Medicare is NOT the Problem

You would have to be living on a deserted island to not know that the Congress — specifically the House — and the Administration are playing chicken in the ongoing posturing over whether or not to increase the country’s debt ceiling. What makes this round of debate unique is for the first time in history, Congress has tied the debt ceiling topic to the budget process. As a result, the body politic is being treated to the excesses of both the politicians and the 24-hour infotainment industry as each side verbally whips the other in an apparent — and transparent — effort to win votes in 2012 which somehow seems to be a more important objective than actually resolving the immediate issue.

The positions of our elected representatives are unfailingly predictable. Republicans want to reduce taxes   and spending, notably on entitlements; Democrats want to increase taxes and protect entitlement programs. In this debate, it is no surprise that Medicare [and Social Security] should be the center of the bullseye for each sides’ daily talking points. The rhetoric is hot on both sides. Unfortunately, as is so often the case when our elected officials focus more on elections than on accomplishing what they were sent to DC to do, both facts and solutions tend to be obscured. That’s the bad news.

The good news is that Medicare, per se, is not the problem. Yes it’s expensive and yes the aging of the Baby Boom Generation will add millions of new beneficiaries over the next 25 years. But the simple truth is that there IS a way to reduce Medicare cost by more than a Trillion dollars over the next decade, without reducing benefits or capping provider pay. The approach derives from this universal truth: Healthier People Cost Less. And they don’t have to be a lot healthier to save a lot of cost.

In a paper published in Population Health Management this past February, the authors demonstrate the significant dollar impact of relatively modest improvements in modifiable health risks. The Trillion dollar savings is fully 25% of the package both sides say they want to reach. Why, one must wonder, is there little or no energy in that direction? There are, I believe three immediately obvious answers to that question.

First, the economics of our health care delivery system dictate how it works. In this case, that means there is little or no economic benefit to providers — particularly hospitals — of reducing the number of people who get sick.

Second, simple inertia enhanced by the skepticism of “How do we know it will work,”  militates against broad support for anything new. Of course, if that attitude had been the prevailing modus operandi 50 years ago we never would have put a man on the moon. But, we already know what won’t work since nothing being discussed now is any different than things that have  failed to solve these issues over the past 50 years. Surely, even in Washington, people remember Einstein’s definition of insanity. I guess they believe that the body politic will forget… and they’re probably right.

Third, there is an election in 15 months. It will take longer than that for candidates to know whether or not a  program to reduce risk on a national level is working.

None of these reasons, nor all of them together, justify continuation of business as usual in DC and brinkmanship is not the same as leadership.

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Day Two at the Healthways Well-Being Summit

The second day of the 2011 Healthways Well-Being Summit began with BlueZones author and Vitality City partner Dan Buettner sharing the BlueZones story and identifying the common elements of diet, exercise, social interaction and other factors that are common to the world’s five identified Blue Zones. Buettner then went on to describe the pilot effort in Albert Leas, MN to  transform that city into a Blue  Zone using the learnings from his years of research and the significant early results in that effort.

The agenda then turned to foocus on well-being at the company level with a number of repesentatives sharing their efforts to improve well-being in the workplace. Kicking off this track was Cheryl Larson of the Midwest Businnes Group on Health who sharred research from their continuing efforts to support their members in improving the well-being of their organizations. Larson was followed by Jackie Austad of Union Pacific and Tonya Vyhlidal from Lincoln Industries who described their respective company’s well-being initiatives and the success each was seeing as a result of the effort. Notably these successes not only resulted in healthier, more productive  employees, but better overall corporate results as well.

The lead up to the lunch break was, appropriate Chris Waugh from IDEO who thoroughly entertained everyone with his story of how teaching employees to cook proved to be an effective, and viral, approach to engaging them in workplace wellness activities.

Following lunch, the agenda returned to well-being at the community level with a presentation from Dr. Lisa Santora and city “re-engineer” Dan Burden and the process and progress to date of the first Healthways-Blue Zones Vitality City project with the Beach Cities in California.

The common messages of the day:

  1. Well-Being Improvement efforts work at bothe the corporate and community levels.
  2. Leadership commitment is required
  3. Well-being improvement is a journey, not an event
  4. Communicate, communicate, communicate
  5. Make it fun; make the right choice the easy choice

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Day One at the Healthways Well-Being Summit

It would be hard to come up with two speakers on one topic –well-being — who at first blush appear more different than the opening speakers for this year’s Healthways Well-Being Summit, Dr. Deepak Chopra and Daniel Pink. As those who have heard these speakers before or read their books would probably guess, Dr. Chopra approached well-being from the perspective of how each of us has the ability to positively impact our own well-being, while Pink focused his remarks on what employers ought to be doing to assure the well-being and, therefore, the creativity and productivity of thir workforce. Since, both are recognized as bona fide experts in their respective areas, the challenge for this author — and for anyone who wants to make a positive impact on well-being — at the personal, organizational, national or even global level — is how to synthesize their individual messages into a cohesive whole. Having had the luxury of a whole three hours since today’s sessions ended, I suspect that I will not achieve that objective in this post, so I will limit myself to sharing some of their key points and observations.

First, some similarities that I think are important, the most important of which is that the conclusions and positions both put forwqard are the results of years of scientific evaluation. Second, that research has led both to conclude that what we think we know, what the conventional wisdom tells us, about human behavior is most likely wrong.

From Chopra’s perspective that conclusion starts with his observation that the human body isn’t a thing, but rather a process; a verb, not a noun, affecting and being affected by the biosphere on a continuous basis. He concludes, therefore that life itself is a dynamic process and that the highest form of that process is represented by awareness or consciousness. That being the case, he concludes that it is that awareness that is the best tool for understanding and affecting well-being. Thus Chopra appraoches well-being from the perwspective of the individual’s ability to consciously make choices to self-improve their well-being.

Pink, on the other hand, has focused his work on the 50% of our waking hours in which well-being is significantly impacted by factors somewhat to significantly out of our individual contro; namely those eight hours we’re at work. The conclusion of his review of the data is that what we have traditionally thought of as “true fact, ” isn’t, at least not in the work context that most of us find ourelves in. His principal conclusion is that incentives — the reward of desired  ehavior and the punishment of undesirable one, doews not lead to more of the former and less of the latter except for ‘mechanica’ work. Creativity and performance, he argues are driven, once basic financial requirments are met, by other factors.

Having established the scientific basis for his conclusions, Chopra then identified three Laws of Performance, namely:

  1. Performance  correlates with how a situation occurs to each individual;
  2. How a situation occurs arises from language, both verbal and non verbal; and
  3. Immediate or future-based language affects how the situation occurs to each individual

Chopra also offered a formuula for Heealth:

H=S +C + V

where S is the “set point” in the brain (essentially each person’s perspective on life), C represents each person’s  Conditions of Living (essentially their soccial/economic condition) and V represents Voluntary Choices (of which there are two kinds; those for personal pleasure and those for fulfillment and purpose, with the second being infinitely more important than the first in driving the equation.) The co-efficients of each variable are 0.5, 0.10-12, and 0.38-40. The important takeaway, Chopra notes is that each of these variables can be changed and, therefore, health and wellbeing can be changed.

Chopra argues tha the weight of the scientific evidence leads to the following conclusions:

  1. People have choices, and
  2. There is new science that clearly demonstrates that what you do, how you think and how you interact changes your biology and, therefore not only your well-being, but the w of your family, friends, associates — and theirs — as well.

Pink, in summarrizing 50 years of reseach on what motivates people at work — research which has so consistently come up with the same results that most social scientists won’t do it anymore — conlcudes that the key factors are Autonomy, Mastery and Purpose.

When one realizes that that Pink’s approach to the issue is really the environmental yin to the yang of Chopra’s individualist perspective — that is, they are approaching the same issue from different starting points – the similarity of his conclusions to Chopra’s are is clear: The factors driving well-being derive from individual choices and the environment — work and social — in which we function.

The good news is that science now makes it excruciating clear that we can change those.

The rest is up to us.

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Well-Being Summit Begins at 3:00 CDT Today

Follow the event’s live webcast at:

http://wwww..healthways.com/wbs2011

follow my tweets at: @healthexec

participate in the discussion at: @healthwaysinc

please tag all your tweets #WBS2011

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Healthways 2011 Well-Being Summit

eThis year, for the first time, the annual Healthways Well-Being Summit will provide a live video web feed for those who can’t be in the room with us in Dallas. Sign up here:

http://www.healthways.com/wbs2011

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Population Health Management Colloquium

I have just returned to Nashville from Philadelphia and three days at the 11th annual Colloquium sponsored by the Jefferson School of Population Health under the able leadership of its Dean, David Nash. Co-located with the Medical Home and Palliative Care Summits, the conclave brought together roughly 800 leaders from virtually every disciple and stakeholder group.

In this post-reform environment, a significant focus of nearly all presentations was “what the future will look like and how will we get there.” While this is not an atypical topic when health care orders get together, we were encouraged by the fact that there was virtual unanimity around the topic of what the future health care system needed to do — namely keep healthy people healthy, reduce risk and assure care for those who have progressed to illness. In other words, work longitudinally with the entire population to help each individual avoid the next episode of disease.

While there are still clear differences that were expressed by attendees and presenters on how the system should morph to best achieve that vision, we could not help but be excited that everybody seemed on-board with nothing less than a new unified field theory for solving the very real problems extant in the current system.

Granted, there was some tentativeness about which stakeholders should ”own” which roles in achieving the new vision and what, in our opinion, was way too much focus on testing and pilots rather than speedy implementation of population health management solutions at have already been proven. Nevertheless, it was clear to this observer that irrespective of what the courts ultimately determine about the constitutionality of the reform legislation, the reform train has already left the station and is gaining speed.

It’s going to be an exciting ride.

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Sounds of Silence

While speaking yesterday to a good friend and religious follower of my efforts here, he pointed out that I haven’t posted since November 12th. Having given some thought overnight to the reasons why that’s so, I now take keyboard in hand to share them with you.

As I trust those of you who tune in for my periodic observations are aware, I make a sincere effort to stay away from commentary that’s either frankly political or that might be considered cheap pandering for my employer. Add to that my refusal to succumb to the demands of the 24-hour (or is it seconds?) news cycle, which requires that something be said every day even if there’s nothing to say, and perhaps the period of my silence becomes more understandable.

Now, I’m not saying that nothing has happened in the world of health care since November 12th, but I am saying that much of it, particularly on the political side, has been theater of the absurd. Nor am I particularly impressed by the growth industry created by the Affordable Care Act (ACA) for conference planners and their associated expert speakers, if for no other reason than that it’s really hard to determine where the train is going while the track is still being laid and the ultimate destination is still being argued in the courts.

As anyone who reads, listens or watches the “news” is readily aware, our national leaders are rehashing all of the talking points with which they entertained us throughout 2010. Perhaps less obvious though is the steady flow of RFIs emanating fro HHS, CMS, CDC and AHRQ as those agencies seek guidance in the rule making necessary to implement the myriad provisions of The ACA.

Perhaps even less visible is the planning for transformational change that is going on at the nation’s health plans. These organizations know, irrespective of the ultimate fate of the ACA, that it will not be “business as usual” going forward and are actively preparing themselves for meaningful roles in the state exchanges and in new relationships — Patient Centered Medical Homes and Accountable Care Organizations — with their provider networks.

It’s easy to be skeptical if not downright jaded about these activities. Didn’t we see all of this before masquerading under different names like Global Capitation, Integrated Delivery Systems and Physician Hospital Organizations? Well, yes, we did. But I perceive tangible differences now as compared to those earlier efforts. They were, to a large extent, experiments. This time there’s a law, an administration that’s committed and the risk of not being on the train as it leaves the station is, to all extents and purposes, a total enterprise risk. With the stakes that high, it’s no surprise that stakeholders are moving to strategically cover their bets.

Of all the changes being driven by the ACA, arguably the most important is the new and exploding interest in wellness, prevention and well-being. The inescapable logic embodied in the concept that “healthier people cost less” is, well, inescapable. The challenge will be in demonstrating that solutions are effective and deliverable at scale. Right now there are plenty solutions available, but scant few that are science-based or have any track record of success.

It is an exciting time to be in health care. The opportunities for meaningful success in restructuring our broken system are real and almost everyone agrees that we can’t afford to fail. If we do, at least we’ll all know who to blame.

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You Can’t Make This Stuff Up

 It’s been exactly eight weeks since we posted “Who Woulda Thunk It?” In that piece, we noted that the pace of the apparently absurd, blatantly self-serving or just downright Duh! factor headlines crossing our desk was increasing. Based on the number of new additions for this post, it appears we were right.

Still, the past eight weeks have been somewhat less than amusing for those of us in the health care world, so maybe these will help and thus be able to lay claim to having some redeeming value. Enjoy!

Children’s physical activity decreases over time, study finds

States could save money by investing in stop-smoking treatments

Smoking ban helps cut hospital admissions for childhood asthma

Healthy lifestyle factors are linked to longer life

Study: Work and leisure activity benefits the heart

Study links metabolic syndrome to heart events, stroke

High Blood Sugar Levels Increase Infection Risk from General Surgery

Low-Volume Hysterectomy Surgeons Tied to Higher Risk

Study shows student eating habits can improve

Obesity, unhealthy lifestyles are tied to more sick days

Lifestyle factors can play a big role in cancer prevention

Lifestyle intervention brings benefits for overweight diabetics

Insurance, Race and Poverty Affect Cancer Care, Researchers Report

Congress Recesses, Putting Off Unfinished Business until After Election

Life choices could affect happiness, study says

Weight and Metabolic Disorders Put Millions at Risk

Study Links Large Waist Size to Higher Diabetes Rates Among Americans

Structured Diet, Exercise Plans Seem to Shed Pounds

Out-of-pocket costs affect patients’ care decisions

Missing Well-Child Visits Risky for Chronically Ill Children

Seniors With Healthy Bones Can Reduce Risk Of Osteoporosis And Avoid Falls

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Reading the Vote

While I try to avoid using this space to flog any particular political position — including my own — the implications of last week’s mid-term elections on the future of health and health care are a topic that cannot be avoided, at least not in good conscience. By this time, the entire world not only knows the results of the election, but has also had ample opportunity to read, listen to or watch the pundits’ opinions of what the vote meant, what the Republicans did right, what the Democrats did wrong and why the President was shellacked. The general conclusion is that the vote reflected “the will of the people,” and both the new and old governmental leadership have bought into that explanation without taking  time to remember that the pundits have their own agenda and should not be confused with either Moses on Sinai or Jesus delivering the Sermon on the Mount. In short, the pundits, even those who claim otherwise, are not providing anyone with divine truths heard from the lips of the Almighty.

Still, it would seem hard to argue that the vote last week reflects the will of the people; after all, that’s what voting means, right? Well, maybe. I would feel a lot more comfortable about drawing that conclusion if there was any evidence that the American electorate actually had some clue about the issues on which the various candidates were taking positions, spewing talking points, or otherwise pandering to what they thought their potential constituents wanted to hear. Now, we might expect that kind of behavior from those voters who are genetically wired to one party or another and are, therefore, self-relieved of their responsibility to think. But what about the independents, the very nature of whom is the supposed careful deliberation of issues which then causes them to move one way or the other in each election? Certainly they knew what they were voting for or against, didn’t they? Well…. not these independents, and not this election.

What the votes of independents reflected in this election was the growing need of Americans for instant gratification. I understand that need in an infant; I have been known to accept it in young children; I can force myself on occasion to tolerate it in teenagers; I find it inexcusable in adults, particularly adults who have access to the ballot box. Two years ago, these independents swung heavily to the Democrats because they were fed up with the results of eight years of the previous administration. This year, they swung back to the Republicans because their chosen Messiah was unable to wave a magic wand and make it all better. It didn’t make any difference that he didn’t create the problem. It certainly didn’t make any difference that he was, in fact, fixing the problem. It didn’t make any difference that the other party was doing everything it could to prevent him from doing anything. The only thing that made a difference was that the problems weren’t fixed. So, “Off with his head; Out with the old and In with the new” conveniently forgetting that it was the “used to be” that got us in this mess in the first place. What the hell, we gave him and his cohort of [insert racist, derogatory or other intolerant adjective here] cronies 18 months and they didn’t deliver. It all reminds me of 12-year-olds on the playground during recess. “Did not. Did too. Did not! Did too!” And speaking of 12-year-old behaviors, let’s not forget we were also treated to the insatiable whining of the extreme wing of the “party-in-power” who, unhappy that all their wants weren’t instantly satisfied, decided to take their ball and go home. Unfortunately all these 12-year olds vote.

So, now that the voters have had their say and the pundits have told us that the voters have had their say, we’re being treated to the politicians’ interpretation of what the voters say actually means. These explanations have two irrefutable truths associated with them; they’re wrong; and they will be pounced on by the pundits and repeated ad infinitum until the voters are convinced that what the politicians say their vote meant is what it actually meant.

For example, by last count, I’ve heard 6,482 times that the voters are telling Washington — whoever that is — that they want smaller government. Only problem is, no they don’t. I’ve never met a voter who wanted smaller government. They may want a government that costs less, although even that’s debatable if you take away the requirement that the voter has to pay for the government with taxes; they may want a government that keeps it’s nose out of their business, unless of course, their business is for the government to stick their nose in someone else’s business; but, what all the voters want, all the time, is for the government to bail them out of whatever problem they find themselves in, even if they are complicit in creating the problem in the first place, to wit: “It’s the bank’s fault they convinced me to take on a mortgage I coudn’t afford.”

Ok, there’s more than enough blame to go around for our current economic and housing problems; and that’s the point. Not so long ago, government used to be about solving problems, not about creating outrageous claims that fit into 30 second sound bites. Differing points of view were debated with at least a modicum of respect for the intellect of the other side. Today, we can’t even get most candidates to talk about what they actually plan to do, despite the best efforts of legitimate journalists like John Stewart and… uh … John Stewart to try and elicit an answer to that simple question. We used to be better; we really did.

So what does all of this have to do with health care? The terrible truth is we don’t know. With the new “ins” threatening to repeal it, investigate it, not fund it and a whole list of other strategems designed to impede the reform bill passed just 8 months ago and only now coming into effect; with a politically polarized Congress and, probably, a veto-proof President, the opportunity for mischief for the sake of mischief is real. And while Congress plays by its rules, the voters will continue to be unwittingly hoist on their own petards. Of course, they’ll get a chance to express their displeasure again in just 23 months. Just remember, all you voters, when the politicians are telling you that you don’t want health care reform, they’re ignoring the fact that 74% of you actually like the individual provisions of the reform bill.

While there is some lack of clarity about who first said it, there is no questions that, “In a democracy, people get the government they deserve.” Or as Pogo said, “We have met the enemy and it is us.” So let’s stop letting OUR elected officials get away with telling us what we believe when they don’t have it right; lets remind them that, generally speaking, the Internet is not a credible source for anything and that spreading an Internet post at light speed through the friendly infotainment outlets does nothing to add to its credibility. Let’s remind those same infotainment outlets, perhaps by turning them off, that we are not so mindless that we have willingly given up our ability to think and that we are not so prejudiced that we will allow political intolerance to flourish as the 21st century’s replacement for the despised and displaced religious and racial intolerances of the 20th.

Maybe, just maybe, when the electorate gets tired of being ingeniously manipulated, maybe then the electorate will demand debates based on fact and platform, not rumor, innuendo and outright falsehood. Maybe then the electorate will demand that candidates for public office actually have agendas they are for, not just causes they are against. Maybe then the electorate will demonstrate that it is no longer 12, but has reached the age where it is both capable and willing to think before pulling the lever to enable another group of candidates to misrepresent us.

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Who Woulda Thunk It?

Like most people in the industry, I receive a number of newsletters every day. Generally, these provide timely and useful information on a variety of topics that are pertinent in trying to stay on top of the frenetic and complex world of health care. Periodically, however, there are pieces that are so glaringly obvious that I have to wonder why anybody spent any time, effort or money doing whatever the piece describes or why they’re wasting time, ink, paper or bandwidth to share it with the broader industry. Unfortunately, the pace with which these “insights” appear seems to be increasing.

Still, they do offer some level of entertainment as my reaction runs the gamut from “Really?” to “You think?” to the inelegant, but nonetheless descriptive headline of today’s post. So, presented below are just some of the headlines from these pieces which I’ve culled over the past 8 weeks. Thank goodness for cut and paste.

Prevalence Of Eye Disorder High Among Older US Adults With Diabetes

Insurers Push Plans That Limit Choice of Doctor

Doctors prescribe veggies to fight childhood obesity

Pacing, nutrition are part of good marathon training

Doctors Prescribe Fruit, Veggies to Fight Obesity

Healthful diet shows benefits for people with metabolic syndrome

Sugary drinks raise risk of diabetes, metabolic syndrome

Healthcare Reform to Impact Hospitals Long-Tern

Women’s behavior linked to … ovulation?

Study: Hormone shift affects how females talk, walk and even dress to attract men

Be Wary About Health Information You get on the Internet

Early High School Start Times Affect Teens’ Ability to Learn, Study Finds

Study Finds African Americans and Hispanics Use Emergency Room For Asthma Incidents More Often Than Whites

U.S. needs a healthier environment to fight obesity

Lyme Disease, Poison Ivy, Bug Bites: Skin Conditions to Watch Out for This Summer 

Consumer poll finds wellness is a quality-of-life measure

Short-Term Overeating Could Make Long-Term Weight Loss Tougher

 That’s the list. SRSLY

 

   

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