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Health Care Reform: A challenge for organizational leaders

Each of my clients in the health-care industry has their own specialty: behavioral health, primary care, etc. One commitment they all share?

To improve the health and wellness of individuals.

The ACA and the intended transformation of the health care system that it seeks to produce, provide a unique opportunity to fulfill on that mission. In order to take advantage of the opportunity, all health care organizations must make fundamental shifts in the services that are provided, the manner in which they are provided, and the way that that business is conducted and managed.

These changes will necessitate a significant culture shift in our organizations.

We all know health-care spending in the United States is sky high. We spend over $7,000 per person — by far the most of any country in the world. Yet, our “healthy life expectancy” ranks at the 32nd in the world at 79.9 years. Certainly, the health-care system is expensive, but that is not what is killing us. We live in a culture that promotes unhealthy behaviors: 32.2 % of men and 35.5% of women in our country are obese, and 12.3% of our people ages 20 – 79 have diabetes.

Most health care experts agree that as much as 80% of health-care costs are spent as a result of five behavioral, lifestyle issues: poor diet, lack of exercise, substance abuse, smoking and stress. It is generally understood that our health care costs are so high because our lifestyles are so unhealthy. If we are to improve the health status of the population we serve, the root-cause lifestyle issues outlined above must be addressed. Until now, under the existing fee for service model — which is designed to treat the diseases caused by these unhealthy lifestyle factors — addressing the root causes has been financially unviable.

The ACA seeks to change that fundamental discrepancy by shifting from a fee-for-service model to a pay-forperformance model. Performance will ultimately be measured based on the measurable health outcomes of the people served, in aggregate. This funding change will be made gradually over the next 10 years, and in order to operate in this new environment, several seismic shifts must be made:

Shift from disease treatment to prevention and wellness.

The service offering must be expanded to include services that support people in changing their behaviors and lifestyle factors. We must not only educate, but inspire them to want to make the changes.

A whole new model of “change management” for individuals needs to be developed and implemented, and it must be done in time to experiment and ensure it produces results before the funding scheme changes.

Shift from compliance to personal commitment. In the current system, people are responsible for complying with mandated protocols established by funders. If the organization is to educate and inspire people to want to change behaviors and adopt healthy habits, each employee must be driven by their personal commitment to improve their patients’ lives. The leadership of our organizations must create this environment of inspired, engaged employees throughout.

Shift to personal responsibility/accountability for patient outcomes. If the organization is to be accountable for outcomes, that accountability must “drill down” and reside with each person within the organization. Everyone must be clear about how their work contributes to patient outcomes. There must be Key performance indicators in place for each employee to measure their contribution against an agreed upon standard.

Shift to a Learning Organization. In order to create this new organization, leadership must be equipped with the necessary mindset, skills, and tools to become transformational leaders. We must develop:

The ability to drive employee engagement with inspirational leadership.

  • A culture of integrity; where we make promises for results (outcomes) and deliver (do what we say we will do).

  • A culture of demand for personal growth. Each employee will need to learn new approaches and methods to accomplish their jobs. In order for them to make the change they must seek out, and be receptive to learning. They must “ask” for coaching and training.

If organizations are successful in executing the shifts outlined above, the potential to impact the wellness of ever increasing numbers of people in a financially sustainable manner is great. If these shifts are not made successfully, the organization risks falling short of being able to improve the health and wellness of individuals’— and the organizations very survival may be threatened.

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