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2014 PPACA Open Enrollment Starts November 15 – Some Thoughts On Round Two

"To predict what might happen in this second enrollment period.... take a look at the 2014 open enrollment data and the role of health insurance exchanges and health insurance navigators....two assumptions:

  1. States with state-based exchanges would have enrolled more individuals than federally facilitated marketplaces.
  2. States that imposed restrictions on health insurance navigators would have lower enrollment rates than those states with navigators that had no additional restrictions placed upon them.

After reviewing the latest data, it turns out that in both cases..."the assumptions were" wrong."

What are the risks of building a program - built upon some assumptions - getting the desired results - and presuming the assumption were correct? Might this foster the creation of myths akin to the Emperor's New Clothes? How do we avoid this risk? How do we assess it without embarrassing ourselves, our peers or our organization?

2015 Managed Care In The Foster Care System – Past The Tipping Point?

"For the first time, a number of consumer populations that have been previously excluded from managed care plan enrollment — dual eligible consumers, people with serious mental illness (SMI), consumers needing long-term care, and importantly, children and youth in the foster care system — are now part of these initiatives."

Are we willing to look at the way we may have segmented our employee/client populations and offered services to them? Are there underserved populations? Are there methods that could be broadened? eliminated? reduced?

2016 MACRA: The Big Picture

"In commercial health plans and employer-sponsored health plans, use of managed care and other value-based approaches to health care financing have been common for years. And, state Medicaid plans have morphed over the past five years with more managed care, accountable care organizations (ACOs), DSRIPs, SIM grants, waiver programs, and health homes.

But much of Medicare, which represents about 20% of total U.S. health care spending, has been outside of this move to value-based payment."

My study of the healthcare system has made me aware of three important factors related to learning:

  1. Understanding of complex systems is not as simple as taking a pill - it is more akin to exercise. While we might wish for a simple and safe weight-loss pill (the 2 day class or one hour elearning module) -  daily commitment to exercise and nutrition (lifelong learning) is more likely to produce the outcomes we desire.
  2. Our perspective on health changes as we experience for ourselves (or those close to us) the health related matters that we had heard about - and yet were not relevant yet to us. Actual (vs. theoretical) context is when learning (or the willingness to learn) can be the most effective.
  3. The world changes. The right decision 50 years ago, 10 years ago or 10 days ago - my not be the right decision 10 days, months or years from now - because of the rate of change - and our ability to become aware of it.

How are we building learning that adapts to:

  • complexity
  • context
  • change?

2017 More Children, Less Money—The State Of Child Welfare Budgets

" Pennsylvania Child Abuse Reports Rose 41% Between 2014 & 2016 and Number Of West Virginia Children Entering Foster Care Due To Parent.... In both of these articles, we learned that states are reporting increases in the number of children involved with the child welfare system. Troublesomely, the Pennsylvania article also reported that despite the increase in children entering the system, there has been no corresponding increase in the number of children and youth services (CYS) caseworkers."

While increasing the number of caseworkers will allow us to "pull more children out of the river" and this is important - will these caseworkers also allow us to "prevent children for falling into the river?" https://www.publicprep.org/blog/irowe/parableoftheriver

2018 Failure To Launch

"As tech-informed and tech-enabled services become the norm, expectations of consumers and health plans will change. And the competitive advantage-referrals and market share, margin, sustainability—will go to the provider organizations who can keep up. That’s where speed in technology adoption comes in. But the reason for the 15- to 20-year science-to-service lag in the field is not a simple one. To speed technology adoption, I think some specific changes by both the technology companies and the health and human service organizations are needed."

How might we innovate to increase efficiencies and outcomes for providers and consumers?

What costs savings on both sides could result in better solutions - more quickly - at lower cost to implement and operate?

What risks and benefits might occur? Do you prefer to watch, inhibit or lead this type of innovation? (All three choices are necessary to have an effective ecosystem.)

2019 What Is A Uniform PDL & Why Does It Matter?

A method of controlling costs in healthcare - is to restrict reimbursement of medications via a preferred drug list (PDL.)

How do we control costs in learning? Do we also restrict reimbursement of learning?

How might we focus on outcomes - with healthcare or learning?

2020 The Pandemic’s Toll On Children, What Lies Ahead?

Is it possible to dig one's way out of a hole? How are we assuring that we are providing ladders to those in need rather than shovels?

2021 Walgreens Boots Alliance Launches New Business Segment, Walgreens H...

What would it take for dentistry to be delivered virtually? What benefits might result?

2022 Can VR Make Digital Treatment More Effective?

What might be the "killer" app related to VR to create consumer demand? If creating VR for learning were as easy and affordable as creating a PPT - how would you use it?

2023 Keys To Generational Talent Management

Try to think of your past - 10, 20, 30, 40 years ago...

What did you think was right or wrong back then - what do you think now?

Think ahead 10, 20, 30, 40 or years from now...

What do you think is right now - that you will still think is right? Where are you afraid you might be wrong?

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