Emily Friedman Independent Health Policy and Ethics Analyst

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1 Emily Friedman Independent Health Policy and Ethics Analyst Presented at the Center for Healthcare Governance National Symposium on Leading and Governing Healthcare Organizations Naples, Florida February 24, 2014 Copyright Emily Friedman

2 Because this area of health care is changing so fast, I undoubtedly tinkered with my slides up to the last minute. As a result, there will be differences between what is in your book and what I show. Also, I cannot share quotes, photos, cartoons, and other copyrighted material, so they won t be in the book at all. Thanks for your understanding. Copyright Emily Friedman

3 Why not management? There are many ways to manage something without improving it People have bitter memories of concepts like access management better known as keeping patients away from care It s very difficult to manage other people s health, in any case Copyright Emily Friedman

4 Just another buzzword? Health care is often better at talking the talk than walking the walk and documenting it ACA requirements/states interest Tax status at risk Payers pushing change It s not just shifting from volume to value; it s from treatment to prevention and improved health status for large populations Copyright Emily Friedman

5 1. Aligning providers across care continuum 2. Utilizing evidence-based practices 3. Improving efficiency 4. Developing integrated IT systems 5. Joining and growing integrated systems 6. Creating employee and physician leaders 7. Strengthening finances 8. Partnering with payers 9. Strategic planning 10. Population health improvement From Second Curve Road Map for Health Care, HRET, April 2013 Copyright Emily Friedman

6 Just another buzzword? Health care is often better at talking the talk than walking the walk and documenting it ACA requirements/states interest Tax status at risk Payers pushing change It s not just shifting from volume to value; it s from treatment to prevention and improved health status for large populations Copyright Emily Friedman

7 Regardless of their motives, those forcing change mean it; we must do the same And that requires A new, almost radical mindset True outreach Partnership, not competition Listening to the community and learning A long-term commitment Copyright Emily Friedman

8 Journey through Radical Change Change Process Starts Promised Land Everything looks like failure in the middle. Morale Journey through Hell Time Courtesy of Dan Sisto Copyright Emily Friedman

9 Regardless of their motives, those forcing change mean it; we must do the same And that requires A new, almost radical mindset True outreach Partnership, not competition Listening to the community and learning A long-term commitment Copyright Emily Friedman

10 Gather data, drill down, and look deeper That means IT infrastructure Culture counts Doing it right Why do it? Risks and rewards What are you here for? Copyright Emily Friedman

11 Culture counts For providers For patients For communities Language matters Sensitivity is imperative But stand your ground when you must And don t tilt at windmills Often, there s a way Copyright Emily Friedman

12 Culture counts Where there s a will Potential partners are where you find them Find healthy, culturally comfortable alternatives Make it affordable Test strips versus blood monitors Make it easy The less hassle, the greater success Copyright Emily Friedman

13 Doing It Right Low-hanging fruit is not enough Respect the dignity (and intelligence) of others Don t just assume Build on what exists, if it does Peer education can be the most effective approach Positive incentives are better than fear-mongering and patronization Timing is everything Don t expect miracles Celebrate successes Copyright Emily Friedman

14 Low-hanging fruit Immunization Insurance Access Related services Harder-to-reach fruit Lifestyle Violence Mental health Copyright Emily Friedman

15 Doing It Right Low-hanging fruit is not enough Respect the dignity (and intelligence) of others Don t just assume Build on what exists, if it does Peer education can be the most effective approach Positive incentives are better than fear-mongering and patronization Timing is everything Don t expect miracles Celebrate successes Copyright Emily Friedman

16 Why do it? It has to go deeper than the fickle winds of policy and payment Healing is healing Risks Practice will be ahead of policy and payment, at least for a while Not all of it will work It will not necessarily get easier as it goes along René Dubos s observation Copyright Emily Friedman

17 Rewards Good health is better than poor health (duh) Avoiding unnecessary spending allows concentration of resources on needs that must be met Greater solidarity with the community Oh, yeah in time, you will get paid for doing this But you will have to prove outcomes This is what you are supposed to do Copyright Emily Friedman

18 The real danger is tokenism doing too little and feeling satisfied and excused from addressing the social and economic injustices that underlie poor patients suffering. Yes, we need to be charitable in every way possible, but we also need to stand alongside our patients in striving for a fairer, more caring world. If physicians want to stand aloof, addressing only the biomedical problems, ignoring and seemingly indifferent to the social circumstances of our patients, then patientcentered medical homes are likely to feel more like gated communities than places where people live and work together. Gordon Schiff, M.D. In the Journal of the American Medical Association, September 25, 2013 Copyright Emily Friedman

19 Rewards Good health is better than illness (duh) Avoiding unnecessary spending allows concentration on needs that must be met Greater solidarity with the community Oh, yeah in time, you will get paid for doing this But you will have to prove outcomes This is what you are supposed to do Copyright Emily Friedman

20 Gather data, drill down, and look deeper That means IT infrastructure Culture counts Doing it right Why do it? Risks and rewards What are you here for? Copyright Emily Friedman

21 And remember You will not be in control of many aspects of this Not everyone will love you for it Be prepared to be out of your comfort zone It has to become part of your organizational culture How about a board committee? Monitor, learn, adjust And share what you ve learned One person can make a difference The commitment must extend to difficult, even extreme, situations Copyright Emily Friedman

22 "Social wounds do not always bleed before our eyes. They are often internal injuries of spirit and of mind. But they will out. The prejudice, hostility, hate, envy and fear we have for our fellow men who differ in any way from us is a cancer. The healing community of the hospital must move toward the healing of the social sicknesses in the community with a commitment to seek to prevent social sickness and not merely to cure or to be content with curing superficially. The whole person body, mind, and spirit must be made whole again. If not, we shall be torn apart, man set against his fellow man. [We must be guided by] the creating and sharing of a common unity of purpose. Rev. John G. Simmons A Sacred Rage, 2010 Copyright Emily Friedman

23 How wonderful it is that nobody need wait a single moment before starting to improve the world! Anne Frank Copyright Emily Friedman

24 Questions? Comments? Thank you! Copyright Emily Friedman

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