The Myriad Ways of Strategy and Population Health for Governance Boards and Health Care Leaders

What's it take to be a "luminary?"

As healthcare organization leaders grapple with health reform's uncertainties, a common refrain is importance of "strategy".

It's no longer enough to maximize revenue, increase patient throughput, lower costs, manage debt, embrace financial risk, optimize FTEs, assure compliance or strengthen the balance sheet.

While those present management and fiduciary functions are still critical, governance boards and c-suite executives in both purchaser and provider organizations also have to make bets about the future.

For example, if healthcare inflation accelerates, how will your current customers react to their future costs-sharing? How and when will today's voters reconcile the burdens from growing public debt and government-sponsorship of the insurance programs you contract with? As "the internet of things" spreads, what is tomorrow's value proposition of your healthcare "things?"  Is reading this blog today going to lead to you being smarter in tomorrow's contentious meeting?

In other words, when leaders grapple with strategy, they're really futurists. They're making bets today on how to adapt current strengths and weaknesses to myriad downstream threats and opportunities.

Uncertainty has become a new watchword. Even if an organization doesn't change and sticks with old fashioned fee-for-service, they're still making a big wager on the future of individual billing versus risk-contracting for populations.

Which is why the Population Health Blog is interested in how leaders outside of healthcare deal with uncertainty. 

Being routinely unable to resist the materialistic allure of the WSJ. Magazine fashion ads, the PHB  happily stumbled into this Soapbox column on the single topic of strategy. Six "luminaries" were asked about it.

The recording industry executive emphasized visualizing the endgame. The professional sailor trusts her gut instincts. The computer gamer is all about capitalizing on lucky breaks. The presidential historian liked ongoing experimentation. The restaurateur is constantly shaping company culture. The matchmaker likes being open to change, even if it means being vulnerable.

Lesson? The PHB has read or heard all of this and more from leaders and in boardrooms. Examples include this (the end-game), this (intuition), this (luck), this (experimentation), this (culture) and this (change management).

"Strategy" remains a highly variable work in progress.  There is no best practice.

And then there's the huge health care opportunities and risks from contracting for the care of populations. Check out this interesting post by George Washington University's Miliken Institute of Public Health that describes a survey of 37 health care luminaries on the topic of population health. As the author points out, consensus on responsibility (and, as a side note, the assets and liabilities that accompany it) is lacking.  In addition, quoting the "Triple Aim" is turning out to be less than its admirers would like.

So it turns out that this is also very much a work in progress.

The PHB's takes?

 There are two:

1) Multiply the many approaches to strategy with the multiple takes on caring for populations and the possibilities are endless. Based on the variations, no one has cracked the code applying strategy to populations and risk-contracting.

For purchaser/provider board members and C-suite leaders, the good news is that your strategic bets on the future are - for now - as good as anyone's. The bad news is that the present day fiduciary work is not lessened and you're going to have to devote more effort (and time) on developing a still unsettled strategy approach to the uncertainties surrounding health reform.

2) Regrettably, despite describing itself as a "luminary" many times to the PHB Spouse, it was not included in the WSJ. column and the Miliken Blog.  This sadly suggests that her skepticism - for now - is warranted.

Image from Wikipedia

Looking Ahead to the Second Enrollment Wave of Obamacare This Fall

Big or small?

The latest just-published edition of Health Affairs has a sobering reminder written by Tricia Brooks ("Open Enrollment, Take Two") that the healthcare marketplace wars will recommence on November 15.

That's when open enrollment starts all over again. While the good news is that more than 7 million people got health insurance through the on-line marketplaces, the bad news is that there are now 7 million people who will have to use the process again to get their insurance renewed.

While Dr. Brooks is generally upbeat and hopes our politicians will put their constituents first, the Population Health Blog asks.... what could possibly go wrong?

What the PHB learned.....

Development work isn't finished yet.  The back-room and behind-the-scenes web machinery dealing with application questions, required consumer notifications and eligibility issues are continuing to get tweaked. In addition, the Feds are working to upgrade the electronic and other processes that are necessary to verify identity and immigration status. Plus, it has yet to be fully integrated with the commercial marketplaces, Medicaid and the CHIP agencies.

It is also possible that during the renewal process, persons who underestimated their income in the process of applying for tax credits may be subject to claw back, and the individual mandate's tax penalty will rear its ugly head.  We don't know how consumers will react.

It also remains to be seen how many consumers will understand the financial assistance or miss the deadline. Look to the Administration launch reprise of a marketing campaign that encourages "tell your friends and family" word-of-mouth.

And then there is no guarantee that many states will want to - or be able to - fully cooperate.

What went unmentioned is the "wild card" of the fall political campaign.  All of the members of the House of Representatives, a third of the Senate and many Governors will be spinning Obamacare.  Thanks to the fog of political war played out our TV screens, individuals may be entering the open enrollment period with a whole new set of opinions and apprehensions.

Stay tuned!