You may have noticed there are a lot of foot-draggers in Washington lately when it comes to healthcare reform. Call them Blue Dogs, obstructive Republicans, or whatever you want.

The reason they can get away with it is because of growing public fear and uncertainty about the changes healthcare reform will bring.  Paul Krugman paints a clear picture of it in his op-ed “Healthcare Realities” for the New York Times.

Leading Change Step By Step

Unfortunately the seeds for this growing fear were able to be planted because of a key missing link. John Kotter, the Founding Father of change management, holds the key in step 4 of his 8 step process to leading change:

Establish a sense of Urgency

Create a guiding coalition

Develop a vision and strategy

Communicate the changed vision

Empower broad-based action

Generate short-term wins

Consolidate gains and produce more change

Anchor new approaches in the culture

Creating a Vision

Kotter holds Vision as a central component of all great leadership and claims it is essential in breaking through the forces that support the status quo. Throughout years of supporting hospitals and health systems in developing a clinical vision upon which to transition to electronic medical records, I also came to realize how critical Vision truly is.

A US Airforce Academy cadet details frequently encountered issues during this step in his review of Leading Change. See if you can see our nation’s leadership (which I define as the White House and Congress) in here:

One of the interesting factors that Kotter describes as “difficulties inherent to the process” is the internal struggle and doubt the guiding coalition has with change.  He says that there are many questions that the guiding coalition has to answer in their own minds before they can effectively implement the change… 

That would certainly define the multiple competing bills and complex in-fighting we have seen on Capitol Hill this year. Creating Vision takes clarity, a lot of time, and communication. 

Communicating The Vision

In Leading Change, Kotter also outlines the 7 key elements in effective communication of Vision: 

Simplicity

Metaphor

Multiple forums

Repetition

Leadership by example

Explanation of seeming inconsistencies

Give-and-take

Well, Mr. President, you have given the American public the last 5 elements in spades. What we’re missing is the first two. Tim Foley provides some very helpful hints in his post “TV Could Make Health Reform Real—Here’s How”. He suggests merely the White House East Room, a camera crew, and four people.

Four People and a Vision For Healthcare Reform

Who are these four people?

1) An uninsured single mom
2) An employer-insured relatively high-income man
3) A small business owner
4) A Medicare recipient who hit the donut hole.

Foley suggests letting these people summarize their current financial and insurance situation, and telling them—very simply—what their future looks like with healthcare reform.

That’s it. A four-prong Vision addressing the major patient and small employer stakeholders. The fascinating thing about Vision is that it creates excitement and removes a great deal of uncertainty. Which is exactly what the American public needs to demand change in unison.

The public voice is badly needed, because meanwhile Republicans are trying to destroy Kotter’s first step to change, Urgency, by letting the issue languish during their summer vacation. I’m sure they’ll be spending plenty of time recreating with their healthcare lobbyist friends, beefing up their donation kittys.

And you? Well, you will be holding onto your health insurance (if you even have it) by a string. Let your Congressional representatives know it today.

©2009, Actively Fused LLC

This morning I browsed through the “Coming Soon” section of MSN Movies and was surprised to see that, although no movie had a critic’s rating yet (due to no pre-screenings on which to base one), each one had at least one—and sometimes dozens—of user ratings.

In fact, The Time Traveler’s Wife had a user review! What was it based on? Nothing but the book and a 2 minute long trailer. Hey, if you want to write a book review, go to Amazon.com. If you want to rate or review a movie, watch it. Simple concept, no?

But speaking of Amazon.com, I was relieved to note while browsing their New Releases that user ratings aren’t allowed until the book is actually released (or advanced release copies are distributed). That stops a lot of clueless editorializing, but unfortunately not all of it.

Joining in the online discussion on a recent Dick Francis novel I just finished, a reader rebuffed my critique. It wasn’t until days later that the reader posted an update that basically said, “Now that I’ve read the whole book, I agree with you.” What? Why are you discussing a whole book when you’ve only read a chapter or two? Just to create noise and feel a part of things?

Sadly, anyone who looks only at the average ratings or reviews on these sites has no idea many of the individual ratings that comprise it are baseless. So it is with the healthcare reform debate.

Where Is The Patient?

So what does all of this have to do with the current healthcare reform climate?

Many entities have strong lobbies and position stands—the AMA, AHA, AHIP, PhRMA, California Nurses’ Association, US Chamber of Commerce, labor unions…and the list goes on. What is missing here? A single entity representing informed patients. Isn’t healthcare, and especially healthcare reform, supposed to be all about The Patient?

Yes, there are multiple groups representing some patients—MoveOn.org, Campaign For America’s Future, and Health Care For America Now among others. But there is no single group representing The Informed Patient. And there are plenty of uninformed individuals masquerading as patients, fear mongering and opining and talking about everything but healthcare.

Opinionated Non-Patients

For instance, a 2008 Kaiser Family Foundation poll found that those who rarely or never use their health plans are TWICE AS LIKELY to rate their private plan as excellent.

That’s not satisfaction. It’s cluelessness.

Especially when the same poll indicates 32% of respondents or a household member had difficulty paying medical bills.

Presumably it’s also non-patients who were surveyed in a June 2009 New York Times/CBS News study often quoted by AHIP President Karen Ignagni. It found:

77% of Americans are satisfied with their existing health coverage

But in the same study 72 vs 20% of Americans also favor the creation of a public plan

Bottom line? Non-patients don’t know what they want because they have no experience with the existing healthcare maze.

The Informed Patient Litmus Test

So how do you know whether you are an Informed Patient? How do you determine whether you are entitled to assign a 5 or 1 star rating and write user reviews?

Simple. Take this quiz:

The Informed Patient Quiz

1. Are you a patient (i.e., been under a healthcare provider’s care recently)?
2. Do you have health insurance?
2a. If No, have you read and understood a provider’s bill for services?
2b. If Yes, have you read and understood an Explanation of Benefits for provider services?
3a. Do you know your other health insurance plan alternatives (i.e., what you are eligible to sign up for)?
3b. Total Premium for your insurance (including employer portion, if applicable)?
3c. Annual Deductible?
3d. Co-Pays and/or Co-Insurance percentages?
3e. Annual Out of Pocket Maximum?
3f. Lifetime Maximum Benefit?
4. Do you know how to determine In-Network vs. Out-of-Network providers?
5. Do you know which services are covered under your health plan?

Grade The Quiz

If you answered “No” to #1 or #2a or #2b, you are not an Informed Patient. In fact, if you answered no to #1 and #2, please don’t complain about any requirements to become insured. Get smart before you become intimately acquainted with bankruptcy and wage garnishment.

If you answered “Yes” to two of the three questions #1, #2a, #2b, you are a Patient. If you answered “Yes” to all the remaining questions, congratulations, you passed! You are an Informed Patient.

For those that didn’t pass? Please shut your mouth.

Because if you’re not an Informed Patient, you have no opinion. Pure and simple. You may have bought the product, you may sell or service the product. But if you don’t use it, you have no valid opinion in the healthcare reform debate and no right to be counted—you are either originating or propagating stereotypes and propaganda.

And to those Informed Patients out there?  Carry on and don’t let the powers that be water down your healthcare reform. You use it, you depend on it. Call your representatives today.

©2009, Actively Fused LLC

Cost control in healthcare reform continues to be a hot-button topic. This is good, as neither private health plans nor the government have even basic competency in spending our money prudently.

Private health plans rake it in and spend as little as possible on care—this does not help us. The government spends even more than it rakes in—this does not help us either. Meanwhile providers of all stripes like to perform as many procedures as possible to capture their share of the $2.6 trillion (and rapidly growing) pie.

So what to do, where to turn? How do we stop this torrent of healthcare dollars flowing inexorably down the drain?

Patient, look to yourself. Get empowered and get smart.

The Smiths and The Jones

Don Kemper has a good post in The Healthcare Blog describing how a better healthcare system depends upon supporting a smarter patient. He writes about two identical hypothetical families, the Smiths and the Jones. They deal with the same medical conditions but have different approaches to self-management. Kemper chronicles their trials with three potentially costly episodes of back pain, chest pain, and dementia.

The Smith family believes in “doctor as God” and relies exclusively on its providers to diagnose and recommend care, not participating in medical decisions. The Jones family uses healthcare decision tools and self-management information available on the internet to collaborate with its providers.

In short, the difference between the two families is this: an MRI, back surgery, physical therapy, an ER visit, an EKG, a stress test, echocardiogram, a Holter monitor, cardiac catheterization, and no-holds barred treatment against late-stage dementia. Cost? Probably $x00,000s versus $300-1000 (my estimates). The results? Identical.

Multiply that cost difference by 305 million, the current US population, and we just saved $trillions (again, my estimates).

Promoting Healthcare Self-Stewardship

 Kemper suggests a two-prong approach to promote better healthcare stewardship. First, support the Joneses. Help them with their:

• Self care,
• Knowledge of clinical guidelines so they can ask for what they need, and
• Ability to say “No” to care unlikely to improve their lives.

Second, motivate the Smiths financially through:

• Reduced/no cost preventive care,
• Lower premiums or co-pays for using decision aids, and
• Rewards for attaining wellness goals.

Certified Patients

I believe we can accomplish both goals through creating a Certified Patient program that incorporates all of the above. It would be multi-tiered,

• Beginning with a basic ability to follow symptom guides and assimilate wellness information,
• Progressing towards a basic knowledge of anatomy and physiology, medical terminology and the healthcare landscape,
• Then an ability to “walk the walk” on diet, exercise and stress management,
• Moving towards understanding complexities of their medical conditions, and
• Finally being able to advocate for other patients, culminating in a “train the trainer” type of program.

The program would require continuing education units or requirements to recertify at regular intervals. Initial education would be free, cost for continuing education units would be market-driven, while recertification would be costly enough to provide motivation to remain certified.

Low-Cost Prevention

Certified patients would receive discounted insurance premiums and lower co-pays/coinsurance, on a graded scale based upon the certification tier attained. They would also benefit from discounted gym memberships, personal training sessions, nutritionist visits, and mental health appointments.

Best of all, most of the program would be web-based and primary support would be from lower cost health and wellness professionals. I include nurses, exercise physiologists, nutritionists, and psychologists in this group.

The focus would be on:

1. Keeping patients healthy and out of the acute care system, and
2. Empowering patients to guide their own care.

The results would optimistically be healthy patients acting as cost-sensitive stewards of their own care. Now that’s real prevention!

© 2009, Actively Fused LLC

Do you want to know what really happened during the White House press conference on healthcare reform last night? Without the usual funhouse mirrors applied by the media, social or otherwise?

Then watch the President’s remarks here and decide for yourself.

American healthcare is the most complex business on earth and no ordinary person can be expected to understand it in its current state. That makes it difficult to comprehend the impact of proposed future reforms.

As many of you have questions about what reform means to you and yours, get your questions answered straight from the source this afternoon.

White House Health Reform Director Nancy-Ann DeParle is holding a live video chat through Facebook and Whitehouse.gov. Join the chat today at 3pm ET.

Meanwhile, check out an NPR transcript from July 31, 2008 on comparing the Swiss healthcare model to America’s needs. It’s no less relevant today than it was then, and may answer many of your questions and concerns.

© 2009, Actively Fused LLC

Oops, sorry. You don’t get that luxury. It’s only for your humble public servants.

At least that’s what the House of Representatives wants to do next week–unless you tell them to get healthcare squared away BEFORE they head out the door.

Firedoglake is sponsoring a petition asking the House to stay in session and pass healthcare reform.

Sign the petition here and Firedoglake will deliver the signatures to Congress at the end of the week.

Otherwise while the House is vacationing for 3 weeks,

 143,250 people will lose their health insurance coverage, and

53,507 people will file for bankruptcy because they can’t pay their medical bills.

Don’t let Congress play before getting their work done. After all, they’ve had 16 years to do it. 

Sign the petition to get healthcare reform passed before summer break!

© 2009, Actively Fused LLC