Tuesday, November 18, 2008

Of Delivery Models. Competencies and Personal Responsibility

So, I donned one of the propeller beanies I keep at home and, over the weekend, waded through one of the publications in the IBM Global Business Services series on Healthcare 2015, “Delivery Models Refined, Competencies Defined.” This book is mostly the supporting text to the executive summary I wrote about last week.

The piece’s thesis is summed up in the opening paragraph (sorry, it’s a little long but a good challenge):

“Healthcare providers can work collaboratively to achieve new milestones in defining, measuring and delivering value, activating responsible citizens and developing new models for promoting health and delivering care, even within growing resource constraints and other challenges. This is important more than ever before as the paths of healthcare systems in many countries are increasingly unsustainable. Moreover, we envision this will lead to a variety of strategic decisions affecting service delivery models and underlying competencies. These decisions could impact the organization’s leadership, culture, business models, organizational structures, skills, processes and technologies.”

There’s a lot in this tome, so I’ll focus today on one idea that is central to their set-up. They build on Porter’s work and the growing chorus of “value” (although the skeptic could wonder if this is a phrase that is soon to lose its meaning through overuse?). “Transforming healthcare requires a corresponding transformation in understanding the value that care providers deliver. In many countries the main focus of care providers is to diagnose and treat sick patients…But, a system that is focused on proactive care strategies, such as personalized prevention, prediction and early detection/treatment and disease management, can help create and maintain a healthier population, possibly at a lower cost.”

There’s nothing too much new here so far. They do later state something I’ve pondered about before in relationship to chronic care and the medical home concept. “There are other potential facets to quality care in a value-based healthcare system: the focus on prediction, prevention, and early detection and intervention; correct and timely diagnosis; the ability to educate patient in managing their conditions and health, and communicate effectively to bolster patient comprehension, compliance, and recall; responsiveness to patient preferences and values, where appropriate; and the ability to coordinate care across venues, care providers and time.”

Now, I wonder aloud, who is doing this and who can really do this? The institutional healthcare superstructure flat-out stinks at it. I giggled aloud at the directive to, “communicate effectively to bolster patient comprehension, compliance and recall.” But boy, for how bad healthcare providers are at this today, it sure is an interesting clarion call for the healthcare communicator of the future. If I were plotting a strategic plan for the marketing communications department of the future, these would be powerful guiding principles that I’d use to challenge the organization.

Complicate this a little further, the document goes next to puzzle on, quite frankly, healthcare’s 800 lb. gorilla; lazy human beings. In “Activating citizens – From ‘fix me’ to personal health management,” they examine the “blind reliance on publicly supported healthcare to compensate for individual health behaviors” which they ultimately determine is an “increasingly unsustainable and unrealistic position,” demanding that “citizen activation has to be a key part of the solution.”

To do this a couple of things have to happen. One is shaped like a carrot; the other is shaped like a stick. The carrot end is the idea of greater individual engagement and activism in their own health decisions. Is it wishful thinking to expect people will ultimately learn more about their health and, as the IBM folks propose, “co-produce healthcare?” I can imagine how this could give rise to a more enlightened populace with a greater satisfaction in their healthcare. But, is it a bridge too far?

The stick end is financial. Will we accept punitive premiums for continued bad health? If a Medicare enrollee maintains and unhealthy BMI and doesn’t bring their Type 2 diabetes under control, will they get nailed with an extra annual premium? Will employers safely follow the lead of places like the Cleveland Clinic and not employ smokers? Further, should we as a system and society be more explicit in the expectation that people have a personal responsibility for financing their health? Should health services be planned like retirement – with the expectation set that very little is guaranteed by society and the rest is yours to fund through a variety of mechanisms? Would that be “mandate” that ultimately pushes people into value consciousness?

The report is practical: “Many citizens, regardless of how well-intended, will not be able to become activated, responsible citizens on their own…they ma need help from a variety of coaches.” They then go on to describe three types of health advisors – health coaches, value coaches and wealth coaches – that would work like contemporary personal financial planners to help people make responsible decisions and plans.

On it’s face it seems like we’ll need a really big stick for that to happen. That said, it would be fascinating to see the activated youth of the 2008 election marching against the AARP legions in Washington DC! Remember what McKinsey & Company reported, that one way to stem out-of-control demand was for the young to finally get angry to the point of refusing to fund the old any longer.

“CDOs [Care Delivery Organizations] can play a key role in helping activate citizens—and that will be increasingly expected by the purchasers of health-related services such as governments, employers or individuals.”

Fascinating implications for institutional healthcare system planners and marketing strategists!

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