Is Healthcare Exploitative And Extractive?

I've had this post sitting around in draft form for far too long and it's time to get it off my chest.

Several years ago, MSNBC commentator Dylan Ratigan interviewed Umair Haque, author of The New Capitalist Manifesto: Building a Disruptively Better Business, founder of Bubblegeneration, Director of the Havas Media Lab and blogger at the Harvard Business Review. Though the topic wasn't healthcare, there was much for healthcare leaders to ponder.

Haque draws a clear contrast between productive wealth and destructive wealth.  Both count toward Gross Domestic Product (GDP) but only the former really contributes.

Says Umair,

"It’s easier to make money in the short-term through exploitation and the extraction and much more labor intensive with a higher failure rate and a much greater degree of challenge to actually advance and create something that is new and different and differentiates in its creation of value. “So to me, this is a crisis that is about failing to create real value, but it is a crisis of our institutions. And it’s a crisis that is of things like GDP and corporate profits, and the ways in which we measure and conceive of income. And so to really get to grips with this crisis, I think we have to begin by taking a cold hard look at those things,”

A 'cold hard look' at income and value-creation in health care is likely to be all of that AND a little bit uncomfortable. The short-term thinking. The fee for service-driven decision making.  The inward-looking, edifice-focused ways we define terms like 'health' and 'success.'

Maybe you don't think of health care as "exploitative" or "extractive?"  What else would you call a willingness to amputate a diabetic's foot while letting the underlying disease process continue apace?

Yeah I know, we're really, finally, truly getting serious about fixing stuff like that.  And though it's been part of every community needs assessment and strategic plan and QI/QA/PI target since, oh, 1965, things have changed. No more business as usual. This time it's different. We mean it. Really.

Or at least we mean it so long as Medicare guarantees us extra payment for meaning it.  Or the payers give us part of their risk pools for doing it. Ahhh, the sweet smell of success.

12:13 PM

"...a social strategy doesn’t mean doctors on Facebook"

How's your patient engagement strategy working out for you?  This article might help:  Engagement is a Strategy IV: 10 Reasons Value-based Health Care Orgs Need A Social Strategy.

If you want to influence behavior (which you do or will), you really can’t ignore a social strategy. We’ll need to get really good at engagement and behavior change on a massive scale. Social media strategies may be our best bet at influencing behavior on a massive scale. Not to push behavior in a direction, but to provide systems that let behavior naturally migrate toward the health people already seek."

7:11 AM

What's the Finance Function's ROI?

"Ads proliferate across St. Louis as hospitals push services, name-recognition" is the headline above this interesting article from the St. Louis Post-Dispatch's website.  Featuring all sides of the debate, the article includes this from Samuel Steinberg, decribed as a Florida-based hospital finance consultant who "...remains skeptical about the benefit of advertising."

“It’s very difficult to be able to demonstrate that these things are worth the investment,” he said. “Hospitals and health systems that put a lot of money into advertising say it is beneficial. But when you ask them to prove it, there’s a real shortage of good research that verifies that it’s worth it.”

Yes, hospital marketers are frequently remiss in not building more value-driven metrics into their work.  Too many of these marketers (those with limited job prospects) devolve from saying that measuring marketing is difficult to concluding it's a waste of time to try.  And in my experience, far too few say "We're going to do MORE of what we CAN measure and LESS (or NONE) of what we CAN'T," even at the cost of annoying a CEO's favorite physician or two.

Yet as uncomfortable as it may be for the Finance side of the house to hear, they and marketing have a lot in common, as BOTH functions sometimes do things based more on faith than on solid evidence of results.

Don't believe me?  I'll bet you have CPA after your name.  But I digress...

Take the internal audit function for example, people and processes designed to keep the organization compliant and fraud-free.  But how do you measure "frauds avoided" - misadventures that would've happened but didn't thanks to the IA boffins' work?  Tough to do.  At some point one must believe - there's that pesky 'faith' thing again - that organizations WITH a strong IA function are more successful than those without (a point with which I happen to agree by the way.) 

There's an entire superstructure of intuition and supposition built around that idea, just as with the idea that a healthy and well-communicated brand is an important organizational asset (even though not everything about it can be measured.)  But intuition and supposition are not facts, and saying that without IA we'd have more Enrons and Worldcoms is wishing and hoping, not evidence.

So bring data to the argument when you can.  But next time you hear Mr. Steinberg echoed by YOUR finance team, ask them for the cost justification on what THEY do.  And watch 'faith' suddenly rise up the priority list.

1:07 PM