“That money is not buying us value,” Emanuel said, adding that some $750 billion to $800 billion could be considered “excess” and he noted how high administrative costs, fraud and, to a lesser extent, defensive medicine add to the cost.
But to truly get a handle on costs, Emanuel recommended a “high touch,” primary-care based approach to the treatment of patients with chronic conditions. He went on to suggest a number of ways this could occur, and a number of different examples of where innovations are taking place just so listeners would know that he wasn't just speaking theoretically.
One example was how Seattle's Virginia Mason Medical Center worked with Starbuck's to lower its healthcare costs related to employees' lower back pain. The usual course of action was that patients were given an MRI which usually was found to have no value—at least no medical value.
The MRIs were found to be profitable and when they were discontinued, Emanuel said Virginia Mason “lost a ton of money.”
Gary Kaplan, Virginia Mason's chairman and CEO, confirmed this later during a panel discussion held near the close of the conference.
Earlier in the conference, Kaplan was awarded MGMA's lifetime achievement award, capping off a good year for him in the awards category as last month he won a John M. Eisenberg Patient Safety and Quality award, given by the National Quality Forum and the Joint Commission for leading the development of the Virginia Mason Production System based on Toyota's manufacturing quality techniques.
That system was in place for the Starbuck's initiative which Kaplan said did well for Starbuck's but lost money for Virginia Mason. On the positive side, he said the experience led to improvements in patient flow and spurred the development of a “new back pain pathway.”
Lowering costs was also mentioned by MGMA President and CEO William Jessee during his keynote address as he highlighted MGMA's ongoing campaign for administrative simplification and its Project SwipeIT initiative promoting machine readable health plan member ID cards.
Like his keynote last year (Print subscription required), Jessee's talk also included provocative statements that were followed by audience silence. In his speech last year in San Diego, Jessee declared that one principle of healthcare reform must be that “healthcare is a basic human right.”
At the time, David Gans, vice president of MGMA's practice-management division, noted that at least the audience didn't boo. Jessee also said that he later received positive feedback from members about his remark.
This year he took on insurance companies.
“Everyone should be able to purchase affordable insurance—regardless of their health status,” Jessee said. “So guaranteed issue is essential. Excluding coverage for pre-existing conditions is simply unfair. And making windfall profits from such an essential commodity as health insurance is immoral—health insurance must be made affordable to the average American.”
Though Jessee received some laughs when he quipped about the civility of the healthcare reform discourse, his remarks on insurers were met with silence. Prior to the Oct. 14 panel with Kaplan, Cleveland Clinic CEO Delos “Toby” Cosgrove and William Wright, executive medical director and president of the Colorado Permanente Medical Group, I saw a woman telling Jessee how much she appreciated what he had said. So, apparently, positive feedback is something MGMA members wait to distribute.
The conference closed strong with a presentation by Cam Marston, founder and president of a consultancy group Generational Insight. I'd have to say that he ranks up there with healthcare strategist Marc Sauvé and University of Pennsylvania Wharton School of Business people-management guru Charles Dwyer as a top generalist speaker. (I'd have to include former U.S. Secretary of State Colin Powell and Princeton University healthcare economist Uwe Rienhardt on my list of top conference speakers but they are in something of separate universe.)
Marston's area of expertise is identifying the characteristics and conflicts of the four generations present in today's workforce: the matures, born between 1909 and 1945; the baby boomers, born between 1946 and 1964; the Xers, born between 1965 and 1979; and the millennials, born after 1980.
Marston talked about how the friction between the boomers and the Xers “is almost palpable.” In a typical dispute, Marston explained, the boomer will say to the Xer: “If you were a good team player, you'd help out with a little extra work.” To which Marston said the Xers' response is: “If you were a good team member, you wouldn't need me to do anything extra.”
In contrast, Marston said the matures and the millennials get along well, and he suggested pairing them up so the older workers can mentor the younger generation in the ways of customer service while the twenty-somethings can train their elders in how to use technology.
Xers are not good technology tutors, Marston said, adding that their typical advice is “Just keep clicking. I'll be back later.”
An Xer himself, Marston didn't spare his generation from any barbs.
Noting that time is especially valued among his peers, Marston recommended that when Xers have worked particularly hard during the week, their boomer managers should tell them to leave early on Friday or come in late on Monday.
“Most will anyway,” he said.
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