Hi, I’m Rob. I’m a Recovering Doctor

Yeah, I know I used that line once before, but it’s a special day for me today.  Humor me.  Five years ago today I earned my last money from an insurance company.  Yep, today is my five year sobriety date.

Five years.

That was before the Affordable Care Act, before the Cubs won the World Series.  Before anyone knelt for the national anthem, and if they had, people would’ve probably not minded.  It was before the election of a reality TV star to our highest office, before “fake news” became a thing (there was plenty of it, but nobody called it that).  It was before half of the rock legends died, before Anthony Wiener went to jail, back when Hamilton was a guy nobody knew much about who was on the 10 dollar bill, when the world wasn’t quite this warm, when Oprah hated me.  Actually she still does.  I’m not sure why.

I left my old practice because of “irreconcilable differences” with my ex-partners.  Instead of going to the VA, joining another practice, or moving to New Zealand, I started a different kind of practice.  My Yoda, Dave Chase (who wrote a book that you MUST read) told me about “Direct Primary Care,” where doctors don’t charge a lot, but are able to see a lot of people and give good care because they are paid by their patients.  It made sense to me.  There were a few folks doing it, and I talked to a couple (I’m looking at you, Ryan) who made it sound possible.

So I did it.  I dumped all insurance and started charging people a flat monthly fee.  People were skeptical and only my most loyal patients followed me (about 200).  It took a while, but we figured out how to make it work, and my patients figured out that this was the best experience they ever had in healthcare.

And we grew.

I added a second nurse, went through several medical record systems (even built my own) before finding one that actually focused on patients over billing.  Had some squirrels in my attic (some of them dead), went through an ice storm, a couple of earthquakes, and a hurricane.  I also got socks with llamas on them.

And here we are.  I have over 700 patients and still have room to grow.  My busiest day was when I saw (gasp) 15 patients in the office.  I still average between 9 and 10 (although much of the care we give is done via messaging or over the phone, so that number’s a bit deceiving).  I still take Monday mornings off, still get home around 5:30 most days, and still seldom get bothered on weekends.  My life is still much better than it ever was.

And there is still room to grow.

So what of my critics?  What of the people who said I was shirking my duty to Medicare, abandoning my patients, and putting myself over what was best for others?  They are idiots.  Was it truly better when I was unable to give good care to any of my 3000 (give or take) patients, or is it better when I can give excellent care to 700?  Am I truly abandoning my duty to the system by keeping people healthy, taking people off of medications, and keeping them away from ER’s and hospitals?  Have I truly put myself above others by taking a huge cut in pay and spending my retirement money?  Yeah, that last bit is finally changing, but I’ve got 700+ people who say I made the right choice (and I am still seeing old patients who finally come back to me from my old practice).

What about the criticism that says that this model can’t work in the big picture?  What about the argument that if all docs convert to practices like mine, they would not be able to meet the care needs in our country?  Again, I am actually giving excellent care to 700 patients.  That’s 700 more than I was giving good care to before switching, and 700 more than most doctors give.  And there is room to grow that number beyond 700 through increased system efficiency, use of midlevel providers, and improved technology enabling better care, automation, and better communication.

This model works.  It is able to give truly good care to people, decreasing their use of the system and dropping the overall cost of care.  Do I have proof of these claims?  No, but direct primary care has dramatically grown in popularity with both patients and doctors over the past 5 years, to nearly 1000 practices around the country.  Patients and doctors chose it because it’s better.  It makes sense.  I don’t have to waste people’s time, force them to wait in my office (my wait time still averages about 30 seconds), or spend most of my time staring at a computer screen.

So I will pick up my medal for 5 years’ sobriety.  There is no temptation to go back to my old life.  I hit rock bottom and have been actually enjoying the job of doctor.  My future is bright.  My income is growing.  My schedule still has plenty of room.  My patients are happy.  How many doctors can say that?

And we are growing.

And I am happy.

Rob Lamberts is a doctor. And he’s happy. 

 

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Big Names, Big Ideas at Health 2.0 Fall Conference

The Annual Health 2.0 Fall Conference has harnessed the creativity and passion of health care’s brightest professionals to tackle the industry’s most intractable problems and leverage technology-enabled solutions to drive more compassionate, more accessible patient-centered care.

Check out the full agenda of our eleventh show, Oct. 1-4, in the heart of Silicon Valley.

Our killer line up of speakers covers the full spectrum of healthcare, and includes:

Innovative leaders, including Jason Pyle, CEO of Base Health; Simon Kos, CMO of Microsoft; Aashima Gupta, Global Head, Healthcare Solutions, Google; Brian Otis, CTO of Verily Life Sciences; Daniel Kraft, Founder and Chair of Exponential Medicine; and Jeff Margolis, CEO of Welltok.

Policymakers, such as HHS CTO Bruce Greenstein; ONC National Coordinator Don Rucker; former ONC Director David Brailer; and former U.S. CTO Aneesh Chopra.

Patient advocates, including Dave DeBronkart (e-Patient Dave) and Patient Power President Andrew Schorr.

Representatives from more than two dozen major health systems, including UPMC, Mount Sinai, Dignity Health, UCSF, and more!

Major healthcare investors, including Providence Ventures, Merck Ventures, GE Ventures, and more!

Check out our full line up of speakers.

Limited amount of tickets are available. Register Today to secure your place at the Fall Conference-event starts this Sunday.

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Lessons From Massachusetts’ Failed Healthcare Cost Experiment

Massachusetts passed a massive medical cost control bill in 2012, a “Hail Mary” effort to make health-care more affordable in the nation’s most expensive medical market. The problems of the Massachusetts’ law offer invaluable lessons for the nation’s health-care struggles.

Driven in part by a Boston Globe investigation that exposed the likely collusion of the Partners Healthcare hospital system (including several Harvard Medical School teaching hospitals) with Blue Cross/Blue Shield, the largest healthcare insurer in the state, the law marked the biggest health reform since Romneycare in 2006. While most agree Massachusetts needed cost controls, there’s no evidence that the 2012 law has accomplished its goal—and these same failed policies have been folded into the national Affordable Care Act.

Romneycare, Massachusetts’ universal health-care law, already lacked effective rules to control the rapid growth of state medical costs. That, paired with the Boston Globe’s exposure of the likely collusion between Partners Healthcare, the largest hospital system in New England, and Blue Cross Blue Shield to raise health care payments to hospitals and doctors by as much as 75 percent, led to passage of a hefty, 349-page cost-control law in 2012. The legislation included a dizzying number of committees, an uncoordinated “cost containment” process, and dubious quality-of-care policies, like “pay-for-performance,” a program that pays doctors bonuses for meeting certain quality standards, like measuring blood pressure. These incentives might make sense in economic theory, but have failed repeatedly in well controlled studies. They’ve even created perverse enticements, such as some doctors avoiding sicker patients. The cost control law also encouraged widespread use of expensive electronic health records, even though there’s no evidence that they save any money.

Additional policies in the law are “accountable care organizations” (ACOs) and “alternative quality contracts,” programs that pay doctors for staying under an arbitrary budget and penalize them for going over it. But the best studies show, again, that these policies actually increase costs if you count the expense of implementing them. In fact, most of the hospitals in the federal government’s “Pioneer ACO” program have dropped out, including Dartmouth Hitchcock, the famous medical center, associated with Dartmouth College, that initially coined the term “ACO.”

Given the MA cost control law’s outcomes so far, we should be very skeptical about its projected savings. Suffice to say, the law is too complex, unwieldy, contrary to evidence and, worse, doesn’t have the teeth (e.g., regulating price) to enforce cost reductions among the most powerful medical providers. Nancy Turnbull, one of the architects of Massachusetts’ health reform and a member of the board of its insurance exchange, told the New York Times in 2012 that the law “was not nearly what we need to deal with the market power and the unjust price differences that result.”

So how has the law’s repeated disappointments been described to the public? Recently, a front-page, above the fold story in the Globe suggested the law resulted in a “slower rise in health spending” in 2015—which amounted to a decrease of 0.3 percent from the previous year. Researchers often doubt such tiny effect sizes and for good reason. They usually aren’t real. But even worse, the Globe’s “analysis” relies on just two data points, both from years after the 2012 law passed. Had the Globe’s story begun with data from before the law’s enactment, (see graph below) it would have shown that per-capita health-care spending growth actually increased by more than two percentage points since the policy began. This month, the Globe again wrongly reported that new data in 2016 shows the state has helped reduce health-care spending. The data from the last few years contrasts with the previous decade, when health-care cost growth had been declining steadily. Thus it’s unlikely that the tiny changes in costs from 2014-2016 had anything to do with the new cost control effort. And the average annual cost growth over the last three years is still about twice the level at the time the law passed.

This figure, with more complete data, shows that between 2002 and 2011, the year before the law, there was a much greater decline in Massachusetts healthcare cost growth—from 9 percent annual per capita growth to under 4 percent. The tiny changes in the growth rate from 2014 to 2016 (years after the law) is not evidence that the 2012 state law reduced costs, because cost growth in those years was still twice as high as it had been in 2012 and 2013.  In addition, the reporting did not even mention the start of Obamacare regulations less than two years before the MA cost control law, so it is impossible to know whether these policies caused the increase in health care costs observed in the graph. This untrustworthy analysis could fool Massachusetts policymakers and citizens into thinking that its policies were working, or convince other states to follow Massachusetts’ model.

The Massachusetts cost control law has not fulfilled its promise to “bend the cost curve.” If anything costs have gotten higher. The commission set up by the law “may encourage, cajole, and, if needed, shame [providers] into doing their part to control costs. “But this is insufficient to fundamentally change the behavior of the systems with the most market power. Charges for a single aspirin pill in a hospital can be higher than $25, but only pennies at the local drug store. It is already clear that the health care cost crisis is threatening the viability of essential government services from education to defense. To make matters worse, the state’s largest newspaper acts as the law’s cheerleader without even considering the history of health care costs that clearly shows the law’s shortcomings.

So what should be done now? In the near term, the legislature should consider much stronger cost controls that do not rely on the voluntary cooperation of hospitals or on market-based incentives and penalties. The state (and nation) must abandon ineffective, wasteful “alternative payment arrangements” that save miniscule dollars while costing delivery systems billions. Massachusetts and the nation need effective, negotiated price controls that fairly compensate hospitals but do not allow a few elite institutions to receive excessive reimbursement. But the current Republican health plan would retain all the failed aspects of Obamacare, while dropping the parts of the law that gave millions of poor Americans access to health-care.

There are better solutions: Our political system thus far has rejected government-run, single-payer systems, like the British National Health Service and Canada, but there are plenty of private, market-based models in Europe that provide better care to their citizens at half the cost. They rely on straightforward price controls, negotiated between the private and public sectors—not more failed market incentives. Germany’s system, for example, relies on hundreds of competing health insurers. The key difference is the use of medical fee schedules (price controls) that are negotiated between provider associations and insurance programs that prevent the kind of price fixing uncovered by the Globe. Switzerland has similar arrangements. The companies compete on quality of service and efficiency. Germany and Switzerland have managed to avoid most of the costly deductibles and copayments that keep health-care out of reach for ordinary Americans: no prohibitively expensive $10,000 deductibles (which is more than most Americans have in savings), as allowed under the ACA. The US could choose the best aspects of these successful plans that fit our culture and our health care environment.

Ten years ago, Massachusetts built the model for the nation’s health reform law, which then expanded health care to more than 22 million Americans and offered needed protections to America’s population, e.g., removal of pre-existing condition restrictions, free mammograms, and the ability to insure adult children. But we remain the only developed country in the world that fails to provide care to all its citizens. And we allow costs to grow at unsustainable rates. Rather than wait for the implosion of our medical system, Massachusetts must again lead by example in the nation’s polarized health reform debate—this time, by establishing affordable health-care as a right for all its residents.

Stephen Soumerai is Professor of Population Medicine and teaches research methods at Harvard Medical School.

Professor Ross Koppel teaches research methods and statistics in the Sociology department at the University of Pennsylvania and is a Senior Fellow at the Leonard Davis Institute (Wharton) of Healthcare Economics.

Marina Bolotnikova is an associate editor at Harvard Magazine.

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Graham-Cassidy is Dead. It’s Back to the Drawing Board. Why Not a Two-Tier System?

Remember back in 2012 when then Vice-President Joe Biden told us, “Bin Laden is dead, General Motors is alive”? The good old days. Also around the time Senators John McCain and Lisa Murkowski promised to repeal Obamacare. Along with a bunch of other Republicans seeking reelection to Congress.

Fast forward to 2017. The new catchphrase is “GOP is dead, Obamacare is alive.” At least their credibility is dead. Buried in the rubble of broken campaign promises. Not only Obamacare repeal, but also tax cuts, immigration enforcement, balanced budgets, reduced spending, and so on.

Repeal and replace, as a promise was simple enough on the campaign trail.  We heard this promise in 2010, when voters gave the House to Republicans.  We heard it again in 2012, when voters gave them the Senate.  Despite controlling Congress, Obamacare remained alive and well.  Candidate Donald Trump, along with most Republican members of Congress, promised repeal and replace last year.

Eight months into the Trump administration, Obamacare is still kicking. Congress had three bites of the apple this year and each time came up with a worm instead. This week was their third attempt to fix Obamacare. Not the promised repeal, instead only financial window dressing to keep Obamacare alive in some shape or form.

Graham-Cassidy didn’t even earn a Senate vote this week after three promised GOP defections. Too bad they didn’t vote. Senator Richard Shelby thought a vote was fruitless saying, “Why have a vote if you know what the outcome is and it’s not what you want.” Why? How about getting the Senators on record with a yea or nay vote? Votes that they could be reminded of during their next campaign.

Once again, the do-nothing Congress has squandered a once in a generation, or lifetime, opportunity to advance a conservative agenda. Instead after 8 months, they have little to show for their control of the executive and legislative branches of government. Obamacare remains the law of the land.

Republican lassitude is not lost on voters, as Luther Strange learned this week. Senator Bob Corker noticed too, choosing to do nothing as a private citizen rather than as a U.S. Senator. Congress may not want to repeal Obamacare, but the voters do.

Many want a simple repeal, similar to what Congress passed multiple times, certain that their virtue signaling repeal bills would be slapped down by an Obama veto. Now that the veto threat is gone, so are the votes for repeal. It won’t happen. Neither will the IRS ever be abolished, or the Departments of Education and Energy be closed. All conservative pipe dreams but far from the reality of current Washington, D.C.

Obamacare remains in a death spiral. Another year of double-digit premium increases, some families paying more for their Obamacare insurance premiums than they are for their mortgages. Not to mention rising copays and deductibles, and narrowing physician and hospital networks. All making medical care unaffordable for many Americans, even though they have insurance.

What’s next? Waiting in the wings is Bernie Sanders’ “Medicare For All” bill which has the support of 17 Democratic senators, more than a third of their caucus. On the House side, John Conyers has his own version of single-payer with 119 cosponsors, more than half of the Democrats’ House caucus.

America is already drifting toward single-payer. Medicaid, Medicare and the VA System are all single-payer health insurance plans. Or more accurately, government-run healthcare systems. Obamacare is following this path. A third of counties have only one Obamacare insurer. It’s not far from what we have now to a true single-payer plan. And the Democrats are ready and waiting to take advantage of Republican chaos and an imploding Obamacare.

Perhaps this was the plan all along. It was then Senator Obama who once said single-payer is the goal, but “we can’t get there immediately.”

If President Trump cannot get anything done with his own party in Congress, maybe he calls his new buddies Chuck and Nancy. Just as John McCain always extolls, “reaching across the aisle.”

Suppose Donald, Chuck and Nancy cook up a two-tiered system, something for everyone? A public option and a parallel private option. Just as most developed countries have. The public option covers everyone. Think of Medicaid for all. A bare bones catastrophic coverage plan available to all Americans. With minimal or no out-of-pocket costs to patients but with the tradeoff of long wait times for care and limited treatment options.

The private option allows individuals to purchase medical insurance or actual care directly, what they want and need, nothing more. Insurance without mandates and regulations. No subsidies, tax breaks or government assistance. Pure free market.

Think of K-12 schools. Public schools available without cost to all students. For most a good education. And a private school option for those who desire and have the means. Pay the private cost or default to the public option and pay nothing.

Pros and cons to each system, but both are separate and distinct, each doing what it’s designed to do. Rather than an amalgam of both systems, which is what we have with Obamacare, Graham-Cassidy, skinny repeal or whatever the witches and warlocks of Congress conjure up.

Something for both the right and for the left. Free market for the right. Universal coverage for the left. Perhaps the only way to get past the current logjam in Congress. If Republicans continue to twiddle their thumbs and do nothing, they may soon find themselves in the minority. Leaving Bernie in charge.

If the Democrats control Congress, make no mistake, they will pass single-payer. No defections. They will change procedural rules such as the filibuster if necessary. And they will accomplish what the Republicans are unable to.

In the meantime, Obamacare is alive and it’s the GOP on life support.

Brian Joondeph is an optometrist based in Colorado.

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How health IT organizations are using security as a competitive advantage

When speaking with our health IT clients, I’m hearing a distinct shift when it comes to cybersecurity. They no longer view it as an IT cost; they understand how it can facilitate growth, create competitive advantage and build trust in their products and brand.

Their executive management is on board with this thinking, too. They don’t want to hear about fear, uncertainty and doubt when it comes to data breaches, hacks and cyber threats, but rather how cybersecurity can help ‘protect the house and the product’ while at the same time enabling the business, customers and partners.

As more products and services in the healthcare continuum are connected, the need to proactively address cybersecurity increases. And as more consumer and business information is generated and shared, data privacy becomes a critical business requirement. This explains why we’re seeing forward-thinking health IT organizations moving to a new model of cybersecurity – one that’s adaptive to evolving risks and threats plus aligns with overall business objectives, such as increased revenue.

The one unifying thing we see with most health IT clients is the cloud. They need to design, build, assess, test and validate architectures and products on the cloud to confidently go to market with secure solutions. They’re finding that as they address cybersecurity in the design and development of products and services, they experience new ways to innovate and move faster. These cloud-integrated solutions can also enhance data privacy and boost customer trust and brand reputation. These are crucial safeguards as consumers are more concerned than ever about how their data is collected and shared.

Organizations aren’t waiting to hear that security program elements to demonstrate customer data protection are a requirement to closing a deal, they’re getting proactive by using cybersecurity as a sales strategy.

They know that threat actors will always be ahead with new tactics and techniques, so they’re being forced to step up their game.  It’s not just about compliance programs like PCI, HIPAA/HITRUST, FedRAMP or SOC reports that prove they’re serious about data protection. Many organizations are implementing additional security measures to ‘protect the house’, such as technical testing conducted on a regular basis to identify vulnerabilities, cyber engineering to fix identified issues, and incident response plans that are tested every six months.

So, what’s the payoff? After continuing to deliver products and services in a secure manner, customers come to trust interaction with certain companies. Security becomes part of the fabric of what these companies offer, which sets them up nicely to build trust into everything they do. And in the end, it’s a huge competitive advantage.

To learn how leading organizations are integrating cybersecurity from the outset, and in recognition of National Health IT Week, Coalfire is hosting a webinar with a panel of health IT executives who will discuss how their security programs have enabled them to better engage with existing customers, attract new ones, and optimize operations, business processes and IT investments.  For more information, or to register, visit http://ift.tt/2xEKsd1.

Andrew Hicks is the Managing Principal at Coalfire

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How Wellness Become the Wrong Word

What do employers want more than anything? Healthy, engaged, productive, energized, and thriving employees who provide great customer service and high quality products. What they have is all too often the antithesis of that.

This article is about why and how to move away from “wellness” to “wellbeing.” Wellness is one dimensional—the absence of illness. But for employees to thrive, they need so much more. The essence? They need to be happy with what they are doing and where they are doing it. Without that, good physical health, engagement, and productivity are almost impossible. It’s as simple as that, and with happiness comes success on multiple levels for the employee and the employer. And yet the all too many of today’s American employees are dreadfully unhappy with their jobs and bosses. It’s time for that to change.

The companies that successfully address the deteriorating health (both physical and mental/emotional) of their employees have a huge competitive advantage, and not just from reduced healthcare coverage, but in cultivating more enthusiastic, productive, and engaged employees which drive competitive and financial success through better products and better service.

Dee Edington confirmed this in his book Zero Trends when he wrote: “Our mission is to create shareholder value. We create shareholder value because we have innovative, creative, and quality products and services. We have innovative, creative, and quality products and services because we have healthy and productive people.”

This is, as we say in Massachusetts, “wicked important.” Yet most American CEOs do not yet see it as even rising to their level of attention. That is nothing short of astonishing given how much they pay for healthcare coverage and the truly poor value they receive in return. Starbucks pays more for employee coverage than for coffee. GM pays more for coverage than for steel. Businesses don’t realize it, but they are truly in the healthcare coverage business whether they like it or not. And that doesn’t even begin to total up the costs of disengagement, absenteeism, and turnover.

So, what about today’s garden variety workplace “wellness” programs? In fact, they haven’t worked on virtually any level. The “wellness” industry has deservedly opened itself to criticism that “wellness” investments are a waste of resources. Critics have eviscerated the industry all too often.

Typically, workplace “wellness” initiatives have been developed by HR and floated to senior management for approval with the usual justifications of reducing coverage costs and a healthier workforce. Someone in C-Suite, often NOT the CEO, might approve such proposal and its budget. In rare cases, there might even be some business plan. But little else. There are so many other things to focus on like quarterly dividends, customer relations, and the current crisis, whatever that might be.

And then the matter goes back to HR and becomes largely indistinguishable from any other employee benefit plan. Nice to have, but not strategic in any sense. HR might retain a vendor or hire wellness coaches, and may acquire programs that focus on exercise, smoking cessation, and nutrition. All good things, but not nearly enough. Employers also may do the dance of incentives and penalties, but neither result in long term lifestyle change or improved morale.

After a few years of lukewarm enthusiasm and modest employee participation, someone in C-Suite might ask about the return on the program’s investment. Unfortunately, few companies even try to measure returns, and if they did, the numbers would be indeed disappointing. Even so, shouldn’t something be done about healthcare costs? And wellness programs, whatever their returns, just seem like the right thing to do. That is indeed sloppy thinking.

The reasons why today’s workplace wellness programs have not worked are many, but the most important are: lack of strategic focus with a comprehensive approach; focus almost exclusively on the physical health side ignoring mental and emotional health; lack of CEO leadership; absence of a culture of wellbeing; and a one size fits all approach that appeals primarily to the already healthy and fit.

The stark truth is that the wellness industry has accomplished remarkably little in the areas of return on investment (ROI, which I define as reducing employee claims expense by more than the cost of the wellness programs) and long term lifestyle behavior change. To have any chance at positive ROI, the focus must be on chronic illness with a supportive culture of “wellbeing” and caring to maximize employee and family enthusiastic participation. Yet so often, it is not. Swim, gym, and weights alone won’t do the trick. Programs for smoking cessation, weight loss, exercise, and nutrition (traditional “wellness” programs), while helpful on almost any level, do not truly move the needle on coverage costs or employee engagement. They are one size fits all and quite randomly implemented.

Accordingly, it is submitted that we must move away from “wellness” to “wellbeing.” There is a world of difference between those two similar nouns. When our society and our medical profession refer to “wellness” (as in being well), what they really mean is the absence of illness, almost always the physical kind. “Wellbeing” is far broader, meaning a positive physical, mental, and emotional state. The difference is profound.

Shawn Achor in his book The Happiness Advantage underscores the importance of this point when he writes:

“You can eliminate depression without making someone happy.  You can cure anxiety without teaching someone optimism.  You can return someone to work without improving their job performance.  If all you strive for is diminishing the bad, you’ll only attain the average and you’ll miss out entirely on the opportunity to exceed the average.”

Despite abundant data from Gallup and others showing the central role of employee wellbeing (as opposed to mere wellness) in driving workplace engagement, American employers haven’t taken the cue. And Gallup has been doing this for decades!!

Gallup’s 2016 Q12 Meta-Analysis of The Relationship Between Engagement at Work and Organizational Outcomes makes it abundantly clear how engagement drives measurable and substantial improvement for “customer loyalty metrics, productivity, employee turnover, safety, absenteeism, patient safety and quality.”  According to Gallup, higher engagement means higher profitability.

And when you combine high levels of wellbeing and engagement, magical things happen. Consider that Gallup’s Well-Being Enhances Benefits of Employee Engagement tells us that the benefits of adding high wellbeing to high engagement are enormous with employees reporting:

  • 42% more likely to evaluate their overall lives highly
  • 27% more likely to report “excellent” performance in their own job at work
  • 27% more likely to report “excellent” performance by their organization
  • 45% more likely to report high levels of adaptability in the presence of change
  • 37% more likely to report always recovering “fully” after illness, injury or hardship
  • 59% less likely to look for a job with a different organization in the next 12 months
  • 18% less likely to change employers in a 12-month period
  • 19% more likely to volunteer their time in the past month

So why is a move away from workplace “wellness” to workplace “wellbeing” so wicked haahd (how we say “very difficult” in Massachusetts) to do well? There is a forest for the trees aspect here. It is so obviously the right thing to do on any business level that it is simply missed. It doesn’t sound critically important or strategic. CEOs and boards are distracted by other things and do not connect the dots between employee wellbeing/engagement and operational success. And if they do consider it, many believe that it is like curing world hunger and sitting around the campfire singing songs. After all, they can’t be responsible for what happens away from work. Yet…they can be responsible for what happens at the workplace, which is where many Americans spend more time than anywhere else and is a primary cause of stress.

Once organizational leaders and boards really, really focus on the importance of the difference between employee wellness and wellbeing, they should have an “aha” moment. Workplace wellbeing should be the​ top strategic objective of any company. Done right, workplace wellbeing must be strategically planned, staffed, and financed like any other mission-critical strategic objective. The outcomes that matter must be measured. Leadership, from top, to mid-level, to front line, must be engaged, enthusiastic, and held accountable. When is the last time a CEO was held accountable by his/her board for employee wellbeing? When is the last time organizations based a significant part of executive incentive compensation on employee wellbeing?

Whole person “wellbeing” must become a defining characteristic of the company’s culture and environment. It must become part of how organizations “do business.” And it most definitely is not too much to take on, particularly considering the potential upside benefits as outlined by Gallup.

Employees and their families must come to understand that the company invests in their wellbeing because it truly does value employees. It also happens to be both the right thing to do and very good business that will reap untold dividends.

More to come on this subject. But please, tell me if I’m wrong. And of course, why. And if you disagree with the move to the word “wellbeing,” what word would you use to be the label for what has been described above?

Jim Purcell is the former CEO of Blue Cross & Blue Shield of RI, and prior to that, was a healthcare and trial lawyer in Providence RI. Today, he mediates and arbitrates healthcare disputes, and is writing a book to start a national movement for employee wellbeing. See ReturnsOnWellbeing.com.

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Postgaming Sunday’s Graham-Cassidy Action

Another day, another draft of Graham-Cassidy. And yet another slew of special deals for Alaska, which I have criticized as unconstitutional elsewhere. Congresional Republicans must pass their recent version of Obamacare repeal by September 30 to avoid the filibuster rules that are usually applicable, and which would require a 60 vote threshold. Until then, they need only 50 of the Senate’s 52 GOP Senators to eke out a victory. John McCain has said he won’t vote for the bill; Susan Collins has said she is leaning against it. Rand Paul, after signalling early disapproval of the bill because it did not go far enough, is now negotiating with the bill’s authors to roll back even more patient protective regulations.
 
If Paul shifts, eyes once more will turn to Lisa Murkowski. In anticipation of this, news outlets are once more reporting sweeteners to Alaska that characterized earlier versions of the bill. The reporting is somewhat vague and sometimes inaccurate, so I thought a deper dive would be helpful.
 
I must caveat all of this by noting that this analysis is based on a quick read of a bill that was released just today—I welcome any corrections or additions.

* Five percent of the funds appropriated for a particular “short term assistance plan” will be distributed to low density states (with less than 30 people a square mile). (Bill, p. 7). This by itself isn’t horribly disproportionate at the moment—in 2015, these states had 3.8% of the population. But over time, as the population in some of these states keeps dipping, it will grown more disproportionate. NBC misreports, however, that 5% of all federal funds will be going to these states, which does not appear to be the case. But Alaska is one of the 9 states that benefits from this slight bump.
 
* It reintroduces (p. 22) a provision that was floated earlier, that would give a bump in funding to low density states whose healthcare costs are more than 20% of the population. This benefits only North Dakota and Alaska. The bump is proportional to how much their costs exceed the national average, so Alaska at 38%, benefits more than North Dakota, at 22%. As I mentioned in my earlier post, the argument that Alaska needs this special treatment is nonsensical. The agency is given the power to adjust the funding to take into account healthcare costs, and there are other reasons for high healthcare costs than low density. 
 
* For states that obtained 1332 waivers under the ACA (exactly two states as far as I can see—Alaska, and Hawaii) an additional 500 million dollars is made available. (p. 44).
 
* It imposes penalties on states whose costs with respect to certain beneficiary groups exceed that of the national average by more than 25%. (p. 81). It exempts from this low density states. It is likely that this benefits only Alaska, and maybe North Dakota, if it benefits anyone at all. 
 
* The states with separate poverty guidelines as of 2017 get additional federal match funding (FMAP). (p. 141-43). This benefits two states—Alaska and Hawaii, the only two states in that category. Alaska will get a bump of 25% of the average spending of the other states. Hawaii will get 15%.
 
* It keeps in place certain funding for Native Americans (p. 138). This benefits states with high Native American populations. At 16.5%, Alaska’s share of Native Americans (Alaska Natives) dwarfs that of other states. New Mexico and Oklahoma follow, with 9.5% and 8% respectively, with a few other “high percentage” states hovering at around 5%.
 
One interesting tidbit. Vox reported that states that recently expanded Medicaid under the ACA would also get additional money. I expected that this would also benefit Alaska, as Alaska expanded Medicaid only in 2015, as did a couple of other states—Indiana and Montana. But as it turns out, a state would have had to have expanded sometime in 2017 to get this perk. (p. 42).  (NB—CNN reports a 2015 cut off.  It’s either using a different version of the bill or got this wrong).

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