MCOL Blog

Health Care Is Personal: In Memory of Karen

Just a few months into my first administrative position at a hospital in 1981, just a year out of college, I remember feeling pleased with myself as I edited the Radiation Therapy Center feasibility study I had just spent countless hours and days preparing. It was a thick report full of projections, tables, charts, and narrative. Then in the background, I could year the sobbing outside my office.

My office had been converted from an admissions room, and was situated next to a quiet area for families, off the main lobby. I had never really paid attention my surroundings. I was too into my new job. But the sobbing persisted, and at some point I had to leave my office for a meeting. As I rounded the corner I spied the family, grieving for a loved one that had just passed away upstairs.

In the years to come, as I progressed in my career, becoming CEO of a regional provider owned health plan, I was typically far removed from the actual rendering of health care. Instead I was immersed in the business of it: budgets, monthly reports, department head meetings, actuarial projections, marketing campaigns, contract negotiations, board meetings, personnel issues.

Now and then, but never often enough, I tried to remind myself of that day outside my hospital office, so early in my career, when I first learned that health care is personal, and can not so lightly treated as just another business or commodity.

During my more than dozen years running that health plan, I had the great pleasure of working every day with Karen (Hutcheson) Speziale. She was the Chief Operating Officer of the plan, and she made the plan run, and run well. Karen passed away this past week, after a six and a half year battle with cancer. Karen should have been with us for at least a couple of more decades.

I remember sitting in my health plan office with Karen and our Medical Director, making decisions on proposed benefit and coinsurance levels for the coming plan year. We set a higher coinsurance level and benefit limitation for Total Parenteral Nutrition (TPN), which was at the time increasingly being used in the treatment of Crohn’s Disease. Years later, one of my children would be diagnosed with Crohn’s. We also set various new benefit parameters for several different prescription and treatment options for cancer.

Health care is personal.

After I left that health plan to start MCOL, Karen went on to take a position with Kaiser Permanente, developing and then managing their expansion in our market. Kaiser is now the dominant health plan in our area. Later, Karen moved away to San Diego, and really flourished there.

Karen volunteered significant time in elementary school classrooms. She became the advisor for the local chapter of her Sorority at the university. She spent countless hours on other civic activities. Several of her former department heads from our old health plan remained the closest of friends with her, taking really cool vacations together, and staying in constant touch. She also kept very close ties with her family. When Karen’s illness required that she fully retire from her job, she continued all her contributions to the community.

I very recently took a quick trip to visit with Karen. She had just returned from a visit to the Kindergarten class where she helped the kids learn to read. They had put on a program just for her. On the wall in her office was a plaque recently given to her by her Sorority as the national “Alumna of the Year.” The perpetual annual award will now bear her name.

Karen’s investment in community time should serve as a wake up  call to all of us working on the business side of health care, to put and keep some balance in our lives, as Karen did.

Karen shared with me how recently at the hospital she had an hour long conversation with a nurse on what was wrong with health care. Karen laughed about it, but its hard to argue that there is something significant that needs to be done with health care. We can start by remembering how personal it is.

Anyone reading this who knew Karen Speziale might be interested to know that donations in her memory can be made to San Diego Hospice at www.sdhospice.org

International Health Care Data and Comparisons

With this election year, health care is a central topic of discussion for Presidential and Congressional candidates. Inevitably, references are made inferring either superior or inferior performance of the U.S. health care system compared to various other countries.
So just what kind of current data is out there reflecting various attributes of international health care? Below is collection of selected international health care factoids, compiled by Global Health Resources this year:

For More Information:

Global Health Resource
www.globalhealthresources.com

What’s Going on at ChangeNow4Health:

We’ve written before about ChangeNow4Health, the open coalition committed to improving the nation’s health care system through the facilitation of action. Below is their latest press release, which announces their Innovation xChnage, inviting and even funding new ideas on how to fix health care today:

ChangeNow4Health, an open coalition committed to improving the U.S. health care system, today launched a series of new online programs to further drive dialogue and transformation in the health care system. Announced at the World Health Care Congress in Washington, D.C. , these programs range from Health Expert Blogs led by national health care consultants to the new “Innovation xChange,” which is an ongoing campaign designed to invite and reward new ideas that address issues in our current health care system.

“ Our health care system is seriously dysfunctional and it’s time we all come together and do something about it,” said Jacque Sokolov, a nationally recognized health care consultant and one of ChangeNow4Health’s founding partners. “T he U.S. spent almost $2.2 trillion in 2007 [1] , but we are not seeing corresponding improvements in quality of care. ChangeNow4Health is designed to be an online, real-time catalyst and clearinghouse that action-oriented individuals can use to propose solutions and start solving problems now.” [ [1] “Health Spending Projections Through 2017: The Baby-Boom Generation is Coming to Medicare,” Health Affairs 27, no. 2 (2008): w145-w155 (published online 26 February 2008)]

ChangeNow4Health is dedicated to improving the way consumers receive, and the industry delivers and administers health care services. The coalition seeks to incubate, expand and make available solutions that are working in one part of the industry and can bring positive change to others.

Through the Innovation xChange, ChangeNow4Health is inviting all participants in health care system to submit practical ideas and solutions. All participants, from providers and health plans to consumers and government, can join in the discussion by simply logging on to www.ChangeNow4Health.com and submitting their ideas in the Innovation xChange. Solutions can be entered in the following four categories:

1. Helping Consumers Make Smarter Health Care Decisions

2. Simplifying the Business of Health Care

3. Preventing Sickness and Maintaining Health

4. General Innovations in Health Care

A panel of industry experts will evaluate all ideas based on criteria, including feasibility for implementation, potential to yield tangible, measurable results and to bring about meaningful change in a reasonable time frame.

All entries submitted on www.changenow4health.com will be open to voting by the coalition’s online communities. The top 20 entries will be published in the ChangeNow4Health e-book, Tomorrow’s Health Care, and finalists will be awarded up to $10,000. (Up to three entries will be awarded $10,000.)

In addition, Humana Inc. (NYSE: HUM), one of the founding members of the coalition, will consider the possibility of a joint venture to incubate the winning idea and bring it to reality through the company’s Innovation Center. Winners will be announced by Aug. 31, 2008.

“The basic premise behind this Innovation xChange is that no one entity can fix the system and a good idea can come from anyone,” said Beth Bierbower, vice president of Product Innovation, Humana. “ The technology and structure of the Innovation xChange allows anyone, regardless of age, sex, professional background, to be part of a solution. The virtual forum and workgroups encourage collaboration, focused thinking and the development of easily actionable solutions.”

In addition to the Innovation xChange, the coalition announced two other online programs to drive dialogue and build support for various solutions. These include:

· National Healthcare Expert Blog Topic Forum : Starting June 1, Dr. Jacque Sokolov, a nationally recognized health care consultant, will launch a new blog bringing together some of the nation’s leading health care thinkers to discuss critical health care issues in one common forum. The blog will feature prominent health care experts and touch upon various topics, including the need for successful quality initiatives, hospital-physician productivity enhancement and a sustainable national health care financing model.

· Point-Counterpoint : To further spur discussions in various ChangeNow4Health communities, the coalition will launch a new Point Counterpoint forum where prominent health care bloggers and experts can put forth dissenting opinions and build actionable consensus on key solutions. During each online forum, two health care bloggers will present differing positions on an issue and members can join in with their opinions.

For more information or to join in the conversation, please visit www.changenow4health.com.

What's the current state of things in the Convenient Care Industry?

After attending two sessions on retail medicine at the World Health Care Congress today, here's what we found out:

John Agwunobi, MD, EVP Professional Services for Wal-Mart shared the following statistics for Convenient Care visits at Wal-Mart locations, through their various contracted providers:

• adults comprise 79% of visits, 21% of visits are for children
• 55% of patients have no insurance coverage
• Patient surveys indicate, had the Wal Mart convenient care location not been available, 40-50% of patients would have seen a primary care physician; 20-35% of patients would have used an urgent care facility; 10-15% would have gone to an ER; 5-10% would have foregone treatment
• 90+% of patients indicate overall satisfaction
• 25-40% of visits are for immunizations & screenings; and 60-75% of visits are to treat common illnesses

Doctor Agwunobi also discussed the Wal-Mart $4 Generic Prescription program, which is offered to all Wal-Mart customers and is proactively promoted through the Convenient Care locations. The program involves 361 generic prescriptions covering up to 95 percent of prescriptions written in the majority of therapeutic categories. Nearly 30 percent of $4 prescriptions are filled without insurance. The $4 prescriptions now represent approximately 40 percent of all filled prescriptions at Wal-Mart.

Web Golinkin, President and CEO, of RediClinic discussed RediClinic customer experiences, noting that RediClinic is a partner of Wal-Marts. Mr. Golinkin is also President of the Convenient Care Association and shared the following insights regarding the Association and industry as a whole:

• There were 150 clinics when the Convenient Care Association founded less than two years ago to more than 950 today nationwide, with 1,500 projected by the end of 2008.
• Overall, the clinics have treated more than 2.5 million patients in 36 states
• Surveys indicate 16% of consumers have tried a clinic and between 34 to 41% say they intend to

Golinkin stated the potential obstacles or events that could slow industry growth would be if:

• The industry suffered future systemic clinical quality issues
• A shortage and/or increased cost of Nurse Practitioners (NPs) and Physician Assistants (PAs) occurred
• If various states continue with additional regulatory impediments (clinic licensure requirements, restrictions on NP/PA scope of practice and prescriptive authority, physician oversight requirements, corporate practice of medicine prohibitions, etc.)
• If increased Operator/business model failures occur. He noted that there have been some failures, commented that this should be expected with any industry having relatively lower barriers to entry but higher ongoing working capital requirements. He felt there will be a shakeout with consolidation.

Michael Howe, CEO of MinuteClinic, states their organization's strengths include:

• They are "Right Size” engineered for efficiency and high quality
• Proprietary Electronic medical record system embedded with standardized “best practice” protocols
• Facilitates measurement of results and continuous quality improvement
• Interoperability drives continuity of care back to the Medical Home
• Consumer friendly - with convenient locations in consumer pathway, and “Lifestyle conscious” hours and “walk in” scheduling
• “High touch” capability of practitioners drives compliance
• Patient Referral system facilitates the creation of “Medical Homes”when lacking

He cited an independent external research study conducted by Market Strategies in April 2007 indicating a patient satisfaction rate, as well as the percent likely to recommend, of 97%. He noted that MinuteClinic adheres to national standards of practice guidelines, (which have been adopted by their Association) but also is the first retail health care provider to be Joint Commission accredited.

Howe also cited a peer reviewed study from September 2005 through September 2006 of 57,000+ MinuteClinic evaluations of acute pharyngitis, looking for outcome measures to include adherence to best practice treatment guideline in presence of negative or positive RST, use of back up confirmatory strep culture testing in presence of negative RST, and documented rationale when antibiotic was prescribed in presence of negative RST. The study indicated an overall adherence rate of 99.15%.