The Future of Healthcare Delivery: Getting Ready for Patient-Centered Care

Today the Centers for Medicare & Medicaid Services (CMS), a client, released its long-awaited proposed rule on accountable care organizations (ACOs)—the engine that will bring Medicare further into the value-based purchasing arena and hopefully spur payment innovation in the private sector.

A recent session at the Global Business Forum: The Business of Health Care: Defining the Future, held at the University of Miami School of Business, titled Patient-Centered Care and Accountable Care Organizations in an Era of Health Care Reform, offered a glimpse of things to come.

Panelists, including John Bigalke, Vice Chairman and U.S. National Industry Leader, Health Science and Government, Deloitte LLP; Delos M. Cosgrove, MD, President and CEO, Cleveland Clinic; Stephen K. Jones, President and CEO, Robert Wood Johnson University Hospital; Anthony Rodgers, Deputy Administrator, Center for Strategic Planning, CMS; and John M. Kirsner, Partner, Squire, Sanders & Dempsey LLP, agreed that ACOs are ushering in a new era of patient care. Among the conclusions offered by the panel:

1. Dramatic change is coming in how hospitals, physicians, and insurers will be incentivized. The focus will be on quality, not quantity. Some hospitals have already begun providing salaries for surgeons and physicians so that they receive the same pay regardless of how many patients they see. The government and insurers will begin increasing allocations for services to ACOs who have fewer patients returning to hospitals prematurely.

2. Electronic medical records (EMRs) mean better outcomes for patients. EMRs are a key tool in the movement to develop ACOs, as they allow providers to monitor patient care throughout the treatment of a condition or illness. Public and private payers are incentivizing the transfer to electronic medical records, providing hospitals and providers with funding and support to create a streamlined, consistent system.

3. Newer strategies for physician-hospital “alignment” will benefit all. First attempts during the 1990s to align physicians and hospitals failed because these were seen as purely economic plays without focusing on patient-centric outcomes. New calls for alignment are driven by reductions in fees from Medicare combined with a poor economy – universally accepted realities. Combine that with awareness that hospitals will become major aggregators and distributors of payments for services, and the increased desire of physicians to have control over their work/life balance, resulting in increased willingness to align.

These insights address some of the operational and strategic issues at play. But the impact of ACOs will be far-reaching, and the implications far-reaching.

What does it mean for stakeholders?
A sea-change in health care delivery such as the kind that is taking shape over ACOs, will require clear and consistent communications to a number of audiences. Patients, for instance, will need to understand the value of more coordinated care if they are to be willing participants in the process. Increased reimbursement—that is, paying for outcomes rather than volume—means little to consumers. What does matter, though, is their health. Both physicians and payers need to collaborate on communications that tell the ACO patient-centric value story.

Policymakers also have a role to play here. Throughout the health care reform debate, the Administration demonstrated its keen ability to take complex health policy issues and put them into language that the general public understands. That work must continue now, as stakeholders work to reform the way care is delivered. The more the government supports the movement toward better coordinated care, the more likely Americans will be to adopt ACOs and other models of care coordination. To that end, CMS’ newly-created Innovation Center must go beyond funding and establishing pilot programs to develop ACOs and other integrated care models. The Innovation Center also must educate consumers on the importance of coordinated care and how new delivery models will make our population healthier. Successful communications will require private-sector collaboration; there is an enormous opportunity for government and industry to work together to foster a dialogue among consumers on the importance of moving toward coordinated care models.

In addition to consumer communications, providers, payers, and government also must now give thought to how to more effectively communicate with one another. At times, the media has been used as a vehicle to influence tense negotiations between providers and insurers. The same may be said for government and those in the private industry. In order for ACOs to work as envisioned, old tensions and the tools used to stoke fires must be put to rest. If providers, payers, and government realize the advent of ACOs and other care coordination models are a win-win-win, they will work collaboratively toward shared outcomes that benefit both the patients and members they serve, as well as their own businesses.

As the panelists at the Global Business Forum noted, the future of heath care delivery holds great promise for a new way of treating the chronically ill. How stakeholders communicate this potential—both to their customers and among one another—will ultimately be critical to the success of these emerging models of next generation health care delivery.

David Sheon, who is a health and medical communications consultant, contributed to this post.

Jeff Smokler is a senior vice president in the health care practice of Powell Tate, a division of Weber Shandwick.

Transparency in the internet age

Last week, I had the opportunity to meet up with John Friedman, founding board member of the Sustainable Business Network (SBN) in Washington, DC. John has a long history of advising and communicating around issues of corporate social responsibility both in his role at Sodexo and as Board Chair of SBN. As practitioners in this field it’s always good to share thoughts and insights from those who influence the community. John is one of those people. A prolific writer and speaker on these topics, John took a few minutes to respond to some questions we posed about the importance of transparency in the Internet Age and the impact it has on authenticity in CSR. He’s discussed this topic quite a bit in his presentations at the “State of Green Business Forum” sponsored by Greenbiz.com and on Radio America. Here’s what he has to say…

What does it mean to be transparent? Companies might think that publishing a CSR report is enough but is it?

Historians will likely look back on the beginning of the 21st century as the time when the concept of transparency went main stream. Thanks to Wikileaks, with its notion of ‘forced’ transparency, the question about the right to privacy has come head to head with the right of people to know. By couching the discussion as one of moral imperative, Julian Assange has challenged the previously held notion that transparency is a voluntary activity.

Of course, there are many examples where transparency has forced organizations to accept responsibility for their actions; from troubling videos of the mistreatment of cows in the meat industry to Google Earth revealing piles of 55 gallon drums leaking industrial waste behind factories. Transparency due in part to internet coverage of the protestors in Tahrir square in Cairo may have helped prevent another Tiananmen Square massacre.

Certainly these examples demonstrate the idealistic power of transparency to address social, environmental, political and other issues. At the same time, the concept of ‘forcing’ transparency is very troubling. This is important to governments, businesses, not-for-profit organization and academia because often these institutions are careful to time their disclosures. The idea that an external organization may ‘out’ your efforts before you are ready to go public can cause problems as well. 

Organizations must now wonder if their work to develop new products for the marketplace, new services or information for their constituents or to advance knowledge might, at any time, be revealed to the public, compromising competitive advantage, and even potentially throwing the validity of research into question (such as when people in a study become too informed about the issue that is being studied.) How then to handle the new age of transparency?

The answer is that the more transparent organizations become on a voluntary basis, the less need advocates and radicals will feel to ‘force’ the issue. Many organizations already embrace the concept – such as producing annual corporate responsibility or sustainability reports or by incorporating those commitments and results within the annual reports. Some use printed documents, and many are moving the reporting onto their websites.

What's the role of social media in transparency?

In 2011, website and print dissemination often are no longer ‘enough.’ Organizations are moving toward real time reporting, leveraging the power of social media to tell their stories and announce their promises, their plans, their programs and, ultimately, their performance. 

Doing so makes sense because social media – Facebook and Twitter being prime examples – are where people come together to share ideas and express their feelings (both positive and negative) about issues, organizations, companies and even governments.

Because social media inspire and encourage debate about issues including the environment, society, equality, justice, labor relations, human rights, ethics and governance, those wishing to be part of the conversation need only to seek out and search those subjects. There they will find the voices of reason, as well as radicals. They will find those who seek to understand and build, along with those who aim to expose. And is there that the debate is happening, whether or not you choose to join it is, of course, up to the individual or organization. But knowing that the discussion is happening right now, the question one really has to ask is whether or not they are comfortable pretending that it is not happening? 

Savvy organizations recognize not only the threat of ignoring what stakeholders are saying and thinking about them (at the same time often spending money on market research to determine the same thing), but the opportunity that social media offer to serve as an early warning system offering real time feedback that is invaluable for any organization whether it seeks to produce and sell products, serve a constituency, further a cause, advance knowledge or even govern a people.

Bottom line, as communications professionals, we incorporate these best practices into our work with all organizations both corporations and nonprofits, alike, not only because it promotes transparency but also because it promotes dialogue. Engaging with your audiences is another key factor in using social media because doing so may help improve your organization. Organizations who are open to transparency will often find themselves open to improvements and what could be better than creating opportunities for constant improvements? Tell us your story about the role of social media in promoting transparency at your organization. We’d love to hear from you. 

Powell Tate bone marrow drive

Pam Jenkins

Sometimes it takes bad news to motivate us to make a difference.

One of our colleagues, Jenna Langer, was diagnosed last month with Myelodysplastic Syndrome (MDS), a blood disorder that causes bone marrow to make dysfunctional blood cells that don’t mature into healthy cells.

But there’s good news. The treatment for MDS is a bone marrow transplant, and it appears that she’s found a donor who is a perfect match.

To show our support for Jenna and to possibly provide life-saving bone marrow to another patient, Powell Tate is holding a marrow donor drive in our office next week to help build the bone marrow registry.

As Jenna points out on her blog, 93 percent of white patients find a match while African American patients have only a 66 percent chance of finding a match. In addition, Hispanic and Asian American patients also have a lower match rate than white patients. These numbers underscore how important it is for people with diverse racial backgrounds to join the registry.

Right now, thousands of patients with leukemia, lymphoma and other life threatening diseases are looking for someone to donate bone marrow and help save their life.

I encourage you to join the Be The Match Registry. It’s a simple process in which you’ll have your mouth swabbed so that tests can determine whether you are someone’s perfect match. In addition, consider a financial donation to Be The Match.

We miss you, Jenna, and we’re pulling for you!

The Great Paywall Of Journalism

Bob Brody

If we are to learn any single lesson about human nature from reaction to the announcement that the New York Times will now charge for online access, it might be this: give us something valuable for free long enough and we’ll forever after expect it to stay free. In short, we’re easily spoiled.

So suggests the latest PoliPulse findings about the controversial move. Online chatter trended heavily negative, with 18 percent complaining the paper is charging too much for online access, 17 percent unsure how the new process works, 15 percent citing too many loopholes and about 20 percent focused on sharing tips for getting stories online without paying. Only 8 percent favored the paywall. (PoliPulse is Powell Tate’s new online monitoring tool for analyzing social media conversations. Visit www.polipulse.com for more information.)

In one sense, nothing much has changed here. The New York Times remains the New York Times. Hallowed, indispensable, call it what you will. Most clients still court its reporters and covet its coverage – favorable, if you please – and most likely long will. And of course business is business. How can you make a living giving your work away?

But in another sense, the new paywall has implications that extend like tentacles throughout the print journalism universe. For starters, it runs the risk of cutting off numerous loyal New York Times readers now either unwilling or unable to pony up, rendering the paper ever-more exclusive. Consider all those college students out there who depend on it as a lifeline for term papers and doctoral theses! It may also finally embolden other major national newspapers – the Washington Post comes most readily to mind – to follow suit.

Any switch to limit access, while perfectly understandable as a financial model, also has an unwelcome byproduct. It rarifies an experience now enjoyed by all, turning a prized reading habit from a democratic right into an elitist privilege. Just when most choices for news sources are expanding exponentially, it turns out, others are starting to disappear.
 

Disaster donations

Bradley Portnoy

The outpouring of support for Japan in the wake of the recent disaster there has been incredible, whether through social media, SMS donations, or simply general statements of support. But is it possible that technology has made it too easy to donate funds in the wake of a disaster?

The effective-giving experts at the GiveWell Blog posted over a week ago that aid being offered to Japan has far exceeded the aid requested, and likely exceeds Japan's final need. With millions being pledged to the Red Cross and other humanitarian organizations, we must question whether today's tools has made it too easy for well-meaning citizens to donate in the face of a disaster.

I know that in recent days my own Facebook newsfeed has been full of friends donating through LivingSocial's donation match, which raised $2.3 million. Almost immediately after the disaster, the Red Cross announced it had raised $8 million, surely assisted by their excellent SMS (text) message program, which allows people to easily donate $10 simply by texting their short code. Global Giving's Earthquake and Tsunami Relief Fund page has over 33,000 likes, indicating a tremendous viral spread. And I personally made a donation to Direct Relief International, and appealed to friends on Facebook and Twitter to do the same. Now I think that that may have been too easy.

The unintended consequences of an excess of funding can be both surprising and frustrating. Annie Lowrey wrote for Slate that after the 2004 Asian tsunami, Indonesian groups found themselves with an excess of funding for orphanages. When parents decided they could no longer reliably feed and clothe their children, they abandoned them. If the organizations had been able to spend the money freely, perhaps more would have been allocated to food and clothing than to orphanages.

Luckily, there is a solution. Organizations such as the Red Cross can easily raise money after a disaster, but are chronically underfunded in normal times, despite continuing critical work. If you donate during a disaster, don't earmark your funds. Relief organizations can then distribute the money across issues as needed - including to disaster relief, if warranted. And these organizations can do their part to increase donation efficiency by more prominently requesting that donors not earmark their funds.

The tragedy in Japan is ongoing, but there is no reason to compound it by misallocating aid dollars that are needed around the world. I know that when the next disaster strikes, I'll make sure to think twice about where my money can best be used before opening my wallet.

Small Groups + Strong Ties = The trend toward deeper engagements and offline action

Colin Moffett

Several members from the Powell Tate team are down at the South By Southwest Interactive Festival in Austin, Texas. They'll be sharing their insights from the festival here on this blog.

I was squeezed into a crowded shuttle the other morning with a dozen or so other bleary eyed SXSW conference goers when I noticed a small group of friends sitting around me, all silently playing the same mobile game together.

This new blurred dimension is the reality for an increasing number of people. We adeptly straddle the online and offline worlds like seasoned gymnasts.

For those of us who are fans of civic participation and actual human interaction, this form of purely virtual communication can be a little scary.

That's why I was excited to see that the standout technology platform at this year's SXSW interactive festival was not only something simple that we're already familiar with, as my colleague David Leavitt points out, but something that encourages and organizes physical world engagement.

GroupMe is a group messaging app that helps you set up mobile chat groups so you can quickly and easily communicate and organize people in your networks – for example, coworkers, family or your bowling teammates. GroupMe, the most buzzed about platform at SXSW, and joins other similar SMS apps such as Beluga (acquired by Facebook) and Fast Society to help us find ways of communicating with smaller, targeted groups within our vast and disparate networks.

This is all a part of a growing trend of nurturing our connections more deeply. Chris Perry, Weber Shandwick's President of Digital Communications summed it up in his post from SXSW when he says, "Intimacy, not surprisingly, is looking to be the killer app."

This is great news to those who are looking to organize people around events and causes. Social Media has been an invaluable tool in reaching vast numbers of people and networks, but we have been longing for ways to leverage the strong ties within our networks. Those of us who help clients rally thousands of people within grassroots networks around causes in the hopes that we get 50 committed people to show up somewhere in person can take solace in the fact that the social space is trending in our direction.

GroupMe took off so quickly at SXSW because people found it useful in using the virtual world to coordinate actual physical meet ups. It allowed people to seamlessly stay in touch from afar and more quickly come back together. I talked to one person on the plane back home who said that everyone in the group they were with -- except one person -- was on GroupMe at SXSW, and they never actually ended up seeing that person.

So, don't be left out. Get on board and start using the power of the virtual world to organize people in the physical world.

Texting is the new texting

David Leavitt

Several members from the Powell Tate team are down at the South By Southwest Interactive Festival in Austin, Texas. They'll be sharing their insights from the festival here on this blog.

Most innovation in the digital communications space is about speed and size. Faster computers. Smaller computers. Mobile phones that give users access to a library of hundreds of thousands of programs.

But sometimes it's the simplest ideas that prove to be the most transformative.

The most useful products coming out of SXSW this year are among the most basic and (for the most part) use technology that was available years ago: group texting apps for mobile phones.

GroupMe, GroupedIn, Beluga and other group messaging apps, the hot trend at SXSW this year, let people create groups of friends/colleagues/family. Users can instantly share text messages, photos and even call all members of their customized group at once in a conference call.

Yes, that's it.

Sure, email accomplishes many of the same things (you can start an email conversation with multiple people, each of whom can "reply all" to the group). And email has no word-count limits or photo restrictions.

But when you're on the go and meeting friends, nothing is more convenient than texting. Especially in crowded areas with weak cell phone reception. Your message is also more likely to be read immediately via text than email – a text message is read within 4 minutes while an email could take up to 48 hours, making texting 720 times faster.

Among the youngest mobile phone users, text messaging is the mostly widely used digital communications tool. And older users are texting more than they ever have.

As a result, it's only natural that the latest trend is to nurture that love for texting with apps that help us do it more efficiently and with a richer experience.

Reflecting on Ronald Reagan’s legacy

Sheila Tate

It is always interesting to be at the JFK School at Harvard, and I was honored to be part of a panel the school held on Ronald Reagan's legacy last week.

This event was especially important to me because it was a chance to reflect on Ronald Reagan the man and tell stories from behind the scenes at the Reagan White House.

The panel represented an interesting cross section. The Reagan alumni included a former and very savvy chief of staff (Ken Duberstein) and a brilliant economic policy expert (Roger Porter) plus the reporter who covered him throughout President Reagan’s political career (Lou Cannon). And me.

I was in a unique position because I got to see the Reagans behind the scenes while serving as Nancy’s press secretary.

My takeaways:

• Ronald Reagan’s greatest strengths were his character and his ability to communicate. People trusted him and were willing to believe in him and the vision he painted for America as “a shining city on the Hill.”
• Nancy Reagan’s greatest service to the country – not her campaign against youth drug abuse, although that was a substantial contribution – was the way she helped protect the president from a variety of problems. As Ken Duberstein said of President Reagan’s interaction with his staff: “He trusted everyone and she acted as his verifier.” She had great antenna for people who were not acting in the best interests of the President. And she kept his schedule properly paced, a huge issue for any White House

Typically, staff tries to overload a president’s schedule because there is so much to be done. Nancy Reagan knew how Ronald Reagan functioned best and she helped make sure he had that kind of schedule.

She took a good deal of political heat for that during his White House years. But when Alzheimer’s disease struck him and she continued to protect him, the American people praised her for helping him be remembered as he was during his presidential years.

Are QR codes the next big thing?

David Leavitt

Several members from the Powell Tate team are down at the South By Southwest Interactive Festival in Austin, Texas. They'll be sharing their insights from the festival here on this blog.

The interactive portion of South By Southwest is under way, which means the inevitable discussion of what "next big thing" will make a splash here. After all, this festival is widely credited with introducing Twitter (2007) and Foursquare (2009) to the masses.

By now, you've probably heard plenty about QR codes, the matrix barcodes that store data (text, a URL, etc.) for camera phones to read. For example, a magazine ad that doesn't have room to give all of the information about a product can include the QR code for people to scan and learn more. But has this type of marketing hit the mainstream?

Not even close.

True, they're prevalent here at SXSW in the form of flyers, posters, billboards and even t-shirts. But even among the crowd here -- the most digitally plugged in slice of America -- there does not appear to be broad QR usage.

That said, things will change quickly. At the moment, 234 million Americans 13 and older use mobile devices and 65.8 million have smartphones. Surely the smartphone numbers will continue to climb. Have you been to a cellphone store recently? They barely even sell non-smartphones (called "feature phones") anymore.

It will take a couple more years for people to cycle through their feature phones and become equipped with the type of device that could read QR codes.

Only when we've reached that point can we can finally address the question of whether people want to scan an advertisement for more information.

Michael Stopford

Executive Vice President and Senior Global Corporate Strategist

Brian Wommack

Senior Vice President

Lance Morgan

Chief Communications Strategist