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The underrated value of coaching in healthcare: 4 thoughts from population health expert Dr. William AppelgateTedAlmonTuesday, January 31, 2017 - 10:27
To lower costs, boost patient responsibility and create a healthier country, we need to inspire people through coaching and a one-on-one basis. Healthcare professionals have been taught to teach and tell. We've found that doesn't work well. Instead, we need to teach healthcare professionals to ask, listen and inspire.
Click HERE for full article.
Ted Almon: Tough to control R.I. health costsTedAlmonTuesday, January 5, 2016 - 11:00
By Ted Almon
Gov. Gina Raimondo’s Working Group on Health Care Innovation is wrapping up its work before issuing its report on how Rhode Island might best control costs that have made health coverage unaffordable for far too many residents.
The working group — including many of our state’s foremost health policy experts along with executives of provider organizations, insurance carriers, business leaders and consumer advocates — followed a pre-conceived agenda and a compressed timeline. The report presents four rather straightforward recommendations, including a “spending cap” on total health-care costs modeled after legislation passed in Massachusetts several years ago.
Certainly, if you are trying to control a runaway expense, knowing how much you are spending is a good place to start, but even that isn’t simple. The Massachusetts law establishes a new government commission just to do the calculating. Then, since the process is retrospective, it isn’t clear what the state can do about overspending, other than to look at offending organizations with stern disapproval.
Massachusetts has decided on a semantic adjustment. It now calls it a spending target, rather than a cap. And the target really is a controlled rate of growth — hardly the solution overwrought consumers and small employers were hoping for.
Why is reform in general and cost containment in particular so difficult in health care? A new study analyzed by The New York Times (“The Experts Were Wrong About the Best Places for Better and Cheaper Health Care," Dec. 15) lends some important perspective. The short strokes are that, in designing many of the current savings strategies, policy experts who crafted the Affordable Care Act, or Obamacare, were looking mainly at Medicare data. It turns out that many areas with very low Medicare costs may have surprisingly high rates for commercial insurance. There appears to be no relation between high and low costs between the two markets, even in the same community.
As strange as this may seem at first, we really shouldn’t be that surprised. What we refer to as health care is a schizophrenic mix of two polar-opposite models. Commercial health insurance is a private competitive marketplace covering about half the people, while most others are in government-run social programs subject to strict rate setting and central planning. Trying to manage both within a single system may be impossible, since many of the incentives are in direct conflict.
Meanwhile, the “market” is convulsing with consolidation as both payers and providers scramble wildly to shore up their market power. Locally, we have seen the Care New England Network explore a merger with Southcoast Health System, but even that much larger entity will still be dwarfed by Partners Healthcare to our north and Yale New Haven to our west. Insurers are responding with mergers of unprecedented scale of their own.
In a free-market model, such consolidation works against the interests of consumers, and indeed the data now indicates that private premiums are higher in markets with limited hospital or insurer competition. On the other hand, larger organizations reduce administrative and programmatic duplication and achieve certain economies of scale. Competition among providers is also associated with less care coordination and increased utilization, which even rate setting cannot control.
Before climbing into our ideological bunkers for this battle, both sides would do well to read the report of the Working Group even though the picture it paints is limited in scope. To add perspective and context, the reform advocacy group HealthRIght has released a series of policy papers available at http://www.rihealthright.org/. They include a broad overview of the reform effort as well as deeper dives into access to care in Rhode Island and cost-containment strategies.
We may well disagree about the best course for health-care reform, but the time to justify inaction is past. More people have to get up to speed on this complex, even paradoxical problem, to inform the debate and move toward consensus and action.
Ted Almon is president and CEO of the Claflin Co., in Warwick, a distributor of medical equipment and supplies, and a member of the Working Group on Health Care Innovation.
Ted Almon: Free market, health care, don't go togetherTedAlmonMonday, October 5, 2015 - 10:09
Ted Almon: Free market, health care, don't go together
By Ted Almon
My first reaction upon reading Don Todd’s Sept. 22 Commentary piece (“Trusting bureaucrats to control health care”) was to defend the Veterans Affairs care he was attacking in the wake of last year’s scandal involving appointment wait times that were apparently falsified by officials.
As I read on, though, I realized the author was merely using the VA as an example of why free markets are always superior, making yet another tired endorsement of what now should be the largely debunked Reagan maxim that government is the problem, not the solution.
I realize that Mr. Todd and others get paid to publicly espouse anti-government agitprop. But still, it strains comprehension that they cling so to their faith in the justice of the free market even in the face of so much clear evidence of drastic failings.
Perhaps it was epic bad timing for his column, but within the same week we also read of one of the world’s leading auto companies, Volkswagen, purposely programming its cars to cheat on emissions tests, endangering all who breathe their pollution. Then there was the Georgia peanut company that knowingly shipped tainted peanut butter that sickened numerous victims and killed nine. Finally we learned of a pharmaceutical firm that upon gaining control of a generic but specialized drug raised the price from $13.50 per tablet to $750.
The column’s example of how VA officials falsified wait times to gain bonuses is not germane. Bonuses are a free-market incentive, not part of the bureaucratic process. The only clear point is that money makes people cheat, and unregulated free markets are all about money.
Now to correct the false impression of the VA hospital system, we should first concede that it is indeed an example of socialized medicine. The government pays for all the care, owns all the facilities, and employs all the doctors, nurses and other workers who provide care to our most cherished citizens. Why? Perhaps it is for much the same reason we don’t trust private enterprises to replace the military that protects us all.
Free markets are marvelous where consumers are spending their own money on products they understand. To function efficiently they require very transparent value propositions and broad competition. None of these conditions exist for the military, or for health care, for that matter. The truth is that for many conditions common among our veterans, there is no better clinical setting than the VA. Veterans rate their care at VA facilities as high as or higher than patient satisfaction at civilian hospitals.
The broader conclusion that free enterprise could somehow cure the ills of our health-care system is similar sophistry. Roughly half the population is already covered by the government through programs such as Medicare, Medicaid, the VA and military systems. Of the remainder the vast majority get their health coverage from their employers, who make most of the choices for them.
The employer-based model is admittedly disorganized. Largely voluntary, and inextricably conflated with wages, it provides good reason to look at why we continue with this uniquely American model. Perhaps we should just figure out what part of health costs are actually in lieu of higher pay and transfer that money to workers or to the government as some sort of payroll or employer tax to be used to subsidize coverage for those who need it.
Health care in our society is an essential commodity that every individual needs but too few can afford and many others don’t understand. Under these conditions competition only drives up costs rather than reducing them. There is no known application of a free-market system that fits these requirements.
We can strive to improve as individual consumers, reorganize the delivery system to be better coordinated and more efficient, and develop metrics that facilitate value analysis. But to do any of these things we will need the government in some capacity.
Free-market forces in health care have produced only chaos; the conservative caviling of those like Mr. Todd is no longer helpful.
Ted Almon is president and CEO of the Claflin Co., in Warwick, a distributor of medical equipment and supplies.
Reducing The Cost Of Healthcare - NPR Ted AlmonTedAlmonFriday, July 31, 2015 - 09:10
Claflin CEO Ted Almon tells RIPR's Dave Fallon and PBN's Mark Murphy that universal healthcare is likely off the table but insurance premium caps may be in RI's future
This week Mark and Dave speak with Ted Almon, president and CEO of The Claflin Company, a distributor of medical and surgical products. Almond is also a member of Governor Gina Raimondo's working group tasked with finding ways to reduce healthcare spending
Why is the RI Exchange Doomed? Providence JournalTedAlmonTuesday, July 14, 2015 - 15:14
Why is the RI Exchange Doomed? Providence Journal
By Ted Almon
Posted Jul. 13, 2015 at 2:01 AM
I must take issue with Mike Stenhouse’s July 7 Commentary piece, “Ruling dooms R.I. exchange." Stenhouse jumps to the conclusion that because insurers are seeking higher rates (not yet approved) for next year, the state's health insurance exchange, HealthSource RI, has failed. Of course the alternative status quo has seen rates escalate at double the rate of inflation for more than 20 years, so his impatience with the exchange seems a bit overwrought.
So is it the cost of operating the exchange, really? Actually the governor and the legislature have only allocated to the exchange the amount it would cost for Rhode Island to use the federal exchange, Healthcare.gov. By any standard, HealthSource RI has performed far better to this point.
So who is it that is so threatened by our nascent exchange? And why? Whoever it is that is funding the opposition, including Stenhouse's organization, the Rhode Island Center for Freedom and Prosperity, is dead set against us saving any money on health care by using the exchange to aggregate purchasing power. Why else, when Rhode Islanders spends over $8 billion on health care, would he be so exercised about HealthSource RI, to which the state has allocated only $6 million.
Well, we won’t find that out from the balance of the column, as the author suddenly turns to a more “disturbingly dangerous agenda," a dark plot of which he purports HealthSource RI must be a part. “The free market must be preserved in Rhode Island,” he exhorts.
What free market was that? And how is it that group purchasing through an exchange isn’t free enterprise? Of course it is.
It may be sad to some, but health care is not a business. The American people decided it was a basic human right when our iconic conservative President Ronald Reagan signed the federal law forcing all hospitals to provide care to all patients in their emergency departments regardless of their ability to pay. Businesses don’t do that, and never mind that half the population is already covered by the government in the Medicare and Medicaid programs. Even Stenhouse's sponsors can’t expect those programs to go away, although I suspect that is exactly what they would like.
I have certainly benefited personally from our system of free enterprise. I believe in free markets and advocate consumerism wherever it will work. It isn’t a blinding paradigm though that keeps me from seeing where it won’t. Even the staunchest conservatives I know don’t want to privatize the military to mercenaries. Just think of health care as akin to our national defense.
Perhaps we can then accept together that health care is a social program. What is making it so inefficient is our own insistence on treating it like a business. Suggestions such as eliminating mandates and selling insurance across state lines have been studied to death or tried elsewhere and found wanting.
I am a reasonably astute businessman and I have spent a good quarter-century looking at ways to make the market work in health care. HealthSource RI is the most powerful tool that consumers and small businesses have had yet. Together, through the exchange, perhaps they can stimulate some new competition, or better yet, reform of the whole system.
Attacking the exchange in defense of free enterprise seems contradictory. HealthSource RI is simply group purchasing, and group purchasing is very much a market force.
The Affordable Care Act of which the insurance exchanges are a part is indeed a political compromise. Most health policy experts I know believe that simply expanding Medicare to cover more of the population would have been a far simpler and more effective solution. Medicare has been working for over 40 years and has higher patient satisfaction and lower administrative costs than commercial insurance.
Facing the logic and simplicity of Medicare for all, you would think conservatives would be satisfied with the compromise that is Obamacare, but obviously they aren’t. Since Reagan conceded we would treat, and therefore pay for, everyone, it makes one wonder: To what exactly do they object?
Ted Almon is president and CEO of Claflin Co., in Warwick, a distributor of medical supplies and equipment. He is a member of the Expert Advisory Board of HealthSource RI.
Going green 101: No longer an elective for hospitalsTedAlmonMonday, June 22, 2015 - 16:11
"Claflin is doing our part to help our customers deal with sustainability issues in the supply chain by offering programs that can eliminate corrugated for recycling prior to or post-delivery as well as a unique recycling program for non-woven “blue wrap” that is ubiquitous in hospital waste streams."
-Ted Almon, CEO of the Claflin Company
To read the article referenced please follow the link below: http://www.beckershospitalreview.com/finance/going-green-101-no-longer-a...
Tolls will take toll on R.I.TedAlmonMonday, June 15, 2015 - 12:06
We should applaud Gov. Gina Raimondo for recognizing the importance of fixing our crumbling Rhode Island infrastructure. No one, particularly a state looking to grow jobs, ever reached prosperity through deferred maintenance. More typically, the state of an economy mirrors the conditions of its roads, bridges and other public facilities. Many of ours have been deplorable for far too long.
One can only assume that we as taxpayers have simply been unwilling to spend enough to keep our infrastructure in proper repair. Perhaps we think we are already taxed enough or that someone else should share the burden — but whom? If ever there was a place that might have served as inspiration for the old rhyme “don’t tax you, don’t tax me, tax that fellow behind the tree,” it could be Rhode Island.
Hence the idea that big trucks passing through our state should pay for fixing our roads and bridges. Brilliant! They don’t vote, we don’t know them, but most importantly, they aren’t you or me. Or are they?
My company, which has grown vigorously in Rhode Island and now employs 264 full-time workers, operates a fleet of large trucks that make frequent, often multi-daily deliveries to our hospitals and other health-care providers. In Governor Raimondo’s toll plan, we and other companies like us are clearly that fellow behind the tree.
We don’t mind paying our fair share of the cost, even if it may be greater than what some others pay, but the present toll plan would place too great a burden on local truckers and others in the logistics business. Ultimately, such costs of doing business just get passed through to consumers as higher prices. In our case, our customers are the same group already targeted for cuts in Medicaid and Medicare.
The idea of tolls and other targeted taxes has a certain apparent logic to it. Let those who use something pay for it. Perhaps for this reason we have come to have innumerable such levies in our state. Gas taxes, sales taxes, real estate taxes, the car tax, a variety of use taxes all combine to make up the burden we decry. In the aggregate though, they make up a tax package that is distinctly regressive, placing a far higher burden as a percentage of their income on those in the low- and middle-income brackets.
Tax policy such as this exacerbates economic inequality, suppresses consumer demand and creates more drag on growth and jobs than more progressive taxation. Just consider the gas tax, which is presumed to be the vehicle that pays for maintenance of roads and bridges. Everyday working people who commute to a job end up paying far more than the wealthy as a percentage of income. Perhaps they use the roads more, but is it pro-growth tax policy?
None of this is meant to be critical of Governor Raimondo. She is absolutely on target that public spending on infrastructure is the most direct route to stimulating growth in our economy. Like Medicaid, spending on road and bridge repairs triggers federal matching funds. It creates private-sector jobs and improves the quality of life for all Rhode Islanders. It is this overall quality of place that I maintain attracts people and their businesses to our beautiful state, not tax bargains and giveaways that often disadvantage businesses already here.
Our share of these costs should be spread as broadly as possible through straightforward, progressive tax policy. The threat of tax migration by the wealthy has never been supported by real data. We all know people who leave, but evidently other wealthy folks are willing to take their place, and those who protest the loudest are often past their role as job creators. Good roads and schools will attract the young entrepreneurs, movers and shakers, young professionals, and others who will drive the prosperity of the future.
We should make Rhode Island a showplace, pay for the renovations equitably, and stop our endless, futile search for that fellow behind the tree.
Ted Almon is the president and CEO of Claflin Co., in Warwick, a distributor of medical equipment and supplies.
Securing the FutureTedAlmonTuesday, May 26, 2015 - 10:01
Since buying The Claflin Co. in 1976, Ted Almon has taken it from near closing to a $200 million medical-products supplier that employs more than 200. This week, however, it isn't growth that he's focused on.
Like many of my baby boomer peers, I have been thinking lately about my eventual retirement and hoping that the company I have been building for 40 years can endure beyond me.
In planning for succession I have come to think differently about a few things political and economic, the relevance of which never struck me before. One issue in particular is economic inequality – not so much the grand scheme of the distribution of income and wealth within our society as much as concern workers aren't sharing sufficiently in the growth of our economy to maintain their critical role as consumers.
In a consumer economy like ours, I fear this could become unsustainable if it continues on its rather severe trajectory. I already see symptoms like the very slow growth in recovery from the recession, persistent unemployment, and even social unrest. The "Occupy" movement, restaurant worker revolts and even other troubling demonstrations are rooted in inequality. My conservative friends attribute such events to other things, such as a breakdown in our culture or morality. I don't think so.
This conclusion has led me to institute open-book management, a form of profit sharing, at our firm. We also have tried as best we could to improve productivity while raising wages.
But ours is a labor intensive and very competitive industry, so we can't do this alone. No organization can. It is something I have come to believe we must all do together. I think we can and should.
The Healthcare Supply Chain in the Era of Reformclaflin_adminTuesday, May 19, 2015 - 15:45
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Ted Almon: R.I. should avoid Medicaid cutsTedAlmonTuesday, February 24, 2015 - 10:05
Before the Raimondo administration addresses Rhode Island's budget deficit, we really should determine how much can really be saved by cutting Medicaid, one of the state’s largest expenses. My case here will be that such savings are clearly not dollar for dollar, and in fact may be ill considered or even illusory.
Gov. Gina Raimondo’s inauguration is barely past and her inchoate administration already faces a structural deficit. Rhode Islanders have seen these before of course, and we know they don’t always materialize as actual deficits in the end. This is because like all forecasts they are based on certain assumptions about revenue and expenses that can vary as the year goes along. This is not to suggest they should be taken lightly.
The corollary in business would be a deficit budget that management must deal with to avoid a loss. Corrective actions could be quite varied but basically fall into two simple groups. We can attempt to increase revenue, or we can shave expenses or some combination of both. Increasing revenue may not be the easier path, but it is generally the least unpleasant. Some strategies are fraught with the possibility of unintended results. Raising prices for example may depress sales and have the opposite of the intended outcome.
So inevitably businesses take a careful look at expenses. Cuts there that don’t affect sales could help the bottom line. But some things businesses spend money on actually produce revenue, so managers must carefully assess the relationship between the cost and the benefit.
When businesses look at expenses, they tend to prioritize, looking at the biggest budget items first. The state does much the same. Medicaid is right up there at the top. The problem with Medicaid though is that, for each dollar we spend, the federal government pumps more than a dollar into our economy. You would think we would know precisely how much we get back, but I’m not sure we do. It is complicated. Different parts of the program have different matches, the CHIP program for children varies from RIteCare, which varies from standard Medicaid, etc. To complicate it further, the expansion of Medicaid resulting from the Affordable Care Act is almost entirely federally funded.
What this means is that any cuts to Medicaid spending would have an immediate and offsetting negative effect on revenue. The federal dollars coming into the state go first to health-care providers, who then pay workers, who then spend the money with local businesses, who in turn pay workers, and so on. This cycling of the money through many layers of our economy is called a multiplier, and estimates of its impact on Rhode Island's GDP vary according to who does the calculation. But real economists would concur it exists.
In order to make a rational decision about cutting Medicaid spending, we must first know what the bottom line economic impact will be. That our benefits may be generous or that our per-capita costs are high really is a separate issue. Medicaid spending in a state trying to grow jobs and its economy may be a good investment. We know that the “meds and eds” sector of the Rhode Island economy is considered one of the most promising areas of growth.
Numerous initiatives to control the overall cost of health care through payment reform and a focus on improving the health of the population are already under way in Rhode Island. These should also benefit the Medicaid budget as they gain traction. Efforts to ensure that Medicaid is as free of fraud and abuse as possible should also be encouraged. But cutting benefits now is not a substitute for these fundamental reforms.
As a final point, admittedly separate from the purely economic analysis, cutting Medicaid benefits really only saves money if we don’t treat the people who would have been covered. Since we all know they are going to be treated anyway in our hospital emergency rooms, community health centers or by other providers, what we are really arguing about as taxpayers is making someone else pay.
I’m all for balanced budget, but at the same time both my practical business and ethical instincts tell me cutting Medicaid is not a good place to start.
Ted Almon is CEO of Claflin Co. in Warwick, a distributor of medical equipment and supplies. He is also on the executive committee of HealthRIght, a reform advocacy group.