Speaking for the American People on Healthcare

Senator Mitch McConnell, Republican from Kentucky, spoke ever so slowly tonight on television while stating his opposition to US healthcare legislation that he says the nation cannot afford. He repeatedly said that he was speaking for the American people yet he barely won his seat by 1%.

Being one of the American people about whom he speaks and for which he does not speak, what I and many of my fellow Americans want are certain outcomes regarding healthcare. I wrote about this in my book, Smart Data, to be published in March of 2010 by Wiley Publishing. I use healthcare as a case study. The following excerpt is from Smart Data, Enterprise Performance Optimization Strategy, ©2010 James A. George and James A. Rodger, Wiley Publishing.

The only thing about which I agree with Senator McConnell is that the legislative approach to healthcare is woefully inadequate.

“U. S. Federal Department of Health & Human Services (HHS)

To optimize performance in the U. S. Healthcare Enterprise, one must recognize that the government is only one participant in the collaborative process that includes public and private healthcare professionals and their organizations, businesses, and individuals. Yet, from the federal executive perspective, the President appoints a Department head for HHS and that person is responsible for leading the collaboration to optimize health care performance for all U. S. Citizens.

As we complete this book, commentators are discussing the administration’s approach, posing questions such as “Is this a capitalist and free enterprise society, or are we moving toward socialism when it comes to healthcare?” That is a profound question and it is a sincere and serious one being waged in America today about a number of topics affecting all Federal Government.

Looking at the HHS annual report for 2007-2012 for “outcomes” and you will not find this term. You will find a discussion about how the department socialized the topics and concerns of Americans through a workshop process that involved representatives from the healthcare community, including citizens. They produced a set of expectations that combine with executive leadership to guide what the department does in accordance with its legislative charter.

If you go to the HHS website on this day, you will see two main topics: Pistachio Recall and Health Reform. Obviously, the former is an immediate health threat and the latter is a long term proposition, though both have one thing in common and that is each requires immediate action by the department. One outcome is to prevent further contamination and people getting sick from contaminated pistachios, just as the department had to do with peanuts the months before.

The data indicates that there is a problem inspecting nuts and ensuring their safety. Combine this with previous year’s onions-in-tacos and tomatoes-in-fast food restaurants and the data would seem to point that there is an overall problem in inspecting foods. Yet, that is a very big leap without specific data facts.

Data-focused management operates this way, however, and encourages exposing all of the data and how it aggregates to point to certain problems. When the problems are identified as to type and level of importance, they are systematically analyzed to determine solutions. This activity comes later as now, in this example, we are in pursuit of identifying the department’s planned and legislated outcomes.

The U. S. Department of Health & Human Services Enterprise is a compilation of processes that have certain inputs: 1) Rising healthcare premiums for U. S. Citizens, 2) Increasing drug costs, 3) People in increasing numbers without access to healthcare, 4) Apparent lack if investment in preventative care, 5) Healthcare quality disparities among the population, and 6) Insufficient number of people entering the healthcare professions. These are all data points entering the HHS system. Most notable is that the USA spends more on healthcare than any other nation in the world, and apparently gets much less in return.

Knowing that these things are the inputs into the HHS Healthcare System, a term that we will use to label the primary activity and that is “Optimize U. S. Healthcare for Citizens.”

Now, that we see the input conditions we can begin to develop some corresponding outputs or outcomes. Missing are the specific measures on the inputs:

What are the average premiums for an individual today? What have they been in the past? At what rate are they increasing? How does the rate of increase compare to other pertinent economic factors?

What are drugs costing today? What is their rate of increase? (Of course one would want to know and understand the cost drivers)

What is the number of the population without access to “affordable” healthcare? What has it been? What is the rate of expansion?

What is the U. S. investment, public and private, in healthcare? What has it been? What is the rate of investment?

What is the investment in preventative healthcare, present and past and associated rate?

What is healthcare quality across the nation, averages and variations?

What is the nation’s healthcare provider present capacity versus capacity needed?

These are basic questions about the inputs that are needed to derive and define corresponding outcomes.

Corresponding outcomes might include:

Targeted average premiums for an individuals

Targeted drug costs

Targeted population with access to “affordable” healthcare

Targeted U. S. investment, public and private, in healthcare

Targeted U. S. healthcare quality

Targeted healthcare provider capacity

 

Each of these requires specific metrics.

Is that all HHS does? The answer is no, these subjects happen to be the ones addressed by focus groups and such as a way of socializing the approach to planning.

Examining the department’s strategic plan, we derived some additional outcomes. HHS identifies four major goals with associated objectives from which we derived outcomes.

Healthcare improved

Insurance broadened

Insurance available

Healthcare quality increased

Healthcare provider capacity increased

Public health improved

Disease prevented and spread limited

Environmental threats prevented or limited from causing injuries

Preventative care promoted

Disasters responded to and averted

Economic independence and well-being promoted

Total lifespan economic independence promoted

Children and youth safety promoted

Community development supported

Vulnerable populations supported

Scientific development advanced

Health and behavioral science researchers nurtured

Basic scientific knowledge increased

Applied research supervised

Research results knowledge transferred

Now, we have identified outcomes for which the department is responsible. Next is to define specific metrics. To complete this process one would have to know the beginning states and the planned end states not only for the outcomes themselves as achievement, but the associated cost and material profiles as well such that a before and after picture becomes clear. What do the laws and regulation say governing the department’s activities? Does the legislation and governance impose specific metrics regulating the budget and allocation to specific outcomes?

Are there disparities between executive direction and legislative mandates?

How much capital resource and material resource is allocated to HHS to accomplish its outcomes? Knowing this is essential in determining the percentage of completion of each of the outcomes as they are also identified as goal.

Goals and objectives are often used synonymously, though we employ outcome and expect each outcome to have a specific quantitative measure or metric.

None of these outcomes say anything about lowering healthcare cost by automating patient records, and yet this is a major focus for the Obama administration. What is the current cost and expected savings? What is the investment required? Digitizing patient data has potential for applying smart data and smart data strategy. Because prospective insured are global, what consideration is given to international standards, for instance?

This consideration belongs somewhere in the plan such that its value aggregates as a part of a parent initiative, or such that it becomes a parent initiative.

Of course, these are all data points for which specific data is required, and you can see how accounting for data can cause executives and their organizations to be more specific, more transparent, and more accountable.

Needed is for government to go through this process and to identify outcomes that ultimately results in departments modeling their enterprises. They place quantitative measures on their primary outcomes, and then begin the process of defining how work gets done to produce them.

Observe that this process does not begin by identifying a bureaucratic organization to determine how to keep them in business. That approach, one that is closer to the present practice, is rejected completely.”