potential opportunity must possess to merit consideration.  Determine the relative weights of those elements in the context of the organization’s business strategy.  And then create a consistent methodology for who and how the individuals responsible for assessing the opportunity will be engaged.

Hope this is helpful . . .
  ~ Sparky