$6k is what Medicine Forward has in the bank.
It’s a tiny amount in the grand scheme of things. But, what if we could do something special with it?
I’ve heard more exciting ideas for what we can do with these funds this week than I have for a while. We could host a hackathon to bring people together to compete in teams with ideas to disrupt prior authorization and offer $500 or $1,000 prizes. We could sponsor Medicine Forward meetups with $250 for groups that want to get together locally and talk about how we can be impactful change makers. We could offer several small scholarships to students who need a little bit of help. And, we can help fund our first-ever in-person retreat. It may not be a large amount of money, but that’s no excuse why we can’t use it to do some good. Those are just a few ideas. Are you ready to help us get creative with how we spend our cash?
It’s time to be bold: zero friction from prior-auth by 2025.
I’m still working through “The 4 Disciplines of Execution (4DX)”. Last week it helped me clarify Discipline #1 - “focus on the wildly important”. I learned that choosing any more than three wildly important goals (WIGs) erodes the chance of achieving excellence on any of them. To recap, here is my draft of Medicine Forward’s top three goals: 1) putting the well-being of our own members and leaders as our first priority, 2) disrupting prior-auth, and 3) funding to make this work sustainable.
There is so much gold in this book. It reminds me that goals need to be actionable and measurable. It’s not enough to say we want to make a difference in prior-auth. There has to be a finish line — a way to win —from X to Y by when? So, how about this for bold: zero friction for patients and physicians from prior authorization by the year 2025. A moonshot? Maybe. But, isn’t that the point? We could shoot for less and be more “realistic”, but what point does that serve? We are beyond crisis mode in so many ways. Isn’t it time to throw down a grand challenge? The criteria are that the goal needs to be winnable and important, not that it should be easy or small.
An effective 4DX strategy also requires: Discipline #2 - “act on lead measures”, Discipline #3 - “keep a compelling scoreboard”, and Discipline #4 - “create a cadence of accountability”. This week I want to expand on the idea of lead measures, or measures of things a team can do that move you toward your goal. Lead measures require that they are predictive and can be influenced by the people working on them. It’s important to choose lead measures that have high leverage for moving the ball forward (not all of them do). Lead measures contrast with “lag measures”, which are the outcomes we want. Lag measures without lead measures are part of the dysfunction of incentivizing doctors for “quality” metrics. I don’t have to tell you how much frustration there is from physicians who are bonused and penalized for lag measures that we have little direct influence over.
So, what do our lead measures need to be to achieve our wildly important goals as an organization?
Becoming a well-being first organization.
The first step here is to decide we are committed to the well-being of our members and our leaders as the top priority of this organization. How do we make that actionable and measurable? One action is sending out this weekly check-in across the organization. We can quantify how many people are reached and follow through by responding to comments and requests. Another action could be to design a super fast/easy survey to check the pulse of how people are doing within the organization. We could poll monthly and track data over time. We can reflect on that data and the story it tells to inform other lead measures to consider. A simple step we all can do immediately is to grow a movement of asking our friends and colleagues regularly, “how are you, really?”
So, how are you, really? I want to know. And, I want to help find better ways to lift all of us up.
Laser focus on disrupting prior auth.
We had a rich conversation with ACP on Monday about continuing our work together. There is definite interest from both organizations to continue this collaboration and to pour kerosene on the fire to create change. We are tentatively planning the next panel to go deeper into prior auth solutions for the end of September.
California is moving forward with a bill to shake things up. Can this get passed? Will it work? What would that mean for other States?
A few highlights of interest from the bill:
This bill would specify that the health care providers involved with developing the above-described criteria or guidelines include a representative sample of physicians and surgeons that compose a plan’s or insurer’s prior authorization requests. The bill would grant a physician and surgeon the right to have an appeal of a prior authorization decision conducted by a physician and surgeon of the same or similar specialty, and would prohibit a plan or insurer from requiring an appeal of an adverse prior authorization request result to be filed before filing an independent medical review.
On or after January 1, 2024, this bill would prohibit a health care service plan or health insurer from requiring a contracted health professional to complete or obtain a prior authorization for any health care services if the plan or insurer approved or would have approved not less than 80% of the prior authorization requests they submitted in the most recent one-year contracted period. The bill would set standards for this exemption and its denial and appeal. The bill would authorize a plan or insurer to evaluate the continuation of an exemption not more than once every 2 years, and would prohibit a plan or insurer from rescinding an exemption outside of the end of the 2-year period.
You read that right, the peer-to-peer would have to be an actual peer!
Funding to sustain our work.
This is perhaps our most pressing challenge. September 2023 when I step down is going to come fast. That’s the deadline to find a way to keep our work going. Dues and donations are not enough to keep us going. For leading measures: 1) I’m dedicating an hour every Tuesday of focused time to work on this problem, 2) I’m bringing this up in all of my conversations about the organization, 3) we are discussing this in all leadership meetings with a bias toward what is actionable. One idea that resurfaced this week was seeking grant funding for our prior auth work. Some good brainstorming, but nothing concrete yet. The accelerator concept is still in the running, though more downsides of this idea are coming forward. I’m especially concerned that it would dilute our focus on our top three wildly important goals.
Let’s have some fun.
The final action that’s on my mind is moving forward with planning our first live retreat. The goal is to have a near-term in-person event that is both meaningful for those of us who participate, and a shot in the arm for the impact we can have together. The dates will likely be a weekend in October or November, to be confirmed. The location will be the Baltimore / Washington DC area. It's going to be intentionally very small so we can focus on the depth of connection with each other, and we're also planning for it to be fun! Slots are filling up fast, please RSVP now if you want to be considered to be part of it.
Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has. —Margaret Mead
For a moment, close your eyes and imagine it’s 2025 and we’ve succeeded in our prior-auth moonshot. We now live in a world with zero friction from prior-auth. What would that feel like? Can you imagine it? Can you even let yourself go there?
I can. I can see it. And, I can believe that a small group of passionate and relentless people can be the nidus for that change. Not only that but in the process of fixing prior authorization, we can develop a strategy that works for grassroots-led disruption of multiple major dysfunctions in medicine. I can see it, and it feels incredible.
One foot in front of the other every day until the patient-physician relationship is restored.
Onward!
-Gabe