Tim's WhatMatters Blog 

As the movie 'Moneyball' hits theaters, we realize healthcare might learn a few things from professional sports when it comes to using advanced data to measure complex outcomes.

Wal-Mart succeeded by building a 'network' organization. New care delivery models will need to operate in the same fashion and will require leaders who are more committed to the nodes on the network than the central hub.

EHR adoption is growing fast and software sales are up. But the difference between success and failure has less to do with the software selected than it does the investment made in the implementation.

Like the national debt, healthcare is a major, complex problem that we have to solve. But will all of the focus on a limited set of public policy solutions, there is not enough attention being given to addressing these problems through growth and innovation, alternatives that are far better and far more likely to be effective.

With all of the momentum around ACOs, will things be different this time? The previous post explored the reasons why the ACO vision will come to fruitition this time. This post looks at some reasons to doubt the ACO model every becoming a reality.

The discussions about ACOs and new delivery systems sound familiar. Will this time be different than the 90s? Here are three reasons why the transformation of our delivery system might happen this time.

With the increased focused on ACOs, provider organizations must come to grips with a key requirement if their ACOs are to be successful. This model requires taking financial risk and risk management requires information processing and management capabilities far greater than what we have today. This will become an IT arms race.

What do you do if you are a practice owner or a healthcare executive at the beginning of 2011 and you have to make some strategic decisions this year about the future of your business? With this number of really, really large macro issues in flux, the probability that you could get them all right is about as low as a misspelling on the product in an M&M factory. Unfortunately, many people stare hard into this level of environmental uncertainty and decide to punt on thinking about strategy at all.

About a decade ago, everyone was talking about 'it' -the next big thing- 'Ginger'. Finally we learned what Ginger, this new thing predicted to change the world, actually was -A scooter. Granted, we’re not yet nine years removed from the HITECH EHR stimulus program as we are now with the mysterious Ginger, but we are getting far enough into the whole concept that some early opinions are forming. Some are sounding a bit like, ‘Really? That just looks like a cool scooter to me.’ Not 'change the world' worthy.

For years now, industries have been using complex algorithms to make quicker, more accurate predictions than any human could. Recently, these computer models have begun to make their way into the healthcare industry, often used in the complicated decision making world of a physician. The equations are coming and are sure to have a dramatic impact on how we do our work, or more importantly, who does our work instead of us.

We have learned from the early EHR pioneers that ‘within the walls’ software implementations only slightly unfreeze the information locked in the paper charts. As a lever of systemic industry change, EHRs alone are pretty limited. Archimedes, the Greek math dude that postulated he could move the world if only he had a lever long enough, would not be impressed. With only EHRs, our data is still mostly frozen. Which gets me to my favorite new buzzword. ‘Data Liquidity’

Years ago, I was reading a book about creativity and innovation. One of the tips from this famed international expert was interesting. When you are struggling to solve a problem, he said, think about doing the exact opposite of what makes sense. This would stimulate creative thinking and open up new options. So I tried to think about how I could apply this advice...

Like the running back with the big contract who is now a little slow, assets become liabilities very fast. Barnes and Noble stores were the secret to selling books just a few years ago. Now that Amazon sells more Kindle e-reader downloads than hardcover books, the technology advantage is only accelerating. Technology is an incredibly disruptive force once it gathers steam. So what does this mean in healthcare?

We all remember Econ 101. If demand goes up and supply is short, prices go…? Up, right? Wrong, in this case. Prices are down. My equity analyst friend said, ‘Prices eventually have to find their rightful level.’ - That is the bigger question for physicians. If demand is growing, and the supply is not, when will physicians act to force pricing to move to its rightful level?

Manufacturing has been investing in IT longer than most any sector, and not surprisingly, saw its productivity grow almost 60% faster over the past 20 years than the economy as a whole. I am not an economist, but as a healthcare guy, finding myself again right at the beginning stage of an IT investment boom, I would suggest there are some long view lessons we can learn from our industry brethren who went 20 years before us. The idea that healthcare IT can, and will, lower costs makes too much logical sense.

One of the consequences of patients paying more and more of the bill is that they are becoming more active consumers. As patients become prudent consumers, providers that fall short of the standard are going to get punished. However, If you are good, really good and not just a legend in your own mind, it presents a great opportunity.

On one play in 1985, Lawrence Taylor came unseen from the quarterback's blind side and literally snapped in half the leg of quarterback Joe Thiesmann, ending his career. Taylor, and those like him, changed the game and changed life for the offensive left tackles. A similar change has happened for physicians and it is becoming very obvious which practices have discovered the value of a good left tackle and which are still exposed to the hit from the blind side.

In a study by Greenhouse Internists in Philadelphia, the physicians work 50-60 hours per week and each see about 18 patients per day. If you assume the average internist gets 15-20 minutes for each visit, patient visits account for about 22-30 hours a week, somewhere around 40-50% of their work time. That is the part of a physician's work week that is actually compensated. So what is up with these physicians? Where does the rest of the time go? This little study sheds at least some light.

In the old days, when the process was highly manual, the economics between doing billing in-house or sourcing it to a third party were sort of apples to apples. But now, as technology plays a larger and larger role in determining whether the RCM process collects 92% of the contractually allowed amounts or 97-98%, that equation has changed.

A client of mine twenty years ago told me healthcare was nothing but an information business, occasionally interrupted by the laying of hands on the patient to do something. The difference is that automation and digitization turn our mounds of data into functional assets, assets that can be converted into money and value. We've seen this evolution in other industries and can consequently see the phases of change that we face in the coming future.