Losing the Super Bowl Year After Year in Health Care

A recent blog post used a Football Team Analogy indicating the success of the Patriots. This team and coach analogy can be expanded and perhaps others might just see how the players feel about what is happening in health care.

Ryan Marling in The Health Care Blog notes "Now a seven-time Super Bowl champion, Belichick has voiced his distaste for overly detailed statistics being used to gauge player or team performance, and instead focuses on how well his players function as a single unit towards the ultimate goal of winning. His motto—“Do your job”—is echoed from his players on the field and in press conferences on a daily basis. He doesn’t ask any single player to win the game, but merely that they do their job, as placing too much significance on a single player’s role fails to recognize the larger picture and is likely to be deleterious toward the goal of winning."

Is Do Your Job the Primary Focus Anymore?

The harsh reality is that we do not even rate the professional team level in health care because our teams and jobs have become so dysfunction. The players have constant changes of job descriptions. The management is bloated and communicates poorly with the team members. The players used to have greater influence, but this is missing. Unlike football, our health care administrators, management, and coaches have not even played the game. Communications have broken down between players and management.





Even worse, the commissioner and major owners and staff control the purse strings. Regulation penalties from on high make it difficult to play to full potential. The commissioner forces the teams to buy equipment that is less than optimal. Productivity suffers. Dollars are distributed at higher levels to the bigger teams with small teams facing lesser revenue and higher costs. The players and the game are what matter most to people but they have been pushed off the screen.

Researchers, foundations, and institutions feed the media material assigning blame to the players. The statistics are about the few losses and not the strings of wins. Their accomplishments are hidden. This is why people like their players and their teams but not players or teams as a whole. This makes it difficult for those who must buy tickets. They have a hard time trusting the players when they most need to be trusted.

The rapid chaotic changes have not been worked out. Changes designed to drive better quality were not tested and were based on assumptions that really have not considered the breadth and depth of the game. A focus on "overutilization" did not consider underutilization, access barriers, or the inability of interventions to address improved outcomes. The changes have eaten into productivity and process. The changes have impacted satisfying relationships with patients and other team members. It is no longer about playing the game.

Documentation

There is so much done after the game that little can be done to prepare for the game. Even worse, there is less time with patients. The players have to spend time after the fact to justify what they did. The players get little feedback about what happens after the game - at least to patients.

Payment Design

The players are not valued for their worth to the team, they are valued for how much money they generate which is also set by the commissioner. The commissioner sets payment not by player experience, but by the exclusiveness of the college attended. Orthopedic players with most exclusive training make as much as experienced orthopedists nearing retirement. Most needed generalists and general specialties are prevented by payment designs. The biggest teams and those most specialized can recruit and keep the most talent and those least paid suffer the consequences.

Those smallest across insurance, systems, hospitals, and practices fall behind by design along with 40% of Americans.

Payment is not set by the value to the team or to the patient. Those doing the long term day to day year after year duties are penalized. Those who spend a few minutes with patients and are most distant from patients in many ways are rewarded.

Health Outcomes Are Determined Outside of the Health Care Game

What is not apparent to the commissioners, management, coaches, or players is that the outcomes of the game are largely outside of their control. The outcomes are about the patient in the context of family, situations, behaviors, environments, community resources - especially lack thereof.

Decades of focus on player errors, big data, quality measurement, digital interventions, managed playmaking, addressing high risks, or minimizing high costs have actually added to the cost of administration and care delivery leaving less for the players and team members. Some wonder why they played the game at all.

More Dollars to More Sources Farther From the Game

The commissioner keeps adding new corporations to feed and each past and present addition demands more dollars. The football team and players must share revenue with more entities, leaving less for those who play the game.

Access Gates Are Too Few, Hidden, and Narrow

Attendance has always been low because half of Americans are too far from the game and tickets for care are too expensive. This also is a consequence of payments too low for the players that they most need (generalist, general specialties) who are fewest among developed nations and 3 times lower where most Americans are found.

Discount tickets are available but only a few and very difficult to find gates take these tickets and sometimes there is not even a game being played when you arrive. There is a ton of paperwork and other hassles required to get these tickets and if you do get in, there is even more required. In a fit of recent reform, many more discount tickets were handed out, but the access gates were not increased and were even more hidden.

More Game and Outcome Declines to Come

Those already most left behind face new proposals to cut 20% of spending or 200 billion from the major source and most certainly there will be fewest gates and fewer who can participate. Gate 65 and Gate 66 will be closed for Medicare. Children in most need of tickets are likely to suffer most along with those trying to escape poverty and the working poor (CHIP). Support funding sources such as Social Security and SNAP are likely to be cut even when such cuts will hurt the Red Counties that shaped the election.

These societal funding changes will result in widening disparities and declining outcomes - no matter what anyone does from commissioner to player. This is because the outcomes are about what happens with people, communities and local resources - not what happens in the game. But the players will once again get much of the blame.

Meanwhile the 2600 Red or Lowest Physician Concentration counties that are growing fastest in people, elderly, and demand will continue to fail to have the right players in the right places resulting in too few gates

But those who pass around information will ignore the situations facing most Americans in the future as in the past decades. The real game goes on at a level largely ignored.




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