Wednesday, September 18, 2013

The Arrogance of Power and The Power of Arrogance

About fifteen years ago, when I was President of GeriMed of America, a Geriatric Medical Management Company, we were having discussions with Oxford Health about working together.  We believed in a model of care that fully embraced Geriatric Medical principles and Care Coordination.  We had data to suggest that it was cost-effective.  Quality data was harder to put one's finger on at that point in time (and still is to a large degree for many complex reasons).  Oxford Health was boasting about their extensive use of Disease Management programs.  They had programs for congestive heart failure, diabetes, heart disease, etc.  Each of these programs had demonstrated cost savings in the millions of dollars.  Oxford Health was the darling of Wall Street.  I was skeptical.  How could multiple disease management programs work in the elderly population.  Many of our patients had all of these diseases.  They couldn't be on all of the programs.  What they needed was a comprehensive approach to care that was based on Geriatric Medical principles and Care Coordination.  But, Oxford Health was a big company and they were the darlings of Wall Street.  They must have been correct?  They believed they were.  Shortly thereafter, Oxford Health reported huge losses and their stock dropped precipitously.

About a year later, we were in discussions with Humana about developing a Geriatric Management program.  We went to Louisville, Kentucky, to meet at Humana's corporate headquarters.  Humana was also proud of their Disease Management programs.  Part way through the meeting, I told them what I thought of Disease Management programs in the elderly.  I thought they looked and sounded good, but that they didn't work.  What they needed was a Geriatric Management program.  The Vice-President we were meeting with suddenly stood up and left the room.  Business opportunity lost.  My VP of  Business Development was quite upset with me. 

I've been watching The West Wing this week as I rest in preparation for Ironman Lake Tahoe.  It's interesting how I don't remember seeing President Bartlett as a supremely arrogant individual whose arrogance clouded his ability to make the right decisions.  I suppose that it helps to be arrogant if you want to become President, but that arrogance has two sides to it.  I used to have an interest in politics.  I still want to improve our health care system in order to effectively and appropriately care for the rapidly growing population of seniors in our country.  Since Medicare is a Federally legislated program, change must wind itself through the political process.  I've gone to congressmen and senators full of information and some degree of arrogance myself.  I've gone to them passively and offered to share knowledge and help them to come to solutions.  Arrogance sometimes requires arrogance in order to communicate.  Other times, it's like a head on collision.  Passivity rarely works, unless you can find a way to couch your message in a way that others can't avoid thinking about it. 

I've had plenty of times in my life when I've been full of myself.  Honestly, at least I can usually back it up with facts and experience.  Still, if I come across as too arrogant, it will turn people off.  On the other hand, not touting accomplishments that support my message will not get me anywhere either.  Our government is chock full of arrogant people, similar to those on The West Wing.  In that regard, the show had it right.  I understand that every day they encounter people who come in and tell them that they have all the answers.  Yet, our government representatives have chosen that life and chosen public service.  Public service should not be about bolstering one's arrogance.  Public service must be about listening to all sides, trying to find consensus, and keeping an open mind. 

I'm not sure what my next step in life is.  I'm a Geriatrician who was successful enough co-founding and building a primary care practice that cared solely for Medicare beneficiaries that I was able to retire at the age of 53.  A practice that no one thought possible in a health care system that is clearly broken.  I've run health care businesses that have been profitable and cost-effective while serving the very population that is costing our government so much money.  I met with Senator Wayne Allard on a few occasions.  It took me 2 1/2 years to meet with Senator Michael Bennet of Colorado.  Finally, when I met with him he told me how he welcomed my ideas and input.  I sent him my ideas.  Never heard back.  Business executives know about the concept of benchmarking.  If you find a successful program, don't try to reinvent it.  Learn from it.  On the other hand, executive in large companies are often trying to protect their own turf.  It's their job that matters, not necessarily results.  Unfortunately, in the health care world, so long as there are profits, no one seems to care about the cost to society or the quality of the care.

What's the message here?  Large health insurance companies believe their own hype and people want to maintain their jobs and power base that they will not welcome solutions from the outside.  Our government seems to run the same way.  Republican, Democrat, it doesn't matter.  I've shared my thoughts with congressmen, senators, and their staffs.  I was part of a company that built the largest primary care geriatric medical practice in the country.  We were successful.  I think that if I am to ever make any headway, I must keep sharing my successes, even if some find it arrogant.  I am always open to a vigorous discussion and debate.  I learn every day that I don't know everything.  There is always something to learn.  On the other hand, does anyone believe that the present health care system is working effectively? 

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