The Coat Check

Tactic or Strategy – Can You Tell the Difference?

Massachusetts recently slipped from first to last place on one key component of health information technology innovation: the state health insurance exchange. This was supposed to be a slam dunk for the Bay State, especially given that Massachusetts pioneered the concept of universal coverage within the United States. The core issue with the site appears to have been basic greed – the prospect of more than $100 million in government funding for a new health care insurance portal, and limited effective oversight in terms of implementing the newer version. Rather than building off the existing foundation, oversight officials chose to start over from scratch using the same contractor who was ultimately fired from the federal exchange. A new company is trying to sort out the federal site now, which is so vulnerable that one security expert penetrated 70,000 records in four minutes flat. Meanwhile, Massachusetts has as yet taken no action to remedy this unfortunate situation. This sad example illustrates two key lessons for aspiring health care professionals.

The first key takeaway from this narrative is that ‘can’ and ‘should’ live in two different worlds. The ability to do something should be a completely different perspective compared to identifying the right thing to do. For example, many medical school admissions web sites are more than happy to do work for clients rather than helping them master the essential tools and strategies for personal success. White Coat Checklist exists to offer an alternative perspective for those with the personal integrity and long-term perspective to hone communication skills for better communication, including better provider-patient communication. Even teenage patients these days are illustrating clear standards in terms of their communication expectations. As such imperatives are transformed into a basis for compensation through global payments, expect administrators to hold clinical staff accountable accordingly. This means that strategic steps will be taken toward tools for measuring communication competencies, and holding professionals responsible accordingly. Under this model of care, using White Coat Checklist’s services align with that strategic need. Similarly, active health care professionals need to focus on immediate priorities and the easiest ways to achieve them rather than wasting valuable tax dollars on substandard resources.

Another related concept from this extended discussion is ‘unanticipated consequences.’ Highly controversial programs such as the Pioneer ACO program are reaping uneven rewards. On the one hand, some Pioneer ACOs are demonstrating massive savings. Elsewhere, some institutions which previously invested in major savings have actually ended up losing money under the Pioneer reimbursement model (at least in the early stages). Other trends we can look at in the health care field with major implications include Massachusetts-level physician wait times emerging elsewhere nationwide, physicians losing face time with patients because of EMR systems, and major insurers looking to exclude the most costly providers from their coverage pools. In one extreme example, Kaiser Permanente has emerged as a somewhat high-priced alternative on the California insurance exchange because of how deeply some of their competitors were prepared to cut their networks despite KP boasting rock-solid quality benchmarks that rank among the best in the nation. There are at present no quality benchmarks on the health insurance exchanges to inform those buying coverage -in fact, many of those looking to save money could actually give up a fortune in savings by not checking out all their available options. As applicants look ahead toward a long and fruitful career in the medical field, they should be able to do so secure in the knowledge that their short-term approaches and long-term strategies are aligned for mutual benefit of their patients, and the institutions they serve as well as themselves. Best of luck to you all!

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