The soapbox, the office, and the backyard BBQ

I had a chance this morning to get breakfast with a close friend and business associate, Jeff Carter. While we stay connected through teleconferences and e-mails, it’s always nice to catch up in person and talk about things not (directly) related to business. This morning we chatted about social media, as it relates to business development, web traffic, personal branding, and the like.

I related my attempts to get a handle on ‘the perfect storm’ of social and professional media, and Jeff told me the story of a recent CFO forum he attended in Las Vegas. Steve Sordello, CFO of LinkedIn was there giving a speech, and explained how despite the glut of social media websites, there is actually plenty of space for competing platforms. Specifically, he compared LinkedIn, Facebook and Twitter with a few other sites. I found these analogies interesting and helpful in trying to understand the unique dynamics of each site:

• Twitter is a soapbox – shout, vent and share whatever you want.
• Facebook is a backyard barbeque – it’s more typically “social”, and interactions are mostly with friends and family.
• LinkedIn is the office – professionally oriented and focused on a particular slice of your life.

As such, there are appropriate places to share certain things – nobody likes the jerk who only talks about work at the bbq, while sharing inappropriate things in the office can hurt your professional reputation. The X-factor here still seems to be Twitter – the soapbox analogy rings true – but in many ways you get to decide who your audience is. To continue the metaphor, you get to decide where to put the soapbox down – at a backyard bbq, or smack-dab in the middle of your board room or office. Each of these sites has a unique focus and appeal – it’s up to the user to determine what constitutes “success” – be it social engagement, professional connections, or attributed web traffic.

(FYI – A full description of Sordello’s talk can be found here.)

Social Media

I recently rejoined facebook after deactivating my account 6 months ago.* In the meantime, I’ve been tweeting up a storm. I was immediately struck by the differences in my social networks between these two platforms. My facebook account, originally created in early 2005 or something, consists of largely college friends and personal connections; people I’ve met in person and “friended” afterwards. My twitter account, on the other hand, was created in 2009 and has really turned into more of a professional outlet for ideas, links, or musings related to health care. Clearly, this blog has leaned that way so far as well.

I think that social media means ten different things to ten different people. While my twitter account hasn’t been used for interacting with friends, others use it frequently for that purpose. Some people I know use facebook almost exclusively for business expansion through professional networking or marketing efforts.  It really is what you make of it and decide to use it for. I think I’m the most impressed when I see seamlessly integrated social media. Particularly in the light of SM as a new business fad,  I haven’t seen any great examples of somebody blending a personal and professional campaign into one – it seems hard to do that without coming across as a tool. It seems like it might be more straightforward in politics (when did you ever think that would be the case?), when somebody becomes a champion for certain issues, but on a macro scale. See Obama, Barack.

I’d love to see any examples of profiles/pages/blogs/etc. to show me how the personal/professional/political blended together looks when done well.

*Actually, I shut it down in the closing moments of the Celtics game 7 loss to the LA Lakers in the NBA finals, as part of a preliminary defense mechanism. Yes, I am a sore loser. NBA: Where High Stakes Social Media Consequences Happen.

Meaningful Use – A Shared Responsibility

 

Here is short piece I wrote for CSC’s Meaningful Use Community. The whole post is available on their site.

As the country moves forward towards a digitized health care system, there is a growing realization that the road will be a bumpy one. The transformation process is a costly venture; maximizing meaningful use payments looks to be a complicated journey; medical professionals face a difficult re-training process involving new skill acquisition. It seems inevitable that this learning curve will be full of headaches and technical difficulties. Complicating this picture further is the lack of clear roles for all involved stakeholders, from vendors to practices.

Unfortunately, in health care these gray areas often translate to risks in patient care… (click to read rest of post)

Leaving patients in the dark?

Interesting article in New England Journal of Medicine about patients’ interaction with the Accountable Care Organization (ACO). The authors assert that Accountable Care Organizations (ACO) – which are basically hospitals, doctors and a payer working together to handle patient care on a continuum – should strive for a higher degree of patient-centeredness in order to prevent backlash and improve patient participation.

One aspect they leave out entirely, unfortunately, is the concept of attribution. Attribution, or the process of assigning patients to an ACO, can be done in one of two ways – prospectively or retrospectively. Prospective assignment – picking out the population in advance and then determining payment levels based on previous years cost data, allows you the option of giving patients a heads’ up. Retrospective assignment –waiting until the year is over, and then seeing which patients actually used the ACO hospital or providers, allows you to calculate payment based on actual use of services.

Both have their ups and downs; Congressional Research Service put out a nice report earlier this month that details these issues a little bit further.

Is it completely ethical to leave patients in the dark about their enrollment in the ACO? No. However, us Americans have proven time and again that we don’t know how to manage our own health care that well. I think sticking patients into an ACO is probably the best bet from a systems perspective – As long as you mail them an opt-out form (which research has shown people are less likely to do), there’s some element of patient-centeredness…right?

The Japanese ACO?

I found an interesting article. This is a keynote delivered by the CEO of a regional hospital in Japan at a recent symposium on Healthcare Reform and Economic Growth in Japan, organized by the Canon Institute for Global Studies. The topic was how a stand-alone hospital is moving towards a regional, integrated system. My knee-jerk reaction was “this is an ACO!” After reading the article, I wasn’t so sure.

As a quick background, Kouseiren are non-profit, regional organizations (originally formed from a national agricultural cooperative…sound familiar?) that help rural populations manage their own care through acute care as well as preventative and long term care management. Each Kouseiren manages several hospitals located throughout a prefecture.

Saku Central Hospital is part of the Nagano prefecture (which has 11 total hospitals), located at the center of Japan. It has 29 specialties and 1,193 beds in total, comprised of an 821-bed main campus and two satellite hospitals, several long-term care facilities, and six outpatient clinics. The hospital has 1,924 employees, with 215 physicians. Other info and financial details are in the article.

• Saku Central Hospital espouses the “5: 3: 2 method”: The ration of total resources should be 5 for inpatient care, 3 for outpatient care, and 2 for public health related activities. “Prevention beats treatment” is one of the hospital’s slogans.

• The hospital has developed a physician training program to overcome the management challenge of recruiting doctors. Over 75% of their physicians are “home-grown” (as opposed to coming from universities). This has had the effect of a more team-based environment, where specialists and general practitioners work with each other to a great extent. It has thus been historically “self-contained.”

• The reasons for transformation into an integrated health network (IHN) are several-fold: aging facilities, increasing population sizes, specializing medicine.

• Saku Central Hospital will turn into an IHN by dividing its hospital into a core hospital that serves community-based care needs and preventative treatment, while acute treatment and specialty medicine are co-located in a different hospital. This seeks to avoid the pitfalls of the ‘one-size-fits-all’ trend of hospital consolidation and provide care that matches the community’s needs.

• Other changes include a revision of the hospital’s management system. A benchmarking, data-sharing program with 6 other hospitals in the Nagano prefecture will help to promote transparency.

What do you think? It seems to be the exact opposite of what an ACO would be trying to achieve – instead of unifying a delivery system, it is fragmenting it. The details around the payment system are non-existent in the paper, so it’s hard to tell if these new components will be operating under some kind of global payment system.  The idea of reversing consolidation may work in a world of not-profit hospitals, but in the US this seems somewhat bizarre.