Skip to main content

Transparency of Price in Health Care

Does it exist?

Health care in the USA is under great pressure to change these days.  So regardless of which pole of the political sphere you personally are drawn toward, the landscape underneath your view point will be changing.  One could ask why.  It is an interesting line of inquiry.  Will the fact that health care is just too costly, increasing at exponential rates, and leaving an ever enlarging number of americans out of the "care" system suffice for the moment?

So this domain of the american system is being pushed off a proverbial cliff into a turbulent troubled sea of change.  I wonder - do we have any system models that would describe what might help in these situations?

Here's a case in point, a CEO announce a spur of the moment policy change, a move toward transparency.  Why?  Perhaps he was frustrated with the ill-rational behavior of "the system".  And decide that a move toward transparency was a rational behavior.

Florida Hospital Takes a Step Toward Price Transparency
Miami's Mount Sinai Medical Center has pledged to publicly disclose its price contracts with insurers
By Kate Pickert June 03, 2013

Speaking in May on a local public radio affiliate, WLRN, Steve Sonenreich, CEO of the Mount Sinai Medical Center in Miami Beach, FLA, said, “We’d be willing to put our prices to all the insurance companies out in public and we would welcome that kind of transparency of everyone in the marketplace.”

More articles on the money issue:  Follow the money with Time's Steven Brill.
Steven Brill - The Daily Show
Watching Jon Stewart's interview you may realize that the health care industry is not like any industry you are familiar with -- let's say one that you work in, where reasonable people do things with reasonable cause and effect correlation.  So how do we model this rather chaotic (Alice in Wonderland) world such that we can make reasonable decision about how to tame the beast?  If you are from another domain (say regular world) you may be tempted to apply regular world logic to a small subset of the problems and be surprised by the systems behavior.  A case in point, almost every other industry has some level of price transparency.  Customers have choices before they purchase a good or service and may choose to shop around based upon price.  So what happens when some nut job suggest that health care do the same?  Well you can bet the chaotic system does not react like your normal world system.

If only there was a general model of this meta system of systems - some which behave sanely, and some which are just too difficult to understand.  A model that could give us some guidance as to how to behave when we knew which land we happen to be in at any one moment.

Do you know of such a model?  Let me see, here's a few:

Reagan's Trickel-down economics (Supply-side)
Keynesian economics
Various economic models compared to scientific models
Wonderland model

I don't think these models will work for our problem.  Why?  Because they do not model insane systems very well.  They all seem to assume the rational mind exist within the system.  And I think we can agree -- there is no rational control within the health care system.

Perhaps if we go a bit more abstract... maybe a weather system model will work.  Those model really weird system that produce erratic behaviors like hurricanes and tornados and even sharknados.

Or maybe we are barking up the wrong tree... perhaps we should simplify our models...  try to make sense of the meta information, apply some common sense to the problems instead of getting inside the tornados of data and assuming that every thing moves in a counter-clockwise direction (talk about getting wrapped around the axel).

Try this simple model... based on the classic two dimensional four quadrant model... but with a dimensional twist out of the page... kinda like MC Escher would do...  So it is a bit like a model that fits wonderland.  Cynefin framework by David Snowden.

Back to the health care price transparency issue now.  Which Cynefin domain is health care pricing?  Hum... oh I fear answering because I could get it wrong...  well there's only 4 domain, I've got a 25% chance just by guessing.  WRONG!  There are 5 domains and the fact that I don't know which domain I'm in tells us the answer, we are in the disordered domain (the 5th one - the one we are most likely to be in most of the time).  Damn, I think Mr. Snowden may be on to something here.

So if health care pricing is in a discorded domain, what's the model tell us we should do?  I think (and I may be wrong - and wouldn't that be FUN) it doesn't matter - we act, then sense.  So was Steve Sonenreich, CEO of the Mount Sinai wrong to just act?  To suggest that price transparency may be a good thing for the system.  Then to sense what the system does with this new input.  Certainly the people in his organization had a bit of panic in their throats and had to change lots of things to make his decision a reality.  We might not see the cause and effect for some years to come.  So be very careful when we sense.  We might not sense the ripple effect.

How does Snowden suggest we sense?

I'll leave that you to you to answer.
Post a Comment

Most Popular on Agile Complexification Inverter

David's notes on "Drive"

- "The Surprising Truth about what Motivates Us" by Dan Pink.

Amazon book order
What I notice first and really like is the subtle implication in the shadow of the "i" in Drive is a person taking one step in a running motion.  This brings to mind the old saying - "there is no I in TEAM".  There is however a ME in TEAM, and there is an I in DRIVE.  And when one talks about motivating a team or an individual - it all starts with - what's in it for me.


Pink starts with an early experiment with monkeys on problem solving.  Seems the monkeys were much better problem solver's than the scientist thought they should be.  This 1949 experiment is explained as the early understanding of motivation.  At the time there were two main drivers of motivation:  biological & external influences.  Harry F. Harlow defines the third drive in a novel theory:  "The performance of the task provided intrinsic reward" (p 3).  This is Dan Pink's M…

What is your Engagement Model?

What must an Agile Transformation initiative have to be reasonably assured of success?

We "change agents" or Agilist, or Organizational Development peeps, or Trouble Makers, or Agile Coaches have been at this for nearly two decades now... one would think we have some idea of the prerequisites for one of these Transformations to actually occur.  Wonder if eight Agile Coaches in a group could come up with ONE list of necessary and sufficient conditions - an interesting experiment.  Will that list contain an "engagement model"?  I venture to assert that it will not.  When asked very few Agile Coaches, thought leaders, and change agents mention much about employee engagement in their plans, models, and "frameworks".  Stop and ask yourselves ... why?

Now good Organizational Development peeps know this is crucial, so I purposely omitted them from that list to query.

One, central very important aspect of your Agile Transformation will be your Engagement model.  

Exercise:: Definition of Ready & Done

Assuming you are on a Scrum/Agile software development team, then one of the first 'working agreements' you have created with your team is a 'Definition of Done' - right?

Oh - you don't have a definition of what aspects a user story that is done will exhibit. Well then, you need to create a list of attributes of a done story. One way to do this would be to Google 'definition of done' ... here let me do that for you: Then you could just use someone else's definition - there DONE!

But that would be cheating -- right? It is not the artifact - the list of done criteria, that is important for your team - it is the act of doing it for themselves, it is that shared understanding of having a debate over some of the gray areas that create a true working agreement. If some of the team believes that a story being done means that there can be no bugs found in the code - but some believe that there can be some minor issues - well, …

Refactoring - examples from the book

Martin Fowler's book Refactoring:  Improving the Design of Existing Code has a simple example of a movie rental domain model, which he refactors from a less than ideal object-oriented design to a more robust OO design. Included in this Zip file are the Java source code files of the Movie, Rental, and Customer classes. Along with a JUnit CustomerTest class. Using these example source files you too can follow along with the refactoring that Fowler presents in the first few chapters of his book.

Metrics for a Scrum Team (examples)

What metrics do you collect to analyze your scrum team?

We live in a world of data and information.  Some people have a mindset that numbers will diagnose all problems – “just show me the data.”  Therefore many directors and senior managers wish to see some list of metrics that should indicate the productivity and efficiency of the Scrum team.  I personally believe this is something that can be felt, that human intuition is much better in this decision realm than the data that can be collected.  However, one would have to actually spend time and carefully observe the team in action to get this powerful connection to the energy in a high-performing team space.  Few leaders are willing to take this time, they delegate this information synthesis task to managers via the typical report/dashboard request.  Therefore we are asked to collect data, to condense this data into information, all while ignoring the intangible obvious signals (read Honest Signals by Sandy Pentland of MIT).
What if …