Opening Pandora’s Box: Exposing Health Care Challenges Requires Tough Conversations

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.

Mission Control Feature Alert: General Availability of Embedded Insights

Mission Control is pleased to announce that accessing your data just became easier.

We believe that the insights empowered by the data we collect on your behalf have the potential to reshape the way you think about patient movement. In the past, we have provided this information through a third-party platform that required a separate log-in and password. We’re committed to making our technology as efficient and easy as possible for you, so starting today you can access Mission Control Analytics within the existing application at missioncontroltransfer.com. No new login. No new password to manage. Just an easy “click” on the Insights tab will bring you straight to the content you need.

No new login. No new password to manage. Just an easy “click” on the Insights tab will bring you straight to the content you need.

Once you navigate to the Insights tab, you can choose from the available reports on the left-hand side.

There are a couple of handy icons in the top right-hand corner: Full Screen (you guessed it, that makes the report Full Screen-sized) and Bookmark. You can create Bookmarks to save specific filters and clicks or save your work and come back to it later. For example, you could set the date to “Last 30 days”, filter to Time Critical Diagnosis = “true,” click on “Stroke” in the Working Dx visual, and save this Bookmark as “Past Month TCD Strokes.” Next time you log in, you can access this Bookmark and get straight to Insights.

Any time you see data in a table, you still have the ability to “export” to a .xcl file or .csv. This can be an effective way to make comments on past transfers that may need further review.

Additionally, all Medical users will now have access to My Missions, a new interactive dashboard that shows you basic info about the patients you have transferred, like common diagnoses, destinations, and acuity distribution.

Keep in mind, this data is limited to only missions that you have created.

Also newly available is the Facility Info dashboard, where a user can see the contact info, preferred destinations, and preferred vendors. This allows users to reference the information being leveraged by Mission Control Operators to carry out the mission according to your hospital’s set preferences. This information can be easily updated upon request to ensure that we are always executing on your behalf, according to your needs.

For you quality directors, ED directors, directors of nursing, CNOs, and others tasked with leading the organization, you can request access to Transfer Insights, and see rich data across every single transfer entered into Mission Control. This is where the magic starts to happen. What time of day do we tend to transfer Orthopedic patients? How long does it take for a vendor to arrive for time-critical strokes? Where am I sending the most STEMIs and by what mode?

All you need to do is reach out to analtyics@motient.io and we will get you up and running (with demos happily available). Training material is also available under the gear icon inside Mission Control.

At Motient, we are committed to continuing to provide you with the most comprehensive data and the most dynamic analytics that we can provide.

More content is planned for release later this year, so look out for exciting announcements this summer.

Rebuilding Healthcare from the Ashes: Finding Opportunities as We Head Towards Recovery

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.

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.

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We started using Mission Control a few months ago because we were struggling with finding patient placement and transportation. Mission Control helped with that significantly. MC is very user friendly! All staff has been so kind and helpful! They are always prompt with assisting us and do a great job in keeping us up to date and informed on any progress they’re making whether that be with a phone call or a message through mission control. They continue to work until transport has been found! We would be lost without them!

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The Creation of Motient: Two Doctors See Possibilities in Challenges

After experiencing the hurdles of patient movement first-hand, two doctors decided to transform them.

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