Healthcare Futurist: Joe Flower

Sharp, funny, and far too true: If airlines worked like health care.

Forward Through the Chaos: The Future Beyond Healthcare Reform

(From H&HN Weekly, November 24, 2009)

It’s not easy being a futurist, but I will make a bold prediction: no clear victory, no simple end. What we will get, one way or another, is years of turmoil, re-definitions, new rules and shifting markets—an industry under great, immediate and chaotic pressure.

This makes plotting a direction for your institution more difficult than ever. Yet the next few years will demand and reward far more active, even aggressive, tactical and strategic management than ever.

By January 1 we may have some version of a “public option” plan enacted. Maybe we’ll get insurance co-ops, or nationwide insurance exchanges, or some kind of universal coverage through mandates and subsidies. Maybe we’ll get some kind of patchwork chimera shambling mess of “reform.” Even if there is no bill at all, or even if President Obama pulls a giant rabbit out of a very large hat, still we face what the elder Kennedy brother called “a long twilight struggle, year in and year out.” This is not over and will not be over for a long time.

We are engaged in a political melee, with a wide array of interest groups willing to cry havoc and let slip the dogs for any advantage. And our institutions, at the center of all this, can too easily end up as just so much collateral damage. Institutions already reeling from the recession, the flood of uninsured, the hammered budgets, could well find themselves further hampered in their fight to simply stay alive and do their jobs.

The Future of Health Care - Is It A Rural vs. Urban Issue?

Rural vs. urban? Or something deeper? A provision in the House health care reform bill (HR 3962) instructs the Institute of Medicine to take two years to look at why health care costs so much more in some areas than in others in the last two years of life - twice as many doctors involved, days in the hospital, re-admits, and dollars spent - and make recommendations to change that. Unless Congress instructs otherwise, the IOM's recommendations are to become law. This NY Times article, and some politicians, are framing it as rural vs. urban issue, Iowa vs. Manhattan. But is it? Look at the map that goes with the article. What's up with big urban centers (and medical research and teaching powerhouses) like Boston, Atlanta, San Francisco, and Seattle, that are on the low end of the cost curve?  This is about something deeper in the structure of how you organize health care, how you compensate people, how institutions make their living. It is absolutely fair and reasonable to study this matter. We will never begin to get a handle on soaring health care costs unless we change it.

How to Mayo Up

From the American Hospital Association Weekly, 9/15/09

If you’re thoughtful, if you’re thinking about how health care in the United States actually works; if you’ve been following the bouncing ball here about why it costs so much for such mediocre results, you’re thinking: Integrate. Get the docs and the hospitals playing on the same team. Align the incentives.

If you’ve ever tried any version of this patchwork, Rube-Goldberg-style, bee-corralling exercise, you’re thinking, “Good luck with that.”

Preparing for What's Next in Healthcare

Are you waiting for the shoe to drop? The anvil to fall?  Don't.

Whether or not we're hit with "reform," this won’t be over soon, and it will affect you and your organization for years to come and in more surprising ways than you might think. 

So what do you do now to prepare? It’s time to start thinking big and deep about what comes next.

Exactly how it affects you will depend on your sector, your market stance, and your organization, but there is a lot we can say already about the economics, the organizational and market challenges you’ll face.

If you’re waiting, don’t.  It is far from too early.

Some of the affects may be subtle, some may be surprising, but most will be big. 

For a talk customized to your sector, your industry, your organization, call me, or email me at joe @ HealthcareFuturist.com.

What's the Future for Specialists?

On June 18, SunTrust Bank sponsored a webinar for its physician clients (most of them specialists), in which I discussed the future of business models and care models: How will medical specialists make a living in the future? And how will they care for patients?

I have prepared a white paper summarizing the webinar on the future of healthcare for specialists.

A recording of the presentation itself, a 40-minute audio and PowerPoint, is available here.

Time for Turnaround

(by Joe Flower, from H&HN [Hospitals and Health Networks] Weekly, 5/5/09)

“Turning and turning in the widening gyre,
the falcon cannot hear the falconer;
Things fall apart: the center cannot hold . . .”

                                            —William Butler Yeats

It must seem, indeed, to many, that we are come apart, that this great lumbering patchwork ad-hocracy we call a health system is finally and beyond rescue falling to ruin, strewing pieces across the landscape, hissing steam, groaning in the joints and couplings, its old iron wheels plowing great furrows in the sand before the last gasping halt.

Maybe. There is plenty of evidence. Hospitals across the country are skirting bankruptcy while the number of people who can’t pay is soaring. As of this writing, some 3.6 million Americans have lost their jobs (and often their health insurance) in this recession, half since last September. At a time when we are really starting to hurt for physicians (particularly in primary care), half of all U.S. doctors are planning to reduce the number of patients they see or to stop practicing entirely in the next three years, according to a recent Physicians’ Foundation survey.

There is, though, a different possibility: that eventually we will look back on 2009 as the great hinge point in the history of U.S. health care, the year of the great shift, the year when we took a new direction and built something magnificent.

I believe in this possibility. The seeds of this possibility are in the vast federal stimulus package known as the American Recovery and Reinvestment Act of 2009, and in the growing momentum in Washington for comprehensive health care reform. But they are only seeds. It will take leadership and strong forward thinking by those of us in the industry to turn the possible into the real.

The difficulties in health care—the high cost, the erratic coverage, the low quality—are all systemic. We cannot cure them by fighting symptoms, or blaming any one sector. The problem, and the solution, is not in the pieces; it’s in the relationships and connections and influences among the pieces.

What this means for providers: At the core of the possibilities of this oh-so-pregnant moment is the struggle of providers to gain control over their processes and to redefine their relationships with clinicians. Each depends on the other; you cannot do either alone.

15 Ways to Make Healthcare Cheaper - By Making It Better

I'm going to say something that may surprise you. There are lots of ways to make healthcare cheaper by making it better.  It's not like getting your fender fixed. People who use healthcare - you and me - have no way to tell what's good and what's not, or even what it really costs - all we know is that we want it to cost less, and be worth more. On the other hand, people in healthcare have no incentive for doing it cheaper - in fact, they are often rewarded for making decisions that end up driving up costs. Like when a hospital gets a new MRI imaging machine - their question is: How do we get people to use it, so we can pay it off? So of course healthcare costs too much, and gives back too little. We need to change the incentives inside healthcare - what people work for, what they actually get paid to do, and we need to bring healthcare into the 21st Century.

15 Ways: Smart Medicine

Here are three more ways to make healthcare cheaper by making it better. These three are about smart medicine.

15 Ways: Smart Medicine 2

Here are three more "smart medicine" ways to make healthcare cheaper by making it better.