Monday, August 31, 2009

Twitter is now on the menu

Earlier this year, there was a Why I Don't Twitter post.

All of those facts are still valid for me. However, I have discovered that there is an entire business opportunity that aligns well with social media.

Without sending a single tweet, you can find all sorts of information, including coupons, special deals, customer service, and professional tools.

For me, Twitter is not about the question, What are you doing, but it is about the question What do you know that might be useful to me.

As you will see in the near future, it also allows me to blog more often. Twitter helps with one of my basic business rules. You have to meet people where they are. The younger, more technologically adept customer is hanging out in social networks.

Twitter is definitely a part of my evolving Technology Action Plan (TAP)

Sunday, August 30, 2009

Healthcare in small chunks, part 3

How are WE paying for healthcare?

Some of the terms below (red plan, green plan) originated earlier in this series of healthcare posts. If you are not familiar, just jump back and check them out.

I could go uber policy wonk and dive into the federeal budget. But let's be real, the average person does not want that level of detail. Here's an extremely short version of health care cost savings from the White House. You can determine how much you believe the numbers and your interest level. Consequently, I wanted to think about funding health care in simpler terms. It's about money from inside the system and outside the system.

Inside money comes from cost savings based on things that we do within the healthcare system. If you used to buy a medicine for $3/pill and you now get it for $2/pill, there is a $1/pill cost savings. You multiply that by the number of these pills used in a year and that is your annual cost savings. The trick is to only count the real cost savings and not the fake ones. A fake one would be a savings of $1 per interoffice call if the price of the call truly stays inside of the hospital. If the cost savings does not show in a reduced cost from the phone company that provides the service, it is a false savings.

There is a lot of money to be saved inside the system. While I prefer that the government stay out of competitive, private industry things, when they do get involved, the Feds MUST get cost savings inside of the healthcare system based on the large quantities they control. This is true for medicines, medical tests, and all sorts of activities that support the basic (previously called red level plan) healthcare. The same is true for all of the current medicare & medicaid level healthcare.

Here is an example of how that inside savings can work for private companies. I need a medical test and for some reason get a 2nd opinion. Let's use the same information when possible instead of running the tests again. If the test are run again, let's have a follow up step to determine the value of the additional testing. If it is a low value test, the reimbursement for that testing is split--some to the testing organization and most to the red level fund. Now wasted tests are helping to pay for basic levels of healthcare. Either the testing becomes more efficient and effective or it helps to fund healthcare for those that cannot afford it. Either way, the system gets better.

One other area that could save money and improve healthcare in the long run is centralized patient information. Instead of relying on the memory of a sick person, let's put all of that healthcare information in a centralized place where medical professionals can access it. We would save money on record keeping. The severe downside is privacy and how the information might get (mis)used. If you want an extreme example, see the movie, Gattaca. You could let people opt out of the system, but they would be responsible for the storage, cost, and accuracy of their own records. No chance to sue the doctor who got the wrong medical information from you.

On the public side, few if any people want to pay more taxes. In reality, the people that have the most resources are probably least in need of healthcare reform. It is politically unpopular to put the burden of healthcare expenses on people with fewer funds. We often turn away from the fact that it is easier to get $1 from the average family than it is to get $1 million dollars from a rich person. There are only so many rich people to go around. How do we balance these concerns for a shared sacrifice? I'd suggest a combination of a consumption tax that impacts everyone and a tax on the high end (green level plan) medical services that are more optional than necessary.

That's my 2 cents on paying for healthcare. Is it enough to make change? Ask your congressperson and senators--soon.

Saturday, August 22, 2009

Healthcare in small chunks, part 2

Levels of care

When it comes to healthcare, some folks want a lot and others want little to none. Most want something in between. I see the goal of healthcare for all as a way to provide a decent minimum option. Individuals will view as an acceptable minimum differently.

Classify healthcare in 3 levels. There will be multiple plans in each level, but the core of the plans are similar in each level.

It's easy to use traffic lights because people are very familiar with them.

The minimum level would be red. This will establish what you get if you are not in an existing health plan. This is the only level that has a lot of governmental intervention. Mostly because the federal governemnt would be actively involved in paying for these services and determining what you get in the red level plans. Many of these services will be preventative, optional services that improve your chances for healthy living. Much of this could be done by medical professionals that are not doctors, such as nutritionists, physicians assistants, nurse practitioners, dental hygenists, etc. Doctors would be used for real medical issues beyond colds and the actual critical care that is needed for emergencies and significant health issues. No more stops at the emergency room to get basic care because someone lacks insurance.

The primary front of the red plans would be cost effective health care clinics and true emergency services. The second level would be referred health services for more significant problems. There are few primary care physicians in this plan.

The next level would be yellow. There are more elective features in this level. Many of these plans would fit traditional ranges of healthcare insurance as most people know it through their employers. The primary front would be the traditional primary care physicians. There would also be choices for the same services. (Examples--choice of color for cast here, no choice in red plan. Fewer options means less inventory management costs for red plan. From a quality of care level, there might be more access to choice. In yellow, you can get a thinner, more expensive eyeglass lens that is included in the price of the plan. In red, you would have to pay extra if you wanted the more advanced lens.)

The top level would be green. The highest levels of services are here and likely include many elective procedures and higher levels of availability. For what you pay, there is even more choice and service levels included in the plan.

Ultimately the tiers would be identified by price, not by service. Much of the healthcare debate is about the funds to provide services. If the average person could get 24/7 coverage with house calls from a great medical group for 1/2 the price of their current insurance, I think they would run to that deal.

The policy makers would have to figure out the numbers, but it might break out as 25% red, 65% yellow, 10% green.

These estimates are based on the following assumptions. Red plan would be uninisured people under 65 + medicare/medicaid people + a few folks who see this plan as superior to their current insurance and buy into the plan. Yellow plan would be most of the currently insured with decent to very good health plans. (Maybe those plans that would get D+/C- to B+ grades for cost.) The green plans would the the A plans.

Here are some healthcare stats via the CDC that may help you get a better feel for some of the details.

Bottom line, everyone gets access to real healthcare, but not quite the same as it has been done in the past for those who are on the public plan. Next part of this deal--how do we pay for it. It's more complex than letting the federal government keep printing paper money.

Thursday, August 20, 2009

Healthcare in small chunks, part 1

Lot’s of chatter out there about health care reform. A complete look at the topic exceeds the reasonable space of any blog. I have decided to put my 2 cents into the discussion in small pieces.

The debate is messy for one of the same reasons that education reform is a messy topic. For the most part, the people that get the service are not the people directly paying the service providers. Also, you can pay a variety of prices for the same basic service. For fun, let’s look at our healthcare through an analogous look at our eating habits.

Imagine the uproar if you went to your favorite fast food place, the Greasy Glutton, and ordered your preferred meal. However, before your price came up, there were discussions about your place of employment, the level of food plan you chose during the enrollment period, and other factors that helped them to price your meal. That’s what we do with healthcare.

Digging a little deeper, imagine if more of that pricing was dependent on your employer. For those more health conscious employers, questions come up about your exercise patterns and quantity of unhealthy food you have eaten in the past month. The worse your diet, the more you pay for the greasy meal.

If you eat at the Healthy Hut, the questions might be the same, but the pricing would be better. The better your diet, the more of a chance that you will be a healthy and productive worker.

Much of this links back to the risk you present to the employer, and more importantly, the company that manages the risk and pays for your food (or healthcare.) The insurance companies are usually the groups with the money that influence behavior based on how and why they allocate funds to the service providers.

What to do, what to do?

Do we get healthcare for all?

Do we get healthcare for some?

How much healthcare do you really want?

If there is no additional cost, the answers will still vary by person. Some people like to have the comfort of a medical professional while others just don’t like doctors, hospitals and the associated structure. Some folks will gladly accept some things from the local drug store and be done. Others want a 4th opinion on the sore throat.

As I lead into the next chunk, I believe the basic look of public healthcare is already out there. We just don’t use it widely…yet.