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Elsewhere: Accountable for care, employers supporting healthy food choices

Elsewhere: Remember me? Yeah, me either. This whole graduate school thing is hard - who knew!?! Elsewhere is my series of posts highlighting content from sources I find interesting, inspiring and supportive.

My world got a little bit smaller the other day. When I walk the dog I usually listen to podcasts, downloadable audio and video shows. Think TiVo for your iPhone. You already knew that didn't you?

So I'm listening to American Public Media's The Splendid Table. If you are at all inclined towards the culinary arts, by which I mean eating, then it is well worth a listen. You can dial it in on most NPR stations, although I suggest you download it to you portable gizmo as a podcast, either through iTunes or their website directly.

Anyway. Host Lynne Rossetto Kasper kicks off each week with a mini-monolog about some food trend or observation.

This week, Lynne discussed an employer which is offering to help subsidize community sponsored agriculture (CSA) memberships for employees. CSAs are like gym memberships for famers markets. Usually you pre-pay to "join" a farm and get regular deliveries of fresh veggies, meats, dairy, etc. You help fund the operations and get a share of the lauder in return.

Think about that for a second - an employer that was willing to sponsor a food lifestyle choice for employees.

Some employers, although I anecdotally suspect the number is low, sponsor gym memberships for employees. The idea is when you workout you are healthier and thus avoid disease and illness which, in turn, saves the company money on healthcare costs.

If that logic holds true (and aren't we told we are what we eat?) then doesn't sponsoring healthy food choices also make sense?

There is a lot of talk in the healthcare industry about "accountable care." Without going into details on the pros and cons and esoteric points, suffice it to say it means healthcare provides partner with the people paying for care to reduce the cost and innovate the care model. Most people who get insurance in the US, outside of Medicare, get it through their employers. Many of those employers are self-insured; meaning they pay for care out of the company's coffers, even if administered through a third-party commercial plan. You may have blue cross, but your employer is likely footing most if not all of the bill.

Given that, doesn't it make sense for employers to support employees who make healthy food choices?

Paying for CSA memberships is admittedly not the norm. It is a little on the hippie, 2000s-dot-com-days side of out there. But it may offer similar benefits as paying for gym membership, or perhaps it is even better. Nonetheless, it is as least accountable, forwarding thinking and socially responsible.

Elsewhere: the Fundamentals of Accountable Care

Since my brain is still on a holiday induced food coma, I am utterly reliant on sourcing excellent content from elsewhere on the web. You (my only reader) may recall some of my other elsewhere posts where I share things I am reading on other sites. A few weeks ago, I posted a tongue-in-cheek animation of a healthcare executive insisting that his organization form an Accountable Care Organization despite being inable to articulate what an Accountable Care Organization is. I was fortunate enough to be in a room full of senior healthcare leaders recently who were asked by a speaker to raise their hands if they were considering Accountable Care (or ACO). Everyone raised their hands. The speaker than asked people to raise their hands if they knew what an ACO was. Hands in laps.

While I suspect everyone was playing into the industry's inside joke, there is a bit of truth there: for a lot of us, ACO as a concept is poorly defined... or at least understood. And that is fair. There are not many models to look at yet.

In this video from Thomas Cassels of the Healthcare Advisory Board, there is some good talk about what ACO (and accountable payment) means. Now, its not exactly ACO 101, and for anyone outside of the industry it may still be jargon and babble. However, if you are interested in the structures and models that make healthcare systems tick, this may be just what you've been looking for.

Thomas makes the following points about the composition and requirements for an ACO (and I offer my quasi definitions):

  • Hospital / Physician Integration -  simply put, hospitals and independent physicians have to form a team, a partnership of care. The ebb and flow of who needs the other one more has to end, docs and hospitals are all in this together, will get payed together and have to work together to get there.
  • Information connectivity - Electronic Medical Records become a crucial part of an ACO. Imagine booking travel if each airplane didn't talk to the next. You'd leave home, get to your first stop and have to start booking all over before getting on the next plane (note, I'm not talking airlines, I mean individual planes) to your destination. We need a common, interconnected platform so that doctors can communicate about care across all points of care.
  • Clinical Transformation - This one gets tricky, so think of it as best practices meets quality control. Again with the travel analogy: pilots don't get to make up how they fly a plane, in fact it is fairly prescribed for a reason. There are best practices for flying a 747 and there are best practices for diagnosing and treating a torn ACL in the knee. They are fairly well established;  we need to make them available through decision support tools to physicians.
  • Payment Transformation - Did I say the previous one was tricky? Well this one is a doozie. Today, providers usually get paid when they see you. Like a mechanic gets paid to work on your car. The more often the car breaks down, the more they get paid. Under the ACO model, it appears providers will get paid as a team (see bullet 1) and based on outcomes. The thought is that will occur through betting on cost savings. The payor (medicare) says "here's $1,000 to care for someone for a year." Well, providers would proverbially name that care in 2 notes and say "ok, we'll do it for $800 and pocket the difference." Thats the prevailing theory at least...

What to know more? Watch the ABC video here, on their site:

Elsewhere: Important advice from Dr. Bottles – culture change important in health reform

Nick's Note: part of my attempt to be a better curator of content in places other than Twitter; below is a snippet from this fantastic post from Dr. Kent Bottles. It is a must read for anyone in healthcare communications and administration.

Hospitals Need To Focus On Culture In Order to Be Able to Survive in an Era of Accountable Care Organizations and Medicaid Reimbursement Rates


In attending conferences and working with hospital CEOs, I have found that there is more emphasis on the technical tasks that need to be accomplished in order to form an Accountable Care Organization than on the culture such a change will require. I have heard a lot of keynotes filled with power point slides on defining the role and reporting structures for newly formed physician leadership teams; creating system-wide operational councils; and specific legal structures of ACOs so they can accept and distribute global payments. These are all important technical tasks, but they will fail if the culture does not change too.

What can healthcare learn from Apple?

Subtitled: in which I offend my tech friends, healthcare friends or both
I synergize, it is what I do. (for those of you playing business jargon bingo, drink!) I am also an unapologetic Apple fanboy (for those playing internet buzz word bingo, drink!) I've long thought that Apple makes bold decisions, and, since Steve's return, calculated long range decisions. Yesterday Apple held their "Back to the Mac" event. They unveiled the next iteration of their OS X operating system along with a new Mac Book Air. To the consternation of technocrats, Apple continues to make moves away from traditional computing paradigms (drink) towards something that is more like an appliance. It occurs to me that healthcare in the United States is undergoing similar changes. If that is the case, what can we learn from watching Apple and its consumers?

First a little watered down techie background. Computers have long been the domain of nerds. Hey, I'm a nerd, I can say that. How many people know that person…scratch that…kid in their family who is the computer person? Put your own memory in? Nope, save it for thanksgiving and they'll do it. (Let the record show that I am that person, and actually quite happy with the mantel). Not everyone knows how to open the command line, clear the cache, defrag the hard drive or replace a motherboard. What happens when that window gets minimized to some new place, or you can't find a file? Today's computer-savvy youth have learned an entire skill set and vernacular that is frankly transitional at best.

Apple is moving computing in a new direction. Will it frustrate those of us nerds who actually enjoy changing our digital motor oil? Of course. There will always be people who want to build a RAID 5 array of hard drives. But most people just want the computer to be like an appliance. Turn it on and it works.

Healthcare is not much different. There are those of us who work in the trenches. We understand what payor mix and covered populations are. Should most people really have the words "explanation of benefits" in their vocabulary? Isn't that the IP Address of the healthcare world? Healthcare reform is a great example of this. Ask ten people what is broken with US healthcare and you will get 10 different answers. Ask that same lot what defragging a hard drive means and I'll bet you get an equally ambiguously and unqualified set of responses. Most people can't articulate much about healthcare because we have a convoluted system that is difficult to unravel.

Where is the Apple of healthcare? Where is the App Store that shows us what apps to buy and automatically installs and updates them? Apple have a much lambasted screening process for apps that make it into the iPhone and iPad store. Some call it closed or a dictatorship. Maybe. But my mother can use her iPhone and never calls me with questions like "how do I get this pop-up window off my phone's screen?" In Apple's world, it just works.

We are moving towards a reimbursement model that is focused on wellness and health. Over the next few years, computers will have a lot more in common with a toaster than the huge beige box from yesterday. Healthcare in ten years may look a lot more like a public utility than the what we have today. There are a lot of us who have been ensconced in the existing healthcare world. We're the nerds who like to drop into the terminal and type cp ~/Desktop/blog.txt ~/Volumes/Server/www/post.txt to copy a file. We're the ones who know how to tweak our reimbursement process to get the most out of medicare for an office visit. Yet there is a huge, increasingly vocal majority of the public who are asking: "where is my healthcare app store?"

Is the answer accountable care? Is it a public plan? Is it a public/private split like our school system (and like the Australian health system)? I don't have that answer. I do know that Apple is on to something when they make their devices more layperson friendly. It may frustrate the old guard, but isn't change always painful for those who can't keep up?

And... for a little light humor regarding accountable care: