There is no doubt that this country needs to find a way to take inefficiencies out of the healthcare system.  But, looking to how other countries have done it, while a useful education, should not suggest that we model our system off of others that do not offer the level of innovative and quality care that most Americans enjoy today.  Similarly, it should not mean denying access to care for those who don’t have it today — or limiting options for those who do have health coverage. 

Clearly, there are big complex issues that need to be sorted out…these range from how to take the inefficiences out of children’s health insurance, medicare and medicaid in a way that maintains access to care but minimizes fraud and waste, to how to help innovative businesses continue to have protection on their innovations such that they can fund research and even fund a greater level of access to free medications and procedures than they do today.  Complex issues..absolutely.  But, in the need to address the complexity, we seem to have forgotten some basics that will save costs and improve care.  Following are 10 things for the experts to consider when reshaping what healthcare will look like in America:

1.  Incentivize health professionals, employers, insurers and individuals to focus on wellness.  Taking the steps to prevent serious disease will pay huge dividends in the future.  Smoking cessation, weight reduction, avoidance of asthma triggers, stress management…all of these preventative approaches slow the use of healthcare services and delay the acute events that drive traffic to emergency rooms and result in costly procedures.

2.  Fund “well” clinics and encourage routine check-ups including basic testing — incorporate nutrition and prevention into the discussion and mandate (and incent for) routine visits.

3.  When you knew ytou family physician and trusted his or her advice, you were more likely to skip the extra ice cream cone (you might run into them at the ice cream parlor).  Relationships with healthcare providers are critical and ensure better compliance with wellness programs.  We must enable people to build relationships with community healthcare providers.   Not just physicians.   If you know the nurse practitioner or physician’s assistant at your local wellness center, you will use that facility vs. the emergency room when flu symptoms strike or allergies are out of control. 

4.  Reward compliance with medications.  Asthma well-managed on a day-to-day basis reduces use of ER services for acute attacks.  Consistent use of prescribed cholesterol-lowering medications not only reduces risk of a heart attack but also may have beneficial effects beyond heart disease.  Consider medications for chronic health conditions to be a preventative action and incent proper behaviors for prescribing as well as taking medications proven to prevent serious complications.

5.  Reimburse allied health professionals and make them the front lines of care.  Nurse practitioners, physician assistants, certified diabetes educators, pharmacists…all can play critical roles in front line medicine — particularly in doing what it takes to keep people well.  Empower them…and importantly, pay them.  Studies have shown that diabetes clinics that employ regular use of certified diabetes educators are more likely to have a patient population with A1C levels in accordance with treatment guidelines.  But, there is a shortage of certified diabetes educators because there’s little incentive to take on this role plus, many diabetes clinics are not adequately reimbursed for their involvement.  Imagine the cost-savings of having people committed to helping a person with diabetes stay in control…reduced use of endocrinologist time, less medication and fewer hospitalizations not to mention the reduction in devastating complications of diabetes from cardiovascular disease to blindness to amputation.

6.  Work with insurers and private entities to get Americans to invest in their own health.  Encourage programs that enable Americans to invest dollars toward their goal of losing weight or stopping tobacco use…and then double or triple their investment when they succeed.  It’s a win-win.

7.  Partner with and reward employers that take care of employee health. 

8.  Healthcare is community-driven.  Work with municipalities to identify the resources, networks, support systems and leaders in their communitie to set up initiatives that will help its citizens to be healthy.  Set up systems to measure success and reward that success.  Whether it’s funding for community education, eldercare or the environment in their city, when a municipality does the right things to improve health while reducing care, other services should benefit.

9.  Foster innovation.  We are fortunate that we live in a world where medical innovation has turned acute and deadly diseases into chronic conditions.  That is part of our cost issue…we live longer.  But, the more we foster innovation, the more likely we are to make less expensive, more effective forms of life-saving technology.  Think of that first computer — bulky, unwieldy, expensive — further innovation led to efficiency, mass availability and even reduced costs.  We need to encourage the same in healthcare.  Innovation for the cure is important.  Innovation for efficiency and mass availability is even more important.

10.  Remember the CARE in healthcare.  Make decisions because they will help people stay well…not just because they will cut costs. 

Every once in a while, we marketing and pr types, have to take a breath and remember, that most of the world doesn’t think about the same things we think about.  We need to remind ourselves that there’s a whole world out there that thinks Digg is something you do in a garden and Twitter, well, sounds a little dirty (thanks Christine, you’re right).  We have to remember that we’re watching the news and analyzing its content, how it’s delivered and the channels used…but most people  — just watch the news.

So, here were my reality checks this week:

Reality check 1:  We met with a client to talk about how to educate a very niche audience about their offering.  Social media made sense for this particular client’s audience — except he had no idea about anything related to social media.  He had heard of Facebook but had never seen a Facebook page.  He sort of knew what blogs were but didn’t understand why people might read them vs. reading a column in a newspaper.  His product is sold online.  He understood e-commerce but nothing else.  And here we were, off on a riff about social media replete with jargon and apps and icons and the poor guy felt like he was on another planet.  For a moment, so did we…we forgot that not everyone speaks the language of digital as fluently as their native tongue!

Reality check - slow down, don’t assume knowledge and drop the jargon please.  And wherever possible, use visual aids.

Second reality check — we pr types have been analyzing the communications about swine flu.  Too much? too little? Too inflammatory? Who said what and could they have said it better?  No question people are scared but should the be scared?  But, wait, why is my 10-year-old walking around the house with a can of Lysol cleaning all the door knobs in the house?!? 

Um, he doesn’t care how the news is reported.  He just knows he doesn’t want to get sick.  Reality check — who cares how they’re doing it, if the news is scaring people, find a way to provide reassurance.  Give the numbers — and put them in context.  Explain that it’s a flu…it can be managed.  Report the news — and the news we can use. 

It’s tough to find the energy to stick with things these days.  We’re all working harder than we ever have before and on many days, feeling as if we’re running in place, at best.  It’s not surprising that people are questioning their capabilities, their ability to prevail and whether they are the ones who will find that critical key to success.  People’s prides have taken a beating as they have run faster and faster on the treadmill with little impact. 

So, it’s good to know that there’s a little thing we can do to make ourselves feel better and be perceived in a successful light…act proud even when you don’t feel proud. 

Today’s New York Times (www.newyorktimes.com) reports on recent research by Jessica L. Tracy of the University of British Columbia and Richard W. Robins of the University of California that shows that feelings of pride can help people weather difficult storms and actually result in body language and expressions that make others see those people in a more dominant, likeable light.  Apparently, there are common expressions — involving a head tilt and a certain smile — demonstrated by all people experiencing a proud moment.  And, when those expressions are witnessed by others, they like us more, are more likely to assign higher status to us and all of that, in turn, makes us feel good.

Now, the researchers say that you can basically fake that attitude of pride.  But personally, I think it would be hard to pull off without being arrogant unless you did some method acting and remembered particularly proud moments and the feelings they evoked. 

But, maybe there’s something the non-great actors amongst us can do…we can take pride in the little things.  We can take a moment to feel proud about helping a colleague, a child’s ability to master a task they had struggled with, the good work and success of friends and family.  Maybe we can also take a moment to make others feel proud…celebrate their work…appreciate the small things they do and…feel proud because we made them feel proud.

My 12 year-old greeted me after work last night by telling me that the Dow went up, St. John’s beat Georgetown and it looked like Seton Hall would do well against South Florida…all in all, he said, a good day!  After I got over the insanity of my pre-teen knowing that the Dow went up, I started to think about how important it is to celebrate small victories in this current environment. 

It’s tough out there and it’s very easy to get demoralized in the face of budget cuts, staff reductions, friends losing jobs and prices going up.  But, just this week, we:

•  brought in two cool projects
• a team pulled off a great presentation to a client that took them out of their comfort zone and made them feel proud in the process
• reconnected with former colleagues who have overcome some challenges only to be celebrating personal and professional successes and wanting us to join them for the task ahead, and 
• got fabulous and well-deserved notice for a long-standing client with one of the junior members of the team really reaping the credit for the great work accomplished

Sure, we had some tough moments too.  It would be very easy to let the tough overshadow the good but why let that happen? 

It’s the successes that motivate so we need to focus on them even as we deal with the tough stuff.  And yes, Seton Hall won…so, all in all, a good day.

My husband and one of my children love tradition and for things to stay the same.  I, on the other hand, love change,  I like to shake up the status quo to see if it make me think differently.  I like to create annual customs instead of repeating the same thing as last year.  But, if there’s one thing I’ve learned, it’s that my desire to shift things about really stresses other people out. 

Changes in the workplace — even small ones — seem to create drama.  Last week, i suggested to some colleagues that we could track their work better so that they could better understand where critical resources were being spent.  One person thought that was great - two others thought I had clearly lost my mind.  So we made some little changes — for now — because the big changes were just too much for them to handle.

Changes to team dynamics are fascinating to watch.  Just watch the politics when a new player is added to a sports team — or a new colleague joins the workplace — or a new pet joins the family (the hamster/guinea pig dynamics are something to behold).

Never mind if you try and switch up the holiday plans.  I really wanted to go somewhere warm for Thanksgiving…okay Christmas…New Year’s?  You guessed it, none of the above.  The little one would have none of it.  Who would cook the turkey? Where would Santa drop the gifts?  Where would we light the menorah?  The stress was too much to bear.

So, rather than stress anyone out, each year I indulge my need for change with new hair.  This year, a backward look at what I think is my original color (hard to say as it’s been a while since I’ve seen it).  While I resolve to try and keep other’s stress to a minimum in the new year, I still have to indulge my need for change and wish everyone out there a Happy New Hair! 

What kind of world is it when a government regulatory body denies someone 6 months of additional life — because they can’t sanction payment for a life-saving drug?  That’s exactly what NICE (National Institute for Health and Clinical Excellence) in Britain said to Bruce Hardy, a British citizen dying from kidney cancer.  And, Mr. Hardy is not alone.  Throughout Europe, countries are making similar decisions about what kind of care patients can get and countries can afford to give.  Make no mistake, this is not an issue that will remain in Europe.  Managed care proiders and other insurers make these decisions daily…and so will our government.

It’s easy to blame drug manufacturers for “charging too much.” But, as we’ve talked about in prior posts, it’s not that simple.  The process of true drug discovery and innovation is expensive.  It’s easy to blame payors — government or private — for not making humane decisions.  But, that’s too pat a response as well.  Money is tight.  Cuts need to be made and the more expenive treatments are often the most innovative and life-saving.

Here’s the answer…we need to become a nation of savers…not just from a financial perspective but from a health perspecive.  The vast majority of Americans are born healthy. But, through poor lifestyle decisions, over-indulgence, stress, lack of exercise, lack of sleep, we chip away at our health.  We don’t store up wellness for a rainy day.  We don’t take the steps needed to help our bodies through rough times or prevent the onslaught of disease.  And then, when we resort to medications to protect the hearts that were once strong, clear the excess sugar from our bloodstream, minimize damage to blood vessels from plaque and high blood pressure, we erode the healthcare coffers of our personal fortunes and the nation’s as well.  And, we complain about the cost.

If we want to fund innovative medicines with government support, we have to stop being wasteful withtheir resources.  If we want to have access to lifesaving medications and devices when our bodies are attacked by the unpreventable scourges of disease or simply the wear and tear of a long life well lived, then we have to do our part to reduce the expenditures on those conditions that are preventable.  We have to invest in our health by protecting it.

The good news is that wellness is less costly — personally as well as to payors, employers and governments — than illness. 

Wellness is as inexpensive as employers negotiating healthful options in their subsidized cafeterias. 

Wellness is as thrifty as a 30-minute walk during lunch hours or after dinner. 

Wellness is as economically sound as stress reduction classes in the workplace or yoga in your living room. 

Wellness is school nurses having sunscreen for recess and hand sanitizer in the classroom.

Wellness is a commitment that pays off.  The reduced spend on docor visits, medications and medical procedures positively impacts our personal pocketbooks, our employers resources and the government’s ability to say “yes” to Bruce Hardy.  It just means we have to say “no” to those things we know deplete our personal health resources and “yes” to those things that fund our health bank.

A historic week it was indeed.  Regardless of your politics, you couldn’t help but be moved by the symbolism of the first person of color becoming president.  Were the campaign to have worked out differently, it could have been about the first woman in office and the symbolism and historic impact would have been just as great.  But what was fascinating to watch was my children and their friends be less impressed by the enormity of either of those scenarios than their parents.  And in an odd way, that is symbolic too.  My children and their friends understand it is a historic first.  And, yes, having learned about the civil rights movement and Rosa Parks and Dr. King, they theoretically understand that the United States was once quite different than it is right now.  But, they don’t really get how enormous it truly is. 

In our school system, parents are encouraged to teach music in the classroom to supplement the music the children get as part of the regular curriculum.  Back when my eldest son was in 2nd grade (about 5 years ago), I was asked if I could approach music in the classroom with an eye toward celebrating the end of Black History month and the beginning of Women’s History month — so I combined music with  discussion that began with Duke Ellington and ended with Aretha.  We talked to the kids about how difficult it was for Black musicians to get club dates or hotel rooms when they traveled.  We talked about how women earned so much less than men.  We played music and ended with a rousing, chairs as drums, performance of RESPECT that resulted in the teacher across the hall chastising us all!  As fun as all that was, the best was the moment when one of the little girls, full of righteous indignation upon hearing how tough things were for Duke and other Black musicians as well as women who sought equality, stood up on her chair and said “What do we do about this?!?”  At the time I said, “we’re still working on it.”

My kids and their friends know women who are CEOs and earn more than many of the men around them.  They have a neighbor who started the first black-owned investment bank.  Their friends are boys and girls of many races, nationalities, religions and genders.  They also know white women who clean homes for a living and white men who are landscapers and handymen.    It is as natural for them to assume success for a person of color as it is for them to assume success for themselves.  And, that is wonderful.  And, it is not how it is everywhere.  But it is certainly much better than how it was when I was a child.

The big historic moment is wonderful and worthy of celebration and reflection.   But the little steps…those that got most of our children to take the election of a person of color to the highest office in our nation as part of the natural order…are worthy of reflection and celebration too.

Back in May, I presented at career day for the third-graders.  I was warned by my then third-grader that I couldn’t come unless I shared “cool stuff” as opposed to the boring stuff he thinks I do most of the time.  So, I approached my cooler colleagues and gathered case histories and collateral for work we do for a shoe/sporting good manufacturer, a fast food restaurant, a camera company — the cooler stuff.  The third-graders asked great questions but the most interesting discussions were centered around how much celebrities charged to help on the campaigns and that the kids thought it was okay for the celebrities to get paid “because everyone knows that they don’t do it for free.”

For many reasons, I’m delighted to learn that the big pharmaceutical companies like Merck and Eli Lilly are now going to disclose payments to physicians, CME grants etc.  (www.pharmalot.com), but one clear reason for my appreciation of this long overdue news is that “we all know doctors get paid.”   Pretending they didn’t created unnecessary skepticism for an industry that does far more good than harm.    I never quite understood why it was a secret in the past. 

I know that there was the worry that reputation would be damaged because the public or other stakeholders would not understand the nature of the payments but let’s face it, keeping that information under wraps didn’t exactly protect their reputations and by the way, why was there anything to hide?  Fees paid to physicians for their insight, counsel, expertise are fair and appropriate.  Lending their credibility and expertise to the sharing of information through publication or medical education is really no different than a celebrity lending their cool factor to a product they use and believe in. 

To assume a spokesperson fee or the costs associated with a clinical trial results in bad medicine is a blanket indictment that is neither fair nor logical.  Most people don’t lend their names and reputation to something they don’t believe in.  Most doctors didn’t attend medical school with the hope of becoming a spokesperson…they did it because they wanted to practice good medicine, create breakthroughs for hard to treat diseases or improve quality of life for chronically ill patients.  Sure, there are some bad apples, as in any industry, who let dollars influence behavior to the detriment of patients — but not most — not even close.  But these are not new insights.  It’s the factual message that pharma has tried to relay for years — to deaf ears.

So, why am I so delighted that they have publicly announced disclosure plans?  Because now, we can move on to what really matters — finding a way for this industry to continue to provide breakthrough science to manage disease for as many people as possible.  Some would argue that the fees paid to doctors are more about marketing than fighting disease — could be.  But, without that physician/industry engagement, the breakthroughs are impossible to achieve.   And, I for one, will be happy to know that the company innovating a new solution has engaged expert physicians to vet the studies, study the product in clinical practice and educate their peers on appropriate use. 

I did the unthinkable Saturday evening.  I agreed with the nine-year-old when he said “he stunk” in his basketball game.  Okay, tell me where i go for the public flogging for telling my child that he was less than perfect.  But, I’d do it again.

The nine-year-old is a VERY good basketball player.  He actually had two games on Saturday.  He was great in the first game, doing everything he’s practiced, listened to the coach, created opportunities for teammates to shine and as a result, shone himself.  By the second game, at the end of the day, he lost interest, steam…who knows.  But, he didn’t play well.  So, when he moped off the court at the end of the game and flung himself in the chair next to me exclaiming, “I stunk.”  I said, “yep, not your best day.”  He was a little shocked but then we talked about what happened, and we moved on.  We won’t know if acknowledging that he didn’t do well will matter…we’ll see in the next game but i didn’t see any value in pretending when he knew it wasn’t his best effort.

I believe in being honest when someone hasn’t done their best…at home and at work.  To do anything else is to underestimate the individual in question.  They know when they’ve done their best and when they haven’t.  I believe that if you take the time to be unemotional but honest with them, discuss what didn’t work and why and then talk about how to do it differently next time, they usually take it to heart and improve. 

Too often, we miss the opportunities to help someone improve because giving the tough input is too hard, or it makes us unpopular, or someone pouts and makes us uncomfortable.  I can attest to the unpopular bit.  For years at work, I gave the thorough reviews — good and bad — and delivered the tough news.  In contrast, my colleagues were saying everything was okay even as clients were complaining abut the quality of work and haphazard team performance.  The result was that I ended up with a reputation that ranges from “tough but fair” on good days to a version of “witch” among those who were less appreciative of the feedback. 

Now, I will admit that early on, i was better at giving negative feedback than I was at balancing it with positive and constructive forward looking advice.  I also tended to take other people’s errors as personal sleights…as if their mistake was my failing.  However,  I was fortunate enough to have managers who gave me lots of “constructive” feedback and while it may not have felt good in the moment, I look back on that criticism as a gift.  By pointing out where I made a mistake, all they really did was put a sharp point on something I already knew — but didn’t yet have the courage to acknowledge. Their input forced me to see that I could do better and furthermore, forced me to choose between trying to correct my mistakes or ignoring them and hoping no one else would notice.

This morning, the nine-year-old was telling his brother about the basketball game and good naturedly said “I stunk up the court…but that’s the last time I’ll do that this season,” and bounced into breakfast singing Miley Cyrus’ “Nobody’s Perfect.”  Message heard? We’ll see.

This day, seven years ago, I sat on the train to work thinking about the cupcakes and goody bags I needed to finalize for my 5 year old’s birthday party that coming Saturday.  I had “call the snake guy to tell him it will be 10 kids not 8″ on my to-do list.  And then, the joyfully mundane changed forever.  Suffice it to say, the birthday party went on, with 3 fewer kids — they each lost a Dad — but nothing else remained the same.

It’s not just about the extra time at the airport or that underlying sense of vulnerability that crops up if you listen to the news or talk radio for too long, it’s the feeling that every day matters.  I don’t think that it’s a coincidence that I became better at prioritizing work and life at about that time. Yes, life got busier.  In addition to the 5 year old, there was a 2 year old but frankly, it was more about the desire to be with them because — you never know when you might not be able to be with them.

I’ve watched my friends — more personally and profoundly touched by 9/11 — find ways to balance and juggle and move on with grace to give their children security and find joy for themselves. Unwitting role models, they also have impacted how I manage my day-to-day and balance what matters with what doesn’t.  They have changed the way i live my life as much as anthing that happened in the skies that day seven years ago.

I know that on this anniversary day, I woke up with much the same to-do list on my mind as I did on that fateful morning.  He’s 12 not 5 but there’s still a party to be planned and a cake to be picked up.  There’s a long to-do list at work and meetings that I know will last longer than what’s on my calendar. I’m wondering when i’ll be able to squeeze in getting party things done. 

But, that’s not all that’s on my mind.  I’m remembering that day 7 years ago — and I’m certain I am not alone in my thoughts and rememberances.

So, answer this…is there a reason why New York Times didn’t think it worth covering except with an editorial about the politics over the constructon on the memorial site?  I’m not sure that day taught them much of anything at all about what really matters.