Peter Durand

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Andrew Agwunobi

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[Music]

[Laughter]

Peter Durand: Good morning! If we could invite all the members of the ACA advisory committee to join us in what we are calling the Radiant Room here in the center. If we have any guest, we have chairs along the back. Please feel free to join us for the next two days

My name is Peter Durand. I'm from the Vanderbilt Center for Better Health and very happy to be here today. We're going to be working you pretty hard. But we're going to start off this morning with a word from our sponsors. So I would like to invite, first of all, the chairman Mr. Harry Spring to take this up. And then we're going to hear from Secretary Okonogi, Dr. Andy.

And then a couple of words from Tom Lloyd who is the Director of Consulting Operations for Vanderbilt Center of Better Health. And he'll talk to you a little bit about the process that we use and the type of work that we've done with Florida and the other states.

So Harry are you here?

Speaker 1: He's eating some breakfast.

[Laughter]

Speaker 2: I think the chair needs to start.

Peter Durand: Alright.

[Laughter]

Speaker: Glad you didn’t wear coats.

Audience 1:  I don’t.

[Laughter]

Moderator:  Welcome.  Welcome everybody.  We have a very unique opportunity.  I hope over the next two days to really put together a game plan of advice with the help of the university and the agency of where we want to see this bureau head over the next three or five years.  I’m really excited about it.

I think we need to be looking in a longer term and I look forward to the next two days.  I hope, like me, that you will see that we all take off our hats as players in the health system and really realize that every one of us is going to be a patient in the next year, in the next few years, or in the next five years.  And we have to think in terms of the consumer of healthcare over the next couple of days and what’s best for citizens before.  We owe that to this day and we owe that to ourselves and to our families.

I really welcome everybody.  I encourage you to hopefully be totally green by the time tomorrow it’s done so that we’ve given everything possible to this briefing.  Thank you.

[Applause]

Speaker 1: Yes, I may be able to help [inaudible] wanted to thank everyone. Special thanks to Harry for assuming the chairmanship of this board which I think is very, very important. I also want to welcome the new physician members and we have maybe introduce themselves. We have Dr....Wasley?

Participant: Wasley.

Speaker 1:Wasley, okay. And we have one other doctor. Yes?

Participant 2: Mark Swanson

Speaker 2: Mark Swanson and Mike Edison. Thank you very much. When I first arrived, you brought to my attention by the FMA and some other that we didn't have enough physicians on this committee and I immediately agreed because I think that we need to have the providers, as many as possible on this important body.

So, I want to thank you for joining and it is going to be an exciting day. For me, I love this type of thing. I love stopping at periodic points in the work that we do every day and stepping back from it and say, "Okay, let's look at the big picture. Let's look at it and say what really are we trying or should be trying to accomplish?

So, it is very exciting. I want to thank you all for being here and being a part of this. Today is about collaboration. It's about ideas and I'm going to stop talking and we can get down to business. Thank you very much.

[Applause]

Tom Lloyd: Good morning. My name is Tom Lloyd. This is the second time I've had the chance to come back to the State. I don't mean to upset anybody but, "Go Gators!" Living and working in another SEC school is nice because every couple of years I get to see the Gators when they come play. So, a little commercial.

The Vanderbilt Center for Better Health is very, very happy to have been selected to be a part of this process. We believe we have some very unique capabilities that we have been using for the last four or five years to help drive change in healthcare. That is our mission and we take it very seriously. I work with some gentlemen who actually believe they want to have a healthcare system that operates the way we all know it could by the time they retire. I'll just leave it there.

Dr. Jacobson and Dr. Stead invested in a set of capabilities, if you will. The Center for Better Health is a place that has focused on policy setting and through that we have done some work at the national level in helping set some of the early administration things around healthcare. We do things around convening very diverse organizations like yourselves.

Groups of people who each have a stake in the game and all understand that if a system is what it does, then the heallthcare system isn't doing that great in America compared along many different axes. I don't think there's a lot of disagreement around that. The question is: How do we work our way out of this? How do we get to a place where we can be proud of the whole system and our part in it?

Another thing that we do is we create methods. And what you see around you is our attempt at bringing the Innovation Center from Vanderbilt to here. At the University, we have two 16,000 square foot floors where we convene groups on a regular basis to do work like this. The process and methods that were invested in and actually licensed by Vanderbilt were created by a couple who have been working in this area for about thirty years, a couple by the name of Matt and Gail Taylor.

That is what we have brought as far as our method for helping. With that method, I was trying to figure out all the different types of sessions I could tell you about that would make sense. Just let it be known that we have touched every aspect of the healthcare continuum. We worked with peers. We work... Number one, Vanderbilt does this to itself all the time. This is how we do out strategic planning so I don't want you to think this is just some service we sell over the market right now.

We actually do provide the strategic plan and resource for the entire University Medical Center and Vanderbilt Central. We work with peers in our own neighborhood. You might have heard of Blue Cross and Blue Shield in Tennessee. I understand they have some cousins around the country. We work for them around quality measures and how do we work together to set some standards to say, "If we can prove to you that when our patients come here, for this set of services and this set of things, we actually provide them better quality. How would you reward us differently? How can we share in it?" So we've done those kinds of sessions.

And then we have done again, I mentioned some national strategy study sessions where we had a lot of senatorial aids come to the center and understand what are these tools. When we talk about an EMR, CPOE, what does all that mean? How do you start legislating some of those.

So those are some examples outside or making some of the topic areas that you are going to be working on the next couple of days to get a little bit closer to home. The other aspect of the Center for Better Health - so I represent the method, the process side and Dr. Frisse represents if you will, a content area called regional informatics.

As we have all learned in the last couple of years, states have orders but the citizens in those states don't. They go everywhere and if they want their healthcare information, where do they get them? We have been working recently on a project with the Robert Wood Johnson Foundation around personal health records.

Working with nine different grantees from around the country to help them go through a very structured process to make sure that they understand what their users want. This is very simple and very easy for us as healthcare experts to sit back and say, "I'm a doctor. I know what's best for the patient. This is what they need so this is what their healthcare records should look like."

It's a much different thing to say, "Okay, you sir are a pain patient. You suffer from chronic pain. What are your needs?"

And you tell me, "My biggest need is that I need somebody to trust me. When I walk into the emergency department to have some way of proving to these people that I'm not there to game the system and try to get high again or any kind of illegal drugs. I just need my medications. I can prove it to you and you will trust me so that I don't have to be there for four hours. I can be there for fifteen minutes to get what I need and get out."

That is a much different experience than most people need. So we had, last year, a great opportunity to really understand what some of those users have. And we are going to be applying that in this session with some of the personas that we have created and go through the rest of the day. .

The other thing is through Dr. Frisse's team's research, we've really are starting to understand the content. What is it really going to take to share information? And they will tell you a little bit more about that. But based on that, we have had a chance to work with four other states in helping them guide their strategy: how they are going to do sharing information and how they are going to apply that information to the governance of their states' healthcare system, which is I think really what we are talking about here which is transparency.

It's not necessarily about the tool that is going to help us get there. This is really about how is that feedback mechanism going to work in trying to create a sustainable system so that we can actually learn to cooperate in a way that is helping for us. So we are very, very pleased to be here. I will be around with Peter and we go through the rest of the session. If you have any questions I'm also happy to address those as well.

Moderator:  Even though Tom is wearing his black and gold tie today.  And somebody who has to work with them in Nashville he never fails to mention that he’s a graduate of the University of Florida.

[Laughter]

Moderator:  And he usually starts every event mentioning his orange and blue colors or his orange and green and mentioning that he’s from Florida.  You have to know that you are well represented.

[Laughter]

Moderator: ...by a proud former native of the state.  I’m going to talk a little about the process.  My background is not in Medicine.  It is not in hospital. It is not in insurance.  It’s in innovation and design.  And what we’re trying to recreate here is an experience that we call a design shop.

We’re going to use the techniques that are employed by product designers, software designers, and healthcare designers.  Anybody who has a complex problem has to understand a very diverse user set and come up with, I guess, quickly.  Test them quickly, enumerate them quickly, challenge them quickly, and come up with decisions.

As you all understand our charts today is really to leave this space with a core set of recommendations for ourselves, for this committee on how to go forward.  And the ultimate goal of that is improving the health of Floridians through tools and methods that brain transparency to beat the whole healthcare experience, OK?

We’re focusing on one tool that exists.  Trying to enumerate that but we’re really focus on the final goal, which is improving the health of Floridians.  We’re going to use some techniques today and they all lend themselves for a set goal.  The first thing that I’m going to ask from all our participants here and for all out guests in the back is that you trust us, OK?  Everything that we design at the beginning of the day feeds in to the ultimate goal of the end of tomorrow.

Who has had a great collaborative experience in their mind?  Anybody?  Oh!  In the back there!

[Laughter]

Moderator:  What was one of the qualities that that collaborative experience?

Audience 1:  It was productive.

Moderator:  OK.  It produced something.  Anybody else having a great collaborative experience?  Meaning you work with other people successfully.  Yes ma’am.

Audience 2:  There was some learning.

[Laughter]

Moderator:  There was learning.

Audience 2:  Yes.

Moderator:  OK, productive and learning.  Yes ma’am.

Audience 3:  Trust on every person in the audience perhaps.

Moderator:  Great, trusting the other person’s ability and experience.  How about this side of the room?  Any collaboration you got?

Audience 4:  I knew what to do at the end of the first phase when issues are called but then we did something afterwards.  It was a real long term.  It wasn’t a short term.

Moderator:  All right.  And what’s buried under what you said is action.  There was action.  You knew what the next right thing to do is.  And that’s hopefully what we’re going to leave with tomorrow.  Is we’re going to know what the next right thing to do is.  Yes?

Audience 5:  You knew how to evaluate whether you were successful.

Moderator:  Great.  You knew how to evaluate how you were successful and a large part of that is orienting yourself and others.  What are we trying to do again?

Audience 5:  and having measurable objectives.

Moderator:  Yes, measurable objectives.  Now, everything that we just mentioned here have also been mentioned as qualities of the great user experience that we’re trying to design which is this transparency in the marketplace that is productive and that is usable.  We know what the next right thing to do is.  We have a way to measure when it’s successful.

I’m going to share with you a couple of rules.  These are 10 laws of simplicity.  And this comes from Dr. John Maeda who has had a MIT and he’s an information designer.  These are the 10 laws of simplicity that he’s called from nature and from complex design projects like the one that we’re engaged in.

1.  The first one is reduction.  Taking out what you don’t needs towards simplicity.

2.  The second one is organization and that is finding the form that underlies the story and being able to attach meaning to forms. 

3.  Number three is time and really think about this because I’ve heard this brought up as one of the most important things where the user of any software product.  Saving time feels like saving money which feels like productivity.  We’re going to do a lot of time compression today in our process.  After this morning you will not hear us presenting to you.  The death ray will be turned off.  The Dell advertisement will be turned off and then we’ll be all about rapid cycles of work in which you will synthesize information and present it back.  We’ll take that into next cycle work.

4.  Differences. Simplicity and comlpexity need each other and the only really, really simple thing is death.  Life is complex.  It has lots of moving parts.

5.  Context is king.

6.  Emotion, we need more not less.  And I would challenge all of us to do two things simultaneously which will create a creative tension.  (1)  Is to bring the experience of being human.  The experience of being a brother, a sister, a parent, and a spouse of somebody who needs a lot of help physically who is in pain.  Bring that life experience of being a fake human and also to temper our emotions.  When you feel the emotions of anger, rage, indifference to really check yourself and to neutralize those; it’s a delicate balance.

7.  Trust.

9.  Failure.  We will fail a multiple times until we’ll succeed and then we’ll fail right after that success.  So, just know it.  This is a process that will be continued.

10.  And the final law of simplicity is called The One.  Design is about the obvious and adding the meaningful.  We’re looking for the differences and make a difference.

We are going to learn a little bit of this morning about the complexities, pain, and trauma from another industry which I think everybody will identify with.  So, Dr. Mark Frissy from Vanderbilt is going to talk us about transparency in another industry and I think you’re all going to enjoy it.

Audience 6:  We want to go and get directions to the restroom or something.

Moderator: Oh, I’m sorry, because I am the flight attendant for this morning.  The restrooms, you pass them on the way in here today.  We’re going to feed you all day today.  You cannot leave the room because the food doesn’t leave the room.  However, if you do need to address anything we ask you to please leave the space.  For our guest, you’re welcome to stay all day and we have plenty of index cards if you want to give us feedback, if you have an ITF write it down and drop it off in the front desk.  We are going to save those and aggravate those because we do want your in put.  

However, this is a workshop so we will have teams that will be working in breakout groups.  We will ensure that all of you know where you’re supposed to go and when.  If we can do anything to make your lives more comfortable let us know.  We have our team from Vanderbilt here.  You’ve seen Matt had the camera, Steven, Aliyah, and Tom.  Is there anything else I forgotten or any questions about this pure logistics?

Audience 6:  Breaks.

Moderator:  Hmm?

Audience 6:  Ain’t no breaks.  So, we are going to be working here.  If you do need to take a break please take one as quickly as possible.  If you leave your group for 10 minutes, they’re going to move on without you and when you come back you will actually do them a great disservice because you will drag them back to where you left and retard their progress.  Please if you do need to take a break, take it very quickly.  Coordinate with your group to ensure that you were as productive as possible.

Audience 7:  Copy that.  Forgot anything else?

Audience 6:  I’m good.

Moderator:  OK.  Talk to Chris now.