Adapting to the New Healthcare Market - Part 1

As I mentioned in my blog last week, I would review with you this week and next the content of a recent presentation I gave as the keynote speaker at the recent MGMA 2011 Financial Management and Payer Contracting Conference.
I began by indentifying the four market drivers of heathcare reform:
       1. High Costs
              >Prices have no relationship to costs
              >Vendor margins
              >Duplication of Services
              >Some people can not or will not pay for services
    
       2. Poor Quality
             >Lack of Consistency
             > Lack of coordination
             >Assuming excellence is a luxury and not a necessity

       3.Physician Dissatisfaction
              >Declining reimbursement
              >Polarization with hospitals
              >Strong supplier relationships
              > No "common voice" among physicians
              >High medical liability costs in most States

        4. Maligned Vision
                >Focus on illness and not wellness
                >Focus on volumes, not values

After reviewing these first four slides, I indicated, as I have in past blogs, that the only surviving healthsystem or free standing hospital in the future will be one that can delivery high quality, low cost addordable care as consistently as possible. However, inspite of these challenges, I stressed that we must always remember that the healthcare industry and healthcare professions have in the past, and always will provide rich opportunities for personal and professional growth, Hence it lead me to the most important question facing that  audience and all of us who serve in the health care ministry........
     How do re reignite the enthusiam and create not only a sustaining, but thriving healthcare industry and
     enviroment?
In next week's blg I will articulate the six ways that we can address that questions successfully. Implementing these strategies will require us to be highly competent leaders and team players in our healthcare roles. A competency can best be defined as the observable and measurable characteristics of a person that include using KNOWLEDGE and demonstarting SKILLS, BEHAVIORS, ABILITIES, and ATTITUDES that contribute to performing well. Next week I will also identify the most critical competency, and also the major contraints that will prevent many leaders from being successful during these challenging and complex times. Until then, have a great week!

An Upcoming Presentation

On Monday, March 27,2011, I will be giving a keynote address at the MGMA 2011 Financial Management and Payor Conference. The topic I was asked to address is "Adapting to the New Healthcare Market." I am sure this topic was driven by those seeking answeres as to what we need to do to adapt to the changes being mandated or regulated though the new healthcare reform law. What is it that it will take to be successful in the future? Certainly, I will answer this question in the presentation, the conent of which I will share with you in next week's blog.
However, as I was reflecting on the comments I would be making, I pondered the question....Are we responding to the "law" or our "reality"? I asked myself.......is it less about "what is being done to us" and more about "what we are doing to ourselves"? What I meant by this, is have we really created a healthcare delivery process that is not sustainable and needs to be changed irregardless of whether a new health care law has been passed and is maintained in place? Clearly, as I have mentioned in prior blogs as the CEO of CHRISTUS Health, health care delievery in the US today is a very high cost product delievered many times in an incosistent and uncoordinated fashion that then often  creats mediocre quailty outcomes. Studies are often duplicated and critical information does not often travel with the patient from one provider or location to the next. Because of all of this lask of coordination, the costs of the product is hig, and often unafordable, especially for those who have little or nor insurance.
In addition, because of the lack of access to primary care in many locations, the patient, as we know, often makes his or entry point into our delivery process at the most expensive and inaappropriate point....our Emergency Departments. And because our pricing of care has often no reasonable relationship with the cost of our care, the bills for this minor care are often exorbitant.
With all of this said , clearly we do have to adapt and change our ways to function in the new market. But I think we are faced with this challenge more so because of what we have been doing, rather than because of the changes heathcare reform is forcing upon us. Either way, we need to change, introducing  new and innovative ways to creat a delivery system that will utlimately guarantee the highest quality of care at the most affordable cost possible.
In next week's blod, I will review the market drivers, many of which we have created, for healthcare reform and what we must do to reignite the enthusiam for creating not only a sustaining, but thriving healthcare industry and enviorment. We have no time to ponder more on who or what is responsible for where we are today. Our job has to be making tomorrow much better for those we serve!

Physician Leadership: A Critical Success Factor

The importance of strong leadership, including that of physicians, is being expressed by a myriad of people as perhaps the most important critical factor for success in healthcare in the future. As an example, on just one day last week, 10 emails crossed my desktop regarding some aspect of leadership. One addressed a new book published by the AHA on Influential Leadership and another spoke of a USC Professor who has been added to the faculty of the American College of Physician Executive’s physician leadership course.

In addition, I have been recently asked to author a chapter of an upcoming book on leadership, specifically focusing on the question…..Does a good clinical physician have the competencies to be a good physician leader?
So why all the increased attention on the importance of leadership, especially for physicians?

·     First, and foremost, there is increased recognition that the healthcare delivery process in all of its settings is getting increasingly complex by the day. Not only the Federal governmental changes driven by healthcare reform, but also the State budgetary crises are causing significant reductions in reimbursements for both heath systems, single hospitals, and physicians.

·     Second, volumes on both the inpatient and outpatients lines of service have declined due to the economic crisis and will not be rebounding to former levels for a multiplicity of reasons.

·    Third, cost reductions in both the labor and supply areas, are never easy and require strong leadership to not only implement, but even stronger communication skills to engender the support needed to sustain the gains.

·     Forth, evidenced-based medical protocols, driven by electronic data bases, must be instituted quickly and will require strong partnerships with physicians in order to implement these drivers of high quality and affordable cost outcomes.

·    Fifth, the Board of hospitals and health systems have developed a higher level of accountability for the CEO and his/her executive team due to the concerns these complexities are raising to the level of governance. They are requiring the teams to develop annual goals driven by metrics which stretch their performance trends positively, monitored through an annual performance evaluation process.

For all these reasons, all physicians, other providers, and support staffs must embrace in a committed fashion the changes necessary to address all the complexities outlined above, Leaders most not only communicate effectively the rationale for these changes, but must instill in each member of the team the desire to make the changes necessary for success. It would seem that strong physician leaders speaking to other physicians and providers would hopefully accelerate this process and create an increased passion on the team for doing what is necessary to provide excellent care each and every day to all they touch!

In the end, then, each leader must make sure that he or she has the competencies required to be successful not only today, but for the future that is evolving. This requires a commitment to personal reflection and self-evaluations, as well as, to a life-long learning process to acquire or strengthen the skills which have been identified to be deficient.



A Transition Gift

As I traveled toward the time of transition after 12 years of service as the founding CEO of CHRISTUS Health, I pondered about what would be the appropriate gift to give to my leadership team upon my departure. I determined that the best gift I could give them would be to record and then share some of my learnings from both my personal and professional life’s experiences. Therefore, my transition gift to me was setting aside some time, usually in the early morning hours, to reflect. As a result, first there were 10 learnings, then 20, and finally the 50 that I included in my first book  and distributed to my family, the 200 leaders in CHRISTUS Health, and to the System Board. This, then,  was my transition gift to all of them.  However, I continued the reflective sessions, each one emanating between 10 and 20 additional learnings, bringing the final total to now over 300.

After perusing the entire collection of learnings, and with the added feedback on the value of the learnings from the readers from the original book, I decided that an effort should be made to publish the entire collection, organizing the numerous learnings related to each other in order to maximize their value to the reader. I did just that and sent the final manuscript to two publishers this week for review. I will keep you posted on their feedback and their recommendations. Although I have written many articles and chapters of books that have been published in the past, I have only had two other books make their way into print. One I authored  while at the Geisinger Health System in Pennsylvania in 1980 entitled Poison Dos and Don’ts, which was published a second time in 1984. Recently I co-authored a book with Andrew Garman and Tricia Johnson entitled The Future of Healthcare: Global Trends Worth Watching, published by Heath Administration Press. Entitled The Learnings of Dr. Tom, this most recent endeavor  has been divided into 16 chapters, ranging from “Creating Leadership that Others will Follow”, “Business Literacy –A Key for Sustainability”, “Passion – The Fuel Needed to Go the Extra Mile”,  to “Personal Learnings – Sometimes the Hardest to Learn”.  The final and 17^th chapter of the book contains my answers to over 50 questions that were asked of me in response to a questions I posed at the leadership conference…..

    If this is the last chance you have to interact with me, what burning question would you like to ask?

Over the next several months, I will blog about some of these chapters in more detail, interposed with topics that are more current with the significant changes that are occurring in our complex healthcare delivery system in the United States. As always, I hope by reading my wireside chats that they bring enjoyment and added value to your life’s journey.