Navigating today's risky healthcare highway
For those of us old enough to vaguely remember life before prospective payment, it is easy to understand why cost-plus reimbursement might be described as the “good old days.” Like a leisurely drive on a straight country road, if you paid attention, maintained a reasonable speed, and navigated the occasional slight curve, you were fine.
Changes that began in the 1990’s significantly changed the landscape. Comparable to a multi-lane freeway, the speed of change increased significantly. Dramatic shifts in hospitals’ relationships with physicians, managed care constraints and increasing risk in payer reimbursement models were like the vehicles coming on and off freeway access ramps. If you made adjustments as necessary, and adapted to the changing traffic flow, you survived.
But like driving the dramatic, curve-filled Highway 1 along the rocky Pacific Coast, today’s healthcare roadway is filled with significantly more risks – as well as potential rewards. Leaders who are in the driver’s seat of provider organizations must pay much more attention to the speed with which they implement major changes to be sure they don’t lose key constituencies along the way.
Think of it this way: if we were driving a small, high-performance sports car we could zip through the hills and curves on Highway 1 easily. But large, complex provider organizations with many constituents to bring along handle more like a Greyhound bus. If we take the curves too fast before our staff, physicians, Board members and patients understand both the “why” and “what” of major changes, we risk careening off the cliff into a devastating crash.
Given the altered terrain, following are key ideas to consider when navigating today’s risky healthcare highway.
Collaborative planning is essential
Gone are the days when a small group of executives could craft strategic plans in isolation and still successfully implement new initiatives. Today, the strategic planning process is more important than the document it produces, giving key players opportunities to both weigh-in and buy-in to critical changes in care models, cost management and clinical service line development.
Education is vital
The economic issues facing healthcare over the next decade are daunting, so it should come as no surprise that many of the changes proposed to lower costs and deliver higher quality care are extremely complex. For Board, health system, and physician leadership, a solid understanding of the incentives and risks associated with new care models is critical to crafting appropriate responses and gaining support for significant change.
Transparency has never been more important
When key partners feel as if they have been left in the dark regarding new strategies, initiatives have very little chance of succeeding in the long-term. While it may require a greater investment of time in the early stages, transparency builds the trust that is absolutely essential. Developing innovative care models that will be successful from both clinical and financial perspectives is not possible without a commitment to transparent processes and communication.
In an environment as complex and changing as healthcare today, it is unwise to abruptly step on either the brakes or the gas pedal; the former risks being run over by competitors while the later risks moving beyond the organization’s capacity to manage change and bring along key constituents. Smart, strategic organizations pay attention to adjusting their pace to appropriately respond to both the anticipated as well as the occasional unexpected curves in the road ahead.
In her remarks at the ninth annual
It was almost nine o’clock in the evening when I finally arrived at my hotel from a long day of meetings and travel in preparation for the full-day workshop I would lead the next day. I was tired, but I was also hungry. I asked the front-desk clerk as I checked in if there was a place nearby where I could still get a quick bite. She pointed across the lobby and said, “I think Joan over in the bar can still get you something to eat.”
I frequently joke with those that I work with that my dream job is to be the “Vice President of Big Thinking.” It would be great to have the time to take all of the complex issues we are facing in healthcare, sit in a room and come up with big ideas and big solutions. Unfortunately, I have not yet been able to find an economic resource willing to sponsor my dream, if not imaginary, job description. Here in the real world, it seems as if the dilemmas we are facing in healthcare- reimbursement, quality, access, legislation - are closing in on us from all sides and with no real solutions in sight and no time to take them on.
Several months ago, I committed the mistake that strikes fear in the heart of every businessperson who is a frequent flyer: I missed a flight. No bad weather. No huge traffic jams on the way to the airport. I simply had in my mind that the flight left one hour later than it actually did. I glanced at the Eastern time zone label on my Outlook calendar instead of the Central time zone.
This past weekend, I got to do something I truly enjoy. My tried and true 2007 Avalon was groaning and moaning a bit more than in days past, so I decided it was time to take the dive and go buy a new car. Unlike many people, I actually enjoy the car buying process. I don’t know if it’s the thrill of the hunt, the joy of seeing all of the new bells and whistles, or just the simple pleasure of that “new car smell.” I enjoy it all. After driving the requisite number and style of cars (sports cars, luxury cars, even an SUV), I settled back in to my comfort zone with a brand new shiny Avalon. Just like my 2007 model, this new Avalon still seemed to fit my tastes just fine.
On one of my many road trips recently, I pulled over at a rest area for a brief stretch and caught a glimpse of something I’d never seen before. It almost felt as if I was getting to see the proverbial “man behind the curtain.” Sitting there in the parking lot next to me was a vehicle with an enormous and complicated camera mounted to the top – the Google maps Streetview car. Here it sat, the very low tech way that Google is creating high tech data -putting together a comprehensive map, neighborhood by neighborhood, seemingly one frame at a time by driving across country snapping pictures from the top of this simply modified car. Even though the data they went out to capture was time consuming and in small bits, their method seemed to be working.
In our conceptual analysis and debate about what really defines “patient-centered care,” healthcare organizations may be missing one of the most basic yet important issues for today’s modern family. Regardless of how compassionate, individualized and inclusive a provider’s approach may be, care is not patient-centered if it’s unavailable when the patient wants or needs it most.

