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Positive Deviance: Innovative Responses to Healthcare Reform

Positive Deviance: Innovative Responses to Healthcare Reform. Dr. Rick Cartor, Director, ChD, LLC HR/OD Consultant @ BB&T Insurance Louisville, KY. Positive Deviance: Innovative Responses to Healthcare Reform. Outline and Goals The HCR context

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Positive Deviance: Innovative Responses to Healthcare Reform

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  1. Positive Deviance: Innovative Responses to Healthcare Reform Dr. Rick Cartor, Director, ChD, LLC HR/OD Consultant @ BB&T Insurance Louisville, KY http://rickcartor.wordpress.com

  2. Positive Deviance: Innovative Responses to Healthcare Reform • Outline and Goals • The HCR context • Key Player Responses: Payers, Providers, Users • Users: Obstacles to Innovation • Overcoming the Obstacles http://rickcartor.wordpress.com

  3. Positive Deviance: Innovative Responses to Healthcare Reform • The GOALS of this session are: • understand how key players are responding to healthcare reform so employers can find ways to survive and thrive • enable participants to recognize and overcome common obstacles to innovative solutions in healthcare benefit design. -a thorough review of PPACA -a debate on PPACA merits -a how to for specific mandates -a how to for being deviant NOT 3 http://rickcartor.wordpress.com

  4. Positive Deviance …the observation that in any community, there are people whose uncommon but successful behaviors or strategies enable them to find better solutions to a problem than their peers, despite facing similar challengesand having no extra resources or knowledge than their peers. E.g.: Malnourished children Viet Nam; Pregnancy in Uganda, Hand washing (MDs) From: Positive Deviance, Appreciative Inquiry, Switch, Checklist Manifesto http://rickcartor.wordpress.com

  5. -exceptional complexity -ongoing requirements-a likely increase in costs -ambiguous terms -unique exceptions -shifting deadlines -penalties for errors-few (or no) experts -increased auditing The “Similar Challenge” “Necessity is the mother of invention.” There are many in this similar situation Resist the tendency to act alone http://rickcartor.wordpress.com 5

  6. The “Similar Challenge” • But not identical! • States  “high quality affordable care” • SOLUTIONS VARY…. • Population (size, demographics) • Geography (size, concentration) • Politics / philosophy re: state/fed • Economic condition • Healthcare history (current status) • Healthcare governance and regulations • Insurance laws / regulations • Penchant for Innovation But the key players remain the same – and are each adapting

  7. $-Payer + Provider User / group 7

  8. $-Payer • Diversify: • New products / M&A • stop loss; level premium • ASO/TPA • Data sales • Medical management • IT services (exchanges) • Wellness programs • Care & Clinics • Telemed / kiosks • DM • Cost: • 1. Relationships • a. Provider focused: • Collab w providers • Shift risk: Pay for Perf • Outcome based • ACOs / Med Homes • Narrow Networks • b. Member focused: • Modify behaviors • Preventive • Transparency • Rx tiers • 2. Admin costs • Technology: Auto enroll; • adjudication, portals • Simplify for exchanges • Outsource / offshore • Retail: • Indiv / small group • 90+% covered • 50% fewer via broker • ¾ direct to consumer • Bare minimum / EB • States’ M&M

  9. Younger, more male & white Less obese, more smokers & drinkers

  10. Related Diversific • Wellness • Biomets • Lab work • Targeted DM • TPA • HCIT • EAPs Quality, Cost Outcomes Direct Employer contact Population management ACO / PCMH/ PCP nets On site clinics Managed Care / Integrated care Physician practices Networks, narrow Physician extenders / PA New entrants: WalMart, mini-clinics, Primary Care clinics, Wellness & biometrics, MD2U, DM, Labs (franchises!) + Provider 11

  11. FTE/PTE: hours • INCREASE PREVENTION • Encouraging Essential benefits • Wellness • Premium incentives for employees • Carrot / stick • Rewards for P’ then results • drawings vs. rewards • contests • Onsite coaches (w + DM) • Chronic costs/ non-adherence • On site near site / shared solo clinics • Primary care externeders • Reduce ICC & ER • Telemedicine and Kiosks • Medical homes • Policies / Reward redesigns • Hiring practices • food on site, fit bits, clubs, • On site fitness • Rewards for PCP • DEPENDENT AUDITS • PURCHASING COALITIONS • TRANSPARENCY TOOLS ATTN TO PROVIDERS AND PAYERS PROVIDER CONCESSIONS Premium rebates Premium discounts (W, PCC, etc) Related discounts (LTD for PCC) TPA/ASO Self-funding Lower stop loss (spec/agg) Level premium PARTNERSHIPS Consultants v broker Data demands analytics Managed care / Population management / ACO BC3 Inpatient Care: Narrow networks, tiers, steer Pass through Rx; tiers, incentives mail, generics, partner, unbundle COMMUNITY RATING: associations, captives; private exchanges <49 50-100 101+ User / group 12

  12. 15 MISTAKENBeliefs • that KILL innovative healthcare benefit design within • Beliefs and Assumptions about: • Healthcare in general • How to find a solution • How to implement a solution User groups http://rickcartor.wordpress.com

  13. MISTAKEN BELIEFS & ASSUMPTIONS ABOUT… (A) HEALTH CARE IN GENERAL U.S. healthcare is unfixable There are no good solutions Healthcare decisions are separate from… SSDD  http://rickcartor.wordpress.com

  14. MISTAKEN BELIEFS & ASSUMPTIONS ABOUT… (B) HOW TO FIND A SOLUTION • 5. In bounds & out of bounds • 6. Criteria: unclear, unstated, assumed... • We have to think in 12 month cycles • We have to settle for insufficient data • We have no partners - but many adversaries • “Innovative” = high risk • Uncommon, Fast Follow, Early Adopter, • 11. Things will settle down soon…one answer http://rickcartor.wordpress.com

  15. MISTAKEN BELIEFS & ASSUMPTIONS ABOUT… (C) IMPLEMENTING THE SOLUTION 12. I will never be able to convince... 13. It won't work here / for us because... 14. We already… 15. We tried that one time... I don’t have the time http://rickcartor.wordpress.com

  16. To achieve innovative benefit design within an organization you must expect & overcome the 15 Killers http://rickcartor.wordpress.com

  17. A Method to Overcome the 15 Killers Seek Structure & Steal http://rickcartor.wordpress.com

  18. SEEK clarity STRUCTURE the problem Seek Structure & Steal STEAL effective solutions http://rickcartor.wordpress.com

  19. Our values? Goals / strategy? Talent management strategy? Comp philosophy? Role of EB? SEEK clarity on criteria = Set Objectives / goals STRUCTURE the problem Seek Structure & Steal STEAL effective solutions http://rickcartor.wordpress.com

  20. Our values? Goals / strategy? Talent management strategy? Comp philosophy? Role of EB? SEEK clarity on criteria = Set Objectives / goals STRUCTURE the problem: Small group Ideal (goal) – Current = Gap -Problem statement (time) -Gather data Seek Structure & Steal http://rickcartor.wordpress.com

  21. Our values? Goals / strategy? Talent management strategy? Comp philosophy? Role of EB? SEEK clarity on criteria = Set Objectives / goals • STRUCTURE the problem: • Small group • Ideal (goal) – Current = Gap • -Problem statement (time) • -Gather data • Potential solutions • Generate • (Brainstorm, etc.) Seek Structure & Steal b. STEAL effective solutions Positive Deviance http://rickcartor.wordpress.com

  22. Positive Deviance …the observation that in any community, there are people whose uncommon but successful behaviors or strategies enable them to find better solutions to a problem than their peers, despite facing similar challenges and having no extra resources or knowledge than their peers. http://rickcartor.wordpress.com

  23. POSITIVE DEVIANCE • Best for complex non technical problems where solutions depend on behavioral / social change • HEALTHCARE BENEFIT INNOVATIONS: • - NOT exact PD application • + Steps & lessons

  24. Steps & Details Use group / participant approach to finding, learning Carefully match the situation / context Respect / tap the collective expertise in the PD group Assume that making it work is in the details Ask open ended Qs, probe, follow up Encourage stories, information, details, visuals Use silence, don’t end, move on or sum too fast Focus on behaviors/actions, details Goal: learn “HOW” not “WHAT” or “WHY” • DEFINE • The problem (causes, challenges, constraints, current practices, desired outcomes) • DETERMINE • Find [true] PDs’ • DISCOVER • uncommon, successful behaviors • similar to behavioral interview discipline ----------------------------------------------------DECISION TO PROCEED / APPLY THIS SOLUTION ---------------------------------------------------- • DESIGN • develop plan of action, practice, activities, involvement • EVALUATE / MONITOR • Keep group involvement, commitment

  25. Steps & Details Use group / participant approach to finding, learning Carefully match the situation / context Respect / tap the collective expertise in the PD group Assume that making it work is in the details Ask open ended Qs, probe, follow up Encourage stories, information, details, visuals Use silence, don’t end, move on or sum too fast Focus on behaviors/actions, details Goal: learn “HOW” not “WHAT” or “WHY” • DEFINE • The problem (causes, challenges, constraints, current practices, desired outcomes) • DETERMINE • Find [true] PDs’ • DISCOVER • uncommon, successful behaviors • similar to behavioral interview discipline ----------------------------------------------------DECISION TO PROCEED / APPLY THIS SOLUTION ---------------------------------------------------- • DESIGN • develop plan of action, practice, activities, involvement • EVALUATE / MONITOR • Keep group involvement, commitment

  26. Steps & Details Use group / participant approach to finding, learning Carefully match the situation / context Respect / tap the collective expertise in the PD group Assume that making it work is in the details Ask open ended Qs, probe, follow up Encourage stories, information, details, visuals Use silence, don’t end, move on or sum too fast Focus on behaviors/actions, details Goal: learn “HOW” not “WHAT” or “WHY” • DEFINE • The problem (causes, challenges, constraints, current practices, desired outcomes) • DETERMINE • Find [true] PDs’ • DISCOVER • uncommon, successful behaviors • similar to behavioral interview discipline ----------------------------------------------------DECISION TO PROCEED / APPLY THIS SOLUTION ---------------------------------------------------- • DESIGN • develop plan of action, practice, activities, involvement • EVALUATE / MONITOR • Keep group involvement, commitment

  27. Steps & Details Use group / participant approach to finding, learning Carefully match the situation / context Respect / tap the collective expertise in the PD group Assume that making it work is in the details Ask open ended Qs, probe, follow up Encourage stories, information, details, visuals Use silence, don’t end, move on or sum too fast Focus on behaviors/actions, details Goal: learn “HOW” not “WHAT” or “WHY” • DEFINE • The problem (causes, challenges, constraints, current practices, desired outcomes) • DETERMINE • Find [true] PDs’ • DISCOVER • uncommon, successful behaviors • similar to behavioral interview discipline ----------------------------------------------------DECISION TO PROCEED / APPLY THIS SOLUTION ---------------------------------------------------- • DESIGN • develop plan of action, practice, activities, involvement • EVALUATE / MONITOR • Keep group involvement, commitment

  28. Our values? Goals / strategy? Talent management strategy? Comp philosophy? Role of EB? SEEK clarity on criteria = Set Objectives / goals Monitor & Compare Implement (pilot?) Evaluate & Select • STRUCTURE the problem: • Small group • Ideal (goal) – Current = Gap • -Problem statement (time) • -Gather data • Potential solutions • Generate • (Brainstorm, etc.) Seek Structure & Steal b. STEAL effective solutions Positive Deviance: http://rickcartor.wordpress.com

  29. Good sources of related content Cartor, Rick. 2013. What I’ve Learned So Far. http://rickcartor.wordpress.com Cooperrider, DL and Whitney, D. (2010) The Appreciative Inquiry Handbook Goldhill, David (2013) Catastrophic Care: How American Health Care Killed My Father--and How We Can Fix It Heath, C. & Heath, D. (2010) Switch: How to Change Things when Change is Hard Herzlinger, Regina. (2007) Who Killed Health Care?: America's $2 Trillion Medical Problem - and the Consumer-Driven Cure National Business Coalition on Health http://www.nbch.org/ National Business Group on Health, http://www.businessgrouphealth.org/ Pascale Richard; Sternin, Jerry and Sternin, Monique (2010) The Power of Positive Deviance: How Unlikely Innovators Solve the World's Toughest Problems Potter, Wendall. (2011) Deadly Spin Starfield, Barbara, Johns Hopkins University. Miscellaneous articles and books Thaler, Richard H. & Sunstein, Cass R. (2009) Nudge: Improving Decisions About Health, Wealth, and Happiness http://rickcartor.wordpress.com 30

  30. Positive Deviance: Innovative Responses to Healthcare Reform • The GOALS of this session are: • understand how key players are responding to healthcare reform so employers can find ways to survive and thrive • enable participants to recognize and overcome common obstacles to innovative solutions in healthcare benefit design. -a thorough review of PPACA -a debate on PPACA merits -a how to for specific mandates -a how to for being deviant NOT 31 http://rickcartor.wordpress.com

  31. Positive Deviance: Innovative Responses to Healthcare Reform Dr. Rick Cartor, Director, ChD, LLC HR/OD Consultant @ BB&T Insurance Louisville, KY http://rickcartor.wordpress.com

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