Can the Media Help Fix Health Care?

Martha BebingerI work with a variety of healthcare brands in my day job, so when the MGH Institute of Health Professionals and the Upsilon Lambda Chapter of Sigma Theta Tau International (Honor Society of Nursing) hosted a talk entitled "Can the Media Help Fix Health Care?" at their campus in the Charlestown Navy Yard recently, I was eager to attend.

Award-wining WBUR health reporter Martha Bebinger (right) led the discussion among an audience of mostly clinicians that highlighted several key issues that healthcare providers and marketers need to consider.

1) Shopping for health insurance isn’t – and may never be – like shopping for traditional consumer goods.

We talk about this a lot with our clients at PARTNERS+simons, particularly on website redesign projects. While it’s true that consumer expectations for how to shop from and engage with a business are being set by large, consumer brands (e.g., Amazon, Zappos, Apple), the reality is that shopping for insurance is a fundamentally different type of purchase. Access to price and quality data is spotty at best, and the ability to customize or configure products is limited by the regulatory environment. Add to that the complex nature of the product itself, the perceived low value for the money, and shoppers with a 12% health literacy rate, and you can see that this is much different from shopping for books, shoes or cell phones.

On her CommonHealth blog this week, Bebinger shared “The 26 Steps I Took To (Try To) Comparison Shop For A Bone Density Test.” She simply wanted to compare prices for this exam at three different labs, and she failed, because despite the hope of transparency promised by the ACA, cost data is not easily accessible (if at all) and requires consumers to wrangle with a myriad of websites, phone calls, and industry speak like “CPT Codes” (the Current Procedural Terminology used to designate a procedure).

Likewise, quality and safety data is difficult to find and assess, as there are no industry standards on how to measure or report it. Outcomes can vary widely depending on the procedure, the precision of the machine, the experience of the people administering the procedure/test, and the body being tested. There is no industry standard that accounts for these variables.

We need to create a culture where it is ok to collect and use these kinds of measures, and Bebinger is hopeful that by covering experiences like her own in the media, we will start moving in that direction.

2) Health Plans need to revamp their phone, web, and mobile experiences to begin to address these challenges.

MA law requires managed care health insurance carriers to “establish a toll-free telephone number and website whereby insured members can obtain the estimated or maximum allowed charge and the out-of-pocket cost that the insured member shall be responsible to pay for a proposed admission, procedure or service” within 2 business days of requesting it. Harvard Pilgrim members can use a tool called NowiKnow to shop for care, Tufts Health Plan says it will launch its own online shopping tool, EmpowerMe, in July, and BCBSMA says it, too, will have an online shopping tool ready for October when insurers are supposed to be able to give patients requested prices in real time. Nationally, Aetna has figured out how to do it.

WBUR runs an online community called Healthcare Savvy designed for patients trying to figure out how to shop for healthcare. At the time of this writing, it was suffering it’s own technical difficulties.

3) It is critical that we use the language of the public, and find ways they can personally relate to our products and services.

As a journalist, Bebinger spends a lot of time translating healthcare topics into language that the general public can (and wants to) understand. She urges healthcare practitioners, legislators, and marketers to get off of the system level and down to the patient level. The cost, quality, and safety measures mentioned above are 3 major disconnects with consumers not only because of lack of availability but also because consumers don’t understand how to read/evaluate them when they are available.

Similarly, NPs confess that they are “caught in the medical model,” using the coding technology and limited by time constraints that don’t support their holistic model. They are hopeful that the switch from fee for service to outcomes-based billing will help the situation, but they have not seen any real changes on this front yet.

Bebinger doubts that healthy people will ever see enough value in these policies to pay for them, especially if we keep talking about them the way we do. She cited cases wherepeople were gaming the system (signing up for coverage in time to get a specific medical procedure and then drop it) and noted the 15% of enrollees who failed to make their second payment were responsible for 70% of the costs.

She urged the audience to present their messages/stories in a way that makes it personal for the reader/listener (and acknowledged this is the best way to pitch her a story). “Scope of Practice” isn’t a phrase that patients know or care about, but hearing a specific success story about a person’s experience with their NP (backed up with sufficient data) may get them to pay attention. This theme of telling human stories and finding ways to emotionally connect with people, was very consistent throughout the talk.

Lastly, Journalists need to steer clear of creating alarm (e.g., “death panels”), reporting errors, and not having the courage to explore the stories that are difficult to tell.

4) As scope of practice rules begin to change, there is an opportunity to educate consumers on alternative care options.

There’s still a lot of speculation around whether the ACA will create a shortage of Primary Care Physicians as predicted. Regardless of that outcome, people don’t currently understand the roles of Nurse Practitioners and Physicians Assistants and how they could support broader coverage.

The AMA and other medical societies have been pushing back on expanded scope of practice to NPs. As it stands, scope of practice is currently determined at a state level, with some states being very liberal (NH allows NPs to run their own practices) while others are not (AL doesn’t allow NPs to write a script). Unfortunately, the ACA doesn’t address this.

The fact is, there is no variation in how NPs are trained from state-to-state, and the healthcare system has become so complex that NPs now get more education than they did in the past. Nursing organizations want the public to know that NPs provide affordable, safe, high-quality outcomes; is there a role that the media can play so that the general public will be more accepting of these options?  The Robert Wood Johnson Foundation is currently doing a study comparing NP expanded scope of practice with outcomes that will hopefully support their case. There have been studies in the past showing that NPs have better outcomes with chronic disease management cases than MDs because they take a more holistic approach, but it hasn’t been widely publicized.

Overall, it was a really interesting conversation from both a professional standpoint and a personal one, as health care - and health reform -  affects all of us.

National Conference for Media Reform

Attention fellow media, arts, technology, and culture junkies!

Ncmr2011 This April, Boston will host the fifth annual National Conference for Media Reform (NCMR), where over 2500 people will gather to collaborate on a new vision for our media system.

For three days, NCMR participants will explore the future of journalism and public media, consider how technology is changing the world, look at the policies and politics shaping our media, and discuss strategies to build the movement for better media.

While the full program schedule won't be available until late March, it promises to include include live musical performances, film screenings and over 50 interactive sessions about journalism and public media, technology and innovation, policy and politics, arts and culture, social justice and movement building, plus hands-on workshops and how-to trainings.

I'm particularly interested in the "Media Makers, Culture, and the Arts" track, which will explore music, art, film and other creative media, showcasing inspiring projects, examining how media and technology are affecting our culture, and connecting the arts to media policy and politics.

Here's a sneak peek of the event:

NCMR is the brainchild of the non-profit organization Free Press, which is dedicated to making media reform a bona fide political issue in America. Through education and advocacy they promote independent media ownership, strong public media, quality journalism, and universal access to communications. From their web site:

Our media system is in a crisis.

The takeover of our country's media outlets by a small handful of giant conglomerates puts too much power and influence in too few hands. That's bad for our democracy, which depends on our ability to access diverse sources of news, information and opinion.

Our media is in trouble in other ways, too.

The big cable and phone companies that control access to the Internet want to be gatekeepers, deciding which Web sites and services you can use depending on which companies have paid them the most. They want to turn the open Internet we've always had into a closed, private toll road.

And public broadcasting, one of our most valuable public resources, is under constant threat in Washington by those who would cripple alternatives to the commercial media and muzzle the critical voices and diverse fare that public media offer.

It's up to us to change the media. The way we do that is by changing media policies.

NCMR 2011 takes place April 8-10, 2011 at the Seaport World Trade Center. About 2,500 people are expected to attend, so get your tickets now! Early bird registration is available through January 28th at $125; regular registration is $175.

Hope to see you there!


November 5th

Helen & Joe November 5th has always been a big day in my family, because it marks my parents' wedding anniversary. They tied the knot on November 5, 1955, which means today is their 55th. How amazing is that?! 

(Incidentally, November 5, 1955 is also the day that Marty McFly went back to in Back to the Future.)

But November 5th has additional historical significance, as I learned recently in a Boston Public Library newsletter: it marks the date of a major holiday formerly celebrated in Boston, Pope Night.

In the years prior to the American Revolution, this day was traditionally marked by political upheaval. Young men carrying "giant effigies of the Devil, the Pope, and current political scapegoats" paraded through the streets, harrassing passersby. At nightfall rival gangs from the North and South Ends brawled in the streets. It was the New World version of Guy Fawkes Day in Britain, which celebrated the November 5th anniversary of an attempted plot by Catholic conspirators to overthrow the Protestant King James.

According to historians,

"Part of the appeal of “Pope-Night” in New England, with its strict Puritan traditions, was that it allowed youths to go wild for one day—to make noise, demand money, and have a feast of their own. They could get away with that behavior on the 5th of November because it was patriotic disorder, aimed at the enemies of their country and religion."

Pope Night became an occasion to protest Crown officials, the epitome of the political movement that eventually led to the American Revolution (after which, the tradition died away).

So, whether you are celebrating an Anniversary, a moment in SciFi history, or your own political convictions, Happy November 5th.




Gasland, BP and The Summing Up

Gasland So, my day job had me doing some research on media outlets in Pennsylvania and I kept coming across stories about HBO's latest documentary, Gasland, which premiered last night.

It was a [controversial] hit at Sundance, and has since been covered by the Wall St. Journal, the New York Times, and the Daily Show among others. I've set my DVR to record it.

Gasland was directed by Pennsylvania-native Josh Fox and documents his multi-state investigation of natural gas companies' use of hydraulic fracturing, or fracking. The process involves pumping large amounts of water deep underground, fracturing rock to release natural gas. It also leads to natural gas leaking into the water supply, gas blow-ups, and according to Fox, an industry that "won't take responsibility for their actions." Sound familiar? Here's a preview:

Later in the day, I chatted with another Pennsylvania native who told me about Centralia, PA. Have you heard of it? A mine exploded (underground) here in 1962 and THE FIRE IS STILL BURNING. The town failed to install a fire-resistant clay barrier between an open trash pit and the mine, and when trash haulers proceeded to dump coal burners there...boom. Centralia's population has dwindled from over 1,000 residents in 1981, to 12 in 2005, and 9 in 2007. All properties were claimed under eminent domain and all buildings were condemned in 1992; the town's zip code was revoked in 2002. It is now a ghost town. 

Centralia [Photo via veender]

And then there is BP, which has been covered ad nauseum, but like the above show a troubling pattern in human history. From William Falk, editor-in-chief of The Week:


"In moments of distress and panic, it is tempting to succumb to ideologies that promise a single, simple solution to the mess that is the human condition. Communism was blinkered like that, but so, in its purest form, is free-market capitalism. While drilling in 5,000 feet of water, the capitalists at BP’s Deepwater Horizon rig made a considered decision to forgo some troublesome safety measures, to save time and about $10 million in costs. Why not risk a small fine when millions of gallons of oil were waiting? It must have seemed like the smart play at the time... This is the problem with Adam Smith’s “invisible hand’’: To work its corrective magic, it depends on occasional disastrous mistakes, depressions, death, and widespread suffering... Regulation, too, often falls short of the ideal. Consider the case of Bernie Madoff, who ran his monstrous Ponzi scheme for two decades, right under the noses of the SEC. Even after a whistle-blower came to the agency with proof that Madoff’s “investment fund’’ was a scam, the regulators did nothing...That leaves us, I'm afraid, back where we started: groping our way forward, with no surefire solutions to human fallability."

From EJ Dionne, op-ed columnist at the Washington Post:
Dionne_author-photo "Deregulation is wonderful until we discover what happens when regulations aren't issued or enforced. Everyone is a capitalist until a private company blunders. Then everyone starts talking like a socialist, presuming that the government can put things right because they see it as being just as big and powerful as its Tea Party critics claim it is. But the truth is that we have dis-empowered government and handed vast responsibilities over to a private sector that will never see protecting the public interest as its primary task. The sludge in the gulf is, finally, the product of our own contradictions."

From W. Somerset Maugham, The Summing Up (1938):

Thesummingup "So long as men are cursed with the sense of possession, and that I presume is as long as they exist, they will wrest what they can from those who are powerless to hold it. So long as they have the instinct of self-assertion, they will exercise it at the expense of others' happiness. In short, so long as man is man he must be prepared to face all the woes that he can bear." (p. 187)

6/23 Update: 3 more soundbytes I came across today that I needed to include here:

1) News from today that a northeastern Pennsylvania school district has reached a five-year gas lease agreement with a company that drills in the lucrative Marcellus shale field.

2) Attorney Eugene C. Kelley's blog post: Are We Doomed to Repeat History With the Marcellus Shale Deposits in Northeastern Pennsylvania?

3) Historian Margaret MacMillan, in Dangerous Games, "History should not be written to make the present generation feel good but to remind us that human affairs are complicated."

Coulter vs. Maher vs. The Audience

Sparks flew last night at the Citi Center for the Performing Arts (f/k/a the Wang Theater), but not necessarily between to the featured guests, diametrically opposed political pundits Ann Coulter and Bill Maher.

Coulter v. maherIt was the Boston debut of MSG Engtertainment's “Speaker Series: The Minds That Move The World,” a timely production that looks at America’s current political landscape through the eyes of prominent political figures. Coulter and Maher kicked things off on Monday night with a show in New York at Radio City, and then hopped a plane to Boston for their 2nd of 3 nights (tonight was Chicago).

We were uncertain of what to expect, but imagined there would be some good-natured ribbing, if not outright controversy, between the liberal Maher and conservative Coulter. What transpired was actually a rather cordial exchange, with each getting 15 minutes to themselves to share perspectives on the current political state, and then joining together to counter each other's comments. There was the expected Obama-bashing and Bush ridicule, and a few inflamatory remarks thrown in for good measure, but in all, nothing out of the ordinairy if you've seen these two before.

The real controversy came from the audience - a raucous crowd that proved to be more incendiary and outspoken than Coulter or Maher ever was.

After taking a quick poll to understand the audience's political leanings (it was pretty evenly split between those who "think Obama has done a good job so far" and those who, like Rush Limbaugh, "want to see Obama fail"), the MC indicated that there would be no further audience participation, and to please respect the speakers and fellow audience members by refraining from speaking/shouting during the performance. We are priveleged to live in a Democratic society with the right to free speech, and this was an opportunity to listen to opposing viewpoints with an open mind (but closed mouth).

No sooner did Ann Coulter step on stage when the woman behind me started heckling her. Really loudly, with inane comments followed by cackling laughter. Others soon followed. I turned and politely asked her to "please stop talking"; she responded with a crinkled face and loud harumph! and proceeded to gripe. It was unbearable (and unbearably rude) so I inquired, "why don't you leave if you're having such a miserable time?" and that silenced her.

Moments later, when Bill Maher took the stage, there was an outburst in the back: a seated gentleman repeatedly yelled out, "Stop the liberal gestapo!" and other complaints. It was so bad that the show stopped while ushers tried to remove him, but failed (these poor ushers - mostly elderly women probably used to more passive showings like The Lion King, seemed shell-shocked by the controversy and expletives; in a moment of levity during the drama, Maher remarked, "where are the security guards? Oh - the security guards are 75 years old? I see...).

That guy finally settled down, and then another one erupted down front. This time it was "I spent 3 years in Baghdad!" and some more expletives. At this point, Maher lost his cool and yelled at the audience member, "Shut the f@#* up! These people did not pay good money to come here and listen to you! If you have so much to say, you should've worked as hard as we did, and then you would be up here! But you're not, are you Joe Plumber? So sit down and shut up!"

It was unreal. The whole show derailed. Beyond the political divisiveness, the show was plagued with audio problems, which prompted even more shouts from the audience. Moderator William Oksner (who?? All I came up with was this) was a dud. Instead of enemies, Coulter and Maher ended the show looking like co-conspirators who couldn't wait to run off together and commiserate. 

In all, it was an entertaining evening, but maybe not for the reasons we had anticipated. Coulter's performance was not what I'd expected; she seemed nervous, her jokes weren't funny, and she clearly wasn't comfortable dealing with hecklers. Maher has presumably had more experience with the latter, and he took most of it in stride; his years of comedy paid off as he was much more glib, engaging, and funny on stage. Coulter seems to need a script, while Maher easily improvized.

But the audience behavior left a sour taste in my mouth. Not Boston's proudest moment.

The Boston Phoenix has a great recap of the drama.

[Photo courtesy of the Herald, who's recap isn't so great, but at least they covered it. Where was the Globe?]

The folks at Paste Magazine are riding the Obama wave with this neat little app which let's you make your own "Obamicon" — your image in the style inspired by Shepard Fairey's iconic poster.

Here's mine (you *knew* I'd use Lulu's pic!) alongside the original.

Change Obama

Head on over the and create your own - you can edit the copy along the bottom and add your creation to their gallery.

Thanks to Beth Kanter for the tip.

McCain in the White House

MccainOn the eve of the Democratic National Convention, McCain is grabbing headlines in the ad world.

Not John McCain, mind you, but McCain Foods, a Canadian packaged foods company that's taking advantage of its namesake's run for the US Presidency to roll out a new ad campaign.

Ads feature the company's frozen french fries, sweet-potato fries and kid-friendly "smiles" - all of which are trans-fat free and accompanied by copy such as, "McCain goes to war over oil."

There will also be a "Recipes for Change" section on the campaign site when it rolls out later this week.

All jesting aside, this post marks the addition of the "Politics" category to CultureJunkie. Time to get serious and take a closer look at the issues as the clock ticks down to November 4th.

Stay tuned.