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‘Why Not’ Concept
A Good Mantra for Organizations?

During the holiday break of my freshman year in college, I joined a few dozen other students on a three-day ski trip to Steamboat Springs, Colo. At the time, I had never skied before. Additionally, I was only six months removed from having knee surgery from a high school football injury. This surgery to repair meniscal tears occurred during the summer of 1978, when arthroscopic surgery was still in its infancy stage and not used by my Ottumwa-based surgeon.

Looking back, especially as a novice, I had no business barrelling down a mountain with a tender knee that was still fragile and sore. But as an 18-year old, I considered myself invincible, and besides, I could rely on a knee brace for added protection.

Why Not

The first slope I encountered at Steamboat Springs was a black diamond, simply labeled, ‘Why Not.’ Based on skiing abilities, slopes are assigned different colors and shapes. A green circle may represent an ‘easier’ slope, a blue square may be ‘more difficult,’ and a black diamond is considered ‘most difficult.’ The slope name, I felt, clearly represented my philosophy about tackling difficult obstacles. I attempted to ski down ‘Why Not’ every possible way but the right way. The slope introduced two primary obstacles – steep terrain and heavy moguls that required technical maneuvers at increasing speed. My abilities were clearly overmatched.

After many failures of descending this expert slope, I decided to take beginner lessons on a nearby ‘bunny’ hill. Applying those lessons eventually allowed me to navigate ‘Why Not’ more prudently (though, not expertly!).

Taking Risks

Organizations and their teams are constantly looking for innovative ways to be curious and experimental while encouraging team members to develop fresh solutions for new products or services. Past management protocols typically allowed managers to take the safest and more predictable routes – similar to hanging out on a bunny hill. These practices many times ran contrary to allowing individuals to initiate a more creative ‘laboratory’ of experimentation.

An article in Harvard Business Review by Sara Critchfield does a great job of describing how organizations can develop new ways to train their cultures to foster ‘divergent thinking,’ which is different from creative thinking. Divergent thinking is not about finding one right answer to a problem, but rather, promote a more intense process of exploring many different possible answers that may include:

  • Coming up with 15 solutions to a problem the organization is currently facing.
  • Rearranging company space to make work more efficient with staff, from executives to interns. From this, make 20 mockups for every design change.
  • Managers must stop answering questions, and instead, respond with “What do you think?” Wait for a response, then ask, “What else?’ Repeat this five to seven times.

Critchfield believes that team members who come up with the ideas must not be segregated from testing these ideas themselves, which allows for experimental learning. Empowered team members have the support, structure and time to do thoughtful, careful, creative testing – a recipe that allows cultures to thrive. Setting baseline failure and success rates will help initiate realistic team member expectations. Knowing that failure is always a possibility will both cushion and promote creativity.

Making the analogy of an novice skier with organizations allowing team members to fail might be a bit extreme. Yet, it was only through adaptive learning did I finally make my way down a problematic slope – and live to write about it!

Allowing employees and their team members to exercise their God-given creative juices is not a new concept. But finding new and different ways to confront risks within the work environment just may improve the culture in which employees are required to perform.

What do you think?

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Why It Matters to Have Private Health Coverage

I should not be astonished, but I am.

In 1910, Dr. William J. Mayo wrote his view on making patients a central reason for his organization to exist: “The best interest of the patient is the only interest to be considered, and in order that the sick may have the benefit of advancing knowledge, union of forces is necessary.”

But 107 years later, the healthcare landscape has changed, running opposite to Dr. Mayo’s credo.

A March 15 article in the Star Tribune revealed a healthcare system truth that some have suspected for years – that it’s a tier-system of care dependent on the type of health insurance card you carry in your wallet or purse. If you are fortunate to have private insurance coverage through your employer or have personally purchased it through a commercial insurance company, you should feel somewhat privileged. However, if you have Medicaid or Medicare coverage, please step to the back of the line.

Dr. John Noseworthy, CEO at the famed Mayo Clinic, was videotaped speaking to his staff last fall about giving preference to patients with private insurance over lower-paying public coverage (e.g. Medicaid and Medicare). “We’re asking…if the patient has commercial insurance, or they’re Medicaid or Medicare patients and they’re equal, that we prioritize the commercial insured patients enough so…we can be financially strong at the end of the year to continue to advance, advance our mission…”.

It is important to note that, regardless of payer source, Mayo will always take patients when they’re unable to find medical expertise elsewhere. However, when given two patients who have equivalent medical conditions, the Mayo health system will “prioritize” the patient with private insurance – private plans pay Mayo (and all other providers) more than public coverages. Noseworthy continued, “If we don’t grow the commercially insured patients, we won’t have income at the end of the year to pay our staff, pay the pensions, and so on…so we’re looking for a really mild or modest change of a couple percentage points to shift that balance.”

Hospitals are not allowed to discriminate against patients seeking care in the emergency room. Outside the ER walls, however, providers can choose to accept (or decline) Medicaid and Medicare patients. Mayo recently indicated to Modern Healthcare that Medicare and Medicaid patients account for half of their services, but with more baby boomers becoming eligible for Medicare, coupled with Medicaid expansion, Mayo is looking to have higher-paying private insurance offset the shortfalls received from public health plans.

The ‘dirty little secret’ of establishing a pecking order of patients, based on payment sources, has not been widely known. In that sense, kudos to Mayo for their honesty, as it appears they are not attempting to sweep this fact under the rug. Yet, the Mayo acknowledgement that commercially-insured patients would get preferential consideration in certain situations should raise questions for those of us who are covered by private payers.

If the provider community establishes a pecking order between public and private payers, could special consideration also be given AMONG private payers? Think about it. If margins are so thin for world-reknown providers like Mayo, why wouldn’t other medical providers seek similarly-related practices with all sources of revenue?

For example, if insurer A reimburses hospitals at a higher rate over other private insurers within that particular market, would insurer A patients receive preferential consideration, much like what Mayo described? If so, are you better off purchasing health coverage at a higher premium from insurer A because their reimbursement rates will guarantee preferential service compared to other insurers within that market?

This raises questions about the potential practices initiated by the provider community. Having a particular insurance card provides a ticket of entry into our healthcare system. But does it also determine the level of care we ultimately receive?

What’s in your pocket or purse? In healthcare, it just might matter a great deal.

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Comparing Two Iowa Counties on Health Insurance Tax Credits

Once again, another attempt is being made by the other major political party to fix what ails our national healthcare ‘system.’ But this newest attempt by House Republicans, the American Health Care Act (AHCA), has already been met with opposition by major stakeholders, such as the American Medical Association, American Hospital Association, the insurance industry, in addition to Democrats and uber-conservative Republicans.

Despite the flurry of headlines, summaries, analysis and opinions about what this bill does and does not do, the Congressional Budget Office (CBO) has scored that the cost of this bill would reduce the federal deficit by $337 billion through 2026, however, it would leave 14 million people without insurance in 2018 compared with the ACA.  The CBO just released its’ findings.

To ensure coverage, the Affordable Care Act (ACA) currently subsidizes insurance premiums based on age and income. The ACA also attempts to factor the local cost of insurance into its subsidy. In addition, for those making less than 250% of poverty, cost-sharing assistance is provided to lower the deductibles and copayments for those enrolled in eligible marketplaces. The AHCA, on the other hand, provides tax credits based on age only, and this phases out for individuals with incomes above $75,000.

For any healthcare reform plan to work, there must be a large incentive for young and healthy people to seek coverage to help equalize (or subsidize) the unhealthy population. This is largely known as Health Insurance 101 – mitigating adverse selection risks.

I took great interest in an interactive map (at the county-level) provided by the Kaiser Family Foundation that compares estimated premium tax credits consumers would receive under the ACA in 2020 compared to what they would receive under the AHCA released by House Republican leaders on March 6. The interactive map does not factor in the cost-sharing assistance offered through the ACA, only the premium subsidy (ACA) and tax credits (AHCA).

I wanted to learn just how different subsidies and tax credits were between the ACA and AHCA, based on age and income, comparing a metropolitan county (Polk) to a rural county that I grew up (Appanoose). The results are quite staggering.

As a 27-year-old earning $20,000 and living in Polk county in 2020, the ACA is estimated to provide a $2,360 subsidy while the AHCA would provide a $2,000 tax credit. Living at this same age (and income) in Appanoose county, the ACA would provide an even greater subsidy of $4,440 vs. $2,000 (AHCA). At this younger age, and presumably healthy, this individual would have a greater incentive to seek insurance coverage through the marketplace under the ACA compared to the new version that would replace it. We don’t know if the replacement plan will generate lower-premium health plans for the public to purchase – this is pure speculation at this point.

Below are summaries of how people compare based on age, income and location (Polk and Appanoose counties). The subsidies and tax credits in red indicate that this amount is less than the opposing plan at that same age (ACA or AHCA). Generally speaking, the comparisons suggest that older people with lower-income (and live in higher-premium areas) receive larger tax credits under the ACA than they would under the AHCA replacement plan. This first chart is for those who earn $20,000, $30,000 and $40,000 annually.

This next chart compares people who earn $50,000, $75,000 and $100,000.

As I have written numerous times in the past, this second attempt to fix healthcare will be meaningless unless we focus on the true drivers of cost, which includes waste, lack of transparency and the exceedingly poor health of our population.

With that said, what are we really trying to solve?

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