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Storm Harvey could financially hurt already strained Houston hospitals
Structural improvements over the last decade to Houston hospitals have helped them so far to avoid devastation like Hurricane Katrina in New Orleans in 2005, but the pounding it is receiving from Tropical Storm Harvey is expected to financially hobble many already strained Texas medical centers.
The storm has forced hospitals to cancel surgeries, evacuate patients and contend with food and supply shortages. Even bigger challenges are expected in coming months when people who have lost homes and jobs avoid medical treatment or seek charitable care.
“A lot of hospitals already were burdened by uncompensated care…they were already struggling, and this will make things much harder,” said Vivian Ho, a healthcare economist at Rice University.
Rice has been temporarily closed because of the slow-moving storm that has killed at least 11 people since Friday and paralyzed Houston, the fourth most-populous city in the United States with a U.S.-census estimated 2.3 million.
Houston’s healthcare industry includes some of the most prestigious institutions in the country and has grown to accommodate a rising population in recent years.
But uncertainty about changes to U.S. health insurance policy, the region’s shrinking energy sector and Texas’ high percentage of uninsured have forced several Houston hospitals to cut thousands of jobs this year and post millions of dollars in losses, even before the storm.
Investment bank Jefferies warned in an Aug. 28 note that Harvey could have a significant impact on Texas healthcare providers, especially HCA Healthcare Inc, which has “11 percent of its beds in the areas impacted by severe weather.”
Texas Hospital Association spokesman Lance Lunsford said medical centers made significant improvements after buildings were damaged by Tropical Storm Allison in 2001.
Harvey broke rainfall records for the continental United States, with one site south of Houston recording 49.2 inches (1.25 meters) of precipitation.
Flooding prompted MD Anderson on Monday to cancel appointments and surgeries until Wednesday at the earliest, St. Luke’s Hospital closed one of its branches, and flooding at Ben Taub Hospital shut its food service.
MD Anderson on Monday told employees not part of its storm “ride out” team to stay home.
Roads around the cancer center’s main hospital were impassible, and a doctor posted photos of flooding that reached into the hospital lobby.
MD Anderson’s economic impact to the area is about $35 billion, according to its web site. Its 21 hospitals and affiliated institutions employ more than 106,000 people.
Data-Driven Policy Making In An Age Of Anecdotes: What Happens When A Foundation Creates A Policy Center?
Why would a health foundation create a public policy research center?
The Healing Trust, in Nashville, Tennessee, has funded a wide variety of health-related service and advocacy organizations in Middle Tennessee. But in 2014, we asked them what additional support we could give to these organizations engaged in policy and advocacy work. One priority quickly rose to the top: timely, high-quality, and nonpartisan research and analysis on public policy issues critical to our community.
Tennessee has several prominent academic institutions with respected researchers in this field, but an independent and nonpartisan public policy research center simply did not exist. We began to explore this idea, using research to vet different business models for similar centers in other states. Ultimately, we decided to incubate this new policy center inside our foundation before spinning it off into a separate and independent nonprofit organization.
Aiming to create a true community resource, The Healing Trust worked with the Nelson Andrews Leadership Center to engage eighty stakeholders in an intense, three-day, co-design process. A core group of participants then spent another three months hammering out the details. This collaborative process established community buy-in and developed the road map for everything from staffing needs and board composition to the policy center’s mission, name, and brand.
Inspired and encouraged by the community’s engagement, The Healing Trust board committed $2.5 million over five years as seed funding to launch the Sycamore Institute.
Lessons Learned Through Launching The Center
What has the foundation learned through launching the Sycamore Institute, and why should philanthropy think about supporting policy research?
Ability to respond quickly in a rapidly changing policy environment: The Sycamore Institute has only been fully staffed for about six months—a period that includes one full legislative session in Tennessee and months of head-spinning debate in Congress over health reform. Yet, in that short time, our foundation’s investment has shown a solid return in the form of more than thirty reports, policy briefs, and blog posts about health policy and budget issues affecting Tennessee. As an independent public policy research center, the Sycamore Institute has the ability and agility to weigh in on rapidly evolving topics like how health reform efforts in Congress could affect our state.
Educating policy makers, the public, the media, and nonprofit partners: No matter where one stands on the political spectrum, we can all agree on the value of helping public officials make better-informed decisions. “Public Policy 101s” like how health insurance markets work and the nuts and bolts of Medicaid are just as important as analysis of specific legislation like the American Health Care Act. Our governor, administrative agencies, and legislators at the state and federal levels have already used the Sycamore Institute’s work to better understand key issues and communicate with their constituents.
These resources are equally valued by our foundation’s other grantees, who have become (1) even more knowledgeable about policy issues that affect their missions and (2) better equipped to engage with policy makers, the public, and other potential funders.
And in an era of shrinking newsrooms, the Sycamore Institute also provides important context and unbiased information to journalists covering health and fiscal policy. In very short order, the institute has become a trusted source for media outlets across Tennessee.
Unexpected Challenges
What were some of the unexpected challenges faced in launching a nonpartisan policy center?
Hiring the right leader: Hiring the right person to lead the Sycamore Institute proved more challenging than expected. The Healing Trust initially focused on candidates with backgrounds in policy research, but the collaborative design process we used shifted our focus to people with leadership experience who could launch a start-up and cultivate a diverse board. (Political, professional, geographic, and cultural diversity were all important criteria for the board.) Going back to the drawing board, our hiring committee interviewed new candidates and ultimately hired an experienced nonprofit executive director with an advanced degree in public policy.
Hiring the right staff: Building a staff with the ability to conduct high-quality research and analysis in-house and communicate about it to interested stakeholders was another challenge. Fully staffing the Sycamore Institute with an executive director, policy director, research analyst, and communications director took fourteen months—just in time to hit the ground running for the 2017 session of the Tennessee state legislature.
Recruiting a bipartisan board: To maximize and broaden the Sycamore Institute’s impact, the design shop showed we needed a bipartisan board committed to supporting nonpartisan work. The board’s balance of Republicans, Democrats, and political independents has been critical to building relationships with policy makers on both sides of the aisle. A balance of skill sets, diversity, and leadership potential is also key. With both the Sycamore Institute and its original board members based in the state capital, Nashville, recruiting additional board members from other regions of Tennessee remains a top priority.
Advocacy or analysis? Another question we wrestled with early on was where to draw the line. The primary goal of founding the Sycamore Institute was to fill a void of credible, independent, and nonpartisan analysis of policy issues in Tennessee. But should the organization go a step further to offer conclusions and recommend specific policies? Ultimately, the board and executive director decided that the Sycamore Institute would not advocate for specific policies, reasoning that doing so could hurt its credibility as a trustworthy source of politically neutral information.
Concluding Words
Building and maintaining health and well-being, which are complex issues, demand significant public and private resources. In Tennessee, as in most states, health care and education are the state’s top two budget priorities. The Sycamore Institute is dedicated to understanding and explaining the state budget and existing and proposed laws that affect the health and well-being of Tennesseans. Its information has already enabled citizens, policy makers, nonprofit agencies, foundations, media outlets, service providers, and others to understand better the fiscal and human impact of pending policies, giving stakeholders a nonpartisan and informed stake in the process and the outcomes.
An Untapped Opportunity For Health Care Progress: Redesigning Care For High-Need Patients
While uncertainty and debate about health care reform remains, there is near-universal agreement on the need to improve care delivery and health outcomes and decrease the rate at which spending continues to grow. An underrecognized but crucial component to achieving these goals is redesigning care for “high-need patients”—in other words, the small cohort of patients with complex needs who represent the greatest usage of the health care system.
Currently, 1 percent of patients account for more than 20 percent of health care expenditures, and 5 percent account for nearly half of the nation’s spending on health care, according to the Agency for Healthcare Research and Quality. Driving these costs for high-need patients are the functional limitations that impact patients’ daily living and ability to cope with health challenges, leading to their use of health care and social services that are often too late and poorly matched to their needs.
A 2014 survey conducted by the Commonwealth Fund found that high-need patients are highly susceptible to lack of coordination within the health care system and are more likely to experience cost-related barriers to accessing care, compared to other older adults. A 2016 Commonwealth Fund survey found that nearly two-thirds of high-need patients reported hardships with housing, meals, or utilities and that this population was also more likely to report feeling socially isolated, compared with the general adult population. Providing quality care for these high-need patients is a sizable challenge—yet it’s also an area where strategic attention and investment could yield significant payoffs for patients and the entire health system.
Indeed, a number of health systems have designed successful models that leverage an understanding of the unique characteristics of high-need patients to deliver quality care at sustainable costs.
Although there is no one-size-fits-all solution, a new publication from the National Academy of Medicine (NAM) says successful models generally share a number of common features across four dimensions:
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- Focus of service setting. Successful models tailor their care settings for either a targeted age group with various combinations of illnesses or individuals who use a significant amount of care. Examples of care settings include enhanced primary care, transitional care, integrated care, home-based care, and others.
- Care and condition attributes. Successful models include practices such as targeting patients most likely to benefit from an intervention, coordinating care and communication among patients and providers, promoting patient and family engagement in self-care, and facilitating transitions from the hospital and referrals to community resources.
- Delivery features. Successful models often feature the use of care managers alongside primary care providers to identify and work with high-risk patients. In addition, they often put high-risk patients under the care of specific physicians who treat a limited number of patients to enhance communication and adherence.
- Organizational culture. For care models to be successful, organizations must emphasize leadership at all levels; be capable of adapting based on the size of the program and local circumstances; offer specialized, customizable training for team members; and effectively use data access, sources, and application.
Denver Health: A Real-World Example
In 2012, Denver Health—an integrated system that includes an acute care hospital, all of Denver’s federally qualified health centers, a public health department, an emergency 9-1-1 call center, a health maintenance organization, and several school-based health centers—set out to create a new care model and transform its primary care delivery system by providing individualized care that would more effectively meet medical, behavioral, and social needs for its largely low-income population. In designing its 21st Century Care model, which included modifications to better serve its high-need patients, Denver Health’s goals were to improve the experience of care, improve the health of populations, and reduce per capita costs of health care. Early in its implementation, a fourth goal also emerged: improving provider engagement and creating healthier and happier patients.
With support from a Center for Medicare and Medicaid Innovation award, Denver Health was able to redesign its health teams and invest in health information technology to enable population segmentation and categorization of patients by clinical risk groups. Funds were also spent on rapid evaluation efforts to refine the care model’s design.
The new model matched care delivery to four risk tiers. Healthy individuals were assigned to tier one and interacted with staff using Denver Health’s eTouch text messaging platform. Individuals in tier two received additional chronic disease management, such as lay patient navigators, nurse care coordination and home visits, and environmental scans for children with asthma. For patients in tiers three and four, integrated behavioral health assessments and care were standard, as was the inclusion of nurse care coordinators, clinical pharmacists, and clinical social workers as part of the care team. For patients in tier four, Denver Health relied on specialized intensive outpatient clinics to serve as adult patients’ medical homes or multidisciplinary special needs clinics for high-risk pediatric patients. Targeted toward individuals who had experienced multiple potentially avoidable inpatient admissions within one year, care teams in these clinics included a dedicated social worker and navigator, and teams were responsible for a limited number of patients. This clinic also worked closely with the Mental Health Center of Denver.
Denver Health’s systems modification paid off, particularly for high-need patients. These innovations not only improved patient outcomes and patient and provider satisfaction, but also resulted in reductions in expected spending. Over a one-year period, the system saw an approximately 2 percent reduction in expected spending. Most of the savings were driven by a decrease in hospitalizations among patients in tier four. Denver Health’s success demonstrates the real potential of strategic models to improve care for these patients while curbing health care spending.
The Opportunity
Health systems can play an essential role in improving care for our nation’s high-need patients. That’s why we, as members of an initiative under the NAM Leadership Consortium for a Value and Science-Driven Health System, are spreading the word about the characteristics of high-need patients, the challenges they face, and the features of successful care models for this population. This initiative was conducted in partnership with the Harvard T.H. Chan School of Public Health, the Bipartisan Policy Center, the Commonwealth Fund, and publication sponsor, the Peterson Center on Healthcare.
To promote improvements to the care of high-need patients, health systems should work with payers, providers, and other health systems to better identify and target high-need patients, test new practices and tools, and develop interactive electronic health records that can include functional and behavioral status and social needs. They should use established metrics and quality improvement approaches to continuously assess and improve care models and partner with community organizations, patients, caregivers, and social and behavioral health service providers outside the health care system to create patient-centered care plans. Health systems can also assess their current culture and promote changes needed to build new and successful care models, blending medical, social, and behavioral approaches.
Of course, health systems can’t do this alone. At the federal level, policy makers should improve coordination among the Medicare and Medicaid programs to increase access to needed services and reduce the burden on patients and caregivers, and should continue payment policy reforms that align initiatives to incentivize pay-for-performance instead of fee-for-service models. Policy makers should also explore the expansion of programs that could mitigate the financial strain of caregiving, such as Medicaid’s Cash and Counseling—a national program in which the government gave people cash allowances to pay for the services and goods they felt would best meet their personal care needs and counseling about managing their services—and incentivize the adoption and use of interoperable electronic health records that include functional, behavioral health, and social factors.
Payers can develop financing models to provide social and behavioral health services that will both improve care and lower the total cost of care for high-need patients, recognizing that even cost-neutral programs are worth supporting if the outcome is positive for patients. Providers can learn to work collaboratively in teams and engage with patients, care partners, and their caregivers in the design and delivery of care.
Return on investment for most models of care for high-need patients will take time. But one of the most expensive and challenging populations for the current health care system will remain underserved and continue to drive health care spending until there is a unified effort to improve their care. We know there are models that work. Now, action is critical, and while health care reform remains on center stage in the national policy agenda, the time is right. By taking the lead in the bold changes needed for this transformation, health systems can play a pivotal role alongside all stakeholders in reducing costs and improving the health of some of the nation’s most vulnerable patients.
Forgotten Heroes: Remembering Dr. Alvin Blount, Who Helped Integrate America’s Hospitals
Mortar rounds shook the bunker. The 8225th Mobile Army Surgical Hospital (MASH) was crammed with casualties—civilians, Americans, and KATUSAs (Korean Augmentation to US Army). The four surgical tables under the direction of its acting chief surgeon, Alvin G. Blount, often operated around the clock, doing as many as 90 surgeries during sleepless protracted engagements. Blount could shut out the mayhem and focus only on his patient’s needs, as if everything else in the world had stopped. His calm, gentle demeanor commanded respect. His was the first racially integrated MASH unit, and he was its first black chief surgeon. Blount received the Korean War Service Medal for these efforts and would later become part of a group of doctors that helped radically reform US health care. He died earlier this year, the last surviving member of the group that initiated that effort.
The stories of the Korean MASH units would become popularized in a book, a movie, and a popular television series called M*A*S*H that ran from 1972 to 1983 and still appears in syndicated reruns. Yet, in an apparent attempt to assure “historical accuracy,” the television series chose to eliminate the black surgeon that appeared in the book and movie version.
After the war, Blount returned to private practice in racially segregated Greensboro, North Carolina. His Howard University medical school mentor, Charles Drew had warned him, “you boys going south will have to sweat it out, but victory will come.” Despite the US Supreme Court’s 1954 ruling in Brown v. Board of Education of Topeka that separate was inherently unequal in education, “separate but equal” remained the law of the land for hospitals. The Hill-Burton Act of 1946 specifically permitted federal funding for the construction of the two white-only hospitals in Greensboro and made similar provisions for other Southern cities. Black physicians in Greensboro were excluded from medical staff privileges at these white hospitals, one of which was the Moses H. Cone Memorial Hospital, the most well-endowed hospital in the region. Segregation in hospitals remained for another decade as Blount and a few courageous colleagues engaged in a polite and seemingly fruitless struggle against a powerful, entrenched white establishment.
George Simkins, Jr., a dentist and aggressive activist, took charge of the Greensboro chapter of the National Association for the Advancement of Colored People (NAACP) in the early 1950s and sought the help of the NAACP Legal Defense and Educational Fund (LDF) to challenge the city’s segregated hospital system. But recruiting black physicians to join as plaintiffs proved difficult. Some were comfortable with the status quo, and most were concerned about damaging ties with white colleagues, who they relied on for help with their patients. Blount himself was reluctant, but he was close friends with Simkins and knew that the segregated system resulted in lower-quality care for his patients. Blount joined the lawsuit and helped Simkins recruit five other physicians to do the same. These five physicians, in addition to two black dentists, two black patients, Blount, and Simkins, made up the final list of 11 plaintiffs. Michael Meltsner, a young, white protégé of Thurgood Marshall, served as lead attorney.
The suit, filed in US District Court in 1962, argued that Greensboro’s two white hospitals, the Moses H. Cone Memorial Hospital and the Wesley Long Hospital, functioned as an “arm of the state,” having received a total of $2.8 million in federal Hill-Burton program funds. By remaining segregated, the hospitals violated the due process and equal protection clauses of the Fifth and Fourteenth Amendments of the US Constitution. Accordingly, the plaintiffs argued, the Hill-Burton law was unconstitutional because it provided federal funding for the construction of racially segregated institutions. As is customary with any case challenging federal law, the US attorney general was given the opportunity to defend the federal government. Surprisingly, however, Attorney General Robert Kennedy joined the plaintiffs, seizing the opportunity to push the administration’s stalemated civil rights agenda. Despite this unexpected support, the District Court dismissed the suit. The “victory” that Charles Drew had promised seemed increasingly distant.
Blount and his fellow plaintiffs, however, now found themselves at the beginning of a long and unpredictable journey to transform US health care. In a 3:2 decision in 1963, the US Court of Appeals of the Fourth Circuit ruled in favor of the plaintiffs. The hospital defendants appealed to the US Supreme Court, but in a rushed ruling, just days before the Senate began its longest debate on the Civil Rights Act of 1964, the Court chose to not review the lower court decision and let it stand. Title VI of the Civil Rights Act, the most likely provision to be eliminated to assure the bill’s passage, prohibited the provision of any federal funding to organizations that discriminated on the basis of race. By letting the Fourth Circuit decision stand, the Supreme Court effectively made Title VI the law of the land before it had even passed through the legislative branch.
Resistant to any federal interference in their organization, the executive committee of the board of the Moses H. Cone Memorial Hospital recommended to the full board that the hospital return its Hill-Burton funds to the federal government to relieve it of any obligation to desegregate. That recommendation was rejected. Nothing in the Court’s decision, of course, prevented other hospitals from choosing not to apply for Hill-Burton construction funds or from returning funds they had already received. There was also no provision in the law for federal enforcement for those hospitals that had already received federal money. The NAACP LDF or other parties could mount challenges against individual hospitals, but it would be a slow and costly process.
The Medicare legislation enacted less than a year later, however, changed the game. Hospitals could survive without Hill-Burton funds, but they could not “choose” not to be Medicare and Medicaid providers. No hospital would be certified as a Medicare provider without being fully compliant with concrete nondiscrimination requirements. Local civil rights groups whose members included hospital workers served as the final arbiters. Any lapses in enforcement by federal volunteer inspectors or subterfuge by the hospitals would not escape notice.
In less than six months, 6,000 hospitals became fully compliant. Thanks to Medicare, America’s hospitals went from being our country’s most racially and economically segregated institution to our most integrated. Almost all of the separate wooden bench waiting rooms and welfare wards disappeared. Patterns of use of services that had always been shaped by racial and economic privilege began, for the first time, to reflect actual medical need. Over the next 20 years, racial and economic disparities in infant mortality and life expectancy narrowed. In Greensboro, Blount became the first black surgeon to operate at Moses H. Cone Memorial Hospital. Yet, the events that propelled all of these changes have been almost forgotten. Only current political events in North Carolina and nationally have stirred some local reflection about that past.
A statue of Simkins was unveiled on the lawn of the Guilford County Courthouse in October 2016, near where he was jailed for trespassing in 1955 after trying to play golf with friends on the city-owned golf course. Only after his death was he honored as the city’s “Moses.”
In 2016, Blount, at age 94, was the only surviving plaintiff in the Simkins v. Moses Cone Hospital suit. He was still seeing a limited number of patients under the watchful eye of his loyal long-time practice manager, Martha Reid. His office on East Market Street was filled with memorabilia and memories of more than a half century of practice. In October, he was invited to a meeting at the regional nonprofit integrated health system that Moses H. Cone Memorial Hospital became. About 250 health care professionals and community leaders attended, along with Blount’s children. Dr. James Wyatt, a black surgeon and president of the Cone Health medical and dental staff, thanked Blount “for opening doors for me.” Cone CEO, Terry Akin, addressed Dr. Blount: “It seems to me, and to our medical and dental staff, that we needed to take the opportunity to apologize for our role in this chapter of our history and to honor these individuals for challenging us to be our best selves, and for their foresight and courage in changing America.” Cone donated $250,000 to a scholarship fund honoring Blount and the other plaintiffs that will provide support for minority students pursuing careers in health care. It will be administered by the Greensboro Medical Society, one of many local black medical societies across the country that played a key role in the hospital desegregation struggle. A month later, a historical highway marker was unveiled on North Elm Street adjacent to the Moses H. Cone Memorial Hospital, acknowledging the plaintiffs and their role in changing the nation’s hospitals.
Dr. Blount passed away on January 6, 2017, at Moses H. Cone Memorial Hospital after a brief illness. His family marked his passing with a quiet event at the small Episcopal church adjoining the North Carolina A&T State University campus, which served as an early organizing center for the lunch counter sit-in movement. “My life is my memorial,” he had told his practice manager. “No big casket or cemetery plot either—cremation. … Just be sure I’m dead before you burn me.”
His life was indeed his memorial. From caring for wounded soldiers in Korea to feeding arrested Dudley High School students after a lunch counter sit-in, Blount was an endless source of compassion and integrity. He and his wife lovingly raised seven children, and his youngest daughter, Gwen Blount Adolph, now a lawyer in New York, recently reflected on her father’s life: “My daddy was a gentle soul who wanted to do right by everyone.” She recalled the night the arm fell off her brother Alvin’s teddy bear, and he was inconsolable. “We all had this vivid memory of my dad taking needle and thread and operating on Teddy…. We all gathered around, as if it was an operating room. He was so patient, and it was so important to my brother. It was as if everything else in the world had stopped—that was Daddy.”
In these divisive times, it is too easy to be dismissive of the past and despairing about the future. The lives of Dr. Blount and the other Moses Cone plaintiffs tell us something different. They tell us that landmark pieces of social policy such as Medicare, when implemented fairly and compassionately, can promote justice and equality. And they tell us that the power to remedy injustices lies with individuals who are willing to challenge the status quo and further the cause of universal health care for all Americans.
Advertising cutbacks reduce Marketplace information-seeking behavior: Lessons from Kentucky for 2018
Advertising cutbacks reduce Marketplace information-seeking behavior: Lessons from Kentucky for 2018
The Trump administration announced Thursday that it was cutting spending on advertisingfor the 2018 Marketplace open enrollment period from $100 to $10 million. Empirical work can inform our expectations for its impact, assuming these cuts are implemented. We already know that higher exposure to advertising has been associated with perceptions of feeling more informed about the ACA and counties with more television advertising saw larger decreases in the uninsured rate during the 2014 open enrollment period.
Kentucky— an early success story under the ACA—sponsored a robust multimedia campaign to create awareness about its state-based marketplace, known as kynect, to educate its residents about the opportunity to gain coverage. However, after the 2015 gubernatorial election, the Bevin administration declined to renew the advertising contract for kynect and directed all pending advertisements to be canceled with approximately six weeks remaining in the 2016 open enrollment period. The reduction in advertising during open enrollment gives us precisely the rare leverage needed to assess the influence of advertising using real-world data.
We obtained advertising and Marketplace data in Kentucky to identify whether a dose-response relationship exists between weekly advertising volume and information-seeking behavior. Television advertising data for Kentucky were obtained from Kantar Media/CMAG through the Wesleyan Media Project. These data provide tracking of individual ad airings, including date, time, sponsor, station, and media market. We used a population-weighted average to create a state-level count of kynect ads shown per week. Our outcome measures were related to information-seeking behavior—phone calls to the marketplace and metrics related to engagement on the kynect website—and came from the Office of the Kentucky Health Benefit Exchange via public records request. We used multivariable linear regression models to identify variation in each outcome attributable to kynect advertising and estimated marginal effects to identify the influence of advertising during open enrollment.
State-sponsored advertising for kynect fell from an average of 58.8 and 52.3 ads per week during the 2014 and 2015 open enrollment periods to 19.4 during the first nine weeks of the 2016 open enrollment period and none during the final four weeks. We found that advertising volume was strongly associated with information-seeking behavior through the kynect web site (see Figure 1). Each additional kynect ad per week during open enrollment was associated with an additional 7,973 page views (P=.001), 390 visits (P=.003), and 388 unique visitors (P<.001) to the kynect web site per week. Based on the average number of ads per week during the first two open enrollment periods, our estimates imply that there would have been more than 450,000 fewer page views, 20,000 fewer visits, and 20,000 fewer unique visitors per week during open enrollment without the television campaign. Advertising volume during open enrollment was not associated with calls to the kynect call center.
Our analysis tells us that state-sponsored television advertising was a substantial driver of information-seeking behavior in Kentucky during open enrollment––a critical step to getting consumers to shop for plans, understand their eligibility for premium tax credits or Medicaid, and enroll in coverage. Extrapolating to the national landscape, our data suggest that lower expenditures on outreach and advertising would reduce consumers’ information seeking. The announced 90% reduction will be paired with a nearly 40% cut to in-person enrollment assistance through navigator programs. This is particularly problematic after a tumultuous summer of legislative threats to the ACA, possibly leaving consumers confused about whether Obamacare is still the law of the land. Lower outreach could lead to a failure to engage so-called healthy procrastinators, resulting in weaker enrollment and a worsening risk pool for insurers. With an already shortened open enrollment period, this cascade of cuts is likely to further jeopardize the stability of the Marketplace.
7 Barnacles Creating Drag On Your Leadership Effectiveness
As a natural process of a ship being in the water for extended periods of time, barnacles and other marine life grow and attach themselves to the ship’s hull. If left unattended, the barnacles can increase drag up to 60%. This can decrease speed by 10% and result in the ship using 40% more fuel. In essence, the ship works harder, spends more energy, and performs worse over time.
The same principle applies in our leadership journey. Over the course of time we accumulate habits and practices that increase drag on our performance. Everything seems to take more time and energy than it should require. It builds up almost imperceptibly until one day we wake up and feel like we’re burned out. Just like ships are periodically removed from the water to have their hulls cleaned, leaders need to regularly remove the barnacles that are holding them back from performing at their best. Here are six common barnacles that weigh you down over time:
1. Meetings — Let’s face it, even though meetings are the bane of our existence, they serve a vital purpose in organizational life. It’s a primary way information is shared, relationships built, and work is accomplished. However, we too often let meetings run us instead of us running meetings. Review your calendar and examine each of your regular meetings. Are they still serving the purpose for which they were created? Do the meetings have specific agendas with desired outcomes identified? Are the right people involved to make decisions? Are there alternative ways to accomplish the goal of the meeting without bringing everyone together? Those are all valuable questions to ask. If the meetings aren’t providing the return on investment that makes them worth your time, cancel them or reshape them to be more productive.
2. Policies, Procedures, Processes — We institute policies, procedures, or processes to handle new activities that arise over the course of time. When money, staffing, and time isn’t an issue, we don’t give much thought to adding new work into the system. But when resources become scarce, it can prove very difficult to reduce or eliminate activities or services that have become the norm. It can be helpful to apply the Pareto Principle, or 80/20 rule, to your leadership practices. What are the 20% of your activities that produce 80% of your results? Focus on the 20% and remove the 80% that are barnacles.
3. Committees — Collaboration is an important and valuable practice but sometimes we take it a bit too far by trying to do everything by committee. It slows down the process and frustrates everyone involved. If a committee is truly needed, make sure it has a clear purpose, goals, and clear decision-making authority. If you’re a member of a committee that doesn’t have a clear purpose and goals, reevaluate your membership. Maybe it’s time to remove this barnacle.
4. No-No People — Every organization has naysayers; it’s a fact of life. However, there is a big difference between people who express doubts or ask questions in a genuine effort to understand the proposed change and make the best decision possible, versus those who are No-No’s—their answer will always be “no,” no matter what. No-No’s are huge barnacles that cause tremendous drag on your leadership. They require enormous amounts of emotional and mental energy that distract you from more important priorities. Removing this barnacle will dramatically increase your productivity and personal satisfaction of being a leader.
5. No Vision or Goals — In a paradoxical sort of way, the lack of something, in this case vision and goals, can actually be something that weighs you down. A clear vision and specific goals help to focus your energy and streamline your efforts. When you know what you’re striving for, you can pare away all the non-essentials that get in your way. Without a clear vision or goals, your leadership energies are widely dispersed and less effective. If you feel like your days are consumed with fighting fires and you go to bed at night exhausted from chasing every squirrel that crosses your path, then chances are you don’t have a clear vision or goals driving your actions.
6. Seeking the Approval of Others — You will always be unfulfilled as a leader (or person) if your self-worth is determined by the approval of others. Striving to please all people in all circumstances is a barnacle that will slow you down to a crawl. Leaders sometimes have to make decisions that benefit one group of people over another and that inevitably leads to conflict. The best thing you can do as a leader to remove this barnacle is to act with integrity in all circumstances. Not every decision you make will be a popular one, but as long as you consistently live your values you will earn the respect and trust of your colleagues.
7. Lack of Self-Care — Imagine your leadership capacity as a large pitcher of water. The water represents your time, energy, and abilities as a leader to influence others. If all you do is pour yourself into others, without periodically refilling your own reserves, you’ll eventually run dry. To maintain your leadership effectiveness, it’s important to nurture yourself through reading, sharing experiences with other leaders, and having mentors or coaches who stretch you and cause you to grow in your own leadership journey.
The buildup of these different leadership barnacles is inevitable but it doesn’t have to be final. Perform a regular cleansing to remove the barnacles and restore your leadership performance to its full potential.
Cartoon – Modern Management Training
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Cartoon – The Fuel to be a Top Leader
HENRY KOTULA 