Optimizing Post-Acute Care Management: Four Key Takeaways from MCG Health Experts

By Claire Thayer, August 4, 2021

Recently, MCG Health’s Suzanne Doran, Managing Editor and Emily Ferguson, Associate Managing Editor, joined us in a webinar discussion on ways to engage patients, identify social determinants of health, and ultimately improve health outcomes while managing costs.  We caught up with Suzanne and Emily on four key takeaways:

1. Do you have more than one assessment to address Social Determinants of Health?

Suzanne Doran and Emily Ferguson: MCG Health currently has 9 assessments that address Social Determinants of Health. These assessments screen for needs such as food insecurity, homelessness, and social support. Based on individual needs, a plan of care is then generated to assist the patient and care manager address any barriers to care.

2. How are Accountable Care Organizations utilizing evidence-based care guidelines to help improve quality of care for their patients?

Suzanne Doran and Emily Ferguson: Accountable Care Organizations are using evidence-based care guidelines for coordinating care for patients across care settings, including chronic disease management and transitions of care. Evidence-based interventions allow providers to focus on giving their patient the care they need, at the right time. Patient care and quality are improved as a result of evidence guiding practices to improve adherence to preventative services and reduce complications associated with chronic disease. Here are links to some real-world case studies of ACOs using evidence-based guidelines and achieving success: Delaware Valley ACO and UnityPoint Accountable Care.

3. Can you share more information on how you approach building a plan of care for patients?

Suzanne Doran and Emily Ferguson: Care planning is individualized to the patient’s specific care needs and goals in order to incorporate the patient’s personal preferences and account for the patient’s unique medical and psychosocial situation. From the individualized self-care plan, case managers can provide the patient with specific and appropriate education, support, and timely follow-up in a manner that adapts to the patient’s capabilities and needs, versus a general plan that may overwhelm the patient because it’s too much information provided too soon:

4. Tell us more about the teach-back method and best practices for initiating patient understanding using this technique.

Suzanne Doran and Emily Ferguson: The teach-back method clarifies the learner’s understanding of instructions by having the patient give a return demonstration or vocally repeat (in his or her own words) what the patient just learned to assure comprehension of material.  An example of teach-back could be having a patient demonstrate how to administer self-injections by using an insulin syringe to inject an orange. This method has been shown to be effective in discharge planning as well as the patient’s vocalization of what medications they should take, when their next appointment is, or warning signs of a problem to their case manager.

If you missed this informative webinar presentation, Populations at Risk: Optimizing Post-Acute Care Management, we invite you to watch the full On-Demand webinar video or short webinar re-cap video.

The Most Important Thing

by Kim Bellard, July 26, 2021

Jack Dorsey has some big hopes for bitcoin.  In a webinar last week, he said: “My hope is that it creates world peace or helps create world peace.”  The previous week Mr. Dorsey announced Square was starting a decentralized financial services (DeFi) business based on bitcoin, joining the previously announced Square bitcoin wallet.  

None of this should be a surprise.  At the Bitcoin 2021 conference in June, Mr. Dorsey said: “Bitcoin changes absolutely everything.  I don’t think there is anything more important in my lifetime to work on.”

I’m impressed that someone with as many accomplishments as Jack Dorsey picks something not obviously related to those accomplishments and decides it is the most important thing he could work on.  So, of course, I had to wonder: what might accomplished people in healthcare say was the most important thing they wanted to be working on?

For many these days, of course, it is the COVID-19 pandemic.For others, perhaps, it would be to address the extreme financial hardships the U.S. healthcare system can cause.  However, both the pandemic and financial obstacles contributed to, but did not cause, the big health inequities in the U.S. healthcare system.  Digital health has never been hotter. We may be in bit of a manic phase right now, but few doubt that digital health is going to be a big part of healthcare’s future. Then there’s artificial intelligence (A.I.).  No industry in 2021 can be ignoring it.

These, and other initiatives, are all important and I sure hope people are working on them.  However, I think about some other things that Mr. Dorsey discussed in the webinar.

We have all these monopolies off balance and the individual doesn’t have power and the amount of cost and distraction that comes from our monetary system today is real and it takes away attention from the bigger problems…You fix that foundational level and everything above it improves in such a dramatic way.

So, for me, the most interesting future for healthcare has to be synthetic biology, including biohacking.

Synthetic biology, in case, you didn’t know, is “redesigning organisms for useful purposes by engineering them to have new abilities,” and biohacking is doing that to your own body, usually to optimize or improve its functioning. 

Observers seem to think that synthetic biology seems to draw an edgy, counter-cultural crowd.  It’s on the cutting edge, and it, too, is getting record funding.  Former Google CEO Eric Schmidt said, at a 2019 synthetic biology conference: “What is changing the fastest right now? Because whatever that is determining the history of next year. There’s lot of evidence that biology is in that golden period right now.” 

When we start talking about “programming biology,” well, if that isn’t “weird as hell,” I don’t know what is.  That’s fun, and that’s the future.

The theme for me is to solve health issues at the source code level.  Fix things, as Mr. Dorsey said about bitcoin, “at the foundational level.”

Mike Brock, who will head up Square’s DeFi business, tweeted: “Technology has always been a story of decentralization. From the printing press, to the internet to bitcoin – technology has the power to distribute power to the masses and unleash human potential for good, and I’m convinced this is the next step.” 

I want the same for our health – use technology to decentralize, and to distribute power to the masses.  That offers the promise of taking control from the traditional healthcare structures – not relying on hospitals, health insurance companies, or even medical professionals. 

As Mr. Dorsey thinks about bitcoin, “I don’t think there is anything more enabling for people around the world.”

This post is an abridged version of the original posting in Medium. Please follow Kim on Medium and on Twitter (@kimbbellard) 

Life Expectancy at Birth in 2020: One Simple Number for COVID-Deniers

By Clive Riddle, July 23, 2021

Deniers of COVID-19's impact - sadly numbering in the millions - posted on social media in droves during the past year that COVID-19 deaths were vastly overstated because they were attributed to other actual causes of death. Countless reports on excess mortality due to COVID-19 have been dismissed by deniers as wonky number manipulation.

Perhaps the CDC’s NVSS Vital Statistics Rapid Release this month of Provisional Life Expectancy Estimates for 2020 will put things into simpler terms for such skeptics. The overall average life expectancy at birth for Americans has gone down. Life expectancy has been tracked as a statistic beyond our lifetimes, and the NVSS report has been released decades before anyone heard of COVID-19. And the report tells us that “in 2020, life expectancy at birth for the total U.S. population was 77.3 years, declining by 1.5 years from 78.8 in 2019.”

Robert Anderson, the Chief of Mortality Statistics at CDC's National Center for Health Statistics states "This is a huge decline. You have to go back to World War II, the 1940s, to find a decline like this." We downloaded the CDC historical data table for 1900-2018, and added in the new 2020 figure to produce this post-World War II chart:

Charts produced in the Rapid Release report also succinctly tell two main messages behind this drop in life expectancy: the cause of the drop (COVID-19) and the disparities of the drop (for minorities). With regard to the cause:

And with respect to changes in life expectancy by race:

Postcards From the Drug Pricing Trail

By Clive Riddle, July 16, 2021

President Biden’s recently released Executive Order on Promoting Competition in the American Economy included provisions regarding prescription drugs, first stating that “Americans pay more than 2.5 times as much for the same prescription drugs as peer countries, and sometimes much more. Price increases continue to far surpass inflation," and that "these high prices are in part the result of lack of competition among drug manufacturers."

The Executive Order:

• Directs the Food and Drug Administration to work with states and tribes to safely import prescription drugs from Canada, pursuant to the Medicare Modernization Act of 2003.
• Directs the Health and Human Services Administration (HHS) to increase support for generic and biosimilar drugs, which provide low-cost options for patients.
• Directs HHS to issue a comprehensive plan within 45 days to combat high prescription drug prices and price gouging.
• Encourages the FTC to ban “pay for delay” and similar agreements by rule.

With respect to drug pricing, its interesting that three days before the Executive Order was released, a USC study "comparing Medicare Part D prescription drug prices with those paid by Costco members finds that the federal government overpaid on roughly half of the most common generic medicines in 2018. The findings suggest that policymakers should take a closer look at the practices of intermediaries who effectively negotiate drug prices on behalf of Medicare but don’t necessarily pass on the savings to beneficiaries and taxpayers."

The study: Comparison of Spending on Common Generic Drugs by Medicare vs Costco Members, was published this month in Jama Internal Medicine, and found:

• Across more than 1.4 billion Medicare Part D claims for 184 products, Medicare plans overspent by 13% in 2017 and almost 21% in 2018 compared to Costco member prices.
• Medicare plans paid more than Costco members on almost 53% of 90-day fills analyzed in 2018. On all 30- and 90-day prescription fills, Medicare plans overpaid 43% of the time.

On the front lines of the drug-pricing front, GoodRx tracks the manufacturer drug price hikes that happen every year in January and July, and recently published  their update on July 2021 Drug Price Increases. They noted that “last July, 67 drugs increased in price by an average of 3.1%, compared to 2019, when 37 brand drugs increased by an average of 4.3%.” So far this July, they have tracked 64 brand drugs increasing an average of 3.5%; 1 generic drugs increasing 0.3%, for an overall total of 65 drugs increasing an average of 3.5%. Topping the price increase list was Zolpimimist from Aytu BioPharma at 15.9%.

For perspective on individual drug costs from a volume standpoint, the ClinCalcDrugStats Datbase  listing of the top 200 drugs of 2021 by volume is headed by Atorvastatin (cholesterol) which had 112.5 million U.S. prescriptions in 2018, at an average total drug cost of $50.97 per prescription ($1.00 per day of therapy) with covered patients paying an average $7.32 in cost-sharing. Number two was Levothyroxine (thyroid) which had 105.8 million U.S. prescriptions in 2018, at an average total drug cost of $25.14 per prescription ($0.50 per day of therapy) with covered patients paying an average $12.50 in cost-sharing.

But the high volume prescription costs haven’t been the chief driver of overall cost increases for some time. The oft-cited culprit are specialty drugs. One report, released last month:  the AMS 2020 Specialty Drug Trends Report, found that:

• Fewer than 2% of the U.S. population utilized specialty drugs
• Specialty drugs account for more than half (51%) of total drug spend
• 80% of annual medical trend increases were driven by specialty drug costs
• The top 10 Medicare Part B covered drugs accounted for 2% of all covered products but 43% of total Part B drug spending

The Necessary Insecurity of Healthcare Leadership

By Dr. Seleem R. Choudhury, July 8, 2021 

Years ago, I accepted a job even though I was told that the team I was to lead didn’t want me as their leader. During my tenure, I received anonymous threats to leave, as well as episodes of sabotage and unhelpful behavior. Despite this, I was convinced that I could win them over with my leadership skills. Instead of improved conditions, however, things got worse. It became clear that the team was just waiting for me to make a mistake. Like all leaders (and indeed all humans), I eventually did. 

Rather than having a supportive team, I instead experienced attempts to oust me from the position. It was an untenable position, and eventually I left. Afterward, many others in the organization voiced concerns that I was a victim of racism.  While it is possible that my colour may have been one strand of motivation, I believe that the deeper issue was the unmanaged insecurity of the organization’s leaders that may have driven the negative behaviors from the start.

Motivation and theory

Most professionals have their own stories of working for organizations with difficult or unhealthy leadership. In fact, being on the receiving end of negative leadership behaviors rooted in insecurity is especially likely if you are competent (Davey, 2017).

Studies have found that conflicts with leadership are a “critical driver of loss of high-performing talent” (Kutty, 2020).  Often, when faced with insecurity, individuals can become more rigid and show reduced creativity, resulting in products, solutions, or work habits that are less than innovative (Probst, Stewart, Gruys, & Tierney, 2007). The irony of these behaviors and methods intended to “re-secure” often go unchecked, which reinforces the leader’s thinking that this leadership method works (Lubans, 2007).

There are many reasons why behaviors like this continue to present themselves in top leaders across organizations and industries. I believe the main reason we continue to see insecure behavior in leadership is that we are all insecure leaders. We all demonstrate that insecurity differently through various characteristics; however, it’s how we manage that insecurity and even our awareness of that insecurity that determine whether subsequent leadership behaviors will be positive or negative.

As a leader, I often feel insecure in my abilities and position, and over the years I have learned that I am not alone in this. Firstly, insecurity is simply fear. As Arash Javanbakht and Linda Saab explain in their 2017 Smithsonian Magazine article:

“Fear starts in the part of the brain called the amygdala. When our ‘thinking’ brain gives feedback to our ‘emotional’ brain and we perceive ourselves as being in a safe space, we can then quickly shift the way we experience that high arousal state, going from one of fear to one of enjoyment or excitement” (Javanbakht, & Saab, 2017).

So, if fear leads to insecurity, then being insecure is a normal reaction. But if it is natural—even expected—to experience insecurity, then why doesn’t our culture embrace leaders who are insecure? We live in a world where we are surrounded by fear-inducing stimuli, propagated by media and our experience, to name just a couple sources. Though these fears are nearly always unsubstantiated, a fear response is tolerated because fear is part of the human experience (Holtz, 2015).  Our expectations of our leaders should be no different.

Being a secure leader is a myth. Instead, strong leaders are adept at managing their insecurities (Weber, & Petriglieri, 2018). When insecurities interfere with your leadership skills and methodology, they can become a danger to your team and your organization (Coveney, 2018).  But insecurities are not inherently threatening. Insecurity allows leaders to self-reflect by reviewing situations, rethinking a process, and shapes leaders into someone with the capacity to evolve and grow, and act in ways that are conscientious of other people’s feelings (Leonard, 2018).

If being insecure is a normal human trait that improves our thinking, makes us more empathetic, and helps us to grow, it seems one could even call it an asset, not a hindrance.  Being insecure as a leader can improve leaders by enhancing their opportunity to lead, making them more mindful of their team, understanding what needs to be done, and ultimately delivering thoughtful, high-performance results. Perhaps the realization of these assets is less commonly seen in leadership because leaders don’t acknowledge that they are insecure. Rather, they deal with their insecurities by over-managing situations or teams, or over-compensating as they try to come across as secure to their employees. 

Managing insecurity

I believe that an insecure leader is a good leader. Behaviors resulting from insecurity are a spectrum, with one side making you more aware and emphatic, and the other side making you angry, controlling, and difficult to work with.

The bottom line is that it’s okay to be insecure as a leader. It is easy to look at other leaders and think everyone else is confident, secure, transformational, and amazing, and feel that lack in ourselves, which perpetuates the insecurity. This is often because among leaders it is rare to find anyone who discusses their own insecurities openly. In many circles it is mistakenly portrayed as a negative leadership trait. Rather, acknowledging one’s own insecurity will help both seasoned and developing leaders to see insecurity as a natural part of leadership and something that must be named and managed.

At every level, good leadership hinges upon emotional health. Our integrity and our ability to be honest about our insecurities and leverage them effectively is especially important in times of crisis (Sager, 2020).  The main driver of insecurity is fear, which typically manifests in feelings of inadequacy, failure, uncertainty, resistance to change, and being judged (Morin, 2020). This list is not comprehensive, but these often appear in leaders with low emotional health and unaddressed insecurities.

The first step in using your natural insecurity as a tool to grow as a leader is to acknowledge the insecurity, and to get comfortable with feeling that way often (Coveney, 2018). The second step is understanding the source of why you feel insecure (Ball, van Dijk, & Mecozzi, 2016). The better you understand the reason, the easier it can be to overcome and leverage for the good of your organization and those you lead (Schawbel, 2013). Thirdly, get feedback from people you trust.

 The majority of management literature is focused on helping to recognize or coach the insecure leader, rather than how to harness insecurity to become a better leader.  Leadership literature negatively portrays insecurity as an all-encompassing term—either you are an insecure leader or a secure one—rather than viewing insecurity from a more humanistic perspective that permits us to experience and often times demonstrate insecurity.  If we can experience insecurity in our personal and professional lives through relationships, parenting, exams, job applications, job evaluations, or our daily work, yet learn and grow from those experiences as a “work in progress,” then we should embrace insecurity in leadership as well.

Read more from Dr. Seleem Choudhury at seleemchoudhury.com 

Resources

Ball, R., van Dijk, M., & Mecozzi, V. (2016). Fear. Thnk.

Coveney, N. (2018). Don't Let Your Insecurities Dictate How You Lead. Forbes.

Davey, L. (2017). The scariest, most anxiety-provoking bosses to work for—and how to cope with them. Quartz.

Hendriksen, E. (2018). Why Everyone Is Insecure (and Why That's Okay). Scientific American.

Holtz, C. (2015). It Is Ok to Be Afraid. HuffPost.

Javanbakht, A., & Saab, L. (2017). What Happens in the Brain When We Feel Fear. Smithsonian Magazine.

Kutty, S. (2020). How To Mitigate The Destructive Force Of Insecure Leaders. Forbes.

Leonard, E. (2018). Beautifully Insecure. Psychology Today.

Lubans, J. (2007). “I’ll Ask the Questions:” The Insecure Boss. Library Administration and Management, 21(4). 

Morin, A. (2020). Almost everyone fears they're not good enough, according to a psychotherapist. Here's how to overcome that fear. Business Insider. 

Probst, T.M., Stewart, S.M., Gruys, M.L., & Tierney, B.W. (2007). Productivity, Counterproductivity and Creativity: The Ups and Downs of Job Insecurity. Journal of Occupational and Organizational Psychology, 80(3):479 – 497.

Sager, D. (2020). The Blight of Insecure Leaders. Word & Way.

Schawbel, D. (2013). Brene Brown: How Vulnerability Can Make Our Lives Better. Forbes.

Weber, S., & Petriglieri, G. (2018). To Overcome Your Insecurity, Recognize Where It Really Comes From. Harvard Business Review.

Go Ahead, A.I. — Surprise Us

By Kim Bellard, June 29, 2021

Last week I was on a fun podcast with a bunch of people who were, as usual, smarter than me, and, in particular, more knowledgeable about one of my favorite topics — artificial intelligence (A.I.), particularly for healthcare. With the WHO releasing its “first global report” on A.I. — Ethics & Governance of Artificial Intelligence for Health — and with no shortage of other experts weighing in recently, it seemed like a good time to revisit the topic.

My prediction: it’s not going to work out quite like we expect, and it probably shouldn’t.

WHO’s proposed six principles are: 

• Protecting human autonomy
• Promoting human well-being and safety and the public interest
• Ensuring transparency, explainability and intelligibility
• Fostering responsibility and accountability
• Ensuring inclusiveness and equity
• Promoting AI that is responsive and sustainable 

All valid points, but, as we’re already learning, easier to propose than to ensure. Just ask Timnit Gebru. When it comes to using new technologies, we’re not so good about thinking through their implications, much less ensuring that everyone benefits. We’re more of a “let the genie out of the bottle and see what happens” kind of species, and I hope our future AI overlords don’t laugh too much about that.

The example that I’ve been using for years is that we can’t even agree on how human physicians seeing patients in other states via telehealth should be licensed/regulated, so how are we going to decide how a cloud-based healthcare A.I. should be?

AI is going to evolve much more rapidly than other healthcare technologies, and our existing regulatory practices may not be sufficient, especially in a global market (as we’ve seen with CRISPR). Not to be facetious, but we may need AI regulators to oversee AI clinicians/clinical support, just as we may need AI lawyers to handle the inevitable AI-related malpractice suits. Only another black box may be able to understand what a black box is doing.

I worry that we’re thinking about how we can use A.I. to make our healthcare system do more of the same, just better. I think that’s the wrong approach. We should be going to ground principles. What do we want from our healthcare system? And, then, how can A.I. help get us there?

If A.I. for healthcare is a better Siri or a new decision support tool in an EHR, we’ve failed. If we’re setting the bar for A.I. to only support clinicians, or even to replicate physicians’ current functions, we’ve failed. We should be expecting much more.

E.g., how can we use A.I. to democratize health care, to get advice and even treatment in people’s hands? How can we use it to help health care be much more affordable? How can A.I. help diagnose issues sooner and deliver recommendations faster and more accurately?

In short, how can A.I. help us reorient our health care from the healthcare system that delivers it, and the people who work in it, to our health? If that means making some of those irrelevant, or at least greatly redefining their roles, so be it.

Right now, much A.I. work in healthcare seems to be focused primarily on granular problems, such as diagnosing specific diseases. That’s understandable, as data is most comparable/available around granular tools (e.g., imaging) or conditions (e.g., breast cancer). But our health is usually not confined within service lines. We need more macro A.I. approaches.

We might need A.I. to tell us how A.I. can not just improve our healthcare but also to “fix” our healthcare system. And I’m OK with that.

This post is an abridged version of the original posting in Medium. Please follow Kim on Medium and on Twitter (@kimbbellard) 

Addressing Mental Health Requires Greater Focus on the Workplace

By Clive Riddle, June 25, 2021

Perhaps no aspect of healthcare is more intertwined with the workplace than mental health. In Health Affairs this week, Amanda Goorin, Richard G. Frank, and Sherry Glied in their post: Addressing Mental Illness Requires Workplace Policy As Well As Health Care Policy, frame a central workplace mental health issue as this:

“Nearly one in five adults, or 51.5 million people, in the United States meets diagnostic criteria for a mental illness, which can impair functioning across a spectrum of severity, ranging from mild to moderate to severe. Yet, despite advances in the diagnosis and treatment of these conditions, and considerable progress on including mental health care in health insurance, people with mental illness—including those with moderate illnesses such as depression or anxiety—continue to be tenuously connected to work and, hence, to full participation in society. Mental illnesses pose difficulties for workers because their symptoms can interfere with essential workplace skills, such as participating effectively in teams, interacting with customers and co-workers, and maintaining concentration.”

The Hartford this week released their 2021 Future of Benefits Study, stating that a “majority of employers recognize employee mental health as a significant workplace issue and report stigma associated with mental illness prevents treatment.” They found “70% of employers now recognize employee mental health is a significant workplace issue, and 72% said stigma associated with mental illness prevents U.S. workers from seeking help. Also, 52% of employers said they are experiencing significant or severe workplace issues due to substance misuse or addiction among their employees.”

Other key findings indicated that employers and workers are divided in key areas about mental health in the workplace::

• 80% of employers said their company culture has been more accepting of mental health challenges in the past year, but only 59% of workers agree;
• 79% of employers said they have an open and inclusive environment that encourages a dialogue about mental health, compared to 52% of workers who agree;
• 77% of employers said leadership at their company encourages conversations about mental health, compared to 56% of workers who agree; and
• 78% of employers said workers have flexibility in their schedule to get the mental health help they need, but just 58% of employees agree about this flexibility.

Chinese Healthcare and More with Rong Yi

by Clive Riddle, June 16, 2021

MCOL is very excited and please to be welcoming Dr. Rong Yi as a contributor to mcolblog. She is the principal responsible for Milliman’s Greater China Healthcare Analytics Practice, and will be be discussing Chinese Healthcare and more in future periodic posts.

We have just featured Rong in a new MCOL Podcast in which she provides a nice overview of healthcare in China, and how their healthcare issues and system compare and contrast to the U.S. She also provides some background on what led her on her own path with healthcare, analytics, and covering these topics in China.

Please take a listen to this new Pocast, in which I interview Rong, and watch for her future posts: https://www.healthsharetv.com/content/chinese-healthcare-and-more-mcol-podcast-rong-yi

Five Questions for Provider Data Experts on the No Surprise Act

by Claire Thayer, June 11, 2021

Recently, LexisNexis Risk Solution’s John Markoff, Senior Director, Provider Data Strategy and Laura Long, Vertical Solutions Consultant, Provider Data joined us in a webinar discussion on the new provider directory accuracy requirements that go into effect in January 2022.  We caught up with John and Laura on five key takeaways:

1. What are some of the common concerns with the No Surprise Act regulations that payers would want to be aware of?

John Markoff and Laura Long: 

• Can the payer outreach to all directory facing providers every 90 days?
• Initial accuracy of a payer’s database.
• Does the payer have ability to process changes from the outreach in a timely manner?
• How will downstream systems be impacted if a provider doesn’t verify, and they need to be removed from the directory?
• Can the payer outreach to all directory facing providers every 90 days?Initial accuracy of a payer’s database.Does the payer have ability to process changes from the outreach in a timely manner?How will downstream systems be impacted if a provider doesn’t verify, and they need to be removed from the directory?

2. Provider data is constantly changing, what are some of the key challenges you're seeing today?

John Markoff and Laura Long: 

It’s a challenge to maintain a high level of accuracy for data attributes that don’t have an authoritative source. Challenges stem from disparate systems, manual processes and out of date sources of data. Payers acquire companies, merge data assets and change systems over time. Resolving the issues that result from this require significant investment from IT, Operations, Data Governance and Provider Management.   

 

3. When evaluating provider data, what are the four key elements of quality?

John Markoff and Laura Long:

• Accuracy – Timely and Correct
• Timeliness – Providing updates in a timely manner
• Completeness – Depth and Breadth
• Governance – Ongoing maintenance and audit resolution

4.  Does this new legislation only impact government sponsored payers?

John Markoff and Laura Long:

This legislation is relevant for any provider listed on a member facing directory, regardless of product line.

5. What steps should payer organizations be taking now to be compliant with the new regulations by the 1/1/2022 effective date?

John Markoff and Laura Long:

• Payers need to start planning now to outreach to payers and ingest that data in a timely manner to meet the timelines presented in the Bill. 
• Conduct a third-party analysis of provider data within their system.       

If you missed this informative webinar presentation, No Surprise - Provider Data Accuracy Mandated, we invite you to watch the full On-Demand webinar video or short webinar re-cap video.

Upswing in Medicare Telehealth Awareness and Use: What Will Be Post-Pandemic Policy?

By Clive Riddle, June 3, 2021

Recent reports indicate that even for the supposedly more tech-phobic Medicare population, telehealth awareness and utilization caught on during the pandemic, and the GAO has some concerns about that. The big question is, what are the post-pandemic implications, and what would be future CMS policy?

A recent Kaiser Family Foundation report: Medicare and Telehealth: Coverage and Use During the COVID-19 Pandemic and Options for the Future, found that: 

• 64% (or 33.6 million) of Medicare beneficiaries with a usual source of care say that their provider currently offers telehealth appointments, up from 18% who said their provider offered telehealth before the pandemic.
• 23% do not know if their provider offers telehealth appointments, and this share is larger among rural beneficiaries (30%).
• 56% of Medicare beneficiaries who had a telehealth visit report accessing care using only a telephone, while a smaller share had a telehealth visit via video (28%) or both video and telephone (16%).

 

GoHealth recently released a 34-page report: United States of Medicare: Similarities and Shared Potential Among Rural and Urban Medicare Beneficiaries, that included these telehealth survey results:

•  86% or urban, and 82% of rural Medicare beneficiaries have a device, such as a smartphone, tablet or computer that allows them to have video communications
• 44% of urban, and 31% of Medicare beneficiaries during the past year have used video communications (telehealth or virtual doctor visit) to access their care
• 77% of urban and 76% of rural Medicare beneficiaries said this their first time using video communications (telehealth or virtual doctor visit) to access care

However, The GAO last month released a report: MEDICARE AND MEDICAID: COVID-19 Program Flexibilities and Considerations for Their Continuation, that included Medicare telehealth waiver discussion, noting “Utilization of telehealth services—certain services that are normally provided in-person but can also be provided using audio and audio-video technology—increased sharply. For example, utilization increased from a weekly average of about 325,000 services in mid-March to peak at about 1.9 million in mid-April 2020.”

The GAO went on to caution about these risks to Medicaid and Medicare if waivers are continued: 

• Increased spending. Telehealth waivers can increase spending in bothprograms, if telehealth services are furnished in addition to in-person services.
• Program integrity. The suspension of some program safeguards has increased the risks of fraud, waste, and abuse that GAO previously noted in its High-Risk report series.
• Beneficiary health and safety. Although telehealth has enabled the safe provision of services, the quality of telehealth services has not been fully analyzed.

Holograms to the Rescue

By Kim Bellard, May 26, 2021

Google is getting much (deserved) publicity for its Project Starline, announced at last week’s I/O conference. Project Starline is a new 3D video chat capability that promises to make your Zoom experience seem even more tedious. That’s great, but I’m expecting much more from holograms — or even better technologies. Fortunately, there are several such candidates.

For anyone who has been excited about advances in telehealth, you haven’t seen anything yet.

If you missed Google’s announcement, Project Starline was described thusly:

Imagine looking through a sort of magic window, and through that window, you see another person, life-size and in three dimensions. You can talk naturally, gesture and make eye contact.

Google says: “We believe this is where person-to-person communication technology can and should go,” because: “The effect is the feeling of a person sitting just across from you, like they are right there.”

Sounds pretty cool. The thing, though, is that you’re still looking at the images through a screen. Google can call it a “magic window” if it wants, but there’s still a screen between you and what you’re seeing.

Not so with Optical Trap Displays (OTDs). These were pioneered by the BYU holography research group three years ago, and, in their latest advance, they’ve created — what else? — floating lightsabers that emit actual beams:

Optical trap displays are not, strictly speaking, holograms. They use a laser beam to trap a particle in the air and then push it around, leaving a luminated, floating path. As the researchers describe it, it’s like “a 3D printer for light.”

Indeed, their paper in Nature speculates: “This result leads us to contemplate the possibility of immersive OTD environments that not only include real images capable of wrapping around physical objects (or the user themselves), but that also provide simulated virtual windows into expansive exterior spaces.”

I don’t know what all of that means, but it sounds awfully impressive.

The BYU researchers believe: “Unlike OTDs, holograms are extremely computationally intensive and their computational complexity scales rapidly with display size. Neither is true for OTD displays.” They need to meet Liang Shi, a Ph.D. student at MIT who is leading a team developing “tensor holography.”

Before anyone with mathemaphobia freaks out about the “tensor,” let’s just say that it is a way to produce holograms almost instantly.

Joel Kollin, a Microsoft researcher who was not involved in the research, told MIT News that the research “shows that true 3D holographic displays are practical with only moderate computational requirements.”

All of the efforts are already thinking about healthcare. Google is currently testing Project Starline in a few of its offices, but is betting big on its future It has explicitly picked healthcare as one of the first industries it is working with, aiming for trial demos later this year.

The BYU researchers see medicine as a good use for OTDs, helping doctors plan complicated surgeries: “a high-resolution MRI with an optical-trap display could show, in three dimensions, the specific issues they are likely to encounter. Like a real-life game of Operation, surgical teams will be able to plan how to navigate delicate aspects of their upcoming procedures.”

The MIT researchers believe the approach offers much promise for VR, volumetric 3D printing, microscopy, visualization of medical data, and the design of surfaces with unique optical properties.

2020 was, in essence, a coming out party for video conferencing in general and for telehealth in particular. The capabilities had been around, but it wasn’t until we were locked down and reluctant to be around others that we started to experience its possibilities. Still, though, we should be thinking of it as version 1.0.

Versions 2.0 and beyond are going to be more realistic, more interactive, and less constrained by screens. They might be holograms, tensor holograms, optical trap displays, or other technologies I’ve not aware of. I just hope it doesn’t take another pandemic for us to realize their potential.

This post is an abridged version of the original posting in Medium. Please follow Kim on Medium and on Twitter (@kimbbellard) 

Patients Want Two “T”s From Providers: Telehealth and Texting

By Clive Riddle, May 20, 2021

Results from two surveys were released this week on what U.S. patients want in their provider communications: telehealth and texting.

Harris Poll, on behalf of NextGen Healthcare, found that 53 percent "say the pandemic changed how they want to communicate with their doctor. Notably, nearly half (48 percent) indicate they would switch to a different healthcare provider if their current provider did not offer telehealth appointments." A HIMSS survey sponsored by SR Health found that “patients want more regular and immediate interactions with providers and to be more engaged in their overall healthcare and wellbeing. Nothing is more effective for that kind of communication than text. Ideally, today, every healthcare interaction should begin with a text message.”

The Harris Poll found "an overwhelming majority of U.S. patients who received telehealth services since March 2020 (84 percent) plan to continue using telehealth appointments in the future, citing reasons such as convenience (43 percent) or to avoid being around people who are ill (39 percent)." 57% say they would be more likely to get follow-up medical care if telehealth appointments were an option.

But beyond telehealth, the Harris Poll also addressed overall online access to providers. 58% of patients stated they want online access to their healthcare provider. Age plays a role in this: Patients from 18-54 are significantly more likely than patients 55 and older to say they would like to have more online access to their healthcare provider (68% under age 55 and 43% age 55+.) The wish list includes:

• online appointment scheduling (49 percent)
• ability to check-in or complete health forms/appointment paperwork online before an appointment (49 percent)
• online prescription management (48 percent)
• online medical records access (47 percent)

The HIMSS survey report: “Patient Communication Preferences in 2021,” concludes that "since the pandemic began, more regular communication is expected from healthcare providers. During the pandemic, emailing and texting healthcare providers has increased with almost half of patients saying they prefer to communicate with healthcare providers via text.”

Their survey found that:

• Overall, 65 percent of people would like to receive healthcare text messages.
• Text communication rose by 14 percent during the pandemic.
• Eighty-seven percent of respondents said convenience was the reason they prefer messaging with providers.
• More than one-third of patients would be willing to switch providers to receive more modern communication like real-time text messaging.

COVID Wars: Attack of the Variants

By Dr. Seleem R. Choudhury

As an increasing portion of the global population continues to receive the COVID vaccine, public health experts, government officials, and healthcare professionals continue to monitor variants emerging around the world. With recent spikes of infections in India that have brought devastating death tolls and an overwhelmed healthcare system, it is clear that reaching the “end” of COVID and moving forward into a sense of normalcy will not be a straightforward process.

What are mutations?

Mutations are tiny errors in our genome sequencing, and are often drivers within evolution (Carlin, 2011). As a child I was occasionally naughty, and as punishment I recall having to write lines. I would have to write and repeat whatever words were deemed necessary for me to learn my lesson and change my behavior. However, as I wrote the lines, slight changes in my handwriting occurred on a word here or a letter there. Though the message remained the same, these accidental small changes caused some lines to look different.

All viruses evolve and change over time.  This allows a virus to not only survive, but thrive (Tajouri, 2020).  Just like my handwriting, these changes, or mutations, happen accidentally and cause the virus’s genome sequence to look different. When a virus undergoes one or two mutations, this is called a “variant.”  Occasionally, the virus will mutate in such a way that the virus can copy itself more efficiently or enter our cells more easily (Cleveland Clinic, 2021). With more than 141 million infections worldwide at the time of this publication—a number that continues to climb—the virus has ample opportunity to mutate.

Current COVID mutations

Currently, there are many different versions, or variants, of COVID circulating. As with any virus, most variants come and go; others persist but don’t spread widely among the population. However, several prominent variants present themselves and gain notoriety, and eventually cause concern.

It is important in any discussion of variants of this virus to make clear that while variants are referred to as “the U.K. strain” or “South African variant,” the actual origin of any given mutation is difficult to prove, and individual countries should not be blamed for variants bearing their name (Ellyatt, 2021).

The World Health Organization (WHO) calls the variants in the graphic above “variants of concern,” signifying “strains that pose additional risks to public health” (Gale, 2021). Recently joining the list of variants of concern is the Indian variant called B1617 (Roberts, G., 2021).  The WHO has also coined the term “emerging variants of interest” for mutations that “warrant close monitoring because of their potential risk” (Gale, 2021).

These variants of concern are worrisome for varying reasons and degrees, but are primarily related to ease of transmission, severity of the illness for those infected, the likelihood the variant will infect people who have already contracted COVID, potential impact on vaccination efficacy, and the prevalence of the mutation in the population (Gale, 2021; Centers for Disease Control and Prevention, 2021).

Tracking these variants is vitally important in order to improve the design of vaccines to be effective against new variants. However, changes to those vaccines take several months, and are a mid- to long- term solution. More pressing in the short term is the increase of sequencing efforts, which experts have criticized for being “small and uncoordinated,” in order to “adequately track where variants are spreading and how quickly” (Zimmer, 2021; Zimmer, & Weiland, 2021).

The vaccine and mutation

There is anxiety regarding the unpredictability of COVID variations and the efficacy of the vaccine against such mutations. While data on the Indian variants is scarce at the time of this article’s publication, a recent study of people worldwide who had received the Pfizer vaccine, including 44,000 people in South Africa who were predominantly exposed to the B.1.351 variant, found that the vaccine was 100 percent effective against severe disease and death (Business Wire, 2021). Additional Pfizer data showed that the vaccine is “97 percent effective against symptomatic COVID-19, hospitalizations, and death” (Business Wire, 2021). The vaccine also “held up against the B.1.1.7 variant” (Ries, 2021). The Moderna, AstraZeneca, and Johnson & Johnson data demonstrated similar levels of effectiveness (Business Wire, 2021; Laguipo, 2021; Deutsche Welle, 2021). 

There are also ongoing trials with unpublished data that demonstrates a booster shot given to previously vaccinated individuals improved the antibody titer responses against several variants of concern (Hippensteele, 2021). Moreover, leading pharmaceutical companies have discussed adapting the vaccine to deal with variants. Recently the first “tweaked vaccine” announced by Moderna successfully neutralized several variants in lab trials (Boseley, 2021).

In short, vaccines offer effective protections against the variants of concern, especially in terms of preventing serious symptoms and death (Ries, 2021).  The World Health Organization states that the COVID “vaccines that are currently in development or have been approved are expected to provide at least some protection against new virus variants because these vaccines elicit a broad immune response involving a range of antibodies and cells.  Therefore, changes or mutations in the virus should not make vaccines completely ineffective (World Health Organization, 2021).”

The future of the virus

One of the challenges for public health experts is understanding what the end of the virus will look like and, furthermore, how it will be measured: daily deaths, hospital admissions, vaccination rates, percentage of the population who have been vaccinated, etc. Regardless of the measurements used, variants have a major impact on the endpoint. Rather than widespread, rapid transmission of the virus, we may see more “sporadic and localized” outbreaks (Joseph, & Branswell, 2021). 

Vaccine hesitancy around the globe, in addition to the emergence of new variants, makes herd immunity unlikely (Aschwanden, 2021). However, there is growing evidence that vaccines not only protect people from contracting COVID, but also reduce transmission of the virus (Joseph, & Branswell, 2021).  Even so, the probability exists that the only way to mitigate outbreaks is with regular booster vaccines due to more transmissible future mutations of the virus (Faulconbridge, 2021).  Though COVID will not be eliminated in the near future, there is a strong likelihood that it can be managed.

Read more from Dr. Seleem Choudhury at seleemchoudhury.com    

Resources

Aschwanden, C. (2021). Five reasons why COVID herd immunity is probably impossible. Nature.

Boseley, S. (2021). Tweaked Moderna vaccine ‘neutralises Covid variants in trials.’ The Guardian.

Business Wire (2021). Moderna COVID-19 Vaccine Retains Neutralizing Activity Against Emerging Variants First Identified in the U.K. and the Republic of South Africa. Business Wire.

Business Wire (2021). Pfizer and BioNTech Confirm High Efficacy and No Serious Safety Concerns Through Up to Six Months Following Second Dose in Updated Topline Analysis of Landmark COVID-19 Vaccine Study. Business Wire. 

Business Wire (2021). Real-World Evidence Confirms High Effectiveness of Pfizer-BioNTech COVID-19 Vaccine and Profound Public Health Impact of Vaccination One Year After Pandemic Declared. Business Wire.

Carlin, J. L. (2011) Mutations Are the Raw Materials of Evolution. Nature Education Knowledge 3(10):10.

Centers for Disease Control and Prevention (2021). Global Variants Report. Centers for Disease Control and Prevention.

Centers for Disease Control and Prevention (2021). SARS-CoV-2 Variant Classifications and Definitions. Centers for Disease Control and Prevention.

Cleveland Clinic (2021). What Does It Mean That the Coronavirus Is Mutating? The Cleveland Clinic.

Deutsche Welle (2021). WHO experts advise J&J jab for coronavirus mutants. DW.

Ellyatt, H. (2021). Coronavirus mutations: Here are the major Covid strains we know about. CNBC.

Faulconbridge, G. (2021). Exclusive: Regular booster vaccines are the future in battle with COVID-19 virus, top genome expert says. Reuters.

Gale, J. (2021). Why the Mutated Coronavirus Variants Are So Worrisome. Bloomberg Quint.

Hippensteele, A. (2021). Moderna Releases Positive Initial COVID-19 Vaccine Booster Data Against Variants of Concern. Pharmacy Times.

Joseph, A., & Branswell, H. (2021). The short-term, middle-term, and long-term future of the coronavirus. Stat News.

Laguipo, A.B.B. (2021). Oxford-AstraZeneca vaccine effective against B.1.1.7 SARS-CoV-2 variant. News Medical.

Ries, J. (2021). COVID-19 Vaccines Are Still Effective Amid Rising Number of Variants. Healthline.

Roberts, G. (2021). Everything we know about the Indian COVID-19 variant so far. World Economic Forum.

Roberts, M. (2021). What are the Indian, Brazil, South Africa and UK variants? BBC News.

Tajouri, L. (2020). What is a virus? How do they spread? How do they make us sick? The Conversation.

Woodward, A. (2021). One chart shows how well COVID-19 vaccines work against the 3 most worrisome coronavirus variants. Business Insider.

World Health Organization (2021). Tweet: Will #COVID19 vaccines work against new virus variants? Twitter: 1/19/2021.

Zimmer, C., & Weiland, N. (2021). C.D.C. Announces $200 Million ‘Down Payment’ to Track Virus Variants. New York Times.

Zimmer, C. (2021). U.S. Is Blind to Contagious New Virus Variant, Scientists Warn. New York Times.U.S. Is Blind to Contagious New Virus Variant, Scientists Warn

Pulse of Payers on No Surprises Act

How are health plans and other purchasers feeling about facing the No Surprises Act at this juncture - with the ACT taking effect January 1, 2022 - ? Zelis recently conduct a survey "of 116 healthcare payer executives representing 85 payer health plans, third-party administrators (TPAs) and health planned-owned TPAs"

Here are six takeaways: 

• 95% of healthcare insurers expressed concern about the ability of the healthcare system to achieve compliance with the Act by the deadline.
• 64%y are concerned about adhering to the timelines required 
• 61% are concerned about transparency requirements
• 41% expressed concern about setting the appropriate reimbursement levels
• 41% are concerned about managing the Independent Dispute Resolution process
• 39% have concerns about provider directory requirements

Healthcare’s Million Dollar Blocks

by Kim Bellard, April 28, 2021

Since I first heard about them, I have been fascinated, and dismayed, by the concept of “million dollar blocks.” For those of you unfamiliar with the term, it doesn’t refer to, say, Beverly Hills. No, it refers to city blocks for which society spends over a million dollars annually to incarcerate residents of that block.

I, of course, have to think about the healthcare parallels.

The concept dates back many years, credited to Eric Cadora, now at Justice Mapping, and Laura Kurgan, a professor of architecture at Columbia University, where she is the Director of the Center for Spatial Research (CSR). The power of the concept is to use data visualization to illustrate the problem.

But if, as they say, a picture is worth a thousand words, then perhaps data visualization is worth a million dollars. Even hardened criminal justice advocates have to blanche at how spending is so often concentrated in certain blocks, and should wonder if perhaps there are better ways to use that money for them.

CSR has a variety of projects in addition to their criminal justice work, including some focused on healthcare. Late last year their New Politics of Care project used an interactive map to highlight existing areas of health care needs. They proposed a New Deal for Public Health, with a million new community health workers deployed around the country based on the identified needs.

Somehow the Community Health Corps didn’t make it into the Biden infrastructure proposal. Perhaps no one in the Administration has seen the map.

Data visualization is nothing new for healthcare. The CDC has an Interactive Atlas of Heart Disease and Stroke, the Dartmouth Atlas has been highlighting healthcare variations for close to thirty years, and, more recently, the Johns Hopkins Coronarvirus Resource Center has been tracking what’s been happening in the pandemic.

Still, if anyone is tracking where healthcare’s “million dollar blocks” are, I’d like to hear about it.

We know — or think we know — that there are underserved communities where too many people end up in the emergency room. We know that there are communities in which maternal and infant mortality/morbidity are much worse.

But do we know where these are concentrated, or do we know how much we’re spending on the results of them? No.

I want to know in which communities the hospitals are the predominant healthcare institution. I want to know what communities are falling behind on preventive screenings and vaccinations. I want to know which communities have suspiciously low healthcare spending, and whether that is a function of better health or lack of healthcare resources.

I want to see the interactive data visualizations for these types of issues, and I want smart people acting on them.

If the pandemic has highlighted anything, it’s that our public health system is woefully inadequate. It doesn’t have the right resources and doesn’t have the right data, collected and acted upon at the right time.

Healthcare generates scads of data, but not the right data, timely, aggregated across all payors for all kinds of services, and we certainly don’t have anyone in a position to really use it to manage.

The “million dollar block” concept highlights the fact that we’re good at spending money, but we’re not very good about how we end up spending it. It emphasizes the rationale of “defund police” movement, and should be applied to healthcare as well (as I’ve discussed before).

I guess we need to see the pictures first.

This post is an abridged version of the original posting in Medium. Please follow Kim on Medium and on Twitter (@kimbbellard) 

COVID-19 Vaccine Incentives: CMS Guidance Needed to Help Medicaid Programs Go Further

By Clive Riddle, April 23, 2021

A major worry is that COVID-19 vaccine takeup, which had been rocketing upward, may now have reach a plateau. Here’s how the Kaiser Family Foundation frames the situation: “Broadly, the COVID-19 Vaccine Monitor has found that vaccine confidence in the U.S. has increased as more and more people have seen their friends and family members get vaccinated, and now a majority of the public has either already gotten vaccinated or is ready to get the vaccine as soon as they can. Yet with a small but persistent group opposed to getting the vaccine and many others still on the fence, the U.S. may soon hit a point where vaccine supply exceeds demand, a situation that is already the case in certain communities.”

Health Plans across the country are announcing various incentive measures to encourage COVID-19 vaccinations:

• Cigna just announced emergency time off and a $200 incentive for Cigna employees to receive the vaccination, and also a program for free Transportation for Medicare Advantage Customers to Vaccine Appointments.
• Florida Blue just announced they are is teaming with Lyft and other transportation companies to offer its members access to rides to and from vaccination appointments as part of its services to support vaccination events across the state.
• Earlier this week AHIP published a summary of health plan initiatives to improve vaccine acceptance and access, list specific measures taken by over 40 regional and national plan.  Included was mention that CalOptima, a Southern California Medicaid plan, is “launching a Vaccination Incentive Program to offer two $25 nonmonetary gift cards to CalOptima Medi-Cal members who get both required doses of the COVID-19 vaccine, subject to state regulatory approval.”

While health plans must be lauded for proactively taking these steps, unfortunately, CalOptima was the only one specifically mentioned with programs targeting Medicaid populations.  Concerns certainly continue about health care equity in fighting COVID-19.

But the lack of announced Medicaid plan and state program vaccine incentive initiatives can’t really be blamed on the health plan industry. Notice that mention of the CalOptima incentive was “subject to state regulatory approval.” And higher up than that, guidance from CMS is still pending.  The CMS web page: Beneficiary Incentives for COVID-19 Vaccine Shots still states “CMS will provide more information about whether we'll allow patient incentives for COVID-19 vaccination during the public health emergency (PHE).”

Specific to Medicaid, the current (published March 15^th) CMS guidance in their State Resource Center: Coverage and Reimbursement of COVID-19 Vaccines, Vaccine Administration, and Cost Sharing under Medicaid, the Children’s Health Insurance Program, and Basic Health Program, with regard to vaccine incentives, states: “Beneficiary incentives: CMS will be providing more information regarding whether beneficiary incentives will be permitted in connection with COVID-19 vaccination during the PHE.”

The health plan initiatives for Medicare Advantage and employer based plans are certainly to be commended, but the vaccine takeup rates for seniors are higher overall, and employer based covered populations do have greater resources than the general Medicaid covered populations. Would not public policy greatly benefit from CMS proactive encouragement of state programs and private Medicaid plans offering incentives including gift cards and cost sharing credits for other plan services?

Organizational culture change as renovation, not demolition

by Dr. Seleem R. Choudhury, April 15, 2021

An organization’s “culture” is simply defined as the expected way to behave within an organization. Stated more simply, organizational culture is “the way things are done around here” (Deal & Kennedy, 2000).  Culture is not written rules or guidelines, but rather the way we act and how we get work done. The values of a particular organizational culture are engrained into the life of the organization.  When culture is found to be ineffective or, worse, toxic, leaders discover that it is extremely difficult to change.

Many organizations start in the wrong place by making sweeping changes to the staff or executive team or attempting to overhaul every aspect of the current culture. Changing culture is more than a matter of changing the players, and seeking to change everything about an organization’s culture will inadvertently remove elements of the organization that are working well.  Rather than taking a demolition approach, leaders would increase the possibility of successfully changing their organization’s culture by thinking of culture change as a renovation.

The importance of culture

A 2017 Harvard Business Review article compares organizational culture to the wind: “[Culture] is invisible, yet its effect can be seen and felt” (Walker & Soule, 2017).  Harnessing the power of organizational culture is one of the keys to getting good work done. A recent conversation with friend, colleague, and mentor Brian Dolan, OBE, RMN, RGN, highlighted that it is a leader’s responsibility to understand this power, and determine if the current organizational culture is effective or ineffective in helping the organization fulfill its mission. For better and worse, culture and leadership are intricately interconnected (Groysberg, Lee, Price, & Cheng, 2018).  Leaders, whether they do so intentionally or passively, are shaping the culture of their organizations. They should be capable of actively shaping culture to the benefit of everyone on the team and the realization of the organization’s goals (Craig, 2018).

Interestingly, though there is a plethora of articles, discussions, and research that focuses on cultural change, much controversy exists on whether it is possible to make these changes successfully. Undoubtedly, changing the culture of an organization is a steep challenge. It requires much more than recognizing a problem and leaders who are committed to making a change. It takes significant effort and investment at every level of the organization.

Still, despite the challenges to making a successful culture change, the outcomes regarding building the right culture are indisputable. Organizations that can turn the tide and maintain a “drive towards lasting improvement in performance and organizational health,” regularly outperform competitors (McKinsey, 2021).

“Culture renovation,” not “culture change”

Terms like “culture change” or “organizational transformation” tend to carry a negative connotation. These phrases often imply that nothing good exists in the organization, and so everything must change, bringing to mind the idiomatic expression, “throwing the baby out with the bathwater.” The danger of culture transformation efforts is making a change that impacts many elements of the organization, including things that are working for the organization or are core to its identity.  A goal of leaders in culture change processes is to ensure that the organization does not lose something important while trying to get rid of unwanted elements of its culture.  Changes to a company’s culture, then, should be carefully and thoughtfully engaged, not left to chance (Patel, 2017).

Kevin Oakes, CEO and Co-founder of i4CP and author of Culture Renovation, proposes a different strategy when exploring the need to transform your culture. In an interview with HR Executive, Oakes describes cultural change as restoring an old 100-year-old house by considering what exists, then deciding what to keep and what to change (Ramirez, 2021).

Oakes states:  

“With a historic house, there are elements that are timeless that you want to hang on to. You keep those elements, while upgrading for the future with new technology and new ways of doing things that increase the value of your house long-term. The same concept applies to companies. Successful companies don’t transform their organization. They renovate their culture, meaning they keep the values and traits that have made them successful, build upon them and recognize what they need to create to increase the value of the organization long-term” (Ramirez, 2021).

This metaphor resonates strongly with me.  When I was a child, my parents bought a Victorian house in London. The house was huge and beautiful. My parents wanted to preserve and honor the Victorian elements of the home, but also wanted to modernize elements within. This was not an easy feat, and the work required to renovate the house felt nearly endless. Yet, it never occurred to my parents to rip down the house and build it anew; rather, they wanted to keep what was good and focus their efforts on areas that needed changing or upgrading.

Organizational culture is quite similar. It is not a one-and-done process. Leaders must also know this and be willing to invest the time, money, and work necessary for the renovation, recognizing that it is a continuous improvement process. 

Perhaps that is why, according to a 2019 study from i4CP, only 15% of the companies studied said their culture change efforts had been successful (Goodridge, 2019). Oakes believes that those organizations that are successful know that no one can truly change their culture; rather, they “intentionally [renovate] their culture” (Fagan, & Prokopeak, 2021). Just like my parents’ Victorian House, organizations should keep what they want, understand what they need, and add what is required.

In his book Culture Renovation, Oakes guides organizations through this process, laying out an evidence-based, three-step process to effectively renovate a culture plan. However, he cautions organizations not to make any changes until they perform a full assessment to evaluate the “readiness and maturity level on the organization's culture change journey” (Oakes, 2021).

It was Peter Drucker who coined the phrase, “Culture eats strategy for breakfast.” While it is certainly true that a thriving culture is essential for organizational success, these sorts of maxims on culture change often drive leaders to feel that a wholesale, top-to-bottom culture overhaul is necessary. In my experience, this is rarely the case.

Before leaders decide if the culture needs to be changed, begin first with an assessment (Dooley, 2021).  Just as in the old house analogy, it is likely that much of the structure is contributing to the organization’s success and should be kept, renewed, or strengthened. Only elements that pose a danger to the structure should be replaced for the health of the organization.

Read more from Dr. Seleem Choudhury at seleemchoudhury.com    

References

Brené Brown Education and Research Group (2021). Brené with Kevin Oakes on Cultural Renovation. Brené Brown.

Craig, W. (2018). 10 Ways Leaders Influence Organizational Culture. Forbes.

Deal, T. E., & Kennedy, A. A. (2008). The new corporate cultures: Revitalizing the workplace after downsizing, mergers, and reengineering. Basic Books.

Dooley, R. (2021). Episode 357: Culture Renovation with Kevin Oakes. Brainfluence Podcast with Roger Dooley. 

Fagan, S., & Prokopeak, M. (2021). Get Reworked Podcast: Why Now Is the Perfect Time for Culture Renovation. Get Reworked Podcast.

Goodridge, N. (2019). Only 15% of Organizations Succeed in Transforming Their Cultures. I4CP.

Groysberg, B., Lee, J., Price, J., & Cheng, J. Y. (2018). The Leader’s Guide to Corporate Culture. Harvard Business Review.

McKinsey (2021). Culture & Change. McKinsey.

McLaren, S. (2019). How Microsoft “Renovated” Its Culture by Following These 3 Steps. LinkedIn Talent Blog.

Oakes, K. (2021). Culture Renovation: 18 Leadership Actions to Build an Unshakeable Company.

Patel, S. (2017). The Importance of Building Culture in Your Organization. Inc.

Ramirez, J.C. (2021). Here’s how HR can lead a ‘culture renovation.’ Human Resources Executive.

Walker, B., & Soule, S.A. (2017). Changing Company Culture Requires a Movement, Not a Mandate. Harvard Business Review.

Springtime in Medicare Advantage Land

By Clive Riddle, April 9, 2021

The seeds are planted in the fall. Then as Spring arrives, you can assess what has been sowed.  Or, as Mark Farrah Associates puts it: “Health insurers compete by offering new pricing and product options to beneficiaries during the Open Enrollment Period for Medicare Advantage (MA) and prescription drug plans (PDPs), that runs from October 15th through December 7th of each year. Plans then begin to analyze final enrollment results in February and March to evaluate their standing and assess which competitors gained and lost members.”

Here's a summary of MA and PDP enrollment that appeared two weeks ago in MCOL’s HealthExecSnapshot:

Mark Farrah Associates has just released their analysis of March 2021 MA and PDP enrollment. They report that “as of March 1, 2021, total Medicare Advantage (MA), including Medicare Advantage with Prescription Drug Plan (MA-PD) membership, stood at 27,158,911 with a net gain of 2,408,192 members from March 1, 2020.  Medicare stand-alone prescription drug plans (PDPs) covered 24,268,611 members as of March 1, 2021, a net decrease of 926,333 from the previous year....MA plans grew by 9.7% while there was a -3.7% decrease for PDPs, year-over-year.”

They also note that:

• The top ten carriers covered 77.6% of all MA enrollees, with UnitedHealth remaining the market-share leader.
• Texas experienced the most sizeable year-over-year increase of almost 208,000 MA members.
• Stand-alone PDPs experienced a decrease of approximately 926,000 enrollees between March 1, 2020 and March 1, 2021.
• CVS, UnitedHealth, and Centene were the leaders amongst the top five companies that control 87% of the PDP market

Here are the top five national MA plans with their total March 2021 enrollment, % growth over March 2020. and national marketshare, from the Mark Farrah Associates report:

1. UNITEDHEALTH  | 7,221,432  | 13.7%  Growth | 26.6% Marketshare

2. HUMANA | 4,854,260 | 8.9%  Growth |17.9% Marketshare

3. CVS | 2,860,379  | 9.2%  Growth |  10.5% Marketshare

4. KAISER | 1,740,733 | 3.5% Growth |  6.4% Marketshare

5. ANTHEM | 1,530,894 | 15.4% Growth |  5.6% Marketshare

And here are the top five national PDPs from the Mark Farrah report:

1. CVS  | 5,738,786  | 1.0% Growth | 23.6% Marketshare

2. UNITEDHEALTH | 4,507,985 | -7.0% Growth |18.6% Marketshare

3. CENTENE | 4,131,374 | -6.5% Growth |17.0% Marketshare

4. HUMANA | 3,556,348 | -5.9% Growth |14.7% Marketshare

5. CIGNA | 3,194,589 | -3.3% Growth |13.2% Marketshare

Tracking COVID-19 Vaccination Enthusiasm and Hesitancy

By Clive Riddle, April 2, 2021

The monthly Kaiser Family Foundation COVID-19 Vaccine Monitor report released this week "finds enthusiasm for getting a COVID-19 vaccine continuing to grow, with roughly 6 in 10 adults (61%) now saying they have already gotten at least one dose (32%) or want to get vaccinated as soon as they can (30%)." KFF tells us "that’s up from a combined 55% in February and 47% in January, as more people report getting vaccinated and fewer say they want to “wait and see” how the vaccine works in others before getting it themselves (17% now, compared to 22% in February and 31% in January)."

The report finds that most people now know how to navigate the vaccine system: “For the first time, a majority of those who have not yet been vaccinated say they have enough information both about where (67%) and when (53%) they can get vaccinated, though the report also finds a sizeable minority that lacks key vaccine information.

For those still unsure how to navigate or if they are eligible, the report states “the share that is uncertain is highest among Hispanic adults (45%), those under age 30 (39%), with annual household incomes under $40,000 annually (37%), and those without a college degree (35%).”

KFF launched their Vaccine Monitor in December, tracking who has received the vaccine, would get one asap, or listed their degree of hesitancy. Previously, surveys were more hypothetical,  asking if they were somewhat or very likely to receive the vaccine We tracked selected surveys during the past year asking that question, indicating a trend of initial enthusiasm a year ago, waning acceptance as the year progressed until the rollout became more imminent, when acceptance picked back up again – just as in Kaiser’s more recent surveys now that actual vaccinations are taking place.

April 2020

• 74% JAMA Research Letter

May 2020

• 72% Pew Research Center

July 2020

• 66%  Gallup

August 2020

• 62%  Gallup

September 2020

• 50% Gallup
• 51% Pew Research Center

October 2020

• 47% SBB Research
• 58% Gallup

November 2020

• 60% Pew Research Center

December 2020

• 53% Invisibly
• 56% JAMA Research Letter
• 61% SBB Research
• 63% Gallup

January 2021

• 65% Gallup

February 2021

• 69%  Pew Research Center

What about those disinclined to be vaccinated? What is their state of mind? The Pew February 2021 study included this listing of reasons for those disinclined to take the vaccine:

• Concerned about side effects 89%
• Vaccines developed/tested to quickly 85%
• Want to know more about them 80%
• Too many vaccine mistakes in past 74%
• Don't think I need it 68%
•  Decline vaccines in general 57%

This compares to these reasons listed in the March 2021 KFF report:

• Might experience serious side effects 70%
• Effects of the vaccine will be worse than getting COVID-19 63%
• Might be required to get vaccine even if you don't want to 63%
• Might miss work if side effects make you feel sick 45%
• Might get COVID-19 from the vaccine 39%

Nanoparticles On My Mind

By Kim Bellard, March 24, 2021

Nanoparticles are everywhere! By that I mean, of course, that there seems to be a lot of news about them lately, particularly in regard to health and healthcare. But, of course, literally they could be anywhere and everywhere, which helps account for their potential, and their potential danger.

Let’s start with one of the more startling developments: a team at the University of Miami’s College of Engineering, led by Professor Sakhrat Khizroev, believes it has figured out a way to use nanoparticles to “talk” to the brain without wires or implants. They use “a novel class of ultrafine units called magnetoelectric nanoparticles (MENPs)” to penetrate the blood-brain barrier.

Professor Khizroev has been working on the technology for over a decade, and has received funding from Darpa as part of its Next Generation Non-surgical Neurotechnology (N3) program (also known as BrianSTORMs), the goal of which is “to develop high-performance, bi-directional brain-machine interfaces for able-bodied service members.” The team got Phase II funding last November in order to build working devices.

“Right now, we’re just scratching the surface,” Dr. Khizroev says. “We can only imagine how our everyday life will change with such technology.” Some of what he does imagine, though, is:

We will learn how to treat Parkinson’s, Alzheimer’s, and even depression. Not only could it revolutionize the field of neuroscience, but it could potentially change many other aspects of our health care system.

Lest anyone think this is either an easy or a solved problem, Darpa points out: “N3 researchers are working to develop solutions that address challenges such as the physics of scattering and weakening of signals as they pass through skin, skull, and brain tissue, as well as designing algorithms for decoding and encoding neural signals that are represented by other modalities such as light, acoustic, or electro-magnetic energy.”

But that’s not all the nanoparticle news from just this week. In no particular order:

· Researchers from Cleveland Clinic and Chungbuk National University tested a COVID-19 vaccine (on ferrets) using antigens attached to nanoparticles.

· Another research team, from Scripps and Temple, also tested using nanoparticles to deliver antigens for COVID-19, using three self-assembling protein nanoparticle (SApNP) platforms

· A research team at the University of Manchester used nanoparticles to discover previously unseen blood markers: This might allow earlier and more definitive diagnoses of Alzheimer’s.

· A research team at the University of Science and Technology China are testing “acid-responsive nanoparticles composed solely of membrane-disruptive macromolecules” to treat pancreatic cancer.

· Russian and Israeli researchers “have developed hybrid nanostructured particles that can be magnetically guided to the tumor, tracked by their fluorescence and pushed to release the drug on demand by ultrasound.

· Another Chinese research team is using nanoparticles to deliver antimicrobial peptides (AMPs) for the treatment of deep infections.

· An international team of researchers assert: “The potential of nanotechnology in fighting this deadly disease [COVID-19] has not only been realized in context of developing a nano-vaccine but by delivering the nano-based anti-viral agents.”

· Spanish researchers have been able to observe autonomous nanobots in vivo — inside the bladders of a living mouse — using Positron Emission Tomography (PET).

Again, that’s just this week, and only health-related nano news.

I’m no expert on nanoparticles, or any kind of nanotechnology. I understand that the technology has a long way to go yet. I realize that there are risks, included unintended health effects, to using nanotechnology. All that being said, too much of our health treatments are “shotgun” approaches that often cause as much collateral damage as beneficial impacts. Nanoparticles offer the promise of “rifle” approaches that offer precise targeting — like using smart bombs instead of carpet bombing.

Within my lifetime, and hopefully within the decade, we’ll have nano-delivered drugs that will greatly increase their efficacy. We’ll have nanobots swimming around in us, for a variety of therapeutic purposes. And we should have nanoparticle mediated brain-computer interfaces too.

Exciting stuff.

This post is an abridged version of the original posting in Medium. Please follow Kim on Medium and on Twitter (@kimbbellard)