I’m told that one should not mix stories in a blog, but, as a serial disruptor, I’m about to do just that.  I’m inspired by Representative Giffords and see her story as a frame for some ideas that simply won’t rest in my tired brain.

POSTED ON TUESDAY, JANUARY 31, 2012 AT 12:20PM BY MCOLBLOG IN NAYER, CYNDY | POST A COMMENT

It’s a bit into the New Year, but I find that these first weeks often are cluttered with tasks from the year before, chaos from holiday celebrations, and a redefining of personal goals.  Eventually, the bright light of early January takes center stage as the days begin to lengthen, and with that brighter light comes renewed energy.

Our November Annual Meeting and Innovation Summit seems far away, yet the success of over 150 people in the room still resonates.  I’m continuing to work with the some of the companies to connect them, define the opportunities to work together, and build showcases of improvement in engagement and accountability for outcomes, the very essence of any value-based design.  I’m waiting for the movies to be clipped to their important messages and the new pages on our website/Facebook/twitter to be created so we can share some of the detail of the summit with all of you.

But standing still is not part of my DNA.  So let’s frame the work of this coming year.

MLK:  A genuine leader is not a searcher for consensus but a molder of consensus.

At the summit, I framed my talk on quotes from Steve Jobs.  Interesting, here, that Jobs and King are in alignment, but perhaps not so surprising, since we were all so influenced by Dr. King.

My role in the Center, as the CEO and one of the founders, has been to assemble leaders, case studies, market evidence, and organizational evidence of improved health outcomes with value-based designs.  But make no mistake:  the accumulation of data points is not my endpoint.  I amass trend data and then create “what if” scenarios that link the art of health promotion to the science of engagement.  I’ve done it my whole life:  I take disparate entities and mold consensus to achieve better outcomes.  Everyday.  In every conversation.

Now there are some who rely on focus groups, surveys, and more.  There is good evidence that these provide information. But my impatience and inability to accept incremental change drives me to rapidly move forward based on the data that is often NOT in the focus group or survey.   In other words, I mold consensus.  I take the vision of “what could be” and compare to the noise of “what is” and ask, “Where is the disconnect that is stalling the improvement?”  Then, I track back to data to see if there is verification of a missed opportunity, I seek evidence and research that show the end-point is valid and achievable, and I prioritize the steps to get there.

Jobs said he didn’t poll the public because he invented what the public didn’t know it wanted—he merged science and creativity into disruptions that changed our lives. King used our emotional ties to our faith to define a disruption that overhauled social systems, forever changing our humanity.  I gain bravery by reading about brave people who carve a different path.  I bring many of those brave people together to solve for improved health.

I don’t equate my efforts with Jobs or King, but I am inspired by them and build my courage from theirs—hence, they are part of my collection of heroes.

This is the ecosystem of the Center for Health Value Innovation as well.  We have created a safe haven for implementing new models for health engagement, an innovation incubator that takes existing and emerging technologies and inserts them into these community models, and an educational resource that informs the general community through our website, summits, webinars and social media.

MLK: Faith is taking the first step even when you don’t see the whole staircase.

It’s imperative that there is a safe haven concept studio such as the Center (CHVI).  People need to know that there are others who have disrupted the status quo and who can share the learnings.  They need to know the first steps to creating the change and avoiding the pitfalls.  They need to know that, once they reset the course, they won’t be left without the map to the next location for supplies—that they can proceed on the course and, when they run into interference, others will help them through.  Vision without action is frustration.  Vision with first steps is the way out of a rut that is holding back progress.  If a company or a person comes to us with vision and faith, we help turn on the lights to the rest of the staircase. Sometimes, we even discover a better way to build the staircase together!

MLK:  All labor that uplifts humanity has dignity and importance and should be undertaken with painstaking excellence.

We are motivated by evidence.  We ask companies who work with us to share their findings and experiences in safe ways, never identifying the company unless the company says it’s ok.  Sometimes companies join our Center to purportedly share learnings, but actually to access leading innovators at big companies.  They quickly find out that they will get little support from us.  The excellence comes because we share with each other.  By creating a data repository of journeys, services that were used, and improvement in outcomes, we quickly can refer or connect organizations.  When the connections are made, the expectation is that a new level of data will come back to the repository.  The excellence in outcomes is sustained by the continual refreshing of the data metrics, which we track over time.

MLK:  Almost always, the creative dedicated minority has made the world better.

We are not a large organization.  Rather, we are a dedicated organization.  We are not solving for better health care—we believe that health care is a tool for better health.  We do not open our doors widely when we are testing a new model, as we’ve learned that others may not revere the confidentiality of a discussion intended to provoke thought.  In order to foster creativity, we respect our differences and leverage them for a better solution.  We understand that all companies are not large brand names and there are no “bad” companies or market segments.  We focus on narrow agendas in order to provide intelligent road maps to the marketplace as a whole.

MLK:  Our lives begin to end the day we become silent about things that matter.

There is no question that is too off-track, too elementary, too argumentative that we won’t ask.  There is no connection of innovation to models that we won’t consider if it’s novel and it’s potential for success has been excellently measured (and has a good chance of succeeding).  The energy in our discussions and presentations is palpable because we believe, en masse, that what we are doing truly matters.   We recognize that some may not move as quickly as we’d hoped, some may even abandon one model for awhile or for another.  But we continue to share among ourselves and with our communities.  We force conversations on their side so we can examine the hidden consequences of our actions.  We are far from silent on the topic that matters and unifies us: health promotion and disease prevention.

That’s who we are at the Center.  Some tell me that we are continually changing our definitions, but we believe we are refining and recommitting to new goals.  Some tell me that we are not growing our membership quickly enough, but we respond that members have to be comfortable with who we are and what we do, and sometimes that takes a bit of learning about us and experiencing our intensity.  Others join our efforts from tweets, posts and seminars in which we present data along with actionable steps for change, a methodology that is rare and based upon some experience and some faith.

Today I find it amazing that one year has passed since I wrote the E Pluribus Unum blog, calling for a commitment to doing better, reaching higher, and securing a stable environment for our children.  You may remember that I was moved by the death of a little girl in Arizona  (Christina) who had gone to meet her Congressional representative and was caught in the shootings that day.  I was overcome with sadness and hoping that others would help me and help them.

It’s amazing what vulnerability can bring.  Today I’m energized with hope and clarity of purpose: I will continue as a change agent for those who truly want to change.  Since last year’s blog, I’ve met new friends at more conferences and private meetings than I ever dreamed possible.  I hear daily from people who are doing nothing less than changing their communities, their companies or their personal lives for the better—and I’m quite sure that’s a commitment that tears at their souls, engages their intelligence, and delivers highs and lows on a daily basis.  I’ve grown more comfortable in admitting that I’m shamelessly working to improve health in America, that I revere the work of Dr. King and Mr. Jobs, that I’m honored to serve with the folks on our Board of Directors in improving the health and economic status of communities.

I’m excited to see who will knock on our door, or phone me on my, well, iPhone, or email me on my (you guessed it) Mac, asking for info or how to join or where we can meet or just chat.

On this day, let us all become disciples of Dr. King, building a better world in whatever way we can.  I hope that we all can stand up and say, “I have a dream…”

NOTE:  Also published by MCOL

I’m thinking this evening of the amazing journey we’ve begun together, and I’m thinking about the conversation I had with Dr. Joycelyn Elders, former US Surgeon General, who will open our Annual Meeting and Innovation Summit on Nov 14.  Each of our phone calls is such a delight.  Imagine being able to call the woman who “explained” to Congress how teenagers need more guidance, and to ask her some of the hard questions on national health policy!

I’ve been very lucky in this career of mine.  I’ve been blessed to work with some of the most amazing folks at every turn.  What’s remarkable is that so many of us know the real gold in health care is not the care itself, but in making HEALTH the goal of our endeavors.  What’s exciting now is that many of us “passionate idealists” are working hard to make sure that the improvement in health is the #1 priority, and that health care becomes one of the tools to get there.

Each of us approaches this in different ways.  For instance, Brian Klepper, whom you often read about when you read my writings, is passionately moving the needle on Primary Care Providers, blogging on Health Affairs and causing a ruckus with the RUC (the panel that sets clinician reimbursement rates, the panel that is so very much under-represented by primary care physicians).  Brian’s efforts are getting bolder and growing stronger, and I am an ardent supporter of the efforts to be sure that Primary Care gets equivalent pay that shows their importance in the health engagement and promotion that keeps people well, working, and building healthier, prosperous communities.

Another good friend is Ron Loeppke, MD MPH, whom I’ve know for far too many years to remember.  Ron’s passion is now directed to his new job, as Vice Chairman of the Board, U.S. Preventive Medicine, Inc. (traansparency: I have the honor of serving on the board with Ron and so many of our mutual friends).  Ron is also the past Chair of the American College of Occupational and Environmental Medicine (ACOEM), and has chaired the Health and Productivity section for as long as I can remember.  Recently, Ron wrote an op-ed piece on the need for preventionists, and it’s posted on the ACOEM site.  Ron has been a driving force for linking worksite health to worksite performance, and we’ve had the joy of sharing many conferences, slides and ideas together.  As he says in the article:

The clinical science of preventive medicine focuses on wellness and health promotion and health risk assessment to keep people healthy (primary prevention); and early identification/diagnosis of illness through age/gender/risk appropriate screening and biometric testing (secondary prevention); as well as earlier evidence-based intervention/treatment to deter complications and the disabling impact of conditions (tertiary prevention). The preventive health care movement reaches well beyond the four walls of medical facilities to include workplace health and community health initiatives. 

I quote this as others in the space of value-based designs do not see the ROI of prevention and wellness.  But think about it:  if we can prevent the high cost interventions, if we can build intrinsic desire for health and accountability to save our health, the saved dollars will go far to build healthier communities.  The companies that tell me that they cannot focus on health, that they only want to get the costs down, are doing themselves, their families, and their communities a disservice.  Simply stated, if the company gets 80% or more of its workforce from the geographic community, then there is an 80% chance that the next person coming to get a job will have the same risk factors as the person who just left.  Want more proof?  Google Ron and start reading.

And on the topic of value-based designs, another friend I’ve been very much in contact with lately is Mike Critelli, the former CEO of Pitney Bowes who is now the Chair and CEO of Dossia, which is so very much more than a Personal Health Record.  Under Mike’s direction, Dossia is quickly growing into the family and community health management tool that I have been hoping for, building the capacity of families to “gather” into one record that the head of the family health improvement plan (usually the mom, folks, that’s been my story all along!), can manage.  With the strong support of a very talented group of programmers, community health improvement experts, international IT experts, and more that are too many to name, the group at Dossia is getting grand traction around the country, and I am, of course, delighted to have them on the CHVI board.  We share many strong ideas of accessibility and accountability, and then we work with our different constituencies to influence change as far and as fast as possible.

It’s stunning, isn’t it, that we expect an “engaged, accountable patient,” yet the patient gets no records, has virtually no decision-making authority except how much he/she is willing to spend out of his/her own pocket for care.  Yet, that’s not the accountable consumer we want.  We want a consumer who protects the health of herself, her family, her community.  We know, from research published by another renowned colleague, Dee Edington (of Univ of Michigan fame), that an engaged consumer of health has costs 30% lower than one who is unengaged.  We know that reducing risks from hi to moderate lowers costs 33%–that’s what happens when people are engaged, not entitled and waiting for the system to cure them.

Yes, I’m quite lucky, indeed.  Yes, I’ve used this opportunity to highlight the amazing work of my friends and colleagues AND to link to our upcoming summit, because I’m excited about our mission, and I’m excited that they will all be there with us.

Maybe, too,  as I watch the sun set over the beautiful SW Florida sky this evening, the stars really are aligning.  Perhaps we’ve squeezed as much value out of the delivery system as we can–and remember, most of the dollars, all $2.6 Trillion of them, are focused on the 10-20% of folks who are not so committed to health promotion or prevention.  Maybe now that the economics of health is so very important to understand, the stars are ready to assist.  Perhaps the stars, whose light has to travel so very far to be seen, have finally arrived in sight–and those of us who have spent so very many years promoting health, are finally being seen as well.  Perhaps the focus on outcomes allows all of us to ask the question, “How do we short-circuit the path to achieving these outcomes?”  and we can, finally, all get quiet while the stars’ universe responds, “It’s in the path to health promotion.”

It’s a wonderful night to dream of what could be, to imagine that there is a growing focus on health, outcomes, and healthy communities.  Tonight I’m not going to focus on this paradise’s need for jobs, affordable care, and primary care clinicians.  Tonight I’m going to hope and pray and dream of the US as healthy, prosperous, and job-wealthy.  I believe that’s what the stars are showing us.  If we’ll only look up, they will tell us that nothing is impossible.

It’s been a long few weeks, and temperatures have not subsided.  The AC needed–the cooling off that would come with accountability throughout the stakeholders of consumers, patients, physicians, health plans, health services, pharma-device-biospecialties, etc.– is not on the horizon.    Today, the heated up consumers have shown they have lost confidence in our economy, and the stockmarket dropped 350 points already today. The Congress is worn out from its weary negotiations, and members have recessed for 5 weeks, leaving less than 90 days for negotiations by the SuperCommittee, who will, in turn, “solve” the money crisis, we hope.  But, the money counting has begun. Does this matter to health care, employee engagement, and accountable care?  It sure does, as it reflects the impact that loss of revenue and loss of taxes will have on our ability to get health care coverage for more citizens.

Then, another stunning blow:  In an overlooked clause in the PPACA legislation, Massachusetts hospitals will recoup $275M in Medicare reimbursements, and 7 other states will also be receiving new Medicare dollars, while the rest of the states get hit for these dollar transfers.  The article, in the Associated Press, explains it this way:

Hospitals in Massachusetts will reap an annual windfall of $275 million through a loophole enshrined in the new health care law. Hospitals in most other states will get less money as a result.

Hospital association executives in other states are up in arms over the news, buried in a Medicare regulation issued Monday. It comes at a time when hospitals face more cuts under the newly signed federal debt deal.

“If I could think of a better word than outrageous, I would come up with it,” said Steve Brenton, president of the Wisconsin Hospital Association.

Even Medicare says it is concerned about “manipulation” of its inpatient payment rules to create big rewards for one state at the expense of others.

Hospitals in 41 states will lose money as result of the change. The biggest loser: New York, which is out $47.5 million.

Seven states come out ahead, though none do as well as Massachusetts. Runner-up New Jersey stands to gain $54 million, or about 20 percent of the Massachusetts windfall.

President Barack Obama’s health care overhaul was supposed to lead to reforms in Medicare’s byzantine payment system. Critics say this latest twist will encourage hospitals and other big players to game the system in a scramble for increasingly scarce taxpayer dollars.

Hospitals are paid under a complex set of formulas for their services for Medicare recipients.  When these kinds of shifts are made, the hospitals, of course, must take the hit–unless they are in the “lucky” states.  But, as you may imagine, these less-fortunate hospitals have bills to pay, too.  So, they often raise pricing on the other national payers of health care:  the employers.  This means we can expect to see the employer-provided costs of health insurance to go up, which means employers have one of 3 alternatives:

1/ pay the increase.  But their sales are down (witness the plunging consumer spends) and their insured population (workers, families) have already absorbed 100%+ increases in insurance costs over the past 10 years;

2/ pass the increase to their covered lives.  See #1 above, and note that recently Kaiser Family Foundation published research that showed that 61% of the uninsured in America are part of a family with a fulltime employee who is offered affordable health care and chooses to not take it. Passing costs to employees who choose not to take it does not make a healthier employee nor a healthier corporation.

3/ do not offer insurance.  Well, it will sure save dollars for America’s employers (up to $13,700 per family in 2010).  But it certainly will not increase employee engagement in their health or performance, and it will not add to the total health improvement for employers, who are experiencing the aging and sicker workforces that have been documented over and over again.

So, Turning on the AC, as noted in my previous blog, hasn’t quite worked so well in the past few weeks.  Accountable Care may well have become AcCOUNTable care, emphasis on the count.  I hope that those that received the reimbursed dollars will be able to support the only reasonable outcome:  send people to those states for the coverage they will not find in their own. Another reason for Medical Travel, but, alas, it’s not about improved health.  It’s about improved reimbursement, just as many have feared.

The news shows this Sunday morning focused on the debt ceiling, a concept causing higher angst and tempers across our very hot country.  Of course, a large part of the discussion is the cost of health care in the country, and the political v clinical costs of cutting benefits and resultant strains on the health care delivery system.  So, on this sunny/rainy day in southwest Florida, typical for this time of year, I began thinking about a concept and a slide that I created about 3 years ago.  As the weather here and across the country is speeding to 100+ degrees, the body screams “cool it off,” much like the body politic is screaming about the debt ceiling.  That conflict of politics, health care, and hot temperatures was actually, was the genesis of the slide, and the concept,  that I created called Turn on the AC.

A play on words, as noted, is often how I begin to frame the “what ifs” in my thoughts.  What if we could cool off the…..for just a bit and have a conversation to reconsider some alternatives—I remember thinking just that in late 2008, as the economy tanked and my speaking engagements picked up.  At the time, I was using the frame of “7 Wonders of Health Value Innovation,” teaching the attendees at various summits how value-based benefit designs could provide relief to a stressed corporate America.  I also remember one of my colleagues telling me, “Cyndy, a little less gloom and doom.”  But that was not really what I was proposing.  Rather, I was setting up a “what if” scenario of plummeting housing market, lower tax revenues, job cuts, hospital distress due to lower disproportionate share reimbursement (this is the Medicaid reimbursement to hospitals for providing care when there is no insurance coverage), public employees losing jobs due to lower tax revenues from lower property values, and so on.

The bad news is, 3 years later, the problem has not gone away.  Now, it’s enveloped in a bigger problem called the debt ceiling.  And this blog is NOT about the debt ceiling.  I have many things to say about debt ceiling, and none of them would I like in print, except to say this game that’s going on in Washington is not helping tax revenues, corporations, working people, unemployed people, health care access, or property valuations.  Back to the subject…

The set-up was, and still is, about the uncomfortable feeling from hot weather.  Debt ceilings contribute to the hot weather feelings, but turning on the AC can help.  We need a cool-down, one in which we remember our basic focus is a healthy, engaged, high performing America.  So, with that in mind, I update “Turn on the AC.”

1.  Accountable Consumers.  At the crux of the problem of escalating health care costs is the entitlement v accountability debate within the consumer population.  Forget, for just a moment, whether insurance is involved.  Each of us has a responsibility to care for our health as the one investment that needs to be fully-funded for our lifetime.  There are some fundamentals here that should be reiterated.

• Set goals and write them down.  If you’ve heard me speak, you know I am quite enthusiastic about personal health records.  As a former trainer of fitness trainers/employer health strategist/chair of the Governor’s Council on Health and Fitness, the number one behavior change strategy that I proposed then and continue to enforce is “write it down, measure it daily.”  “You can’t manage what you don’t measure,” applies to corporate strategy, so but it’s a curious item that folks don’t realize the same applies to them:  you have to set goals (small, large), then measure your success in attaining them.  No exceptions.
• Get the preventive care that you need.  Love it or hate it, the Accountable Care Act has ingrained this into our lives now.  In the Health Value Accelerator^TM that is being deployed in many communities now, I’m seeing just how much of an “un-engagement” this is.  In many companies, particularly larger companies (over 10,000 employees), there is less than 10% participation in primary care for prevention.  Yet, there is no cheaper investment any consumer/patient/employee/mother/father/child can make:  get your physical, your immunizations, your age-appropriate screenings.
• Get your family involved.  If you are the health advocate for your family, share the info you are learning.  Take the kids on a walk after dinner.  In my house, it’s about encouraging my husband to exercise, so I “coax” our fabulous dog, Phoebe, to take him for walks.  Families that eat healthy and exercise tend to forestall health issues.
• Spread the word at work.  Share your story of success, of challenges.  Volunteer to coordinate walking groups or healthy vending snacks.  Make your voice heard on health improvement ideas.
• Reward yourself.  If you are doing well on your journey, don’t reward yourself with the hot fudge sundae, but, instead, perhaps a manicure or a movie?  New walking shoes?  Even a lovely glass of wine?  Consumer-driven rewards are completely satisfying, as no one else is dictating either your behaviors or your rewards.  Step up to identifying those rewards that will keep you motivated.

The key message here is that YOU are responsible for your health—your doctor, your counselor, your fitness trainer, your financial advisor are your consultants, not your health-owners.  You simply must assume this responsibility or be subject to the whims of the market place and latest insurance products.  If you want some semblance of normalcy in your health, own it, track it, demand it, enjoy it.

2.  Accountable Corporations.  Business is the backbone of America.  Business provides revenue for us to buy houses, support social causes, and even campaign for elected officials.  But business that creates barriers for its employees to get health is not a healthy business.  Wasteful spending in the health system has been calculated at up to $1.2 trillion of the $2.2 trillion spent in the United States, more than half of all health spending.  (PriceWaterhouseCooper)  Whether your position is that the ACA is going to help businesses or hurt businesses with its legislation, realize that every week there are new rulings, and American business cannot afford to waste one minute waiting for “final rulings.”

Recently we all read that one consulting enterprise predicted what many of us saw as an abnormally high exit from corporate health benefits.  In our survey from the Center for Health Value Innovation (176 companies, 4 million lives), we saw no numbers that came close to this prediction, and, evidently, neither did many of the other large consulting companies.  But what we did hear last week was another challenge for American business:  new rules on the Health Insurance Exchanges said that states did not have to launch them by 2014—the date can be 2015, or perhaps beyond.

What this means to American businesses is, once again, the heat is on, again.  There’s no time to waste in getting your employees healthy, re-engaging them in managing their health.  Value-based designs are one tool, and I don’t have to reinforce that message—it’s also in the ACA:  reduce beneficiary out-of-pocket costs for valuable services.  But take it a bit further:  consider those rewards, or incentives, that are outside of the insurance plan design.  How about a contest for movie tickets?  How about a healthy lunch for the business channel with the most people who get their flu shots or track 150 minutes of exercise in one week?  Think of games and challenges that cause an uptake in healthy behaviors, and applaud your champions.  Create a business expectation that people who work at your company are expected to manage their health and that the company respects all efforts for improved health.  Create a culture of engagement, in which employees bolster employees’ efforts at health promotion. Colleagues at Journal of Occupational and Environment Medicine, Pam Hymel MD and others, have written extensively about the link of health to corporate performance.  Build your culture of engagement so that you create accountability from the C-Suite to the receptionist and beyond.

3.  Accountable Care.  This, too, is part of the national and local change that is occurring with the ACA.  But in 2008, and even now (hard to believe that the measures are the same 3 years later), my focus was on the delivery system to deliver health as we want and measure it:  healing with less infections, less mistakes, less days absent, less avoidable pain and suffering, less use of unneeded diagnostics and treatments; care with more compassion, more time to listen, more care coordination so that people are not “on their own”; more interoperability so that records support efficient care.

The 2008 AC slide was the genesis of the Outcomes-Based Contracting platform that has become the extension of everything value-based and patient-provider-engaging.  Identifying high performance providers and systems, creating benefits plans that guide consumers to competency and better health care, and linking these delivery system improvements to the shared rewards for all of the stakeholders, is true American engineering.  Removing friction and competition for dollars, installing competition for a “better outcome” is the foundation of accountable care.  Medical Homes, care coordination, benefits advocates who coach beneficiaries on improved behaviors and their link to lower premiums or expanded services—all of these are part of Accountable Care, but only if we hold our principles intact:  efficiency, effective care, and appropriate care delivered in a timely, competent fashion.  Self-insured employers understand the link and are searching for ways to direct contract with organizations so that, togetherm the accountability link is communicated.

4.  Accountable Communities.  When the AC is going full-blast, when the accountable consumers support the efforts of the accountable corporations, who, in turn, provide healthcare coverage to the employees through identification and purchasing of outcomes-focused suppliers, the community at-large benefits.  Accountability grows in small increments, but its effect is felt throughout the families and corporations that benefit from the improved service lines and improved health status of the citizens.   When 1 or 3 or 7 corporations demand hospital-based performance metrics, everyone who uses that hospital benefits from the improved quality.  When 1 or 3 or 7 corporations demand to pay for disease management that builds engagement (instead of numbers of calls made to beneficiaries who may never engage), the systems for disease management change and the others in the community benefit.  When benefits coaches help employees and their families not only choose the right insurance plan but use it for full maximum value, they teach other families how to maximize their health benefits.  When few people use the emergency room for primary care, and instead use lower-cost onsite or offsite clinics or telehealth Emergency Room visits, more resources are saved for under-insured and uninsured folks—more accountability for choice leads to better use of existing resources.

What the AC focus does is create engagement across single, multiple, and varied participants in the health value supply chain.  AC shares the requirement of engagement and builds the outcome of accessible, affordable, actionable care.  AC rewards all of the engaged participants with lower costs and fuller wallets due to appropriate care at the right resource at the right time.  AC limits inappropriate use, instability in resource budgets, and insufficient funds for treatments that could have been managed more effectively and more efficiently “upstream,” when they didn’t cost so very much in dollars, pain, and stress.

So, on these hot days of summer, consider cooling down and challenging yourself and your constituents to a better outcome.  Turn up the AC, from the Accountable Consumer to the Accountable Corporation, to the Accountable Care and the Accountable Community.  Walk earlier, when it’s not so hard to breathe.  Consume more locally-grown fruits and vegetables to protect your heart on these hot days and protect the revenues in your community.  Create co-worker opportunities to learn and share improved health management techniques.

And don’t forget about that debt ceiling.  Be the Accountable Constituent and let your local and national representatives know how you feel.  It will reduce your body temperature and lower your stress levels.  We could all use that right now.

Allow me, then, to tie this to my passion for improved health.  To do this, I’m using some quotes from the Founding Fathers as well as some from more modern efforts.

We hold these truths to be self-evident: that all men are created equal; that they are endowed by their Creator with certain unalienable rights; that among these are life, liberty, and the pursuit of happiness. This line from our Declaration of Independence, penned by Thomas Jefferson, captures the intent of the Founding Fathers (note: I’m choosing to translate “men” as the placeholder for both genders).  People are born with certain rights that must be protected and promoted.  Jefferson also linked the pursuit of happiness to the health of body and mind, writing,  “Happiness is not being pained in body or troubled in mind.”  He wrote, too, of purpose, education, and walking fast—all items that would enhance our life, liberty and the pursuit of happiness.  If one respects Jefferson, one respects health and understands that health grows as we acknowledge its importance in our pursuit of happiness, building wisdom and proficiency in managing our health.

Let us not proclaim infallibility. Benjamin Franklin thoughtfully considered every word and passage in our Constitution.  Writing that he could not proclaim that all evils were addressed in its words, he cautioned humility and the opportunity to let time judge the words—and then he signed the Constitution.  He was quite sure that it was better than any other guarantee of freedoms that existed: it was a game-changer.  He also knew that healthy living was a game-changer (“healthy, wealthy and wise…”), and he wrote of value in words that ring true today: “When the well’s dry, we know the worth of water.”  Today, the wells of both health and wealth are running low, with obesity on the rise, inactivity robbing our children of their future, and wealth stolen from them as we argue over “who pays.”  Our communities are paying, our businesses are paying, our government is paying, and all of those mean that we, individually, are paying.   Yet we behave as though our declining health is worth the lack of attention we personally give to it.  Unhealthy, un-wealthy, and unavoidably unwise? The fallacy of ignoring our personal health is the mounting debt that poor health leaves on all of us. That’s not the test of time Franklin, Jefferson, nor any of the Patriots envisioned. Young men, lean and often hungry and cold, fought for the freedom to pursue better lives, and their wives and sisters kept the spirit alive in every home.   The spirit of America demands we do better, that we are not infallible and can recognize our poor behaviors and change them.

The question isn’t who’s going to let me; the question is who’s going to stop me. Ayn Rand wrote these words.  For those of you too young to know her, she’s not a Founding Father but an insightful author.   Her words ring true on this day of Independence:  Each of us has, within us, something that causes us pride, rouses us in the morning, proclaims devotion to a significant other, perhaps a child, a spouse, or a higher purpose.  We support that flame of purpose by building a machine that can withstand the trials of both success and failure: a healthy body and mind.

I hope that this July 4^th, we each pause for a moment to declare our independence from poor health, poor wealth, and lack of wisdom to acknowledge the implications of both.  In America, we have the opportunity to do better for ourselves:  take a walk.  In America, we have the responsibility to do better for our families:  teach them healthful eating.  In America, we have the spirit to lift our communities to be the healthiest in the world, shining a new level of hope as a beacon for the world.  We have the tools, we have the model, and we have the obligation to those who came before us and those who will come after us to embody the freedoms we passionately defend.  On this July 4^th, I wish America well.

I’m here in DC for a series of meetings on impacting the health outcomes of businesses in order to improve the communities in which they and their employees live.  From my dearly-valued leadership colleagues, to the folks on Capitol Hill, to those who persevere in creating quality standards, I have meetings throughout the next few days.

I’ve also engaged the help of some sophisticated social media experts to guide my self-sown experiment.  The hypothesis of this experiment is that I will build a distribution network of transformational concepts that will build bravery, skill, and excitement to change the status quo.  A job for Superman or Superwoman, but goal-setting and goal-achievement is in my DNA, so I’m launching a new methodology based upon the advice I’m receiving.

The first idea, which has “brilliantly” lit up the end of my evening, is that I have to shorten my lists so I can achieve my goal.  I have to stay in touch with those of you who consider my rebel push to improve health to its best impacts–personal, employer-employee, family, community and even US.  So, with this brief blog, I hope to engage more of you and create a conversation that knows few borders, builds on health-wealth-performance improvement for those who participate in the challenge, and results in meaningful, measurable impact to each of us, for each of us.

I hope you’ll contribute to my brief experiment.  Number one rule in behavior change:  set a goal and measure to it.  Number two rule:  set a goal that’s challenging yet achievable in a short timeframe–I like and often lead groups with the timeline of “30 days or you won’t see the impact!”  Visit me on twitter @cyndynayer, or on our CHVI Facebook page .  Tell me about your goals to improve health outcomes and what you achieve in 30 days–and tell me how it affects you and your loved ones.

There’s no doubt that a few committed people can change the world–we know that quote from Margaret Mead.  What happens when a few thousand commit?  A few million?  Let’s go!

FOR IMMEDIATE RELEASE CONTACT:

March 15, 2011 Carl Graziano

(202) 737-5781

Care Continuum Alliance Releases Value-Based Addendums to Outcomes Guidelines

WASHINGTON, D.C. – The Care Continuum Alliance today released three addendums to its Outcomes Guidelines Report that illustrate how the guidelines’ evidence-based program measures can support a value-based benefits design framework developed by the Center for Health Value Innovation (CHVI).

The addendums build on work started in 2010 to combine the Care Continuum Alliance’s structure for measuring outcomes in population health management with the CHVI’s framework for “Outcomes-Based Contracting.” At the Care Continuum Alliance’s 2010 annual meeting, The Forum 10, the groups presented the concept during a joint educational session.

Each of the addendums released today includes a matrix that provides guidance on data and outcomes measures, incentive “levers” and delivery methods for three value-based design approaches: waste reduction, risk reduction and performance and productivity improvement. The addendums also include case studies keyed to each of the value-based design levels to demonstrate the various approaches in practice.

“Our collaboration with CHVI is a valuable extension of our Outcomes Guidelines work and these new documents show the synergy between our approaches to improving care quality and value,” says Jeanette May, PhD, MPH, Care Continuum Alliance research and quality vice president.

“The Care Continuum Alliance has repeatedly published the evidence of coordinated care management for better outcomes. Linking this with the work of our CHVI has been a joy, as it shows the alignment of incentives for better outcomes through engagement, accountable care and predictable cost trends,” says CHVI President and Co-Founder Cyndy Nayer, MA.

The Care Continuum Alliance last year produced a fifth volume of its landmark Outcomes Guidelines Report, an industry consensus, evidence-based approach to measuring clinical and financial outcomes in wellness and chronic care programs. The guidelines and new addendums are available as free downloads from the Care Continuum Alliance at www.carecontinuum.org.

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About the Care Continuum Alliance

The Care Continuum Alliance represents more than 200 organizations and individuals and aligns all stakeholders in the care continuum toward improving population health. Through advocacy, research and education, the Care Continuum Alliance advances strategies to improve care quality and outcomes and reduce preventable costs for the well and those with and at risk of chronic conditions. Learn more at www.carecontinuum.org

About the Center for Health Value Innovation

The Center for Health Value Innovation (CHVI, 501c3) showcases evidence of improved health quality and economic trend through value-based benefit designs. CHVI has developed the Health Value Accelerator™ so that the market can use the evidence to improve business health outcomes. Evidence and Health Value Accelerator are available at www.vbheath.org