Thursday, July 23, 2009

Talking to Americans About the Health System

I’ve wanted to take a break from the endless drumming on health reform for, as I said two weeks ago, there’s more to our business than reform. Then I had a couple of energizing experiences that both evolved and reinforced this idea.

For a project we’re working on with Geisinger Health System, we’re having long, complicated conversations about discussing health reform with the general public. The major news outlets have the political and policy stuff well covered. Where is there room for another voice (and is it needed) on the topic?
In researching the project we found an interview from October 2008, with Geisinger CEO Dr. Glenn Steele that inspired and brought clarity to the project. In a blog post/interview with the New America Foundation Dr. Steele discusses what in the Geisinger system is “generalizable” and scalable to the larger US health system. The interviewer writes, “Dr. Steele isn't all that focused on reform from Washington in the next administration. If he has a wish list for the next president, he isn't sharing it. "What can Washington do? Who the heck knows?"

Who the heck knows?

Then it hit us what we—in all our propellerheaded geekiness—were missing. While payment reforms and insurance structures are important and certainly impact providers, providers can only lightly influence what will ultimately come out of Washington. However, regardless of legislation, they can and should act independently to modify their processes and systems to constantly revolutionize quality and cost-effectiveness of care. I mean, in radical, forward-thinking ways that are not just “quality improvement” but actual delivery system reform. The REAL reform.

If you’re interested, Google “Geisinger Transitions of Care” and “Geisinger Personalized Medicine” and you’ll quickly find articles and resources that discuss powerful transformations of the healthcare landscape. Stuff that will impact patients, improving their quality of life, care experiences and drive down their lifetime cost of medical care.

Also, last week I spent 2½ days in and around Mankato, MN working with ISJ Regional Medical Center of the Mayo Health System. The visit culminated with a 2-hour-plus discussion with the system CEO about the remarkable accomplishments and potential of their integrated system of critical access hospitals, physician offices, outpatient facilities, the ISJ Regional Medical Center hospital in Mankato, and the Mayo Clinic.

The long and the short of it being citizens in small communities throughout rural southern Minnesota have access to a level of care that is simply not found many other places in the US. Docs in clinics and at these critical access hospitals are all integrated on a common (Mayo) electronic health record, taking advantage of Mayo Clinic best practices and patient care materials, successfully leveraging specialty care outreach from Mankato and Rochester, all well-positioned to accept case rate risk for episodic and chronic/ongoing care.

Digesting these two projects the question quickly becomes, “How do you engage the average American in a conversation about health care delivery reform?” Can you? Here’s where the mainstream media can’t and won’t be effective. Worse, voters’ eyes glaze over when the policy bickering goes high-octane. Add to that the $1 trillion question posed in yesterday’s New York Times–What’s in it for Me?—and the uncomfortable answer that comes with it, and you have a serious health care communications dilemma.

Right now, the answer feels like “small bites” and “straight talk.” We (the collective “health care marketing communications” We) struggle with the conversation around quality, wondering if we can have engaging conversations about Core Measures, HCAHPS scores, and mortality rates. It seems to me that perhaps that’s focusing on the wrong end of the elephant.

If people understand that the transition from hospital to home is a very important step in their care and that has to be planned carefully at their time of admission (if not before) perhaps they’ll engage and drive improvement. If people realize that simply having a computer in your physician’s office doesn’t mean they are getting best practices cues for managing your type 2 diabetes then they have to demand a more enlightened approach to care.

But that seems like asking way too much. So then maybe it’s more about helping them understand the difference between providers—hospitals, networks and systems—which are actively revolutionizing care to improve quality, satisfaction and cost-effectiveness and those who are not. Then, we are left to hope, in the presence or absence of enlightened payment changes emanating from Washington, they choose more evolved models over less evolved ones. But sadly, we all know, hope is not a strategy.

So then we have to get even further.

Can’t say that nut is completely cracked yet.


  1. This example with their high percent of gov't providers may truly be a benchmark system for success for the future.

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  5. Nice effort to join peoples in a health system movement. Its beneficial for peoples that they get health related exercises, tips and more.

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