Revive


Category Archives: Revive


HIMSS 2014 Recap: What HIT Companies Can Learn From Amazon

Jeff Speer
Senior Vice President, ReviveHealth

On the heels of the forward-looking, landmark Health Affairs issue dedicated to the future promise of telehealth, a 20-year old, non-health care company (Amazon) was a frequent topic at the 2014 HIMSS Conference.

What gives?

In many ways, it’s a step forward that both providers and their technology companies spent so much time talking about Amazon, which was founded in 1994. Both parties, sometimes reluctant and frustrated partners, embraced common strategies that have taken Amazon to greatness and could propel health care forward, including: 

  1. Technology is the means, not the end. Ed Park, COO of athenahealth, said it loud and clear to a packed room of potential customers and, in a separate session on streamlining patient flow, so did Ed Ricks, CIO of Beufort Memorial Hospital and Barbara Bryan, VP at Medhost. So, is your team focused on attestation and dollars tied to meaningful use or improving patient care and experience?
  2. Innovate processes instead of automating broken ones. Conceptually illustrated with the below picture by Ed Ricks, transforming how things are done (not just what they are done with) was emphasized throughout the conference. How, when, and by whom data is captured and care is delivered are some of the elements that probably need to be assessed when bringing on new technology.
  3. Collaborating and competing. In a system as broken and complex as health care, working together, on systemic problems like data sharing and continuity of care, is the shortest (and maybe only) path to the promised land for providers and technology companies, even among direct competitors.

These themes really stemmed from one grand argument: philosophically focusing on the patient, as Amazon does its customers, is an absolute imperative for the health care industry. And there is much to be learned from other industries, which are much further ahead in pleasing the customer than health care is (by a long shot). Edward Marx, SVP and CIO of Texas Health Resources, and his team spend time with companies like 7-Eleven, P&G, and Kimberly Clark as the company strives to move from health care to wellbeing.

Pleasing the customer, whether it’s a patient or a CMIO, is priority number one. Just make sure you quickly communicate your success, internally and externally, in order to reap the full benefits and keep the momentum going. 

HIMSS 2014

Is There REALLY a Single Strategy That Can Fix Health Care?

Shannon McIntyre Hooper
Vice President, ReviveHealth 

In the midst of all the confusion and panic that is the health care industry, it’s rare for me to come across a read that cuts through the noise and makes me say, “Aha!”

But that’s what happened when I got my hands on this Harvard Business Review article entitled, “The Strategy That Will Fix Health Care.” The title alone made me raise my eyebrows and open the first page with some hesitancy and trepidation; I mean, really, could there truly be a simple strategy that can fix this mess we’re in?

The short answer is, perhaps. After reading this piece, I felt more encouraged about where we can take health care than I have in a long time.

The article starts with a simple vision that errs on the side of cliché: “We must move away from a supply-driven health care system organized around what physicians do and toward a patient-centered system organized around what patients need.” Easier said than done, right?

Hold your judgment: the article spends the next 17 pages spelling out how it can all realistically happen. This was the first time I’ve read about a full transition to value-based care and understood the role that every individual and stakeholder has to play in the process in a way that seems feasible.

The approach is outlined in six core steps, which are interrelated and should happen simultaneously in many cases:

Harvard Biz Review_6 steps for Health care

The authors argue that the transformation must come from within, since “only physicians and provider organizations can put in place the interdependent steps needed to improve value, because ultimately value is determined by how medicine is practiced.” This is advice we often give our clients when it comes to their brand, their reputation or a marketing or public relations strategy designed to either repair some damage that has been done or reposition them in the new health care landscape. Begin within, because that’s’ where all real change begins. That’s where authenticity and clarity of purpose and mission lives: within an organization.

That doesn’t mean other stakeholders are off the hook: patients, health plans, and employers are also given their share of tasks to make this a reality. And if you think that magic bullets like global capitation, evidence-based medicine requirements, or consumer-driven health care incentives are the key to the process, think again. These minute, tactical elements have distracted us from the much broader strategy shift needed for far too long.

In short, this article is worth a read by everyone interested in the health care industry. Or, if you’re a health care geek like myself, perhaps two or three reads.

Are You Telling Your Story When it Comes to Consolidation?

Brandon Edwards
CEO, ReviveHealth

Conventional wisdom says hospital consolidation leads to higher prices, and AHIP and the entire payor community has worked hard to promote that idea.  Unfortunately, sometimes the conventional wisdom is just wrong, and people are left with a distorted version of reality that stymies needed changes in the system.  That’s why the results of a recent report commissioned by the Federation of American Health Systems showing that there is no link between consolidation and high prices, is so important – it turns conventional wisdom on its head, and provides a roadmap for hospitals and health systems to tell their stories and protect their reputations.

Why is this an important story for you to tell?  There are many reasons, but we will touch on three briefly.  First, consolidation is a major trend right now, as hospitals acquire other hospitals, physician practices, and ancillary providers. That means providers need to be prepared to tell their story because so any organizations have this strategy baked into their business plans. You can’t let a communication shortfall imperil an important business strategy.  

Second, consolidation is driven by the ACA, since coordination of care and the assumption of risk based contracts with private insurance companies is driving health systems to vertically integrate like never before. There is an imperative to bring disparate groups together, and consolidation is one sure way to make it happen. This makes consolidation a business imperative as well as a care coordination imperative.  

And third, whenever issues arise between hospitals and payors during contract renewals, payors use the consolidation story line to attack and put the health system on the defensive.  As a result, hospitals often concede critical points rather than tell their story and win the argument. In that case, a communication shortfall can lead to subpar payment rates and inadequate commercial payor contracts.   

The news story that accompanied the release of the report shows how the Federation is reframing the issue, and wisely so.  Perhaps consolidation will be accurately portrayed in the media, and hospitals will take the opportunity to tell their story.  Consolidation is about survival, investment, efficiency, and care coordination. That’s the real story.

Connecting the Dots: Selfishness and The Health Care Trust Crisis

Brandon Edwards
CEO, ReviveHealth

It’s not often that I read a piece of non-health care news or editorial and decide we can’t live without saying something about it. Yet the recent Wall Street Journal editorial by Peggy Noonan spoke to me, and it seems to connect in some tangential way with the “Trust Crisis” we have diagnosed in the health care system.

Noonan (who I think I have a crush on), talks about the “destructive force of selfishness” and how selfishness is embodied in the phrase “everyone wants more.”  The article is focuses on politics more than health care, but Noonan uses an entire paragraph to highlight the destructive influence of selfishness – Obama’s, in this case – on the American health care system. She says, “There’s an increasing sense in our political life that in both parties politicians call themselves public servants but act like bosses who think the voters work for them. Physicians who routinely help the needy and the uninsured do not call themselves servants. They get to be called the 1%. Politicians who jerk around doctors, nurses and health systems call themselves servants, when of course they look more like little kings and queens instructing the grudging peasants in how to arrange their affairs.” Whether you agree with Noonan’s politics or not, it’s hard to argue with her observations.

What does this selfishness have to do with trust, and the Trust Crisis?  For one, the perception of selfishness in all corners, whether justified or not, damages trust. If you believe that your provider or business partner is selfish, you can’t trust them. If you believe that your insurance company “wants more” – more leverage, more market share, more earnings per share, more reserves – you can’t trust them. And if you believe your elected officials and your government are selfish, you can’t trust them.

The Trust Crisis between government and every health care audience – hospitals, physicians, consumers, employers, brokers, and seniors – is now well documented. There are a lot of reasons, but the consistent and massive gap between promises and performance is a major contributor. The recent Wall Street Journal article on the exchanges clearly demonstrates one of the gaps: “Only 11% of consumers who bought new coverage under the law were previously uninsured.”  The ACA promised a massive decrease in the ranks of the uninsured, and yet enrollment has been way short of projections, older and sicker than projected, heavily weighted toward new Medicaid enrollees rather than commercial enrollees, and heavily weighted toward people who had coverage and merely found new options on the exchanges after existing coverage was cancelled. Basically, the enrollment looks absolutely nothing like the enrollment we were all promised, and the projections used to justify the passage of the ACA in the first place.

Even those lucky people who find coverage after years of suffering without the protection of health insurance suddenly find they cannot prove their new coverage to the physicians, hospitals, and pharmacies taking care of their health needs. A recent New York Times article said, “In addition to the difficulties many face in proving they have coverage, patients are also having a hard time figuring out whether particular doctors are affiliated with their health insurance plan. Doctors themselves often do not know if they are in the network of providers for plans sold on the exchange.” How can you trust the health care system when you wait years for coverage, only to find that your coverage cannot be verified by the very company that sold you the policy? If you’re scratching your head, you’re not the only one.

Perhaps the greatest single opportunity in health care is establishing trust and diminishing the perception of selfishness. The right marketing communications, and the right story, can help solve that problem. Yet the right business practices are needed to build the right foundation, and marketing makes it real.

The Ingredients of Successful Negotiation: Exactly the Same in Other Industries

Brandon Edwards
President, ReviveHealth

As we covered in a recent series of blog posts, the difficult economic conditions, the pressures of health reform and government budget cuts have created a difficult environment for all health care organizations. As a result, tough and contentious negotiations between payors and providers are increasingly common.  Since we’ve been involved in more than 350 situations like this over the years, we know exactly what ingredients are required for success.  We’ve seen a consistent pattern emerging over the years, and we know that managing a successful payor issue requires five things – Clarity, Resolve, Strategy, Story, and Discipline.
 
It turns out that the same issues are playing out in other industries, and the most recent and public example is the dispute between DirecTV and Viacom that happened this summer.  In case you don’t remember, the New York Times did a great article that maps out the entire issue.  The parallels between health care negotiations and the TV providers dispute are really interesting.
 
In the DirecTV vs. Viacom issue, Viacom was “out of network” for nine days.  DirecTV wanted a “narrow network,” with Viacom content available only through its distribution and not free on Viacom web properties and other online channels (Viacom didn’t want content out there for free, either).  When Viacom went “out of network,” it continued to provide service to its customers through other “payors,” and when DirecTV tried to get its customers access to the content from other sources, Viacom turned them away.  This sounds a lot like a hospital refusing to treat Medicare Advantage members if the payor is unwilling to pay fairly.   
 
Viacom, of course, provides high quality services, just like physicians and hospitals – only it’s Nickelodeon, MTV, Comedy Central and other cable channels in this case.  It participates in multiple “payor” networks, including Dish, cable companies, and certain online pay services.  Its content has a strong reputation, and it really provides a huge part of the value inherent in the DirecTV service – just like hospitals and physicians do from payors.  In fact, DirecTV seems just like a payor.  The company extracts discounts from “providers” like Viacom and aggregates customers to perpetuate those discounts – just like Anthem, United, and Blue cross plans aggregate employers and individual policyholders and Medicare Advantage members.
 
So if you’ve endured the extended metaphor and you’re still with me, what can we learn from this?  How can hospitals, physician groups, health systems, and specialty providers exercise their own leverage and win the contract rates and terms they need to be successful?  Viacom, for it’s part, won a 20% increase in rates, according to analyst estimates based on the financial information provided by both sides.
 
First, we learned the critical importance of communication.  I know, selfishly that’s good for ReviveHealth, but that doesn’t mean it isn’t true.  In the DirecTV battle with Viacom, both sides deployed extensive PR campaigns.  Viacom tried to get people to switch to Dish, and DirecTV tried to get people to pressure Viacom to settle (and embarrass them in the process).  Your brand matters – just like the AMC and Comedy Central brands mattered.
 
Second, we learned the greater power of the group that is closest to the customer.  We’ve had DirecTV for years, and millions enjoy the convenience of the service – but Viacom’s channels are much closer to the consumer.  The same is true of payors and providers.  People may have their insurance for years, but it’s only as good (and the loyalty only as deep) as the “content” it provides – in the case of health care, that content is the provider network.
 
You may be saying to yourself, “This analogy doesn’t hold.  Employers don’t buy DirecTV for their employees.  Consumers pick for themselves, and they rarely pick their own health insurance.”  True enough.  But in a few short months, millions of people will behave just like DirecTV consumers, buying health insurance on the exchanges.  Many are uninsured today, but it’s likely that many have employer-sponsored coverage today and will soon find themselves cast into the exchanges to choose for themselves.  The power of the provider brands in those networks should drive the selection process, but we will have to work hard to make that happen.  
 
It’s important that hospitals, health systems, physician groups, and specialty providers think more like Viacom.  We own valuable “content” that people want – access to emergency care, high quality health care services, life saving and advanced treatments, highly trained and skilled physicians that people trust.  We have services carefully calibrated to community need, and new wellness and population health capabilities coming online to help employers and consumers alike in ways they don’t expect.  Hospitals, health systems, physician groups, and specialty providers are the real providers in health care, no matter what health insurance companies have started calling themselves.  
 

Five Ingredients for Successful Payor/Provider Negotiations: Discipline

Brandon Edwards
President, ReviveHealth

Discipline matters, whether it’s in sports or business or communication strategies.  Discipline matters a great deal when it comes to payor/provider issues.  Payors are disciplined communicators, and they are capable of very effective campaigns when provider organizations refuses to roll over and accept their terms.

And as we’ve mentioned, the economy, pressures of health reform, and government budget cuts have created a difficult environment for all health care organizations. As a result, tough and contentious negotiations between payors and providers are increasingly common. Since we’ve been involved in more than 350 situations like this over the years, we know exactly what ingredients are required for success. We’ve seen a consistent pattern emerging over the years, and we know that managing a successful payor issue requires five things: Clarity, Resolve, Strategy, Story, and Discipline.

This week, as we enter the final months of 2012 and the peak season for payor/provider contract negotiations, we will explore one key ingredient of success per day. Today we explore Discipline as a key ingredient of success.

Disciplined execution of the Strategy, supported by Resolve, will help you win. The best Strategy, poorly executed cannot be successful. Our approach brings together your negotiating Strategy, business strategy, and a highly effective communication strategy to help you win. Too many strategies are derailed by second guessing and worry, and we keep your plan on track with disciplined execution. No matter what the payor does, or their false promises of resolution if you will unilaterally disarm, we create the leverage and pressure you need to win – and protect your reputation along the way.

 

  • Does the hospital have the negotiating discipline to take the payor over the hurdles?
  • Does hospital leadership have the relationships in the community and the business community?
  • Can the internal PR/marketing team carry out the needed communication effort?
  • Can the organization withstand patient and physician complaints?
  • How does the hospital leverage relationships and communication channels to reach critical audiences?

 

Discipline at the negotiating table, Discipline in carrying through with Resolve, and Discipline in executing the communication Strategy will combine to create the right result.

Five Ingredients for Successful Payor/Provider Negotiations: Story

Brandon Edwards
President, ReviveHealth

Storytelling has become an important part of any corporate PR effort and reputation management strategy. Particularly in payor/provider contracting controversies, where the issues are so complicated and the details so opaque, the ability to tell your story is paramount. That’s where ReviveHealth’s expertise and experience really delivers.

And as we’ve mentioned, the economy, pressures of health reform, and government budget cuts have created a difficult environment for all health care organizations. As a result, tough and contentious negotiations between payors and providers are increasingly common. Since we’ve been involved in more than 350 situations like this over the years, we know exactly what ingredients are required for success. We’ve seen a consistent pattern emerging over the years, and we know that managing a successful payor issue requires five things: Clarity, Resolve, Strategy, Story, and Discipline.

This week, as we enter the final months of 2012 and the peak season for payor/provider contract negotiations, we will explore one key ingredient of success per day. Today we explore Story as a key ingredient of success.

Executing your strategy depends on your ability to tell your Story. The best Strategy, powered by Clarity and backed by executive Resolve, will fall flat if your Story is confusing, unemotional, lifeless or complicated. To build the right Story, we must understand the perceptions in the community, especially in the employer and broker communities. We must communicate our value, validating it with cost and quality data. We have to explain what we need, and what the payor demands in simple terms that people can understand. Then we have to go tell that Story to all key audiences.

 

  • What are the perceptions of the hospital and the payor with each key audience?
  • How do we communicate the hospital’s value to the community?
  • How do quality and cost metrics benchmark against other comparable hospitals?
  • What are the facts and how can they be explained to different audiences?
  • What is the payor demanding that can be characterized negatively?
  • What are the hospital’s weaknesses and how do we navigate around them?
  • What emotional ties can we tap into from each target audience – whether it’s community pride or service lines like OB and pediatrics?
  • What are the consequences if the hospital is out of network? Who will be blamed?

Storytelling is an art, and telling the right story brings the Strategy to life. The Strategy we build upon a foundation of Clarity and Resolve comes to life over the course of your contract negotiation as our Story unfolds. The right Story will also escalate over time, creating leverage that gradually intensifies just before the contract is signed (or expires). The right story reminds everyone why they love your organization, and why they are suspicious of their managed care provider, and who they really trust.

Five Ingredients for Successful Payor/Provider Negotiations: Strategy

Brandon Edwards
President, ReviveHealth

Preparation for payor/provider negotiations often starts with Strategy, yet our last two blog posts have demonstrated the critical importance of Clarity and Resolve as precursors to Strategy.

And as we’ve mentioned, the economy, pressures of health reform, and government budget cuts have created a difficult environment for all health care organizations. As a result, tough and contentious negotiations between payors and providers are increasingly common. Since we’ve been involved in more than 350 situations like this over the years, we know exactly what ingredients are required for success. We’ve seen a consistent pattern emerging over the years, and we know that managing a successful payor issue requires five things: Clarity, Resolve, Strategy, Story, and Discipline.

This week, as we enter the final months of 2012 and the peak season for payor/provider contract negotiations, we will explore one key ingredient of success per day. Today we explore Strategy as a key ingredient of success.

Mapping your Strategy is key to controlling the agenda of debate, and ultimately winning your negotiations. You must understand each payor’s unique playbook, determine the best approach – proactive or reactive – and determine the pivot points for escalation. The key is to engage and activate, not just to inform. Every payor situation comes down to two factors. One, how do we keep the physicians with us? And two, how do we peel the employers away from the payor? You must have contingency plans and adapt to changing circumstances, yet it’s even more important to carefully map your strategy and focus on what you want to accomplish:  

 

  • What payor are we dealing with and what does their playbook look like?
  • What unique environmental circumstances do we need to factor in?
  • What is the best approach – proactive or reactive – in this situation? What factors would cause us to change this approach
  • What are the pivot points for escalation?
  • Do we need to engage commercial and MA audiences with different messages?
  • When are we prepared to share specific language about the possibility of being out-of-network?

There are many other questions that must be asked, but this list is a good start. The Strategy will be built upon a foundation of Clarity and Resolve created in the first two steps, and it will map the communication plan for the duration of the contract negotiation. The right  Strategy will also plan for the worst-case scenario, including the messages and approach that will be deployed if the hospital is out-of-network. Proper planning will not allay all fears, but combined with the right Resolve, it reduces uncertainty and builds confidence.

Five Ingredients for Successful Payor/Provider Negotiations: Resolve

Brandon Edwards
President, ReviveHealth

The economy, pressures of health reform, and government budget cuts have created a difficult environment for all health care organizations. As a result, tough and contentious negotiations between payors and providers are increasingly common. Since we’ve been involved in more than 350 situations like this over the years, we know exactly what ingredients are required for success. We’ve seen a consistent pattern emerging over the years, and we know that managing a successful payor issue requires five things: Clarity, Resolve, Strategy, Story, and Discipline.

This week, as we enter the final months of 2012 and the peak season for payor/provider contract negotiations, we will explore one key ingredient of success per day. Today’s key ingredient is Resolve

Clarity should produce Resolve, and Resolve drives everything else. Without Resolve, the right strategy won’t be developed, the story will be hollow and unconvincing, and disciplined execution will be impossible. Resolve powers the decisions and actions necessary to hold the line against powerful payors and the strategies they employ. Ultimately, all discussion of Resolve comes down to these two questions: is the juice worth the squeeze? If not now, will it be easier in 2013, 2014, or beyond? We have every reason to believe it’s only going to get tougher and tougher. You must carefully analyze your team’s “intestinal fortitude” and examine every strength and weakness that could be exploited during this tumultuous process. You will need to ask yourself:

 

  • How much pressure can the board endure?
  • Will the CEO, CFO, and the entire executive leadership team stand behind the strategy?
  • Will board, physician, an executive leadership remain supportive if the contract ends and your organization is out-of-network?
  • Can resolve be projected to the payor every step of the way?
  • Will key employers and influencers in the community support you over the payor?

The question of Resolve is a touchy one. Every executive wants to project strength and resolve, since those are the qualities of a leader. In a perfect world, the work done to create Clarity helps the executive team and board develop strong Resolve. However, self-awareness is just as critical as Resolve. If real Resolve doesn’t exist, the organization must be able to project Resolve during the negotiations and in all communication with the payor and others in the community. Real Resolve is best, and projecting Resolve is the next best thing. If neither exists – and the latter can’t be manufactured – there may be the need for a quiet approach to settling the contract. 

Five Ingredients for Successful Payor/Provider Negotiations: Clarity

Brandon Edwards
President, ReviveHealth

The economy, pressures of health reform, and government budget cuts have created a difficult environment for all health care organizations. As a result, tough and contentious negotiations between payors and providers are increasingly common.  Since we’ve been involved in more than 350 situations like this over the years, we know exactly what ingredients are required for success.  We’ve seen a consistent pattern emerging over the years, and we know that managing a successful payor issue requires five things: Clarity, Resolve, Strategy, Story, and Discipline.

This week, as we enter the final months of 2012, and the peak season for payor/provider contract negotiations, we will explore one key ingredient of success per day, starting today with Clarity.  

Clarity requires you to know the facts about the negotiation landscape. You must assess your position, and the payor’s position, with a cold analytical eye. Ask yourself some key questions, and carefully analyze the data necessary to gain complete clarity. You must examine the tough issues, without regard to preconceived notions or internal biases, such as:  

 

  • What are the facts about the negotiation landscape?
  • How does the hospital benchmark in-state and out-of-state, when it comes to rates, costs, quality, and other factors?
  • What does the hospital need for rates and contract language?
  • What are significant issues that can be addressed that improve the contract, beyond fixed rate increases?
  • What’s driving the need for a rate increase, and how can that be explained to internal and external audiences?
  • What is the hospital’s BATNA (best alternative to no agreement)?  
  • What are the payors’ biggest priorities in these negotiations, and in the marketplace?
  • How will the physicians react, and what is in their self-interest?
  • What does the redirection analysis show?  
  • How much business can the hospital expect to keep through the ER and otherwise, if the negotiations result in being out-of-network?
  • How will cashflow be affected if the hospital is out-of-nework?

There are many other questions that must be asked, but this list is a good start.  Clarity comes first because the other ingredients cannot come together without it.  Consider clarity the yeast in the bread.