Saturday, August 15, 2015

Simon Stevens: Best guy for NHS or JCPenny?




We learn little or nothing from our successes. 
They mainly confirm our 
mistakes, 
while our failures,
 on the other hand, are priceless experiences
 in that they not only open up the way to a deeper truth, 
but force us to change our views and methods. 
C.G. Jung

The best guy from Apple was not able to sort out JCPenny so the best guy from UnitedHealth may not be able to sort out the NHS!


It appears Mr Stevens has dug a hole for himself and the NHS in failing to negotiate a workable deal. When you juxtapose the growing severity of the NHS financial crisis and the now open calls to look at alternative funding models for the NHS with Mr Stevens' previous post as president of the global health division of UnitedHealth Group, a giant US private healthcare company, some people may ask: Is the NHS being set up to fail?


Mr Stevens said in his 5 Year Forward View that "the NHS is the proudest achievement of our modern society". If he wants to be seen as the torch-bearer for our NHS he must openly acknowledge that the £8bn request was wholly insufficient and have the courage to call for increased NHS funding to a level that ensures the continued survival of a safe, effective and public NHS. 
J.C. Penney

Big dreams, arrogance, infighting, and delusion all collided in the disastrous attempt to fix venerable retail giant J.C. Penney. The inside story of a revolution derailed.
Originally published in Fortune, March 2014. 
When you find a savior, you don’t quibble over details. So it was that J.C. Penney, the long-stagnating mid-tier department store chain, announced in June 2011 that it was hiring Ron Johnson, the man in charge of Apple’s wildly profitable retail stores and a Steve Jobs acolyte whose golden halo also included past triumphs as an executive at Target. The news sparked euphoria, but conspicuously absent from the media coverage was any mention of how Johnson planned to save this faltering retailer in a fading industry. That’s because there were no plans. His mandate could be reduced to a single word: change. What that entailed could be figured out later.

Simon Stevens' switch to NHS 'is like Arsenal signing Mesut Özil'

The man who helped orchestrate New Labour's massive NHS investment is seen by many as the right choice for the job

The unveiling two days ago of Simon Stevens as the new chief executive of NHS England prompted widespread relief, a broad consensus that he is the right choice and, in some quarters, an almost desperate desire for him to succeed in what is one of the toughest jobs in public life.
Partly, of course, that is due to the man himself. He may have worked in the United States for the last nine years for the private health firm UnitedHealth, but the 47-year-old is respected and remembered both at Westminster and inside the NHS for helping to orchestrate New Labour's huge investment in the service in the early part of the last decade, which rescued it after years of neglect and decline.
But wait: The Independent



UHC’s phenomenal rise – it is now ranked no 17 in the Fortune 500 list - has not come without controversy. During the 10 years Mr Stevens was a senior executive, the firm was the subject of a class action lawsuit filed by the American Medical Association after it claimed UHC used faulty claims data to underpay doctors and overcharge patients. 

New York Attorney General Andrew Cuomo said patients had been victims of “consumer fraud” for a decade in a settlement that saw UHC agree to pay $350m in compensation to the claimants. Investigators had found that insurers using the Ingenix database, a UHC subsidiary, underpaid up to 28 per cent for claims based on inaccurate or insufficient information in the system. As part of the 2009 settlement, UHC also contributed $50m to help fund a new database that would replace the old one ending a “clear conflict of interest” according to Mr Cuomo.

An updated version of Ingenix is again causing controversy today. OptumInsight, another UHC-owned data firm, which uses algorithms to find efficiencies from calculating the most expensive patients, or doctors with the fewest number of patients, has been blamed by analysts for UHC dropping thousands of doctors caring for elderly Medicare patients this month. The company claimed it wants to provide “a network of physicians who we can collaborate with to help enhance health plan quality, improve health care outcomes, and curb the growth in health care costs”.

......UHC was also under investigation by the SEC in 2006 when then chief executive William McGuire was ordered to pay back $468m as part of a partial settlement over stock options backdating. The scandal, which led to Mr McGuire’s resignation, cost the firm almost $1bn.

....Although NHS England said Mr Stevens will “divest himself of any UnitedHealth Group shares before taking up his new NHS post in April, and will comply with all public service rules related to these matters,” a review of this agreement by NHS England chairman Sir Malcolm Grant will be made after Mr Stevens’s first year. Critics argue that this could pave the way for greater collaboration between the NHS and United HealthCare, which already runs some GP services in the UK.

Johnson demonstrated that he’d learned a thing or two about stagecraft from his legendary former boss at Apple. He had commandeered a large basement studio at Penney’s Plano, Texas, headquarters and had workers construct two rooms. (Johnson wanted to go further and install floating stages in the company cafeteria, but the fire marshal nixed the plan.) After he had made his presentation, the new CEO brought the directors downstairs to deliver the coup de grâce in the form of a sound and light show. In the first room was the taped commotion of shouting voices and visual noise: a profusion of signage, coupons, offers, and clutter. This was the off-putting cacophony of J.C. Penney at that moment. Johnson then ushered the directors into the next room, which was white, tastefully austere, and had a celestial serenity: the new JCP.


Finally Johnson led the board members into the cafeteria, where 5,000 employees, who had been waiting on their feet for hours, greeted the group with a raucous ovation. Then it was party time. Officially the fete was intended to bid farewell to Johnson’s predecessor, Myron “Mike” Ullman III, but it felt more like an ecstatic celebration of the company’s rebirth. With nary a whisper of opposition, the 109-year-old retailer had decided to abandon not only its strategy of many decades but arguably its fundamental way of doing business.
So the NHS of 60 plus years has now a genius from UnitedHealth, sorry Labour that will dismantle it and turn it into something even better than UnitedHealth that he left in Minnesota.
Just 16 months later Johnson was out. Penney was hemorrhaging cash; it lost $1 billion during his one full year as CEO. Its shares were hurtling downward. The press had turned against him. One of the two investors who installed him had fled. As fast as they had once anointed Johnson a messiah, Penney’s directors turned their backs on him.
Since his departure the company has behaved as if Johnson’s entire tenure was a coup rather than a strategy blessed by the board. The retailer has renounced his philosophy, restored Johnson’s predecessor, Ullman, as CEO, and reverted to its old ways. If we’re heading for oblivion, the board seems to be saying, let’s at least try to get there slowly. Some observers think bankruptcy is a possibility, despite improved results of late (at least compared with the previous bloodletting).
This era has seen some truly epic corporate conflagrations. There was the precipitous collapse of Lehman Brothers, which came to symbolize the greed and corruption of Wall Street, and the multidecade decline and, finally, bankruptcy of General Motors, which seemed to embody the slow death of American manufacturing. But for its stomach-churning mix of earnest ambition, arrogance, hope, and delusion – along with a series of comic and tragic miscues – it’s hard to top J.C. Penney.
“I came in because they wanted to transform,” the former CEO told me before his fall. “It wasn’t just to compete or improve.” (Johnson was interviewed for this article but declined to be quoted beyond saying, “I do not want to interfere with Penney’s attempts to succeed.”) He and his team did indeed transform Penney – from a sleepy behemoth known for serving the needs of Middle America into something quite different: an ambitious wannabe startup that fancied itself cool, with a radical pricing and merchandising model that had never been pulled off before. The outcome was doubly disastrous: Penney alienated its traditional customers without attracting new ones.
Everyone understands that the Johnson revolution ended in catastrophe. But the full story has never been told. The reality, it turns out, is even worse than many people imagine – and in a few respects, very different. What follows is the story of what actually happened at J.C. Penney, based on months of interviews with 32 current and former executives and vendors and more than 20 investors, analysts, and competitors.
It’s a saga with a swirl of overlapping forces. It stars a charismatic leader bent on radical change and features a failed attempt to Apple-ize Penney, a mission that ended up being every bit as crazy as it sounds. There’s a board of directors who sometimes seemed more concerned with what they’d be served for dessert than with the fate of the company. Then there’s the mistake that cost the company $500 million – and the fact that Penney actually began retreating from its controversial pricing strategy even before Johnson left, raising the question of whether the company can even truly be said to have tried his approach. Throw in a hedge fund titan who always knew better – except when he didn’t. The result: Billions in revenue were vaporized, and more than 20,000 people – many of whom embraced the new Penney – lost their jobs, seeming to hasten the decline of American brick-and-mortar retailing. This is a tale with very few heroes.
 Fortune reported , March 2014. 
So getting the best guy from Apple was a disaster for JCP, now back to being J.C. Penney.
Will NHSEngland revert back to just NHS? I doubt. But Simon can blame his American wife and young children if he wanted  to go back to Minnesota. After all there is Mayo Clinic there and they have never changed.

Or would J.C. Penny some day take on Simon?
Or would we some day read that: Big dreams, arrogance, infighting, and delusion all collided in the disastrous attempt to fix NHS England!

An Entrepreneur!         
UnitedHealth & Big Profits             

Thursday, August 13, 2015

NHS: Rosy future for Health Insurers!

Looks like the future is bright for Health Insurers as they can cherry pick!


Patients could have to start to pay charges to use basic NHS services such as GPs because the health service’s finances have become so dire, the leader of Britain’s doctors has warned. 
Dr Mark Porter, the head of the British Medical Association (BMA), said that whoever takes office after the general election will inevitably be tempted to bring in charges and may not be deterred by the unpopularity of such a seismic change to the health service.
....“You say it’s politically toxic. It’s not, really, is it? Look at dentistry and look at social care. They carry with them exactly the same offer to the public by which the NHS was set up; that we will remove from you – this society, us acting collectively – the terrible fear of bankrupting yourself by having an illness, by needing healthcare.
“And yet we allow people to be bankrupted by social care and we allow people to be deterred from seeking dental care because of charges,” Porter said.

Can we think of ways round this?

There is little doubt that a system based on insurance will need smart legislation to control the insurers. If the NHS is going to make use of wealthier individuals to use Health Insurance, then the same smart laws will need to be enacted for the regulation of Insurers. We should have learnt through the banking failures that in business, there is no such thing as self regulation.


In the US: Obamacare!


Here are some things the law will do:
·         It will prohibit insurance companies from refusing to sell coverage to people simply because they have one or more pre-existing conditions.
·         It will also prohibit them from cancelling our coverage when we get sick just to avoid paying for our care.
·         It will prohibit insurers from charging women more than men for comparable coverage and will not allow them to charge older folks more than three times as much as younger folks.
·         It will require them to spend at least 80 percent of what we pay in premiums actually paying claims and improving care.
·         It will allow young adults—who comprise the largest segment of the uninsured—to stay on their parents’ policies until age 26.
·         It will reduce the number of uninsured Americans by at least 30 million if all the states agree to accept federal dollars to expand their Medicaid programs.

That said, Obamacare is not a panacea for all that ails the U.S. health care system. I view it as the end of the beginning of reform. We will have to do more as a nation to bring everyone into coverage, to control costs and to improve the way we deliver care. But Obamacare does not resemble the law that many politicians have spent millions of dollars trying to persuade us it is.  Don’t be fooled into voting against your own best interests tomorrow.


As we admire the roses:






 ©2014 Am Ang Zhang

"In fact, to save money, government can buy insurance 

for 

the mental patients and the chronically ill."

It must be very obvious that all the talk about medical cover for visitors to England never mention the need for health insurance.

Could this be because insurers have managed not to cover for everything. One need to ask the question on how one ever travel to the US where cost of medical care is extremely high.

It may well be prudent for government to insist that non EU visitors to this country must have mandatory Health Insurance as part of the admission requirement. This should apply to students and tourists alike. After all nobody in their right mind would dream of going to the US without proper insurance.

We have managed to get people to insure their cars, why not their bodies.

There is of course the need to fully control Health Insurers for those that live in England if they want cover. 

Let people opt out of the NHS if it is so bad! But Insurers need to cover every thing. 

Citizens could be given a tax break and yet have the insurance policy incorporated into their NI/NHS number so that those with the tax break, the insurer will be charged for every kind of medical care they receive if they were within the NHS.


 

Summary of a popular post:

·                     Ends discrimination against people with pre-existing conditions.
·                     Limits premium spread to normal, high risk and healthy risk to say under 20% either way of normal.
·                     Limits premium discrimination based on gender and age.
·                     Prevents insurance companies from dropping coverage when people are sick and need it most.
·                     Caps out-of-pocket expenses so people don’t go broke when they get sick.
·                     Eliminates extra charges for preventive care.
·                     Contribute to an ABTA style cover in case Insurance Companies go bust and many might.

We could legislate that Insurers will have to pay for any NHS treatment for those covered by them. It will stop Insurers “gaming” NHS hospitals. This will prevent them saving on costly dialysis and Intensive Care. Legislate for full disclosure of Insured status.

Insurers cannot drop coverage or treatment after a set period and even if they do they will still be charged if the patient is transferred to an NHS Hospital.

This will eliminate problems like PIP breast implants.

It will indeed encourage those that could afford it to buy insurance and in any case most firms offer insurance for their employees including the GMC.

To prevent gaming of Insurers by individual patients (I look after their interest too), the medical fee should be paid up front by the patient and then deduction taken from premiums. Corporate clients like those with the GMC should not be gaming Insurers.

Imagine the situation where those with “individual personalised budget” being able to “buy” their own insurance!

In fact, to save money, government can buy insurance for the mental patients and the chronically ill.

This way there will be real choice and insurers will be competing with each other to provide the worst deal.

Why?

What Health Insurer will want the business? 


Perhaps they will go back to the US and we will have our own NHS back.                                                                                   

Monday, August 3, 2015

Anorexia Nervosa & South Africa: Cello & Bach!!!



Cape Floristic Region (CFR) of South Africa
 ©Am Ang Zhang 2005
South Africa reminds me of my Anorexia Nervosa patient.

Protea, Cape Floristic Region (CFR) of South Africa
 ©Am Ang Zhang 2005

Nikon 180/2.8 ED on Nikon D70(around 250mm)

The Cape Floristic Region of South Africa and South Western Australia are two of five areas on Earth with a Mediterranean-style climate which have been designated ‘biodiversity hotspots’ by Conservation International. The others are central ChileCalifornia, and the Mediterranean basin.


In The Cockroach Catcher I got my Anorectic patient to play the cello that was banned by the “weight gain contract”:
 


                 Jane got on well with me.

          She had to, as nobody understood that to her achieving was not a hardship but something she secretly enjoyed. She was no longer allowed to pick up her books as she had not put on any weight since her admission.
         
          Cello would be banned too, if her nurse was to have her way.

          For the unit to function the nurse must have her way. After all I was not there all the time to watch her. To watch if she was eating, vomiting, exercising or whatever else they did to avoid gaining weight.
          But I was determined that it would be the first privilege she would get if she put on half a gram.  Or any excuse I could think of.
          Brutal confrontation is often what happened in many adolescent units dealing with Anorexia Nervosa. The brutality is not physical.
          But these patients are intelligent and have such strong will power that confrontation generally fails and the failure can be a miserable one.  Yet it is the kind of condition that hurts. It hurts those trying to help. It hurts because these patients deserve better for themselves. It hurts because they are not drop-outs of society. 
          Was it too hard for Jane to keep at the top academically? Someone offered that as an explanation. Perhaps she should be moved to a state school.
          The idea horrified me.
          A fourteen year old non-smoking, non-drinking, non-drug taking, intelligent Audrey Hepburn look alike virgin turning up at your local comprehensive.  It sounded like a major disaster to me.
          I had to take the matter into my own hands. She did put on some weight and at the earliest opportunity I decided she should get back to the cello which had always been by her bed at the unit.

          She missed the cello, the only thing she could use to shut out her worries.
 

          Fourteen and carrying the burden of the world.
 

          Then she started playing.
 

          “Ah. The Bach G-major!”

 
          “So you know it.”
 

           Of course I do. The hours I spent listening to Yo Yo Ma and it was such amazing music, melancholic and uplifting at the same time.

          For a moment I forgot that I was her psychiatrist and she forgot she was my patient.
 

          “My grandma gave me Casals.”
 
          I knew Casals was even more emotional than Ma, but Ma is Chinese and he was less affecting, allowing the listener to tune in to his own mood.
 
She played from memory. What talent! What went wrong?”
 

          “I wish my dad could hear me.”

          It was the first time she could talk about her father. They had a very comfortable life in South Africa when father was alive. It was very difficult to imagine what he would have looked like. It was never clear what he did but he was involved in a number of ventures. The plantation Jane’s grandfather ran was sold when apartheid came to an end. He was involved in some private reserve and he was a photographer of sorts but my junior told me that mum started to cry when she talked about him so she did not pursue too deeply.


Read more:

NHS: The Way We Were! Free!
FREE eBook: Just drop me a line with your email.

Email: cockroachcatcher (at) gmail (dot) com.



A Brief History of Time: Anorexia Nervosa





Bach - Cello Suites:  Yo Yo Ma