Author: Richard Watson

Guest post by Motient co-founder Dr. Richard Watson

Growing up in the rural Midwest, I would never consider myself a “farm boy.” My parents were both PhDs, and although we had cattle and horses, hauled hay, and planted milo, I don’t think we would have qualified to be in the same class as the revered families that know what it’s like to depend on a series of variables that no one has control of to make a livelihood.

Understanding moment-by-moment the importance of coexisting with the land and the weather, respecting what you know and don’t know, and being humbled at every turn either molds character or destroys it. The whole idea seems merciless to me, but some of the most important figures in my life came out of that crucible. I have so many memories of those days, mostly happy, some wonderful, some sad, but many that are hilarious and representative of the chaos that humans, animals, and land can find themselves in.

I would sometimes work for the farmer who lived down the road from us and enjoyed seeing a pro at work and trying to get my head around how someone would choose that life. Harvest was the best in my mind: The moment when all the other moments would come together, and the beauty of the fields gave up their hard worked-for crop. Silage was by far the most mysterious to me. Cutting corn while still green and then blowing it into cylindrical towers where it would be left to ferment and become rich nutrition for livestock. Silos themselves are amazing: These monoliths of the plains are the icons of hard work. They are formidable to withstand the elements and their intended purpose.

The View from Inside a Silo  

I find it interesting that in healthcare, we refer to the silos of care. Certainly, this is true of patient movement. Sending facilities, receiving facilities, and transport services all have formidable foundations, and the infrastructure is an almost impermeable structure that seems limited by its own occupied geography. Standing in a silo, the walls are readily apparent. You become acutely aware of the limitations of your own space. When you do look out, the only view is straight up and is limited to a very small picture of the outside world. That limitation gives minimal data as to what the outside is really like. Healthcare mirrors this in the way we develop space in our own confined geography, but the view out is very limited. Amazingly, you can never see another silo from inside of your silo.

Building Fresh & New on a Strong, Clean Foundation

One of my jobs before harvest would be to clean out the silo. At the beginning of each harvest season, there would be silage leftover from the previous year. I would crawl in through one of the openings and begin shoveling the remains out. At first, it was the sweet fragrance of the fermenting silage, but it would quickly deteriorate into a stinky, wet, rotten mess! Much like health care, there is little interest and getting rid of the old and the rotten.

We continue to keep that covered.

Healthy Harvests — and Systems — Require Regular Maintenance

The future of health care depends on the constant, consistent, calculated dismantling of our silos. We have readily learned that we can’t have a never-ending supply of healthcare resources. We’re only beginning to experience the wave of the aging boomer population and the financial challenges ahead. The decreasing rural population and the regionalization of more and more services will require us to match patients more thoughtfully with medical services. Forming links to telehealth resources will help maintain transport and referral capacity and will be essential. Intentional, proactive communication between sending facilities, receivers, and transporters, will be the first step in understanding the needs and obstacles of the individual institutions. Forming these coalitions and including payers will actually give financial teeth to the decisions made.

The most important realization for health care is that we all have a place in this world. Fears that drive protectionist activity are limited page progress and unnecessarily unhelpful with what we know to be the future.

It is time to shovel out the old and prepare for a new crop.

Guest post by Motient co-founder Dr. Richard Watson

I once had an elderly patient who came to me following complicated heart surgery. She needed a very specialized procedure, and we sent her to a prestigious facility with a renowned medical team. She was from a small, rural farming community, and I wondered how she would react. I asked her what she thought of it all.

“Oh, it was wonderful!” was her response.

“What made it wonderful?” I asked.

“They took such good care of me!” she replied.

I was really glad to hear that, knowing how much effort it took to get her there. I imagine she was impressed by the system, or maybe by the quality of a surgeon. The facility itself had to be impressive.

So, I asked, “What made it so good?”

She said, “Every day in the afternoon, there was this nice woman who would come in and rub my back and talk to me. It was wonderful!.”

Amazing. Literally, hundreds of thousands of dollars had gone into her care. From the early diagnosis to the multiple consultations, to the lab work and the further diagnostics, eventually leading to extensive surgical treatment and rehabilitation. With all of that in the background, the thing that made her care wonderful- high quality in her eyes – was the woman who took the time to rub her back each day and talk to her daily.

And make a human connection.

I wonder who that woman was. Probably not part of the highly trained team whose responsibilities have made them less accessible to the patient. It probably wasn’t even part of this person’s job description. Here’s what it was, was one human being showing compassion for another human being—the essence of high-quality medicine. Human connection is something that can never be replaced or replicated by any technology.

Humanizing the Face of Healthcare  

As we are just now beginning to piece back together our health care system, our understanding of how important the people part of the equation has come forward. The isolation of social distancing, families with their loved ones passing alone, caregivers who are not in any real contact with their patients, a lot of people in healthcare watching their friends and colleagues leave the profession because of the risk and stress, all of which have taken their toll and left us wondering what healthcare will look like now.

The margin in the system as it relates to people has to be addressed. The ability of the hospital environment to expand and contract must be developed and incentivized. Cross-training of staff, training for different staffing levels, stratifying patients more thoughtfully to the varying staffing levels all are needed to maximize the people-to-people interaction during surges. Investing in the education of caregivers and career tracks for nurses that retain our most important part of healthcare is essential.

Creating an environment that allows mandates and excessive workloads to be the norm will disincentivize care teams and career nurses. The mobility of staff continues to be a challenge, but more so for future surges. The balance between pay and commitment must be realized. As salaries catch up, I think this will be less of an issue.

Turning Data into Useful Information & Better Decisions  

All these discussions need to be data-driven. Understanding the current stress on a health ecosystem is essential for making calculated, proactive, and justified decisions about patient care. Data-driven decisions offer a proactive way to identify the moment patient movements are needed to keep the system moving and intact.

People who run facilities need to understand their own capabilities and strengths. Patients need to be matched with the proper resources needed to care for them. Consider the regional need to understand capacity and capability and broadly understand how patients move within the system to utilize appropriate resources fully. The ability to make decisions based on data allows the ecosystem to expand and contract. It gives confidence and expectation to the people doing the hard work of caring for others.

It All Comes to This…

No doubt, each of us will face a moment where we need someone to “rub our back.” It is a constant reminder that simple acts of kindness, even in the midst of the behemoth that health care has become, are what makes our lives rich.

Human beings caring for other human beings—that’s the essence of human connection in healthcare.

Guest post by Motient co-founder Dr. Richard Watson

Olympic legend Shaun White gave his final snowboarding farewell at the 2022 Beijing Olympics. Despite winning no medals this year, the three-time gold medalist leaves a legacy behind. Still, it is evident how much teammates admire him. His casual, calm, and nice-guy approach to the sport and life itself made him a real favorite to follow. It was palpable to watch as White walked among other boarders, many of whom he has heavily influenced. As for White’s next chapter, it seems to include his snowboard and lifestyle apparel company, Whitespace. Even with my very limited marketing understanding, it is not lost on me — a guy named White, who loves snow, and the creative space outside the lines—it’s very clever!

Growing up with pencils and our trusted Big Chief tablet paper and no white space — where the lines went clear to the edge of the paper and so did our writing—that break from regimented, constrained borders is compelling. It brings to mind a book I remember from the 90s, entitled “Margin,” written by Richard Swenson. Margin, to me, has always signified a difference: a margin of victory, a margin of risk, or a profit margin.

Life is Lived Beyond the Lines

But that was not where Swenson was going with the concept. If our lives were a thin sheet of paper, a significant area would be devoted to the responsibilities of work, family, and the cares of the world. Only a margin would represent that part of our lives outside of the regimented. Those areas of creativity, contemplation, and rejuvenation are places where our brains find the most freedom.

How easy it is to “drag and drop” our margins right to the edge, constraining us to that which is within the lines. But isn’t that exactly what health care has become?

While Healthcare is Trapped Inside the Lines

If healthcare ecosystems were a sheet of paper, the incentives have produced a day-to-day behavior with very little outside of the hearing. Lower inventories, single-source supply chains, and conscripted functionality with little or no flexibility for change have all locked us into a box. The system as a whole has become so ingrained with the very concrete processes that disincentivize any freedom to deal with variation.

It’s as if there wouldn’t be a moment outside of the two standard deviations from the mean. The HHS’s Medical Capacity and Capability Handbook is certainly comprehensive if it is nothing else. Layers on layers of oversight and committees, multiple layers of bureaucracy, and micromanagement. The National Stockpile Plan is similar in its comprehensive nature, but at the same time, allows only three days of medical supplies. Not to mention that the lack of replenishment has pilfered every reserve. It is no wonder that the system has been dangerously lean.

We Have a Chance to Reflect, Re-Evaluate, and Rewrite — Outside the Lines

Health care will soon be emerging from the current wave of the pandemic. It will hopefully be a time of reflection and revaluation.

1. Central versus local roles should be examined. With geographic disease variability and seasonal variations taken into account, distinct lines between primary decision and control and that of a supporting function are critical. A one size fits all is insufficient and heavy-handed. Networks for information, supplies, and technology become essential central functions.
   Strengthening the public health system is crucial. To become national healthcare’s real infrastructure and resource, the local public health system has to be the leader in resources, day-to-day monitoring, and system preparation.
2. Incentivizing local and regional supply chain and sourcing. Having these functions locally ensures adequate means that fit the need. Incentives need to be in place to solidify the idea that margin in the system is not waste but is essential to the ability to expand and contract with the need.
3. Bio-surveillance is critical to being in front of these global events. Appropriate recognition of the cost of not embracing vigilance in this area is obvious. In that vein, the FDA has a responsibility for emergent pathways for vaccine and drug development. These need to gain the public trust to assure that pharmaceuticals are available in the appropriate quality and quantity and in a safe manner.

A Healthcare System with Room to Grow  

The lack of white space in healthcare has been glaringly obvious over the last couple of years. The lack of local and regional control has constrained the actual activity of caring for the people around us. As the balance shifts back to the level of care delivery, the system will be free to meet the demands of any challenge.

Guest post by Motient co-founder Dr. Richard Watson

When I was in medical school, I painted houses for work. While my friends seemed to have medically related jobs, I was out on a ladder with a brush in hand, under the scorching heat of Kansas City. The money was good, and I had a wife and two small children to support.

It was good work, but it did have its interesting twists. We’d get a request to paint, and we’d go out to the address, measure, count the windows, look at the trim, and make a bid. One coat, two coats, scraping, pressure washing, repairing all the rough spots, all factors that influence the final dollar. We always added a fudge factor, trying to guess where the issues and labor would go.

Without a doubt, we would be painting the house and come across some issue that needed a repair period, so we would try to remove enough of the problem so that the owner could make a decision about how far they were willing to go to repair. Sometimes they just wanted to “caulk it and paint it,” meaning, ‘we don’t care what’s under there, just cover it up.’ Others would want to open it up and see just how extensive the problem would be. This process is known as “Pandora’s Box.” Some houses, of some vintages, are just massive maintenance money pits. And the more you open, the more you find. It can be a never-ending project!

When Your System Need More Than a Patch Job

There’s a lot of discussion around health care post-pandemic. The system is limping out of this current phase, but everyone seems resigned that these ebbs and flows are the new reality. Our company works in the area of helping facilities understand the movement of patients between facilities and helping in that process.

We’ve come to see how our cobbled-together reimbursement system is not prepared to deal with the changing healthcare landscape. Our per capita healthcare spending has ballooned to almost $13,000, about twice that of the next country. For that big-ticket, we have more hospitalizations for preventable disease, a higher suicide rate, and lower life expectancy. The difficulty in discussing any change in this environment makes the process seem fruitless. The bureaucratic nightmare that is our reimbursement system and our approach to providing private insurance is so complex, that there is no appetite to do any major repair. Instead, just “caulk and paint it”.

How to Open Pandora’s Box — and Transform It

Understandably, if the layers were uncovered, the Pandora’s Box would be unleashed. But make no mistake, to move the needle on this issue isn’t about antibiotic choices or readmission rates, it requires wholesale elimination of current segments of the non-direct patient care expense line. Hardly something bureaucratic systems with a heavy capitalist overlay are in the mood for.

Value-based care seemed to offer some solutions. It just seems that if you don’t change the rules, the bottom line looks the same regardless of who spends the money. Personally, I think this will take a greenfield effort. Go to where the change is happening and use that as an opportunity.

1. We as a country have to embrace health. We can’t make the choices we are making individually without having to be financially responsible for those choices. Our unhealthy population that continually doesn’t bear the burden of those choices is crippling the entire system. We constantly are given examples of other countries with seemingly better healthcare systems only to realize that their population embraces health in a much a different way, than we currently do in the United States. These philosophical changes don’t come easy and most often it is necessary to start early in order to see a real difference.
2. Paying for and delivering healthcare will need to look a lot different in the next 20 years. The tsunami that is the coming healthcare expense line cannot be supported under any reasonable financial basis. Connecting people and resources with the continuum of care model, utilizing targeted interventions, and careful allocation of diagnostic tools and treatments will be imperative. It is hard to believe that introducing new layers of technology to the system will actually make the system more financially sustainable. It seems that every layer of technology just adds a layer of opportunity for those in the business of paying for health care. Resource matching will be necessary at every level.
3. Novel models need to be embraced. The Rural Emergency Hospital is just now being explored. A novel payment method tied to a very specific set of services in the discrete locale might have some chance. But it will only have the chance to be effective if the bureaucracy is not there. The system must be willing to let go of the encumbrances that are dragging it down. The increasing costs of electronic health records, quality metrics, and numerous layers of middle managers and marketing people end up hurting patients and patient care. It’s not hard to argue that in spite of all of the technological changes over the last 20 years, we have done little to advance true patient care and outcomes.

There’s no doubt that we are at a crossroads. The choices that are made in response to the struggle we have come through will be solidified for the foreseeable future. The will and the perseverance to get to the real issues, not just the quick patch and paint, will truly transform health care.

Guest post by Motient co-founder Dr. Richard Watson

Recently, our neighbor’s house burned down. Just two weeks ago. Ironically, I woke up early that day to smoke a brisket. As I went out to check the smoker, I heard the popping of wood burning. I looked up to see the faint glow just a block away. I ran up the hill to find six-foot flames at the back of the house.

Thankfully, my neighbor’s family managed to escape. Together they sat safely on the curb in their pajamas as they watched all of their earthly possessions turn to ash. It’s a sight I will never forget.

Few events are as personally devastating as a fire. And on that day, in the early morning, a small light fixture chose to malfunction. And it set off a series of events that pushed the reset button on an entire family.

When I eventually spoke to firefighters, they described it as a “defensive” fire. When they rolled up and saw the house completely engulfed in flames, they quickly assessed that it was already a total loss and moved to protect people and property around the perimeter.

Shedding What’s Not Working in Healthcare

Maybe I’m inclined to see everything as an analogy for COVID-19, but this one seems to be a natural fit. From the beginning of the pandemic, it seemed that our “house of healthcare” was on fire. This conflagration felt like a set-up in many ways. For example, we were already too lean on people—even though healthcare workers are the lifeblood of healthcare itself. Plus, short supply of necessary resources, like medications, equipment, and supplies. Many organizations felt forced into the corner by ever-shrinking reimbursements and expanding layers of expense unrelated to patient care.

All too quickly, health care workers and ecosystems became defensive. That is because we were all just trying to protect the perimeter and do the best we could with the resources we had. In the meantime, the families — those directly affected by the infection — also sat on the curb in disbelief, no different than the family that lost their home in the fire. They have suffered much, and they will never be the same.

Recently, there was a crowd of passersby at the burn site of our neighbor’s home. They comprised of neighbors, people out on their morning runs, or families walking their dogs.

Many pontificated about how the fire might have started. Did trucks get there quickly enough? Why wasn’t our 911 dispatch more effective? Others in the neighborhood slept right through it. Neighbors only a few houses away seemed insulated by the blaring sirens and dangerous flames, blissfully unaware of the unfolding tragedy.

Once again, I draw upon the similarities of our COVID-19 experience. While just a few have been in the midst of the fire, passersby are content to offer advice and point out gaps in the system. Most, especially now, are sleeping through the fire, feeling somewhat secure that the most severe stages are over, and life can go on. All the while, the house smolders on.

Rebuilding the Future of Healthcare

Fast forward a year from now. The charred roof and frame will be long gone. Builders will be on-site with fresh lumber. The sound of hammers and saws will have long replaced the crackling of wood and the breaking of glass. Discussions about carpet and tile, new appliances, moving bathrooms, and enlarging the kitchen will take center stage.

As for healthcare, we will also have a chance to rebuild. Our collective understanding of the people, processes, and resources that are necessary for cost-efficient, high-quality healthcare is stronger than ever.

I wonder, will we take the time to look at the floor plan of what we rebuild? Will we move the walls of reimbursement? And enlarge the communication and networking to connect our previously siloed infrastructure? Or will we slap up some cheap edifice to the old ways of thinking, and bring wheelbarrows filled with charred processes back into the healthcare house?

Anyone who has lost their home will recognize the emotional tug-of-war between rebuilding a site that reflects the previous structure versus starting fresh and rebuilding for the future. There is understandable excitement about returning to the old house we remember. Maybe even with a few upgrades.

At some point, the homeowner might voice a thought about a very meaningful personal item, once situated in a box somewhere in the home. And then their voice trails off with the memory and a sobering realization that this item is forever gone. The heart and soul of our lives are often grounded by memories tied to these material things.

My hope is that healthcare has not lost its heart and soul during these last two years. I choose to believe that the process of dealing with constant unknowns, coupled with loss and grief, hasn’t wrung out the last drop of compassion from those who are driven to take care of people in need.

We have a big job ahead. We can look forward to the chance of stripping away truckloads of bureaucracy that accumulated while we applied bandages to our current system. Together, we must create a new floor plan. We must choose our builder wisely. The lumber must be carefully selected, and we must stand firm: We will not bring the charred processes of the past back into our new healthcare house. The people in healthcare are up for the challenge. Together, we will build it back even better than before.

Guest post by Motient co-founder Dr. Richard Watson

Amid the transition to electronic health records, the rise of the virtual patient, the never-ending push for data gathering at every interface, and a hardware and software explosion, the fax machine lives on. A good friend of mine, who is now the product owner at Motient, first joined the team as we were surveying facilities to assess their patient movement needs. Somewhat new to the environment, he was a quick study; after just a few visits, he made the astute observation that “Healthcare is solely responsible for keeping the fax industry alive!”

As of 2019, approximately 90% of healthcare providers still rely on faxes, a phenomenon that has prompted a recommendation to end all fax usage by 2020. Today, while the percentage of facilities using faxes is elusive, estimates put it at above 75%.

The Rise of EHR

Healthcare as a whole has not been a rapid adopter of the digital revolution. We all remember the MS-DOS green screen that was a mainstay of the nurse’s station while the rest of the world was well into advanced graphics. Yet there are exceptions. As an example of how our inertia can quickly be upended, let’s look at the rise of the electronic health record (EHR) system.

In 2005, a Rand study claimed that EHR systems could potentially save healthcare $77 billion per year through optimized resource utilization, along with providing a seemingly endless list of patient care advantages. Fueled by that study, Congress passed the 2009 American Recovery and Reinvestment Act, which supplied $35 billion to support the “meaningful use” of EHRs, words we have come to know well. With the creative use of reimbursement withholding, adoption came quickly; 13 years later, more than 90% of facilities use EHRs.

Obviously, that much money creates new leaders in the industry. Epic and Cerner took advantage of the moment to move into multi-billion-dollar positions. They became household names, and with the stroke of the legislative pen, an entirely new billion-dollar healthcare expense line was born. As is true of most top-down initiatives, healthcare organizations did not realize the promised results. Costs were higher and savings lower than expected, and the EHR quickly evolved into a very efficient billing machine with little utility as a clinical tool. As EHRs are now loaded with inaccurate data and plagued with inconsistent application, the lack of standardization has become a sinkhole for precious healthcare dollars. EHRs require a constant influx of cash to assure security; review, clean and purge data; and integrate other non-standardized data into the new system of record.

As the two dominant players, Cerner and Epic have chosen two different paths. Epic continues to be insular, with even its own versions not playing well together. The company’s refusal to move toward any data compatibility hampers usability. While Epic Anywhere gives access to others in the club, the company’s protectionist philosophy stymies the industry. As the second most popular EHR, Cerner has scrambled to adapt an interface that is clearly inferior to Epic’s. Cerner’s recent sale to Oracle for $28 billion indicates where this market is headed. Oracle’s public business plan says it will integrate disparate data sources into a cloud-based solution as the company attempts to leapfrog over Epic.

I am dated enough to remember VHS and Betamax. With its name brand, national footprint, and arguably better format, Sony decided not to play with others. As VHS quickly found its way into the market through a wide variety of brands, the format became ubiquitous — not because of its quality, but due to its availability and price point. We’ll see if the analogy plays out.

The evolution of healthcare data also reminds me of how photography has changed. Film, the dominant player, ends up in boxes in an attic with no reference point other than quality, context, and our memories of the captured moment. Any effort to organize one’s pictures required a Herculean effort. Once the digital age struck, those boxes simply moved to file folders collated by date. Fortunately, software can now group them by location, content, and even person. We have programs capable of cleaning up files and reducing redundancy. Video was once 8-millimeter, then Super 8, then digital. All formats created a constant flow of images that ended up in boxes and then files, which were even more challenging to categorize and collate.

Finding the Best Way Forward in the Digital Healthcare Revolution

Healthcare data is following a similar course. While healthcare systems are already struggling with the usability and interconnectedness of their data, here come the wearables: small devices that can harvest an almost endless number of parameters. There are so many companies trying to solve the problem of integration and usability for this endless stream of data that there is almost a festival atmosphere for investment firms. Which are the best short-term and long-term plays? Which company will win the golden prize? In all likelihood, information brokers such as Google and Oracle will develop a platform that will level the playing field. EHR specificity will diminish and become a commodity.

At a more granular level, there are a few realities that should be recognized in the next few years of the digital healthcare revolution:

1. Healthcare billing and clinical data demands need to be separated. While they draw on similar elements, the format of clinical data collection must move away from checking boxes for reimbursement. Macros are now a large part of the current record, which does not represent the true clinical experience; macros are simply a reimbursement multiplier. Cut and paste elements have ballooned medical records to the point of being unusable.
2. Healthcare data needs to be stratified. Categorizing data based on verification, validity, accuracy, and usability is absolutely necessary. The heart rate data from my Garmin watch and the most complex surgical videos are worlds apart; they should be treated as such.
3. The industry needs to be comfortable with not collecting every piece of data possible. Instead, we must be willing to distill the problem down to the necessary elements. Inaccurate and conflicting “data fat” hinders every system; unchecked, it’s a killer.

At this point in the digital healthcare revolution, the deck will soon be reshuffled. Big players will set the rules for the playing field, but the market will ultimately decide what products are most usable. Reimbursement will either hinder the process or propel this reshuffling onward. To find elegant solutions to basic problems that actually require solutions, nimble companies will need to carefully pick and choose which data elements are essential to their function, limiting their scope to solving specific problems. Integrating these precise solutions into our current landscape will help show our industry the way forward.

Sources

1.  90% Healthcare Providers Still Rely on Fax Machines, Posing Privacy Risk. Health IT Security. https://healthitsecurity.com/news/90-healthcare-providers-still-rely-on-fax-machines-posing-privacy-risk
2.  RAND Study Says Computerizing Medical Records Could Save $81 Billion Annually and Improve the Quality of Medical Care. https://www.rand.org/news/press/2005/09/14.html

Guest post by Motient co-founder Dr. Richard Watson

It would not be surprising to anyone associated with healthcare to state that money drives the motivations and decision-making in the industry. It is certainly noted that the rank-and-file patient care cohort continues to carry the quality torch, but even these voices are filtered through a complex algorithm of “metrics” and “standards.” It has long been noted that the easiest way to control this US healthcare behemoth was through constriction of the dollars and then releasing surplus through carefully gated wickets. And so, as one could imagine, all behavior is now judged against the perceived disruption of revenues.

Now, during the last two years of navigating the rapidly decreasing number of resources, facilities and systems have come to the end of mitigations. The need to move patients creatively in the environment of no hospital capacity and the flexibility needed to make decisions on the fly is not supported in the current CMS reimbursement environment of comply or appeal. Even the easing of constraints does not offer the motivation and direct view to revenues that our health care system requires.

Connecting the Right Resources to the Right Needs

What will it take to comprehensively adapt to a rapidly changing environment? If we approach the answer from the standpoint of what is lacking in the current environment, it would be quickly evident that the system has little ability to match needs with resources. Continuing to push the needs of the patient back to the pinnacle of health care decisions must be the fundamental guiding light for decision-makers. Next, the system should have the ability to assess, categorize and apply the correct resource to the correct need. Standardizing this idea of capability is critical to understanding capacity, which is crucial to the idea of margin in the system. But that is not the whole story. When a new movie hits the streaming services, and suddenly the network is dealing with an isolated surge, the server confirmation flexes to meet demand. The system is decentralized so that multiple resources can be dealing with the traffic, not just a central hub. The math surrounding distributive networking comes into play to shift resources to areas of need. No doubt we are a ways from that dream in healthcare. But we can begin to reward those types of behaviors in the reimbursement process.

Systems that consistently assess the acuity and needs of the patient, track and connect with ecosystem resources using consistent methodology as well as analyze post hoc for trends and outcomes should be rewarded. These small steps are quickly obtainable if the revenue path is clear. We must continue to embrace the idea that matching the right patient with the right resource at the right time is the surest path to the highest quality, cost-efficient care. The technology is there to deal with this environment, and interested groups can see this vision. The question will be if larger facilities and particularly larger health systems can look beyond their own desire for advancement and make the choice to join the ecosystem. I can imagine that the disincentives for that type of protectionist behavior will have to be in place.

We Must Change for the Better, and for Each Other, to Get Where We Need to Be

If there is a lesson we should learn from the last couple of years, it is that we are all in the same sandbox, and we need each other. Citizenship in this privileged industry requires us to care about each other and look beyond self-interest. We no longer have the luxury of a never-ending supply of healthcare, and it will take several years to build back from where this pandemic has taken us. The reimbursement system must change, not only to recognize from where we have come, but those changes must also take us to where we need to be.

Guest post by Motient co-founder Dr. Richard Watson

Recently, I was on several calls concerning the rise of COVID-19 cases and the burden to the health care system. There’s no doubt that there is a point where challenges become crisis — and crisis becomes collapse.

The constant influx of “Breaking News” into our psyche has blunted any ability to decipher the nuances of this escalation.

And, as this is not our first go at this sort of thing, most of the stakeholders have exhausted their list of mitigations. The problems are well known:

• Among the unvaccinated individuals, there is a real percentage that will need hospitalization and intensive care.
• No one vaccinated or unvaccinated has complete immunity.
• Everyone will have an experience with the virus.

Vaccination does not prevent infection, but it will most assuredly keep you from needing hospitalization. The young do well; the older, the obese, and the unhealthy fare less well.

Faster, Harder, More is Not Working. It Never Does.

When I was a doc on the sidelines at the small college football games in the town where I was a family physician, I was fortunate to get to experience quite a few halftime locker room speeches — some effective, some… not so effective. We weren’t a great team, most of the players were there for the academics, not for some higher sporting aspiration. More often than not, we would be behind on the scoreboard as we came in at the half. The guys would be worn and tired, but always competitive.

I remember one particular halftime ended with the plan: “We’re going to run faster, block harder, tackle more, and we’re gonna win this game!” Little consolation for guys who were already giving it all they had — not one player takes to the field to do less.

But I remember one coach, who had the fortune to be on the coaching staff of a Super Bowl championship NFL team. His words went something like this: “They are killing us in the secondary, so we’re going to switch it up. We’re going to a four-man front and blitz more. On offense, we’re going to keep it on the ground even if we don’t score in the third quarter. We’ll draw them in close and then we’re going to open it up in the fourth quarter.”

A real plan — something tangible, thoughtful, and informed. The players knew what they needed to do and there was buy-in that the second half would be different.

Changing the Game Plan Utilizing the Tools We Have

There are few times in the last two years that this global scenario has afforded us the ability to have a tangible, thoughtful, and informed plan. But we know more now than we ever have. We have more tools at our disposal than ever before, and we have people who day in and day out are committed to taking the field — they just need a plan.

Emergency declarations and crisis standards of care are a knot at the end of the rope, a stopgap, a plan of last resort. Essentially, it is telling our caregivers and first responders to run faster, block harder, and tackle more.

We must change the game plan. Here’s how:

• Reimbursement must be changed to allow compensation for the type of patient movements that haven’t had to occur in the system before: longer distances, different destinations, movements up and down the chain more freely.
• We must address agency nursing that allows poaching of staff from one state to another.
• We must use the technology that already exists to improve communication, leverage data, and improve networking at all levels of the system to enhance care in place, match demand with resources and protect quality.

State and federal leaders are constantly looking for new ways to change the COVID-19 landscape. No one likes to deliver the same ineffective byline.

We have the power to do something tangible. We have the information to make concise, effective change.

It’s time to go out and finish the game!