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Achieving Organizational Alignment within Healthcare Organizations

StrategyDriven Organizational Alignment WhitepaperCo-authors Nathan Ives, StrategyDriven Principal and Scot Park, Artower Principal, released a new white paper on organizational alignment and performance improvement for the healthcare industry. The paper describes how best practices in measuring organizational performance in the nuclear power industry can be applied to healthcare providers facing the daunting challenge of concurrently increasing production, efficiency, and quality – all while reducing operating costs. The Value-Based Performance Improvement Model© is an affordable approach that healthcare providers can use to develop a Lean Six Sigma style performance measurement system.

StrategyDriven recently formalized an alliance with Artower Advisory Services to deliver Value-Based Performance Improvement services to healthcare providers and are looking forward to helping these organizations realize the critically important economic benefits created through the use of this new performance improvement model.

Download a copy of Aligning Healthcare Organizations: Lessons in improved Quality and Efficiency from the Nuclear Power Industry by clicking here.


About the Authors

Nathan Ives, StrategyDriven Principal is a StrategyDriven Principal, and Host of the StrategyDriven Podcast. For over twenty years, he has served as trusted advisor to executives and managers at dozens of Fortune 500 and smaller companies in the areas of management effectiveness, organizational development, and process improvement. To read Nathan’s complete biography, click here.

Scot Park is a Principal and co-founder of Artower Advisory Services. He has spent the past two decades serving the Healthcare Industry with a focused on Aging Services, Senior Housing and Post-Acute/Long-Term Care. Scot holds a BA in Economics with concentrated studies in Public Administration from John Carroll University. To read Scot’s complete biography, click here.

Using Healthcare Performance Management as a Business Strategy

Explore how Healthcare Performance Management (HPM), combined with self-insurance, can empower organizations not only to better manage their governance, risk and compliance exposures, but also to deliver bottom-line business value to a company.

By applying the right people, processes and technology to those three focus areas, HPM can empower companies to execute a powerful business strategy that can reduce healthcare costs while also improving employees’ health outcomes.

The first step rests with how companies choose to deliver health benefits to their employees. While every organization’s healthcare plans differ, for example UCLA benefits offers custom packages for each employee, there are two ways coverage can be provided: through fully insured plans, in which they purchase coverage from an insurance company, or through self-insured plans, in which they directly cover employees’ healthcare expenses.

Self-insurance recently has become the option of choice for a majority of the workforce. In 2008, the nonprofit Employee Benefit Research Institute (EBRI) found that 55 percent of workers with health insurance were covered by a self-insured plan. The decision to self-insure has been embraced enthusiastically by large corporations – 89 percent of workers employed in firms with 5,000 or more employees were in self-insured plans in 2008.

By self-insuring, employers can control the costs of providing health benefits to their employees because it allows them to:

  • Obtain more specific information about their actual healthcare expenditures.
  • Control costs, because instead of paying health insurance premiums that typically rise 9 to 10 percent per year, they can pay for routine expenses such as doctor visits, procedures and prescription drugs through a self-insured plan, obtaining lower-cost catastrophic or “stop-loss” policies to cover major medical events.
  • Enable better “human capital management” by recognizing in advance what types of health events are emerging in their covered population in time to help employees avoid a catastrophic event.

An HPM strategy has profound implications for senior management in the three critical areas of governance, risk and compliance. This manifests itself in the following ways:

  • Governance requires the active engagement of business units beyond human resources – strategic planners, financial and operations executives, and the IT group.
  • Self-insured firms must manage their own risk, so access to real-time data that is tied to the plan is imperative.
  • Although corporations have dedicated resources to compliance activities, an HPM system is automated and therefore can deliver those required reports as an ancillary function. This way, organizations can generate the necessary documentation for auditors, regulators and others without devoting valuable resources to that single function.

Governance, Risk, and Compliance Management Strategies for Self-Insured Health Plans: How Senior Executives Can Use Healthcare Performance Management as a Business Strategy explores how HPM, combined with self-insurance, empowers organizations to better manage their governance, risk and compliance exposures, and delivers bottom-line value to the company.

Click here to download a complimentary copy of this Healthcare Performance Management Institute report.

Want to learn more?

Listen to our recent StrategyDriven Editorial Perspective podcast interview with George Pantos, Executive Director of the Healthcare Performance Management Institute during which we discuss how companies can keep their current health plans in light of the recently passed healthcare legislation and under what circumstances they may wish to do so.

Healthcare Mergers: An Emerging Crisis

Advocates of the president’s health care reform package have expressed alarm over a wave of mergers spurred by the new law.

Johns Hopkins Medicine, for instance, is snapping up hospitals in the Washington, D.C.-area, a move it describes as “driven largely by health care reform, which demands an integrated regional network.”

Johns Hopkins is not alone. Many established actors in the health care industry – including insurers, brokers and providers – are searching for ways to increase their market clout.

That’s bad news for ordinary patients, who will be forced to pay ever more for their care as the level of competition in the health care marketplace dwindles.

It’s easy to see why competition drives down costs. When insurers or health care providers have to battle one another to attract customers, they must differentiate themselves by charging lower prices or providing better service.

But if an insurer dominates a marketplace, it can raise prices and lower service standards with impunity.

Many insurers and providers are already taking steps to limit competition. Consider ‘most favored nation’ (MFN) clauses, which insurers use to prohibit hospitals or doctors from charging competitors less. Insurers claim that these discounts are necessary to help them secure the best possible deal.

Unfortunately, it’s the “best possible deal” for the insurer — not ordinary patients. The ‘low’ prices included in these MFN clauses are often based on artificially high price quotes from the provider. In some cases, insurers have actually agreed to increase what they’ll pay so long as other insurers are forced to pay even more.

Patients, of course, lose. The favored insurer passes along artificial cost increases directly to their customers, while disadvantaged competitors have to charge even higher premiums to continue offering access to offending providers. Many insurers simply exit a market once a rival negotiates an MFN.

Such an exit can be disastrous. According to an American Medical Association study, two or fewer health insurers control more than 70 percent of the market in 24 states. And if a competitor is foolhardy enough to try to work around an MFN, then the dominant insurer can simply force its rival out of the market.

A case in point is TheraMatrix, a small Michigan company. In 2005, TheraMatrix contracted with Ford Motor Co. to provide physical therapy services to its employees. TheraMatrix cut Ford’s costs by nearly half – saving the company millions of dollars. Last year, Ford expanded the program to cover 390,000 employees and retirees nationwide.

Everyone was happy – except Blue Cross Blue Shield of Michigan (BCBSM), which handled the administrative side of Ford’s insurance plan.

As TheraMatrix added other automakers to its customer base, BCBSM dropped the company from its medical provider network, which covers most Michiganians. BCBSM also threatened to revoke its other customers’ hospital discounts if they carved out their physical therapy benefits and contracted with TheraMatrix to provide them.

Blue Cross wrote that TheraMatrix’s operations were “competitive and damaging not only to BCBSM’s financial interests, but also to its business relationships.”

In other words, BCBSM would not allow its customers to shop around for better deals. And it would try to bully TheraMatrix out of business.

Such anti-competitive behavior harms employers and patients alike. Further consolidation of insurers and providers could make things worse.

Over the last 10 years, employer-provided health insurance premiums have more than doubled. Premiums for the most popular employer-provided plans are projected to increase by another 10 percent next year.

If businesses are to stop runaway medical costs, they’ll have to take control of their benefits. They can do so with the help of a new business strategy: ‘Healthcare Performance Management’ (HPM).

HPM uses powerful software to show companies where their health plan dollars are going, and where opportunities for savings exist.

For instance, HPM analysis of employee medical and prescription claims data might show that a company is spending too much on brand-name prescription drugs and that alternatives like generics could help it save millions.

Unsurprisingly, insurers don’t want to share this data with businesses. After all, if a company can’t pinpoint exactly how it’s spending its health dollars, it will be less likely to question premium hikes. Nor will it be able to find efficiencies, as Ford did, by cutting the insurer middleman out of the equation.

In many parts of the country, big health insurers have enjoyed virtual monopolies. Unburdened by real competition, they’ve abused their powers while businesses and their employees footed the bill.

HPM empowers businesses to inject competition into the healthcare marketplace and fight back against decades of cost increases. Employers should take advantage.

Additional Information

In addition to the invaluable insights George shares in this StrategyDriven Editorial Perspective article are the resources accessible from his website, www.HPMInstitute.org.   George can be reached at [email protected].

Final Request…

StrategyDriven Editorial Perspective PodcastThe strength in our community grows with the additional insights brought by our expanding member base. Please consider rating us and sharing your perspectives regarding the StrategyDriven Editorial Perspective podcast on iTunes by clicking here. Sharing your thoughts improves our ranking and helps us attract new listeners which, in turn, helps us grow our community.

Thank you again for listening to the StrategyDriven Editorial Perspective podcast!


About the Author

George Pantos is Executive Director of the Healthcare Performance Management Institute, a research and education organization dedicated to promoting the use of business technology and management principles that deliver better and more cost-effective healthcare benefits for employers who provide health insurance coverage for employees and their dependents. To read George’s full biography, click here.

Be Good to Your Employees and They Will be Good to You

The recession we have been experiencing over the past few years has created a strong upper hand for employers across many industries. Because getting a job has been very difficult, many employers have taken advantage of the climate and chosen to offer their employees less in the way of income and benefits.

In my experience, this strategy is a short-term solution and a short-sighted approach that will lead to reduced profits and poor company morale.

Companies show how much they care about their employees when they offer and pay for a part of every employee’s health, dental and vision coverage.

For example, we had an employee whose husband was going through cancer treatment at the time our company was searching for a new insurance policy. At the time, we employed over 550 people and could save tens of thousands of dollars on new healthcare. The only problem we had was that most insurance carriers wanted to exclude our employee’s husband from the new policy, thus leaving him with COBRA or no healthcare at all. This was unacceptable to us, so we kept the policy we had and paid the additional premium until the cancer treatment was complete.

This example is part selfless and part selfish. All of our employees knew why we had made the choice to stay with our healthcare provider, and that helped to improve our corporate culture and further showed how much we care about our employees.


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About the Author

Daryl Wizelman is a leadership, corporate culture, emotional intelligence, life planning and work/life balance visionary. Daryl combines his inspiring story with some practical tools which can be implemented immediately to improve the lives, careers and companies that he touches. Daryl spends his time speaking, consulting and motivating companies, associations, professional athletes, sports teams and individuals all over the world. To read Daryl’s complete biography, click here.

StrategyDriven Editorial Perspective – You Don’t Get Something for Nothing

Some would argue that with President Obama’s signing of health care legislation into law a great deal of uncertainty was eliminated from the marketplace. While the uncertainty associated with whether or not health care legislation would become law has been resolved, the new healthcare entitlement itself represents an injection of new uncertainty into the market. As is the case with many laws, the various regulatory agencies of the U.S. government must now determine the specifics of how the new law will be enacted. This process itself may take several years to accomplish; allowing the uncertainty to continue to fester within the U.S. marketplace. Additionally, legal challenges as to the constitutionality of the healthcare law also inject an unknown into the business environment. Thus, businesses are left to deal with the healthcare uncertainty at least for the time being.

One thing is for certain, you don’t get something for nothing. Provisions of the new healthcare law provide for the extension of benefits to millions of currently uninsured Americans. Insurance companies will not be able to deny coverage to individuals with pre-existing health conditions and there will no longer be lifetime insurance payout limits. Another requirement extends the age for which children can be carried on their parent’s insurance policy to twenty-six. …and the list goes on. All of these additional healthcare benefits have to be paid for by someone or some company even if the specifics of those payments remain unknown for some time.

Some leaders already estimated the cost of the new healthcare law on their organization as:

  • AT&T: $1,000 million
  • Verizon: $970 million
  • Deere & Co.: $150 million
  • Beoing Co.: $150 million
  • Caterpillar: $100 million
  • Prudential Financial: $100 million
  • Lockheed Martin Corp.: $96 million
  • 3M Co.: $85-$90 million
  • Exelon Corp.: $65 million
  • AK Steel: $31 million
  • Eaton: $25 million
  • Illinois Tool Works: $22 million
  • Xcel Energy: $17 million
  • Valero: $15-$20 million
  • Honeywell: $13 million
  • Goodrich: $10 million
  • Allegheny Technologies: $5 million1

Other companies warning of an increase in benefits costs include: Con-Way Inc., Navistar Inc., Xerox Corp., Public Service Enterprise Group Inc., and Met Life Inc.2


The total cost of this [healthcare legislation] has been significantly underestimated,” said Jim Rogers, Chief Executive Officer of Duke Energy Corp. and a director of U.S. health insurer Cigna Corp. “Corporations are going to pay billions of dollars this year that no one even talked about in the debate and that’s just the beginning.

Rogers said the health-care law makes it more economical for Duke Energy to pay a penalty for not providing health coverage for employees, forcing workers to “go shop” for a plan. The company won’t take this route, he said.

Your health-care program is important; it demonstrates that you care about your employees,” he said. “So as a practical matter we won’t be driven by the most economic thing to do, we will be driven by taking care of our employees.3


StrategyDriven Recommended Practices

So what is known? Unless the new healthcare law is found to be unconstitutional, it is reasonable to infer that existing capital within our economic system, regardless of its source, will be diverted in larger portions to the healthcare industry – and away from other market sectors. It is also reasonable to assume that those receiving health care coverage will make greater use of the medical services now available to them than simply the emergency room visits they were entitled to before. These reasonable yet broad assumptions drive StrategyDriven leaders to consider the following strategic options:

  • Eliminating, streamlining, and outsourcing all labor intensive work activities. The goal is to reduce hiring and/or eliminate headcount in order to avoid the potential costs associated with the new healthcare legislation. In the case of outsourcing, serious consideration should be given to transferring those functions not absolutely required to be performed within the United States to overseas providers.
  • Relocating operations to another country not as heavily burdened with taxes and other mandates. The goal is to reduce non-value adding payments required by the government. Consideration must be given to other added costs such as transportation and importation taxes when evaluating whether or not to relocate.
  • Examining the potential competitive advantage the organization’s health care program provides when seeking to attract and/or maintain talent. The goal is to use the organization’s healthcare benefits as a differentiator when acquiring and maintaining top performing individuals.
  • For those organizations providing products and/or services to the healthcare industry, reevaluating the company’s production capacity with respect to the potential change in the demand resulting from the influx of millions of newly insured patients. The goal is to be appropriately prepared and positioned to seize as much of the newly created market as possible.
  • For those organizations not currently providing products and/or services to the healthcare industry, considering the impact of the diversion of discretionary personal funds and/or corporate capital away from their market segment. This evaluation should take into account the extent to which the product and/or service is provided are a human or business necessity. The goal is to estimate the amount of business loss that may be incurred because of the diversion of personal and corporate funds to the healthcare industry.
  • For those organizations not currently providing products and/or services to the healthcare industry, evaluating the company’s capability and opportunity to provide products and/or services to the healthcare industry. The goal is to be appropriately prepared and positioned to seize some of the newly created market if it is reasonable for the organization to do so.

Final Request…

StrategyDriven Editorial Perspective PodcastThe strength in our community grows with the additional insights brought by our expanding member base. Please consider rating us and sharing your perspectives regarding the StrategyDriven Editorial Perspective podcast on iTunes by clicking here. Sharing your thoughts improves our ranking and helps us attract new listeners which, in turn, helps us grow our community.

Thank you again for listening to the StrategyDriven Editorial Perspective podcast!

Sources

  1. “Companies Take Billions In Health Care Charges,” Reid Wilson, National Journal, April 2, 2010
  2. “Deere & Co. says new health care reform law will increase fiscal 2010 expenses by about $150M,” Josh Funk, Associated Press, March 25, 2010
  3. “Duke Energy Says Health Law to Result in ‘Large’ Cost (Update1),” Kim Chipman and Jordan Burke, Bloomberg, April 01, 2010