Channeling the Fox News Rebublican Debate for Health Care Reform

Last night, the Population Health Blog secured a suitable beverage supply, pulled up a chair and tuned to the Republican Party debate. As predicted, there was little substantive attention to health reform.

That won't stop the PHB.   Lacking specifics, it's offering an important public service by channeling the debate's bombast to a hypothetical question:

"Specifically, what is the first thing you would do on the first day of your administration, as the next U.S. President, to control the growth of health care spending?"

Chris Christie - "I'd do hugs, not drugs!"

Scott Walker - "Since they've hacked all our medical records anyway, let's outsource it to China."

Rand Paul - "Stop the outsourcing of how we pay for it to China!"

Ben Carson - I've done brain surgery on conjoined Siamese Twin health policy specialists; one lost their brain and when I was done, I couldn't tell the difference between the two!"

Donald Trump - "You're stupid for even asking that, but I'd build a wall around every hospital."

Jeb Bush - "If everyone ate some milquetoast everyday like I do, they'd be calm and healthy, like me!"

Ted Cruz - "I'd shut down the government."

John Kasich - "If all Americans would only go to Ohio hospitals, costs would go down."

Marco Rubio - "I had a $100,000 in educational loans, and I look forward to $100,000 in loans to pay for my health care bills."

Mike Huckabee - "The purpose of health care is not not kill people or break things!"

"Opt-Out" Health Insurance Enrollment

Say no to your health insurance?

Kudos to the New England Journal for providing a tidy summary of the latest Republican healthcare reform proposal. Up until now, the Population Health/Disease Management Care Blog was only vaguely aware of the GOP's evolution from the political party of "no" to one of "go," albeit with lots of caveats. 

It seems the Senate Republicans no longer want to repeal Obamacare and are OK with keeping many of its more popular reforms.  Instead, they're focusing on undoing selected provisions, such as repealing the minimum benefit, returning some aspects of medical underwriting and resurrecting the "block grants" for Medicaid.

But one of the more interesting wrinkles in the proposal is "auto-enrollment."

Those of us from the bygone days of "disease management" may recall the debates over the merits of "opt-in" versus "opt out" participation in our programs.  The former required persons to actively chose to be entered into nurse coaching, which had the advantage of committing resources to a highly motivated population.  The latter approach assumed all patients with a condition were enrolled and, only if they specifically requested it, would they allowed to stop the coaching phone calls.  Unfortunately, "opt-out" usually gathered many patients who never answered the phone and were "engaged" in name only.

Well, the Republicans are apparently proposing that states be allowed to "auto-enroll" persons eligible for premium payment support into an insurance plan or Medicaid without their up-front permission, just like the old "opt-out" disease management days.  The tax credit would cover the insurance costs, no bills would be issued to the consumer and voilà! the risk pools would expand.  Patient choice would be preserved, because persons could always just say no.

The DMCB was always of fan of opt-in disease management.  Not only were patients who wanted to be in the program more amenable to behavior change, it allowed the program to "flex" the nurses that we needed as the program grew in scope.  However, when it comes to insurance, the DMCB thinks the Republicans may be onto something with their opt-out insurance approach.

Count it as a fan.

Media Savvy and the Implications for Business Leadership in the 21st Century

The Disease Management Care Blog continues to be beguiled by Meghan McCain, and not just because she could be a good match for one of the DMCB's unmarried spawn. Ms. McCain's career may hold some early lessons in the coming style of 21st century leadership.

Way off topic for the health industry-oriented DMCB? 

Not quite.  It explains below.

As the DMCB understands it, the very blond daughter of Arizona Senator John McCain has a reputation for a liberal style of nontraditional Republicanism. That, combined with her namesake's political and media connections, has undoubtedly (and perhaps unfairly) catapulted her into the national spotlight.  She could have faded away along with her dad's presidential ambitions, but she now has a web-TV gig that is a curious mix of 50% reality show (e.g., the travails of hanging taxidermy), 50% social commentary (e.g., her generation's lackadaisical views on privacy) and 50% chatty self-promotion.

That's not the point.  What is the point is that 20th century old-fashioned (in politics, think Ronald Reagan or in business, Jack Welch) leadership skills were honed by decades of practice practice practice in the written word, public speaking and retail networking. Once they mastered that, their formidable communication skills helped propel these very talented men into their very successful careers.

We don't know where Ms. McCain's career trajectory will take her, and it's very possible that she could ultimately fade away. The DMCB bets not. While her current views and public persona can come across as naïve and unpolished, this young woman is likewise practicing practicing practicing to master a newly emerging 21st century style of leadership that will rely on the broadcast word, media savvy and web-based networking.  By the time she is in her 50s, decades of experience combined with her other skills on both sides of the lens could make turn a diamond in the rough into a formidable force in business or politics or both.

Which brings the DMCB back to the business and politics of health care.

This has important implications for health industry leadership, including population health management. Simply avoiding the social media is no longer a formula for success. Smart hospital administrators are also mastering blogging to mitigate threats. Bad moments captured on YouTube can make health industry leaders look bad.  Branding without Twitter is now like personal injury attorneys without contingency fees. Boards of Directors can't ignore the threat of adverse media relations like this in their enterprise risk management.

And who will be best positioned in the coming decades to lead health care companies through these challenges?  Smart CEOs and executives who have a deep familiarity with leveraging TV and social media - thanks to decades of personal experience -  to engage their constituents and customers to choose their products and services instead of their competitors'.   And if they go into politics, they'll be leveraging the same social media skill-set to get voters choose their ideas and to vote for them.

You go gurl!

Image from Wikipedia