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By John O'Leary. This was originally posted on JohnOLearyInspires.com. When John O'Leary was 9 years old, he suffered burns over 100% of his body and was expected to die. He is now an inspirational speaker and bestselling author, teaching more than 50,000 people around the world each year how to live inspired. John's first book, ON FIRE: The 7 Choices to Ignite a Radically Inspired Life was published March 15, 2016. John is a contributing writer for Huff Post and Parade.com. John is a proud husband and father of four and resides in St. Louis, MO. Order John’s book today anywhere books are sold.
All the buildup, excitement, planning, time away from work, family gatherings, gifts exchanged, and holidays celebrated is just about over. And as we prepare to flip the calendar to another year and head back to work, to school, and to real life, many of us wrestle with the question: So, now what? A woman with nine and a half decades of experience gave me some sage advice at our family Christmas Eve celebration a couple years ago, and today, I’m going to share it with all of you. Are We Racing and Missing the Gifts Right in Front of Us? Every year, my parents host as many of their children, daughters and sons-in-law, grandchildren, and dear friends as find themselves in town. In the midst of the chaos two years ago, the matriarch of the family, my 96-year-old grandmother Caddy and I stepped into a quiet room and had a wonderful conversation. Caddy is an amazing woman. She drinks from the fountain of youth, always wears a smile, and strives to put a smile on the face of anyone with whom she’s speaking. Grandma Caddy’s short-term memory is fading a bit, but her zest for life and natural beauty remain perfectly intact. During our conversation I asked about her childhood, how she met my grandpa, what it was like during World War II when he was in the Pacific, what life was like raising kids during the 50s, and a few of her favorite memories. I then asked what advice she’d give me as I continued along this path in life. She looked me in the eyes, patted my right leg, and responded thoughtfully, “John, it seems like everyone today is so busy racing. All that racing means they’re busy doing things, but also more likely to miss the gifts that are in front of them right now.” How Can You Embrace Grandma Caddy’s Advice? Caddy’s 96 years of raising kids and losing friends, savoring mighty blessings and minor gifts, learning through mistakes, and living life has taught her what matters most. She knows that the success so many of us long for is illusive until we slow down long enough to notice the joys that are already ours to celebrate. My friends, as we step into a new year, with new goals, new resolutions, new opportunities and new uncertainties, I encourage you to embrace the sage advice of Caddy to slow down and take an inventory of the blessings in your life. Look around at all you have and stop searching for all you don’t. Take account of the lessons you’ve learned, the adventures you’ve experienced, the wisdom you’ve received, the life you’ve lived and the possibility before you. Because it’s not only the scenery you miss by going fast. You’re also likely to miss the sense of where you are going and why you were going there in the first place. Looking for your next healthcare speaker? Get in touch with us at the Capitol City Speakers Bureau today to make your healthcare event a success!
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By Courtney Clark
For many parents, the thought of seeing your kids’ faces light up on Christmas morning has been keeping you going for the past several busy weeks. But now Christmas is over, the gifts are unwrapped, and for many families, the trouble is just beginning. If your family is starting a post-holiday meltdown, and you’re counting down the days until school is back, don’t worry! Here are some ways to combat the most common after-Christmas behaviors in kids. Being Wild For younger children, the threat of Santa watching can encourage good behavior for several weeks leading up to the big day. But once that red-suited incentive is removed, there’s QUITE a lot of pressure built up in your little ones, just waiting to explode! Instead of being frustrated at what feels like an about-face in their behaviors now that Santa isn’t watching, give them physical outlets to get their sillies out now that the day has passed (yes, even if it’s cold outside!). It’s practically a biological certainty that there’s going to be a rebound effect after prolonged effort to be good, so don’t get caught off guard, and be prepared to intervene with lots of active games to channel the wildness. Being Lazy On the opposite end of the spectrum, some kids get ridiculously lazy after Christmas has passed. This can happen for one of two reasons: First, many humans (of all ages) experience a health dip after big events. Don’t you remember those days when you managed to power through college finals but then get the flu break? Our bodies sometimes just give out on us once it’s “safe.” The second thing that could be happening is a bit of situational depression, where your child may be experiencing a “let-down” now that Christmas is over. If your kid is channeling a sloth, it’s best not to take it too personally. Chores have to get done and showers must be taken, but what’s wrong with a little rest time (other than how jealous it makes you!) Just keep an eye to make sure that seasonal or situational depression doesn’t linger any longer than that. Being Sassy Cookies aren’t the only thing left over after Christmas. You may find that the holidays have left behind a seriously smart mouth on one or more of your kiddos. Older children may not have been behaving nicely because of the threat of Santa, but they likely DID feel the pressure to get along and be sweet, because “that’s what Christmas is all about.” Kids see and internalize that societal pressure for family harmony at the holidays. Once Christmas is over, then, there can be a rebound effect. You don’t have to accept rude treatment ANY time of the year, so ignore the proximity to the holidays and just address the behaviors the way you would any other time of year, without adding in any extra “but it’s Christmastime” guilt. Kids who internalize that everyone has to get along at Christmas just because can grow up into adults who make themselves crazy at the holidays trying to make everything perfect. Christmas can be an amazing time to look at the world through the eyes of a child. But the days following can be meltdown city, so be prepared in advance with strategies to head off these common post-Christmas behaviors. Looking for your next healthcare speaker? Get in touch with us at the Capitol City Speakers Bureau today to make your healthcare event a success! By Karyn Buxman. This was originally published on Karyn's blog.
Flying can be stressful any time of the year, but the holiday season can be especially nerve-wracking: Fretful flights. Cranky crews. Pissy passengers. Instead of instructing people to buckle their seatbelt, flight attendants might be better served to have people fasten their straight jackets! If only there was a way to deal with the strain… But wait—Popeyes Chicken comes to the rescue! Many passengers traveling through the Philadelphia International Airport during Christmas week 2018 skipped the Philly Cheesesteaks and grabbed a to-go box that also served as an Emotional Support Chicken. Yes, I said, “Emotional. Support. Chicken.” These chickens don’t bite, they’re TSA-friendly, and they’re “cheap” comfort food. (Sorry, I just can’t resist a good chicken pun.) Popeyes Chicken thought this emotional support animal wouldn’t ruffle any feathers…but they were wrong. PETA and its supporters squawked that this stunt was insulting and in poor taste:
Whether it’s politics, religion or how a dress affects the visual perception of your derrière, people are hesitant to joke about nearly anything these days for fear of offending someone. And while I’m all about inclusive humor, the fact of the matter is that jokes always have a target. I love Mike Birgbilia’s insight in his brilliant one-man comedic show, “Thank God for Jokes,” that jokes are, by nature, a volatile type of speech. His mom once posed the question to him, “Well can’t these writers just write jokes that aren’t offensive?” He turns to the audience and observes, “I thought about it. And I said, ‘I’m not sure that’s possible, because all jokes are offensive to someone’.” In my book, Funny Means Money. Strategic Humor for Influence & World Domination (ForbesBooks, 2019) I discuss how to make your humor 99% safe. But safe isn’t always going to get you to your desired outcome. While Popeyes may have offended a few, they entertained and comforted thousands of passengers—and they reached millions more on TV, radio and social media…Especially after PETA took them to task and created a twitterstorm. But they seem to have shot themselves in the foot, as the vast majority of people didn’t take offense, and, in fact, they thought that emotional support chickens were hilarious. Many tweets were similar to this one: “Emotional support chickens are FUNNY. And all this brouhaha makes me hungry for chicken!” In my estimation, Popeyes’ strategic use of humor was a savvy marketing move. Their digital footprint is still spreading as we speak! Scowl if you must, but I’m putting Popeyes Chicken on Santa’s “Nice” list for delivering holiday cheer and spreading humor to a population that is hungry for it. Looking for your next healthcare speaker? Get in touch with us at the Capitol City Speakers Bureau today to make your healthcare event a success! By Kenneth Kaufman
We have all seen the attacks on hospitals for exercising their right to merge and make decisions about how to best fulfill their missions in a rapidly changing competitive environment. In this blog post, Kaufman Hall presents its point of view on this critical issue. For more information, see the American Hospital Association’s resources on hospital integration. Each day seems to bring a new outcry that hospitals are attempting to get bigger in order to raise prices. A recent article, for example, said that hospitals have “enormous clout”…are “behemoths” that are “throwing their weight around”…have “essentially banished competition and raised prices for hospital admissions.” Reading these articles, you would think we were living in 1985, rather than closing in on 2020. The healthcare environment that these articles describe no longer exists. In 1985, hospitals competed with the hospital across town for inpatient business. Today, hospitals are struggling to hold onto large chunks of their outpatient business in the face of new competitors that have scale and technological knowledge never before seen in healthcare. UnitedHealth/Optum and CVS Health/Aetna are aiming to unbolt outpatient business from legacy hospitals. Amazon, Apple, and Google are investing heavily in healthcare from numerous angles, looking for the most effective entry points to care and services. Hospital organizations are doing what any company would do when confronted with a highly disruptive environment like this: They are trying to gain the financial and intellectual resources to compete in a new world. Hospitals are making this transition in the face of a difficult financial reality. The Moody’s 2019 outlook shows revenue growth for hospitals will continue to decline under pressure from weak inpatient volume and low reimbursement payments. At the same time, expenses continue to grow faster than revenue. This puts hospitals in an extremely difficult economic and competitive position—one in which the status quo is simply not an option. The normal response of any company in any industry in this situation would be to seek scale in an effort to meet this different level of competition and adjust to a new business model. That is exactly what is happening among hospital stakeholders. The opening sentence of a recent Crain’s Chicago Business article states the obvious and the inevitable: “The news that Walgreens is in preliminary talks to link up with Humana showcases just how critical it has become for healthcare players of all stripes—from pharmacies to hospitals—to bulk up….” Of course. “Bulking up” is the logical response. Legacy hospital organizations need to grow along with everyone else. Scale will help ensure that America’s hospitals can keep pace—that they can continue to build on their deep community connections, expertise treating the full range of health conditions, and history of serving our most vulnerable populations. In this competitive milieu, pricing is of minor consequence. It is immaterial to competitive position. Raising prices would not have helped Borders to compete against Amazon, or Blockbuster to compete against Netflix, and it won’t help hospitals compete against healthcare’s new entrants. UnitedHealth’s revenue grew 12 percent in the third quarter of 2018, compared to the third quarter of 2017. Moody’s projects 2019 mean revenue growth among rated hospitals will be 3 percent to 4 percent. The new competitors like UnitedHealth and CVS Health/Aetna are among the largest companies in the country and, in some cases, the world. The very largest hospital systems are ten times smaller. Scale will be critical, but it is not an end in itself. Scale is a means to gain intelligence—to get the best intellectual capital, to tap information about a vast group of people, to test new ideas, and then to scale those ideas. A recent New Yorker article described scale at Google as “the beginning of a feedback loop—bigness would be the source of Google’s intelligence; intelligence the source of its wealth; and wealth the source of its growth.” The competitors that hospitals face are not just large; they also are among the smartest organizations on the planet. These companies draw on a huge amount of data, apply sophisticated analytics, and have the capabilities to develop radically new tech-enabled care and digital connections. This is the state of play today. Scale is the platform that will allow hospitals to acquire the resources—such as more working and intellectual capital, and significant digital capabilities—to compete in this brand new healthcare marketplace. Looking for your next healthcare speaker? Get in touch with us at the Capitol City Speakers Bureau today to make your healthcare event a success! By Colette Carlson
The holiday season is chock full of additional, and often unrealistic, expectations around entertaining relatives, parties, decorating, shopping, wrapping, cooking, cleaning and traveling. All this activity fills what little whitespace remained on your already-crammed calendar. Emotions run high filled with seasonal stress, as well as crowded mall parking lots, airports and freeways. If you prefer peace and joy, rather than more pressure and juggling, put the following survival strategy to work: Embrace a Less is More Mindset. By choosing to buy less, do less, or do (fill in the blank) less perfectly, you’ll immediately trade in chaos for calm. Granted, online shopping saves time, but look for shortcuts at every turn. For example, rather than purchase individual gifts for colleagues, show up with an edible everyone can enjoy. Better yet, make a pact to skip gift-giving entirely in lieu of a coffee date next quarter deepening a relationship. My hairstylist appreciates receiving the finely wrapped thyme candle gift, and shared she also appreciates my gift bottle of wine minus bag or bow. Rather than slave over a stove, grab and go instead. The homemade, smoked trout crostinis with dill sauce someone brought to a recent party I attended were devoured and enjoyed — but then again, so was the Costco shrimp platter. Rather than put up outdoor lights or even a Christmas tree, hang a beautiful wreath or create a mantle display. Skip the greeting cards and send a photo card from next year’s vacation if you must. Depending on the ages and stages of your family, align gift giving with a less is more approach. Now that my own daughters are grown, the packages under the tree are few. They’re blessed to have enough stuff, and I’d rather create memories through experiences together. My sweetheart and I gave up gift-giving years ago and instead contribute to a vacation account for the same reason. In fact, we’ve adopted a BOGO (Buy One, Goodbye One) philosophy when it comes to adding items to our life to reduce stress and clutter. Rather than accept numerous holiday invitations, ask yourself, “Will this activity bring me or my family more joy? Will it allow us to deepen our connection to others?” By limiting your commitments, you’ll maintain your sanity, but also your credibility as you’ll prevent last minute cancellations. Prioritize one or two events that mean the most to you and/or your family and then let the rest go. Here’s some phraseology that might make it easier: “I appreciate being included, however my calendar is fully committed.” If you’re uncertain, give yourself an out. “I will try to attend, but please don’t count on me given my obligations that day.” If pushed, you can respond, “Thank you, and the timing doesn’t work this year.” It’s okay to be missed. Remember, choosing to do less does not equate to being less. It means you’re time savvy and gives others permission to do the same. For those of you rolling your eyes, here’s the truth: If you’re determined to create a perfect Pinterest holiday, don’t be surprised when you find yourself sick, crabby, or exhausted. Good luck being present or creating connection with others in that state! Instead, give yourself the gift of doing less or doing things less perfectly. Seek connection, not perfection, to discover the true joy of the season. Looking for your next healthcare speaker? Get in touch with us at the Capitol City Speakers Bureau today to make your healthcare event a success! By Roger Crawford. This was originally published on Roger's blog.
Do you remember a time when you had a challenge to overcome, an important project to complete, or a situation that you had never faced before? Were you unsure where to start? Was it a positive or negative experience for you? How did you feel about the results? What I’ve found after thirty years of speaking to over 4,000 audiences and coaching hundreds of highly-successful executives and industry experts is…the more positive you think, the better results you get. Take a look at the lives of successful people and you will find a common denominator. They have a positive mindset that allows them to break through obstacles and maintain momentum. Instead of retreating, they lean into their challenges and discover new opportunities less-successful people missed. Those opportunities create a path through obstacles that leads to achievement. A positive mindset that results in success doesn’t mean you overlook challenges. Instead, you lean in and say, “Yes I can” which helps you see circumstances in the most favorable positive light possible. If you choose a negative mindset, you will look for and magnify what is negative around you. You immediately anticipate the worst and start blaming yourself or others for a bad outcome, whether it occurs or not. There’s no opportunity to create a positive result and success. My priceless years of experience show that a positive mindset is essential to perform your best and realize your awesome potential. Here are four key ideas to develop and maintain a positive mindset. If you think with a negative mindset, you will look for and magnify what is negative around you. You immediately anticipate the worst and start blaming yourself for a bad outcome, whether it occurs or not. Your Mindset Matters!A positive mindset is essential to perform at your best and realize your awesome potential. Here are four ideas to help you develop and maintain a positive mindset. #1 Manage Your Mouth The language you use has a tremendous influence over your mindset. What you say affects how you feel; how you feel determines how you act; and how you act either increases or decreases results. Choose your words carefully because what you say impacts whether you’re crushed by, or conquer your circumstances. Positive words make you strong; and negative words make you weak. It’s important to make a habit of using words that accurately reflect your reality. This way you won’t turn a molehill into a mountain. In other words, don’t exaggerate the situation. How many times have you heard someone say something like this? “It’s a disaster!” Think again. Maybe it’s actually an inconvenience. “It’s impossible!” Is that a fact or an opinion? The important point is that using language that mistakenly depicts our circumstances is a clear path to excuse making. Failure to take responsibility leads to an inability to find solutions. When you have negative thoughts, strive to reframe your thinking in a more positive way. Instead of saying, “I am a failure,” try a more positive and accurate representation. “I failed this time, but what I learned will help me succeed in the future.” #2 You Have the Control People that have a consistently negative mindset have likely forgotten that they have control over their thoughts. They let challenges, other people, or even the weather determine how they think. The reality is all of these are completely out of our control and most often unchangeable. Would you agree that we live life from the inside out? The thoughts and beliefs you have inside shape what you see in the outside, not the other way around. One of the most important principles of maintaining a positive mindset is understanding that while you may not control your circumstances, you do control how you respond to your circumstances. Remember, you are the boss of your brain! #3 Have a Grateful Mindset People with a positive mindset resist dwelling on their disadvantages and appreciate what they do have. A grateful mindset is not automatic… it’s intentional. So, instead of waiting for something to make you feel grateful, deliberately look for the blessings you already possess. Being grateful doesn’t eliminate problems. However, by focusing on what’s good about your life helps remove bitterness and negativity. New York Times best-selling author Lewis Howes says, “If you concentrate on what you have, you’ll always have more. If you concentrate on what you don’t have, you’ll never have enough.” #4 Release Setbacks – Rehearse Success The next time you experience a loss, turn it into a lesson, and then let it go. Someone with a negative mindset spends time living in the past, dwelling on previous problems, and continually asks “why.” They ask themselves, “Why did it happen?” “Why me?” or “Why not someone else?” On the other hand, someone with a positive mindset is present focused, learns from their past circumstances, and then asks “how.” They ask, “How can I learn from this?” and “How do I move forward?” A positive mindset can take you from where you are to where you want to be. A negative mindset will stop you from even trying. The ability to develop and maintain a positive mindset is always within your reach, and I’ve given you four keys to help you. Lean into the opportunity to discover the tremendous potential you have and experience the great things you are capable of. Believe that success is possible, develop a winning mindset, achieve more, and become more of who you are meant to be! Looking for your next healthcare speaker? Get in touch with us at the Capitol City Speakers Bureau today to make your healthcare event a success! By Ron Culberson. With a master’s degree in social work, Ron Culberson spent the first part of his career working in a large hospice organization as a clinical social worker, middle manager, and senior leader. As a speaker, humorist, and author of "Do it Well. Make it Fun.The Key to Success in Life, Death, and Almost Everything in Between", he has delivered more than 1,000 presentations to associations, government agencies, non-profit organizations, and corporations. His mission is to change the workplace culture so that organizations are more productive and staff are more content. He was also the 2012-2013 president of the National Speakers Association and is a recognized expert on the benefits of humor and laughter.
One of my favorite movies is It’s a Wonderful Life. In addition to an ending that always makes me tear up, I love the theme of this film. George Bailey works at the Bailey Bros. Building and Loan in Bedford Falls and throughout his entire life, he longs for greater adventures. He wants to go to college, see the world, and succeed in business. However, after a series of events prevent any of his dreams from becoming a reality, he realizes he may never leave his hometown. At the end of the movie though, George realizes that even though he thought his life was uneventful, he had touched many other lives. In other words, he was successful at providing value to the people around him. To me, that’s significance. I constantly struggle with the rub between success and significance. I’ve seen some very successful people who do not provide much value to the people around them while others who might not be seen as particularly successful make an incredible impact on others. And, of course, there are some who are both successful and significant. In Jordan Peterson’s book, 12 Rules for Life, the author talks about the ways we compare ourselves to others. Often we look at more successful people and compare only one aspect of our lives to theirs. For instance, I might look at a very successful speaker and wish that I had the number of speaking engagements she has. Or I might read a book by a gifted writer and wish I could write like him…uh…he…uh…them (See what I mean?). Or I look at a friend who has a full head of hair and wonder why my head, although incredibly sexy, is bare. The problem, as Peterson describes it, is that I am comparing only one quality. The successful speaker may have sacrificed relationships at home due to the busy-ness of her business. And the writer may have addictive issues that prevent him from benefiting from his literary gifts. And the man with a full head of hair may not rock the chiseled body that I have. You see, the qualities we may admire don’t necessarily paint the entire picture. As a kid, I use to tell my mom, “I won’t be happy until I’m famous.” I had no particular talent which would suggest that I might one day become famous. But the idea seemed like a good one. Ironically, when my father got upset with me, he often would be so flustered, he would call me by my dog’s name. So, clearly, if my father couldn’t remember my name, I wasn’t even famous in my own house! But perhaps fame wasn’t the best target for my career path or my life. Now, looking back at my work in hospice care and then as a professional speaker, I realize that the choices I made that led to so-called success were usually tied to the value I provided rather than success in and of itself. For instance, seeking a management position because it entailed more power and prestige did not interest me as much as learning to be good supervisor or mentor. Speaking for a huge sum of money did not excite me as much as working with non-profit groups who rarely had the opportunity to experience a funny and engaging presentation. And becoming the chair of a committee or the president of a national association was the result of doing valuable work on committees rather than seeking that top spot in the organization. I have found that value will almost always lead to significance while success may not. Many people will seek money, power, or fame as if achieving those benchmarks automatically lead to significance. I suppose a person who has achieved a high level of success does possess more ways to also become significant. They have financial resources, powerful connections, and the notoriety to touch a lot of people. But, sometimes, the very goal of success requires one to spend so much time focusing on continued success that value or significance may be sacrificed along the way. I recently read about Alan Naiman, a social worker who worked for the state of Washington’s Department of Social Services. He was quite frugal and it appeared to his colleagues that he had limited financial resources. Yet, he had been saving money for years and when he died, he left $11 million to a variety of charities that support disadvantaged children. His focus was not on success but making a difference through his job and then ultimately, his generous gift. That was valuable, and ultimately significant. In my community, I’m surrounded by people who provide value every single day. My wife delivers food to a woman who lost her sight. Several neighbors knit blankets and scarves for those who can’t afford them. And our local tree company donates wood to disadvantaged people rather than selling it for a profit. Perhaps it is the value in what we do that leads to significance. So, as we go through our lives and our work, we should continually ask ourselves if what we are doing is leading to something of value. If so, then I would argue that we are achieving significance—even when we might not feel particularly successful. I did not achieve fame as I told my mother I would. But, hopefully, along the way to being un-famous, I have provided value through the work I do and the life I lead. And that just might be more significant than fame. Looking for your next healthcare speaker? Get in touch with us at the Capitol City Speakers Bureau today to make your healthcare event a success! By LeAnn Thieman. This was originally published on LeAnn's blog.
In 2013, about 30 percent of Americans said they slept six hours or less at night, but that number increased to 33 percent by 2017, according to findings published online in the journal Sleep. Sleep experts recommend that most adults get 7 to 8 hours of good quality sleep each night. The University of Southern California in Los Angeles researchers said many factors could account of lack of sleep. Some people are troubled by economic insecurity. Some feel they are working longer and harder for less. There is also a growing stress level associated with our increasingly connected world. People are glued to their cellphones, reading news and Twitter and Facebook, and seeing world, national and local troubles delivered right to devices in their hands. In addition, people are staying up binge watching TV or movies on tablets and cell phones. Hispanic and black Americans showed the largest increases in inadequate sleep. The number of black study participants who said they slept less than six hours rose from 35 percent in 2004 to 42 percent in 2016. Among Hispanics, it went from 26 percent to 33 percent during that time period. Among white people, those reporting short sleep increased from 29 percent to 31 percent over the same time. By 2017, a 10 percent difference existed between blacks and whites. Not getting enough sleep is tied to increased risk for obesity, decreased mental functioning, dementia, heart disease and diabetes. In addition, getting too little sleep can increase the risk for car crashes, accidents at work and troubled relationships. To learn more about how to increase sleep and improve your selfcare, visit LeAnn at SelfCare for HealthCare™. Looking for your next healthcare speaker? Get in touch with us at the Capitol City Speakers Bureau today to make your healthcare event a success! By Joe Flower
Leading lights of the health insurance industry are crying that Medicare For All or any kind of universal health reform would “crash the system” and “destroy healthcare as we know it.” They say that like it’s a bad thing. They say we should trust them and their cost-cutting efforts to bring all Americans more affordable health care. We should not trust them, because the system as it is currently structured economically is incapable of reducing costs. Why? Let’s do a quick structural analysis. This is how health care actually works. Health care, in the neatly packaged phrase of Nick Soman, CEO of Decent.com, is a “system designed to create reimbursable events.” For all that we talk of being “patient-centered” and “accountable,” the fee-for-service, incident-oriented system is simply not designed to march toward those lofty goals. A machine for creating reimbursable events The health care system is a machine for creating reimbursable events. This means that its systemic business aim is to maximize reimbursable events and to increase their price, that is, to maximize the energy the system can draw in from its customers. There’s Point 1: health care provider organizations are designed and energized to increase reimbursable events and drive up their costs. This system is self-limiting, as drawing ever-increasing energy from its customers actually debilitates those customers (individuals, employers, governments) and causes them to find ways to reduce payments or opt out of the system altogether. Health insurers, on the other hand, have a somewhat more complex situation. Insurers are paid by their ability to finance these reimbursable events, spreading the risks, and keeping a percentage of the flow for administration, marketing, and profit, limited by the Affordable Care Act to 15% or 20% of the total. So the systemic business aim of a health insurance business is to get the risk right, so that the actual payout for reimbursable events comes as close as possible to the lower bound of the medical loss ratio. There’s Point 2: Health insurers get paid a percentage of the total cost. They have no incentive to reduce the total cost, and every incentive to increase it. Let’s be honest: In this picture, neither the health care providers nor the insurers find any institutional advantage in providing actual lower costs per life, per case, or per procedure. Incentives are not aligned with outcomes. The “affordable” part of the Affordable Care Act was about forcing modified community rating on insurance companies (so that at least for older and more compromised people, health insurance would be more affordable) and about getting insurers to compete for the low end of the market. But the many health plan executives I have worked with over the years tell me that they do not want the low end of the market. The ideal customer is the middle of the market, the stable customers, the not-so-sick-or-expensive customers. If you design your premium structure to catch a lot of people who are purely price-shopping, your medical loss ratio will climb above 100%, you will have to raise your premiums next year to recoup, and all those price shoppers will go away. There’s Point 3: Because of this structure, no one wants to compete for the bottom in healthcare markets. At the same time, health care providers have by and large avoided opportunities to take on some risk, to be transparent about their costs, or to guarantee their patients anything at all. Instead they have mostly stuck with the fee-for-service model, largely because of institutional inertia. Change can be expensive, difficult, and requires strong leadership. Adjusting internal information silos to provide the complete picture of a patient, to track quality metrics, to transparently measure physician outcomes, and so forth is disruptive—but it is what’s required to win. Rather than radically move off of the fee-for-service model, health care providers have consolidated enough that in many markets they now hold monopoly-like power. In those markets a health insurer or major employer aiming to build a lower-cost alternative system within the region simply cannot provide its members a full array of health services without paying the high prices of these consolidated health care systems. And the insurer cannot pick apart the provider, which insists on whole-system contracts. This combination of consolidation and lack of transparency means that there is no real competition on price and quality among health care providers—and therefore no possibility of real competition among insurance companies. There is no competitive market in health care. There’s Point 4: The lock-in between large monopoly-like health systems and the few dominant health insurers makes a true competitive market in healthcare impossible. All this will remain true as long as the market is dominated by the opaque, fee-for-service, treat-to-code payment system that accounts for the vast majority of healthcare payments today. When that changes, when other payment systems such as competitive bundles, subscriptions, direct pay primary and others gain serious market share, the system will shift, the walls will come tumbling down. The very structure of health care, as it exists today, means that no major player across the entire market is truly competing to provide the best medical care at the lowest cost. The only serious way to evaluate any “reform” that lays claim to lowering prices is to ask: How does this reform plan change that? Looking for your next healthcare speaker? Get in touch with us today to make your healthcare event a success! |
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