Sunday, December 21, 2014

Future of Physical Therapy 2015 (Part 3)

Welcome to Part 3 of Future of Physical Therapy 2015.

If you wish to look back further, you can find Part 2 HERE!


So what needs to occur to ensure that a great idea isn't snuffed out by the process and organizational values already in play?

Answer: Ambidextrous Design.

Some people call this a parallel process. Regardless the label, it is the ACTION that matters. What occurs in this strategy is the creation of a separate value chain. Some companies will actually reallocate human resources, giving managers a break or incentivizing them with, "You had to downsize anyway, right?"

By hand picking out key players already in favor of an innovative vision, you are creating an all-star team and are setting them up for success. This is very much like the smart data I mentioned earlier. Where smart data is more about strategically using big data with situational, striated, and actionable user-driven perspectives, the Ambidextrous Design similarly attacks the problem by selecting leaders who are already very intune with the tactical circumstances to which an innovation must emerge.

Leaders in this environment must be involved, highly constructive, minimally critical, positive, and visionary. This is NOT where micromanagement needs to be. (Some would argue, micromanagement never needs to be anywhere, ha!)

The separate value chain is critical because it allows for the development process of any innovation to be evaluated through strategic lenses rather than marginal lenses. This becomes extremely important in the early phases since most projects fail to demonstrate financial gains in nascency. However, the exponential gains are made excitingly abundant in the later cycles.

Separate value chains also allow for a co-existence of the old and the new; this is helpful because the visionary leadership at the top intends on converting everything to the new ways for widespread success. However, if leadership were to make sweeping changes right now, there would be an uprising on their hands. This separate value chain allows for a small department to serve as a pilot of sorts, demonstrating to the larger majority who are resistant to change the value of what they now bring to the table. Once their superior metrics are proven, transferring the new values, processes, and resource models become attractive as any manager would be more than happy to take on those benefits now that they are actually proven.

Another HUGE issue in 2015 will be eliminating the middle man. If one examines the study of supply chain management, it is quickly appreciated that "the middle man" or the "distributor" should ONLY exist if they add value to the entire supply chain.

In healthcare, the supply chain exists to give patients access to the content experts, make available technical skills they cannot perform themselves or for themselves(clinicians, technicians, surgeons etc.), and unlock access to products (primarily drugs and DME).

However, the resources of healthcare have been overwhelmed. There's nearly no more water left in the well, so resources are being rationed. However, the industry is looking at this the wrong way.

It isn't that the well is drying out, it is that we keep drawing from the well while ignoring the oasis behind us.

Why see a gatekeeper who knows little about the problem you have, only to have your gatekeeper send you to the expert afterward? Why go in for an office visit when communicating through an app will do? Why go for a follow up when all anyone was waiting for was the results from a lab study? The prescription can be sent in remotely anyway, right? And, why use expensive machines to diagnose when its been plainly demonstrated clinical diagnosis can glean far more useful and actionable pieces of information for both long term and short term benefits?

This eliminating the middle man is really a battle of eliminating redundancies. Redundancies typically serves to waste resources and make processes less efficient. This will be a very big focus in 2015. While this is a great initiative, it is not enough. Reinforcing an agile supply chain for healthcare will emerge as a key partner. When we think about health services, what is really going down?
  1. A patient (consumer) has a concern or ailment to be addressed.
  2. The patient wants to know if they need to be seen, and if so, to be seen NOW.
  3. The patient wants to receive the solution to their concern or ailment directly and ASAP.
The common story of going to the primary provider, waiting for the one specialist only to be referred to another specialist only to be referred to the diagnostic suite, then a follow up with the first specialist -- all of which took 5 months (if they were lucky). Of course, when this person finally sees the first specialist, they will ultimately be referred to the REAL specialist who could do something about their concern.

These kinds of stories will only exist for FAILING health systems.

Instead, the cutting edge systems will employ predictive modeling where beneficiaries will be contacted for emerging risk factors detected by their clinicians, smart data, and  with self reporting.


Finally, the last key strategy I'd like to introduce for physical therapy and healthcare in 2015 is the entrance into emerging markets. Most emerging markets tend to be disruptive. Others, create an entire genre of their own.

While I made mention to this last year, I would still like more PTs to show up in the space of childhood prevention; I've made many mentions to how dentists have done this to prevent cavities. PTs can certainly do this for the many functions of the body. Considering childhood obesity and manner other PHYSICAL concerns on the alarming rise, are not Physical Therapists best suited to address these public concerns?

For healthcare, emerging markets aren't necessarily about treatment of disease and physical ailments. And, it's not even really about keeping the body running in a healthy, fit, and functional way -- in my humble opinion, this has been the goal of healthcare all along.

I think the emerging market we need to carefully and honestly examine is that which involves reimbursement. Reimbursement MUST move beyond billing units and fee for service. If we're honest with ourselves, the more you deliver health services as a system, the more you have sucked in doing your job adequately.

Why would your beneficiaries need more care and more services if you actually did your job to keep them healthy in the first place?

Instead, I suggest to be on the lookout for differential resource management and value added opportunities. These will both help eliminate our problem children and reward our high performers. I mean, really: In acute care, does it REALLY help for a post-op day 3 inpatient to be walked around the hall by PTs or even PTAs? NO! For SNFs, is it really that helpful to boost up a RUG level and have a clinician bat balloons around for minimal gains in Tinetti scores? NO!

However! How incredible would it be for a PT to follow up as a primary care resource to a patient who had a mechanical fall and landed themselves in the emergency department, following them for 2, 3, or even 5 years with regular check ups both physical and digital? Imagine how this would play out for a population of say 5000 people who fell. Imagine the good this would do, the savings that would be made, and the value that would be added by those people staying healthy and actively participating in economy at large!

Feast on the thought that an outpatient office serves as a informatics source and seed site to where a company of several hundred individuals contracts a PT firm to address workplace injury concerns directly. The company already spends over $10 million dollars a year on work injuries. By applying principles of smart data, this PT firm is now able to reduce this company's expenditures on work injuries by $5 million dollars. What of the difference? Well, per the contract, $1.5 million goes to the PT firm! The hiring company saves $3.5 million this year... not to mention the improved productivity throughout.

Toward the end of 2015, I anticipate source and seed processes to take on a social network spirit where like minded allies band together to demonstrate greater value together. This will become powerful on the financial and political front, garnering much momentum to drive legislative changes.

Process and policy changes will occur organically. After all, if Firm A is saving millions because of an innovative process, wouldn't Firm B quickly attempt to adopt it through their own means?


Some Closing Thoughts
For 2015, I anticipate that the large contract model will occur through networks of PTs, attracted to each other in spirit and demonstrating superior solutions to big picture problems that chop shops can't handle. I also sense that PTs will be repeated denied the timid option of billing for clinical services in the near future. I mean really, how much longer before another clinical profession begins to replace what we do for less cost? If you feel absolutely compelled to survive in this space, the network model will still reign supreme when network A demonstrates better outcomes than network B with an average of 10 less visits per case.

Our knowledge base and skill sets demand us to do more. Therefore, we must step out of the box of ONLY clinical care. We need to think on every possible aspect of how we can use our knowledge and skills in meaningful and valuable ways -- not just for patients but entire systems of business.

2015 is the year of healthcare disruption. Roles, accessibilities, and resources never before tapped are going to be mined, trumped and championed. The first few who jump on this opportunity will win out. Wise firms who know that they are behind will seek expert help to seed their success. Those who try to catch up will inherently fail as their organizational structure will refuse to support such initiatives. Some will try so hard that their entire infrastructure will collapse... just watch!

This coming year, I rebuff my encouragement for PT programs to favor clinical affiliations in the space of private practice, acute care hospitals, and out of the box firms who do much more than the day to day workings. There will be plenty of opportunity for that in the working world, now is the time for our students to learn the cutting edge... learning these things after is far too late. Oh and PS. Why not use some of that tuition money during affiliation semesters as financial incentives for clinics of strategic repute and professional integrity? It would only help elevate the profession at large.

The future of Physical Therapy in Healthcare?
  • Disruption. Internal and external disruption. PTs entering emerging roles outside of the clinical space, leading the charge for value added models and innovative processes.
The mechanism?
  • High impact network models; quality coming together, separating the wheat and the chaff. Small business will become the new source code for "big."
The strategy?
  • Ambidextrous, parallel processes -- many will choose a source and seed tactic. Others will separate their value chains to protect and nurture innovative developments.
The winners?
  • Those who are taking on the risks now.

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