Selling Healthcare Changes – Loss Aversion & Adoption of Innovations

September 26, 2011 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Health System Reform, Information & Communications, Medicare, Politics / 1 Comment

Healthcare issues ranging from national health reform to stem cell research have become a major force in political rhetoric – often overwhelming substantive information. This creates challenges for individuals and organizations seeking to achieve positive changes as their communications are swamped by election-driven messaging.

Creating and implementing successful communications programs in this turbulent environment is easier when the principles of “loss aversion” and the factors affecting the adoption of innovations are used constructively.

Loss Aversion & Campaign Messages: Swinging Votes Not Actions
Campaign communications – particularly negative messages – are very effective because they use loss aversion principles to leverage people’s reluctance to embrace change.…

Patient-Centered Care? Or Not?

July 11, 2011 / Michael D. Miller MD / Access to Healthcare, Clinician-Patient Relationships, Delivery of Healthcare, Health Policy and Communications Blog, Health System Reform, Innovation, Politics, Public Health, Quality of Care & Safety / No Comments

The term “patient-centered care” has increasingly been used to describe healthcare structures that deliver better quality care – as well as often doing so with lower costs. And today there was a news story about how some medical schools are assessing applicants’ interpersonal skills, something that is fundamental for being a patient-centric clinician.

While there are have been numerous articles demonstrating the value of patient-centered care and concluding that it is better and should be promoted – including those looking at the ill named “Patient-Centered Medical Homes” – I’ve found myself pondering the following questions:

“What type of care have clinicians been providing if it hasn’t been patient-centered?…

Cultivating Health Reform and Transformation

July 5, 2011 / Michael D. Miller MD / Delivery of Healthcare, Health Policy and Communications Blog, Health System Reform, Information & Communications / No Comments

Listening to various speakers at a two-day HIT/Delivery System Transformation Summit last week reinforced my thinking about the concept that reforming (or transforming) the US healthcare system is more like farming than business management.

Transforming healthcare is like farming because it involves cultivating collaborations and coordination among independent people, organizations, and stakeholders who all have varied interests and reporting/governance structures. In this way, “managing” or “leading” health transformation is like growing plants – the soil needs to be prepared, the plants (or seeds) need to be planted, and then they need to be watered, fertilized, weeded, pruned, etc…. And depending on the plant, (i.e.…

Medical Homes (PCMH) in 2011 – Patient and Consumer Centric

February 23, 2011 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Health System Reform, Quality of Care & Safety / No Comments

Patient-Centered Medical Homes (PCMH) are continuing to be a bigger and broader part of the real-world discussions about health reform and transformation in the US. According to the the National Committee for Quality Assurance (NCQA) at the end of 2010 there were 7,676 clinicians in 1,506 recognized PCMH practices in the US. This information was released last week by NCQA with their updated 2011 PCMH Standards.

Another marker of medical homes’ increasing pervasiveness is the blurb – “Home sweet medical home” – in the March 2011 issue of Consumer Reports magazine that starts with, “If you haven’t already heard the term ‘patient-centered medical home,’ chances are you will soon.”…

Smoking, Exercise and Obesity – The Big Three

February 2, 2011 / Michael D. Miller MD / Economics & Financing, Health System Reform, Information & Communications, Public Health / No Comments

I’ve been working with a Midwestern community for the past 7 months to improve the quality, efficiency, and value of their healthcare – as measured by public health population status, and the cost and quality of medical services. This experience has reinforced what I’ve been hearing repeatedly for the 28+ years I’ve been working with healthcare challenges: The three most significant areas for improving quality and controlling costs related to illness and healthcare are reducing smoking, increasing exercise, and reducing obesity. (The latter two are connected, but they also have separate and important benefits.)

While I will be writing more about each of these health problems in the coming weeks, (along with many other health policy issues involving innovation, system transformations, and the ongoing debate about health reform legislation), I first wanted to lay out some top line perspectives on smoking, exercise, and obesity.…

The Internet Solves Everything in Healthcare – – – NOT

April 23, 2010 / Michael D. Miller MD / Delivery of Healthcare, Economics & Financing, Information & Communications, Quality of Care & Safety / 3 Comments

Improving healthcare will require people having better information. That concept is generally agreed upon. The challenge is getting the right information to the right people at the right time. That is the interconnected goal of different facets of health information technology – from EMRs and PHRs, to health information exchanges.

People Are Complex
However, the complexity of medical care and individual variability – both human physiology and patient preferences – makes collecting and analyzing health information so that it is useful for individual clinical decisions much more difficult than presenting information about TVs, computers or cameras on a website such as CNET.…

Politics of Health Reform: Selling Anger or Catharsis

March 22, 2010 / Michael D. Miller MD / Federal Healthcare Reform, Health System Reform, Information & Communications, Politics / 3 Comments

With the health reform legislation process winding up, it is clear that going forward politics are – and will be – front and center, with the divide between the Democrats and Republicans as wide as the orbit of Pluto…… the planetoid, not the Disney character. This divide is depicted in black, white, and red in the National Journal’s March 13th Insiders Poll question, “If Congress enacts something close to President Obama’s latest health care reform plan, how would that affect your party in the midterm elections?” 87% of Democrats thought it would “help a lot” or “help a little,” and 100% of Republicans thought it would help them.…

How Long is the New Health Law?

March 21, 2010 / Michael D. Miller MD / Federal Healthcare Reform, Health System Reform, Information & Communications, Politics / 1 Comment

With the House of Representatives passing the Senate’s version of the health reform legislation tonight, it can now be signed by the President. An historic step by any measure. While one of the criticisms leveled against the bill has been its length – typically cited as 2,409 pages – I recently pointed out to someone that the 2,409 page length is because the bill is printed to make it easy to read by using a large font, leaving lots of space between the lines, and sequentially indenting subsections to make the overall structure clearer. (Below is one page from the printed version of the bill.)…

Doctors Communications to Patient’s Family

February 10, 2010 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Information & Communications / 2 Comments

The great writer John McPhee’s article in the February 8th issue of the New Yorker is primarily about his experiences fishing for pickerel in New Hampshire, but the subtext is his connecting to his dying father who is in the hospital after a severe stroke.

While the article is extremely warm and heart-felt, two short sections stand out because of his visceral reaction to his father’s doctor:

“His room had a south-facing window. My mother, in a flood of light, eighty-seven, looked even smaller than she was, and space was limited around her, with me, my brother, my sister and a young doctor together beside the bed.…

Congressional Accomplishments for 2009

February 9, 2010 / Michael D. Miller MD / Information & Communications, Miscellaneous, Politics / No Comments

Why the Democrats are increasingly becoming politically vulnerable is a topic that pundits are dissecting in great detail. A general consensus is that the root cause of the public’s growing discontent is a lack of progress on the economy and jobs.

While the economy and the job market have stabilized somewhat – even if they haven’t rapidly rebounded – the President and Congress haven’t gotten much credit for not letting the ship sink. In addition, most of the President’s and Congress’ major accomplishments occurred in the first part of 2009, while towards the end of the year the focus shifted to the very slow moving health care bill – which also included many real and concocted controversies.…

What “Will” Happen With Health Reform

November 29, 2009 / Michael D. Miller MD / Access to Healthcare, Information & Communications, Politics / No Comments

With the Senate scheduled to start debating (and likely amending) health reform legislation this coming week, speculation is rampant about what will happen with health reform. Since the title of this blog is “health policy and communications,” I want to focus on the use of language in discussing health issues, studies, proposals and legislation – specifically the word “will.”

The word “will” is very strong and it implies a high degree of certainty about predicting future events, such as “The Sun will come up tomorrow morning.” And while I have no problem with predicting the future – as my friends know, I have a great reputation for predicting the future, particularly about sporting events like fake punts and winning 8 straight games to win a World Series – but using the word “will” to describe the implications of scientific studies, or legislation and policy proposals, can be misleading.…

Thanksgiving Conversations About Health – Engage With Grace Blog Rally

November 24, 2009 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Miscellaneous / 3 Comments

For many years I’ve used the Thanksgiving dinner table conversation as a model for discussions about healthcare – but usually I’ve put it in the context of people who work for healthcare companies, (e.g. pharmaceutical or managed care), trying to address, rebuff and rebut the criticisms they might get from family members, (e.g. Aunt Lilly), about the problems with the US healthcare system and the actions or positions of various companies or industries. However, last year – and again this year – several bloggers have been cooperating to promote Thanksgiving weekend discussions about end of life care issues. This effort has been called the Engage with Grace, and last year it was a great success, with over 100 bloggers participating.…

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