Digitizing the healthcare market … one doc at a time.

Bottom line: Why not fix what’s broken rather than just creating mayhem ?

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Excerpted from WSJ: Health Care’s ‘Radical Improver’, Dec. 12, 2009

Choice & Rationing

For all the talk about expanding coverage, the real problem is that “You can’t buy what you want.”

(Politicians are) living in this alternate universe where there’s no such thing as a market in health care and they don’t understand why one might be remotely useful.”

The profound problem with U.S. health care is that there’s “no landscape of choices, or choosers.” Due to the complexity of America’s third-party laundromat for health dollars—your doctor’s clerical staff bills your treatment to an insurance company picked by your employer, and it pays him with your money via premiums or foregone wages—”few doctors in America know the actual value of the services they render.”

The government imposes standardized rules and mandates with no concern for how much they will cost or who will bear the burden. Given the choice, consumers might decide on cheaper policies that cover some services but not others, or decide to run more risk.

Another way of putting it is that if the politicians have their way, “everyone will have access to transportation, and it will be a black Escalade, with spinners. That’s it. There’s no Hyundais, no bicycles, no nothing.”

And that’s scandalously unfair. “These poor people who clip the things off the backs of cans to make the tomatoes cheaper are subsidizing the hypochondriac who gets his shoulder done with an arthroscope because it clicks when he serves at tennis.”

Under ObamaCare, Mr. Bush says, “everyone is going to get health care according to the wise-men benefit panel, who will tell you exactly what it is, and then they’ll run out of money, so every year the wise panel will just squish the benefit a little. People will start to say, well, that’s not going to work for me.”

Central health planning won’t have any longevity, and eventually people “will start leaking out into the [private] market once we run out of money.”

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A Digital Revolution ?

Now, most transactions are conducted on paper. Few people really understand how to navigate the dense and bewildering coding rules for dozens of different insurers or the fee schedules for government payers like Medicaid. Claims were denied with no explanation or vaporized in purgatory.

One reason the digital revolution has so far passed over the health sector is sheer bad product. The adoption of EMR in health systems across the country has been dogged by cumbersome interfaces, error propagation and other drawbacks.

Much of the the nearly $47 billion in stimulus cash the White House has budgeted to prime the pump for health IT adoption is going to legacy software companies, with code that was written in the ’70s.  They’re getting federally sponsored life support.

The irony is that … the status quo for all its flaws is capable of organic change and real progress without the blunt-force trauma Congress is likely to inflict. Or in spite of it.

Athena is one of the country’s most innovative health IT firms. Its core business helps doctors manage their practices and get paid, but the larger purpose of the company, is to try to shore up health care’s resemblance to a normal market.

Athena designed a program to digitize records and automate billing. It now colonizes the wilderness of paperwork and habitual financial chaos that defines running a doctors office, and it is also moving into clinical record-keeping for individual patients. Some 15,000 physicians in 43 states use Athena as a virtual office, a number that is growing at an annual 30% clip.

It is a massive logistical undertaking. Athena’s main facility is housed in a decommissioned World War II arsenal on the Charles, where 30,000 pounds of paper is processed every month, most of the tonnage being paper checks.

Incredibly, doctors also receive on average 1,185 faxes each month—mostly lab results—and those are handled too.

State Medicaid programs, by the way, are easily the worst payers. In New York, for instance, claims must be tendered on a dead-tree form instead of electronically and in blue ink—black is grounds for rejection—and then go on to spend a full 161 days, or almost a half year, in accounts receivable.

While streamlining this disorder frees up time for the company’s clients to treat patients, it also throws off vast data, which are fed in central servers, aggregated and analyzed.

This “athenanet” system is among the few health-tech offerings based on “cloud computing”—in the sense that the applications are accessed on the Web, instead of a computer’s hard drive, allowing constant updates and refinements. If a regulation changes or an insurer adjusts a payment policy, it is reflected on athenanet almost in real time; on the clinical side, the program can adapt at the same rapid pace as medicine itself.

Full article:
http://online.wsj.com/article/SB10001424052748704240504574586260904799386.

Healthcare reform … historic firsts … uh-oh.

Excerpted fron RCP: The Liberals’ Weaselly Panic, by Rich Lowry, December 15, 2009 

President Obama and Harry Reid can rightly claim to be making history.

If he passes health-care reform, they’ll depend on a series of historic “firsts.”

• It’d be the first time Congress had passed a major new entitlement program without bipartisan support;
  [Unless you count the Congressional dude from Louisiana.]
• It’d be the first time it passed such a program without popular support;
  [A CNN poll last week found the public against it by a nearly 2-1 margin.]
• It’d be the first time that such a large-scale program would be passed without anybody knowing (or particularly caring) what’s in it.
  [This is bipartisanship Harry Reid style – nontransparency for everyone. Who needs openness and legislative details when you’re remaking one-sixth of the economy?’

Full article:
http://www.realclearpolitics.com/articles/2009/12/15/the_liberals_weaselly_panic_99557.html

There’s nothing like a good fight when it comes to boosting the bottom line

Takeaway: A healthy dose of discord may be just what the doctor ordered when it comes to promoting innovation and achieving profitability within an organization.

Companies recruit employees for the diversity of their backgrounds, so why do these recruits so often transform into bobble-head yes-men?

Let’s face it, we all love a good round of Kumbaya, but effective MBAs should aim to be selectively disruptive in order to deliver real value to their employers.

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Excerpt from Harvard Business Review, “How to Pick a Good Fight,” by Saj-nicole A. Joni and Damon Beyer, December 1, 2009.

The effort to eliminate discord at the firm had backfired. Lehman’s board of directors and management team became too agreeable—and too loyal, content to follow even when they knew better. In 2007 and 2008, numerous signals indicated that the firm was heading into a crisis, but insiders who paid attention to them were afraid to point out the elephant in the room. Nobody wanted to disrupt the peace.

The problem is that a peaceful, harmonious workplace can be the worst possible thing for a business, according to consultancy eePulse, which conducts in-depth surveys that measure employee engagement. Complacency, in fact, is the single greatest predictor of poor company performance. The second greatest predictor is an environment in which employees are overwhelmed. In the first case, employees are reluctant to rock the boat. In the second, the level of employee satisfaction is low and the amount of dysfunctional fighting is high. In both situations, low energy levels and fear of political fallout curb action that might address any looming crisis. At Lehman, many alums told us, raising difficult questions could kill your career.

Most leadership experts argue that the best way to manage change is to create alignment, but our research indicates that for large-scale change or innovation initiatives, a healthy dose of dissent is usually just as important. Within an acceptable range of competition and tension, science shows, dissent will fire up more of an individual’s brain, stimulating more pathways and engaging more creative centers. In short, more of what makes people unique, innovative, and passionate is available for use.

Many successful companies are known for their stressful work environments. Microsoft, in its early days, had one of the most contentious, high-strung, and fast-paced corporate cultures in the United States. Bill Gates and Steve Ballmer were famous for yelling at people. Food distributor Sysco, an unusually successful company built on roll-ups and acquisitions, dismisses district managers who don’t meet annual productivity targets—a pretty tough standard for an operating company with thin margins. Market leaders Goldman Sachs and McKinsey are notoriously competitive, hard-driving places to work. Not places you’d go if you were looking for polite and equal regard for all voices.

So it’s time to stop candy-coating what’s taught to executives and their direct reports. It’s time to stop pretending that conflict-free teamwork is the be-all and end-all of organizational life. It’s time to own up to the truth that the right balance of alignment and competition is what pushes individuals and groups to do their best. It’s time to push employees into the right fights.

Let’s be clear—alignment is important. But the purpose of alignment is not harmonious agreement. It is to sustain an organization’s ability to fight for what really matters, and to pull everyone together again once the fight is resolved.

 

Edit by BHC

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Full Article
http://hbr.harvardbusiness.org/2009/12/how-to-pick-a-good-fight/ar/1

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