Life is messy, more like the picture on the left. From time to time healthcare helps, but life is not about health….care.
It is important to remember this amid the policy maelstrom and the basic fact that the healthcare industry absorbs about 18% of all economic activity in the US economy. I talked about this with a dozen very bright Wake Forest MBA students last week. Len Preslar, the former CEO of Baptist Hospital, leads the class which opened with a review of one of Michael Porter’s landmark analyses of the healthcare industry (http://hbr.org/2013/10/the-strategy-that-will-fix-health-care/ar/1#comment-1084800628 ). We just have to do better or MBA students 40 years from now will still be reading articles about redefining healthcare.
The problem is obvious to everyone outside the industry: healthcare is not a self-contained industry–it is just part of life.
Porter believes that healthcare can be redefined by optimizing the focus of competition among providers so that each incident of treatment is provided by the organization expert (and cheap) in that procedure. This is a good idea, but utterly misses the opportunity.
There is a persistent myopia in a vision of larger conglomerations of providers rationalizing their services as the way provide better value to patients and payers. This helpful but inadequate view of healthcare ignores the larger community context. The good news lies in what Porter leaves out.
Quietly over the past two years a growing number of faith-based and community-oriented healthcare systems have been meeting to ask a basic question: can they actually achieve their founding mission to care for the whole community, not just the insured? Most of these systems predate the birth of health insurance. They were founded by visionary religious bodies or people like Henry Ford, who saw in modern medical science a powerful tool for social justice. Is that vision a delusional relic? The learning group discovered that even amid the half-built policy scaffolding and confusion of state-level politics, we can do what we were intended to do—if we adopt an ensemble of practices very different from Porter’s list because we need more stakeholders to play critical roles. That’s why the group is now moving under the name of Stakeholder Health (you can sneak an official peak at the website stakeholderhealth.org).
The first step is to move toward the people (who are only sometimes patients) and the places where social and environmental conditions play a significant role in limiting economic opportunity, dashing the hopes of young people, and perpetuating negative health behaviors. These also happen to be the same communities where much of the Medicaid expansion will be concentrated. We must take focused action, and do so in serious partnership with the panoply of organizations (mostly not healthcare)
which care about these communities. This includes thousands of faith congregations and nonprofit organizations, as well as a growing number of business leaders—all totally invisible if you limit your focus to the healthcare sector.
We must focus on proactive, compassionate problem solving rather than reactive charity. Omitted from Porter’s management view is the fact that the largest single item in the operational budget of almost every health system is charity care. In the case of Wake Forest Baptist Medical System, the total is $68 million last year. While we can’t predict exactly which person will need charity care, we know the census tracts where they likely live. If we engage those complex communities in real partnerships—including with our own lowest paid employees who live there—we could improve outcomes and provide the profound value we were founded for. We have to see the larger system and the full array of stakeholders. The good news is precisely in the larger team that cares about…..life.