We drew a bigger crowd when Lee Cockerell came to give us a soft talk about how Disney customer service can transform your healthcare organization, which really ended up being more about marriage and wellness advice, than when one of the preeminent and most respected healthcare policy and medical pioneers in the country, Dr. Thomas Lee, came to town late last week.
Dr. Lee was a great selection by the Health Enterprises Network because he helped created ‘Romneycare,’ making Massachusetts the first state in the U.S. with a universal health insurance program. Dr. Lee, along with the famed Michael Porter, also just co-authored the largest-ever Harvard Business Review article on transforming healthcare to a more patient-centered, value-driven model – a ‘must read’ for all HC organizational leaders. He designed change, lived through it, and now wants to help you change your mental modes.

This is not a knock on HC Disney’s Cockerell but a validation of why last week’s breakfast should have been packed wall to wall. Here is the skinny from Dr. Lee comments, and some predictions based on his experiences…
HC costs will drop quickly because acute volume will drop and payment incentives will shift on top of the volume drop – and, most important, it’s already started.
The goal of any provider organization should be to reduce human suffering through compassion, and improved access and affordability, not through over-utilization due to aggressive business practices.
State HC exchanges will not be as important as many are predicting because employers will still drive insurance products for the time being. (Very few in Massachusetts actually use it.)
HC Reform will come at you in three ways: first, insurance reform (Affordable Care Act); then, payment reform (gate keeper changes occurring now); and lastly, delivery system reform (how and where care is delivered, etc).
As part of this shift, unfortunately, the majority of small rural hospitals and small Critical Access Hospitals – we have 131 hospitals including a large percentage that are critical access – will slowly close, not because of Congress, but because of MCOs and gate keeper changes.
The ‘mega-mergers’ world will accelerate and the push-back from the providers who are getting pounded by Managed Care Organizations will reverse course, validated by recent acquisitions already taking place, that re-balance risk and profits for providers (versus now, where MCOs have the upper hand).
The Massachutts plan was never repealed but modified every two years, so keep that in mind that Obamacare will shift in many ways, but it’s unlikely to ever go away.
Bundled payments are simpler to adopt than our complex provider systems, they are growing quicker than you realize, and early adopters have been rewarded with higher market share.
Here is his strategy map for all of us to implement — and it’s only 6 steps:

1. Build real teams of Integrated Practice Units (IPUs)
2. Measure outcomes and costs for all patients
3. Episode-based incentives for value
4. Integration of care across delivery system
5. Growth of excellent IPUs
6. Enabling information technology platform

Once in a while you realize exactly where you are in your career, the timing of industry cycles that are bigger than all us and that your inner private thoughts on HC policy are scary to simulate because it challenges every assumption you ever made. But the great news is that Dr. Thomas Lee is here to help.
When I stayed around to talk with him, he knew about Signature and our Spirituality pillar, and that our leaders were all CNAs, and of our innovative culture, which made Dianne and I feel proud to be part of a very special organization during an epic time of change.
Talk about crazy timing for one of the most respected HC policy pioneers and top medical leaders, Dr. Thomas Lee, to be here. He gave me his card and we are already communicating. I just hope we can live through it to see the end…compassionate, patient-centered HC with high social value in the U.S.!
Dianne Timmering’s blog reflection on this event, “Defy Suffering”>>

‍