First, a video 😀
I love ideas.
People who know me know that I've always got an idea or mental model (or three) that I'm spending a lot of time thinking about. This week it's the book, "The 4 Disciplines of Execution" by Chris McChesney, Sean Covey, and Jim Huling. It's been a #1 Business Bestseller and for fans of "The Innovators Dilemma", the forward is written by Clayton Christensen. What I like the most about this book is not that the ideas are revolutionary (they aren't), but that it's actionable if you want to get better results with the things that matter most to you. In fact, Discipline #1 is identifying and focusing on what's "wildly important" to you. I'm a generalist by nature—I like to explore a little bit of everything—so focusing like this really is a disciplined effort for me. Discipline #2 is acting on leading measures, Disciple #3 is keeping a compelling scorecard, and Discipline #4 is creating a cadence of accountability. I may love having lots of ideas to pull from, but I also love structure. And, you may notice me pulling more from this structure in my thinking about our organization and how we can create transformational impact.
How does this apply to this week's check-in? I'll start with Discipline #1, focus. The book argues that choosing 2-3 goals is the sweet spot for what you can knock it out of the park with. If you decide on 2-3 goals that are wildly important and keep a laser focus on them, you can achieve those 2-3 goals with excellence. Choosing more goals diminishes the returns. Choosing 4 to 10 goals reduces the likelihood of excellent results to 1-2 goals. Choosing 11-20 goals lowers the likelihood of excellent results on any of them to zero.
So, here we go.
My first draft of the three most wildly important goals for Medicine Forward: wellbeing, prior auth, and organizational sustainability:
Putting wellbeing first - I've been in many conversations about how to fix what's broken in the healthcare workplace, and one idea keeps coming up. Organizations need to figure out how to make wellbeing a top priority, if not THE top priority. With that in mind, it only makes sense that Medicine Forward commits to being a wellbeing-first organization ourselves. What does that mean? It means we are committing to take care of each another. It means that how you are doing as members and leaders of this organization is the most important thing, and we are going to talk about it and act on it. We will be relentless in looking for opportunities to help. Two weeks ago I re-titled this newsletter as a check-in, and that was on purpose. I genuinely want to know how you are doing and how I and Medicine Forward can better serve you. Don't stop with the comments on these posts and on our Mighty Network. Being a wellbeing-first organization also means there will be times we have to make compromises and hard decisions. We may slow down progress on a project or cancel a meeting if someone's wellbeing is at stake. It's time to be different, and it's time to lead by example. That starts here, and it starts with us. Thanks to Tom Cooney for sharing this great piece about a structural change we can implement immediately to improve wellbeing. There should be no viable argument from administrators or clinicians about why we should continue this evidenceless practice:
When peer comparison information harms physician well-being | @PNASNews "implementation of peer comparison did not significantly improve physicians’ #preventive care performance, but it did significantly decrease job satisfaction and increase #burnout" pnas.org/doi/10.1073/pn…And, thank you to Colleen Christmas for pointing out what we all experience to be true: we are too often graded on things we have little or no individual control over. A lost sense of personal agency is a huge driver of burnout. As an organization, we will keep raising our voices about how this must change.
@SAmbertPompey @PDX_Tom @MParshleyMD @sue_bornstein @GIMaPreceptor @InduPartha @drsusan @jesscolburn @kavitapmd @RosenthalHealth @doctorbecca1 @PaulNWilliamz @gabrieldane 👆🏼 That’s my theory, too. We attribute to a single person something that has more to do with teamwork and support, and dang that is frustrating when that person is treading water to stay afloat.
Disrupting prior-auth - We've done the hard work to choose this as our most important advocacy action. If you're not already fired up, consider this: while being one of the most notorious offenders with prior auth, UnitedHealth Group's profit topped $5 Billion in the second quarter of 2022. 🧐
UnitedHealth Group's profit tops $5B in Q2 ...ahem. Same people burdening and obstructing healthcare with prior auth. The evidence that prior auth benefits care doesn't exist. Evidence of harm keeps getting more compelling 😡 #FixPriorAuth (source 👇) beckerspayer.com/payer/unitedhe…And, how about this? A case in Ohio where a doc was awarded financial reimbursement for his time spent doing prior auth. The case highlights how insurance admits that there are now 40,000 prior auth inquiries in same time frame where there used to be only 700 total. That’s a 57-fold increase in prior auth volume. The insurer also admitted that prior auth had nothing to do with patient safety. That flies straight in the face of the argument that this is about protecting patients.
ATTENTION!! To all docs who despise prior authorizations(PAs)--there is hope. In 2007, Gary Gibson, MD sued Medco Health Solutions, a health insurance company in Ohio, for compensation for time used in performing prior authorizations. Duties which could also have been performedWe’ve still got a lot to learn and a lot of work to do, but we are on a good trajectory with prior auth. Tatiana, Brian, Emily, Nate, Sanford, and I will meet with ACP leaders next Monday the 25th to discuss our next steps together and how to make progress on actionable solutions.
Sustaining our work - This is the third wildly important goal for our organization. I am so proud of our team and eternally grateful to each of you for the support that has gotten us to this point. As we go into my final year as President, I’m going all in on finding a way to keep us going in a way that can be sustained for years to come. I had some great conversations about the accelerator concept and other potential strategies for funding this week. We still don’t have it figured out, but I will not let this go. We’ve come to far and it means too much. Janice Mancuso (Osler Symposia) and I have agreed to have weekly planning meetings to bring our retreat idea to life. We are excited to energize this work with a small but powerful in-person experience. We are looking at dates for a weekend in the Fall in the Baltimore / Washington DC area. Tatiana Prowell, Brian Dixon, Scott Gibberson, Janice, and I are planning to be there. That leaves 15 maximum more spots to join us. I’d love to have you with us, and I encourage you to RSVP now if you want to be considered to be part of it.
I want to close this week’s newsletter with a very special invitation. Jeff Cohn is a retired oncologist and current life coach. I’ve had to honor of getting to know him well through our Medicine Forward book club. Jeff has volunteered to take six of us thought the Positive Intelligence mental fitness boot camp experience free of charge. This is usually a $1,000 program, but Jeff is so passionate about helping physicians that he’s doing this pro bono. I’ve been a skeptic about the role of coaching in the past. Afterall, isn’t it the system that needs to change? That’s a BIG YES …,AND there is massive potential benefit in working on our inner game as effective change agents. I am signing up for sure. If you’d like to learn more, check out the program here.
The first five people to respond by the end of the week will have the chance to do this.
Onward!
Gabe
I had no idea about those numbers. Both United’s profitability and the massive jump in PA’s. My biggest grips is that the whole process is automated ie its not even a person who denies but an algorithm. I will get denials before I leave the room sometimes! I am sure it's always that fast I just spent always catch it that fast.
Great writing Gabe. Thank you for all that you are doing. Your persistent enthusiasm and diligence keep me going!
How did i miss that tweet about United?! 🤯 I always learn so much from your check-ins, Gabe., and they give me much needed sparks of hope. Thank you for these. Please count me in for an in-person meeting in the fall. And if there is space, I’d love to try the coaching program (will admit to being a bit of a skeptic protective of her time).