Accountable Patient

Motivating Employees. More Than Providing Direction

By DrScott – Posted on February 6, 2014 on www.compassphs.com

Fifth in the How to Switch On Your Employees Series

An employee from a remote office location stopped by the office of her President at the corporate headquarters. Unsure of the exact purpose for the visit, the CEO thanked her for stopping by and her years of loyal service. Once seated, he paused and asked “how can I help you today?”.

She looked at her hands folded in her lap and said, “Two years ago you announced that we were going to have to get our biometrics done, see our doctor, and get our cancer screening done to qualify for the best health plan. I was really angry. I am 28 years old, a single mother of two children, and frankly, I can barely get everything I need to do done and catch a few hours of sleep at night. To tell me I had to do more felt unfair. But I also could not afford to pay more for my health insurance, so I complied. At my exam the doctor found a breast lump and sent me for a mammogram. I then found out that I had stage one breast cancer. To make a long story short, it was a real hassle, but I got my treatment and the doctors say that I am now cured.”

She paused, obviously straining to maintain her composure. She looked at him directly and continued, “I can tell you that without you requiring me to get my screening I would have put it off another five years. The doctor told me that if I had waited even one more year my cancer would have spread and my chance of surviving would have been a lot less. So I came here today to tell you thank you. Thank you for caring enough to require me to do the right thing, even though it costs the company more money and you didn’t have to. Thank you for saving my life, and thank you for giving my kids their mom; they are still young and would have been alone if I had died.”

Surprised, the President expressed his appreciation at her stopping by to share her story and the great news that the doctor thought she was healed from her cancer. This was the second time in a month an employee had contacted him to thank him for helping discover early cancer.

Their health plan had gone from just another requirement, to a campaign to catch disease early, and to save employees lives. Employees were inspired, and morale was better than ever. They had even begun a program to support “Health Champions” who encourage and support their employees in taking the ‘Baby Steps’ to go from reactive to proactive lifestyles, and to create a culture of wellness.

Chip and Dan Heath in their book, Switch – How to Change Things When Change is Hard, point out the need for three major principles to be honored in order to promote successful change (see previous blogs). The rider must be directed, the elephant must be motivated, and the path must be clear.  In this instance, the company provided employees motivation to move down a different path to a new destination. The employees not only understood the task at hand, but also found the feeling that motivated them to change. The change had been broken into realistic small steps, and employees gained more knowledge and experience in proactive wellness. A new mindset was emerging. It had taken two years but success was no longer in question.

Implementing Outcome Based Wellness – Making the Switch

By DrScott – Posted on February 4, 2014 on www.compassphs.com

Fourth in the How to Switch On Your Employees Series

How does a company switch directions to a plan that will actually improve the health of their employees and reduce health care costs? Using the paradigm for effective change from the book Switch by Chip and Dan Heath, the analogy of a rider changing the direction of an elephant as it walks down the well-established (less desirable) path, they reveal that it is not a single strategy that insures success, but multiple concurrent strategies that are needed.

In this blog we are going to focus on the first of these factors; the rider. The “rider” must know:

  1. The exact destination (To change, the rider must know where to go):
    • In health benefit terms, employees must:
      • get their biometrics done,
      • get their numbers to goal, and
      • identify and see a high quality primary care doctor for US Preventive Services Task Force (USPSTF) wellness, cancer screenings, and fulfill diabetes and heart disease recommended guidelines.
  2.  Script the critical moves (The rider must understand the specific steps to complete):
    • The employee learns where they must go to accomplish required steps and where to get more information:
      • Biometrics will be done at certain locations without charge for employees throughout the year, or get biometrics done at their primary care doctors and send in a required form;
      • Seeking out a high quality primary care doctor and following recommendations;
      • Being directed to the list of USPSTF age and gender appropriate tests that are available on line.
  3. Why go to this destination? (The rider must know why the change is necessary):
    • Treating conditions early, or preventing conditions, improves and saves lives, and also saves money.
    • Just acting based on if an employee “feels fine” delays identification of early diabetes, heart disease, and cancer. Early disease must be addressed before symptoms appear.

The rider is much smaller than the elephant and therefore must exert significant energy to change its direction. Clarity, commitment, and a well-designed plan are vital. Otherwise, the resources needed to promote change without such clarity, commitment or a well-designed plan make having to attempt to “turn the elephant” a second or third time cost prohibitive in both resources and energy, and usually without the desired sustainable results.

There must be a sense that the journey is attainable. If the destination seems too far away, or the required change is too drastic, the rider can lose enthusiasm and focus. Laying out realistic and attainable “baby steps” allows the rider to stay focused.

Insure the “rider” of your change efforts knows exactly what to do and how to do it. Breaking the steps into smaller manageable steps increases the likelihood of change being successful. But the rider is only one part of the equation. In the next blog we will look at motivating the elephant to stay on the right path.

The Next Generation of Value Based Medicine: Corporate Population Health Management™ – Part 1

Working with corporations and providers to create Value Based Care. Read more at the Open Health Market Blog: The Next Generation of Value Based Medicine: Corporate Population Health Management™ – Part 1.

Special Medical Provider(s) Wanted

GOH Medical is growing.  Over the next several months we will need to add a new medical provider: a doctor, nurse practitioner, or a physician’s assistant.  Do you know the right person for this job?  Here are some thoughts to consider;

  1. “Not on our watch”  The Institute of Medicine has boldly declared that we “know what to do, but are not doing what we know” and this must stop.  What would a clinic look like if the commitment was to proactive, preventive health care first; illness management and reactive care second?  We are looking for a provider that wants to review each patient for possible future issues to address them before they develop symptoms.
  2. “Committed to curing the ‘I Feel Fine’ Syndrome”  There is a big difference between “I feel fine” and “I am healthy.”  Patient engagement before symptoms occur is vital to preventing diabetes and heart disease, and diagnosing cancer in stage 1.  Using The Seven Numbers as a teaching tool and foundation we empower each patient to learn and live the Seven Numbers that Can Save their Life,
  3. “Only the best” When problems do appear what does it take to find the best solution? A large part of GOH Clinic is making sure that each person gets what they need when they need it at the right place for the right price – whatever it takes.  Coordination of care, transitions of care, communicating and getting records sent out, and following up are vital commitments,
  4. “Technology leverage” Text, email, blogs, electronic health and medical records, the latest equipment.  We are looking for a technology geek/nerd with a personality,
  5. “Part of a team”  Each teammate at GOH Medical is a link on a chain that includes everyone from the maintenance crew to the super-specialist at the hospital.  All important for a successful healthcare, over-communication and a commitment to six sigma/lean processes ensure success,
  6. “A teacher committed to delegation and empowerment”  Medical knowledge doubles every 18 months.  The best we can do for patients is to understand their challenge, educate them, suggest a course, and encourage them to learn as much as they can to play an active, vital role in their health; GOH Medical understands that there is more that we know that we do not know, than there is that we know, about any particular topic.  Even if we read 24/7/365 we will fall hopelessly behind.  There is no place for arrogance, coercion or convincing; only sharing what we know, sharing what we expect to occur, and then closely communicating if this does not occur over time.  We are a member of a team, we empower, encourage and give 110% effort.
  7. “Focusing first on lifestyle” Food is the strongest drug we put in our bodies every day, exercise the best medicine; but that is not all, there are The Seven Healers we need to pull into our lives each day.  It is from this foundation that we encourage our patients to win the Game of Health.
  8. “An open minded healer” Allopathic medicine has changed the worldEvidence based, informed, outcomes oriented… and it is incomplete and often fails to provide complete healing.  Weak in mind:body medicine, lifestyle intervention, natural healing, myofascial manipulation, meridian management/acupuncture, supplements and other disciplines that may be less rigorous or researched in their body of knowledge, these other disciplines  must be recruited for whole person, successful healing.  Focusing on the patient, not the dogma of one discipline, is required,
  9. “Courageous” we do not believe in codependency or enabling – this means supporting patients to support themselves through The Empowerment Dynamic – TED, not rushing in to “save” or “cure” our patients.  Our patients are not powerless victims of situations; they are powerful creators of a great life and we are a vital member of their team.  Healthcare workers want to help, but this can digress into a one up: one down dependency – one we are committed to avoid.  Sometimes it takes more time and effort to promote, but ultimately it is the road to health,
  10. “Serving all”  With our innovative GOH4Health, GOH4Wellness, and GOH4Breakthroughs we serve people with and without insurance, insured patients and corporations.  Our population based, proactive approach minimizes the waste and redundancy creating very high Value {= (quality + safety)/cost} care.
  11. “Loving” we are followers of Jesus Christ.  This is not to say we discriminate, convince, coerce or force our beliefs on others – quite the opposite.  We see each patient as a gift, tremendous potential, and our commitment is to make sure they know we are Christians by our actions; the loving, non-judgemental care they receive from us.  At GOH Medical, all are welcome, all are served.

Our systems are in place, our team is becoming more competent and proactive.  By this fall we will be running smoothly and ready to serve a larger group of patients with a population based, whole person orientation.  We are looking for a provider(s) who shares our beliefs and philosophy to add years to the life and life to the years by empowering breakthroughs in the lives of those we serve.

Please contact us if you are interested or if you know someone who is.

Free at Last, Free At Last, Thank God I am Free At Last. Time to head home (the Medical Home)

I am overjoyed (and greatly relieved) that I can now report that I am a “free agent.” I met with Dr Stoltz last Thursday and, at this point, I am no longer associated with Medical Edge or Texas Health Physician Group and will not be opening an office with them.

So it is time to get down to brass tacks and figure out what we are going to do.  As all of you who know me well appreciate I am absolutely committed to

“Adding years to the life and life to the years of individuals, corporations, systems and nations to empower intuitive wellness.”

There will be two aspects of this pursuit for me – clinical practice and creating an Accountable Care System that empowers the Accountable (or Activated) Patient.

In the clinical practice I am committed to finding and growing old with a group of patients who too are committed to living a great life – reaching 100 years of age with vitality and joy.

What does not work for me in the practice is running in and out of rooms 15 minutes at a time until I am exhausted.  This model does not work – the American Healthcare System has proven this without a doubt.  So here are some basic to consider;

  1. One on one, face to face visits will be necessary for part of the time.  But guiding, directing, supporting, and coordinating the effort is as or more important to the process of attaining intuitive wellness.
  2. Creating a medical home with opportunities like group visits, on line visits, telephonic care, and having other members of the team like dietitians, exercise specialists, social workers, pharmacists available to us are also vital.
  3. Working with a great physicians assistant and/or nurse practitioner (and at some point additional doctors) as a part of the team will add tremendous value to the practice.
  4. Finally, the freedom to speak with the specialist or go to the visit when it could/would contribute greatly to your health cannot happen when I am running room to room but may be vital at times to your health.

So now we start building a new model.  The first thing is building the team to get the logistics of starting a practice accomplished.  Not glamorous but necessary.  let’s start with one foundational person; an organized, capable, motivated individual with some healthcare background (possibly an MA or nurse) who would like to run with the ball and create this enterprise.   Do you know this person?  If so, asap please send me their contact information to drscott@scottconard.com

Secondly, this individual will need some help.  Would anyone be willing to volunteer to help with basic tasks ranging from filling out forms to running errands?  It will take a village to create the ideal medical practice for our community, but and now we have the green light for go and we can proceed!

I miss you and look forward to seeing you soon in our new facility.

Dr Scott