Dathan and Braden Miller of Waverly may be twins, but they are one-of-a-kind to Leah Thier, the boys’ physical therapist at Waverly Health Center. The seven-year-olds have cerebral palsy and have been working with Thier for the past five years to build their strength and coordination.
“We’ve been coming to see Leah for so long that it’s almost like she is a part of our family,” stated Tina Miller, Dathan and Braden’s mom. “Leah is very patient with our boys and she can redirect them when needed. She makes therapy fun.”
Tina continued, “Leah also gives me and my husband tips and ideas for what we can do at home to support their therapy. These strategies are very helpful and not something we would have been able to develop on our own.”
Braden and Dathan recently started working with Charm, the hospital’s service dog. “Working with Charm was a big milestone for the boys because they haven’t been around dogs and they were a little scared. Leah didn’t push them and waited until they were ready to begin working with Charm. The first time, a lot of the other therapists came to watch because they knew it was a big deal and they were excited for the boys,” Tina added.
When asked what they liked to do the most during therapy, both boys responded, “Play the Wii!”
“It’s very important to remember that a child’s job is to play,” stated Thier. “We make therapy play with a twist to help our young patients accomplish their goals. The more fun they have, the harder they work.”
Tina concluded, “It’s obvious the therapy team at Waverly Health Center really cares about their patients. Leah is very passionate about what she does and it shows in how she treats Braden and Dathan. We chose WHC because it was close to home, but we continue to go there because of the great care they give our family.”
As Apple Watches makes their way onto the wrists of millions in the coming weeks, the company has demonstrated once again that success and sustainability are a direct result of innovation and modernization. Proof lies in the fact that, like cellular phones, time keeping and personal health tracking isn’t new, but Apple has again re-imagined an old concept to develop something that feels brand new and drives consumers to line up around the block to get their hands on it.
But believe it or not, there is still a sector of our society that lags in innovation, a place where quality and speed are not incentivized and teamwork is more of a concept than reality. That would be government.
For the most recent example, one need look no further than the request for proposals (RFP) released by the governor’s office that proposes to privatize the state’s Medicaid program. On first glance, it would seem that privatization could indeed bring about efficiency and better outcomes. Unfortunately, innovative products and services are only as good as the engineer’s vision and the blueprints used to build them. And if the RFP serves as a metaphorical blueprint for Medicaid managed care, it’s anything but modern or innovative despite almost humorously being dubbed the “Medicaid Modernization Initiative.”
There’s no doubt that the Medicaid program wants for efficiency, but the companies being asked to find it must design their products using a flawed blueprint that appears to have been simply pulled off a shelf from 25 years ago and dusted off. Imagine if Apple was preparing to release the Apple Pocketwatch or the new iRotary Phone – how well would that go over?
As Coca-Cola discovered with its “New Coke” re-branding flop in the 1980s, putting a new name on an old idea doesn’t produce anything but new consequences and consumer skepticism. In this case, Medicaid “modernization” puts hospital payments and beneficiary access to services at risk.
So where do we go from here? Well, Steve Jobs once said, “Innovation distinguishes between a leader and a follower.” The state of Iowa needs to determine whether it intends to lead or follow on this initiative. Will it go the route of New Coke or can the state muster the courage to innovate?
IHA is pushing the state toward the latter, but with a proposal anchored to a jalopy of an idea, it will take significant muscle from hospital advocates to move things in the right direction. By following hospitals’ lead in innovation, the state itself can lead by example. Under those conditions, just like Apple Watch hopefuls, Iowa’s hospitals, Medicaid beneficiaries and the uninsured hopefuls, just might consider lining up days in advance to get signed up.
Lynda Douglas thought she had a deal with Tennessee. She would adopt and love a tiny, unwanted, profoundly disabled girl named Charla. The private insurance companies that run Tennessee’s Medicaid program would cover Charla’s health care.
Douglas doesn’t think the state and its contractors have held up their end. In recent years, she says, she has fought to secure essential care for Charla.
“If you have special-needs children, you would not want to be taking care of these children and be harassed like this,” Douglas said. “This is not right.”
Across the country, state Medicaid programs, which operate with large federal contributions, have outsourced most of their care management to insurance companies like the ones in Tennessee. The companies cover poor and disabled Medicaid members in return for fixed payments from taxpayers.
That helps government budgets but sets up a potential conflict of interest: The less care these companies deliver, the more money they make. Nationwide, such firms had operating profits of $2.4 billion last year, according to regulatory data compiled by Mark Farrah Associates and analyzed by Kaiser Health News.
In an attempt to manage that tension, Washington regulators are about to initiate the biggest overhaul of Medicaid managed-care rules in a decade. Prompted by the growth of Medicaid outsourcing and concerns about access to care, the regulations are expected to limit profits and set stricter requirements for quality of care and the size of doctor networks.
“We want the enrollees to have timely access to integrated, high-quality care,” James Golden, who oversees Medicaid managed care for the Department of Health and Human Services, told a group of insurance executives in February.
Tennessee Medicaid contractors — operated by BlueCross BlueShield of Tennessee, UnitedHealthcare and Anthem — are among the most profitable Medicaid plans in the country, according to data from Milliman, a consulting firm.
State officials point to data on quality and survey results as evidence that the companies are doing a good job while allowing the state to spend far less on Medicaid than predicted. In a survey last year, more than 90 percent of customers using TennCare, as the program is known, said they were very satisfied or somewhat satisfied, officials note.
TennCare Director Darin Gordon worries that new federal rules could hinder states from improving Medicaid quality while controlling costs. “Don’t hamstring us,” he said.
But doctors and patient advocates say state savings and insurer profits come at the price of inadequate physician networks, long waits for care and denials of treatment. Answering another question in the survey, 30 percent of adults said the quality of their TennCare care last year was fair or poor.
More than half of Medicaid beneficiaries in the nation now receive coverage from managed-care companies. That shift helped prompt inquiries by the HHS inspector general last year that found widely varying state requirements for access to doctors and poor information for members on where to find them.
Policy experts believe that the proposed rules, expected soon, will set stricter standards.
In Tennessee, where TennCare’s member-per-doctor ratio for primary care is one of the worst among states that have such rules, views diverge sharply on whether those rules are necessary. Many, like Lynda Douglas, say the system is far from adequate.
Douglas, 69, knew that she wanted to adopt Charla a decade ago, as soon as she took the girl for foster care from the state. Charla’s problems include cerebral palsy, a badly curved spine and frequent seizures. She is 16, cannot speak, weighs less than 80 pounds and loves Barney the dinosaur.
Douglas, who lives about an hour east of Nashville, was grateful that TennCare contractors sent daytime nurses to monitor Charla’s seizures and maintain a tube that delivers medicine or nourishment eight times a day.
Then, more than a year ago, UnitedHealthcare reduced the nursing to one hour a day, even though Charla’s condition hadn’t improved. Douglas protested with the help of the Tennessee Justice Center and a pro bono lawyer and won. But TennCare appealed. It took two more rounds of adjudication before a judge ruled in Douglas’s favor late last year.
The managed-care companies “are making a mint down here,” Douglas said. “They’re getting rich at the expense of the kids. This is not right.”
UnitedHealthcare made an operating profit of $236 million last year on revenue of $2.8 billion in its Tennessee Medicaid business, according to state filings. Anthem’s operating profit for TennCare came to $53 million on revenue of $946 million. BlueCross’s operating profit for TennCare was $121 million on revenue of $1.8 billion. Those results do not include expenses for taxes, depreciation and other items not directly related to health coverage.
“Our care teams worked with the family and with [Charla Douglas’s] physicians and other providers to assure that her services were appropriate,” UnitedHealthcare said in a statement. The plan followed TennCare’s contract and care guidelines, it said.
Gordon, the TennCare director, rejects suggestions that managed-care networks are inadequate or that contractors deny needed care.
TennCare members sometimes have trouble seeing specialists, but so do patients in commercial plans, he said. Like many state Medicaid directors, he wonders how HHS can publish network rules for 50 states with widely varying geographies and health systems.
He also doesn’t accept that Medicaid plans need rules that limit profits and force them to spend a minimum portion of revenue on medical care. Written the wrong way, the standard could discourage spending on coordinators who improve care quality at decreased cost, he said.
“Yeah, we’re a little concerned,” he said. “There are some things that we think may have adverse effects.”
That may have been the common query from health care providers the world over after Cuban shared on Twitter that he intends to have his blood drawn and analyzed every quarter “for everything available” and that anyone who “can afford to” should do the same. It was just a few words from a mid-level celebrity on social media; then again, there are more people following Cuban on Twitter than there are adults living in Iowa.
Cuban, who owns the Dallas Mavericks professional basketball team but may be better known for the business “reality” show “Shark Tank,” insisted that he was simply advising people to build a base of personal health data for future reference. But anyone this obsessed with data isn’t going to just let it sit; they’re going to look for abnormalities, outliers, changes. And when they see one, no matter how small, they are going to take action because, after all, we are talking about health.
“More is not better,” health care experts told Cuban. The kind of overtreatment Cuban advocates wastes scarce health care resources and runs the risk of creating more waste through a ripple effect of possible tests and their results, which may produce either false positives or false negatives. Here’s how Dr. R. Adams Dudley from the University of San Francisco Center for Healthcare Value described the escalation:
- If a patient gets just five things checked in his blood every quarter, that’s the equivalent of 20 tests a year. (An activist patient like Cuban may be getting many more tests done.)
- Given normal variation, about 5 percent of tests may produce an unexpected result. That means out of 20 tests, “even one test is expected to be abnormal, even if (the patient is) healthy,” Dudley points out.
- Although doctors may suspect that nothing’s amiss, “we are trained not to just ignore an abnormal result, but to do further testing or even treatment,” Dudley points out. “That testing or treatment always involves risks.”
Cuban’s particular piece of advice undermines the value hospitals are working harder than ever to bring to the health care system. But, at the same time, hospitals are also trying harder than ever to get patients engaged in their health care. It is a delicate balancing act.
Problem is, despite health care providers’ efforts to carefully convey the more-is-not-better message, there will probably be more Mark Cubans in the future – a lot more. Health care blogger Andrew Holtz summed it up: “It won’t be long before the incessant data logging that is already widespread in sports sprints past the daily-steps tracking by a Fitbit to global monitoring of every breath and heartbeat… even analyzing our blood without those pesky phlebotomists. Look, the Apple Watch already has a blood sugar monitor add-on and it’s not alone.”
A stream of data will become a torrent that will “flow into a void of understanding,” Holtz predicted. But it doesn’t have to be that way, not when providers are prepared well ahead of the flood and not when patient-provider relationships are built through access to care and a medical home that is not hampered by income, geography, politics or regulations, including disconnected reimbursement policies.
That’s where IHA comes in – to get the information to hospital leaders and advocates, to share the hospital story with the public and to knock down the barriers to high-quality, high-value, patient-centered health care for everyone.
(From time to time, the blog features recipients of the IHA Iowa Hospital Heroes Award. These outstanding hospital employees come from across the state and work at hospitals of every size. They exemplify the courage, caring and community focus that are at the center of the hospital mission in Iowa.)
Having retired in 2008, Dr. Ronald Myrom is still a daily fixture at Palmer Lutheran Health Center in West Union and other health care organizations within his community. He regularly sees patients in area nursing and residential homes and fills in and provides back-up for the hospital’s urgent care clinic and emergency department.
In addition, “Doc,” as he is affectionately called, is currently the acting medical director of Palmer Hospice. He has taken his vision of providing quality care and dignity to terminally ill patients and has imparted it into the hospice belief it is today. This is evident by the many hours of devotion he gives to the patients, family members and the core members who make up the hospice team.
During visits, Dr. Myrom always gives 100 percent of his attention to each individual patient. He has an amazing bedside manner with hospice patients and this is shown through his compassion, dignity and respect he gives to each one of them. All of this is done at no cost to the agency as he volunteers his skills and time to serve the patients who live within our local communities. He does this because he truly enjoys giving back to people we serve.
Donating to the hospital’s foundation and various other community events, organizations and projects, he insists that no recognition be given to him and his wonderful wife, Michele. He simply gives as a selfless act of kindness knowing he is able to serve his community and the amazing people that call it “home.”
Such a humble man, Dr. Myrom continues to be as much of an engaged healer today as he was throughout his career. Dr. Myrom has “retired” yet continues to serve his community. We recognize his value and appreciate what he does for us – personally, professionally and philanthropically. We know of no one who has more dedication, care and compassion for a hospital, patients and a community as a whole.