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The one where I get all soapboxy about the term Obamacare

Tidal Basin

Dear Friends, Pundits, and Politicians,

Can we please stop calling health reform Obamacare?

Opponents began calling the health reform law and its associated components Obamacare as a way to both detract from the law and the President. Those who are not in favor of the PPACA report on Obamacare’s problems and challenges; linking the bill and the President hand in hand with some scary story about how Americans will somehow be less well off if more people have access to healthcare. Let’s defund Obamacare sounds a little to me like taking your toys and going home.

[And, correct me if I’m wrong, I don’t remember calling anything the Bushwar, Clintonbudget or Kennedymoonmission - when did taking liberties with the President’s name become acceptable?]

Those in favor of the the PPACA have co-opted the term; adopting in as a rally cry for the Act’s benefits. Do you like Obamacare, I think it’s a good thing… people will confide in me during meetings and events. Even CMS and policy wonks promoting the Act use the term frequently. Remember the kid in school with an unkind nickname who eventually started referring him-or-herself by the nickname? I bet they didn’t love it, deep down inside.

But here’s the thing…

We’re talking about healthcare. We’re talking about the difference between someone being able to see a doctor or not, to get medications or not, to have better, more fulfilling lives… or not. Making healthcare about politics —and I understand, the two have been an odd couple well before Jack Lemmon and Walter Matthau —does our humanity a disservice.

It’s not Obamacare, it’s the PPACA, health reform, Medicaid expansion, health insurance exchanges, accountable and population health, wellness visits and more.

And besides, spellcheck doesn’t even think Obamacare is a word.

Now, would someone help me down from this soap box, my knees aren’t what they used to be.

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: 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.

reading list: getting real about socioeconomics and policy

Following the lead of the great Susannah Fox, I want to share a few articles which have the hamster wheel in my brain spinning in double time. We’re starting to seriously wrestle with some of the real socioeconomic and policy  challenges of health and providing healthcare. Two of these articles appear in popular press rather than journals.

Sabrina Tavernise in the New York Times writes about The Health Toll of Immigration to America.

A growing body of mortality research on immigrants has shown that the longer they live in this country, the worse their rates of heart disease, high blood pressure and diabetes. And while their American-born children may have more money, they tend to live shorter lives than the parents. “There’s something about life in the United States that is not conducive to good health across generations,” said Robert A. Hummer, a social demographer at the University of Texas at Austin.

Thanks to Dennis Boyle for sharing the article.


The New York times, H. Gilbert Welch writes Diagnosis: Insufficient Outrage

Consider another recent shift in health care: hospitals have been aggressively buying up physician practices. This could be desirable, a way to get doctors to use the same medical record so that your primary care practitioner knows what your cardiologist did.

But that may not be the primary motivation for these consolidations. For years Medicare has paid hospitals more than independent physician practices for outpatient care, even when they are providing the same things. The extra payment is called the facility fee, and is meant to compensate hospitals for their public service — taking on the sickest patients and providing the most complex care.

Hat tip to Doctor_V and DrNancyGlass1 for finding the article:


In the New England Journal of Medicine, Michael Rawlins, MD publishes: NICE: Moving Onward

There is now wide acceptance that no country seeking to provide universal health care has the resources necessary to achieve the highest possible standards of care for everyone. …

This part is important:

However, priority setting in health care must encompass more than the technical and scientific demands of health technology assessment. It must also take account of the social values of the relevant communities. NICE therefore established a Citizens Council, with members drawn from the general public, to examine, deliberate over, and report on the social principles on which the Institute’s guidance should be based.

Grateful for Pritpal Tamber, MD for the oignal quote and link:


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: