Category Archives: Uncategorized

Medicaid Expansion Out of Pocket Spending Low Income

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http://www.commonwealthfund.org/publications/newsletters/ealerts/2017/aug/low-income-families-in-medicaid-expansion-states-have-much-lower-oop-spending?view=newsletter_email&email_web=true&omnicid=EALERT1260685&mid=henrykotula@yahoo.com

New Commonwealth Fund research out today demonstrates how states that expanded Medicaid eligibility have not only improved low-income residents’ access to health care but have also reduced what families must spend out of pocket on premiums, cost-sharing, and other related expenses.

Prior studies had shown that low-income residents of states that expanded Medicaid under the Affordable Care Act (ACA) are less likely to experience financial barriers to health care access. But the impact on people’s out-of-pocket spending had not been measured until now.

The new analysis, conducted by a team headed by Sherry Glied, dean of New York University’s Robert F. Wagner Graduate School of Public Service, found that the average low-income family in a Medicaid expansion state saves about $382 annually relative to a comparable family in a nonexpansion state. Moreover, low-income families in states that expanded Medicaid are less likely than their counterparts to have any out-of-pocket health care costs at all.

The authors say there was no statistically significant difference in outcomes for states that expanded through conventional Medicaid or through a waiver program.

http://www.commonwealthfund.org/publications/issue-briefs/2017/aug/medicaid-expansion-out-of-pocket-spending-low-income?omnicid=EALERT1260685&mid=henrykotula@yahoo.com

 

89% OF EMPLOYEES ARE DEMOTIVATED BY INEFFECTIVE MANAGERS AND LEADERS

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89% of Employees are Demotivated by Ineffective Managers and Leaders

It might hurt, but look in the mirror if people around you are low energy slugs.

The greatest ability is the ability to develop abilities.

98% of employees who have good leaders are motivated to do their best. Only 11% of employees with ineffective managers felt motivated to give their best.*

The magic question:

Improvement stops when people believe they’ve reached the level of “acceptable” performance.

Challenge people to reach for the next level by asking a simple question.

“How do we take this to the next level?”

I’ve been asking teams this question. It works.

7 keys to reaching the next level:

  1. Paint a picture of the next level. “What might the next level look like?”
  2. Ask, “What might you do to take your performance to the next level?” Identify three or four possible behaviors.
  3. Create focus before performance.
    • “What do you plan to do?”
    • “What’s important?”
  4. Give pep talks before performance.
    • “You got this.”
    • “I know you can do this.”
    • “I know you’re going to do even better than last time.”
  5. Provide immediate feedback after performance.
    • “You looked down when you were thinking. You lost me.”
    • “You wandered at the end of the meeting. How might you end better next time?”
    • “You seemed resistant when you kept asking the same question. How might you practice greater openness?”
  6. Appreciate improvement. “You paused and lowered your voice before the main point of your presentation.That really worked.” The Boston Consulting Group reports that the number one factor in employee happiness is appreciation for their work.
  7. Clarify reasons for success.
    • “What did you do differently?”
    • “What did you do this time that you need to keep doing?”

Tip: You never get to the next level by repeating the past.

How might leaders bring out the best in others? In teams?

Stop Hiring for Cultural Fit and Start Hiring For Cultural Fitness

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https://www.tlnt.com/stop-hiring-for-cultural-fit-and-start-hiring-for-cultural-fitness/?mkt_tok=eyJpIjoiWmpsbE5HVmpNRFl6WXpabCIsInQiOiI0V1Fvbmcrbk1LMVBWcHpDZ3hCYmc1MVJMTlwvT2g1RUdzMHNBeFY3Vit3b2tiU2dDaDdFWStzYzFnaG9YZ1dzVDgrTUZvR2p1T212MTBKTnFVa0RzNUVyWXdNUXhCUlUrV04wVFBqeGhxWWt0aVBBVzQzbENKUjdkTTlMN00zT2YifQ%3D%3D

Culture is the glue that brings a team or organization together. But if the glue is too sticky it can make them stuck instead of making them stay together. Cultural fit can become a limitation rather than a strength.

Which takes me to the topic of hiring the right talent for your organization:

Do you hire people that are a cultural fit?

Or do you hire to improve your culture fitness?

Culture is something dynamic

The notion that people can or can’t fit into a specific culture is, to at least some extent, at odds with the fluid teams organizational structure. Cultural fit as an operating requirement not only forces new employees to adapt but, also hinders your culture’s ability to be influenced by outsiders. It limits its ability to grow.

When interviewing people, I do care about cultural fit,  but I also look for culture disruption. As I like to tell candidates: “I want you to be influenced by our culture but, most importantly, I want you to challenge and influence our culture too.”

Cultural dynamics involve an ongoing struggle between old and new elements. If you only stick to what fits your existing culture, your organization will get stuck. Yet, if you only care about the new shining object, you might be throwing away core elements of your culture just for the sake of change.

Before practicing any competitive sports, we need to prepare our body. We stretch our muscles and warm up, not just to avoid injuries, but also to make sure we can play to our highest potential.

The same is true when confronting change. Just like with sports, you need to stretch your organizational culture. It needs to prepare, to warm up, to be ready to adapt to an ever-changing world.

Hire for cultural fitness

When evaluating candidates, choose those that will make your team grow. Stretch your culture by hiring people who will make it more adaptive, experimental and resilient.

Here are some considerations when hiring for cultural fitness:

  • Amplify your team’s perspective:Hire people with diverse backgrounds, skills and personalities to avoid biases and so you are drinking something more inspiring and refreshing than your own corporate Kool-Aid.
  • Encourage teams to dissent:Promote differences and tensions, not just affection. Dissent is not comfortable for everyone, but is the only way to avoid group thinking and stretch your team beyond its comfort zone.
  • Continuously challenge your culture: Hire opinionated people, hire outsiders or hire from outside your industry. Bring someone with the right talent, but goes against your culture. Shaking things up from time to time will keep your culture in good shape. As I wrote here, misfits are the best option for energizing a team.
  • Promote diversity of thinking not just demographic diversity: Train your team to embrace difference of opinions. The more heterogeneous the members, the more interesting and productive the team. Being more open to people from different walks of life will provide fresh eyes and make the team smarter. It will help solve for the “demographic” diversity needed too but with a purpose.

Diversity takes training

The real problem behind diversity is that teams are not trained to deal with differences of opinions. Managers and team members alike have been trained to think and behave the same: the corporate way. People are expected to accommodate rather than to challenge the status quo.

One of the key issues of bringing “diverse” people to a team is that they see things differently. They challenge things through their fresh eyes. And not every organization and manager can swallow that.

Here are some points to help embrace diversity to improve cultural fitness.

  • Diverse means different not inferior: Conversations around diversity need to shift from quota to curiosity. Instead of thinking how we can provide a certain demographic with opportunity — a hierarchical approach — we need to ask what we can we learn from people that are different from us. Diversity is about becoming better at interacting with those who can provide fresh eyes and challenge the way we operate.
  • Quotas limit rather than provide opportunities: Establishing percentages to have representation from different sectors might come from a place of good intention. But, in most cases, it misses the point — the need to create a balanced team. I’ve seen many companies that use quotas, simply to check the box and appear to be a good corporate citizen. But they have little commitment to embracing diversity of thinking.
  • People are more than a demographic: Being part of a minority (age, gender, sex preference, etc.) is just one aspect of any person. Our identity is more complex than our religious or sexual preferences. Those do play an important role. But who we are is a composite of multiple factors: our origin, experience and dreams. Organizations need to encourage their teams to see people beyond their demographics.
  • Encourage transparent conversations:Trust is the basis in which all emotional transactions are done. And is one of the most powerful elements to keep culture alive. Conversations around diversity are still too controlled. Organizations need to discuss these things more openly. Help people realize we are all different, not just those who don’t belong to our tribe. Creating experiences where people can share their journey or their personal hobbies and passions can definitely spark curiosity and show how that everyone can learn from each other. Creating a culture of transparency can help reposition diversity as learning.

Why cultural fitness matters to me

Everyone can learn (almost) anything. And anyone can adapt to any corporate culture. It can be hard or tough but smart people always adapt.

What I care the most, is how a new hire can help make our organization smarter. This is my checklist of what I look for:

  • They are smart and talented
  • They possess the ability to adapt to change
  • They are genuine and have a voice of their own
  • They are open to learn
  • They are generous rather than selfish

If they score well in the above, then they will definitely help our culture stretch, regardless if they are – today — the right cultural fit.

One last thing. I always like to ask candidates: “What are you bringing to the table that is unique?” Basically, I want to know not just what that person is good at but how they will help make our organization smarter. I want people who will build and strengthen our cultural fitness.

A Looming Leadership Talent Crisis: Can you solve the Leadership gap?

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https://cdn2.hubspot.net/hubfs/498900/WP_Healthcare_Looming%20Talent%20Crisis.pdf?t=1503343642250

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Coverage expansion and primary care access

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Coverage expansion and primary care access

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When you have a health problem, your first stop is probably to your primary care doctor. If you’ve found it harder to see your doctor in recent years, you could be tempted to blame the Affordable Care Act. As the health law sought to solve one problem, access to affordable health insurance, it risked creating another: too few primary care doctors to meet the surge in appointment requests from the newly insured.

Studies published just before the 2014 coverage expansion predicted a demand for millions more annual primary care appointments, requiring thousands of new primary care providers just to keep up. But a more recent study suggests primary care appointment availability may not have suffered as much as expected.

The study, published in April in JAMA Internal Medicine, found that across 10 states, primary care appointment availability for Medicaid enrollees increased since the Affordable Care Act’s coverage expansions went into effect. For privately insured patients, appointment availability held steady. All of the gains in access to care for Medicaid enrollees were concentrated in states that expanded Medicaid coverage. For instance, in Illinois 20 percent more primary care physicians accepted Medicaid after expansion than before it. Gains in Iowa and Pennsylvania were lower, but still substantial: 8 percent and 7 percent.

Though these findings are consistent with other research, including a study of Medicaid expansion in Michigan, they are contrary to intuition. In places where coverage gains were larger — in Medicaid expansion states — primary care appointment availability grew more.

“Given the duration of medical education, it’s not likely that thousands of new primary care practitioners entered the field in a few years to meet surging demand,” said the Penn health economist Daniel Polsky, the lead author on the study. There are other ways doctor’s offices can accommodate more patients, he added.

One way is by booking appointment requests further out, extending waiting times. The study findings bear this out. Waiting times increased for both Medicaid and privately insured patients. For example, the proportion of privately insured patients having to wait at least 30 days for an appointment grew to 10.5 percent from 7.1 percent.

The study assessed appointment availability and wait times, both before the 2014 coverage expansion and in 2016, using so-called secret shoppers. In this approach, people pretending to be patients with different characteristics — in this case with either Medicaid or private coverage — call doctor’s offices seeking appointments.

Improvement in Medicaid enrollees’ ability to obtain appointments may come as a surprise. Of all insurance types, Medicaid is the least likely to be accepted by physicians because it tends to pay the lowest rates. But some provisions of the Affordable Care Act may have enhanced Medicaid enrollees’ ability to obtain primary care.

The law increased Medicaid payments to primary care providers to Medicare levels in 2013 and 2014 with federal funding. Some states extended that enhanced payment level with state funding for subsequent years, but the study found higher rates of doctors’ acceptance of Medicaid even in states that didn’t do so.

The Affordable Care Act also included funding that fueled expansion of federally qualified health centers, which provide health care to patients regardless of ability to pay. Because these centers operate in low-income areas that are more likely to have greater concentrations of Medicaid enrollees, this expansion may have improved their access to care.

Other trends in medical practice might have aided in meeting growing appointment demand. “The practice and organization of medical care has been dynamic in recent years, and that could partly explain our results,” Mr. Polsky said. “For example, if patient panels are better managed by larger organizations, the trend towards consolidation could absorb some of the increased demand.”

Although the exact explanation is uncertain, what is clear is that the primary care system has not been overwhelmed by coverage expansion. Waiting times have gone up, but the ability of Medicaid patients to get appointments has improved, with no degradation in that aspect for privately insured patients.

Time Crunch Among Hurdles for Bipartisan Senate Push to Bolster ACA

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https://morningconsult.com/2017/08/18/time-crunch-among-hurdles-bipartisan-senate-push-bolster-aca/

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The leaders of a key Senate committee say they are cautiously optimistic about reaching a deal to shore up the Affordable Care Act’s individual marketplaces, but even with a bipartisan effort, it is far from certain whether they can hash out an agreement in time.

The Senate Health, Education, Labor and Pensions Committee leaders of both parties have set a self-imposed mid-September deadline for a bipartisan agreement. To keep lingering animosity from the Obamacare repeal fight from seeping into negotiations, Chairman Lamar Alexander has made clear that what he’s seeking is far from comprehensive.

The bill will have to be “small, bipartisan and balanced,” the Tennessee Republican said in a statement Wednesday.

Above all, Democrats want to make sure insurers continue to receive payments that help them cover out-of-pocket costs for some low-income patients. President Donald Trump has threatened to cut off the payments, and the administration has kept insurers on tenterhooks by making them only on a month-to-month basis.

Without the subsidies, known as cost-sharing reductions, some insurers warn they’ll be forced pull out of the ACA markets or hike premiums. The companies need certainty about payments at the latest by Sept. 27, the final deadline for them to decide whether to sell Obamacare plans in 2018.

If the committee can reach agreement next month, it would still be a challenge to get a bill through the full Senate and House before the key deadline for insurers. And Trump would still have to sign a bill into law that extends payments he is loath to continue.

The potential for chaos was highlighted this week when the nonpartisan Congressional Budget Office released a report estimating average premiums would rise 20 percent next year and the federal deficit would grow by $194 billion by 2026 if the administration stops paying.

While some conservative hard-liners want to cut off the CSRs, Alexander and other top Republicans have shown they’re willing to work with Democrats to have Congress extend the payments.

Sen. Patty Murray of Washington, the panel’s ranking Democrat, on Thursday called for quick action.

“People across the country are facing much higher premiums next year because of uncertainty driven by the Trump Administration, so I hope Republicans will join Democrats to act quickly to protect patients and families from paying more for care they need — and then continue working in a bipartisan way to make health care more affordable, accessible, and higher quality for all,” Murray said in a statement.

Democrats also want some sort of reinsurance program, an idea that has bipartisan support and would help insurers pay for their most expensive enrollees.

But in return for extending CSRs and including reinsurance, Republicans want to give states more authority over their health care systems, and Democrats could balk at some of their proposals.

Alexander has specifically pointed to changing the ACA’s 1332 waiver program, which allows states to opt out of key ACA regulations as long as it doesn’t lead to reduced coverage, skimpier benefits, more expensive insurance or a higher federal deficit.

In remarks to reporters earlier this month, Alexander noted a proposal that would eliminate all of those requirements besides increasing the federal deficit, in order to give states “more of an opportunity to approve insurance plans.” The plan, which was included in Senate Republicans’ health overhaul bill, would also bar the administration from rejecting a waiver as long as it doesn’t increase the federal deficit.

Democrats would likely oppose that proposal, wary of allowing states to undercut key Obamacare requirements without those other conditions in place.

Sen. Tim Kaine (D-Va.) said he’s interested in a proposal from Sens. Bill Cassidy (R-La.) and Susan Collins (R-Maine) to let states replace Obamacare’s most contentious provision — the mandate requiring people to purchase health insurance or pay a penalty — with a system that automatically enrolls individuals in low-cost coverage if they don’t do so on their own.

Backers of this approach argue it would offer comparable coverage to the individual mandate while being less intrusive, allowing people to opt out.

“I think that’s intriguing,” Kaine said earlier this month in a brief interview. “We ought to have that discussion, but you can’t blow the mandate without something to bring people into the program and do what insurance needs to do, which is to spread risk.”

But auto-enrollment has raised concerns among some liberal health care analysts, including over how to implement and administer such a system. The outstanding questions cast doubt on whether it could garner enough backing to be included in the stabilization bill.