by Tony Chen

Have you noticed the recent social movements that have harnessed the power of branding and community?

- Kevin Bacon started sixdegrees.org. Visitors to Sixdegrees.org can click on a celebrity, find out what that his or her favorite charity is and then make a donation. Initially, Six Degrees was just a boardgame (that Kevin Bacon despised). But now, he's turned it into a charity that's raised $70,000+ in just a few weeks. Looks like St. Jude's Children's Hospital has a friend in Jennifer Love Hewitt.

- Global-Cool is a hip new website that encourages all of us to do little every day things to "save the planet." They are trying to get 1 billion people to reduce their CO2 output by 1 ton/year. So far, they've got 10,000 people. Simple things - unplugging your unused chargers, stuffing your freezer, lowering your laundry temperature - seem trivial, but when millions do it together, it starts to add up.

- Last and maybe most innovative: the (RED) campaign, spearheaded by Bono. You've seen the commercials - buy this (RED) phone / credit card / watch / iPOD / shirt, and you're helping to prevent AIDS in Africa. So far, $20MM raised.

You know that an idea is a good one when it makes you want to say: "I should've thought of that!" The beauty of these ideas is in their simplicity. Say what you will about the fuzziness and vagueness of "brand identity," but these ideas work primarily because of branding/association.

You can't get people to turn off the lights to save their life, but if they feel like they're a part of a community of light-turn-offers, then they will. People might not normally give to charity, but will if they feel connected to their favorite celebrity in doing so. People might not choose to buy a red ipod, but they just might if they feel like they're making a statement with Bono.

So what's the next big idea that could impact our everyday very non-hollywood hospital lives? I don't see any A-listers lining up to be a spokesman for preventing MRSA infections, helping the uninsured, or reducing medical errors.

Tell me your thoughts, and I'll share a few of my initial thoughts...
(1) Borrowing Global-Cool's idea, what are the 2 or 3 little things that everyone could do together that would change our nation's healthcare for good and forever? Exercise? Eat right? People won't do that to save their lives - literally. Somehow we'd have to link exercise & eating right with something more "emotional" - for example, if people thought exercising was patriotic, they might be more motivated to do so to help their country. Or if they realized that not exercising will eventually be linked to their children growing up having to pay 60% in taxes... I know, i know, it's a stretch, but you get the picture. help me - what's the compelling link?

(2) Borrowing Bono's thought process, what innovative partnerships could hospitals cook up? Maybe hospitals, governments, and insurance companies should team up to PAY people to get screenings or meet certain health goals? Or what if all of the Chicago hospitals & employers teamed up to make Chicago the "healthiest city in the world?" (talk about a powerful branding advantage!) Wouldn't that eventually draw entrepreneurs and employers to Chicago, and to our hospital doorsteps?

Go check out the "Running a Hospital" blog. Paul Levy (CEO) posts his specific salary info, his financial incentives, and asks all to respond: "does he make too much?"

for more on the hospital CEO position, click here.

on a side note, and speaking of big numbers, Hospital Impact had its 100,000th visit today. to that visitor from Northern Illinois University who did a google search on medical identity theft and landed on Hospital Impact, you're our big winner.

by Nick Jacobs

Just some interesting facts . . .

Under the category "If I had known that I would live this long, I would have taken better care of myself" . . . If you are a 50 year old woman today, there is a 40% chance that you will live to be 100 years old.

Here's another age related fact. If you count all of the people in the history of the world who have ever reached 65 years of age, 65%of them are alive today.

How about this fact? In 2012 five years from now, there will be more people in the United States as Social Security beneficiaries than there are working Americans to support them.

Finally, in the age related fact list; if you are a child today, there is a 30% chance that you will develop Type II diabetes. One third of all children today will be afflicted with Type II diabetes and the devastating impact of that disease.

So, how do we cope with these statistics? How do we deal with the potential impact of these statistics? How do we, as a country, prepare for these statistics?

Universal Health care? Well, in England, you will have a 1.5 year waiting time right now, today, for elective surgery. If you happen to live in Scotland, that wait goes to 2.5 years.

Keep in mind that at least 30% of every health care dollar that is spent in the United States is spent on the last 30 days of life.

It's also important to reflect on the fact that in 1993, 13.8% of the Gross Domestic Product was dedicated to health care, and by 2015, 20% of the United States GDP will be dedicated to health care. This year we spent $2.2 Trillion on health care and only 4% of that on preventative medicine.

We have 42 M uninsured and 43 M under insured citizens in the United States, and I'm not sure if that includes our illegal aliens.

We have 98,000 unnecessary deaths in our health system from medical errors each year, and we spend $10 a day more on average to imprison someone than we do for long term care.

Bottom line? If you don't see the need to correct or to work to correct these challenges, turn to the person to your right and ask them to help you remove your blinders.

(note from Tony: I talked to the President of US Preventive Medicine last week, and I think they are on to something. Here's a letter from them. Not everyday that a healthcare company purchases full-page ads in NYT, Washington Post, and USAToday to write a letter to the American public and the American government. My guess is their response to this will be overwhelmingly positive - what do you think?)

To President George W. Bush, Members of Congress and the American Public:

As Americans await the State of the Union Address, the nation is hoping to hear a fresh approach to our healthcare challenges. Our country spends $2.2 trillion on healthcare annually, yet it’s been estimated that only four percent is devoted to prevention. Consequently, the U.S. is experiencing alarming levels of obesity and serious illnesses like heart disease, diabetes and cancer.

We believe a far greater emphasis on prevention is the solution to this problem – putting in place programs, protocols and procedures that detect and treat health risks early, preventing them from becoming life-threatening diseases.

The prevention model of healthcare holds enormous promise for individuals, employers, healthcare providers and policymakers. Embraced nationally, it will save lives, extend the period of healthy life, reduce healthcare costs and improve the productivity and vitality of our nation.

We are proud to introduce U.S. Preventive Medicine®, a new company dedicated entirely to prevention. As representatives of senior management and the company’s Advisory Boards, we enthusiastically support its mission: to organize and advance a culture of prevention throughout America by partnering with hospitals, physicians and employers – all with the goal of enabling individuals to enjoy more good years.

Since we first published this letter, we’ve heard from a broad spectrum of health systems, physicians, employers, organizations and individual consumers. They have overwhelmingly endorsed this approach to healthcare as being long overdue. Clearly America is ready for prevention!

In the coming weeks and months, you will learn more about this exciting prevention-based approach to healthcare, including the prestigious health systems that are establishing Centers for Preventive Medicine. You will also hear about The Prevention Plan™, a groundbreaking benefit that will make preventive health services available to millions of consumers nationwide through their employers.

The next generation of healthcare in America has arrived. We encourage Americans to embrace it!

Christopher T. Fey
Founder, Chairman
Chief Executive Officer
U.S. Preventive Medicine

Boyd D. Lyles, Jr., M.D.
Executive Vice President,
Chief Medical Officer
U.S. Preventive Medicine

David B. Nash, M.D., MBA
Chair, Dept. of Health Policy
Jefferson Medical College
Chair, National Advisory Board
U.S. Preventive Medicine

Brian J. Baum
President,Chief Operating Officer
U.S. Preventive Medicine

Barry B. Bercu, M.D.
Professor of Pediatrics, Molecular
Pharmacology and Physiology
University of South Florida
College of Medicine

John Ferry, M.D.
Director
Navigant Consulting, Inc.

Lynn Helmer, M.D.,
FACP, MBA, FACPE
President
DRD Consulting, Inc.

M. Akram Khan, M.D.
President
Cardiac Center of Texas

S. Jay Olshansky, Ph.D.
Professor
School of Public Health
University of Illinois at Chicago

Thomas J. Fogarty, M.D.
President
Fogarty Engineering
Clinical Professor of Surgery
Stanford University

R. Allen Lawhead Jr., M.D.
Director
Women’s Cancer Alliance

Ron Loeppke, M.D., MPH,
FACPM
Fellow
American College of
Preventive Medicine

John A. Rumberger, M.D.
Director of Cardiac Imaging
Princeton Longevity Center

Douglas S. Peters, LFACHE
Former President and CEO
Jefferson Health System
Former President
Henry Ford Hospital

James F. Fries, M.D.
Professor of Medicine
Stanford University

Robert N. Butler, M.D.
President and CEO
International Longevity Center
Founding Director
National Institute on Aging

George K. Anderson, M.D., MPH
Fellow and Past President
American College of
Preventive Medicine

By Nick Jacobs

Well, the temperature was 16 degrees and it was snowing when I left Pittsburgh. By the time I arrived in Ft. Lauderdale, it was 74, down from a high of 83 degrees. The trip was for two days and for 12 credits toward continuing certification as a Fellow in the American College of Healthcare Executives. The classes were held in an overly air conditioned room with dark shades drawn over both windows. For all intents and purposes, it could have been held in Erie, PA. The course was on Managing Change for the 21st Century, and the instructor John Sena, PhD, a professor at Ohio State University, was truly an expert in his field.

Although I could share numerous tidbits from this course that would help each and everyone of you manage change, I'll just say, spend the $1000 and go take it. That would be good for both John and for the ACHE continuing education program.

What I will talk about briefly in this blog is that, in spite of the wisdom present in the room represented by both the instructor and the participants, it was painfully clear to me that the field of healthcare management in the United States has not made much progress since 1990 when I first started taking these courses.

The sad thing about that statement is that everyone in the room acknowledged it in one way or the other through the two day course. If the clocks were turned back to 1990, and the instructor was changed, and most of us were still wearing neckties and jackets to this business casual course, not much of the dialogue, admissions or observations had changed.

We discussed healthcare's approach to business delivery, customer service, business development, patient centered care, and physician relationships all in relation to managing change. Except for the fact that I have less hair, the conversations could have been audio taped from 17 years ago. No, we have not adapted the Ritz Carlton model for patient care/customer service. No, we have not adopted the Hertz model for registration. No, we have not embraced the concepts utilized by Google for employee satisfaction or Microsoft or 3 M for strategic planning. No, we have not made much progress with our food service or our room service. Unlike utilities and other industries, we have not made our billing practices transparent. We have not embraced the model develop by . . .

Well, you get the point, and, as the future closes in on us with LPN's in Wal Marts and stand alone specialty hospitals, we will pay the price for our lack of responsiveness, our inability to get even a little bit out of our comfort zone and our "herd mentality" approach to doing business. Our populations are diverse, but our healthcare leadership was primarily made up of guys like me: old, white, and conservative. Okay, well, I am old and white!

by Tony Chen

It's been a little nutty recently. I thought I would have more time to blog after my CHE exam. Alas, the boards I am on are kicking into high gear. Nonetheless, I wanted to share a few articles that I found that provoked some good thinking:

- There is a whole new generation of Google copycats coming. Imitation is best form of flattery, right? Makes you wonder if someone will try to carve out healthcare out of google. I think Revolution Health has a shot at it. Imagine all the best healthcare content without all the buy-viagra clutter. As always, content will drive eyeballs will drive ads.

- Check out the Top 10 innovations coming in 2007. A bunch are medically related and will have impact on hospitals down the line. Just think, one day we will implant bones made out of cow bones, we'll have lunch-hour lipo, and we'll have to deal with generic-only drug plans.

- Finally, I put this one to use immediately: The Art of the perfect voicemail. We've all received that 180-second voicemail that could have been 30. And honestly, we've all left voicemails before where we hang up and immediately regret how badly we did so. The best tip: scope out & specify your request for them with a time frame - "I just need 15-20 minutes of your time to ..."

A post by Andrew Barna

Well it has been a few months since I last posted on Hospital Impact, but with the new year, Gov. Schwarzenegger's plan to cover the 6.5 million uninsured in CA, the President's tax incentive plan is being dusted off again, and pretty much everyone is joining a coalition to tackle the problem of the uninsured, it seemed like time to rejoin the conversation.

I have perused the Schwarzenegger plan and frankly I am skeptical. Here are a few initial impressions.

First of all, the plan to tax hospitals and physicians in order to fund a MediCal increase just doesn't make sense. As the saying goes, why rob Paul to pay Peter? There just doesn't seem to be a point to tax providers. They are at the end of the food chain, so no new money is being added to the system that wasn't already there. There is no doubt that MediCal is severely underfunded - it pays between 9 and 13 cents on the dollar - but taxing providers is equivalent to cutting reimbursement.

One of the other big funding sources for this plan is a mysterious $5B coming from the federal government, but where is this money coming from (does the federal government match state medicaid dollars?). I know we have left SCHIP money on the table, but $5B is a lot of money.

The requirement for businesses with 10 or more employees to either provide insurance or pay into a state pool is not a bad idea on its face. It puts new money into the system and puts that money to good use. Unfortunately, CA is already a difficult state to do business in and this will be seen as putting an unfair burden on employers.

As for the President's perennial tax shifting scheme to help people pay for insurance coverage, I have said it before and I will say it again: unless the working poor see more money in their paychecks each week, they won't be able to buy insurance. The promise of less taxes/more refund on April 15th will not give the working poor the cash flow to pay monthly premiums.

The relatively good news is that more and more people are acknowledging the problems with our health system and jumping on the bandwagon to fix them. Perhaps a Democratically lead Congress can make healthcare a priority, but we still need to resolve some fundamental issues: mis-aligned incentives and who ultimately is going to pay for the healthcare we want.

by Nick Jacobs

Today, I opened the Sunday newspaper to see an article by David Wallechinsky that very carefully challenged us to look at ourselves as a nation. Under the realm of leadership the question has to be: When will our leaders begin to address these issues in a meaningful way? We have no national health care policy. We have no viable energy policy. We are still not open minded enough to even elect a female to the Presidency. Yet, according to Wallechinsky, we remain the strongest country economically in the world. Too bad economic strength isn't representative of moral, ethical and social strength and commitment.

As I sit with my children and grandchildren today, I can only hope that their generation will take hold of these issue. After such a strong start, we Boomers certainly seem to have missed our major opportunity to make a dent in these socially challenging situations.

From "Parade:Magazine" by David Wallechinsky

The U.S. spends the most on health care but lags in life expectancy.

43 Countries have more physicians per capita than we do.

33 Countries, including Cuba, have lower rates of infant deaths.

Residents of 27 countries live longer.

We lead all nations in the consumption of oil, using a quarter of the world's annual supply.

Highest per capita rate of people in prison, 737 per 100,000 people or 2.2 million.

We perform the fourth highest number of executions trailing only China, Iran and Saudi Arabia.

Only South Africa and Canada have higher rape rates.

We also have the 15th highest murder rate

71 countries do better at electing women to national legislatures.

Of eligible citizens who vote, U.S. ranks 139th of 172 nations.

WE consume more calories per capita than the citizens of any other nation, and lead the world in the prevalence of obesity.

By Lavinia Weissman
Managing Director: WorkEcology a Community of Practice
Journalist: Strategy & Business -Leading Ideas, a web based journal
Executive Coach

Recent entries in Hospital Impact related to the payer system, organization, leadership, being a CEO – all of these entries made me think how can the “healer heal thy self.” The most recent remark that “people complain about “health care,” and not their personal physician” got me thinking. It is clear to me when we talk “health care” we objectify a system that we work at mechanically based on driving down costs and doing more with less.

So within that equation you have to ask, how can the people, who work in health care gain control? And what would control mean? And could people taking control over their lead initiatives for innovation and positive change? I then reflected what it would mean in some “systems” to actually call “time out,” and invite people to begin new conversations.

I returned to Boston in 1999 for some personal reasons and a hope that I would return to working in health care. I came back to a health care region, which was steeped in layoff and cost cutting measures. One day after I called an old boss at my former employer, Harvard Pilgrim, I opened to the Boston Globe and found in the headline, “HPHP $98M and in state receivership”. Based on my very limited view a lot of good people I knew had not stopped and declared “time out” and problems that existed when I worked there had multiplied.

With Charlie Baker’s appointment much has changed that is good at HPHP and other good changes are occurring in many places in the city. Yet, Massachusetts has the highest premium for health insurance and it remains to be seen how our universal health insurance system will be implemented. Many citizens in Massachusetts do not have access to the quality care a few get and rumor has it that we have a primary care physician shortage. I am not certain if that relates to being a State in which more people move out than in because we have the highest cost of living and a resident completing his residency cannot afford to pay back school and get decent housing.

What I don’t see are people taking “time out,” and opening up to conversations that are not mechanical and structured in the same old way. So if we assume good things are done each day in health care by physicians and many others, maybe what we have to heal is how we work together and hence relate to the patients and our administrative and budget leaders.

So I invite people reading this entry to comment here and declare an imaginary “time out” that others might take serious and join you in, and start off by stating powerfully, what kind of group you would like to convene and what kind of innovation would you like this group to foster?

In the management literature today, much research has proven that good innovation comes with very little investment. As Art Kleiner, editor-in-chief of Strategy and Business recently stated
in an email introducing a report on this topic:

“New York, December 14, 2006 -- Booz Allen Hamilton's second annual study of the world's 1,000 largest corporate R & D budgets shows that investment can't buy success. The Global Innovation 1000 study identifies 94 "high-leverage innovators," including Black & Decker, Dentsply, and SanDisk, that consistently spend less than their competitors on R & D yet outperform their industries across a wide range of performance metrics. The study provides insight into how to get the most bang for your corporate innovation buck.”

For more on this topic, read this report:

Smart Spenders:
The Global Innovation 1000
by Barry Jaruzelski, Kevin Dehoff, and Rakesh Bordia

To read the full Resilience Report:
http://www.strategy-business.com/resilience/rr00039:

So maybe change in health care is not about the lack of resources and money, and maybe it’s about how we relate with each other and how we engage or don’t engage our time. If this can happen in industry, why not health care?

By: Craig Allan Ahrens
The Business of Healthcare
A talk show and discussion forum dedicated to the strategic issues impacting the business of healthcare

It is a new year with ambitious personal goals. As most of you are aware, I am completely redesigning the www.thebusinessofhealthcare.com website and related podcasts by the first quarter of this year and that is why you have not seen new podcasts posted. I apologize, but I want to migrate all the podcasts to the new site and I hope that this doesn't impact the loyalty of my listeners. The wait will be worth it with new services, material, and innovative programming!

On another note, I discovered on my birthday (New Year's Eve) that I was going to a large health system to be an interim executive for neuropsychiatry. The neuropsychiatry program is part of a large neuroscience institute. It is very exciting to lead a department related to a newly recognized sub-specialty. In 2004, the American Neuropsychiatric Association (ANPA) achieved the recognition of neuropsychiatry certification. Since neuropsychiatry is relatively new to most markets, it is often misunderstood as to what the clinical purpose and benefits are for patients in a neuroscience program. This leads to challenges in program development. In case you are unaware of the purpose of neuropsychiatry, the following is the definition of the specialty:

Neuropsychiatry (definition Wikipedia):

Neuropsychiatry, as a subspecialty of Psychiatry, is the branch of medicine dealing with mental disorders attributable to diseases of the nervous system. It is closely related to the field of Behavioral Neurology, which is a subspecialty of Neurology that addresses clinical problems of cognition and/or behavior caused by brain injury or brain disease. Another closely related discipline is neuropsychology - with its roots in neurology and psychology. It focuses more on psychological testing procedures, and is practiced by clinical psychologists who have further training in neuropsychology.

Nowadays, these three related disciplines play important interactive and somewhat different roles in brain-behavior studies.

Challenges to Program Development:

1. Turf Issues: Since neuropsychiatry is a relatively new subspecialty certification, there are significant turf issues that must be addressed with the introduction of a program. Neurologists are often the most threatened specialty because some of the neurodiagnostics utilized encroach upon their traditional domain. It is important to effectively commmunicate that neuropsychiatry is meant to complement neurological services. Neuropsychiatric services are often the best to manage difficult care choice decisions between behavioral versus surgical options of care.

2. Marketing: It is important to develop and educate referral channels concerning the clinical benefits of neuropsychiatric services. One must identify referring physician champions who will communicate neuropsychiatric success stories in a manner that meaningfully demonstrates the importance of the subspecialty.

3. Reimbursement: Significant Medicare changes in neurodiagnostic reimbursement have recently occurred that lowered the reimbursement to less than half what it was previously. Neurodiagnostics drove a large portion of the profitability for the service, so either volumes need to be increased to compensate for the change or new sources of revenue need to be created. Some potential new revenue sources to explore include: stroke assessment, pediatric neuropsychology, and VNS collaborative initiatives.

I would be interested in hearing your opinions. Please provide comments via this blog or email. Thank you.

You can listen to the previous podcasts on my website or on Itunes!

A podcast is up on the "The Business of Healthcare" website or on the Itunes store under the Business of Healthcare. Our last guest was Parveen Chand, who is a facilities and business development planning executive for BJC Health System's Barnes Jewish St. Peter's hospital in St. Louis, Missouri. We discussed their innovative approach to facilities planning and budgeting.

If any of you have any ideas, people, or topics that you think that would be interesting for the "The Business of Healthcare" podcast, please email me at info@thebusinessofhealthcare.com.

Thank you.

If you have Itunes on your computer, click here
If you don't have Itunes, go straight to "The Business of Healthcare" blog

Most recent podcasts:
Show 8: Healthcare Facility Planning and Strategy - A New Approach
Show 7: Roundtable Discussion with Three Healthcare Leaders: Strategic Issues - A Midwest, East Coast and West Coast Perspective
Show 6: Service Line Success and the Strategic Impact of the Rebasing of DRGs
Show 5: Orthopedic Service Line Planning
Show 4: Neurosciences Planning for Healthcare Institutions
Show 3: Human Resources as the Critical Hospital Strategic Partner?
Show 2:Patient Satisfaction and Customer Service as a Hospital's Strategic Priority
Show 1: Surviving and Thriving as an Independent Hospital in a Competitive Market

Mr. Ahrens is a healthcare strategy consultant at ECG Healthcare's Midwest office with expertise in general hospital strategic planning, operational turn-arounds, physician business development, and service line planning. You can reach him at info@thebusinessofhealthcare.com.

Guest article by Jared Johnson

I have been going through an unexpected process while revisiting our hospital's online strategy. I should have seen it coming since it's at the core of what we do in the health care practice. Still, it evaded my thoughts until our forward-thinking CEO shed some light on it.

I refer to the process of thinking about every detail of our business from the perspective that matters most: the patient's. The context that brought about my awareness may seem trite, but it likely will stick with me for a long time. Over a three-month period, I had been working with our marketing and IS directors to lay the foundation for a Web content redesign. We started by brainstorming ways to engage users more meaningfully. We were throwing mud on the wall, and a lot of it was sticking. We had some true epiphanies in those moments, and the future for our little Web site seemed bright.

I got right to work creating a site blueprint, but soon I became bogged down in the details. Necessary details, mind you. Anyone with a drop of tech blood in their veins will tell you that you can't go live without considering a host of things like browser compatibility, back-end functionality, security risks, validation, aesthetics, etc., etc., etc. After several weeks of project planning, our CEO requested a status update meeting in the board room. I readied the new design template, the content plan and a host of other technical data to woo and impress him.

But I was the one who was impressed. We had scarcely fired up the projector when our CEO scanned over the new design and asked,

"What would the patient want?"

The question hung in the air as he elaborated. What information and functions would the patients want that would improve their experience at the hospital? How could we possibly make their lives easier and more pleasant? Why can't we let them start the pre-admission process early by posting the forms online? Wouldn't that save them some time when they arrive? Why couldn't we list our staff oncologists on the cancer care page? Wouldn't that help them find a physician in a time of need?

In that short meeting, I understood why our CEO is who and where he is. He had been humanizing something that is not normally regarded as personable, to make it another part of the patient's experience. That fits every definition of hospital leadership I've ever read.

I'm pleased to say that we incorporated more than a dozen new ideas that came out of that meeting. When our new public-facing site goes live a month from now, patients and potential patients will be able to schedule outpatient tests, download a personal medication card, fill out pre-admission forms and much more. And I made sure to add a note in my strategic planning process to ask that patient question throughout the entire process next time.

The full meaning of "What would the patient want?" is unclear to me. Maybe it means that sometimes we get buried in the processes, the scores and the data and forget to think as if we're the ones being admitted. Or maybe it serves as a reminder that "patient-centric" is more than just a buzzword. Implementing change is no easy thing, but it can start with small instances. Things like adding the words "Your Hospital Visit" and "Patient Care" to our Web navigation. Will it translate to higher patient satisfaction scores? Will it drive volume? I'll let you know, but I have a feeling you already know the answer.

by Tony Chen

Just a few days ago, I shared my thoughts about Revolution Health's nifty new beta site. It was the most compelling preventive health product for individuals that I've ever seen. Yes, I do mean that.

But how about some serious healthy competition from US Preventive Medicine? Ever heard of these guys? You should get to know them - I believe they could very well be Revolution Health's most formidable competitor. Check out the letter they just wrote (PDF) to the American public in a full-page ad in the WSJ on Wednesday. I know that they must have gotten a great response because they nailed it. And kudos to them for believing in it and dreaming big - for announcing it in WSJ, not in Modern Healthcare, for thinking through web and media strategies (and not just doing a portal), and for partnering with hospitals and physicians instead of ignoring them. Just like Revolution, these guys also want to be the "household" name in preventive medicine. Just as Kleenex is to tissue paper, just like Xerox is to a photocopy, USPM could be to preventive health. Their tagline nails it, too: "more good years."

From what I can gather and share with you all at this point, I've already eluded to one of the main differences between USPM and Revolution Health: USPM is partnering with hospitals and physicians, Revolution Health is not (and when I say, "is not," I'm putting it nicely).

I honestly can't think of another business example in which you are banking on the open-mindedness and innovative spirit of hospitals. Aren't hospitals at the bottom of the heap in the area of business innovation? Nonetheless, prevention is such a long time coming, and I'm willing to bet that there are progressive hospitals out there that will outright surprise you with their ability to be nimble and out-of-the-box. Plus, I'm guessing there's room for the both of them.

Would it be fair to compare USPM & Revolution Health to Blockbuster & Netflix? Hear me out. The recent ads for Blockbuster highlight a very distinct advantage: you can rent DVDs via their website and get it mailed to you OR you can still go to the store. Netflix is website / mail only. Similarly, Revolution Health is really just a really robust web portal (with some phone coaching and other goodies / tools). USPM is prevention both through a robust web portal AND physical Centers for Preventive Medicine across the country.

Whatever happens, know this - preventive health is too big, too important, and too overdue for this to just be a fad. Someone's gonna figure out how to monetize prevention (read: decreasing hospital utilization) and make billions.

By Nick Jacobs

The day starts with a trip to Starbucks where they hand me my decaf, nonfat, grande, latte. Reaching for my car keys the foamed skim milk drips onto my black top coat and as the sleeved cup is carefully placed in the holder between the seats, the car lunges forward. When I fumble to place my Bluetooth headset back into my right ear, the excess foam drips onto the screen of my Treo cell phone, and it’s only 6:30 AM.

The lighted icon of a yellow skidding vehicle appears on the top of my odometer as the company car flies toward the first meeting of the day with the medical staff. This group prefers the predawn hours of the day more than any other time. (As a former professional musician, the only time I enjoy seeing the sunrise is when I'm coming at it from the night before.)

After the medical staff meeting, the next three hours are filled with meetings with my direct reports. If charted, these meetings would look similar to my last EKG as the personality types move from conservative to liberal, from detailed to ethereal from muted to encouraging. It's a roller coaster ride of emotions, issues, problems and potential solutions as they bare their souls in this hourly cleansing session, receive absolution where appropriate and move on with their work lives with the same passion and commitment that Rudy displayed at Notre Dame, that Armstrong demonstrated on the moon, that Custer . . . well, you get the idea.

At noon, lunch is consumed as almost an afterthought. It's vegetable or meat loaf, tossed a salad and a whole wheat dinner roll with a side of bottled water. Chewing and swallowing continues as we contemplate the fates of the various physicians who have applied for privileges to work at our hospital. All are considered as the names are discussed by the various physician leaders. Their credentials, their recommendations, their history, their record with the Physician data bank and, when appropriate, the side of their head on which their hair is parted, are issues for discussion at this meeting.

After this working lunch, there is a one hour teleconference with six CEO's from other hospitals where we discuss governance issues for our regional organization.

All of the earlier meetings lead to the high light of my day, the marketing meeting. I'm sure that my peers from finance probably have a similar high from meeting with their number's jocks, but, for me, it's the right brain creative's, their interns, their assistants and subcontractors.

This group gathers in the conference room with a high level of positive energy, usually not exactly on time, usually not in an orderly fashion, sometimes with late lunch in hand. This group is filled with our dreamers, the positive, not usually too serious, creative types. They plan the press conferences, the television commercials, the employee parties and the strategic acceleration that will produce dynamic marketing surges for our various service lines. With this group it is about telling the positive stories, translating those complex medical issues into understandable human speak. Usually, these employees are fun . . . out of the box types who, without their input, would make my life a little more tense. In fact, I'm thinking that without this weekly meeting that grande, decaf, latte would include a couple of shots of something else!

Two more meetings with individual physicians and our Chief Operating Officer, a dinner board meeting of a local non profit, and then finally, at 9 PM the beginning of 90 minutes of e-mails that went unanswered during the day.

Bed finally arrives at 11:30 PM and the clock clangs again at 6 AM the next morning. Believe me when I tell you that, compared to many, this isn't a bad schedule.

(note from Tony: looks like Nick is facing a lot of reorg - in the government (see his post below), and potentially also at his hospital as they move toward "systemness")

by Nick Jacobs

NEW & NOTEWORTHY (From the AIRI website)

Another Appropriations Subcommittee important to AIRI is the Commerce, Justice, Science Subcommittee, which exerts jurisdiction over the National Science Foundation (NSF). Rep. Alan Mollohan (D-WV) was chosen to lead that body.

If any of you don't know the significance of these decisions, you need to turn the clock back 12 years or so when the Dems were in power. These individuals will have a significant impact on your potential funding if you are associated with any medical centers that receive funding from either NSF or NIH.

Finally, PA's 12th Congressional District's John P. Murtha was also appointed the Chairmanship of the Department of Defense Subcommittee on Appropriations.

Funding can come from numerous committees of government. If you aren't considering a run at your tax dollars, you may be, like the fleas in the circus, living too securely inside your flea box.

by Nick Jacobs

Under the heading of "Dah" we get this phenomenal piece of information.

Is it possible that the information below could be true? Is it possible that HSAs would be under funded? Is it conceivable that this plan to underwrite healthcare costs may not produce viable results? Looks like there's plenty to do for the new Congress.

From AHA News now:

Report shows low corporate contributions to HSAs
A report released yesterday by Vimo.com, a Web site that offers health care cost comparisons, show a significant gap between the number of people enrolled in high-deductible health plans and the number of people that hold a health savings account. According to the report, only one-third of consumers eligible to open tax-free HSAs have done so, and funds on deposit in the average HSA are half of the amount needed to cover the typical annual health plan deductible for these consumers. While normal spending on medical expenses can explain some of the low HSA balances, the report said, the low average balance nationwide suggests a general trend of low, or no, HSA contributions from employers.

by Tony Chen

The Terminator wants to terminate uninsuredness in CA. Sounds familiar? It should - remember how the blogosphere went ablaze when Gov. Romney of MA declared health insurance for all MA residents almost a year ago? (Maine and Vermont also have similar set-ups)

Terminator's plan is quite similar - a form of "required" insurance for employers with more than 10 workers. If individuals can't afford insurance, the state will step in to help. But the twists? Hospitals and physicians would pay a "tax" (2% for docs, 4% for hospitals) to pay for the program (and in return for more favorable reimbursement). Also, the illegals are also eligible. One last thing: the program will cost $10B, 10x more than the MA plan.

This brings up the age-old question of incentives. Wanna know what's the most ironic thing in healthcare? The person with the greatest incentive for you to be healthy is not you, your doctor, or even your hospital. For you, why be healthy when there is always a catch-all safety-net in the form of your local hospital/physician - they'll fix you up regardless. Your physician makes a living off of utilization of their services, and so do hospitals. If you're healthy, how will they profit and grow?

How ironic is it that out of all the folks in healthcare, it's only the insurance company getting capitation payments who "cares" about you and wants you to be as healthy as possible. In fact, you healthy folks are the apple of their eye - they'll fight over you cuz your employer sends them a check for $300 per month and it goes right to the bottom line. Has anyone seen UnitedHealth's 5-year stock price trend lately (and read Matthew Holt's post on how entire occupations are simply deemed ineligible)?

Anyway (sorry for that cynical rant just now), Arnold's proposal is far from being approved. Expect a good debate in CA. Expect the nation to be watching. Maybe Arnold will prove me wrong - I forecasted that universal healthcare would not work in '07 - no desperation, no crisis (yet), and thus, not enough political courage.

Read the news stories: NYT AP ReutersUK LAT

by Tony Chen

Yes, the much-anticipated, much-hyped Revolution Health Website is up for semi-public preview - click here to preview it for yourself. Once you register, you can rate doctors/ hospitals, take health risk assessment surveys online, join community groups (e.g. everything from diabetes to dieting), read/comment on health-related stories from others, populate your health history, learn about conditions/treatments, create a health-related blog, try out a free trial of their health expense manager. In other words, it's worth a look! The public launch is January 16.

Implications for Physicians
As of today, there were 1,114 ratings (compare to RateMDs 69,223 ratings). If this site becomes as popular as some think, physicians would be wise to track/manage ratings. Also, maybe this will be the final straw for physicians - is it time to finally start a blog? It's never been easier, and now you can open one up within the Revolution Health community.

From another perspective, will folks utilize physician services less or more? If they are more aware & educated about their condition (or at least they feel they are), if they have easy access to nurse & personal health coaches online, you have to wonder how this effects the patient/PCP relationship.

Implications for Hospitals
Someone in each hospital will probably be assigned the task of managing these online communities/forums/information sources. I tried comparing my hospital to local hospitals and it was very intuitive and easy. I could compare quality measures based on body system, health topic, condition, or treatment, and conveniently clicked through stats on patient volume, mortality rates, complication rates, severity of patients, length of stay, and OF COURSE, cost of care. We've always commented how hospital comparison sites would one day be like vehix - that day has come! Obviously, the validity, usefulness, and objectivity of the data is still questionable - nonetheless, consumers WILL shape their opinions based on this data.

Also, how will hospital capitalize on a new wave of health awareness? Can Revolution Health align with your hospital's prevention & screening programs?

Implications for Consumers
In my mind, this website provides two things I never had before: (1) one-stop shopping & management of my health; (2) community with others like me. Both of these are the kinds of things that can actually change my lifestyle and behavior. I posted a weight loss story yesterday and already got my first comment - more validation/motivation for me to keep at it. The one-stop shopping has the life-simplication value for me - I can manage my medical history, my medical bills, and learn about conditions from a trusted source. All in all, I see this site as a WebMD + Rate MDs + QuickenMoney + Blogger + googlehealth + Vehix-for-Hospitals-and-Insurance-Plans put together. Pre and Post care, I could see someone going back to Revolution Health.

Implications for Insurance Companies
No brainer - if you're a health insurance company, you better have your insurance information available on Revolution Health's insurance comparison tool. But also watch out - Revolution will offer its own insurance product as well.

I'd be curious to see what they come up with next - skype webcasts on health topics? Health conferences or retreats? Revolution Health magazine? virtual and/or live life/health coaching? could they sell some sort of employee health management package to large employers?

The main question is: the value of the community is proportional to the number of people who join. So will 10,000s join... or millions? If they actually get a critical mass, the sky is the limit. And for $10/month for individual memberships, we are talking about billions of dollars of market potential. I'm guessing that membership revenue will be the smaller revenue stream compared to the advertising.

Google, RateMDs, WebMD, UnitedHealth, Aetna, US Preventive Medicine, weightwatchers.com(?) and primary care physicians... get ready for a good fight.

by Tony Chen

Obviously, the most common new years resolution? Going on a diet.

A while back, I did a series on becoming an organizational change agent (and honestly, how difficult it is to be one). If heart disease patients won't change their behavior to avoid death, how can leaders change other's behavior "for the good of the organization?" Why are we humans so stuck on our ways?

Change or Die is a new book by Alan Deutschman (who wrote the original Fast Company Change or Die article). Check out his blog at Fastcompany.com on why diets never work:

Start by realizing that it's hard to do away with our "problems" when those "problems" are actually our attempted "solutions" to deeper issues. For example, you might think that overeating is your problem, and so your New Years resolution is to go on a diet and lose weight. But what if overeating is the way you try to solve more fundamental problems such as stress, anxiety, loneliness, and existential despair? Overeating is an "attempted solution" to those deeper troubles. It's a bad solution, because ultimately it can undermine or ruin your health. But it's the "solution" that you know and trust.

In this case the way to change is to find other, better solutions to the underlying problems of stress, anxiety, and loneliness. Instead of going on a diet, you might want to take up yoga or meditation, or to get more involved in a social group or church. Instead of going back to the same "solution" that has failed you year after year when you make New Years resolutions--in this case, dieting--why not try a new solution?

Bingo. Perfect example of a root cause analysis of our motivation in life.

Personally, I continue to be pleasantly surprised at my own experiences in 24-hour fasts. I don't fast for health reasons; more so, it's sort of a personal expression of a deeper hunger (I love John Piper's description of fasting). As strange as it sounds, my mind is unusually clear when I'm fasting. Amazing how my mind can focus on the truly important things when I'm not subconsciously always thinking about the next treat.

by Tony Chen

This may be the most scary form of identity theft - imagine a thief using YOUR name, your health record, and your insurance info to get an expensive medical procedure done. Just ask Lind Weaver (and read this BusinessWeek article) - she quite literally had to kick the door down of the local hospital CEO to tell him that her leg wasn't amputated and thus she shouldn't have been charged for it! What's worse - now the thief's medical records are intermingled with hers (her thief had diabetes, but she doesn't).

At least with credit reports, you can clean it up and make corrections. with medical ID theft, good luck...

Get ready for more regulations, more sophisticated policies. Just like we need a picture ID to board a plane, maybe we'll need a picture ID to get surgery, too.

by Tony Chen

Well, it's been a while since I've last written a substantial post. I could jump on the bandwagon and make 2007 predictions about retail clinics (this one's for real), consumerism (not yet, but will hit full stride in 2008), transparency (will still be too complicated), and universal healthcare (we aren't desperate enough to make this happen). Instead, let me just confess something very plainly to start the new year.

There is actually so much that I wish I could blog about, but I can't. It turns out that my job and my blog intersect a lot more than I originally imagined. I am working on a lot of innovative, interesting initiatives (well, at least to me!) that I would love to discuss, but can't for fear of tipping our organizational hand. Thus, since my job pays the bills (and my blog currently is one of the bills!), my job wins.

Don't worry, though, there are still a lot of things to discuss. Now that I've passed the CHE exam, settled into my new job, settled into the new house, and settled into fatherhood (is there such a thing?), I'm ready to tackle the new blogging year. As always, please let me know if there are issues of specific interest to you.

By Nick Jacobs

The fundamental needs of your workforce revolve around their ability to be heard, their access to leadership and recognition of their contribution to your organization. This particular list is not a complex list. It is not an impossible list. It is not an expensive list and it is not, above all, uncommon sense. Once again it is the MOST common of sense.

Back to the old book, I'm OK. You're OK. It involves a non controlling approach to management, the Golden Rule, common sense, adult to adult interaction, as opposed to the parent to child interaction that is typically embraced in many healthcare venues.

How can you engage your workforce? First, ask your employees "what they think." Ask them all the time.
Tell your staff that you love them . . . Seriously, take time every week to write something nice about one of your associates/employees. Like Colin Powell says in his presentations, a great deal of his time was spent recognizing those with whom he worked, those individuals upon whom he counted to be successful as a leader. WRITE THEM RECOGNITION NOTES.

If you're a Planetree Hospital, take some time to hug them, or, in our case, send the massage therapists to the floors to give neck or foot massages, too.

MAKE ROUNDS. Be out there. Be visible. Ask for their input and take time to recognize them for that input.

If you follow these simple suggestions, your life should continue to improve.