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by Leslie Small
You might think that after the Supreme Court rejected a series of Affordable Care Act challenges and a presidential veto nixed Congress' repeal attempt, ACA opponents might take a break to lick their wounds and regroup.
You'd be wrong. Their tactics have simply shifted to be less grandiose--think less "get rid of it" and more "chip away at it." What's interesting is that ACA opponents and proponents alike have succeeded at actually tweaking or delaying some less-popular parts of the law, including the small-group market expansion and the Cadillac tax.
But from that shift to small-ball has also come a more aggressive breed of ACA-related activity in Washington. Congress members are increasingly investigating how taxpayer money was spent on the law, especially for programs such as the state exchanges that went belly-up. To Council for Affordable Health Coverage President Joel White, however, this is less of a new development than an ongoing saga that the public is just now starting to notice.
"Actually this has been more of a slow boil more than a sudden outbreak of activity," White told me in a recent interview.
Earlier this month, I had the opportunity to address a conference room full of physicians and clinical leaders on what matters in patient experience and the new mindset that is shifting the way we work in healthcare today. What stood out for me in that engagement and the dialogue that ensued was as one participant shared, “the reality of how vulnerable a conversation on the patient experience [is] makes me feel.”
This sentiment was not the outlier, but rather this idea emerged as central to the discussion I had with many about the challenges they felt in today’s system, the constraints that impeded efforts and their ultimate desire to reignite a focus on the fundamentals that drove them to chose healthcare as their life’s work. Vulnerability in this light is not just about the implications of the systemic issues of the day, but it seems to be the true acknowledgment of the humanness that we find at the core of healthcare interactions overall. It is this same vulnerability that lies at the core of the experience for a patient, family or caregiver network. It is grounded in the fear of the unknown, the anticipation of the challenges to be faced, the hopes and dreams of what outcomes will result.
by Barry Ronan
First off, I do not consider myself a superboss; that is for others to decide. But I do find this concept to be most interesting.
For those of you who may not be familiar with the term, it comes from a recently published book by Sydney Finkelstein. The focus of his book and related article in the January/February 2016 issue of Harvard Business Review is how these superbosses hire talent and hone it going forward. So, just who are they? They are innovators who have the ability to groom talent and develop future leaders; they are confident, competitive, intelligent and imaginative and, most importantly, they act with integrity. Wow--superhuman or simply, superboss?
Actually, I have been blessed to have worked for a number of such superbosses; they have been mentors and leaders who have possessed the traits and characteristics identified above. I was mentored extensively in the early years of my career, first starting as an equipment orderly in central processing through moving to the position of executive vice president of the health system some 20 years later. I am certainly a better person and leader as a result of that superboss mentoring.
Recently, I had the opportunity to query successful healthcare organizations large and small, academic and non-academic, and ask them, “What are the key factors that enable your organization to perform at such a high level?” Nearly every organization gave the same answers and thus, there appear to be universal attributes that lead some organizations to great outcomes and leave others behind. They are:
I. Commitment to culture
As a quip attributed to management guru Peter Drucker states, “culture eats strategy for breakfast.” It certainly transcends it, as every organization iterated that culture had to be addressed before anything was possible. Hill Country Memorial Hospital in Fredericksburg, Texas, went through a period almost a decade ago that its leadership affectionately call “the purge” whereby individuals who could not or would not live up to the organization’s values were asked to leave and the organization went from a low performer to a 2014 Baldrige Award Winner. It is now considered one of the best small healthcare organizations in the nation.
Back in the early 1990s, while working for Harvard Community Health Plan (later Harvard Pilgrim Health Care), I was involved in the implementation of quality-based incentive programs (now called pay-for-performance or P4P programs) where we incentivized physicians and medical practices to do certain things such as improve patient satisfaction and adhere to a drug formulary.
Some years later, while at Martin’s Point Health Care, I developed these incentive models and oversaw their use and impact. And over time I learned a great deal about controllable outcomes, unintended consequences and the direct and indirect impacts of such models.
Now 15 to 20 years later, as we continue to move from productivity-based reimbursement to quality-based reimbursement via the accountable care organization and other payment reform models, a large caution sign is illuminated before me.
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