The debate on healthcare reform continues to simmer.

For anyone who hasn’t read the thousand or so pages of legislation, we invited Jeff Goldsmith Ph.D. (President of of Health Futures, Inc. and Associate Professor of Public Health Sciences at the University of Virginia) to offer his insight on what we can expect from the next chapter in health reform – and how we can start thinking ahead of the curve as healthcare providers and insurers.

In a session to many high-level healthcare executives, Dr. Goldsmith touched on the following points:

Deficit reduction

• The Congressional Budget Office forecasts massive deficits over the next ten years
• When Congress gets around to reducing those deficits, they will be forced to cut Medicare, the balance item in the Federal budget
• When the budget is again balanced, it will likely focus on health plans, specialty physicians and hospitals – particularly their outpatient costs

Widening of hospital role in health system

• This is due to a combination of cuts in non-hospital surgery and imaging Medicare payments as well as the increasing amount of hospital-employed physicians
• Hospitals are still viewed by policy makers as the principal leverage point in controlling health costs
• An increased focus on managing clinical risk in chronic disease

What role will health plans and DM firms play in reshaping the health system?

• Current provisions lack a unified view of the patient; Medical Home is on the right track, but we need to do more. At present, both physicians and hospitals are poorly equipped to actually manage the health or health costs of populations of patients. This creates a new opportunity for providers, health plans, and DM firms to collaborate.
• Use data analytics to track patients’ behaviors and nudge them in the right direction when it comes to caring for their health
• Really listen to the people served, understand their health motivations and challenges, and give them the tools and support to better manage their health risks

Read Dr. Goldsmith’s other takes on the current and future state of healthcare.

It’s good food for thought, no matter which side of the debate you stand on.

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The day before a recent business trip Josh popped into my office to drop off Eliza’s new blog cards.

These are about half the size of a normal business card, featuring the red mohawked chocolate rabbit and the elizablog web address. They’re on good paper, and cool, and I since I had been sweating Sarah’s since the Audience conference  in NYC I was glad to take these on the road with me.

The clients I gave it to got a kick out of the rabbit and it turned out to be a great way to start a conversation about the “hardcore” analysis that’s part of the ElizaLive suite of engagement and analytic products.

The reaction of my niece, on the other hand, is another story…

It just so happens that my sister and brother-in-law live 5 minutes from one of the clients I was visiting so I stopped by to see them and my nieces who are 7 and 4. During the visit I pulled out the cards and handed them to the girls.

The oldest, Paige gave it a look and a chuckle and asked, “Is that a chocolate rabbit?” I said it was.

Then Brooke (the precocious one), who had been blankly looking at it the whole time, passed it back to me and said deadpan: “I better not find that in my Easter basket” …and walks away.

They must not get to discriminant function analysis until kindergarten.

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We often look to the world of consumer product design for inspiration when designing our own outreach.

So we read with interest a recent review in Wired magazine that singled out one new mobile device from the crowd. It wasn’t the phone with all the latest bells and whistles – it was the one with an interface described as “endearing.”

When food is cooked with love, people taste the love; when things are designed with love it makes for a loving experience.

Those are words to live by to the folks behind Sagem’s Puma phone, and they are words that we take to heart, too.

The result? Comments like these from the people with whom we interact….

“I do appreciate [health plan’s] concern and maybe for waking me up a little a little bit to get a little more aggressive in seeing a doctor, so I thank you for your wake-up call.”

“Oh thanks for jogging my memory; thank you so much. I’ll get on the phone and make my appointment tomorrow without fail. Thanks again; bye-bye”

“I feel very good about that; about you calling me. I mean it makes me feel special. And I was having sort of- a little bit of a down day today and that has cheered me up. Thank you very much. Bye-bye.”

“It’s wonderful that I would get a call from Medicare. It makes me feel good. Makes me feel a little bit lifted; more than what I was earlier. It makes me want to cry because people out there really care. They care about people and their health. It’s not just because of the money they can get from them. But it’s down to heart loving people. It’s the health they care about. People is what matters. Not the money. And I hope the world will think about that. I appreciate it and thank you so much. Bye-bye.”

“Well I usually don’t engage with phone solicitations of any kind but I went ahead and listened and I felt- I would say somewhat inspired by that very meaningful reminder. So thank you; I will see what I can do to take that walk in the park. Have a great holiday; bye-bye”.

There’s always going to be a Next Big Thing.

To us, the challenge is in staying fresh, staying relevant, and most of all, staying authentic.

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Valentine’s Day is a pretty big deal at Eliza.

And why not?

It’s about celebrating life, enjoying yourself, friends and family and the meaningful connections that intertwine us all.

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So how to celebrate?

How about some impromptu cards, temporary tattoos and chocolate? (All things in moderation, of course.)

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Moderation? Oh yeah, did we mention the world’s largest gummy bear?  No?

Okay.  Well we did that too.

Yes, it is completely ridiculous and there’s not much of an argument one can make for it — except for sheer unadulterated fun and general silliness.

Both of which are key ingredients of the connections that intertwine the best relationships.

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We talk a lot at Eliza about accountability and ownership. It is even one of the criteria that we rate employees against when evaluating their performance. This concept really hit home for me this week when an incident happened with my daughter, who is in the fifth grade.

All the elementary classes at her school were participating in a reading contest, and the class that read the most books would get treated to a lunch out. Every student in the class had to read at least one chapter of their favorite book out loud. My daughter was really excited about this, since she’s been an avid reader since an early age.

About a week ago she came home with a note saying that she was talking in class when it was work time. This has never happened before and when asked about it, she said she was sorry. It happened a second time a few days later. She was given an after-class assignment.

When she got home I sat her down and asked why this was going on — she told me that she couldn’t talk about it. Now I am perplexed - is she watching too much tv? Is this the start of teenager issues? Have I been traveling too much and not paying attention to her?

The next day I picked her up from school and told her that no matter what - I HAVE to know what is going with her so I can help. She calmly explained that she didn’t need my help, but the little boy who sits next to her in class can’t read very well and his father beats him. My daughter was reading the assignment to him in class so he could finish it and not get in trouble. She was also whispering the words to him so he could read his book out loud.

I asked why she would do that and she said “because Mommy, it is the right thing to do and no one else would help him.” She went on to explain that if all the kids in her class didn’t do the reading to win the prize, they would make fun of him.

I looked at her in awe and it dawned on me - this is the example I will use when people ask how they can become more accountable in their jobs.

Every person at Eliza owns a piece of the culture and environment of the company. If there is another department or team member who needs help and support, it is up to each of us to take action.

If we stand by and watch things happen that we know aren’t right - we are just as guilty. If we sit around and talk about how hard or horrible things are and don’t come up with solutions - we are just as responsible.

Photo by Clearly Ambiguous  used under Creative Commons License

This is true in my daughter’s situation too. Even though it isn’t “my business” I set up a meeting with the teacher to tell her what’s going on. My husband went to the boy’s family’s house so he could talk with the parents and offer our assistance.

We are working to help that little boy succeed, because without him, the class can’t succeed.

That same all-for-one, one-for-all spirit applies here at Eliza, too. I am so glad I work here.

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Every year Eliza throws a holiday shindig.

Food, fun, friends and of course…

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(Note: you must have Flash to watch the dance video above - get it here)

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Dancing!

Our CEO and President Luke and Alex can cut a rug.  We found this footage in the old Eliza archives and decided to share with the entire Eliza family as part of the Holiday Party invite.

But the more we thought about it the more we just couldn’t keep it from the world — click the play button and enjoy. Or, if you’re lucky enough to be part of the Eliza family, swing by the party to see it live.

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I have written in past blogs about cultivating an exciting environment at Eliza and how we as a company are always striving to innovate and improving upon what we know and do.

As an HR professional, I don’t claim to know it all, and one way we try to keep our edge is to check out what other cool companies are doing.

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One of my all time favorite places is Zappos (and not just because they have awesome shoes and fantastic customer service). The crew at Zappos has continued to be the industry leader in both people programs and figuring out how to make their company a really great place to work.

One of the programs they run for new hires really caught my interest - after about six weeks they make new employees an offer to leave. Basically it is a test of commitment - do you really want to stay here?  This should be more than just a job for you — did you make the right decision joining us? It gives the employee a chance to more easily remove themselves from a fit that they know won’t work longer term, and that benefits the company.

The Eliza team talked it over and decided that we would try out this concept as an experiment. We let new folks know that after a month or so at Eliza, we’re going to make them an offer: cash to walk out the door. Then when the time comes, we sit down together and explain: we love you and don’t want you to leave, but, if you want to leave today we will give you a significant sum of money - cash to walk out the door with no hard feelings either way.

To date we’ve done this fourteen times, with a decision to stay instead of take the money each time. After folks make their decision, we’ve asked them how they felt about it and their thoughts on the process. Feedback about the offer varied overall - some thought it was really great and others weren’t thrilled about it.

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Photo by bandita, used under Creative Commons Licence

One thing that resonated from everyone involved was respect and appreciation for the fact that we are not afraid to try new things. I think that above all else is the kind of culture we want to feed and nurture - and continue to build on.

Eliza employees are always trying to learn from others’ best practices, we are not afraid to try new things, and we are confident enough in ourselves to stand up and say “hey, we tried this and it didn’t work” or “hey, we borrowed this from somewhere else and have adapted it Eliza-style”.

Eliza style is just that. We practice what we preach and we preach what we practice:

Everything Starts with Integrity
Always Innovating
Great Talent - Our People are our Core
The Customer is at the Center of Everything we do

2010 is going to be a fantastic year for Eliza - I can hardly wait to see what comes next!

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Engage With Grace ranks as one of the 10 phrases that became part of the healthcare lexicon in 2009. 

Thank you again to all who supported this non-partisan effort to have end-of-life care wishes expressed and honored. If nothing else, health reform has given us the opportunity to introduce the concept in a fresh way.

So, what other phrases should we add to that list?

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Few of us really eat as well as we should.

It’s especially tough in the office.  Tough to get the right food prepared.  So often we end up grabbing junk — and taking a long time to do it.

We’ve found a solution that’s working for us: the office snack bar.

Bring in some healthy, quick stuff: bread, peanut butter, oranges, apples, nuts, water - whatever else works.

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Put it in an open corner of the office and snack when needed.  Share with other folks and let them bring stuff in too — like a perpetual picnic.

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Go online and shop for clothes that have been selected to fit your shape at MyShape.com. Log on to Facebook and see ads that have been selected especially for you. What’s going on?

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According to Bruce Kasanoff, author of and founder of the blog NowPossible.com, what we are witnessing is the emerging personal economy—not just in commerce, but in areas as diverse as education, entertainment, politics and health care.

Here at Eliza we make personalization our watchword in all that we create, and so we sent Mr. Kasanoff some questions about this subject in which we’re so keenly interested and begged him to wax eloquent.

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Thank you to everyone who participated in the second annual Blog Rally – as you can see from this partial list of participants it was a great success.

We counted over 100 posts plus countless tweets and Facebook postings – people spreading the word and sharing their stories over Thanksgiving weekend.

And for that, we are incredibly grateful.

Here’s just a sample of some of the comments we saw:

“Engage with Grace, what a wonderful idea. Anything to get a real conversation started. If we can help people understand that by taking the time to make their wishes known that a great deal of suffering could be mitigated.”

“Wow, thanks a lot for that useful information. It is very true because sometimes you just get stuck and don’t know what to say. Some conversations are easier than the others. Sometimes it also depends on the person we are talking to.”

“Last year I had a discussion with my loved one because of the blog rally and unfortunately it actually came into play in Sept. when she was diagnosed with end stage pancreatic cancer. Something that we did not anticipate but really must be brought to light, especially with elderly couples; often the primary advocate is so distraught at the probability of losing their 47+ year partner, emotions cloud key judgment. We experienced battles with my uncle over increasing pain meds., etc. and hospice walked such a fine line because he, as her health proxy could have asked them to leave at any time (as we were told). So in addition to having a discussion regarding these end of life questions — elderly couples really need to think about whether their spouse will truly be able to carry out their wishes when the time comes.”

Let’s keep the momentum going, moving from the blogosphere to our dinner tables, to our presentations at work, to our friends at book group – anyone, really.

Thank you again, and best wishes to you and yours this holiday season.

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Last Thanksgiving weekend, many of us bloggers participated in the first documented “blog rally” to promote Engage With Grace – a movement aimed at having all of us understand and communicate our end-of-life wishes.

It was a great success, with over 100 bloggers in the healthcare space and beyond participating and spreading the word. Plus, it was timed to coincide with a weekend when most of us are with the very people with whom we should be having these tough conversations – our closest friends and family.

Our original mission – to get more and more people talking about their end of life wishes – hasn’t changed. But it’s been quite a year – so we thought this holiday, we’d try something different. 

A bit of levity.

At the heart of Engage With Grace are five questions designed to get the conversation started. We’ve included them at the end of this post.  They’re not easy questions, but they are important.

To help ease us into these tough questions, and in the spirit of the season, we thought we’d start with five parallel questions that ARE pretty easy to answer:

Silly? Maybe. But it underscores how having a template like this – just five questions in plain, simple language – can deflate some of the complexity, formality and even misnomers that have sometimes surrounded the end-of-life discussion.

So with that, we’ve included the five questions from Engage With Grace below. Think about them, document them, share them.

Over the past year there’s been a lot of discussion around end of life. And we’ve been fortunate to hear a lot of the more uplifting stories, as folks have used these five questions to initiate the conversation.

One man shared how surprised he was to learn that his wife’s preferences were not what he expected. Befitting this holiday, The One Slide now stands sentry on their fridge.

Wishing you and yours a holiday that’s fulfilling in all the right ways.

(To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team. )

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Another great article about the importance of broaching difficult conversations around end-of-life wishes appears in the Indianapolis Star this week.

The piece offers advice on how to have these conversations (including using the five questions  offered on Engage With Grace) in a way that’s non-partisan, not mired in legal mumbo-jumbo… just, well, human.

And what better example of humanity than the upcoming holiday season – family members gathered together for food, watching the big game, and hitting the stores for bargains.

So while we can’t promise that discussing end-of-life preferences with your loved ones will be easy as pie (pumpkin or otherwise), we do promise that the effort will be worthwhile.

And maybe even as satisfying.

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Dr. John Kroeker

John Kroeker didn’t know it at the time, but a hitchhiking nun in 1978 changed the course of his life.

This doctoral student in neurobiology and behavior at Cornell made an impulsive decision to drive the nun upstate to her ashram instead of going back to campus, and the conversation they had about meditation during that long drive was the impetus for him to travel to India after graduation on his own search.

He landed in Auroville, a utopian community on the southeastern coast. He didn’t stay long (“just a month”, says John) and didn’t find exactly what he was looking for, so he went off to Cal-Tech for his post-doc fellowship work.

But the planted seed bore fruit, and 30 years later Dr. Kroeker , internationally recognized expert on learning algorithms, bioinformatics, digital signal processing and speech recognition (and a co- founder of Eliza Corporation) not only is a long-time student of the Institute of Applied Meditation, but a teacher and mentor of their system of Heart Rhythm Meditation.

Aside from the obvious benefits of having a meditation savant forming best practices at Eliza, employees were the happy beneficiary of his expertise at a recent lunchtime seminar offering. According to research in the field, meditation with the proper breathing technique can have these positive outcomes:

Physical

· Bolsters immune system

· Lowers blood pressure

· Helps with pain management

· Increases metabolism

· Increases oxygenation of blood

· Circulation aid

Mental

· Stress management

· Maximizes concentration

· Develops decisiveness

· Improves creativity

· Improves communication

· Restores optimism

Eliza employees tried this interesting meditation technique as well, which places emphasis on posture, breathing, and connecting with the heartbeat—along with a high-tech computerized biofeedback display for a few folks who volunteered to be hooked up to a monitor.

Eliza likes to talk about getting “soul to soul” with people. That’s not just vendor to client, doctor to patient, health plan to member. We’re actually trying it out on the ground, co-worker to co-worker, starting with the heart.

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The recession has a way of bringing savings strategies into the mainstream. Competitive coupon clipping, for example.

There’s a great article in Healthcare IT News about how the recession has also driven a trend to more automated calls in healthcare – especially when it comes to connecting people with clinicians who offer health and wellness support.

It’s no secret that as the US healthcare system serves more aging and newly-insured people, the nursing shortage is widening. Demand for RNs is expected to continue to grow at 2 percent to 3 percent per year, while the supply of RNs is expected to grow very little as large numbers of nurses begin to retire.

So how can we help these folks be more efficient, without burning them out?

We like to say that Eliza never has a bad day – meaning that automated calls are really well suited for carrying out repetitive tasks in what are (by definition) a consistent way. Such as asking members a series of health screening questions.

By identifying and handing off patients who are already engaged, this approach gives nurses a morale booster too, since they can focus on the most rewarding parts of the job that demand that uniquely human touch.

Like coupon clipping, the benefits can be quantified in dollars and cents, as well as in hard-to describe-but-just as-important ways. Like feeling smarter about how we spend our resources.

So what’s your best strategy for weathering the recession?

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