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Open Mike - 2010

Notes from the Colorado Health Symposium
August 11, 2010

During the last week of July I traveled to the Colorado Health Foundation’s annual symposium in Keystone, CO. It was an honor to represent all of you in front of 425 people from the worlds of policy, government, business, and health care who want to make a positive difference. What follows are some highlights from the conference. You should know that national thought leaders have a great interest in what you do every day.

The speakers were very high quality—people like former U.S. Surgeon General Dr. Richard Carmona and Dr. Elliot S. Fisher of the Dartmouth Institute for Health Policy and Clinical Practice.

Sessions are archived on the Colorado Health Foundation's Ustream.tv page, and my fellow speakers and I have posted our presentation slides. The Colorado Health Foundation also blogged about all of the major panels and speeches.
 
It’s not the same as being there, but I hope you can enjoy parts of these great exchanges.

A few conference highlights

A chance to talk up your good work. The people I met had all heard of Group Health and have great respect for us. They want to know how we do it. What policies could promote the kind of care we provide? There are so few examples of integrated systems that actually have aligned incentives, created the vision, and built the infrastructure to create better health—and a better value— for patients.

A panel called "Prevention: A Cure for What Ails Health Care?" looking at preventive care from different points of view. Policy folks are clear that though the new health reform act will "cover preventive services" it is unclear how that will play out in the real world of health care delivery and reimbursement, especially with a dearth of research about how prevention saves money.

An evening debate— Resolved: ObamaCare gives the federal government too much control over Americans’ health care. It was a rousing exploration, in particular of the “Individual Mandate” which has been the lightning rod for the constitutionality of the act. Even so, constitutionality was not the biggest concern in the room. Effectiveness of the act, and its impact on costs, was.

A preview of a documentary to feature Group Health. Journalist and documentary creator T.R. Reid (Sick Around the World) previewed his yet-unfinished film about areas of the country that have found a way to give better care at lower costs. Producer Lisa Hartman came to Group Health about a month ago to interview people related to this documentary, and Mr. Reid is coming later this month.

It's broke — now how do we fix it?

Follow the link above for the panel I spoke on—my portion starts about 25 minutes in to the video clip. The presentation started with moderator Dr. Jay Want, President and CEO of Physician Health Partners. He gave a context-setting picture of what's wrong: mostly that our entire system is designed not to enhance health and wellness, but to produce billable events. He closed with that great quote from Jerry Garcia of the Grateful Dead: "Somebody has to do something, and it's just incredibly pathetic that it has to be us."
 
Each of the four panelists got 20 minutes to speak. The idea was to start with the most high level and theoretical and get down to a system (ours) that has actually done some of these things. In that vein, they asked me to "bat cleanup.”

  • John Rother, Executive Vice President of Policy and Strategy, AARP, talked about the patient/consumer point of view, and how the system just isn't delivering what patients want and need. 
  • Jason Hwang, MD, Executive Director of Health Care, Innosight Institute, talked about "disruptive innovation" in other industries over the last century and how that is playing out in health care. He is the co-author of the highly acclaimed book The Innovator's Prescription: A Disruptive Solution for Health Care
  • Harold Miller, Executive Director, Center for Healthcare Quality and Payment Reform, is an expert in payment systems and paying for value instead of volume. He talked about the health care "non-system," various perverse incentives, and how we might align incentives and policy to actually give better care and lower costs to our patients.
  • I talked about our Medical Home (that's what I was asked to do) but also touched on other delivery system reforms. I put our work in the context of our 63-year history, our unique marriage of finance and care, and our founding mission in 1947: to serve the greatest number (and to remove affordability as a barrier to high quality care).

I closed with…
  "We are in a struggle for the soul of American medicine. Don't underestimate that struggle or your role. The system will implode if we don't fix it. 
    We can only do this together by crossing our tribal boundaries, political parties, health plan/delivery system boundaries, and primary care/specialty boundaries.
     We need to learn together with open minds, unwavering principles, and unflinching focus.
     We can do this."
 
Then we fielded an hour of Q&A with the 350 or so folks in the audience. They were clearly fascinated by what we have done—and are doing—and how we look at our work. There are so few models that work. Our work at Group Health was so appreciated.Print

Open Mike Articles
  • 2012  
  • |  2011  
  • |  2010  
The Path To The Best Care At Lower Cost   12/01/2012
The US spends $2.7 trillion on health care every year. If our collective wallets feel lighter, that’s because $304 billion comes out of our own pockets. How can these kinds of costs be brought under control, without sacrificing quality of care?

Certainty   09/04/2012
Sustaining momentum in uncertain times can be hard, but one way to keep it up is to celebrate progress. I’m really proud to call your attention to a study published in Health Affairs today.

Affordable Care Act ruling brings stronger imperative to transform health care  07/11/2012
As important as the Supreme Court Ruling is for the future of health care, it’s really just one step in a process that started before the Affordable Care Act passed and will continue for a long time to come.

Only connect 05/16/2012
This spring I spent five weeks in clinical immersion all over our system. I had 34 small-group discussions with 172 different clinicians. In March, I shared some early insights at the half-way point. Now I want to wrap up everything I heard.

What if? 04/11/2012
What if the “new normal” doesn’t feel normal at all, for many years? I try to remind myself and others that the current turmoil in health care is driven by market forces—not politics—and can only be solved by directly addressing the market. Our “new normal” is all about reaching across silos to work with partners in new ways.

Business problem? Diagnose it.
03/21/2012
I’m about halfway through my 2012 clinical immersion. When I tried this last year it was new for all of us, and it felt right to start our conversations around values. This year I'm trying to dig a little deeper.

What will your legacy be?  02/24/2012
What a night! It felt terrific to see over 700 clinicians and special guests at the GHP Annual Meeting on February 15. “A Legacy of Leadership” was our theme for the evening, touching on our shared past, present, and future.

Performance matters  10/19/2011
Only nine Medicare Advantage plans in the country earned 5 stars overall, and Group Health Cooperative’s Medicare Advantage plan is one of them!

Looking back, and ahead: reflections on my first three years  9/17/2011
The last three years have passed quickly, largely because I’ve had such an amazing group of people to work with. What you’re capable of no longer surprises me. It inspires me.

Our people are our culture, and we’re constantly evolving  8/17/2011
One thing I’ve noticed since my last Q&A on Group Health culture with Scott Armstrong is that conversations like ours are spreading.

More than elbow room  7/6/2011
Growth is a good problem to have in turbulent economic times. But as I’ve heard in medical staff business meetings and conversations, growth is hard on daily life at work.

Erikson and Soman on partnership and growth  6/15/2011
Sustaining growth isn’t about Michael and I being leaders; it’s about teams of seasoned, excellent colleagues and leaders and clinical teams. We both have tremendous confidence in them.

The good, the bad and everything in between  5/11/2011
I went all over the state in March, talking with small groups of GHP physicians and other clinicians about critical issues. 

Why are we here?  3/23/2011
Easily eight out of ten of you mention that our philosophy of medicine—the way we practice—drew you here. And paired with the people and relationships in your workplaces, it’s a major thing that keeps you here.

Culture at Group Health: 7 questions for Scott & Michael  3/9/2011
Scott and I kicked off some fresh thinking about culture and respect for people at our Leadership Conference about five weeks ago. Recently, we sat down to check in with each other about it.

Put some passion in your workplace 2/17/2011
What satisfies you, motivates you, or makes you want to tell your friends and family about your day? Do you know how your co-workers would answer these questions? Talk to each other to learn from each other.

Sometimes growth don't feel like it should  1/28/2011
We know that taking on new patients—and engaging them in their own good health—takes time. But it’s what’s unique and important about our kind of medicine.

What will it take? You.  12/1/2010
About 350 leaders from the Group Practice and throughout Group Health gathered for the Group Practice Annual Fall Forum on November 12.

Demystifying clinical integration
11/3/2010
Clinical integration is the key, so let’s define what that phrase means.

Step back and take it all in. You’re making great things happen.  10/21/2010
In the last issue of Open Mike we had just learned that we had won the 2010 Acclaim Award from the American Medical Group Association.

Group Health sees a big jump in NCQA private plan rankings  9/22/2010
Group Health is one of the highest rated health plans and among the top 50 in the nation, according to the National Committee for Quality Assurance (NCQA).

Innovation is where we shine  9/8/2010
I am very excited to share that the American Medical Group Association (AMGA) has honored our work with its 2010 Acclaim Award.

Measuring up  7/28/2010
Quality. Ask a hundred people to define it, and you’ll get a hundred answers.

The risk and opportunity of Accountable Care Organizations
6/30/2010
Shared values, physician-led care models, and aligned incentives can bridge the distance between organizations in the world of accountable care.

Let’s start a conversation about our workplace  4/4/2010
People are our most important resource, our “secret sauce.”

Decreasing “unwarranted” variation in clinical care  3/24/2010
As you read this, we are in the midst of unprecedented reform to our national health care system.

Making the transition from “I” to “we”
2/10/2010
Last night the Group Health Permanente Annual Meeting left me feeling inspired and confident.

Looking ahead to 2010  1/13/2010
First, for 2010, our goal is as follows: We will lead the top delivery system in the state.

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