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The Managed Care Insider eNews
Volume Three Number 8
August 2001
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This issue of The Managed Care Insider eNews is a "tongue-in-cheek" dialogue
related to the obstacles or the obstructionists involved in the managed care
industry today. Touched with humor, though there is truth in humor, our fearless
leader nominates a few individuals deserving recognition and award. We hope you
enjoy this edition and welcome your comments and suggestions for those you believe
are worthy of such awards. Please email your comments to insider@scheur.com.
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Insider Vision: BOHICA
by Barry S. Scheur, President, Scheur Management Group;
Chairman, Venture Health Partnership Group
"There's a big difference between kneeling down and bending over."
-- Frank Vincent Zappa
BOHICA? What is it? A new product? A health plan's new name? The name of a new
claims system that will solve my operational problems and will also accurately
calculate my IBNR? Do I need it to survive in managed care? Maybe, but probably
not.
BOHICA is a word I coined as a response to many obstacles to which I have had
to adjust in the past year or so -- challenges that require one to analyze and
think quickly, respond proactively, or eliminate them. About a year ago, after
a routine "crisis de jour" type of day (which seems to be the norm),
I came up with the word and have uttered it repeatedly since then, sometimes
inappropriately in meetings where outsiders don't know what it means. Recently,
however, it came back to haunt me when my management team, who does know what
it means, presented me with the first annual BOHICA Award on the occasion of
my fiftieth birthday. I have subsequently submitted the trademark application
for the term, and I offer it to those of you who have, as my award stated, survived
years of getting your butt kicked!
Our industry is fraught with obstacles and challenges. Most are created by wanna
be's or those who know nothing about the intricacies of owning, running, or keeping
sane while operating a health benefits organization in today's roller-coaster
market. I most often use it when I'm confronted by one of those people, organizations,
or politicians who really doesn't seem to want to "get it," so to speak,
and I can only utter the word in exasperation or frustration. So what is BOHICA?
In my tradition of leading with my face and telling it like it is, usually with
a dash of sarcastic humor, BOHICA stands for: Bend Over, Here It Comes Again!
What "it" is really doesn't matter, but it's an all-too-often recurring
phenomenon in managed care these days. Whether it's provider contract negotiations,
system snafus, or employers who can't understand why their premiums have to go
up, it all comes down to the notion that what you've seen before you are about
to see again, and it's likely to be uncomfortable. Maybe the term should be licensed
for an examination procedure utilized by urologists and obstetricians!
We've actually created an award for these kinds of problems, people, and organizations.
If interested, e-mail me your candidates and we'll see if they are worthy of
the name. In its three-dimensional representation, the BOHICA Award is a plaque
with a certain part of the anatomy strategically placed and the words "BOHICA
Award" under it. It leaves little to the imagination, and you can almost
feel the discomfort as you see it.
I would now like to present my nominations for several candidates to receive
this award, in this case because they created an obstacle or did the butt kicking,
rather than being on the receiving end of getting their butts kicked.
1. Tom Scully, our infamous new head of DHHS, who decided to rename HCFA instead
of reshaping or reorganizing it. What's in a name? In this case nothing. The
Center for Medicare and Medicaid Services (CMS) is not a center; it is a bureaucracy
filled with people who obstruct needed services to seniors and indigent people
throughout our nation. Does anyone there really understand the cost of health
care? Does anyone
there really know that their compliance regulations, reporting requirements,
and forests of paper, not to mention the issuance of policies in stilted bureaucratic
language that seniors cannot understand, are causing most of us to question our
sanity when it comes
to remaining in Medicare+Choice programs? Do they even care?
2. McCain, Kennedy, Frist and all the others who authored the Patient's Bill
of Rights for HMOs without inserting one iota of common sense, have added to
the litany of potential lawsuits to keep attorneys living comfortably for the
next millennium, but have done nothing to truly facilitate the affordability
and redesign of health benefits coverage for those who need it. Yes, we must
afford due process to folks and follow ethical guidelines for dealing compassionately
in situations where individuals are most troubled and vulnerable. That is the
very basis of our integrity in organizing and delivering health care, and I thought
it could be done effectively until I bought health plans and tried to make this
happen in the face of regulatory obstructionists and financial institutions --
but that's another column and perhaps a whole new series of BOHICA Awards. So
to all those political wonders of the world, have a BOHICA on me.
3. Banking institutions of all kinds. There is a song by singer/songwriter Cheryl
Wheeler entitled "The Bank" that begins: "We're the bank, we're
not your friend." It ends, "We're the bank, with hearts of steel, heads
of stone." On "Saturday Night Live," there is a segment entitled "Deep
Thoughts by Jack Handy" which are, of course, not very deep. So here's my
deep thought for this month. Health insurance is just about the only industry
where you can't borrow against your cash flow to finance expansion or to turn
around the business. In other situations, you can finance your inventory until
you sell it off, finance new equipment, or a new product line. Not in managed
care. Banks don't want to take a chance lending against cash flow, even when
they have tens of millions of your dollars in their coffers on which they are
earning money by lending it every day. The only way for a start-up or turnaround
growth company to borrow money is to personally guarantee it with collateral
that is separate and apart from the health plan -- an approach that I have now
labeled as "sure thing economics."
Given the banking situation when it comes to financing private enterprise in
health care, some things are very clear. The consolidation in which the bigger
get bigger and the smaller disappear or close down will continue. And the de-personalization
that comes with centralization and outsourcing to reduce costs will increase.
The bottom line for the future of entrepreneurial healthcare organizations trying
to reshape managing care and taking risk is: "In God we trust, but you'd
better have lots of cash!" So, for all of those short-sighted, risk averse
bankers, investment bankers, venture capitalists, and other financial institutions
who raise questions but don't help with creative problem solving, have a really
big BOHICA on me.
4. Technology companies in managed care. The turmoil in this sector of the business
is all too well known to those of us who have to deal with antiquated and inefficient
systems, exorbitantly costly workarounds, and customer service mazes that would
leave a rat screaming for mercy. And then there's the host of Internet companies
that promise great solutions for problems which they will only magnify utilizing
vapor technology that may, but probably won't, work from companies that really
don't understand our needs or those of our customers. I wish I had a trap door
in my office when, after five minutes, I wanted to end the discussion with a
representative of one of those companies. They are all entitled to the big BOHICA
Award too.
This is just my starter list; I'm sure our readers have lots more creative ideas.
Just keep on laughing, because we really have no other choice as we confront
change, chaos, and opportunity, all in the same breath. Soon, perhaps, I'll devote
a column to another of my other favorite words, coined I think by the political
commentator William Safire: "klong" -- the feeling that comes from
a totally unexpected onrush of s..t to the heart.
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Sites and Sounds on the 'Net
SMG has no ownership of, nor does it endorse the following sites. This information
is presented as a resource for subscribers. In keeping with this issue's focus
on the
humorous awards for obstructionists, we present the following sites:
Humor and Health: to learn more visit http://www.humorandhealth.com/
Contrarians: Barry Scheur is known as one. Know any others? Find out
about three business contrarians in this article at
http://www.businessweek.com/2000/00_11/b3672150.htm
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Speaking Engagements:
September 9, 2001
NAHQ's 26th Annual Educational Conference
Reno NV
Topic: "Resuscitating Managed Care: Getting Off Life Support and Recovering
Credibility"
Speaker: Barry S. Scheur
October 12, 2001
ViPS interAct 2001 Conference
Monarch Hotel, Washington, D.C.
General Session: "e-Health"
Speaker: Barry S. Scheur
If you are interested in contracting either Barry Scheur or any SMG/VHPG associate
for your organization, please contact Nancy Belle at nbelle@scheur.com
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End of The Managed Care Insider eNews,
Volume Three, Number 8.
Scheur Management Group (SMG) is one of the most experienced specialized healthcare
operations management and business revitalization consulting firms in the country.
Our expertise is in time-sensitive analyses, strategic business and market planning,
operational re-engineering, and communications, as well as implementation of
start-ups, expansions, and new products. The firm's clients cover the spectrum
of insurers, managed care organizations, physician groups, integrated delivery
systems, hospitals, employers, governmental entities, vendors, and other providers.
Contributing to this edition is Barry S. Scheur. Editing and Research by Judith
Jaffe. Production Coordination by Nancy K. Belle.
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