Highlights from ABL's "Health Reform Summit" -- Part 1

On July 7th, ABL held its first Health Reform Summit in San Francisco, discussing several aspects – among the myriad – of healthcare reform. The audience spanned the senior executives of a spectrum of payers (from plans to CalPERS to CMS), providers (hospitals to SNFs to med groups), and a full range of ancillary service suppliers, health IT, pharma/biotech, medical device and diagnostics companies, to service suppliers and advisors.

Framing the “discussion” was Tom Lorentzen, who recently left government service, after serving in three Republican administrations, most recently as Regional Director for the U.S. Department of Health and Human Services, Region IX. Given his long experience in and with government, he’s seen – from defense to healthcare – the importance of semantics. He believes that selecting the right words to label the desired outcome can actually help us to achieve it. So, for example, when over 70% of the population hears the words “health care,” what they interpret is “medical care.” So, if what we really want from all this is a healthier population, we need to start speaking more about the importance of “health” – including getting “health customers” to buy into caring for their health and staying healthy.

Gerry Hinkley, a Partner with Davis Wright Tremaine, has become a nationally-respected expert in “Determining ‘Meaningful Use’ for EMR Stimulus Investment” – or, how to tap the billions promised to pay for the implementation of Electronic Medical Records as stipulated in the American Recovery and Reinvestment Act of 2009. Gerry shared that the incentives for non-hospital-based physicians achieving “meaningful use” could begin as early as 2011, for those providers demonstrating that the use of their “certified EHRs” enhance quality, patient access to information, and care coordination, as well as improve public health, and ensure privacy and security of information. He also mentioned that the oft-quoted incentive amount of $44,000 per physician is frequently misunderstood: it’s a maximum payment paid out over five years; e.g., a payment of $18,000 is only allowed to physicians demonstrating meaningful use in 2011 or 2012, with lesser amounts of $12,000, $8,000, $4,000 and $2,000 paid out in subsequent years. For those who start in 2013, their max – again, over five years – would be $41,000; those who implement later get even less. The formulas for hospitals, Critical Access Hospitals, and providers launching their meaningful use in later years, are more complex (and time-sensitive); fortunately Gerry spelled out many of the specifics for us in his handouts, and provided us with a “Meaningful Use Matrix” that detailed the Health Outcomes Policy Priorities, Care Goals, and the Objectives and Measures for 2011, 2013, and 2115, at least as they’re currently understood. Stay tuned!

EDITOR'S NOTE: In our next issue of ABL Healthcare Online, on July 23rd, we'll print Part 2 of "Highlights from ABL's Health Reform Summit," which will include Mimi's takeaway from presentations by Jennie Chin Hansen, President of AARP, and Carolyn Clancy, MD, Director of the Agency for Healthcare Research and Quality.

Going Virtual

Frequently, in the pages of ABL Technology Online, we congratulate our Members on new achievements and awards. Among those mentioned this week is that our Member, Kim Shepherd, CEO of Decision Toolbox, received the Alfred P. Sloan Award for “Business Excellence in Workplace Flexibility.” While on the surface, the move to “going virtual” sounds like just sending all your employees home and, viola!, instant overhead savings, it’s truly much more complicated than that. In fact, if just saving money on rent were the primary reason for going virtual, that would be the recipe for disaster.

As it turns out, I’m very familiar with Kim’s model, since I’ve worked first-hand with Kim’s virtual organization, and I’m an incredibly satisfied customer. But, going virtual doesn’t come without a price tag. First there’s the technology: every one of Kim’s associates, regardless of where in the world they are based, has access to DT’s highly sophisticated computer-based and telephonic network. As a client, it’s been absolutely inconsequential as to where the associate I’m speaking to is based, because I’ve just dialed their “562” area code number in Long Beach. So for the associates internally, they’re all just an extension apart. They also are linked via video cam, so whenever they’re online, they’re up and ready for work with, as Kim would call it, their “mascara on.” No pajama parties here.

Also, part of the “flexibility factor” is the flexibility in their client relationships. In the past, when dealing with external recruiters, it’s been strictly a 9-5 operation. Now, when I connect with “our recruiter,” Heidi Webster, I know I can call her at “off-peak” hours, when I have more time, to discuss the job specifications, review candidates, and compare notes – usually around 7 pm. And Heidi’s in the Washington, DC area! Among the many other “tools” in the Decision Toolbox is Kim’s passion for staying inter-connected with her team, through frequent “all hands” phone calls, newsletters, and quarterly team-building get-togethers and brainstorming fetes.

Truly, Kim could – and should! – write the book on Going Virtual, because far more than “prize worthy,” she’s made Decision Toolbox a model for what will undoubtedly be an ever-more virtually connected world.

CEO Best Practices: CEO's One-Page Reports - What Works

Every month in ABL’s Technology Executives Round Tables we discuss a different issue that revolves around a “CEO Best Practice.” This month we delved into “One-Page Reports.” Of course, most CEO best practices end up involving the entire management team, and inputting key data and discussing the “action steps” demanded by “The Report” is no different.

For many, the One-Page Report (which frequently is more than one page, with additional pages by division or department) is how CEOs keep their team on track, focusing on what some call “The Vital Few Objectives.” Discussed by Members in three different Tech Round Tables, virtually all of them use The Report to guide their executive staff meetings, most of which are held weekly. Frequently mentioned “Key Performance Indicators” included on The Report, by area, were:
Financial: Budget to Actual - Revenues, Profitability, cash-on-hand, ARs, Billings, Bookings, and Balance of revenues/billings/bookings needed to “make the quarter.”
Sales: closing ratios, sales cycle length, hot/cold areas.
Marketing: leads, marcom objectives, notable press/social media exposure.
Manufacturing: Inventory turns, uptime/downtime, scrap ratios.
HR: productivity metrics, open requisitions, revenue/employee.
Engineering: (sometimes daily) number of engineers booked/billed, unbilled “hours inventory” available.
Operations: depending on the type of company, metrics tracked included asset utilization, throughput, both quality and quantity measures.
Business Development: opportunities closed, in the pipeline, and status of other major initiatives. Depending on the company, sometimes “lesser” departments weigh-in on The Report, even including shipping. In the finish, The Report is a “trigger for action,” featuring “alerts with escalators.”

As for how The Report is “compiled,” most of our CEOs shared that their Direct Reports send ”their sections up” to them, sometimes as much as two days before The Report is printed and discussed in the Management Team Meeting. One company uses a “5/15” guideline: it should take no more than 15 minutes to put together a report that takes no more than 5 minutes to read.

Over the 25 years that I’ve been facilitating Round Tables for ABL and its predecessor organization, the Southern California Technology Executives Network, one of my most significant take-aways has been that frequently the process IS the product. Of course, one can get hung up on processes to the detriment of producing anything. But when there’s a well-defined mission, strategic plan of attack, and processes to measure how well The Plan is being executed, the disciplined process of having a weekly Report frequently provides the “early warnings” that signal it’s time to be an adaptive business leader and get ahead of the market, rather than be trampled by it.

Why ABL Healthcare Round Tables are Reporting Record Growth

Just five months into 2009, the Adaptive Business Leaders Organization has experienced a record number of new members in our ABL Healthcare Executives Round Table program. Twenty-two executives from healthcare-related companies throughout California have joined ABL’s ranks since the first of the year. While the plurality have joined our new Silicon Valley Round Table (16 Members have either joined anew or transferred into this new Table from their former San Francisco Group), each of our other Round Tables – including Healthcare Tables in Los Angeles, Orange County, San Francisco and Dana Point’s Healthcare Device/Tech Table – have benefitted from the surge in Membership.

There’s nothing like concern about the impact of significant Health Reform that awakens a Healthcare CEO’s previously latent interest in finding a forum where the opportunities and threats posed by Reform and other significant changes in the healthcare system are intelligently and openly discussed. In each of our Healthcare Round Tables, we’re fortunate to have Members who are closely linked to – or at least very knowledgeable about – The Powers That Be in Washington, DC and Sacramento, and they are keeping us informed as to likely outcomes, as the debate swirls around us. And there’s no question, this time around, about the velocity of the momentum for Change.

In response to our Members’ request for input from those on the national scene, on July 7th we’ll host ABL’s “Healthcare Reform Summit,” our first since a series of Workshops we held in the 1993-94 time frame, when Reforming Healthcare was last on the National Agenda. Our objective in our 2009 Summit is to bring together knowledgeable speakers about what is already happening with the Stimulus for Health IT spending, and what is likely to happen in the areas of Competitive Bidding, the impact of the Senior’s Lobby (and how they feel about cuts to their Medicare Advantage plans), aggressively publishing Comparative Effectiveness Research, and the various Bills emerging from Congress that are sure to vie for the People’s Support, and Legislative approval, in the weeks and months ahead.

One thing is certain, even Legislation will be just the beginning of this new branch in the road. Just as Medicare has been “tinkered with” for over 40 years, long after the “final” Bills are passed, most likely later this year, the value of CEOs conferring on how to take advantage of the opportunities they present – and dodge the pitfalls – will still be there. And so will ABL.

Amalia Ladas makes her debut ... on Facebook

For about the past six months, I’ve increasingly noticed ABL’s Technology CEO Members taking quizzical glances in the direction of our Member Services Manager, Patty Diamond Ladas’s tummy. Of course, many of us have learned the hard way by congratulating someone who was not pregnant to suck in our curiosity about a woman’s bulging waistline until she’s wearing a t-shirt imprinted with the word “Baby” and an arrow pointing down. However, t-shirts are not in the ABL Round Table dress code. So by last month, when Patty announced her retirement to full-time motherhood, it was pretty evident to all that she was expecting a baby, and not another order of Twinkies.

So today was the day. And how did we find out about it? Facebook. By mid afternoon, Patty was posting play-by-play progress of her labor to her 351 Facebook friends, and by day’s end, when Amalia made her debut, her first picture was on Facebook, too. So much for waiting for a month for the printer to deliver the cute little pink birth announcements!

Ironically, at the same time we were keeping up with Patty’s news, we were discussing what we’ll need to do in anticipation of our upcoming move in September – about 3 blocks, but a city away. Among the first thoughts that came to my mind was letterhead bearing our new address. But then I was reminded that because of the quality of the color copies printed on our copier, we really don’t need letterhead, when we actually need to mail something, we create it using our letterhead graphics, on demand. Besides, how many letters do we really mail anyway?

It’s amazing when you think about how much our personal and business communications styles have changed in the last ten years, and with Facebook in just the last five. By the end of the day, all of us who graduated more than five years ago scheduled an Advanced Facebook Tutorial with our new Member Services Manager, Brittney Sochowski (Chapman University, Class of 2009, and 5-year Facebook veteran). Pity the commercial printers.

Meet Harry and Louise's friend, Shona Holmes

Just when it was beginning to look like passing Healthcare Reform was inevitable this time around, the Wall Street Journal reported yesterday that two organizations are already running ads to derail the President’s plan. Of course, unless you’re traveling to places like Montana, Virginia, Arkansas, Louisiana, South Dakota, Indiana, Alaska, Nebraska or Washington, D.C., you probably won’t see them. That’s because organizations like Americans for Prosperity Foundation (who brought us the April 15th Taxpayer Tea Party) and Conservatives for Patients’ Rights are spending, respectively, $1.7 million and $20 million on ad campaigns that will run in “battleground states” where their lawmakers are considered “influential” in the healthcare debate, and, of course, in the Beltway.

Since California didn’t make the cut, we’ve brought them to you here. The first features a Canadian, Shona Holmes, who says she would have died had she not had access to the U.S. healthcare system (the Mayo Clinic). She closes the 30-second spot with: “Government healthcare isn’t the answer, and it sure isn’t free. My advice to Americans: as patients, it’s your care. Don’t give up your rights.” It’s powerful, and gets five stars from its youtube viewers. For the benefit of those living in the other 32 states, FOX News interviewed the Toronto-based brain cancer survivor in a pretty compelling five-minute news segment. As the anchor says, the fear – particularly with the Public Health Plan – is that “Government healthcare for some will turn into government healthcare for all.”

So here’s the ad, and here’s the FOX News segment.

The first 30-second ad from Conservatives for Patients’ Rights features its Chairman, Rick Scott. Yes, the Rick Scott of Columbia Hospital fame. While not as personally compelling as Shona Holmes, Rick is putting $5 million of his own money into his quest to stop the Obama Health Reform Plan, along with $15 million in OPM. Here’s his spot (it only rates 2.5 stars), but this Sunday, his full 30-minute version, warning that the Obama plan will be a Socialized solution, akin to those found in Britain and Canada, will air in D.C. Oh, and the agency behind it is CRC Public Relations, the masterminds of – you guessed it – Harry and Louise.

Why Cybersecurity is Every CEO's Job

This morning, on one of my frequent flights to the Bay Area, my seat companion turned out to be an expert in cybersecurity. Casey Potenzone, who heads U.S. operations at international software marketing firm Avangate, regaled me with examples of how vulnerable our freeway’s changeable message signs, sewage systems, nuclear power plants, and even the power grid are to hackers. These hackers work their IT black magic, violating private and governmental systems alike, usually not for money or to be malicious, but merely for fame among their hacker buddies. One example he shared was how easily our traffic light system can be manipulated – specifically, at the off ramps near the intersection of the 10 and 405 Freeways. The ensuing hours-long back-ups caused millions of dollars in lost productivity.

I found his stories disturbing, but frankly, I wasn’t too concerned; after all, ABL is hardly a target.

But then: after my Silicon Valley meeting, I tried to log onto my remote desktop to get out an important email. Assuming the reason I couldn’t get into our system was a bad phone card connection, I called the office. It was then that I learned that our T1 line had been down all day, no one in our office could send or receive emails, nor access the Internet. Finally, around 4 pm, AT&T showed up and went to the phone closet, which is accessible from the outside of our building. What they found in it was that some miscreant (not for fame in this instance) had “hijacked” our T1, by patching into it.

Later, exchanging emails with Casey about the irony of this situation, given our earlier conversation, he replied: “Patching into a T1 line is very similar to what we were talking about, it’s much like the old-fashioned method of stealing cable. A method by which you can hack the traffic infrastructure would be to do the exact same thing. Once on the network, you’re in… When I was CIO at Uniloc, I invented a product called StrongPoint that I was telling you about to protect critical infrastructure. As part of our marketing (almost all grass roots back then), I built this: http://www.squidoo.com/hack-attack. It’s a little out of date, but has most of the stories I was telling you about today.”

If you’re a fan of scary stories, reading a few of Casey’s blogs will be entertaining. If you’re not, it will make you afraid, very afraid. And, as a responsible CEO, ensuring the security of your IT and phone systems – from hackers and hijackers alike – should become a priority, if it’s not one already.

The Elephant in the Room

It’s estimated that in 2007 Americans spent $2.26 Trillion on healthcare – that’s $7,439 per person, and 17% of the nation’s GDP (4.3 times what we spend on national defense). Way back in December 1999, no less an authority than JAMA took on “Economics, Ethics, and End-of-Life Care” in a path-breaking series of articles. In their research they found that:
-10-12% of all healthcare expenditures and
-27% of Medicare expenditures
are spent at the end of life.

While we are moving ever closer to an affirmative conclusion in the debate about whether or not healthcare is a right, we are no closer to requiring Medicare beneficiaries, let alone all Americans, to have Advance Directives and an honest discussion with their physicians as to what “end of life” could be like – hooked up to machines with tubes running in and out of every orifice, and then some. It’s not like in the movies.

An experiment in one of the VA’s nursing homes integrated a drop-down menu that required the clinician to choose between four Advance Directive orders about resuscitation in the event of a cardiopulmonary arrest, before they wrote an Admissions Order:
-full resuscitation
-do not resuscitate and do not intubate
-intubate, if necessary, but do not cardiovert, and
-cardiovert, if necessary, but do not intubate.

The second step, as reported in a February 2008 Provider article, was – within 24 hours of the resident’s admission – a requirement that the primary clinician complete a templated Advance Directive discussion note. An alert flashed every time the physician signed into the EMR until the note was completed. The result of these changes, largely enabled by the VA’s impressive EMR system, was within three months these Advance Directive discussions had risen from 4% at the beginning of the experiment to 71%. Additionally, the documentation/discussion led to a 98% concordance between clinical orders and patient preferences not to be resuscitated.

While the article did not report by percentage which of the four Advance Directive alternatives the patients selected, just the first step of having the conversation is huge. And, logically, the hospital could in good conscience – and without risk of being sued – follow the patient’s Directive; and ultimately, save the healthcare system futile-care expense. If we’ve determined that health coverage is a right for all, this sounds like an approach that CMS – and even commercial carriers – should think seriously about applying to all their beneficiaries regardless of age or health status.

America's Reverse Brain Drain

It wasn’t so very long ago that the United States was viewed the world over as the Promised Land. Movies were made about immigrants who’d pay big bucks to marry an American, just to get a green card. And when the 65,000 H-1B visas became available, they’d be snapped up in just a couple of days. But this year is different; now there are still 20,000 visas still available after five weeks.

There are another 20,000 visas available to foreign workers who’ve earned advanced degrees from American’s finest universities – who, without a visa, must return home, using all of our U.S. tax-supported education to benefit another country. This is becoming so common in China, they have a name for it. As described in China’s Awakening Dragon e-zine, “’Hai Gui’ means the returning ‘Sea Turtles’ – an abbreviation that sums up returnees from overseas. The pronunciation also suggests the Chinese phrase for sea turtles that were born on the shore, grew up at sea, but eventually returned to the shore again. The name was first used by Ren Hong, a young man returning with a degree from Yale seven years after leaving China aboard a tea freighter from Guangzhou for the U.S.”

The article continues: “Of the 390,000 Chinese who have gone overseas for study and training, 140,000 have returned thus far.” Those are 140,000 of the best and brightest we’ve just educated and exported, never to realize a return on our investment.

A great example exists of a country that modified its immigration standards, establishing a “point system” for education, skills, health status, wealth, and business class: Canada. Between 1983 and 1996, about 700,000 Chinese business people (mostly from Hong Kong) settled in Vancouver and, to a lesser extent, Toronto. They brought billions of dollars worth of investment funds with them; for example, between 1981 and 1983 alone, Chinese immigrants invested $1.1 billion dollars in the Canadian economy.

Lest we forget, America was built on immigrants; we should be doing everything in our power to retain the best and brightest of those who come here to study, rather than seeing them slip away, like so many sea turtles washed up on the shore.

Where's the Stimulus for Healthy Living ed?

Of the $787 billion promised in the American Recovery and Reinvestment Act of 2009 (ARRA), $147.7 billion is earmarked for healthcare – but of that, only $1 billion is targeted for Prevention and Wellness. Granted, this is probably about a billion dollars more than has been targeted by previous Administrations, but I still can’t help feeling it’s like we’re funding a nation of body shops without first teaching our residents how to drive. What we need is “Healthy Living ed.”

There’s common agreement that over 70% of what we spend in healthcare goes to the treatment of chronic – largely preventable – diseases. I loved the Daily Dose posting on April 27th by Dr. Murati, where he recommended that we “hire retiring Army, Navy and Marine personnel to become drill instructors in every public school in this country, and mandate every institution getting even a penny of public funds to enforce an hour of rigorous mass physical education from K-12.” The result of which would be: “a fitter, less fat, sharper, smarter next generation.” He goes further to say, “We have lost over two generations to sloth and obesity….Poor health and fitness robs us of the opportunity to be productive workers.”

Of that Stimulus Prevention and Wellness billion, the ARRA devotes $650 million to "evidence-based clinical and community-based prevention and wellness strategies…that deliver specific, measurable health outcomes that address chronic disease rates." This is the moment for anyone who has developed a program to Keep America Healthy to file a grant proposal!

Our Member, Jim Kovach, MD, JD and former NFL 49er, described the “healthy aging” potential curve to me this way: “typically a male reaches his peak fitness at age 28, so his ‘life fitness’ curve looks bell-shaped; the objective is to ‘square the curve,’ so that once the ‘peak’ is reached, it’s basically sustained, until a relatively sudden drop-off at the end of life.” Just looking at the British EPIC study on longevity*, it doesn’t take much effort to make a huge difference in the quality and quantity of life. The longitudinal Study found that just four things – not smoking, physical activity, moderate alcohol consumption, and eating five servings of fruit or vegetables a day – resulted in an average of 14 more years of life. So, where are those “Healthy Living ed” schools now?

*Read more about the EPIC study here

The Government is Listening

Remember way back in 1993, the last time Healthcare Reform was seriously discussed in Washington, DC? Hillary Clinton and Ira Magaziner locked themselves in rooms with ultimately 630 wonks and “representatives of the healthcare delivery system,” broken down into 34 working groups. And, on November 20th, they delivered to Congress the 1,342-page Health Security Act, a bill that ultimately was regarded as a turkey, rather than a cause for Thanksgiving. Not only “Harry and Louise” didn’t like it, lots of other constituencies found it distasteful enough that it just faded away. (All of this – and much more – is detailed in Tom Daschle’s excellent book, CRITICAL: What We Can Do About the Health-Care Crisis.)

Flash forward 16 years, and the new folks on the Hill are once again talking about Healthcare Reform, but this time they’re listening, too. The Federal Coordinating Council for Comparative Effectiveness Research held its first "Listening Session" on April 14th, and has two more scheduled for May, so they’ll be able to compose their official “wish list” (due June 30th) regarding the priorities for Comparative Effectiveness Research. The $1.1 Billion set aside for this research was one of the first manifestations of the Recovery Act. Rapid-fire appointments of 15 government and policy officials were made to the Federal Coordinating Council for CER, who have been tasked to:

1. Conduct, support, or synthesize research that compares the clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, disorders, and other health conditions.

2. Encourage the development and use of clinical registries, clinical data networks, and other forms of electronic health data that can be used to generate or obtain outcomes data.

In reading White House Advisor Zeke Emanuel’s book, Healthcare, Guaranteed: A Simple, Secure Solution for America (available at Amazon for $11.66, or synthesized in a speech to the Commonwealth Club: http://fora.tv/2009/01/08/Zeke_Emanuel_Scrapping_the_Health_Care_System), and other pronouncements from the White House, Comparative Research will change everything. First of all, to compare you have to have data, and to have data you have to store it, preferably in Electronic Medical Records, so the data can be aggregated, and ultimately determinations made about what truly are the superior approaches and technologies that drive the best outcomes.

Since they want to hear from you, if you want your viewpoint heard, here’s the place to keep abreast of the next “Listening” date: http://www.hhs.gov/news. And, if you want to hear what was already shared on 4/14, here’s the place to watch or listen in: http://nmr.rampard.com/fcc/20090414/default.html. What a difference 16 years makes!

Next thing you know they’ll even decide, for all of us, how to spell health care, health-care, I mean healthcare!

Smaller is (Oftentimes) Better

Traveling up and down the Coast carrying a 11.5 pound laptop/power block, had really become a drag. After all, the darn thing weighs about 10% of me, and I swear it’s given me back problems from trying to hoist it into the overhead compartment – along with the rest of my travel gear. So when at last Friday’s San Gabriel Valley ABL Round Table, Dave “Mr. Gadget” Berkus displayed his new Acer Aspire One 10.1” Notebook computer, I knew I had to have one. Sure enough, the very next day, there it was at Costco – not even with the other computers, but next to the TurboTax and specialty items. So at $349.99, I grabbed the card to get one. (In fact, while I was studying the model, and reading the card, two other customers picked up their cards to carry to the cashier, too.) Once home, I started making the comparisons: indeed, block-and-all, it weighs 3.5 pounds. The idiot-proof directions had even me setting it up and using it within half an hour. Then, the acid test: how well did it work with my Round Table projection unit? It was even better! And, at the airport (where it typically takes me nearly 10 minutes from plug-in to Remote Desktop ready), I was operational within 2 minutes, max. Frankly, this may be the first product endorsement I’ve given here, but, in the realm of sharing “best practices,” this one’s definitely life changing, at least for me!

A second tribute to “smaller is better,” is what changing infrastructure allows you to do with it. A number of years ago, at a “creativity conference,” I came away with a new appreciation for how the ubiquity of bottled water made Crystal Light’s “On the Go” packets a run away-success – just add to water to make instant Peach Tea, etc. Now, once again, “infrastructure” evolutions have changed the way we get entertainment.

Enter Redbox, the DVD vending machine. When home videos typically came in a 7.5 x 4.25 x 1” box, you had to go to Blockbuster to pick them up. What vending machine could have handled anything that large and bulky? Then, Netflix came along and mailed you your DVD in a 8.5 x 6 x 1/16” envelope – better than schlepping to Blockbuster, but you still had to wait for it to come in the mail. Now Redboxes, which have popped up our local Wal-Mart and Albertsons – and in nearly 13,000 other locations across the country, are filling our “gotta have it now” fix by vending 5-3/4 x 5 x 1/4” packaged current releases. Redbox epitomizes the convergence of technologies: small format entertainment, sophisticated (very small) bar-coding, and a vending machine that appears to contain a store-full of a broad-gamut of DVD offerings – that can be reserved online, and returned anywhere, for just $1 a day. At first, the Redbox at our local Albertsons was a curiosity, now the line for it is typically at least three customers deep.

So the question is: what amalgam of technologies and needs can you bring together? Particularly if it’s better, faster, cheaper and smaller, there could well be a market hungry for it!

mHealth: When Healthcare's In Your Pocket

Twelve years ago, as I taxied from Queen Alia International Airport for 20 miles into Amman, Jordan, I was struck by the numerous billboards, seemingly one after the other, promoting cell phones. When we arrived in the capital my first question was: Why?

The answer was, because few Jordanians had landline phone service, so cell phone technology was bringing them telephonic communication for the first time. According to our Member, Ed Buckley, a native of South Africa, this story is repeated throughout the third world.

So what does that have to do with healthcare? Perhaps everything.

According to HHS-funded researchers, only 1.5% of nonfederal U.S. hospitals use a comprehensive electronic health record system. Why? At least one reason is they’re really expensive, and take a long time to implement. Yet, since 2007, more than 170 smartphone applications for healthcare professionals have been developed. Perhaps only 1.5% of the hospitals have EHRs, but 54% of physicians own smartphones or other handheld devices. And, today, more medical schools are requiring students to use PDAs, too.

At UCLA Med Center, for example, they’re piloting a mobile, wireless patient information retrieval system that gives physicians instant access from throughout the hospital and around the world to real-time patient data via wireless PDAs and cellular smart phones. Elsewhere, mVisum’s Medical Communication System provides a secure, HIPAA compliant means of sending medical data, including EKGs, medical images (including ultrasounds, CT scans, MRIs, X-Rays, etc.) directly to the physician's phone -- anytime, anywhere.

And, then there’s the iPhone. The iTunes online storefront, which lets independent developers sell applications for the iPhone, now has over 15,000 aps that have resulted in over 500 million downloads. Among them: the Healthcare & Fitness category has 745 options, including My Life Record, which – for $49.99 -- lets you manage and access medical records, including doctor information and images such as X-rays, ultrasounds and electrocardiograms. The company says it uses industry-standard encryption to keep the data safe.

With thousands of developers working on ever-more sophisticated mHealth tools, the health IT landscape is beginning to look a lot like Jordan’s cellular revolution.

A Not-So-Misguided Youth After All

I used to be concerned about kids spending so much time playing video games, nimbly moving their joy sticks as they simulated flight. But then I had the opportunity to see – and use – Intuitive Surgical’s daVinci unit. This impressive system “combines superior 3D visualization along with greatly enhanced dexterity, precision and control.” Now, doesn’t that sound like gamer copy?

At over a million dollars, the daVinci is no toy. It’s most commonly used for prostatectomies, cardiac valve repair and a range of other delicate surgical procedures. It has four robotic arms, three of them are for tools that hold objects, like scalpels and sutures, and the fourth “holds” a camera with two lenses that gives the surgeon full stereoscopic vision from the console. With your head buried in something that feels like a snorkel mask, you “control” the robotic arms that actually do the surgery. As you can see from the picture, the guy in green at the console is the surgeon. The fellow draped in blue on the table is the patient – whose surgical site is several feet removed from the doctor. Oh, and somewhat like an organist, while the surgeon is maneuvering two of the arms with “hand controllers “ – actually more like pincher fingers, he’s moving the other two arms with foot pedals.

At the UCI University Hospital VIP opening, where the guests were treated to this experience – trying to suture some plastic globes on the table, we universally came away in awe of the wizards who are wielding over a thousand of these systems worldwide. And, we were told, the docs who played with joy sticks in their youth are indeed the ones who most readily adapt and skillfully use this amazing, technology-enabled, minimally-invasive, surgical-wonder machine.

The Third Option in Labor Relations

Tuesday was a significant day in California Healthcare Labor Relations. First, the six-week old National Union of Healthcare Workers signed up their first members: 350 nursing home workers at four North American Healthcare skilled nursing facilities. And, second, they did so using “Majority sign-up” – a process approved by the NLRB that allows workers to choose their union directly, without a secret ballot election, if the employer agrees to this process, according to the Sacramento Business Journal.

For over a year, subscribers to the labor-friendly Los Angeles Times have been reading about the mounting power struggles, financial wrongdoing, and corruption going on within the Service Employees International Union-United Healthcare Workers West, frequently on page one. Finally, according to the Sacramento Business Journal, national SEIU president Andy Stern gave Sal Rosselli, the head of SEIU-UHW an ultimatum: “Agree to support the transfer of 65,000 nursing home and home care workers out of UHW or face immediate takeover and expulsion of the local leadership.” Rosselli balked, and five days later Stern fired him and other senior leaders on January 27, 2009. The day following his firing, Rosselli founded the National Union of Healthcare Workers, and began circulating petitions seeking elections to fire the old union and bring in the new.

Fast forward a month: the National Labor Relations Board put all work site elections on hold so it could investigate the unfair labor charges filed by SEIU – blocking 20 petitions for elections. Among the contracts blocked was one for CHW, covering 14,000 employees in 30 facilities statewide. Although a tentative agreement had been reached as early as October 12, and its ratification announced on October 31, 2008, a final “settlement agreement” wasn’t signed until January 28 – the day NUHW was formed. Since labor law bars new elections when a contract is in place, the NLRB’s Joseph Norelli’s decision to dismiss NUHW’s petition for new elections at CHW, announced March 18, was significant.

Meanwhile, on March 3, according to the San Francisco Business Times, the trustees of SEIU-UHW filed a lawsuit against Rosselli seeking a court order to stop him from “obstructing the trusteeship and using or destroying union property.” And, after the NLRB ruling, an NUHW leader declared, “What the letter demonstrates is that SEIU and CHW are in bed together to deny workers at CHW the opportunity to select a union of their choice.”

So why is all this important? While UHW may say “they’re focused on protecting our member’s jobs, their wages, their pensions and their health care,” the rank-and-file members know otherwise, and some are creating new unions, like the Caregivers and Healthcare Employees Union, that will only charge “1.83 hours pay per month,” compared to “2.1% of gross monthly pay” that SEIU extracts. Majority sign-up just requires the majority of the employees signing a petition – without a secret ballot, and according to the Sacramento Business Journal, “the controversial legislation dubbed the Employee Free Choice Act would give all workers the option of forming unions this way.”

Beyond SEIU and NUHW, there is a third option: no union. If workers really believed that their employers had their best interests at heart, and they could take home an extra 2.1% – why wouldn’t they? While the unions are busy fighting each other, this could be the prime time to start making the third option more attractive. Because once EFCA is in place, the employer will have no choice.

Transition of an Era

For the past 14 years, one of the most exciting – and loudest – tourist attractions in San Francisco has been the 45,000-square-foot Virgin Megastore. Truly living up to its name, the store spread out over three floors with awesome displays of DVDs, CDs, books, apparel, and even vinyl records. And now it’s all up to 40% off. This retail fixture at the corner of Market and Stockton, not far from Union Square, will be closing next month. In fact, all but three of the one-time 23 stores in the chain are closing. But the closures are less a casualty of the recession, and more emblematic of a time that’s quickly passing: when people actually bought CDs and DVDs on discs – before iTunes, downloads, Netflix, and pay-per-view changed the home entertainment marketplace.

Ironically, at the same time the San Francisco Virgin Megastore was opening, in 1995, Jeff Bezos was taking Amazon.com online, first selling books, then CDs and DVDs. Since then, the Internet has enabled the “disintermediation” of some industries, like travel; while also providing a conduit for its “surfers” to morph into “social networkers,” and online purchasers of …everything.

Yet, the closing of Virgin Megastores does not signal the end of retailing – the Apple Store across the street is thriving. But it is a reminder that technology can and does enable consumers (who drive 70% of the economy) to change the way they learn about, “try out,” and actually purchase goods and services. And some of those changes are mega.

The New "3i's of Healthcare"

Earlier this week the Federation of American Hospitals held their annual meeting in Washington, DC. Among the Congressional speakers addressing the gathering was Sen. Mark Warner (D-Va.), billing himself as the troika’s “bipartisan radical centrist.” Addressing the Obama Administration’s goal of universal coverage, according to Modern Healthcare’s “Daily Dose,” Warner said it must be put in the context of the $2.4 trillion the CMS estimates was spent on healthcare last year in the U.S. Bottom line: the Administration is not looking to disproportionately reduce the amount the Government spends for healthcare; it’s looking to reduce the total amount spent on healthcare.

To this end, Warner said, “providers must be prepared for the “three I’s of healthcare reform: infrastructure, information and incentives.”

Clearly, the $18-20 billion specified in the Stimulus package for healthcare Information Technology is a major stake in the ground for Infrastructure. To quote from the Stimulus Bill itself: “To save not only jobs, but money and lives, we will update and computerize our health care system to cut red tape, prevent medical mistakes, and help reduce health care costs by billions of dollars each year. $2 billion in this bill, and $20 billion overall, for health information technology to prevent medical mistakes, provide better care to patients and introduce cost-saving efficiencies.”

“Information,” according to Warner, is “using those systems that determine what works clinically and to measure it.” Again, the recovery package includes “bill language establishing the Federal Coordinating Council for Comparative Effectiveness Research to coordinate comparative effectiveness and related health services research and to advise the President and Congress on strategies with respect to the infrastructure needs of comparative effectiveness research within the Federal government.” Already Senior Advisors to the Administration, like Ezekiel Emanuel, MD, PhD – brother of President Obama’s Chief of Staff, Rahm Emanuel - are positing that “technology assessments might determine whether a technology is covered by insurance at all, covered but with different copayments, covered with the development of new evidence, or linked to reimbursement to providers.”

And, third, Incentives. Next week IHA will host its fourth annual Pay-for-Performance Summit. Through its California P4P program, the country’s largest, the State’s health plans paid out over $210 million in the program’s first four years. And, according to the March 5th issue of H&HN, “The 800-pound gorilla in payment policy, the Centers for Medicare & Medicaid Services, under congressional mandate, is devising a plan to deploy pay for performance on a broad scale by fiscal 2009.” And, for good reason: “Under the Hospital Quality Incentive Demonstration, a joint effort between CMS and Premier Inc., quality indicators for 260 participating hospitals rose by 11.8 percent over two years.”

So, in the ever expanding lexicon of healthcare abbreviations, make note of the latest: “3i.” For infrastructure, information and incentives are where the emphasis – and the money – will be, at least over the next four years.

Tough Times Stimulate Collaboration

Both of the “Technology Trends” reported in this issue reflect a spirit of collaboration. First, the GSM Association – a global trade group representing over 850 GSM mobile phone operators across 218 countries – has convinced the mobile phone manufacturers to standardize on their charging interface. Anyone who’s ever bought a new cell phone knows that’s just the beginning. Next come the chargers for home, office and car, all of which add to the “total cost of ownership” and – until now – would be worthless with the next phone upgrade.

The second collaboration “trend” is among the major search engines: Google, Yahoo and Microsoft. They’ve mutually agreed to another new standard, one that will simultaneously allow Web publishers to remove duplicate pages from their sites, while enabling search results to be more comprehensive. Even though Google figured out how to do this, they’re sharing their invention with their two largest competitors. And, it sounds like we will all win in the process.

The key to making collaborations work in any environment, according to the ABL Organization’s Bob Kelley, is “priority mutual benefit.” Bob credits the concept to Jordan D. Lewis, author of Trusted Partners: How Companies Build Mutual Trust and Win Together; Partnerships for Profit: Structuring and Managing Strategic Alliances; and Connected Corporation: How Leading Companies Manage Customer-Supplier Alliances.

While most of Jordan’s corporate examples of Collaboration are between MegaCos, in the wake of the Internet era, far more examples of collaboration are abounding – many of which don’t even have a profit motive. In recent years two new forms have specifically emerged, notes Wikipedia. The first is “commons-based peer production,” a term coined by Yale's Yochai Benkler to describe a model of economic production in which the creative energy of large numbers of people is coordinated (usually with the aid of the Internet) into large, meaningful projects, mostly without traditional hierarchical organization or financial compensation. Among the most notable of these are Linux and Wikipedia itself. The second, Mitch Kapor, of Lotus 1-2-3 fame, dubbed “massively distributed collaboration,” describing an emerging activity of wikis and electronic mailing lists and blogs and other content-creating virtual communities online.

The bottom-line: Synergistic, collaborative strategies that can save common customers time and/or money can result in triple wins during these challenging times

CEOs: “Upgrading Talent in a Down Economy”

At this week’s Healthcare Device/Tech Round Table, Buster Houchins and Tom Koch, respectively the Lifesciences Practice Leader and Partner of CTPartners, led a presentation/discussion on “Upgrading Talent in a Down Economy.” As always, the session was greatly enhanced by the Members’ real-world/right-now experiences. These are just three of the many highlights of the discussion:

First, in any economy, the employees who are most engaged at all levels are the ones who understand the Company’s vision and plans. Several ABL Members cited making the rounds of all their employees in sub-unit groups within every two-month period to openly address their questions and concerns. Others agreed: “on-boarding” is not the role of HR; rather the CEO and all the other “touch points” of the organization should be responsible for sharing the Company’s “lore and history” with new hires – so there are no inside jokes or “we/theyisms” (along the lines of “they weren’t here at the beginning when it was really tough”).

Second, it’s critical to keep employees in the know about both how valuable they are to the company - advising the “keepers” that you really want them on the team through thick and thin, as well as the reality of the business. If things are down, off-plan, etc., keep the team informed of the negatives – but let them know what you, as their leader, are doing about it. In the absence of information, the “water cooler grapevine” will take over, and that message will undoubtedly be much worse than the reality. And, unless they know they’re keepers, the best people will be those most vulnerable to recruiter’s calls.

Third, this is a great time to upgrade talent. Using Brad Smart’s (and GE’s) TopGrading “20-70-10” approach to sorting of A-players, B-players, and C-players, there’s really no excuse for keeping “C’s.” Of course, this requires a forced ranking of all employees, at all levels, including the C-suite. With a number of companies RIFing entire divisions, let alone departments, today is indeed a “candidate-rich” environment. Unfortunately, sorting the wheat from the chaff does take more time now. Thus, it’s more important than ever to be very clear on your “Requirements List,” to ensure you’re hiring only “A’s.” To ensure this, Tom shared the importance of tying every capability to what the candidate has actually personally accomplished previously, using the acronym SPAR: over-viewing the SITUATION, identifying the PROBLEM, describing the ACTION taken, and RESULT achieved.

In any environment, having a great team is a Company’s most important asset; in this one, it’s critical.

What Are YOUR "Five Questions"?

In flying back to Southern California following the launch of our second Northern California Healthcare Round Table, I had the luxury of reading The San Francisco Chronicle cover-to-cover. My greatest take away was a comment in Kathleen Pender’s “Net Worth” feature in which she quoted Adam Lerrick, an economics professor at Carnegie Mellon University. Speaking about Timothy Geithner’s market-tumbling testimony to the Senate Banking Committee, Lerrick says Geithner failed to answer five questions, at least to Wall Street's satisfaction: "What is he trying to do? How is he going to do it? Why is it going to work? How much is it going to cost? Where is he going to get the money?"

It struck me that providing compelling answers to a slightly modified version of these five simple questions is really the essence of every great elevator speech:

- What does your product or service do? – ideally that’s unique
- How does it work? – preferably better, faster and/or cheaper
- Why does it work better than any alternative? – what’s its “secret sauce”?
- How much does it cost? And, particularly now, why that’s a bargain
- How can they pay for it? – ideally, with optional terms

You may not be up against the Senate Banking Committee, but in this market, you might as well anticipate that closing The Big Deal can be just as challenging. So it’s well worth the time to determine in advance what the “Five Questions” likely to come from the other side of the table most likely will be – and be prepared with the answers that will motivate them to act most expediently.