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…”

I’m inspired by that message, and I have joined forces with other passionate idealists to build the Center for Health Value Innovation.  Simply, we have founded a virtual tent where innovators and disruptive thinkers can come to consider the “what ifs,” test ideas and learn the mistakes of other disrupters ahead of them, and solve for one goal:  how do we improve health? The early member-innovators of this safe haven always knew that our non-profit Center, now known as CHVI, would attract a multi-stakeholder group.  Because people get the letters confused, I made it more memorable:  think of us as the Chevy (sorry, GM) that makes cars affordable and accessible for the masses.  That’s what we do within CHVI (see? Chevy?)—we develop and test and measure new affordable, accessible plan designs so more folks will engage in the management of their health, and more of the delivery system will focus on the improved health of the individual rather than the unit cost of the care. I call that “focusing on the IMPACTS, not the INPUTS.”

Our end goal was never about installing a replica of the Value-Based Benefit Design that my business partner and co-founder Jack Mahoney installed at Pitney Bowes.  As we accumulated a burgeoning stack of innovation and case studies, then surveys and trajectories, our goal was never focused on the benefit design EXCEPT as a tool for health value innovation:  building more health with the dollars that were already in the system.   People who have heard me speak or read my writings know that I tell stories to drive home a point, stories that make the data actionable because the listeners can relate.  The juxtaposition of the shuttle breaking boundaries with our everyday lives showcases these delicate balances in life.  It’s hard work, and lonely work, pushing transformational change up very steep walls.  We build a platform of bravery and courage and innovation that we share among ourselves and with the market. Lately, our innovation summits (invite-only, please) are getting some serious traction and more folks are joining just so that they can be invited to consider new ideas and build themselves into the community of innovators. My passion is the improvement of personal competency in health management.

I have been quite vocal for many years about individual responsibility for our health.  As the former Chair of the Missouri Governor’s Council on Health and Fitness, I tracked the increasing obesity issues in our children and tried in vain to get legislators to hear.  I wrote a book 5 years ago branding the concept of “CEO of MYHealth,” with the poor title of 101 Lifetips for Personal Health Management (you can still get it online, along with the Center’s book Leveraging Health).  I have been very vocal about the need for personal health records and apps for phones that aggregate all the data for me, for you, on our phones, so that WE are the keeper of the health record for each of us.  I’m perfectly capable of pushing a “yes” button so that all of the folks who care for me can download the info into MY record that I will have with me when I visit another care provider who could need to know.  There is no other way that we can build accountability—you can’t be accountable for info you don’t have.

Other brave innovators joined CHVI because they saw the opportunity of sharing the vision and acting in concert for transformational change.  No more incremental baby steps, we would shout our successes as well as our challenges to the communities we serve, calling others with our joined voices to improve health and settling for nothing less.  We were focused on health; health care reform, value-based benefit design, patient-centered care were all a part of the toolbox.  We are a community of all-comers who are primed for disruptive innovation.

We believe it’s really not so hard to engage people in managing their health:  provide the right “cookie” at the right time and people do engage.  We are proud to be launching a tool into the market (Health Value Accelerator^TM) that will cut through the data chaos and show other payers the pathway to better engagement and better health. Value-based benefit design was always the engagement tool that causes accountable behaviors and better outcomes for the consumer, the provider and the payer.  I have managed to reframe our mission into twitter-ese:  we focus on impacts not inputs.

I believe it’s a travesty that $2.7 trillion can be spent in one year and yet our communities are unhealthier and economically distressed.  I believe we are purchasing the wrong item (health care) at the wrong price (widget or unit cost) for the wrong outcome (better health care does not necessarily give better health) and we are asking the wrong question (how much will that care cost?).  We must change the question to “How much new health will that amount of dollars purchase?” (thank you, Peter Hayes).

We have to use our money to invest in the outcomes (that’s why we developed Outcomes-Based Contracting^TM) instead of purchasing on merchandising schemes (preferred products or services are preferred because of their price/rebate/other and not because of their outcomes to the patient and the community).  We must set our goal to achieve more health, not more health care, and the solutions will change and grow as they always do when we ask the right question.

Because it’s really not so hard to get our kids healthier:  reward them for health well-done instead of sitting quietly. Teach them how to choose lifestyles wisely so that they can avoid extraneous health care costs.

Because it’s really not so hard to get the right information to consumers.  I can get my bank balance and withdraw money from any one-eyed steel box on a post anywhere in the world, and I can get directions to all the unhealthy food in any neighborhood that I want—so I don’t tolerate the message that the data fields can’t talk/won’t talk/shouldn’t talk when I can’t get my health data.

Because I learn more in every city, on every plane, when the person in the next seat tells me about the extraordinary health care and outcomes he/she received, and, sometimes, shares the stories of inequities that caused pain.

Because I never want to hear and you never want to hear that others have died because the “system” didn’t work. I want to see one life saved, and then another and another, because I worked so hard and you worked so hard to make the “system” respond to the goal, not for more health care, but for more health—personal health, clinical, financial, emotional, physical, social.

Because I really can’t imagine how we spend $2.7 Trillion yet we are the 37^th industrialized country on the health scale.  We should be the healthiest country, but our safety, access and affordability are awful and we are drowning in health debt.

We are determined star-seekers: we use our disruptive intelligence to change this picture.  We are focused on health.  We build better engagement and adherence, better payment and reimbursement, and we measure milestones to health.  We keep our focus on the impact, the value of the investment in health, and we do it because passionate idealists take on challenges and reach for the stars.  I learned at Boeing years ago that the sky is no limit.  At the Center for Health Value Innovation, we build courage to break barriers to achieve sky-high levels of health.

I wrote a note to some close friends that evening, and one shared it with the local paper.  Will it become a letter to the editor?  I don’t know.  What I do know is this:  $2.7Trillion is more than enough to bring health resources to all of our citizens.  $2.7Trillion is more than enough for every child to have pediatric care, immunizations, and a healthy, safe childhood.  $2.7Trillion is more than enough for quality clinicians, hospitals without infections, and info technology that links centers of distinction across the country and the world.  $2.7Trillion is more than enough to ensure that our workforce is healthy and that our companies and our families do not go bankrupt for unexpected health care expenses, more than enough that we are never #37 on a list for quality and safety again.

We can do better, and we have shown many cases of new evidence that re-thinking the barriers, and removing the impediments to quality, clinically-relevant and financially efficient health care is not a dream, it’s a reality.  Health Affairs continues to publish new data on this (Gibson, et al, http://content.healthaffairs.org/content/30/1/100.full), and we continue to push boundaries with our Outcomes-Based Contracting™ endeavors.

Mental health is the issue here. The system failed us, and it failed Christina and her parents.  The accused shooter had a history of mental illness.  Did he attempt to get help?  Not sure…but there were signals throughout his life, and the $2.7Trillion holds enough to help him and his family.

We cannot turn away from the fact that our security and financial structures are bending under the strain of the enormous costs of health care in this country despite the efforts to provide for all.  We can compare our total costs with those of other countries see that they are getting more value for their dollars.  We can compare our total costs between companies here in America and see that some are getting much more value for their dollars.

This is why the Center exists:  to innovate and publish and educate about the successes and, yes, the challenges of building healthy communities and worksites and hospitals and care providers and families.  Yes, we are focused on the business community.  That’s because a lot of innovation in products comes from this community, but also because it’s where America works, and America working is what we all want to see. That’s why we are in relentless pursuit of innovation in benefit design that accelerates engagement, improves accountability, and creates replicable predictive cost trends, because with these, we can plan for our futures, including those of our children.

So let’s come together, as one country, to be respectful of ideas, concepts, values.  Let’s tone down the noise and listen, instead, to the common goals, appreciating that each of us may take a different path but achieve similar outcomes.  Let’s reach back and pull the more frail–even if they are frail with mental illness–along with us, soothing their pain and helping them heal.

Let’s never let another life be lost due to our deafening refusal to consider another point of view.  Let’s not let Christina’s life, one very important child among many, go unfulfilled.  Out of many, one.  E Pluribus Unum.

Outcomes-Based Contracting^TM: The Value-Based Framework for Optimal Accountability

Wisconsin–the state best identified with cheese, high taxes, the Green Bay Packers and beer–is also known for health care, creating diverse collaborative health care systems and well-established prevention programs. But it is also plagued by high costs and expenses.  Despite Wisconsin’s health care woes–it ranked as the 16th state with the highest health spending per capita in 2004 (the most recent year for which comparative state-level data are available), it is a state primed for reform, a path it has been pursuing throughout the past decade. Employers, health plans and county governments all share in the journey towards cost-effective, high-quality, accessible health care.

This report, Wisconsin: Levers Drive Value-Based Innovation Across the State, makes a business case for value-based design as illustrated by Wisconsin companies Quad/Graphics [QuadMed], Humana, Journal Communications and Chippewa County. The four organizations are a representative sample of how innovation is providing resolution and relief in Wisconsin and how the state culture has contributed to the success of their solutions. The report is built on the Health Value Continuum, a development pathway for value-based design that shows the route to quality health improvement and behavior change. The Health Value Continuum was developed by the Center for Health Value Innovation to detail the experiences and path of early innovators in value-based benefit design. The four organizations highlighted in this paper (QuadMed, Humana, Journal Communications and Chippewa County, WI) have each reached different points along the Continuum as they move toward optimal health.

“We think Wisconsin is a truly unique learning laboratory,” says Cyndy Nayer, president and chief executive officer of the Center for Health Value Innovation.  “Wisconsin has demonstrated a willingness to innovate, share, and do more. We want to learn about and share the experience of these Wisconsin companies by cataloguing the levers–or incentives–currently in place, the metrics used to measure outcomes, and how statewide efforts can be replicated in the marketplace. These companies are all members of the Center, and our mission is to provide evidence of improved health value so that other companies can improve the value of their health care spend.”

For the complete report in PDF format, please click here.

Understanding that things had to change if employers were to be able to continue to afford health care, a few forward thinking payers and influencers began to rethink their health care strategies. Two health care pilots began to take hold. One involved refocusing employees on the virtues of health and wellness. The other focused on decreasing the financial barriers to some of the care that would actually put healthier people back to work because they were compliant with their treatments.

These experiments that utilized reductions in co-pays for some populations continued to broaden with the inclusion of incentives for participation in annual or baseline health risk assessments, health fairs, and disease management. So began the development of behavior change through incentives that actively engage consumers to participate in their health and healthcare. The use of these incentives have evolved into the levers of population change that form the core of value-based design initiatives.

Learning Objectives:

Understand the nature of value-based design and the challenges it is designed to resolve.

Be conversant with the 4 Ds of value-based design . . data, design, delivery and dividends.

Know why health promotion is a foundational element of value-based design.

Learn the key skills and competencies that health promotion practitioners bring to successful implementation of value-based design.

Cyndy Nayer and John Riedel, Leveraging Health: A Primer for Health Promotion Practitioners using Value-Based Designs from Michaela Conley, HPCareer.Net on Vimeo.  Learn more about HPCareer.net here!