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I contributed here as to the Future of Healthcare. Turn to page 13. Thank you!

I contributed here as to the Future of Healthcare. Turn to page 13. Thank you!

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Ordinary Miracles Presentation Transcript

  • 1. INTRODUCTIONWe want to be healthy and when we are not we want access to the right care for us. A universal desire, realized in as many different ways as there arepeople. Thus, we have the conundrum of “health care reform”. What is it? What should it be? Who deserves it? Who pays for it? Who oversees it? Thinkingabout it is daunting. Many are choosing to wait and see what “others” think it should be.We think it’s personal. We think it’s approachable. We think there are no one-size fits all solutions. We think there are many brilliant, simple, complex,tailored and basic solutions being implemented everyday and everywhere–ordinary miracles. We think awareness and dialogue are the starting points torealizing the manifestation of everyone having the opportunity to be healthy, and when they are not, to have access to the right care.We know awareness is growing, and despite the sometimes angry rhetoric reported in the media, true dialogue is happening among institutions, companies,health professionals, and individuals. The Mayo Clinic held Transform: A collaborative symposium on innovations in health care experience and delivery inSeptember (2009). The purpose and the message were “…the next great leaps in health care will result from collaborative discussions and the sharing ofinsights from across disciplines.”Inspired by that symposium, its speakers and attendees, we invited others to share what they believe will make American health care the best experiencefor consumers and the model for the rest of the world. Our contributors are first and foremost people–mothers, fathers, sons, daughters, husbands, wives–individuals who want healthy families and access to good health care. They have unique experiences, both personal and professional. What we all share is adesire to participate in the dialogue and a belief that transformation, not just reform, is possible.Our hope is that Ordinary Miracles: Health Care, Wellness and the Next American Dream, encourages you to participate in the dialogue, too.Alan Parr and Karen AnsbaughOpenSky ConsortiumOpenSky Consortium does not take responsibility for the opinions expressed. Each contributor’s thoughts, ideas and opinions are their own and are understood to be original or appropriately attributed to their original source. 1
  • 2. CONTENTSGOING AROUND IN CIRCLES 3The basic questions we all seem to ask but can’t get answeredA PERSONAL GLOBAL PERSPECTIVE 6The health care experiences of someone who has lived in several countriesWELCOME TO THE FUTURE 13A core issue that many don’t associate with health careI, CARE 24A response to health care sound bitesFAMILY PRACTICE 29A plea for coordinated chronic issues careCONNECTED 35An illustrated story of health care delivery in the near futureQUALITY OF LIFE 44Quality housing and care for our elderly is hit and miss todayPICTURE OF HEALTH 49Four requirements for health care deliveryBUILDING A LEGACY 54An insurance company’s vision and journey towards transformationSTEP BACK… THEN STEP UP! 65A challenge to take part in the dialogue about health care 2
  • 3. Going Around In Circles Simple Questions Without Simple Answers Bobbi
McCrady
&
 Christine
Schmucker
 3
  • 4. This is just not a subject that I think a lot about, but should.Tell me:Why is health care so expensive?Why are there so many options?Why do the regulations surrounding healthcare and charges seem to be so… loose?Why wouldn’t every company have the same options, with the employees deciding which option to choosebased on their family need—with companies contributing what they can? “Why?” Why are medical costs themselves so high?How is it that insurance companies get away with not covering—or gouging—those with preexisting medicalconditions? Arent those the people who really need good coverage? With adequate coverage andappropriate guidance, couldn’t insurance companies and medical professionals be helping these people byoffering options to prevent further decline in their health? Would it then be so expensive? 4
  • 5. ABOUT
THE
AUTHORS
Bobbi
 McCrady
 ‐
 Independent
 Consultant
 since
 2007
 focusing
 on
 Project
 Management
 and
 Business
Analysis;
 majority
 of
 career
 spent
 managing
 operational
 areas
 in
 many
 facets
 of
 the
 mortgage
 industry;
extensive
 background
 in
 training
 and
 mentoring;
 Bobbi
 has
 worked
 for
 GMAC‐RFC
 and
 various
 other
financial
institutions
the
last
15
years.

Christine
Schmucker
‐
Consultant
since
2007
focusing
on
Business
Analysis.

Christine
has
worked
for
GMAC‐RFC
and
other
institutions
for
the
past
8
years.
COPYRIGHT
INFORMATION
This
 work
 is
 licensed
 under
 the
 Creative
 Commons
 Attribution‐Noncommercial‐No
 Derivative
 Works
 3.0
United
 States
 License.
 To
 view
 a
 copy
 of
 this
 license,
 visit
 http://creativecommons.org/licenses/by‐nc‐nd/3.0/us/
 or
 send
 a
 letter
 to
 Creative
 Commons,
 171
 Second
 Street,
 Suite
 300,
 San
 Francisco,
 California,
94105,
USA.

The
copyright
of
this
work
belongs
to
the
author,
who
is
solely
responsible
for
its
content. 5
  • 6. A Personal Global PerspectiveHealth Care Coverage Here and There Jari
Jison
 6
  • 7. I haven’t had to think about health care coverage for a long time. It was always there in oneway, shape or form. Last year I was laid-off; a victim of this economic crisis. Until then I only complainedabout the cost of coverage and the ever-increasing cost of medical care. Now, I worry about the kind ofmedical coverage my family and I will have after my COBRA coverage expires.I grew up in a developing country where third-party health insurance was almost non-existent. My health“insurance” was provided by my parents, who were lucky enough to be members of a very thin middle classthat could afford regular medical care. Certainly, my home country has made huge strides in creating aprivate health insurance industry. However, the sad reality is that probably only 10% (my guess) of thepopulation is covered today. The rest pay for medical care only as they can afford (which is not much) andas much as they can obtain from the free and barely adequate (in scope) and sub-standard (in quality)government medical system.When I moved to the US and started working, health insurance was something an employer provided. Inmy case, I worked for a relatively generous company that paid a large portion of the premiums. We had anexcellent plan with a high coverage percentage and minimal copayments. Over time, I had kids (we havefour now) and we shouldered a larger portion of the total premiums and higher out-of-pocket costs due toincreased deductibles, copayments, and cost of services. The reality was that medical expenses as aproportion of my income was going up and the annual increase in these expenses was outstripping anyincome gains I made. My employer giveth and my employer taketh away. Whatever raise in salary I hadwas largely negated by inflation and a slow reduction in medical benefits. Nevertheless, we could not 7
  • 8. complain. All our kids were healthy and we weren’t exactly living below the poverty line.In 2002 and six years thereafter, I had the opportunity to work in Europe, specifically, Germany. Germany,like other countries in Western Europe, has almost universal health coverage. As an expat, we enjoyed avery rich international medical plan. I paid the same premiums relative to my US colleagues but my overallout-of-pocket expenses decreased significantly. I suspect these reasons for my lower overall expenses: • Cheaper medical care – we paid about 35-40 Euros (approximately $52-60) for a regular doctor visit that might easily cost $150-200 in the US. However, not all medical care was cheaper. Dental care was expensive. We regularly exceeded our annual limits. In a league of its own, orthodontic care was akin to legal highway robbery! I won’t tell you how much we spent lest someone ransom our children’s teeth. Our children’s orthodontist owned his practice, had a brand new two story building in the swankiest part of town, and drove around in a Mercedes S-class. But maybe, that’s because all his patients were children of expats. • The Insurance Carrier paid more – I’m guessing this was because there were no negotiated contract rates and my carrier had no benchmarks for “reasonable and customary” fees for medical procedures.We were, of course, visiting German doctors and facilities that every local citizen had access to and thestate of medical technology was at least on par with that of the US. So what’s wrong with this picture? Inreality, there was a two-tier pricing system. The government paid doctors a “low” (that is how the doctorsdescribed it) rate for doctor visits and medical procedures. They could charge a little bit higher if they knew 8
  • 9. that the fees would be paid by a private insurer. I have an interesting story here; my regular doctor“retired”, as he said he could not support his practice on government rates, but then quickly started asmaller, lower-profile practice that only accepted patients with private health insurance. These were hisgolden years.What did the locals have to say about their health care? The Scandinavians were generally happy. TheGermans said “ok” but complained about some government-imposed limits. The French said their systemworks. I haven’t talked to a Brit about their health care system but expat friends living in the UK say it isdifficult to get doctor appointments, and even harder with specialists. This is just anecdotal and not ascientific study, so please don’t quote me on this.Back to the present. The word “unemployed” scares me. I can’t stand the thought of going hungry,losing my house, and not having medical insurance. OK, I’ll admit that I’m also bummed that I can’t travelas much, buy a new car, and upgrade to the fastest computer on the market. So I took care of thatproblem first. Now, I am “self-employed” which means my income is less predictable, my taxes as aproportion are higher, I have no benefits, and I now have to worry about getting my own medical insurance.It’s the last item that incensed me the most. 9
  • 10. A good friend referred me to a health insurance broker, and we applied with an in-state provider. Guesswhat–my application was denied! As I worked to replace my COBRA coverage, I discovered that a) the costof equivalent coverage was outrageous, and b) the health insurers only want healthy people. Now, I canunderstand if I had some life-threatening, incurable, or chronic disease. But no, I’m just a regular middle-aged person that has back problems, controlled high-blood pressure and cholesterol levels, and who needsto shed a few pounds. Pretty typical in this country. The absurdity of it all is that when they denied me, theyalso “denied” coverage for my family! Wait a minute, they are innocent! To counter this, I had to splitmyself off from my family and have my wife apply for coverage (with the same company!) with our childrenas her dependents. Luckily, her application was approved. Like before, I’m still paying through the nose ontotal premiums and co-payments but I at least have coverage for my wife and kids. My next challenge is tofigure out how to replace my COBRA coverage. “My employer giveth and my employer taketh away”The health care debate is raging and our lawmakers are busy working on reforming the system. What’s thesize of that document these days? It was over a thousand pages the last time I checked. I’ll have to admit,I haven’t read the document (and some lawmakers have shown they don’t read the documents either). I’mtoo busy working by the hour to pay for my health insurance premiums. One thing’s for sure, none of myclients would pay me to write a 1,000-page document. And who would read it? 10
  • 11. So what happens next? Well, I’m not a health care expert and I wouldn’t last a minute in a debate onpublic versus private coverage. I did not write this to explore the ills of medical care in a capitalistic society.We try to stay healthy. We have never abused our coverage by frivolously seeking medical care. We’vepaid our premiums and co-pays. I’ve tried hard to not become a ward of the state by collectingunemployment benefits. All I need is to make sure we have good value health coverage for my family. Forall the economic and scientific achievements of this country, I cannot accept that the US does not havesome form of universal health care. I am not against paying my fair share or making tradeoffs. However, Iam certainly against being overcharged (i.e. high payments/taxes, low benefits) or much worse, not makingany progress on this issue. I don’t expect this country’s health system to be fixed tomorrow nor do I expecteveryone to be happy with the result. The current system is falling apart.We need to get moving on this. 11
  • 12. ABOUT
THE
AUTHOR
Jari
 Jison
 was
 born
 and
 raised
 in
 the
 Philippines.

 He
 completed
 his
 undergraduate
 studies
 in
 Industrial
Management
 Engineering
 at
 De
 La
 Salle
 University
 in
 Manila.

 After
 a
 short
 stint
 as
 a
 small
 business
owner,
 he
 came
 to
 the
 US
 to
 pursue
 advanced
 studies
 and
 earned
 his
 MBA
 from
 the
 Kellogg
 School
 of
Management
at
Northwestern
University.


Jari
now
works
as
an
independent
consultant.

He
has
extensive
international
experience
and
has
held
a
variety
of
senior
management
positions
with
a
large
financial
services
company.

Jari
makes
his
home
in
Farmington,
MN
with
his
wife
Nettes
and
their
four
children.

COPYRIGHT
INFORMATION
This
work
is
licensed
under
the
Creative
Commons
Attribution‐Noncommercial‐No
Derivative
Works
3.0
United
 States
 License.
 To
 view
 a
 copy
 of
 this
 license,
 visit
 http://creativecommons.org/licenses/by‐nc‐nd/3.0/us/
or
send
a
letter
to
Creative
Commons,
171
Second
Street,
Suite
300,
San
Francisco,
California,
94105,
USA.

The
copyright
of
this
work
belongs
to
the
author,
who
is
solely
responsible
for
its
content. 12
  • 13. Welcome To The Future Of Health Care Jay
Michael
O.
Jaboneta
 13
  • 14. Imagine that youre a member of the World Health Organization attending its annual conference onmajor health issues. Imagine today that you are facing the best minds in the sectors of medicine, science,technology and other related fields.Imagine someone barging in during your committees meeting and presenting a different take on the healthchallenges of today.“Are YOU ready?” he asks.He starts by telling you that youre going on a tour inside the worlds mind-numbing health-related statistics.He tells you to delve deeper into the data.“Ask questions why this is the case. Dont just read.”“Digest. Digest. Digest.”He asks, “Lets eat, shall we?”This year, one (yes 1!) in every six people worldwide goes hungry every day. This marks a dark moment in the 14
  • 15. history of the human race. 2009 became the year in which 1/6 of our world population is going hungry everysingle day.Now, picture yourself being one of those who go hungry every day.Take this seriously.Internalize it. How would you feel? Can you eat just one meal a day? Or worse, can you imagine goingthrough your day without eating? How about three days? (How about never?)The next time you take a bite of your favorite sandwich inside Subway, imagine sitting with someone acrossthe street begging for food.Would you still like to eat?Probably not.That is how we have neglected for too long this mind-numbing statistic! Can anyone honestly feel that he issuch a loser when a sixth of the worlds population is going hungry every single day?This statistic is from a statement made by the Avaaz organization (www.avaaz.org) and it further states that 15
  • 16. “the world produces enough food to feed everyone. Yet the number of people suffering from chronic hungeracross the planet has reached the record-high figure of 1 billion this year.”Why is this the case? No one actually has any concrete answers. So maybe it’s time we ask ourselves why.Now we come to the first major challenge that the health care industry is facing today–its about thechallenge of world hunger. This must be addressed first before we go any deeper into tackling other majorhealth problems that the world faces today.Hunger should be addressed first.The Developing World, which is much of the Third World, still suffers from hunger. In the latest global reportby Oxfam International, it is reported that there are almost a billion people worldwide who suffer frominvoluntary hunger. This is the highest number of people in the entire history of humankind. This is veryalarming and is at the root of many major health problems we are facing.The foundation of any developed society is a healthy population. This is shown when a significantpercentage (if not all) of the population can lead normal lives–eat at least three times a day, have clothes towear and a roof to sleep under. These basic needs are fundamental human rights and they play an importantrole in the well-being and the health of all humans. Governments must first address these serious issuesbefore they go on and waste time on what kind of health care systems their citizens deserve. We can start 16
  • 17. talking about health care issues like health care plans, hospitalization insurance, wellness programs andothers but these should be back-burner issues–the main ISSUE that needs to be tackled first should be thechallenge of world hunger. World hunger affects each and every country. Even in the United States and partsof Europe, there are still people who suffer from involuntary hunger. This is of course much worse in thedeveloping world.Any health care plan should take into consideration the issue of world hunger. Malnourishment hinderschildren’s development. This in turn hinders them in reaching their full potential. They end up working at thebottom of the corporate pyramid and giving birth under adverse conditions. There are exceptions, but theyare quite few. If we are to address the escalating challenges of health care (and all the other challenges ofthe world), we must first develop strategies that will wipe out the challenge of world hunger andmalnourishment. How can we talk of universal health care for all when there are millions (a billion in fact) whocant even eat on a given day?Multilateral organizations like the United Nations, the Food and Agriculture Organization, the World FoodProgramme and Oxfam International together with the World Health Organization, governments and medicalNGOs must pursue a two-pronged approach: one that addresses worldwide hunger and suffering; andanother that pursues universal health care coverage for all. It should be an international plan, as we enter the21st century where a significant portion of our workers will criss-cross national boundaries in a given day.This is already happening in Europe with London residents working in France and French professionalsworking in parts of the United Kingdom. 17
  • 18. The challenge of world hunger is surely not a walk in the park. We need local governments andrepresentatives all the way up to the international multilateral organizations working together to come up witha collaborative plan (much like this open collaborative book) to address the issue of involuntary hunger andset timelines, key milestones and to re-energize government and volunteer organizations to respond andtackle it collectively.You ask the man who barged in “Sir, how do we begin tackling the challenge of world hunger?”He responds by showing you a page from Tom Peters book Re-Imagine, on the left portion of page 66,Tom writes “Studies repeatedly show that lousy practices in US hospitals lead to as many as 50,000 to100,000 unnecessary deaths per year. (And perhaps another one or two million patients are injured.) Thesehorrors are mainly a result of clunky, manual processes and an unwillingness to embrace procedures, such asbar-coded patient wristbands, that would help nurses confirm appropriate doses of meds.”Youre in a bit of shock but the man continues and tells you that love (yes LOVE!) is the answer. “This year, one (yes 1!) in every six people worldwide goes hungry every day.” 18
  • 19. Why LOVE is part of the equationAnother crucial issue that we need to focus on is the role of LOVE in our well-being and health. LOVE is partof the equation. An unhappy man or woman is not healthy. Health refers to both physical and mental healthand some may even argue to spiritual and emotional health as well. Hospital and care-giving facilities mustlearn to truly CARE. They should be designed in the context of the “customer” (patient) experience.To be truly health-oriented, medical professionals should also be of sound mind and body.The man cites you an article by the HealthLeaders Magazine quoting Joe Pine, best-selling author of TheExperience Economy, telling participants in a health care conference that the future of health care will becentered on creating memorable experiences for customers (patients).In an article by Elyas Bakhtiari, managing editor with HealthLeaders Media, he discusses what Joe Pineidentified as the four priorities for hospitals to improve patient experience: Theme the experience. Just as every hospital has a mission that guides its internal workings, every business should have an organizing principle for their customers experiences, he said. Whether it is a childrens hospital with baseball-themed patient rooms or Disneys sand-castle imaging machines, experience themes are pivotal to overall satisfaction and are the differentiators in todays economy. 19
  • 20. Direct workers to act. "Work is theater, and every business is a stage," Pine said. Every worker, from the receptionist to the CEO, affects the patient experience, and each employee should know his or her part to play. Mass customize offerings. Businesses need to learn how to customize customer experiences while staying efficient, he said. While each patient may receive a similar service, minor customizations can make the experience unique and more meaningful. Go beyond experience. The next economic stage that Pine envisions is a "transformation" economy, in which businesses not only provide good experiences, but life-changing ones. Health care is perfectly suited for this model, and hospitals that are able to create a transformative connection with patients will win long-term loyalty, he said.The man cites yet another article from HealthLeaders Magazine by Tom Mallon, co-founder and CEO ofRegent Surgical Health where Tom writes this observation “My experience is that when we create a betterenvironment for our people and our patients, the results are happier patients and patient families, and happierstaffs that perform at higher levels. Certainly its more than just everyone being happy. Such a total healingenvironment helps patients recover faster and leave the hospital sooner, which lowers costs. Improved patientoutcomes translate into higher patient satisfaction—and of course most important, a patients return tohealth.” 20
  • 21. The man tells you why he cites Tom Peters and the HealthLeaders Magazines articles. It’s becausehospitals and other medical facilities should take into consideration that their “patients” are their customers.As such, they are king. And they should be treated with respect, dignity and LOVE. He tells you he lovesthat word, LOVE.He tells you to repeat it – LOVE, LOVE, LOVE.He talks a little about why Kevin Roberts of Saatchi & Saatchi is right in promoting that instead of buildingbrands, we must build lovemarks. And that is exactly what we need.The world would be a better place to live in if we show our love for one another. Its not difficult. It takescourage but its not difficult. It runs counter to many teachings of the medical professional world. He asksyou if youve watched the Robin Williams movie, Patch Adams, where the doctor really cared for his patientsand treated them with laughter and love. It’s based on a true story.He goes on and on, but now you understand.He leaves the room and all of you are left dumbfounded.You all look at each other and you see everyone smiling. You all know what to do. 21
  • 22. But you know, deep down inside, that the real work is just about to begin.Leaving the room after the committee meeting has adjourned; you are reminded of a story about Gandhiwhere at one time while getting on the train somewhere in India, the shoe on his left foot fell off. Then thetrain started to move. He couldnt reach the shoe that fell anymore. But instead of jumping off the train andgetting his shoe back or getting angry at the turn of events, he simply removed the shoe on his right foot andthrew it off the train too. It landed right beside the other shoe. Asked why he did this, he just smiled andanswered, “so that whoever finds it, will have a pair of shoes”.This further inspires you to write a manifesto entitled Welcome To The Future Of Health Care. 22
  • 23. ABOUT
THE
AUTHOR
Jay
 helps
 people,
 companies,
 non‐profits
 and
 brands
 breathe
 life
 into
 their
 brand
 story.

 He
 believes
remarkable
people
and
organizations
deserve
the
attention
of
the
world.


Jay
is
a
hungry
man.

He
eats
at
least
a
100
books
a
year,
loves
chocolate
and
sometimes
cant
live
without
coffee.

He
has
worked
for
companies
as
diverse
as
Procter
&
Gamble,
Australia
and
New
Zealand
Banking
Group
 Ltd.
 (including
 Metrobank
 Card
 Corporation),
 and
 Diethelm
 Keller
 SiberHegner
 (DKSH).

 He
 has
worked
 as
 a
 sales
 manager
 managing
 over
 70
 people,
 managed
 category
 management
 and
 retail
operations
 for
 a
 range
 of
 brands
 for
 a
 national
 supermarket
 chain,
 as
 a
 portfolio
 manager
 getting
cardholders
to
spend
more,
and
has
in
many
instances,
climbed
insurmountable
“mountains.”




He
writes
regularly
for
the
HungryPeople
blog
at


http://HungryPeople.posterous.com
COPYRIGHT
INFORMATION
This
work
is
licensed
under
the
Creative
Commons
Attribution‐Noncommercial‐No
Derivative
Works
3.0
United
 States
 License.
 To
 view
 a
 copy
 of
 this
 license,
 visit
 http://creativecommons.org/licenses/by‐nc‐nd/3.0/us/
or
send
a
letter
to
Creative
Commons,
171
Second
Street,
Suite
300,
San
Francisco,
California,
94105,
USA.

The
copyright
of
this
work
belongs
to
the
author,
who
is
solely
responsible
for
its
content. 23
  • 24. I, CareAlternatives To Common Health Care Views Alan
Parr
 24
  • 25. They say: “Health care is expensive.”I say: “Health is wealth. It is the basis for productivity and fulfillment. Without it, how can you afford to pay for it?”They say: “The elderly should pay more, because they use more services.”I say: “When you are at the end of the line, you won’t be looking at the bottom line.”They say: “Outsourcing some basic health services lowers costs for all Americans.”I say: “The more middlemen you put between Americans and their health service providers, the greater the distance between them and the less these middlemen care.”They say: “If it ain’t broke don’t fix it.”I say: “If they don’t fix health care, we’ll all go broke.”They say: “Americans are among the healthiest people in the world.”I say: “Health care shouldn’t have to come in size Husky for our children and XXXL for adults.”They say: “Wellness isn’t like health care – that’s New Age kind of stuff.”I say: “If you’re well there is no need for health care. Change your priorities.” 25
  • 26. They say: “Health care is just too big a subject to understand-I’ll wait until someone else comes up with a solution.”I say: “Health and wellness are deeply personal, as personal as it gets. And your health choices can affect my health choices. You need to educate yourself about what is possible, practical and prudent-and tell those around you. You owe it yourself and the rest of us.”They say: “Americans aren’t worried about their health care.”I say: “I care. And you will too when you are faced with a health emergency. Better to start worrying about it now.”They say: “The Health Reform Bill will put things right.”I say: “That bill deals with insurance reform, and saying that health, care and wellness are about insurance reform is like dancing about architecture.”They say: “This guy on a talk show last night said…”I say: “Turn the TV off and go talk to your friends and neighbors about community-based health.”They say: “At least we don’t have socialized medicine.”I say: “Don’t knock it ‘til you’ve tried it, eh?” 26
  • 27. They say: “American health care is good enough.”I say: “Since when did people in this country start settling for ‘good enough’? What’s next? We’re happy with ‘our health care system isn’t as bad as some third world countries’?”They say: “We’re facing bigger problems than health care-what about Global Warming?”I say: “The American health system has a big, fat carbon footprint-its responsible for almost a tenth of all CO2 emissions in the country. Most of it comes from hospitals, which have complex ventilation and temperature control systems along with energy-intensive lighting and equipment. The pharmaceutical industry is the second biggest CO2 culprit. How about we fix the health care system to go green?”They say: “We don’t know how to fix health care.”I say: “There isn’t one person with one right answer. There isn’t even one right answer. Being right is based on knowledge and experience–knowledge and experience of old situations and old problems. The good news is: Anything is possible. Get creative.” 27
  • 28. ABOUT
THE
AUTHOR
Alan
 is
 co‐founder
 of
 OpenSky
 Consortium,
 an
 Innovation
 Lab
 specializing
 in
 business
 transformation.


Alan
is
an
Advisor
with
OpenSky,
helping
clients
solve
problems
through
business
architecture,
design
and
prototyping.
He
is
co‐author,
along
with
business
partner
Karen
Ansbaugh,
of
several
e‐books
including
“Ideaicide”,
 “I
 Am
 The
 Walrus”
 and
 “Change!
 Making
 A
 Dent
 In
 The
 Universe”.
 You
 can
 see
 more
 of
 his
work
and
view
his
portfolio
at:


http://opensky.typepad.com
COPYRIGHT
INFORMATION
This
work
is
licensed
under
the
Creative
Commons
Attribution‐Noncommercial‐No
Derivative
Works
3.0
United
 States
 License.
 To
 view
 a
 copy
 of
 this
 license,
 visit
 http://creativecommons.org/licenses/by‐nc‐nd/3.0/us/
or
send
a
letter
to
Creative
Commons,
171
Second
Street,
Suite
300,
San
Francisco,
California,
94105,
USA.

The
copyright
of
this
work
belongs
to
the
author,
who
is
solely
responsible
for
its
content. 28
  • 29. Family PracticeFamily Care Reform Peggi
Fossell
 29
  • 30. When I reflect on health care today and think about what I miss most, I keep coming back to thepast, when you had a family doctor, one who knew you and your whole family. I am not talking about“house calls”, just someone to treat you as a whole person. Health care today is so specialized; focusingon various body parts or conditions. What happened to the whole person, not to mention the whole family?I understand the need for specialization but I really think it has gone too far.You might not think you would hear a comment like this from me if you knew my family’s story. In today’shealth care protocol, my family is an expert when it comes to specialized medicine. We may even hold therecord for the highest number of “oligists” treating one person. My 48-year-old husband has had diabetesfor 37 years and was declared disabled by the time he turned 40. Over the past 20 years, his health hasslowly deteriorated and progressed to the current situation where he has had a kidney transplant, numerouseye surgeries to slow down his diabetic retinopathy as he goes blind and continuous management of highblood pressure, cholesterol, and Crohn’s disease. These are just the major issues without going into whatare considered secondary issues like skin reactions to meds, watching for nerve damage in his extremities,mental health concerns, drug reactions and interactions resulting from taking 35 – 40 pills daily, along withmonitoring sugar levels and insulin injections several times every day.Some might say Richard is alive today only because of specialized medicine. I say he is alive because mydaughter and I work very hard to be his “Family Practice”. It would be so much easier to know you aredoing the right thing for your family member, not to mention reducing costs, if you had a Family Practicedoctor who helped you coordinate the medical challenges that come up, while also understanding the total 30
  • 31. impact this has on the physical and mental health of the whole family. My husband and I get so frustratedwith the duplication of effort between the specialists he sees on a regular basis: certain ones are monitoringjust his diabetes (Endocrinologist), or just his kidney transplant (Nephrologists and Urologist), or just hisCrohn’s disease (Gastrologist), or just his eyes (Vitro Retinal Surgeon) and then there are the various otherdoctors that each of them refer him to.When you step back and really look at what is happening in all of these appointments, you see theduplication and the waste. Each doctor manages a duplicate set of records and 90% of each visit is spentupdating records with the nurse. When the doctor finally comes in you are lucky if you get talk to him for 5to 10 minutes, and they almost always ask the same few questions (most of which are exactly the samedoctor to doctor), order blood work, and send you on your way to await the results in the mail. Even afterall these years there are only a couple of doctors who recognize my husband on sight. Unfortunately, theparamedics in our area remember our family more than the doctors do.I don’t understand why the health care system can’t get this figured out. I feel like I have gotten a degree inmedicine myself over the years just trying to help him navigate among doctors and keeping the doctorstalking to each other. My husband’s care has become more about liability mitigation, with each doctor notwanting to hold the medical malpractice risk for a critically ill patient, than it is caring about the wholeperson. I wonder when my daughter and I will pay the price for the toll this is taking on our physical andmental health as we feel we are his last line of defense against medical errors. Not to mention theconditions or treatments we let go for ourselves because the medical costs are bankrupting us–even with 31
  • 32. employer based health insurance.If you don’t think this takes a toll on the children in a family, think again. I remember my daughter’skindergarten teacher calling me to let me know that my daughter tried to tell the class about her daddy’skidney transplant at “show and tell”. She came home sad as some of the kids made fun of her becausethey thought it was “icky” to take a body part from one person and put it in someone else. She is afreshman now in college, going for a BA in Fine Arts, and she recently showed me a short video she madefor her film class that featured her life with her father. She didn’t know if at first she wanted me to see it, butthen decided I could as long as I promised not to share it with her father. The last thing she ever wouldwant is to make him feel bad for something he can’t control. When I first saw it I couldn’t say anything–Ijust cried. As much as I thought I knew how her father’s health issues impacted her, I never really saw itfrom the eyes of a young child the way the film shows. I didn’t realize the extent of responsibility she felt tohelp her dad. “My husband’s care has become more about liability mitigation, with each doctor not wanting to hold the medical malpractice risk for a critically ill patient” 32
  • 33. Life is not easy and my family continues to step up to the challenges that we face. I just wishthose challenges did not include the time consuming processes of keeping the doctors from undoing eachothers’ treatment strategies and managing the insurance claims. I can’t tell you how many times over theyears I wished I had a Family Practice doctor to consult with and to be the go-between for all of thespecialist care. In my opinion, many of the in-office specialist appointments are unnecessary and could behandled by a doctor to doctor consult with a primary care physician. The primary care doctor wouldconsolidate all the information, share all the test results electronically with the appropriate specialists andtogether they could weigh in on changes to his treatment plan.....but then the specialist loses money on thedeal, and lowers his/her status in the current health care world as it is structured today. The odds areagainst it.We need to figure out health care reform and get this right. It may be too late for our family’s situation butthe next generation deserves better since they are going to pay the price. 33
  • 34. ABOUT
THE
AUTHOR
Peggi
 and
 her
 husband
 Richard
 are
 now
 empty
 nesters
 living
 in
 Bloomington,
 Minnesota.

 Peggi
 has
worked
in
various
management
and
independent
contributor
roles
in
the
Financial
Services
industry.

She
currently
works
for
GMAC
as
a
Sr.
Business
Advisor
in
Risk
Management.
COPYRIGHT
INFORMATION
This
work
is
licensed
under
the
Creative
Commons
Attribution‐Noncommercial‐No
Derivative
Works
3.0
United
 States
 License.
 To
 view
 a
 copy
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 license,
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 http://creativecommons.org/licenses/by‐nc‐nd/3.0/us/
or
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  • 35. ConnectedHealth Delivery Redefined In1000 Words, 10 Drawings & 5 Links Alan
Parr
 35
  • 36. Joel wakes during the night feeling unwell. He has been unable to sleep–he has a big interview tomorrow morning–but this is somethingdifferent, not just the nerves he has been suffering with for the past couple of days. He really isn’t feeling good. Tapping the screen he wakesup his computer to check out his symptoms. Updating his online status as “sick” (it can’t hurt, he thinks), his computer is triggered to prompthim for his symptoms. “Stomach pain, dizzy, chills,” he quickly types. This basic information is used in a number of ways; the computerprovides him with a list of possible diagnoses, but the data is used anonymously to check for a wider pattern. Predictive analytics correlatehis symptoms against those reported in his neighborhood network, his wider social network, and the larger geographic area. No healthemergencies are being tracked right now so no alert is triggered. This looks to be just a virus. Still, after clicking on a diagnosis Joeldiscovers the possibility that his symptoms will progress to something worse, and finding that no one else in his network is online to talk to atthis time of night, he opts to talk to an Online Physician (OP). 36
  • 37. The physician appears on screen and asks how Joel is feeling. The physician already has Joel’s health records in front of him, pulled from thecentral health archive, as a precursor to engaging online. As an OP, he specializes in remote diagnosis of illness and helping the consumerreach decisions on their health care. Part of that involves being an advocate of wellness and having advice that is relevant to the consumer’slifestyle and location. The OP notices that Joel’s health records are rather sparse and that Joel hasn’t been making use of his local resources.“Your virus isn’t that severe but it’s most likely being exacerbated by the stress you’re going through. I think you should check in at a healthcenter tomorrow,” he says, “there may be something we can give you to ease your symptoms and help you rest. In the meantime I amsending you some links to resources in your area that you can use when you are feeling better. You need to work on some stressmanagement techniques.” “But I have an interview tomorrow,” says Joel. The OP issues a self-check-in request, “In case you decide youneed it. Try and get some rest and good luck with the interview”. The self-check-in request and the entire online conversation are saved aspart of Joel’s health records. Joel goes back to bed. 37
  • 38. The next morning Joel is definitely not feeling well. He is short on sleep, unable to eat, and feeling out of sync with reality. The only thing thatcomes through clearly is the stress he is feeling about his interview. He skips breakfast, dresses and catches the express into downtown. Onthe train, his stomach cramps and he groans. A fellow passenger pats him on the shoulder. “You don’t look too good. Maybe you should getsome help. There’s a great walk-in health center on 32nd and Barcombe if you get off at the next stop.” Joel thanks the passenger anddecides to get off the express. At 32nd street he pulls out his phone and scans the street. The nav app on his phone locates the nearesthealth center; clicking on it he sees that their wait time is low this morning. He can still make it to the interview. He clicks on his “optional”self-check-in request to let them know he is on his way. Within minutes Joel is walking into their reception area. 38
  • 39. In the lobby, Joel heads to the “Self-Check-In” booths. Self-check-in automatically registers his arrival, places him in the next availabledoctor’s patient queue, and begins an automated evaluation of Joel’s biometrics while he waits. Had he needed a nurse, one is available, butJoel likes the self-check-in. It’s quick, convenient, and private. The system lets him browse health care topics while it works, so he can bebetter informed when he meets the doctor. As he exits the booth it automatically logs Joel out, preserving privacy. 39
  • 40. The doctor asks questions about Joel’s health and lifestyle, recording notes on a clipboard-style computer tablet. The tablet allows her toexamine Joel’s record, his care history, and as the In-person Physician, she takes the opportunity not only to treat his current issue, but to fillin any blanks in Joel’s record. The goal is to treat the whole person; current issue, background, lifestyle and goals. As the doctor will handJoel back to an online physician for remote follow-up, knowledge of online possibilities and recommendations are shared as part of thecentral records system. All the details of the in-person interaction and the doctor’s notes are stored in Joel’s medical record which isreturned to the central health archive. 40
  • 41. Joel has a great follow-up with the OP. He did not realize he is part of a community-based care system; receiving mutual support fromshopkeepers (for online diets and products) and workout partners (virtual teams with similar health goals), and community based planning. Allof this wellness activity is added in to Joel’s records so that health care professionals can consider his whole lifestyle–his environment,activity, history–when helping him with future treatment options and health choices. Joel is better informed, better connected to hiscommunity and to his care providers. Joel is connected. Joel is well. 41
  • 42. While this story is set in the future, it is actually grounded in the present. New technologies are being introduced all the time, and are beingintegrated into our health care system:1) Helping Hands Software: http://www.youtube.com/watch?v=UU8novBB7xE&feature=player_embedded2) Phone Navigation: http://layar.com/layar-is-in-the-iphone-app-store/3) Patient Kiosk: http://www.chcf.org/topics/hospitals/index.cfm?itemID=1338824) Doctor’s Computer Tablet: http://www.dexigner.com/design_news/fujitsu-siemens-computers-wins-2009-if-product-design-award.html5) Community-based Health: http://www.heartofnewulm.org/From a technical perspective, the distance between the present and the future is narrowing. But technology alone is not enough. What wecurrently lack is a “big picture” view of the health and wellness possibilities in which the consumer is firmly rooted at its center, wherewellness, prevention and cure are integrated and connected into everyday lives. 42
  • 43. ABOUT
THE
AUTHOR
Alan
Parr
is
an
artist
with
a
passion
for
visual
concept
development.

He
brings
this
talent
to
his
work
with
OpenSky
Consortium.

Every
new
problem
needs
to
be
seen
before
it
can
be
solved,
every
new
idea
needs
to
be
brought
to
life
so
that
others
can
share
it
and
engage.

This
 story
 is
 dedicated
to
the
amazing
 people
of
 the
 Women’s
 Breast
 Center
at
 Regions
 Hospital
 in
 St.
Paul,
MN.
They
truly
show
what
it
means
to
provide
great
connected
care.
COPYRIGHT
INFORMATION
This
work
is
licensed
under
the
Creative
Commons
Attribution‐Noncommercial‐No
Derivative
Works
3.0
United
 States
 License.
 To
 view
 a
 copy
 of
 this
 license,
 visit
 http://creativecommons.org/licenses/by‐nc‐nd/3.0/us/
or
send
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the
author,
who
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responsible
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content.

 43
  • 44. Quality of LifeA Tale Of Two Grandmothers Jill
Johnson
 44
  • 45. Everyone should be entitled to spend their last days in a happy, warm environment withadequate care, the ability to make their own choices and most of all their dignity.Here are two scenarios currently playing out in our family:My grandma (age 100 and totally sharp mentally) recently had to move into a nursing home in Woodbury,MN due to her becoming wheelchair bound and needing a lot of assistance physically. She is on a waitinglist for a private room (which is unlikely to become available in her lifetime) but in the meantime is in herthird room in 2 months. Her latest room is tiny–only room for a bed and a nightstand for each resident. Noeffort has been made to match her with a compatible roommate (mentally) and she is now stuck with onethat roams their room at night and tries to steal my grandma’s things. The place is completelyunderstaffed. My grandma is unable to get out of bed by herself and has often had to wait up to an hourafter pressing her call button to be taken to the bathroom (which by then is usually too late, if you get mydrift). Every single time I visit I spend much of the time flagging someone down to help her. She tries toengage the staff in conversation but they are too busy/rude/non-English speaking. My grandma is typicallya very upbeat person but now she cries every time I see or talk to her. Everything is done on a rigidschedule, and she is put to bed for the night at 6:30 p.m. whether she is tired or not. The food is awful andthey aren’t given any choices. In addition, she can’t chose where or with whom to sit, so she typically isunable to have a conversation with her tablemates. The foot pedals to her wheelchair have been lost (andthe staff are making no further attempt to find or replace them) so she has to hold her legs up herself whenbeing wheeled anywhere. She shares a bathroom with FOUR people and it is often dirty and foul smelling. 45
  • 46. The only positive thing my grandma has to say is she is happy to be on the “window” side of her room (vs.her roommate who spends the entire day behind the curtain separating their beds). At the end of your life,shouldn’t there be more than just hoping to have a window?My husband’s grandma (age 94) is in a nursing home in New Richmond, WI. It is owned by PresbyterianHomes (needed to put in a plug for them here!). She is also wheelchair bound, but unlike my grandma, isconfused much of the time. She has a private room which is large and decorated with all her favoritethings. The residents choose when they would like to get up, when they’d like to eat and when they go tobed. The dining room is open all day and the residents order whatever they like off an extensive menu.Families are invited to have meals there any time at no cost, and when we do a separate table is set up forus with decorations. There are many activities throughout the day and the staff is very caring–they willoften stop in her room and sit and chat with her. Numerous parties are held during the year and familiesare invited to participate. For example, they recently had an Oktoberfest out in the parking lot with livemusic, games, face painting, a petting zoo, food etc. They are building a new nursing home and will moveall of the residents there when it is completed. The new facility will have all private rooms, each with aprivate bath and kitchenette.By the way, the cost for each of the facilities is the same: $6,500 a month. 46
  • 47. You may ask why my grandma doesn’t move to a better facility. We have been begging her to look atanother facility (there is a Presbyterian Homes’ one close to where she is now) but she wants to staywhere she is because it is in the same complex as her old independent apartment, so she has a lot offriends that come over from there to visit. Change is really hard at her age–just switching rooms has beena big adjustment each time. I took her on a wheelchair ride outside a couple of weeks ago and she said itwas the first time she had breathed fresh air in two months (again, to compare, at Bill’s grandma’s placethey are regularly taken outside to sit in the sun). What is amazing is that my grandma’s place actually hasa waiting list! “At the end of your life, shouldn’t there be more than just hoping to have a window?”Living into our nineties and past the century mark is becoming more commonplace. How do we ensurethat our elderly are properly cared for when they–and we–can no longer care for them in our homes? Whyis there such a disparity in services and quality among nursing homes? Everyone should be entitled tospend their last days in a happy, warm environment with adequate care, the ability to make their ownchoices and most of all their dignity. 47
  • 48. ABOUT
THE
AUTHOR
Jill
Johnson
is
an
independent
capital
markets
consultant
with
over
25
years
of
experience
in
the
financial
services
 industry.
 She
 has
 had
 various
 roles
 as
 a
 treasury
 consultant,
 structured
 finance
 director,
transaction
manager
and
project
manager.
Most
recently,
she
was
with
GMAC‐ResCap
for
16
years.
She
has
 an
 MBA
 from
 the
 University
 of
 Minnesota
 and
 a
 BA
 from
 the
 University
 of
 St.
 Thomas,
 and
 is
 a
Certified
Treasury
Professional.

Jill
resides
in
Chanhassen,
MN
with
her
husband
and
two
sons
(and
a
very
cute
goldendoodle).
COPYRIGHT
INFORMATION
This
work
is
licensed
under
the
Creative
Commons
Attribution‐Noncommercial‐No
Derivative
Works
3.0
United
States
License.
To
view
a
copy
of
this
license,
visit
http://creativecommons.org/licenses/by‐nc‐nd/3.0/us/
or
send
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letter
to
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Commons,
171
Second
Street,
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300,
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Francisco,
California,
94105,
USA.

The
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of
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work
belongs
to
the
author,
who
is
solely
responsible
for
its
content.

 48
  • 49. Picture of Health Karen
Ansbaugh
 49
  • 50. Dear Legislators, Insurance Companies, Health Care Professionals:Here’s my picture of health. I don’t have all the answers. This may not be someone else’s picture. Nor do Ihave the financial expertise to suggest how to pay for this on a large scale. All I know is I am self-employed.My husband is self-employed. For us, after food and shelter needs are met, medical insurance is our toppriority. We think we are very fortunate that we can meet all three of these needs. It is not cheap and wechoose to give up other things to pay our medical insurance premiums and out-of-pocket expenses. Wedon’t have dental insurance, but we do see our dentist regularly.Do I know if we have the best cost to benefit ratio? Absolutely not. I do track our premiums, out-of-pocketexpenses and what is charged and what the insurance company allows. I am often stunned at the differencebetween “charges” and “allowed amount”. Without insurance we would be paying a lot more. Could we payless? Maybe…my husband and I have different policies due to his “pre-existing” conditions.Focus on wellness: check-ups, fitness, nutrition, optimal mix of services for our needsI am responsible for my well-being, but I need guidance and help. I receive mailings from the insurancecompanies about programs, but it’s confusing. I go on-line and there is so much information. My financialadvisor is required to review with us our portfolio at least once a year and my car/house insurer sends us ayearly report, too. I have been with both for years, they know us. I would love to have a knowledgeableperson at my medical insurance company review my policy with me once a year and tell me about services 50
  • 51. and products that fit my needs better or how to save money. I mean really, you have the information on whatI’ve used my insurance for. It would be wonderful to have the same person each time and also have themavailable for questions as things change. Yes, I would pay more for this service. I want to be a client–not apatient or a customer–a client. I am paying you for services.Basic care for all: young, old, middle aged, rich, poor, middle class, healthy, illNone of us knows which combination we may end up with at any given time. Ask any one who has lost a jobor been diagnosed with a chronic disease or out-lived their savings. I would rather hedge my bets, helping tosupport others when they need it so I am supported if I need it. Our ability to promote wellness and containinfectious diseases is predicated on ensuring that everyone has access to basic health and wellness care.Coordinated care: holistic view of my needs, my health records consolidated and available towhomever I give permission (including my dental)It’s not like I can send my ailing body part in to be taken care of the way I can send my area rug in to becleaned and mended. I am an integrated being and as such want to know that my health care professional istaking into consideration my family history, my lifestyle, my spiritual beliefs, my values and any othermedical/dental treatment I am receiving. I also want them to have the time to review and think about me; noone appreciates being “the sore throat in Room 2”. Yes, it is up to me to make sure that I am prepared foreach visit, having chosen someone I can work with and to be honest about what I am doing or not doing. 51
  • 52. Supportive convenience: nurse line, on-line abilities, follow-up written summary and instructions,access to all my medical recordsMany health care plans include a nurse line, which is really great. My insurance company knows that I madethe call, but I’ve never been asked if I would like my doctor notified of it. I also, want to be able to contact mydoctors via email, have on-line appointments, schedule appointments on-line. If it’s safe and cost-effective, Iam happy to be treated for minor ailments at a shopping mall clinic or urgent care, as long as that informationis added to my records and my doctor notified. “I want to be a client–not a patient or a customer–a client. ” 52
  • 53. ABOUT
THE
AUTHOR
Karen
is
co‐founder
of
OpenSky
Consortium,
an
Innovation
Lab
specializing
in
business
transformation.
She
 has
 been
 an
 independent
 business
 advisor
 since
 1999.
 She
 and
 business
 partner
 Alan
 Parr
 provide
firms
 with
 new
 ideas,
 creative
 thinking
 and
 insights,
 then
 experiment
 to
 drive
 change
 in
 people,
companies
 and
 markets.
 She
 and
 her
 husband
 are
 each
 self‐employed
 and
 solely
 responsible
 for
 their
health
care
premiums
and
out‐of‐pocket
expenses.




http://opensky.typepad.comCOPYRIGHT
INFORMATION
This
 work
 is
 licensed
 under
 the
 Creative
 Commons
 Attribution‐Noncommercial‐No
 Derivative
 Works
 3.0
United
 States
 License.
 To
 view
 a
 copy
 of
 this
 license,
 visit
 http://creativecommons.org/licenses/by‐nc‐nd/3.0/us/
 or
 send
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 letter
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 Creative
 Commons,
 171
 Second
 Street,
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 300,
 San
 Francisco,
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author,
who
is
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responsible
for
its
content.

 53
  • 54. Building On A LegacyBlue Cross Blue Shield Of Minnesota Is Designing Health Care For Tomorrow MaryAnn
Stump
 54
  • 55. As a society, we are in an age of change and upheaval. Everything from our personal lives to theway we do business is changing. Ten years ago, tweeting was left to birds and Google was merely a searchengine. Now, nearly 100 million of us use Twitter; and Google is a major player in everything fromadvertising to health. As the world changes all around us, we either choose to change with it, accepting andanticipating the next wave, or we find ourselves becoming obsolete and irrelevant. For health care, thatchoice has become a crisis in the midst of the call for reform. The health care industry is also changing, andas the Chief Innovation Officer for Blue Cross and Blue Shield of Minnesota, I get to be at the helm—and inthe midst—of some exciting changes. “Our big question is—what does a health insurance company for the new age look like?”The answer we have discerned is that we, in fact, aren’t really a health insurance company—we are aHEALTH company—working to design health care in a way that is focused on consumers—and aligning ourservices to better meet their needs. 55
  • 56. From Insurance Company to Health CompanyWhat is a health company? A health company is not your Mom and Dads Blue Cross Blue Shield ofMinnesota (BCBSMN), but it has all the wisdom of its age and experience. It promotes, encourages, andensures optimal health for all consumers, not just the traditional notion of members. The health companydoesnt abandon its role in management or financing care, but rethinks and re-forms those roles looking athow to do them best and in such a way that puts the consumer and the consumer’s health front and center.And while the business may still be insurance, it is no longer a payment business; its a relationshipbusiness as health care should be.What makes the new health company different? The health company is relationship-driven and personalizedbased on the consumers unmet needs, plus the wants and needs defined by the consumer. We want toleave behind the trappings of a paternalistic model of care and coverage, and focus on helping consumersbe as well as they can be.BCBSMN is actively seeking ways to engage and serve all consumers above and beyond the current notionof benefits. Were mobilizing our own employees as designers and consumers to help us shape this newworld. We’re gaining practical consumer insights and a deeper understanding of what consumers trulywant, need, and might expect from a health company. 56
  • 57. Democratizing health care is a priority for us. We’re working to offer products and services directly toconsumers that truly personalize health and health care. We want to overhaul health insurance thinking tobe health company thinking. We need to be a connector, facilitator, collaborator, and a catalyst. Thismeans courageously focusing on: • Benefiting the consumer, not the consumers benefits; • Collaborating, not managing; • Learning, not knowing; • Thinking imaginatively and valuing agility and innovation, not business as usual; and • Emphasizing outcomes and the consumer experience.But most of all, the health company is a leader in a time of change. Through exploration and discovery,we’re finding new and better ways to engage, ensure, and provide care and support relevant to theconsumer. We’re discovering what it means to be a connector, facilitator, collaborator, and catalyst; we’rerealizing that none of these things are interdependent. 57
  • 58. A ConnectorHealth insurance started as a way to prepay for hospital care. In those early days, the company connectedpatients to doctors as a means of payment. The role was vital, although simple and one-dimensional.Over the next nearly 100 years, insurers continued to pay the bills, but began to realize there was more tobeing a connector than writing checks. Provider and hospital networks helped connect members to careand insurers helped remove some of the guesswork in finding a provider.Today, BCBSMN continues to find new and innovative ways to connect consumers with care that best fitstheir needs through such tools as: • HealthcareScoop.com, an online community dedicated to consumers sharing their health care stories, and • Online Care Anywhere, an online platform allowing consumers to connect immediately to a provider for care.As BCBSMN journeys toward becoming a health company, opportunities to provide connections forconsumers are a priority. 58
  • 59. A FacilitatorAs health insurance companies began to expand the services offered, insurers took on a new identity as thehealth plan. Health Maintenance Organizations (HMOs) capitalized on the network of providers andfacilities. The health plans goal was to ensure the best care for their members at the best cost for theircustomer, whether it be employers or the member directly: • Members chose a primary care provider who worked with the health plan to facilitate all care decisions. • Disease management emerged to help provide continuity of care for members with chronic illness.Today, BCBSMN has expanded this idea to incorporate Health Guides within the notion of Whole PersonHealth. Health Guides are individuals trained to do more than just provide traditional customer service. Theyare trained to listen to what the member is really asking and actually needs. Health Guides, as a result, helpmembers identify programs and benefits of value. Often times, the connection is one the member maynever have made alone. The service is provided at all points in the relationship with the member, not just attraditional points of intervention. 59
  • 60. In addition to facilitating connections for our members, we recognize the impact that health inequities haveon our communities. To that end, BCBSMN supports community health workers in minority and immigrantpopulations to facilitate social connectedness and navigation of the sometimes daunting health caresystem.As we look toward our future as a health company, we are dedicated to finding new and better ways forconsumers to actively manage their health and the health of their families. From facilitating Personal HealthRecord adoption and finding ways to make your personal health information accessible on-the-go toconcierge-style health services, BCBSMN will work to build mutually beneficial relationships betweenconsumers and the health care that best fits their lives. 60
  • 61. A CollaboratorWhile the era of HMOs saw collaboration between providers and health plans, becoming a health companynecessitates collaboration with all stakeholders—employers, policymakers, providers, and consumers. Thefight against Big Tobacco in Minnesota was an example of how collaboration between all stakeholders canand does work. The collaboration resulted in not only a significant settlement, but also MinnesotasFreedom to Breathe Act passed in 2007. Currently, we see the beginnings of such collaboration in healthtechnology and the push toward Personal Health Platforms where ones entire health history and tools willbe centrally accessed and managed. For the Personal Health Platform to succeed, all stakeholders mustactively participate and contribute to the evolving capabilities. Long gone are the days when developmentand design without significant consumer input were accepted ways of doing business. Instead, consumerinsight should be real-time, un-sanitized, shared openly, holistic, and applied. 61
  • 62. A CatalystWhile insurers have at times to varying degrees assumed the role of collaborator, facilitator, and connectorthere is obviously a long way to go before we really begin to function as a health company. The key to thatchange may very well be becoming a catalyst for change and action. BCBSMN has begun working as acatalyst for positive change in the health care industry. We were one of the first insurers to reduce or waiveco-payments for retail clinics.Stepping outside the traditional roles and responsibilities of an insurer, we’re working for change in ourcommunities as well. Recognizing that public health issues, such as obesity, are lifestyle issues, not just ahealth care issue, BCBSMN is finding innovative ways to reach out to the community and support positivelifestyle and activity choices: • A major sponsor for Nice Ride Minnesota (http://niceridemn.com) to bring public bicycle-sharing to downtown Minneapolis and the students, faculty, and staff of the University of Minnesota. • A sponsor of the planning and construction of walking and bike friendly community developments. • A resource for employers, offering consultation on cafeterias, wellness programming, and the effective use of social media to communicate important health and wellness messaging to employees. 62
  • 63. That same force for change can be seen in our own employees as weve launched Online Care Anywhereas a proof of concept first with our employee population. We’re taking the opportunity to truly be thechange we want to see within our own industry.Toward Being A Health CompanyWe arent a health company yet, but were working to get there. Each day, we are discovering new ways todo business and alternative approaches to old and evolving problems. We find new perspectives on ourwork that better focus on the needs of the consumer and incorporate true, real-time consumer feedback.Were finding ways to work faster, cheaper, and more efficiently while not compromising the quality andreliability you expect from Blue Cross Blue Shield of Minnesota. Our evolutionary shift to health company ishappening now and were discovering our new direction. Our transformation will be a journey of explorationand discovery, and we intend to change the very face of the health insurance business industry in theprocess. We’re ready to be in the health business. 63
  • 64. ABOUT
THE
AUTHOR
MaryAnn
Stump
Senior
Vice
President
and
Chief
Strategy
and
Innovation
Officer
Blue
Cross
and
Blue
Shield
of
Minnesota

President
Consumer
Aware

MaryAnn
Stump
is
a
recognized
leader
in
health
care
consumerism
and
passionate
advocate
for
health
care
reform.
She
engages
stakeholders
in
viewing
health
care
from
the
consumer’s
perspective
and
encourages
collaboration
and
innovation
in
care
delivery.
A
former
cardiac
critical
care
nurse,
Ms.
Stump
was
lead
architect
of
Blue
Cross’
Cardiac
Center
of
Excellence
Program
and
Minnesota’s
first
community‐based
residential
treatment
facility
for
eating
disorders.
She
serves
on
Yale
College
of
Nursing’s
External
Advisory
Board,
is
a
past
president
of
Minnesota
Healthcare
Quality
Professionals,
and
a
former
Robert
Wood
Johnson
Foundation
National
Advisory
Board
member.

She
was
recognized
in
2008
as
one
of
the
“Top
100”
most
influential
people
in
Minnesota
Healthcare
by
Minnesota
Physicians;
in
2009,
Minneapolis‐St.
Paul
Business
Journal
named
her
a
“Women
in
Business
Industry
Leader.”
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 64
  • 65. Step Back... Then Step Up! Karen
Ansbaugh
 65
  • 66. These are the days of miracle and wonderThis is the long distance call(The Boy in the Bubble, words by Paul Simon)As we ignore, ponder or debate exactly what health care reform means; as we agonize overhow we are going to pay for “solutions”, we forget to look around us. Change rarely comes upon us in aninstant. Change comes gradually, then suddenly*. Step back from the debate and look around you. Don’tget overwhelmed by the issues. They are real, but you can’t become paralyzed by the confusing andcontradictory rhetoric. We are not starting from zero here. Many people, in many ways, have been workingon “health care” for a long time. The difference now is that the momentum to make great change is uponus! These are the days of miracle and wonder.And what are miracles, let alone ordinary miracles? Webster’s dictionary defines miracle as: “1) anextraordinary event manifesting divine intervention in human affairs or 2) an extremely outstanding orunusual event, thing or accomplishment.” Ordinary elicits words such as commonly encountered, usual,regular, and normal. That would make an “ordinary miracle” an oxymoron–or does it? By blending andbending those definitions the whole is greater than the sum of the parts. In other words, regular peopledoing commonly encountered things that result in extraordinary events and accomplishments within theirsphere of influence. And lest you think a sphere of influence is something large and grand, it can be asintimate as a family, as broad as a country or somewhere in between. 66
  • 67. For a historical perspective on change in this country look at the Suffragette movement, the Civil Rightsmovement or the Equal Rights movement. None resulted in instant change. All included complicated issues,challenged current belief systems, and if realized–even in part–would change aspects of American lifeforever. People who believed things should be different, better than they currently were, worked to makechange happen, and did so over a long time. Some became leaders of their movement, such as MartinLuther King Jr.; but the majority were “ordinary” people who believed that change needed to happen. Theyworked as best they could to make it happen and to bring the rest of us along with them.It’s not the first time we’ve struggled with a health related movement that took a while to bring aboutchange. What about the anti-smoking campaign? Research in the 1950s linked smoking to lung cancer andother diseases. It wasn’t until the mid-1970s that the momentum against smoking became very visiblethrough legislation such as the Minnesota Clean Air Act of 1975. Today we are surprised to learn if a friendor colleague smokes. This mindset change did not happen quickly, quietly, or easily; contrary researchdenying the health risks was presented; the fears of economic impact to areas supported by tobacco wereraised; debates and lawsuits raged on. Smoking and the use of tobacco products have not been eradicatedin the United States and legislation is still being discussed and enacted. But the majority of us work, shopand eat in smoke-free environments, health insurance companies have programs to help smokers quit, andwe educate our children on the hazards of tobacco use. 67
  • 68. Health care reform, health insurance reform, Medicare reform, changes to health delivery system–whateveryou label it–is happening and more importantly has been happening all along in this country. The onlydifference is we’ve reached a point of critical mass with regards to cost, delivery and access to care. It isnow very personal. It is now that we have to sift through all the noise and make sense of it for ourselves andour families. It is now that each of us has to weigh in on what we need and what we want.This is the long distance call. Not a phone call out of state, but a call for change in health care that goes thedistance. Step back from the legislative debate and see what else is going on in the health arena. There arepeople who have been working on tangible solutions. None of us can educate ourselves on all aspects ofhealth care, but we can on the aspects that are meaningful to us. Step up and share your thoughts andopinions in your spheres of influence–family, friends, health vendors and elected representatives. Each of usis part of the problem and part of the solution.I am in awe of the health developments that I read about on a daily basis just in my local newspaper. All areordinary miracles, accomplished by people from all walks of life trying to make things better. Here is a fewweeks’ worth of health related articles that caught my eye. See what you can find out there that appeals toyou. Please, step back…then step up. 68
  • 69. Better Access to Healthy Food: Discusses food banks partnering with businesses and farmers to gethealthy food on tables of people with limited incomes. The health implication: A 10% increase in povertycorrelates with a 6% increase in obesity due to nutritious food being more expensive.http://www.parade.com/news/intelligence-report/archive/091108-better-access-to-healthy-food.htmlRev up the brain while practicing motor skills, by Dee DePass: Shayne Adair teaches simple physicalexercises that help older people build neuroplasticity; help maintain dexterity, balance and brain function.http://www.startribune.com/lifestyle/health/69402627.htmlWhen the Best Doctor is Far Away, by Sean Flynn: Telemedicine provides expert medical care inemergencies and “routine” monitoring remotely. For example, teleconferencing to provide expert medicalcare to patients who live long distances from a major hospital, thus reducing the need to transfer critically illpatients between hospitals, not only saving lives, but reducing costs.http://www.parade.com/health/2009/11/22-when-the-doctor-is-far-away-telemedicine.htmlAcing the mat test, by Sarah Moran: Yoga in Minnesota schools benefits students. “Studies have linkedyoga in schools to better grades, behavior, health and relationships among students.”http://www.startribune.com/lifestyle/76320887.html 69
  • 70. Grow your own body parts? The future is now, by Karen Youso: Medical advancements that are or nearreality now. • Growing your own organs: in preparation for getting FDA approval, lab-grown bladders are being transplanted into patients in the US. • Aging gracefully at home: more telemedicine through smart phone technology to allow health professionals to monitor people’s health at home reducing the need for (and some of the costs of) hospitalizations and nursing home stays. • Robot nurse: Robotic help in home for people who need elder care. • Aging treatment: A compound that works on genes that regulate aging is being studied. It is much stronger than resveratrol (anti-aging ingredient in red wine).http://www.startribune.com/lifestyle/health/76322897.htmlTracking a killer, by Thomas Lee: The development of a device that may possibly help doctors performinitial biopsies and monitor prostate cancer through low-cost 3D images using elasticity imaging.http://www.startribune.com/business/74236432.htmlFeeding a need to help others, by Curt Brown: Laverne and Babs Wheeler, a retired suburban TwinCities’ couple, give dinner parties at which they collect food for northern Minnesota food shelves. SinceNovember 2007, when they started, they have collected and delivered more than 9,000 pounds of food andnearly $15,000.http://www.startribune.com/local/west/74157697.html 70
  • 71. Minnesota grants fund initiatives in health care, by Chris Williams: SHIP, Statewide HealthImprovement Program, provides grants that help promote walking school buses, allow farmers’ markets totake food stamps, link college students to stop smoking programs, show daycare providers how to providebetter nutrition and exercise. The goal: To persuade whole communities to eat better, exercise more, stopsmoking and thereby reduce health costs.http://www.startribune.com/lifestyle/health/63993827.htmlAnother source of health change information is the Mayo Clinic’s Center for Innovation website. On thissite, you can also find the video coverage of Mayo’s Transform: A collaborative symposium on innovationsin health care experience and delivery which inspired the collaborative e-book project which this article is apart of.http://centerforinnovation.mayo.edu/http://centerforinnovation.mayo.edu/transform/*(repurposed quote from The Sun Also Rises, Ernest Hemingway) 71
  • 72. ABOUT
THE
AUTHOR
Karen
is
co‐founder
of
OpenSky
Consortium,
an
Innovation
Lab
specializing
in
business
transformation.
She
 has
 been
 an
 independent
 business
 advisor
 since
 1999
 providing
 clients
 with
 expertise
 in
 project
management,
 analysis,
 process
 design,
 operations
 management
 and
 organizational
 development.
 Find
more
of
her
and
business
partner
Alan
Parr’s
writing
(e‐books
“I
Am
the
Walrus”,
“Change!
Making
a
Dent
in
 the
 Universe”,
 “Ideaicide”,
 “Dreams
 with
 Deadlines”
 and
 numerous
 articles)
 and
 a
 portfolio
 of
 their
work
at:

http://opensky.typepad.com
COPYRIGHT
INFORMATION
This
work
is
licensed
under
the
Creative
Commons
Attribution‐Noncommercial‐No
Derivative
Works
3.0
United
 States
 License.
 To
 view
 a
 copy
 of
 this
 license,
 visit
 http://creativecommons.org/licenses/by‐nc‐nd/3.0/us/
or
send
a
letter
to
Creative
Commons,
171
Second
Street,
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300,
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Francisco,
California,
94105,
USA.

The
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belongs
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the
author,
who
is
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responsible
for
its
content.

 72
  • 73. IN CONCLUSIONTo our fellow contributors: Thank you! For taking time from your busy schedules to collaborate with us. Thank you! For stepping up to sharewhat you are thinking and doing about health care. Thank you! For the variety of “takes” on what’s right, what’s wrong, what’s being doneand what could be done. Thank you! For showing that asking questions is just as important as trying to answer them. Thank you! Fordemonstrating it takes all of us to weigh in on Health Care, Wellness and the Next American Dream.To our readers: Please continue the dialogue. What does healthy mean to you? What does good health care delivery look like for you, yourchildren, your parents? Read about what others are doing and not just here in the United States. Out of necessity, individuals in manycountries have come up with unique and cost-effective deliveries for health care and wellness. You may have brilliant, simple, complex,tailored, and basic solutions–Ordinary Miracles–that address specific issues that are important to you. Share them. Listen to others’ ideas.Because “…the next great leaps in health care will result from collaborative discussions and the sharing of insights from across disciplines.”To all: Good health and access to good health care!Alan Parr and Karen AnsbaughOpenSky Consortium 73
  • 74. COPYRIGHTThis work is licensed under the Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License. To view acopy of this license, visit http://creativecommons.org/licenses/by-nc-nd/3.0/us/ or send a letter to Creative Commons, 171 Second Street,Suite 300, San Francisco, California, 94105, USA.The copyright of this work belongs to the authors, who are solely responsible for its content.OPENSKY CONSORTIUM 

An Innovation Lab specializing in business transformation. Our Advisors provide firms with new ideas, creative thinking and insights, thenexperiment to drive change in people, companies and markets.Web: http://opensky.typepad.comEmail: opensky@q.com 74