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from elsewhere

When Giants Stumble

When giants stumbleHDR Sunset

Local Cleveland channel News 5 reporter Cassandra Nist posted today:

The Cleveland Clinic announced Wednesday morning that they will be cutting $330 million from their 2014 budget.

“This is a process and the Cleveland Clinic is focused on driving a more efficient healthcare system. The goal is to make healthcare more affordable [and] efficient to patients,” Cleveland Clinic spokeswoman Eileen Sheil said.

The Cleveland Clinic acknowledges that there will be a reduction in the workforce, however the numbers are unknown at this time.

Shiel said this is “not unique to the Cleveland Clinic“ and that it is ”happening to hospitals across the nation.”

Our large healthcare providers —health systems and big hospitals —are in trouble. Public and political concern about hight costs are putting pressure on providers to lean out their organizations. (The true source of much of that cost may be out of their control, by the way). Simultaneously, we are living through a sea change in how care is being delivered. We’re not as far away from the smart phone physical as one may think.

Let’s also not forget population health. Forget concerns about about bridging the gap between the payment models. Do we really know how to take our existing large, complex healthcare ecosystem and turn it 180 degrees towards prevention and wellness?

Recently, while speaking to a group of hospital leaders, I shared an analogy I’ve been kicking around in my brain: these systems are giants and they won’t suddenly fall over. Instead, like Atlas, they will become increasingly unable to bear their the weight and will begin to stumble. Some, from time to time, might even drop to a knee to catch their breath.

Is Cleveland Clinic the first giant to stumble?

I’m all for cutting the fat and being more efficient. But how much of that is spin and how much reflects concerns around constrained reembursement and a changing care model?

Not to be all grey clouds and Andy Rooney here… These giants are giants for a reason. I have great faith in their sophistication, leadership and clinical abilities. Unlike small community hospitals, I doubt we’ll see any of them fall down outright. The smart ones, like Cleveland Clinic, are already thinking about:

  • Population health - Cleveland Clinic’s lauded bundled payment program for Lowes and Walmart is a clever example.
  • Patient engagement - Cleveland Clinic’s highly regarded Empathy video shows a serious commitment to the human side of healthcare.
  • Integrated model - The clinic model, with its employed physicians and team-based care, continues to make a lot of sense. I think we’ll see large health plans follow Lowes and Walmart, with renowned clinics like Cleveland Clinic, Mayo Clinic, Stanford, and Johns Hopkins, become preferred centers of excellence for these plans (further challenging community systems and hospitals).

From elsewhere: NC hospital closes, but was it really because of politics?

You know you are early for your flight when...

Posting on the Huffington Post, Jeffery Young writes: North Carolina Hospital Closes, Citing No Medicaid Expansion

A small hospital in a coastal North Carolina community will close its doors within months and its parent company says Gov. Pat McCrory’s (R) decision not to expand Medicaid under President Barack Obama’s health care reform law is partly to blame.

But wait, there’s more…

Other considerations, including outdated facilities, also led to the company’s decision to close the hospital but North Carolina foregoing the Medicaid expansion contributed to the decision, Vidant Health CEO David Herman told The Huffington Post.

I’m not surprised we’re seeing smaller community hospitals struggle. Last week the great Mike Sevilla, MD wrote an op-ed for KevinMD questioning: is the end near for small community hospitals?

Without doubt, I think we’ll see more of these closures. But we have to also pay attention to the root cause, particularly in these still early days of PPACA’s implementation.

Note Mr. Herman’s other considerations —outdated facilities. At some point, buying a multimillion dollar scanner or other required life saving equipment for a 49 bed hospital just doesn’t make sense.

It also may not make sense to operate 49 bed hospitals within an hour’s drive of a larger, more sophisticated facility.

We’re seeing the shift away from the shiny hospital on the hill as the only anchor for providers and care delivery for a community.

That story is a lot more interesting than politics and Medicaid expansion.

From Elsewhere: H&R Block using retail locations for insurance exchange enrollment

About to be the least authoritative speaker at Apple's medical event tonight

Writing in Modern Healthcare, Jonathan Block pins: Reform Update: H&R Block, online insurance broker team up to sell health plans

The GoHealth platform will be available through H&R Block both online and over the phone nationwide beginning Oct. 1, said Michael Mahoney, senior vice president of consumer marketing for Chicago-based GoHealth.

Here’s where it gets interesting:

In a separate development, H&R Block on Wednesday said as part of a pilot program, it would have health insurance agents in its tax offices in Arizona to assist with choosing and enrolling in a plan.

Is this really all about the physical footprint of H&R Block’s stores?

It’s not news that funding communication around the rollout of PPACA and health exchanges as been challenge for CMS. What is a problem for the government could be an opportunity for private industry like H&R Block.

In the age of Quicken and TurboTax, its hard to imagine that H&R Block gets as much bang for the buck out of their many physical locations as they once did. By offering in-person health insurance exchange enrollment, they might have found a niche to pull people back in.

What’s next, FedEx and UPS to follow? Maybe Apple could leverage their Genius bar for insurance advice… or, maybe not.

From elsewhere: What would happen if hospitals funded ideas from patients, docs and staff?

Med Students (and interlopers) only

From Deanna Pogoreic at Medcity News:

Stanford has established a three-year partnership with Stanford Hospital & Clinics and StartX, an accelerator for students, faculty, alumni and staff, under which the institutions will support the accelerator and create a fund called the Stanford-StartX Fund.

Teams that take part in the StartX accelerator will now have optional access to financial backing from the university and hospital if they are raising $500,000 or more in a round. The fund, which Stanford says is uncapped, will participate in rounds as a minority investor.

I like this idea, and it seems to echo a few other trends.

We’re seeing a move towards younger workers preferring contract roles. Some suggest it is employer driven, owed to increasing healthcare costs. But others —and I favor this view —say it’s because knowledge workers like to move quickly between projects and environments.

There is also a glowing ember (not ready to be called a trend) within healthcare to practice rapid iteration. For a long time perfection wasn’t even good enough. Today, we’re understanding we need to quickly test processes, tools and procedures to see what works and what can be improved.

What’s exiting about Stanford’s announcement is how it fits comfortably with our the workforce and an entrepreneurial culture.

What might happen if hospitals started funding ideas generated by staff, doctors, patients and family members? Can you imagine the pace of innovation?

From Elsewhere: The Bossless Office

Bossless Office (Photo: Illustration by Marc Boutavant)

…“Management is a term to me that feels very twentieth century, … That 100-year chunk of time when the world was very industrialized, and a company would make something that could be stamped out 10 million times and figured out a way to ship it easily, you needed the hierarchy for that. I think this century is more about building intelligent teams.”

—Simon Anderson, CEO of DreamHost

One of my biggest concerns about the future of healthcare is the industry’s attractiveness to bright young people. Let’s face it, unless you are doig cutting edge clinical work, there’s not a lot in healthcare which compares to Google’s sushi bars, segways and wifi-blanketed busses.

The hospital workplace is still one of the most conservative environments in corporate america. Dark suits, wood paneled board rooms and hierarchy are the norms. I haven’t spoken to many college-aged young adults who are anxious to flock to that kind of workplace.

Enter the Bossless Office. A feature this week in New York Magazine looks at an emerging trend in management, or the lack of it.

There’s a lot to like about this idea and its application to the healthcare environment. Could it help entice more of the start-up, rapid pace, rapid reward crowd? I think so.

This structure—largely flat and very flexible—is especially appealing to those new to the workforce, twenty-somethings who tend to approach work differently from their parents. “The way workers are motivated is changing,” says Anderson of DreamHost. “Twenty years ago, it was about higher pay. Now it’s more about finding your work meaningful and interesting.” As more and more millennials enter positions of power in the business world, Anderson believes we will soon reach a point where hierarchy itself is “passé.”