Cobb

Michael Porter, Strategic Thinking & Bundled Payments

Some cat named Michael Porter who teaches at Harvard said one of the first utterly comprehensible things I've heard about the problem with American health care delivery. It's piecework.

Essentially the problem is this, the business model of healthcare incents doctors and specialists to become more specialized. A patient is not a patient, so much as a target of a set of procedures that are delivered by a group (not a team) of various professionals who all want to get their piece in. A patient is not a project whose success or failure matters in terms of on-time, to spec and under budget. Such concepts are not applied to patients.

The next time you see a television show or movie in which the doctor comes to the patient and reads the chart extensively, think about it this way. They have no idea who that patient is nor have they spoken to the other people who does. They see the chart and the chart dictates a plan of action - which means the doctor has to think up a new leg on their trip through the system.

"OK we're going to run some tests". Which means, I think I can make a referral to this other kind of specialist who heretofore has had nothing to do with you, but I can only get his attention of we give him the results from this new branch of treatment I'm going to queue you up for. You pay for the tests and you wait for the specialist to pay attention. You cannot, ever, get two doctors in the room looking at the same patient at the same time, unless it's surgery. The business model does not support a customer focused organization.

Bundled Payments means, pay a team for patient outcomes. Here's 40 thousand dollars and 12 days. The six of you get together and figure out how to get Sally healthy again. Put your heads together. If you get her out in six days, there's a bonus. If you don't spend all of the money, you can roll it over into a reserve account and use it when you get a more complicated patient.

It's about the insurance, sure, but it should be about patient outcomes, and right now hospitals in America are running off a system of incentives that are not about patient outcomes.

That There Was Football

Like most people are to politics I am to professional sports. I only pay attention during the playoffs, and I try not to miss The Day, but if I do, no big deal. This year I hosted my first ever Super Bowl party, thanks to the fine folks at Samsung who made such things a pleasure.

What a game. It has to be one of the most exciting Super Bowls ever. I just wanted to say that I know a thing or two about football and now a few more listening to Boy.

1. Doggett. Who knew that people pierced necks? When he got in at Ben R. in the 4th, I thought it was over and the Steelers would not be able to regain the lead, but the Steelers line just stopped him dead. I saw him twice as Ben connected on the final drive, 7 yards out of the play.

2. Safety. Holy smokes what's a safety? I haven't seen a safety in so long that I don't even say it out loud when it looks inevitable.

3. The fieldgoal over. I thought my DVR was broke when some penalty or other called back a field goal and then several downs later there was a field goal.

4. Penalties. Homeboy from the Steelers who put his knee in dude's back and held him on the ground? That was brutal. Was that Harrison? There were probably 3 facemask violations. For all the penalties in this game, they kept it moving. Big up to the officials. They got it right every time. Superb officiating in a close contest.

5. I'm sure I feel about Clarence Clemmons the way some people feel about Michael Steele. I think The Boss needs to get over to Bally's because he's still got nothing on Mick Jagger.

6. Jennifer Hudson just owned the National Anthem. Sorry Whitney, it ain't yours any more. Where can I get the MP3?

7. Best answer to a stoopid question, by head coach Mike Tomlin. Well, basically everything he said because every question was stoopid. Very nicely low key. Righteous.

Mr. Poppins

It took me all of 10 minutes to raise my blood pressure and hopefully by the end of this paragraph it will be appreciably normal. The occasion would be Frank Capra's 1938 flick, "You Can't Take It With You". Since I don't expect more than a small bit of twist in the plot, I'll put the thing down and accept that it stands no test of time so well as "Holiday" with Hepburn and Grant both being meditations on the twists of the soul the caretaking of money foists on folks.

I've not seen a film that so blatantly twists around a particular notion of the responsibilities of business. But then again, it was just a happy movie. I figure people just on the edge of the Depression needed some kind of feel-good message to show that money isn't everything. So before I go after Capra with both feet, I'll take in some more context.

Keep Lying to Me

The amateur psychologists are having a field day. Enter the new meme: ' verbal-body congruency'. Which is another way of saying 'good acting'. I think we have just entered another era of intelligent stupidity.

In case you haven't noticed, there are some experts who make a living eyeballing people's body tics and, in combination with slow motion video, have made something of a science of telling if people are exhibiting behavior that indicates that they may be lying. It might be a science, it might be an art, just like playing poker. Whatever it might be, there's definitely some entertainment value  - therefore the new reality show on Fox 'Lie to Me'. 

But here Shay Riley is applying some form of this armchair analysis to Michael Steele rather as it was applied to Bill Clinton in another era. I certainly remember the expert who, after the fact, came on television and said that in his professional opinion some of the lies that Clinton was telling were obvious. And we get to the basic question of a standard.  As far as I'm concerned, there is no standard, and I think any attorney or judge who allowed this sort of foolishness into a court of law would be ejected. So I am bringing down my skeptical hammer on this tomfoolery.

Am I being harsh? Let us try to keep in mind something that is also in the news before we jump to any conclusions about the efficacy of this sort of videotape analysis. That is the matter of interrogation.

Pause. Breathe. Think.

If it were simple for experts to ask a series of questions to suspects and determine thir veracity simply by watching their eyeballs and tics and their 'verbal-body congruency', then what that Army manual for? And of course if everybody could do it, then everybody *is* doing it, and that means of course that everybody knows that everybody is doing it and trying to be convincing otherwise.

A Defense Procurement Softball for Obama

This defense procurement nightmare of a 'split buy' is a softball sitting on a tee waiting for Obama to smack out of the park.

As Amy Butler of Aviation Week reports, the split buy option will be a topic of conversation when Pennsylvania Congressman Jack Murtha visits the Alabama plant where the Northrop-Grumman tanker would be built. Murtha's endorsement is considered essential in mustering Congressional support for the split buy option.

So far, the King of Defense Pork has not revealed his position on the issue. But convincing Congressman Murtha and his colleagues may not be difficult. In the early stages of a recession, no politician wants any part of a decision that would elminiate thousands of high-paying aerospace jobs, many of them filled by union members.

That's why officials close to the tanker program say dual sourcing by is the "only politically palatable way" to move forward. Under the split buy approach, Boeing and Northrop-Grumman would build 90 tankers each, creating (or saving) more than 80,000 defense jobs across the country.

What exactly will the Air Force--and taxpayers--be getting for their money? While buying tankers from two different contractors will win support on Capitol Hill (and in places like Mobile, Alabama and Seattle), dual sourcing is a terrible idea, for a number of reasons.

First, there's the issue of unit cost. Buying fewer aircraft from a particular supplier drives up the price tag. The B-2 became a billion dollar bomber because the projected purchase dropped from 132 aircraft, to only 21. Both the Boeing and Northrop-Grumman tankers are based on commercial airliners, but the same production rules apply. Buying 90 aircraft from one contractor and the same number from another will raise the project's cost well beyond the current $40 billion dollars.

Still, the duplication doesn't end there. To support two different tankers, the USAF will be required to create two aircrew training programs, and separate schools for technicians who will maintain the Boeing aircraft and those assigned to the Northrop-Grumman jet.

Murtha is a stumblebum of colossal proportions whose idiocy has been demonstrated six different ways every year. Obama needs to smack him down, save the taxpayers money, cut defense spending and do something smart all in one fell swoop. I'll stand waiting with a high five if he does it.