Ordinary Miracles v1-0

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INTRODUCTION We want to be healthy and when we are not we want access to the right care for us. A universal desire, realized in as many different ways as there are

people. Thus, we have the conundrum of “health care reform”. What is it? What should it be? Who deserves it? Who pays for it? Who oversees it? Thinking

about it is daunting. Many are choosing to wait and see what “others” think it should be.

We think it’s personal. We think it’s approachable. We think there are no one-size fits all solutions. We think there are many brilliant, simple, complex,

tailored and basic solutions being implemented everyday and everywhere–ordinary miracles. We think awareness and dialogue are the starting points to

realizing the manifestation of everyone having the opportunity to be healthy, and when they are not, to have access to the right care.

We know awareness is growing, and despite the sometimes angry rhetoric reported in the media, true dialogue is happening among institutions, companies,

health professionals, and individuals. The Mayo Clinic held Transform: A collaborative symposium on innovations in health care experience and delivery in

September (2009). The purpose and the message were “…the next great leaps in health care will result from collaborative discussions and the sharing of

insights from across disciplines.”

Inspired by that symposium, its speakers and attendees, we invited others to share what they believe will make American health care the best experience

for consumers and the model for the rest of the world. Our contributors are first and foremost people–mothers, fathers, sons, daughters, husbands, wives–

individuals who want healthy families and access to good health care. They have unique experiences, both personal and professional. What we all share is a

desire to participate in the dialogue and a belief that transformation, not just reform, is possible.

Our hope is that Ordinary Miracles: Health Care, Wellness and the Next American Dream, encourages you to participate in the dialogue, too.

Alan Parr and Karen Ansbaugh

OpenSky Consortium

OpenSky Consortium does not take responsibility for the opinions expressed. Each contributor’s thoughts, ideas and opinions are their own and are understood to be original or appropriately attributed to their original source.

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CONTENTS GOING AROUND IN CIRCLES 3 The basic questions we all seem to ask but can’t get answered A PERSONAL GLOBAL PERSPECTIVE 6 The health care experiences of someone who has lived in several countries WELCOME TO THE FUTURE 13 A core issue that many don’t associate with health care I, CARE 24 A response to health care sound bites FAMILY PRACTICE 29 A plea for coordinated chronic issues care CONNECTED 35 An illustrated story of health care delivery in the near future QUALITY OF LIFE 44 Quality housing and care for our elderly is hit and miss today PICTURE OF HEALTH 49 Four requirements for health care delivery BUILDING A LEGACY 54 An insurance company’s vision and journey towards transformation STEP BACK… THEN STEP UP! 65 A challenge to take part in the dialogue about health care

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Going Around In Circles

BobbiMcCrady&ChristineSchmucker

Simple Questions Without Simple Answers

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This is just not a subject that I think a lot about, but should.

Tell me:

Why is health care so expensive?

Why are there so many options?

Why do the regulations surrounding healthcare and charges seem to be so… loose?

Why wouldn’t every company have the same options, with the employees deciding which option to choose

based on their family need—with companies contributing what they can?

Why are medical costs themselves so high?

How is it that insurance companies get away with not covering—or gouging—those with preexisting medical

conditions? Aren't those the people who really need good coverage? With adequate coverage and

appropriate guidance, couldn’t insurance companies and medical professionals be helping these people by

offering options to prevent further decline in their health?

Would it then be so expensive?

“Why?”

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ABOUTTHEAUTHORS

Bobbi McCrady ‐ Independent Consultant since 2007 focusing on Project Management and BusinessAnalysis;majority of career spentmanaging operational areas inmany facets of themortgage industry;extensive background in training and mentoring; Bobbi has worked for GMAC‐RFC and various otherfinancialinstitutionsthelast15years.ChristineSchmucker‐Consultantsince2007focusingonBusinessAnalysis.ChristinehasworkedforGMAC‐RFCandotherinstitutionsforthepast8years.

COPYRIGHTINFORMATIONThis work is licensed under the Creative Commons Attribution‐Noncommercial‐No DerivativeWorks 3.0United States License. To view a copy of this license, visit http://creativecommons.org/licenses/by‐nc‐nd/3.0/us/ or send a letter toCreativeCommons, 171 SecondStreet, Suite 300, San Francisco, California,94105,USA.Thecopyrightofthisworkbelongstotheauthor,whoissolelyresponsibleforitscontent.

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A Personal Global Perspective

JariJison

Health Care Coverage Here and There

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I haven’t had to think about health care coverage for a long time. It was always there in one

way, shape or form. Last year I was laid-off; a victim of this economic crisis. Until then I only complained

about the cost of coverage and the ever-increasing cost of medical care. Now, I worry about the kind of

medical coverage my family and I will have after my COBRA coverage expires.

I grew up in a developing country where third-party health insurance was almost non-existent. My health

“insurance” was provided by my parents, who were lucky enough to be members of a very thin middle class

that could afford regular medical care. Certainly, my home country has made huge strides in creating a

private health insurance industry. However, the sad reality is that probably only 10% (my guess) of the

population is covered today. The rest pay for medical care only as they can afford (which is not much) and

as much as they can obtain from the free and barely adequate (in scope) and sub-standard (in quality)

government medical system.

When I moved to the US and started working, health insurance was something an employer provided. In

my case, I worked for a relatively generous company that paid a large portion of the premiums. We had an

excellent plan with a high coverage percentage and minimal copayments. Over time, I had kids (we have

four now) and we shouldered a larger portion of the total premiums and higher out-of-pocket costs due to

increased deductibles, copayments, and cost of services. The reality was that medical expenses as a

proportion of my income was going up and the annual increase in these expenses was outstripping any

income gains I made. My employer giveth and my employer taketh away. Whatever raise in salary I had

was largely negated by inflation and a slow reduction in medical benefits. Nevertheless, we could not

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complain. All our kids were healthy and we weren’t exactly living below the poverty line.

In 2002 and six years thereafter, I had the opportunity to work in Europe, specifically, Germany. Germany,

like other countries in Western Europe, has almost universal health coverage. As an expat, we enjoyed a

very rich international medical plan. I paid the same premiums relative to my US colleagues but my overall

out-of-pocket expenses decreased significantly. I suspect these reasons for my lower overall expenses:

• Cheaper medical care – we paid about 35-40 Euros (approximately $52-60) for a regular doctor visit

that might easily cost $150-200 in the US. However, not all medical care was cheaper. Dental care

was expensive. We regularly exceeded our annual limits. In a league of its own, orthodontic care

was akin to legal highway robbery! I won’t tell you how much we spent lest someone ransom our

children’s teeth. Our children’s orthodontist owned his practice, had a brand new two story

building in the swankiest part of town, and drove around in a Mercedes S-class. But maybe, that’s

because all his patients were children of expats.

• The Insurance Carrier paid more – I’m guessing this was because there were no negotiated contract

rates and my carrier had no benchmarks for “reasonable and customary” fees for medical

procedures.

We were, of course, visiting German doctors and facilities that every local citizen had access to and the

state of medical technology was at least on par with that of the US. So what’s wrong with this picture? In

reality, there was a two-tier pricing system. The government paid doctors a “low” (that is how the doctors

described it) rate for doctor visits and medical procedures. They could charge a little bit higher if they knew

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that the fees would be paid by a private insurer. I have an interesting story here; my regular doctor

“retired”, as he said he could not support his practice on government rates, but then quickly started a

smaller, lower-profile practice that only accepted patients with private health insurance. These were his

golden years.

What did the locals have to say about their health care? The Scandinavians were generally happy. The

Germans said “ok” but complained about some government-imposed limits. The French said their system

works. I haven’t talked to a Brit about their health care system but expat friends living in the UK say it is

difficult to get doctor appointments, and even harder with specialists. This is just anecdotal and not a

scientific study, so please don’t quote me on this.

Back to the present. The word “unemployed” scares me. I can’t stand the thought of going hungry,

losing my house, and not having medical insurance. OK, I’ll admit that I’m also bummed that I can’t travel

as much, buy a new car, and upgrade to the fastest computer on the market. So I took care of that

problem first. Now, I am “self-employed” which means my income is less predictable, my taxes as a

proportion are higher, I have no benefits, and I now have to worry about getting my own medical insurance.

It’s the last item that incensed me the most.

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A good friend referred me to a health insurance broker, and we applied with an in-state provider. Guess

what–my application was denied! As I worked to replace my COBRA coverage, I discovered that a) the cost

of equivalent coverage was outrageous, and b) the health insurers only want healthy people. Now, I can

understand if I had some life-threatening, incurable, or chronic disease. But no, I’m just a regular middle-

aged person that has back problems, controlled high-blood pressure and cholesterol levels, and who needs

to shed a few pounds. Pretty typical in this country. The absurdity of it all is that when they denied me, they

also “denied” coverage for my family! Wait a minute, they are innocent! To counter this, I had to split

myself off from my family and have my wife apply for coverage (with the same company!) with our children

as her dependents. Luckily, her application was approved. Like before, I’m still paying through the nose on

total premiums and co-payments but I at least have coverage for my wife and kids. My next challenge is to

figure out how to replace my COBRA coverage.

The health care debate is raging and our lawmakers are busy working on reforming the system. What’s the

size of that document these days? It was over a thousand pages the last time I checked. I’ll have to admit,

I haven’t read the document (and some lawmakers have shown they don’t read the documents either). I’m

too busy working by the hour to pay for my health insurance premiums. One thing’s for sure, none of my

clients would pay me to write a 1,000-page document. And who would read it?

“My employer giveth and my employer taketh away”

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So what happens next? Well, I’m not a health care expert and I wouldn’t last a minute in a debate on

public versus private coverage. I did not write this to explore the ills of medical care in a capitalistic society.

We try to stay healthy. We have never abused our coverage by frivolously seeking medical care. We’ve

paid our premiums and co-pays. I’ve tried hard to not become a ward of the state by collecting

unemployment benefits. All I need is to make sure we have good value health coverage for my family. For

all the economic and scientific achievements of this country, I cannot accept that the US does not have

some form of universal health care. I am not against paying my fair share or making tradeoffs. However, I

am certainly against being overcharged (i.e. high payments/taxes, low benefits) or much worse, not making

any progress on this issue. I don’t expect this country’s health system to be fixed tomorrow nor do I expect

everyone to be happy with the result. The current system is falling apart.

We need to get moving on this.

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ABOUTTHEAUTHORJari Jisonwasborn and raised in thePhilippines.He completedhis undergraduate studies in IndustrialManagement Engineering at De La Salle University in Manila. After a short stint as a small businessowner,hecameto theUS topursueadvancedstudiesandearnedhisMBAfromtheKelloggSchoolofManagementatNorthwesternUniversity.Jarinowworksasan independentconsultant.Hehasextensive internationalexperienceandhasheldavarietyofseniormanagementpositionswithalargefinancialservicescompany.JarimakeshishomeinFarmington,MNwithhiswifeNettesandtheirfourchildren.

COPYRIGHTINFORMATIONThisworkislicensedundertheCreativeCommonsAttribution‐Noncommercial‐NoDerivativeWorks3.0United States License. To view a copy of this license, visit http://creativecommons.org/licenses/by‐nc‐nd/3.0/us/orsendalettertoCreativeCommons,171SecondStreet,Suite300,SanFrancisco,California,94105,USA.Thecopyrightofthisworkbelongstotheauthor,whoissolelyresponsibleforitscontent.

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Welcome To The Future Of Health Care

JayMichaelO.Jaboneta

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Imagine that you're a member of the World Health Organization attending its annual conference on

major health issues. Imagine today that you are facing the best minds in the sectors of medicine, science,

technology and other related fields.

Imagine someone barging in during your committee's meeting and presenting a different take on the health

challenges of today.

“Are YOU ready?” he asks.

He starts by telling you that you're going on a tour inside the world's mind-numbing health-related statistics.

He tells you to delve deeper into the data.

“Ask questions why this is the case. Don't just read.”

“Digest. Digest. Digest.”

He asks, “Let's eat, shall we?”

This year, one (yes 1!) in every six people worldwide goes hungry every day. This marks a dark moment in the

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history of the human race. 2009 became the year in which 1/6 of our world population is going hungry every

single day.

Now, picture yourself being one of those who go hungry every day.

Take this seriously.

Internalize it. How would you feel? Can you eat just one meal a day? Or worse, can you imagine going

through your day without eating? How about three days? (How about never?)

The next time you take a bite of your favorite sandwich inside Subway, imagine sitting with someone across

the street begging for food.

Would you still like to eat?

Probably not.

That is how we have neglected for too long this mind-numbing statistic! Can anyone honestly feel that he is

such a loser when a sixth of the world's population is going hungry every single day?

This statistic is from a statement made by the Avaaz organization (www.avaaz.org) and it further states that

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“the world produces enough food to feed everyone. Yet the number of people suffering from chronic hunger

across the planet has reached the record-high figure of 1 billion this year.”

Why is this the case? No one actually has any concrete answers. So maybe it’s time we ask ourselves why.

Now we come to the first major challenge that the health care industry is facing today–it's about the

challenge of world hunger. This must be addressed first before we go any deeper into tackling other major

health problems that the world faces today.

Hunger should be addressed first.

The Developing World, which is much of the Third World, still suffers from hunger. In the latest global report

by Oxfam International, it is reported that there are almost a billion people worldwide who suffer from

involuntary hunger. This is the highest number of people in the entire history of humankind. This is very

alarming and is at the root of many major health problems we are facing.

The foundation of any developed society is a healthy population. This is shown when a significant

percentage (if not all) of the population can lead normal lives–eat at least three times a day, have clothes to

wear and a roof to sleep under. These basic needs are fundamental human rights and they play an important

role in the well-being and the health of all humans. Governments must first address these serious issues

before they go on and waste time on what kind of health care systems their citizens deserve. We can start

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talking about health care issues like health care plans, hospitalization insurance, wellness programs and

others but these should be back-burner issues–the main ISSUE that needs to be tackled first should be the

challenge of world hunger. World hunger affects each and every country. Even in the United States and parts

of Europe, there are still people who suffer from involuntary hunger. This is of course much worse in the

developing world.

Any health care plan should take into consideration the issue of world hunger. Malnourishment hinders

children’s development. This in turn hinders them in reaching their full potential. They end up working at the

bottom of the corporate pyramid and giving birth under adverse conditions. There are exceptions, but they

are quite few. If we are to address the escalating challenges of health care (and all the other challenges of

the world), we must first develop strategies that will wipe out the challenge of world hunger and

malnourishment. How can we talk of universal health care for all when there are millions (a billion in fact) who

can't even eat on a given day?

Multilateral organizations like the United Nations, the Food and Agriculture Organization, the World Food

Programme and Oxfam International together with the World Health Organization, governments and medical

NGOs must pursue a two-pronged approach: one that addresses worldwide hunger and suffering; and

another that pursues universal health care coverage for all. It should be an international plan, as we enter the

21st century where a significant portion of our workers will criss-cross national boundaries in a given day.

This is already happening in Europe with London residents working in France and French professionals

working in parts of the United Kingdom.

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The challenge of world hunger is surely not a walk in the park. We need local governments and

representatives all the way up to the international multilateral organizations working together to come up with

a collaborative plan (much like this open collaborative book) to address the issue of involuntary hunger and

set timelines, key milestones and to re-energize government and volunteer organizations to respond and

tackle it collectively.

You ask the man who barged in “Sir, how do we begin tackling the challenge of world hunger?”

He responds by showing you a page from Tom Peters' book Re-Imagine, on the left portion of page 66,

Tom writes “Studies repeatedly show that lousy practices in US hospitals lead to as many as 50,000 to

100,000 unnecessary deaths per year. (And perhaps another one or two million patients are injured.) These

horrors are mainly a result of clunky, manual processes and an unwillingness to embrace procedures, such as

bar-coded patient wristbands, that would help nurses confirm appropriate doses of meds.”

You're in a bit of shock but the man continues and tells you that love (yes LOVE!) is the answer.

“This year, one (yes 1!) in every six people worldwide goes hungry every day.”

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Why LOVE is part of the equation

Another crucial issue that we need to focus on is the role of LOVE in our well-being and health. LOVE is part

of the equation. An unhappy man or woman is not healthy. Health refers to both physical and mental health

and some may even argue to spiritual and emotional health as well. Hospital and care-giving facilities must

learn to truly CARE. They should be designed in the context of the “customer” (patient) experience.

To be truly health-oriented, medical professionals should also be of sound mind and body.

The man cites you an article by the HealthLeaders Magazine quoting Joe Pine, best-selling author of The

Experience Economy, telling participants in a health care conference that the future of health care will be

centered on creating memorable experiences for customers (patients).

In an article by Elyas Bakhtiari, managing editor with HealthLeaders Media, he discusses what Joe Pine

identified as the four priorities for hospitals to improve patient experience:

Theme the experience. Just as every hospital has a mission that guides its internal workings,

every business should have an organizing principle for their customers' experiences, he said.

Whether it is a children's hospital with baseball-themed patient rooms or Disney's sand-castle

imaging machines, experience themes are pivotal to overall satisfaction and are the differentiators in

today's economy.

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Direct workers to act. "Work is theater, and every business is a stage," Pine said. Every worker, from

the receptionist to the CEO, affects the patient experience, and each employee should know his or

her part to play.

Mass customize offerings. Businesses need to learn how to customize customer experiences

while staying efficient, he said. While each patient may receive a similar service, minor

customizations can make the experience unique and more meaningful.

Go beyond experience. The next economic stage that Pine envisions is a "transformation"

economy, in which businesses not only provide good experiences, but life-changing ones. Health

care is perfectly suited for this model, and hospitals that are able to create a transformative

connection with patients will win long-term loyalty, he said.

The man cites yet another article from HealthLeaders Magazine by Tom Mallon, co-founder and CEO of

Regent Surgical Health where Tom writes this observation “My experience is that when we create a better

environment for our people and our patients, the results are happier patients and patient families, and happier

staffs that perform at higher levels. Certainly it's more than just everyone being happy. Such a total healing

environment helps patients recover faster and leave the hospital sooner, which lowers costs. Improved patient

outcomes translate into higher patient satisfaction—and of course most important, a patient's return to

health.”

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The man tells you why he cites Tom Peters and the HealthLeaders Magazine's articles. It’s because

hospitals and other medical facilities should take into consideration that their “patients” are their customers.

As such, they are king. And they should be treated with respect, dignity and LOVE. He tells you he loves

that word, LOVE.

He tells you to repeat it – LOVE, LOVE, LOVE.

He talks a little about why Kevin Roberts of Saatchi & Saatchi is right in promoting that instead of building

brands, we must build lovemarks. And that is exactly what we need.

The world would be a better place to live in if we show our love for one another. It's not difficult. It takes

courage but it's not difficult. It runs counter to many teachings of the medical professional world. He asks

you if you've watched the Robin Williams movie, Patch Adams, where the doctor really cared for his patients

and treated them with laughter and love. It’s based on a true story.

He goes on and on, but now you understand.

He leaves the room and all of you are left dumbfounded.

You all look at each other and you see everyone smiling. You all know what to do.

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But you know, deep down inside, that the real work is just about to begin.

Leaving the room after the committee meeting has adjourned; you are reminded of a story about Gandhi

where at one time while getting on the train somewhere in India, the shoe on his left foot fell off. Then the

train started to move. He couldn't reach the shoe that fell anymore. But instead of jumping off the train and

getting his shoe back or getting angry at the turn of events, he simply removed the shoe on his right foot and

threw it off the train too. It landed right beside the other shoe. Asked why he did this, he just smiled and

answered, “so that whoever finds it, will have a pair of shoes”.

This further inspires you to write a manifesto entitled Welcome To The Future Of Health Care.

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ABOUTTHEAUTHORJay helps people, companies, non‐profits and brands breathe life into their brand story. He believesremarkablepeopleandorganizationsdeservetheattentionoftheworld.Jayisahungryman.Heeatsatleasta100booksayear,loveschocolateandsometimescan'tlivewithoutcoffee.HehasworkedforcompaniesasdiverseasProcter&Gamble,AustraliaandNewZealandBankingGroup Ltd. (includingMetrobankCard Corporation), andDiethelmKeller SiberHegner (DKSH). He hasworked as a sales manager managing over 70 people, managed category management and retailoperations for a range of brands for a national supermarket chain, as a portfolio manager gettingcardholderstospendmore,andhasinmanyinstances,climbedinsurmountable“mountains.”HewritesregularlyfortheHungryPeopleblogathttp://HungryPeople.posterous.com


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I, Care

AlanParr

Alternatives To Common Health Care Views

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They say: “Health care is expensive.”

I say: “Health is wealth. It is the basis for productivity and fulfillment. Without it, how can you

afford to pay for it?”

They say: “The elderly should pay more, because they use more services.”

I say: “When you are at the end of the line, you won’t be looking at the bottom line.”

They say: “Outsourcing some basic health services lowers costs for all Americans.”

I say: “The more middlemen you put between Americans and their health service providers, the

greater the distance between them and the less these middlemen care.”

They say: “If it ain’t broke don’t fix it.”

I say: “If they don’t fix health care, we’ll all go broke.”

They say: “Americans are among the healthiest people in the world.”

I say: “Health care shouldn’t have to come in size Husky for our children and XXXL for adults.”

They say: “Wellness isn’t like health care – that’s New Age kind of stuff.”

I say: “If you’re well there is no need for health care. Change your priorities.”

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They say: “Health care is just too big a subject to understand-I’ll wait until someone else comes up

with a solution.”

I say: “Health and wellness are deeply personal, as personal as it gets. And your health choices

can affect my health choices. You need to educate yourself about what is possible,

practical and prudent-and tell those around you. You owe it yourself and the rest of us.”

They say: “Americans aren’t worried about their health care.”

I say: “I care. And you will too when you are faced with a health emergency. Better to start

worrying about it now.”

They say: “The Health Reform Bill will put things right.”

I say: “That bill deals with insurance reform, and saying that health, care and wellness are about

insurance reform is like dancing about architecture.”

They say: “This guy on a talk show last night said…”

I say: “Turn the TV off and go talk to your friends and neighbors about community-based health.”

They say: “At least we don’t have socialized medicine.”

I say: “Don’t knock it ‘til you’ve tried it, eh?”

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They say: “American health care is good enough.”

I say: “Since when did people in this country start settling for ‘good enough’? What’s next?

We’re happy with ‘our health care system isn’t as bad as some third world countries’?”

They say: “We’re facing bigger problems than health care-what about Global Warming?”

I say: “The American health system has a big, fat carbon footprint-it's responsible for almost a

tenth of all CO2 emissions in the country. Most of it comes from hospitals, which have

complex ventilation and temperature control systems along with energy-intensive lighting

and equipment. The pharmaceutical industry is the second biggest CO2 culprit. How about

we fix the health care system to go green?”

They say: “We don’t know how to fix health care.”

I say: “There isn’t one person with one right answer. There isn’t even one right answer. Being

right is based on knowledge and experience–knowledge and experience of old situations

and old problems. The good news is: Anything is possible. Get creative.”

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ABOUTTHEAUTHORAlan is co‐founder ofOpenSky Consortium, an Innovation Lab specializing in business transformation.AlanisanAdvisorwithOpenSky,helpingclientssolveproblemsthroughbusinessarchitecture,designandprototyping.He isco‐author,alongwithbusinesspartnerKarenAnsbaugh,ofseverale‐books including“Ideaicide”, “IAmTheWalrus”and“Change!MakingADent InTheUniverse”.Youcanseemoreofhisworkandviewhisportfolioat:http://opensky.typepad.com


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Family Practice

PeggiFossell

Family Care Reform

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When I reflect on health care today and think about what I miss most, I keep coming back to the

past, when you had a family doctor, one who knew you and your whole family. I am not talking about

“house calls”, just someone to treat you as a whole person. Health care today is so specialized; focusing

on various body parts or conditions. What happened to the whole person, not to mention the whole family?

I understand the need for specialization but I really think it has gone too far.

You might not think you would hear a comment like this from me if you knew my family’s story. In today’s

health care protocol, my family is an expert when it comes to specialized medicine. We may even hold the

record for the highest number of “oligists” treating one person. My 48-year-old husband has had diabetes

for 37 years and was declared disabled by the time he turned 40. Over the past 20 years, his health has

slowly deteriorated and progressed to the current situation where he has had a kidney transplant, numerous

eye surgeries to slow down his diabetic retinopathy as he goes blind and continuous management of high

blood pressure, cholesterol, and Crohn’s disease. These are just the major issues without going into what

are considered secondary issues like skin reactions to meds, watching for nerve damage in his extremities,

mental health concerns, drug reactions and interactions resulting from taking 35 – 40 pills daily, along with

monitoring sugar levels and insulin injections several times every day.

Some might say Richard is alive today only because of specialized medicine. I say he is alive because my

daughter and I work very hard to be his “Family Practice”. It would be so much easier to know you are

doing the right thing for your family member, not to mention reducing costs, if you had a Family Practice

doctor who helped you coordinate the medical challenges that come up, while also understanding the total

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impact this has on the physical and mental health of the whole family. My husband and I get so frustrated

with the duplication of effort between the specialists he sees on a regular basis: certain ones are monitoring

just his diabetes (Endocrinologist), or just his kidney transplant (Nephrologists and Urologist), or just his

Crohn’s disease (Gastrologist), or just his eyes (Vitro Retinal Surgeon) and then there are the various other

doctors that each of them refer him to.

When you step back and really look at what is happening in all of these appointments, you see the

duplication and the waste. Each doctor manages a duplicate set of records and 90% of each visit is spent

updating records with the nurse. When the doctor finally comes in you are lucky if you get talk to him for 5

to 10 minutes, and they almost always ask the same few questions (most of which are exactly the same

doctor to doctor), order blood work, and send you on your way to await the results in the mail. Even after

all these years there are only a couple of doctors who recognize my husband on sight. Unfortunately, the

paramedics in our area remember our family more than the doctors do.

I don’t understand why the health care system can’t get this figured out. I feel like I have gotten a degree in

medicine myself over the years just trying to help him navigate among doctors and keeping the doctors

talking to each other. My husband’s care has become more about liability mitigation, with each doctor not

wanting to hold the medical malpractice risk for a critically ill patient, than it is caring about the whole

person. I wonder when my daughter and I will pay the price for the toll this is taking on our physical and

mental health as we feel we are his last line of defense against medical errors. Not to mention the

conditions or treatments we let go for ourselves because the medical costs are bankrupting us–even with

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employer based health insurance.

If you don’t think this takes a toll on the children in a family, think again. I remember my daughter’s

kindergarten teacher calling me to let me know that my daughter tried to tell the class about her daddy’s

kidney transplant at “show and tell”. She came home sad as some of the kids made fun of her because

they thought it was “icky” to take a body part from one person and put it in someone else. She is a

freshman now in college, going for a BA in Fine Arts, and she recently showed me a short video she made

for her film class that featured her life with her father. She didn’t know if at first she wanted me to see it, but

then decided I could as long as I promised not to share it with her father. The last thing she ever would

want is to make him feel bad for something he can’t control. When I first saw it I couldn’t say anything–I

just cried. As much as I thought I knew how her father’s health issues impacted her, I never really saw it

from the eyes of a young child the way the film shows. I didn’t realize the extent of responsibility she felt to

help her dad.

“My husband’s care has become more about liability mitigation, with each doctor not wanting to hold the medical malpractice risk for a critically ill patient”

33

Life is not easy and my family continues to step up to the challenges that we face. I just wish

those challenges did not include the time consuming processes of keeping the doctors from undoing each

others’ treatment strategies and managing the insurance claims. I can’t tell you how many times over the

years I wished I had a Family Practice doctor to consult with and to be the go-between for all of the

specialist care. In my opinion, many of the in-office specialist appointments are unnecessary and could be

handled by a doctor to doctor consult with a primary care physician. The primary care doctor would

consolidate all the information, share all the test results electronically with the appropriate specialists and

together they could weigh in on changes to his treatment plan.....but then the specialist loses money on the

deal, and lowers his/her status in the current health care world as it is structured today. The odds are

against it.

We need to figure out health care reform and get this right. It may be too late for our family’s situation but

the next generation deserves better since they are going to pay the price.

34

ABOUTTHEAUTHORPeggi and her husband Richard are now empty nesters living in Bloomington, Minnesota. Peggi hasworkedinvariousmanagementandindependentcontributorrolesintheFinancialServicesindustry.ShecurrentlyworksforGMACasaSr.BusinessAdvisorinRiskManagement.

COPYRIGHTINFORMATIONThisworkislicensedundertheCreativeCommonsAttribution‐Noncommercial‐NoDerivativeWorks3.0UnitedStates License. To view a copy of this license, visit http://creativecommons.org/licenses/by‐nc‐nd/3.0/us/orsendalettertoCreativeCommons,171SecondStreet,Suite300,SanFrancisco,California,94105,USA.Thecopyrightofthisworkbelongstotheauthor,whoissolelyresponsibleforitscontent.

35

Connected

AlanParr

Health Del ivery Redefined In 1000 Words, 10 Drawings &

5 Links

36

Joel wakes during the night feeling unwell. He has been unable to sleep–he has a big interview tomorrow morning–but this is something

different, not just the nerves he has been suffering with for the past couple of days. He really isn’t feeling good. Tapping the screen he wakes

up his computer to check out his symptoms. Updating his online status as “sick” (it can’t hurt, he thinks), his computer is triggered to prompt

him for his symptoms. “Stomach pain, dizzy, chills,” he quickly types. This basic information is used in a number of ways; the computer

provides him with a list of possible diagnoses, but the data is used anonymously to check for a wider pattern. Predictive analytics correlate

his symptoms against those reported in his neighborhood network, his wider social network, and the larger geographic area. No health

emergencies are being tracked right now so no alert is triggered. This looks to be just a virus. Still, after clicking on a diagnosis Joel

discovers the possibility that his symptoms will progress to something worse, and finding that no one else in his network is online to talk to at

this time of night, he opts to talk to an Online Physician (OP).

37

The physician appears on screen and asks how Joel is feeling. The physician already has Joel’s health records in front of him, pulled from the

central health archive, as a precursor to engaging online. As an OP, he specializes in remote diagnosis of illness and helping the consumer

reach decisions on their health care. Part of that involves being an advocate of wellness and having advice that is relevant to the consumer’s

lifestyle and location. The OP notices that Joel’s health records are rather sparse and that Joel hasn’t been making use of his local resources.

“Your virus isn’t that severe but it’s most likely being exacerbated by the stress you’re going through. I think you should check in at a health

center tomorrow,” he says, “there may be something we can give you to ease your symptoms and help you rest. In the meantime I am

sending you some links to resources in your area that you can use when you are feeling better. You need to work on some stress

management techniques.” “But I have an interview tomorrow,” says Joel. The OP issues a self-check-in request, “In case you decide you

need it. Try and get some rest and good luck with the interview”. The self-check-in request and the entire online conversation are saved as

part of Joel’s health records. Joel goes back to bed.

38

The next morning Joel is definitely not feeling well. He is short on sleep, unable to eat, and feeling out of sync with reality. The only thing that

comes through clearly is the stress he is feeling about his interview. He skips breakfast, dresses and catches the express into downtown. On

the train, his stomach cramps and he groans. A fellow passenger pats him on the shoulder. “You don’t look too good. Maybe you should get

some help. There’s a great walk-in health center on 32nd and Barcombe if you get off at the next stop.” Joel thanks the passenger and

decides to get off the express. At 32nd street he pulls out his phone and scans the street. The nav app on his phone locates the nearest

health center; clicking on it he sees that their wait time is low this morning. He can still make it to the interview. He clicks on his “optional”

self-check-in request to let them know he is on his way. Within minutes Joel is walking into their reception area.

39

In the lobby, Joel heads to the “Self-Check-In” booths. Self-check-in automatically registers his arrival, places him in the next available

doctor’s patient queue, and begins an automated evaluation of Joel’s biometrics while he waits. Had he needed a nurse, one is available, but

Joel likes the self-check-in. It’s quick, convenient, and private. The system lets him browse health care topics while it works, so he can be

better informed when he meets the doctor. As he exits the booth it automatically logs Joel out, preserving privacy.

40

The doctor asks questions about Joel’s health and lifestyle, recording notes on a clipboard-style computer tablet. The tablet allows her to

examine Joel’s record, his care history, and as the In-person Physician, she takes the opportunity not only to treat his current issue, but to fill

in any blanks in Joel’s record. The goal is to treat the whole person; current issue, background, lifestyle and goals. As the doctor will hand

Joel back to an online physician for remote follow-up, knowledge of online possibilities and recommendations are shared as part of the

central records system. All the details of the in-person interaction and the doctor’s notes are stored in Joel’s medical record which is

returned to the central health archive.

41

Joel has a great follow-up with the OP. He did not realize he is part of a community-based care system; receiving mutual support from

shopkeepers (for online diets and products) and workout partners (virtual teams with similar health goals), and community based planning. All

of this wellness activity is added in to Joel’s records so that health care professionals can consider his whole lifestyle–his environment,

activity, history–when helping him with future treatment options and health choices. Joel is better informed, better connected to his

community and to his care providers. Joel is connected. Joel is well.

42

While this story is set in the future, it is actually grounded in the present. New technologies are being introduced all the time, and are being

integrated into our health care system:

1) Helping Hands Software: http://www.youtube.com/watch?v=UU8novBB7xE&feature=player_embedded

2) Phone Navigation: http://layar.com/layar-is-in-the-iphone-app-store/

3) Patient Kiosk: http://www.chcf.org/topics/hospitals/index.cfm?itemID=133882

4) Doctor’s Computer Tablet: http://www.dexigner.com/design_news/fujitsu-siemens-computers-wins-2009-if-product-design-award.html

5) Community-based Health: http://www.heartofnewulm.org/

From a technical perspective, the distance between the present and the future is narrowing. But technology alone is not enough. What we

currently lack is a “big picture” view of the health and wellness possibilities in which the consumer is firmly rooted at its center, where

wellness, prevention and cure are integrated and connected into everyday lives.

43

ABOUTTHEAUTHOR

AlanParrisanartistwithapassionforvisualconceptdevelopment.HebringsthistalenttohisworkwithOpenSkyConsortium.Everynewproblemneedstobeseenbeforeitcanbesolved,everynewideaneedstobebroughttolifesothatotherscanshareitandengage.Thisstory isdedicatedtotheamazingpeopleof theWomen’sBreastCenteratRegionsHospital inSt.Paul,MN.Theytrulyshowwhatitmeanstoprovidegreatconnectedcare.

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44

Quality of Life

JillJohnson

A Tale Of Two Grandmothers

45

Everyone should be entitled to spend their last days in a happy, warm environment with

adequate care, the ability to make their own choices and most of all their dignity.

Here are two scenarios currently playing out in our family:

My grandma (age 100 and totally sharp mentally) recently had to move into a nursing home in Woodbury,

MN due to her becoming wheelchair bound and needing a lot of assistance physically. She is on a waiting

list for a private room (which is unlikely to become available in her lifetime) but in the meantime is in her

third room in 2 months. Her latest room is tiny–only room for a bed and a nightstand for each resident. No

effort has been made to match her with a compatible roommate (mentally) and she is now stuck with one

that roams their room at night and tries to steal my grandma’s things. The place is completely

understaffed. My grandma is unable to get out of bed by herself and has often had to wait up to an hour

after pressing her call button to be taken to the bathroom (which by then is usually too late, if you get my

drift). Every single time I visit I spend much of the time flagging someone down to help her. She tries to

engage the staff in conversation but they are too busy/rude/non-English speaking. My grandma is typically

a very upbeat person but now she cries every time I see or talk to her. Everything is done on a rigid

schedule, and she is put to bed for the night at 6:30 p.m. whether she is tired or not. The food is awful and

they aren’t given any choices. In addition, she can’t chose where or with whom to sit, so she typically is

unable to have a conversation with her tablemates. The foot pedals to her wheelchair have been lost (and

the staff are making no further attempt to find or replace them) so she has to hold her legs up herself when

being wheeled anywhere. She shares a bathroom with FOUR people and it is often dirty and foul smelling.

46

The only positive thing my grandma has to say is she is happy to be on the “window” side of her room (vs.

her roommate who spends the entire day behind the curtain separating their beds). At the end of your life,

shouldn’t there be more than just hoping to have a window?

My husband’s grandma (age 94) is in a nursing home in New Richmond, WI. It is owned by Presbyterian

Homes (needed to put in a plug for them here!). She is also wheelchair bound, but unlike my grandma, is

confused much of the time. She has a private room which is large and decorated with all her favorite

things. The residents choose when they would like to get up, when they’d like to eat and when they go to

bed. The dining room is open all day and the residents order whatever they like off an extensive menu.

Families are invited to have meals there any time at no cost, and when we do a separate table is set up for

us with decorations. There are many activities throughout the day and the staff is very caring–they will

often stop in her room and sit and chat with her. Numerous parties are held during the year and families

are invited to participate. For example, they recently had an Oktoberfest out in the parking lot with live

music, games, face painting, a petting zoo, food etc. They are building a new nursing home and will move

all of the residents there when it is completed. The new facility will have all private rooms, each with a

private bath and kitchenette.

By the way, the cost for each of the facilities is the same: $6,500 a month.

47

You may ask why my grandma doesn’t move to a better facility. We have been begging her to look at

another facility (there is a Presbyterian Homes’ one close to where she is now) but she wants to stay

where she is because it is in the same complex as her old independent apartment, so she has a lot of

friends that come over from there to visit. Change is really hard at her age–just switching rooms has been

a big adjustment each time. I took her on a wheelchair ride outside a couple of weeks ago and she said it

was the first time she had breathed fresh air in two months (again, to compare, at Bill’s grandma’s place

they are regularly taken outside to sit in the sun). What is amazing is that my grandma’s place actually has

a waiting list!

Living into our nineties and past the century mark is becoming more commonplace. How do we ensure

that our elderly are properly cared for when they–and we–can no longer care for them in our homes? Why

is there such a disparity in services and quality among nursing homes? Everyone should be entitled to

spend their last days in a happy, warm environment with adequate care, the ability to make their own

choices and most of all their dignity.

“At the end of your life, shouldn’t there be more than just hoping to have a window?”

48

ABOUTTHEAUTHORJillJohnsonisanindependentcapitalmarketsconsultantwithover25yearsofexperienceinthefinancialservices industry. She has had various roles as a treasury consultant, structured finance director,transactionmanagerandprojectmanager.Mostrecently,shewaswithGMAC‐ResCapfor16years.Shehas anMBA from the University of Minnesota and a BA from the University of St. Thomas, and is aCertifiedTreasuryProfessional.JillresidesinChanhassen,MNwithherhusbandandtwosons(andaverycutegoldendoodle).

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49

Picture of Health

KarenAnsbaugh

50

Dear Legislators, Insurance Companies, Health Care Professionals:

Here’s my picture of health. I don’t have all the answers. This may not be someone else’s picture. Nor do I

have the financial expertise to suggest how to pay for this on a large scale. All I know is I am self-employed.

My husband is self-employed. For us, after food and shelter needs are met, medical insurance is our top

priority. We think we are very fortunate that we can meet all three of these needs. It is not cheap and we

choose to give up other things to pay our medical insurance premiums and out-of-pocket expenses. We

don’t have dental insurance, but we do see our dentist regularly.

Do I know if we have the best cost to benefit ratio? Absolutely not. I do track our premiums, out-of-pocket

expenses and what is charged and what the insurance company allows. I am often stunned at the difference

between “charges” and “allowed amount”. Without insurance we would be paying a lot more. Could we pay

less? Maybe…my husband and I have different policies due to his “pre-existing” conditions.

Focus on wellness: check-ups, fitness, nutrition, optimal mix of services for our needs

I am responsible for my well-being, but I need guidance and help. I receive mailings from the insurance

companies about programs, but it’s confusing. I go on-line and there is so much information. My financial

advisor is required to review with us our portfolio at least once a year and my car/house insurer sends us a

yearly report, too. I have been with both for years, they know us. I would love to have a knowledgeable

person at my medical insurance company review my policy with me once a year and tell me about services

51

and products that fit my needs better or how to save money. I mean really, you have the information on what

I’ve used my insurance for. It would be wonderful to have the same person each time and also have them

available for questions as things change. Yes, I would pay more for this service. I want to be a client–not a

patient or a customer–a client. I am paying you for services.

Basic care for all: young, old, middle aged, rich, poor, middle class, healthy, ill

None of us knows which combination we may end up with at any given time. Ask any one who has lost a job

or been diagnosed with a chronic disease or out-lived their savings. I would rather hedge my bets, helping to

support others when they need it so I am supported if I need it. Our ability to promote wellness and contain

infectious diseases is predicated on ensuring that everyone has access to basic health and wellness care.

Coordinated care: holistic view of my needs, my health records consolidated and available to

whomever I give permission (including my dental)

It’s not like I can send my ailing body part in to be taken care of the way I can send my area rug in to be

cleaned and mended. I am an integrated being and as such want to know that my health care professional is

taking into consideration my family history, my lifestyle, my spiritual beliefs, my values and any other

medical/dental treatment I am receiving. I also want them to have the time to review and think about me; no

one appreciates being “the sore throat in Room 2”. Yes, it is up to me to make sure that I am prepared for

each visit, having chosen someone I can work with and to be honest about what I am doing or not doing.

52

Supportive convenience: nurse line, on-line abilities, follow-up written summary and instructions,

access to all my medical records

Many health care plans include a nurse line, which is really great. My insurance company knows that I made

the call, but I’ve never been asked if I would like my doctor notified of it. I also, want to be able to contact my

doctors via email, have on-line appointments, schedule appointments on-line. If it’s safe and cost-effective, I

am happy to be treated for minor ailments at a shopping mall clinic or urgent care, as long as that information

is added to my records and my doctor notified.

“I want to be a client–not a patient or a customer–a client. ”

53

ABOUTTHEAUTHOR

Karenisco‐founderofOpenSkyConsortium,anInnovationLabspecializinginbusinesstransformation.Shehasbeenan independentbusinessadvisor since1999.SheandbusinesspartnerAlanParrprovidefirms with new ideas, creative thinking and insights, then experiment to drive change in people,companies andmarkets. She and her husband are each self‐employed and solely responsible for theirhealthcarepremiumsandout‐of‐pocketexpenses.http://opensky.typepad.com

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54

Building On A Legacy

MaryAnnStump

Blue Cross Blue Shield Of Minnesota Is Designing

Health Care For Tomorrow

55

As a society, we are in an age of change and upheaval. Everything from our personal lives to the

way we do business is changing. Ten years ago, tweeting was left to birds and Google was merely a search

engine. Now, nearly 100 million of us use Twitter; and Google is a major player in everything from

advertising to health. As the world changes all around us, we either choose to change with it, accepting and

anticipating the next wave, or we find ourselves becoming obsolete and irrelevant. For health care, that

choice has become a crisis in the midst of the call for reform. The health care industry is also changing, and

as the Chief Innovation Officer for Blue Cross and Blue Shield of Minnesota, I get to be at the helm—and in

the midst—of some exciting changes.

The answer we have discerned is that we, in fact, aren’t really a health insurance company—we are a

HEALTH company—working to design health care in a way that is focused on consumers—and aligning our

services to better meet their needs.

“Our big question is—what does a health insurance company for the new age look like?”

56

From Insurance Company to Health Company

What is a health company? A health company is not your Mom and Dad's Blue Cross Blue Shield of

Minnesota (BCBSMN), but it has all the wisdom of its age and experience. It promotes, encourages, and

ensures optimal health for all consumers, not just the traditional notion of members. The health company

doesn't abandon its role in management or financing care, but rethinks and re-forms those roles looking at

how to do them best and in such a way that puts the consumer and the consumer’s health front and center.

And while the business may still be insurance, it is no longer a payment business; it's a relationship

business as health care should be.

What makes the new health company different? The health company is relationship-driven and personalized

based on the consumer's unmet needs, plus the wants and needs defined by the consumer. We want to

leave behind the trappings of a paternalistic model of care and coverage, and focus on helping consumers

be as well as they can be.

BCBSMN is actively seeking ways to engage and serve all consumers above and beyond the current notion

of 'benefits.' We're mobilizing our own employees as designers and consumers to help us shape this new

world. We’re gaining practical consumer insights and a deeper understanding of what consumers truly

want, need, and might expect from a health company.

57

Democratizing health care is a priority for us. We’re working to offer products and services directly to

consumers that truly personalize health and health care. We want to overhaul health insurance thinking to

be health company thinking. We need to be a connector, facilitator, collaborator, and a catalyst. This

means courageously focusing on:

• Benefiting the consumer, not the consumer's benefits;

• Collaborating, not managing;

• Learning, not knowing;

• Thinking imaginatively and valuing agility and innovation, not business as usual; and

• Emphasizing outcomes and the consumer experience.

But most of all, the health company is a leader in a time of change. Through exploration and discovery,

we’re finding new and better ways to engage, ensure, and provide care and support relevant to the

consumer. We’re discovering what it means to be a connector, facilitator, collaborator, and catalyst; we’re

realizing that none of these things are interdependent.

58

A Connector

Health insurance started as a way to prepay for hospital care. In those early days, the company connected

patients to doctors as a means of payment. The role was vital, although simple and one-dimensional.

Over the next nearly 100 years, insurers continued to pay the bills, but began to realize there was more to

being a connector than writing checks. Provider and hospital networks helped connect members to care

and insurers helped remove some of the guesswork in finding a provider.

Today, BCBSMN continues to find new and innovative ways to connect consumers with care that best fits

their needs through such tools as:

• HealthcareScoop.com, an online community dedicated to consumers sharing their health care

stories, and

• Online Care Anywhere, an online platform allowing consumers to connect immediately to a provider

for care.

As BCBSMN journeys toward becoming a health company, opportunities to provide connections for

consumers are a priority.

59

A Facilitator

As health insurance companies began to expand the services offered, insurers took on a new identity as the

health plan. Health Maintenance Organizations (HMOs) capitalized on the network of providers and

facilities. The health plan's goal was to ensure the best care for their members at the best cost for their

customer, whether it be employers or the member directly:

• Members chose a primary care provider who worked with the health plan to facilitate all care

decisions.

• Disease management emerged to help provide continuity of care for members with chronic illness.

Today, BCBSMN has expanded this idea to incorporate 'Health Guides' within the notion of Whole Person

Health. Health Guides are individuals trained to do more than just provide traditional customer service. They

are trained to listen to what the member is really asking and actually needs. Health Guides, as a result, help

members identify programs and benefits of value. Often times, the connection is one the member may

never have made alone. The service is provided at all points in the relationship with the member, not just at

traditional points of intervention.

60

In addition to facilitating connections for our members, we recognize the impact that health inequities have

on our communities. To that end, BCBSMN supports community health workers in minority and immigrant

populations to facilitate social connectedness and navigation of the sometimes daunting health care

system.

As we look toward our future as a health company, we are dedicated to finding new and better ways for

consumers to actively manage their health and the health of their families. From facilitating Personal Health

Record adoption and finding ways to make your personal health information accessible on-the-go to

concierge-style health services, BCBSMN will work to build mutually beneficial relationships between

consumers and the health care that best fits their lives.

61

A Collaborator

While the era of HMOs saw collaboration between providers and health plans, becoming a health company

necessitates collaboration with all stakeholders—employers, policymakers, providers, and consumers. The

fight against Big Tobacco in Minnesota was an example of how collaboration between all stakeholders can

and does work. The collaboration resulted in not only a significant settlement, but also Minnesota's

Freedom to Breathe Act passed in 2007. Currently, we see the beginnings of such collaboration in health

technology and the push toward Personal Health Platforms where one's entire health history and tools will

be centrally accessed and managed. For the Personal Health Platform to succeed, all stakeholders must

actively participate and contribute to the evolving capabilities. Long gone are the days when development

and design without significant consumer input were accepted ways of doing business. Instead, consumer

insight should be real-time, un-sanitized, shared openly, holistic, and applied.

62

A Catalyst

While insurers have at times to varying degrees assumed the role of collaborator, facilitator, and connector

there is obviously a long way to go before we really begin to function as a health company. The key to that

change may very well be becoming a catalyst for change and action. BCBSMN has begun working as a

catalyst for positive change in the health care industry. We were one of the first insurers to reduce or waive

co-payments for retail clinics.

Stepping outside the traditional roles and responsibilities of an insurer, we’re working for change in our

communities as well. Recognizing that public health issues, such as obesity, are lifestyle issues, not just a

health care issue, BCBSMN is finding innovative ways to reach out to the community and support positive

lifestyle and activity choices:

• A major sponsor for Nice Ride Minnesota (http://niceridemn.com) to bring public bicycle-sharing to

downtown Minneapolis and the students, faculty, and staff of the University of Minnesota.

• A sponsor of the planning and construction of walking and bike friendly community developments.

• A resource for employers, offering consultation on cafeterias, wellness programming, and the

effective use of social media to communicate important health and wellness messaging to

employees.

63

That same force for change can be seen in our own employees as we've launched Online Care Anywhere

as a proof of concept first with our employee population. We’re taking the opportunity to truly be the

change we want to see within our own industry.

Toward Being A Health Company

We aren't a health company yet, but we're working to get there. Each day, we are discovering new ways to

do business and alternative approaches to old and evolving problems. We find new perspectives on our

work that better focus on the needs of the consumer and incorporate true, real-time consumer feedback.

We're finding ways to work faster, cheaper, and more efficiently while not compromising the quality and

reliability you expect from Blue Cross Blue Shield of Minnesota. Our evolutionary shift to health company is

happening now and we're discovering our new direction. Our transformation will be a journey of exploration

and discovery, and we intend to change the very face of the health insurance business industry in the

process. We’re ready to be in the health business.

64

ABOUTTHEAUTHORMaryAnnStumpSeniorVicePresidentandChiefStrategyandInnovationOfficerBlueCrossandBlueShieldofMinnesotaPresidentConsumerAwareMaryAnnStumpisarecognizedleaderinhealthcareconsumerismandpassionateadvocateforhealthcarereform.Sheengagesstakeholdersinviewinghealthcarefromtheconsumer’sperspectiveandencouragescollaborationandinnovationincaredelivery. Aformercardiaccriticalcarenurse,Ms.StumpwasleadarchitectofBlueCross’CardiacCenterofExcellenceProgramandMinnesota’sfirstcommunity‐basedresidentialtreatmentfacilityforeatingdisorders.SheservesonYaleCollegeofNursing’sExternalAdvisoryBoard,isapastpresidentofMinnesotaHealthcareQualityProfessionals,andaformerRobertWoodJohnsonFoundationNationalAdvisoryBoardmember.Shewasrecognizedin2008asoneofthe“Top100”mostinfluentialpeopleinMinnesotaHealthcarebyMinnesotaPhysicians;in2009,Minneapolis‐St.PaulBusinessJournalnamedhera“WomeninBusinessIndustryLeader.”

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65

Step Back... Then Step Up!

KarenAnsbaugh

66

These are the days of miracle and wonder

This is the long distance call

(The Boy in the Bubble, words by Paul Simon)

As we ignore, ponder or debate exactly what health care reform means; as we agonize over

how we are going to pay for “solutions”, we forget to look around us. Change rarely comes upon us in an

instant. Change comes gradually, then suddenly*. Step back from the debate and look around you. Don’t

get overwhelmed by the issues. They are real, but you can’t become paralyzed by the confusing and

contradictory rhetoric. We are not starting from zero here. Many people, in many ways, have been working

on “health care” for a long time. The difference now is that the momentum to make great change is upon

us! These are the days of miracle and wonder.

And what are miracles, let alone ordinary miracles? Webster’s dictionary defines miracle as: “1) an

extraordinary event manifesting divine intervention in human affairs or 2) an extremely outstanding or

unusual event, thing or accomplishment.” Ordinary elicits words such as commonly encountered, usual,

regular, and normal. That would make an “ordinary miracle” an oxymoron–or does it? By blending and

bending those definitions the whole is greater than the sum of the parts. In other words, regular people

doing commonly encountered things that result in extraordinary events and accomplishments within their

sphere of influence. And lest you think a sphere of influence is something large and grand, it can be as

intimate as a family, as broad as a country or somewhere in between.

67

For a historical perspective on change in this country look at the Suffragette movement, the Civil Rights

movement or the Equal Rights movement. None resulted in instant change. All included complicated issues,

challenged current belief systems, and if realized–even in part–would change aspects of American life

forever. People who believed things should be different, better than they currently were, worked to make

change happen, and did so over a long time. Some became leaders of their movement, such as Martin

Luther King Jr.; but the majority were “ordinary” people who believed that change needed to happen. They

worked as best they could to make it happen and to bring the rest of us along with them.

It’s not the first time we’ve struggled with a health related movement that took a while to bring about

change. What about the anti-smoking campaign? Research in the 1950s linked smoking to lung cancer and

other diseases. It wasn’t until the mid-1970s that the momentum against smoking became very visible

through legislation such as the Minnesota Clean Air Act of 1975. Today we are surprised to learn if a friend

or colleague smokes. This mindset change did not happen quickly, quietly, or easily; contrary research

denying the health risks was presented; the fears of economic impact to areas supported by tobacco were

raised; debates and lawsuits raged on. Smoking and the use of tobacco products have not been eradicated

in the United States and legislation is still being discussed and enacted. But the majority of us work, shop

and eat in smoke-free environments, health insurance companies have programs to help smokers quit, and

we educate our children on the hazards of tobacco use.

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Health care reform, health insurance reform, Medicare reform, changes to health delivery system–whatever

you label it–is happening and more importantly has been happening all along in this country. The only

difference is we’ve reached a point of critical mass with regards to cost, delivery and access to care. It is

now very personal. It is now that we have to sift through all the noise and make sense of it for ourselves and

our families. It is now that each of us has to weigh in on what we need and what we want.

This is the long distance call. Not a phone call out of state, but a call for change in health care that goes the

distance. Step back from the legislative debate and see what else is going on in the health arena. There are

people who have been working on tangible solutions. None of us can educate ourselves on all aspects of

health care, but we can on the aspects that are meaningful to us. Step up and share your thoughts and

opinions in your spheres of influence–family, friends, health vendors and elected representatives. Each of us

is part of the problem and part of the solution.

I am in awe of the health developments that I read about on a daily basis just in my local newspaper. All are

ordinary miracles, accomplished by people from all walks of life trying to make things better. Here is a few

weeks’ worth of health related articles that caught my eye. See what you can find out there that appeals to

you. Please, step back…then step up.

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Better Access to Healthy Food: Discusses food banks partnering with businesses and farmers to get

healthy food on tables of people with limited incomes. The health implication: A 10% increase in poverty

correlates with a 6% increase in obesity due to nutritious food being more expensive.

http://www.parade.com/news/intelligence-report/archive/091108-better-access-to-healthy-food.html

Rev up the brain while practicing motor skills, by Dee DePass: Shayne Adair teaches simple physical

exercises that help older people build neuroplasticity; help maintain dexterity, balance and brain function.

http://www.startribune.com/lifestyle/health/69402627.html

When the Best Doctor is Far Away, by Sean Flynn: Telemedicine provides expert medical care in

emergencies and “routine” monitoring remotely. For example, teleconferencing to provide expert medical

care to patients who live long distances from a major hospital, thus reducing the need to transfer critically ill

patients between hospitals, not only saving lives, but reducing costs.

http://www.parade.com/health/2009/11/22-when-the-doctor-is-far-away-telemedicine.html

Acing the mat test, by Sarah Moran: Yoga in Minnesota schools benefits students. “Studies have linked

yoga in schools to better grades, behavior, health and relationships among students.”

http://www.startribune.com/lifestyle/76320887.html

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Grow your own body parts? The future is now, by Karen Youso: Medical advancements that are or near

reality now.

• Growing your own organs: in preparation for getting FDA approval, lab-grown bladders are being

transplanted into patients in the US.

• Aging gracefully at home: more telemedicine through smart phone technology to allow health

professionals to monitor people’s health at home reducing the need for (and some of the costs of)

hospitalizations and nursing home stays.

• Robot nurse: Robotic help in home for people who need elder care.

• Aging treatment: A compound that works on genes that regulate aging is being studied. It is much

stronger than resveratrol (anti-aging ingredient in red wine).


Tracking a killer, by Thomas Lee: The development of a device that may possibly help doctors perform

initial biopsies and monitor prostate cancer through low-cost 3D images using elasticity imaging.

http://www.startribune.com/business/74236432.html

Feeding a need to help others, by Curt Brown: Laverne and Babs Wheeler, a retired suburban Twin

Cities’ couple, give dinner parties at which they collect food for northern Minnesota food shelves. Since

November 2007, when they started, they have collected and delivered more than 9,000 pounds of food and

nearly $15,000.

http://www.startribune.com/local/west/74157697.html

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Minnesota grants fund initiatives in health care, by Chris Williams: SHIP, Statewide Health

Improvement Program, provides grants that help promote walking school buses, allow farmers’ markets to

take food stamps, link college students to stop smoking programs, show daycare providers how to provide

better nutrition and exercise. The goal: To persuade whole communities to eat better, exercise more, stop

smoking and thereby reduce health costs.


Another source of health change information is the Mayo Clinic’s Center for Innovation website. On this

site, you can also find the video coverage of Mayo’s Transform: A collaborative symposium on innovations

in health care experience and delivery which inspired the collaborative e-book project which this article is a

part of.

http://centerforinnovation.mayo.edu/

http://centerforinnovation.mayo.edu/transform/

*(repurposed quote from The Sun Also Rises, Ernest Hemingway)

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ABOUTTHEAUTHOR

Karenisco‐founderofOpenSkyConsortium,anInnovationLabspecializinginbusinesstransformation.She has been an independent business advisor since 1999 providing clients with expertise in projectmanagement, analysis,processdesign,operationsmanagementandorganizationaldevelopment.FindmoreofherandbusinesspartnerAlanParr’swriting(e‐books“IAmtheWalrus”,“Change!MakingaDentin theUniverse”, “Ideaicide”, “DreamswithDeadlines” and numerous articles) and a portfolio of theirworkat:http://opensky.typepad.com


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IN CONCLUSION

To our fellow contributors: Thank you! For taking time from your busy schedules to collaborate with us. Thank you! For stepping up to share

what you are thinking and doing about health care. Thank you! For the variety of “takes” on what’s right, what’s wrong, what’s being done

and what could be done. Thank you! For showing that asking questions is just as important as trying to answer them. Thank you! For

demonstrating it takes all of us to weigh in on Health Care, Wellness and the Next American Dream.

To our readers: Please continue the dialogue. What does healthy mean to you? What does good health care delivery look like for you, your

children, your parents? Read about what others are doing and not just here in the United States. Out of necessity, individuals in many

countries have come up with unique and cost-effective deliveries for health care and wellness. You may have brilliant, simple, complex,

tailored, and basic solutions–Ordinary Miracles–that address specific issues that are important to you. Share them. Listen to others’ ideas.

Because “…the next great leaps in health care will result from collaborative discussions and the sharing of insights from across disciplines.”

To all: Good health and access to good health care!

Alan Parr and Karen Ansbaugh

OpenSky Consortium

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The copyright of this work belongs to the authors, who are solely responsible for its content.

OPENSKY CONSORTIUM

An Innovation Lab specializing in business transformation. Our Advisors provide firms with new ideas, creative thinking and insights, then

experiment to drive change in people, companies and markets.

Web: http://opensky.typepad.com

Email: [email protected]

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Ordinary Miracles v1-0