IG&H and GroupLife combine forces

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Consultancy firms IG&H and GroupLife are moving forward together under the name IG&H, resulting in a specialized consulting group that is able to help realize business and technology transformations from start to finish.

Both companies have in-depth sectoral knowledge, close customer relationships, high quality people and service. By combining their expertise in strategy, organizational transformation, data analytics and technology, they will be able to more effectively help organizations with transformative matters. The new consortium includes more than 220 specialized professionals.

Execution of strategy requires integral approach

Jan van Hasenbroek, managing partner IG&H: “The rapid developments in the technology sector have an enormous impact on the business models of our clients. In order to remain successful in the future, our vision must include addressing organization and technology together. This will lead to corporate strategies being immediately operable, providing concrete results and sustainable organizational transformation. GroupLife has an impressive track record and a proven methodology in business modelling, implementation of technological platforms, and data management. That’s why a collaboration fits well within IG&H’s strategy to continually strengthen its technological ecosystem.”

Wim Groenen and Tom Bottinga, co-founders of GroupLife: “In previous projects with joint clients, we discovered that we had similar ideas about how to address complex business transformations. IG&H knows how to combine its expertise in strategy, data analytics, technology and organizational transformation with sector knowledge. We are delighted with the collaboration and together with IG&H we can make an even greater contribution to the success of our clients.”

About IG&H

IG&H is committed to help leading organisations in the financial services, retail and healthcare sectors. With 160 involved and enterprising professionals, the consultancy and implementation firm, based in Utrecht, helps organizations take steps towards radical customer centricity. They set high standards for themselves and their way of working. With in-depth knowledge and a personal approach, they aid their clients to help them improve the sector. IG&H is recognized as a ‘Great Place to Work’ and puts a lot of emphasis on a high net promotor score.

Granular share of wallet data for all major product lines for truly data-driven sales management

By Analytics, Insurance, Uncategorized

What they wanted
Make data-driven choices in the broker market: that is what leading Dutch omnichannel insurers want to be able to do. Key questions are: Who are today and tomorrow’s leading brokers? Where do we stand in terms of both volume and NPS? How do we enhance our position to realize sustainable growth? To this end, they wanted to gather in-depth data on volume, movements, share of wallet, and NPS. Read More

Part 4: Blue Ocean Medical Center

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Introduction
The mirrored-windowed facade of Blue Ocean Medical Center (or Blue Ocean Med) only just catches the watery October sun as it sinks below the city skyline. Situated between the edge of a mid-size city and the Atlantic Ocean, Blue Ocean Med is a hub for regional healthcare. Like most hospitals it is also among the biggest employers of the region. In the particular case of Blue Ocean Med, they are only outmatched by the local tinning plant. As an organization, however Blue Ocean Med has no match for complexity. The hospital aims to serve the regional community on all relevant aspects of specialist care. They offer all regular diagnostics and surgical interventions, but also prevention programs, radiotherapy, e-health and research and development. For anyone familiar with hospitals: a truly wonderful organization and a wholly unremarkable general hospital. It is actually almost identical in organization, size and offering to both of the two nearest general hospitals. These also deliver (in about equal measure):

  1. Extensive high-tech facilities
  2. A comprehensive care offering
  3. Fee-for-service
  4. E-health
  5. Qualified and caring personnel
  6. R&D and cutting edge medicine

Blue Ocean Med, like all general hospitals, is struggling with issues of quality, cost and profile. Focused clinics are taking more of their market, insurers are tearing down tariffs, real-estate cost is through the roof and the media are just waiting for anyone to slip up. In order to stand up to all this while delivering ready access to high quality yet affordable care, they know they must make some fundamental changes.
They need to move from marginal improvement to far better ways of doing things. But how? What can they do differently with real impact? Can they afford to? And how can they do this without doing the exact same things everybody else is doing?

Follow Blue Ocean Medical in a series of blogs as it tries on alternatives on the above characteristics. Each article will feature one characteristic, yielding one alternative Blue Ocean Medical. There are three reasons for following these thought experiments. First; the dramatic changes Blue Ocean Med goes through may inspire those of you in healthcare to start doing things a little differently too. Second; I hope you will challenge and build on the presented ideas, working toward a greater truth and having fun while at it. Third I hope that some of you may one day join me in actually building Blue Ocean Med.

BOM Four: When Prediction meets Precision

Many people will agree that E-health is doing wonderful things for healthcare. Mostly through the application of distance monitoring, wearables, PHRs and other internet-connected devices and applications. We are talking about information gathered by a huge number of people over long periods of time, combined with all the available knowledge and empirical expertise of medicine, applied to people personally. But isn’t that exactly what doctors have been doing to the day?  In this perspective, current E-Health practices and development do no more and no less than boost current abilities of doctors and patients. And for a good part the applications are long overdue repairs, like digitized health records and sharing crucial information.

As he wanders the grey-green corridors of the (still fictional) Blue Ocean Medical Center this cold November morning, Blue Med’s CEO sees patients in wards and waiting rooms and the regular bustle of doctors and nurses going about their business of comforting, caring, co-operating and curing <insert appropriate verb beginning with ‘c’>. To him the ‘E’s’ in E-Health should stand for efficacy, efficiency, expertise, empathy < insert appropriate noun beginning with ‘E’>.  What he realizes is that healthcare actually has little to do with mobiles, wearables, sites, records and apps. These are just things. Soon to be outdated and rather cold stuff. By definition of dr. Clay Christensen, these are sustaining innovations. Novelty boosting current offerings and existing business models. Disruption will come when two other developments in healthcare connect: advanced analytics and precision medicine.

Advanced Analytics
The local tinning plant near Blue Ocean Med is using advanced analytics. Not only do they monitor production and evaluate performance. They are actually combining all kinds of data to predict both the demand for tinned fish as the supply of fresh product. And these predictions are over 90% accurate to the day. They even linked data from social media to their production schedule to predict absenteeism and break downs in the production line. In most cases they are in time to prevent a break down and if not, they are always in time to take effective countermeasures. This always seemed as something which could impossibly be applicable to such a complex world as healthcare. But it is not. There are apps on the market that combine all kinds of data, including GPS positioning and local weather conditions to accurately predict an asthmatic seizure. This year market leaders in Health-Tech launch analyzers that use big data to accurately predict performance loss and even break downs in time for labs to do the necessary maintenance.  Using massive cohorts and the data trail we all leave behind have become far more important than scrutinizing small experimental set-ups and control groups.

Knowledge unused is useless knowledge

The importance to Blue Ocean Med, or any general hospital for that matter, for such monitoring and prediction is self-evident. Sure: through the advanced analysis of multiple ‘big data’-sources, capacity use and efficiency of the hospital’s facilities can be optimized.  But the real gain is in applying the power of prediction to the primary processes. Unfortunately that also means that Blue Ocean needs more than significant statistical results. knowledge-unused-is-useless-knowledgeThey need clinically relevant questions and accurately interpreted results. John Halama, information officer at Beth Israel Deaconess Medical Center: “To me, the bigness of data is not its (..) size, but the task of transforming it into wisdom.” Blue Ocean Meds CEO couldn’t agree more. People generate and own data. But that’s just numbers. Information is produced when numbers are combined in a meaningful (and significant) way. When this information is analyzed in context by knowledgeable people, we are creating knowledge. Wisdom comes when that knowledge is actually used to enhance health. Because what is the use of accurate prediction if you can do nothing about the predicted outcome? What hospitals need are both wisdom and science to turn knowledge into effective action. That requires the artificial intelligence and accuracy of IBM’s Watson but also a new breed of medical specialists and new healthcare professions. How can the stereotypical TV- Dr. House stand to be outwitted and outperformed by artificial intelligence like IBM’s Watson? He cannot. And patients rather have an emphatic and knowledgeable specialist wielding a very accurate Watson than Dr. House wielding educated guesses, sarcasm and a massive God syndrome. Blue Ocean Med therefore offers educational programs and degrees for Bioinformatics, Medical AI Design and Healthcare Navigators. What Blue Ocean Med needs next are the tools to effectively intervene on predicted outcomes or complications.

Making it personal
That’s where precision medicine comes in. Diagnosis and treatments are now becoming available which are custom-tailored to the uniqueness of a person’s body, maximizing outcomes and minimizing side-effects. These treatments range from tailored biomarkers to personalized medication to 3D-printed bone and tissue. This level of precision is also needed to keep healthcare affordable. Doing the right things right first time, every time is the most cost effective way of doing things. Than this is what we need. And as with analytics Blue Ocean Med needs both the technology as the specialists to wield it. Patients are extremely diverse in nature, yet unbelievably similar in symptoms. Same goes for diagnoses and treatments. We need people who can connect the dots between the expressed and observed symptoms and complaints, diagnosis and proposed treatment (boosted by AI), and the precision medicine on a genetic level. Not making the mistake of adding to the tasks of already stretched medical professionals, Blue Ocean Med has started offering programs and positions for Custom Implant Design (3D printing) and invests in pharmacogenetics to minimize side effects of clinical genetics and maximize treatment outcomes.

Conservative innovators
The question is how long it will take the ever conservative healthcare community to really dive into all of this. Well; Blue Ocean’s CEO has a feeling that it will not take long at all. As soon as technology becomes available that actually lifts medical expertise and the efficacy of healthcare professionals, it will take off like nothing. He bets that anyone in healthcare who can envision what being able to accurately predict or prevent, precision medicine and having more time for patients will do to healthcare, will want to start right away. Whether they are healthcare professionals, boardmembers, patients, insurers or working in government.

Part 3: Blue Ocean Medical Center

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Blue Ocean Medical Center
Part three in the series of our famed fictional hospital as it tries on alternatives to the status quo in healthcare. Let it continue to inspire you to think and act a bit differently and engage with me to find a greater truth. For the extended introduction and parts one and two (‘Hospital without a Home’ and ‘Cells instead of Structures’), please follow this link. Still to come in the weeks ahead: When Prediction meets Precision, Evidence Based Only Please and the Ultimate Medical Mall.

Introduction
The mirrored-window facade of Blue Ocean Medical Center, or Blue Ocean Med, only just catches the watery October sun as it sinks below the city skyline. Situated between the edge of a mid-size city and the Atlantic Ocean, Blue Ocean Med is a hub for regional healthcare. The hospital aims to serve the regional community on all relevant aspects of specialist care, offering all regular diagnostics and surgical interventions as well as prevention programs, radiotherapy, e-health and research and development. A truly wonderful organization and a wholly unremarkable general hospital. It is actually almost identical in organization, size and offering to both of the two nearest general hospitals. These also deliver, in about equal measure:

blue-ocean-medical-center-intro

  1. Extensive high-tech facilities
  2. A comprehensive care offering
  3. Fee-for-service
  4. E-health
  5. Qualified and caring personnel
  6. R&D and cutting edge medicine

Blue Ocean Med, like all general hospitals, is struggling with issues of quality, cost and profile. In order to stand out, they know they must make some fundamental changes. But how? What can they do differently with real impact? Can they afford to? And how can they do this without doing the exact same things everybody else is doing?

BOM Three : A Shareholders’ Hospital

How on earth did Blue Ocean Medical Center end up in a fee-for-service environment? Even more importantly: how the hell are they going to get out?! Leaving yet another fruitless bout of negotiating with insurers and local government, the CEO of our seaside general hospital is fuming. How are innovation and ready access to affordable high quality care going to come about when all involved are primarily interested in price times quantity? How was it ever a good idea to start saving cost by putting incentives in place to produce more and more? Key-in ‘fee-for-service’ on your I-pad and this is what you’ll find (Wikipedia):‘ Fee-for-service (FFS) occurs if health care providers receive a fee for each service such as an office visit, test or procedure. It creates a potential financial conflict of interest with patients, as it incentivizes overutilization and treatments with an inappropriately excessive volume or cost.‘ Dead right. And because most patients are insured and do not directly feel the cost there is very limited push back to the production itch. This raises the question if ready access to affordable healthcare can be attained by a market model based on FFS. There are both ethical and practical reasons for Blue Ocean Med to start looking for alternatives.

Affordable solidarity

Let’s get ethical first. A regular marketplace functions under three conditions (among others):

1: customers able to make a choice

2: the availability of choice

3: some form of price-elasticity

First –and let’s be honest- most customers (patients like you and me) don’t know the first thing about medicine. One simply doesn’t bridge the gap of many years of medical training, specialization and experience with a Google search.  No matter what the websites and app-builders tell us. So what do we base decisions on? Then there is the fact that when we are patients, we are by definition not in the best shape to make great decisions. The very definition of illness revolves around the lack of control one has over one’s life (Huber). Second: even if we areable to tell the difference between healthcare providers and their proposed services -and admittedly in some cases we are- there ought to be some excess of supply versus demand to yield freedom of choice. There is no such thing. The demand for affordable high quality care is limitless. Ready access to it is not. Try and get spinal surgery for your daughter or your parent into a nursing home and find out. Of course there is self-medication, low complexity care and foreign or private options. But these are either impracticable or unaffordable. Third is price-elasticity. In a market supply and demand vary with price, right? Supply goes up, price goes down. That sort of thing. Now, how does that translate to a situation when we are so seriously ill that we need the services of a general hospital? We don’t have that live-saving stent placed this month because prices are way up? On the other end of the spectrum; there is no limit to what parents will do or pay for the health and security of their child. So price in many cases is actually quite meaningless. It is a failed attempt at controlling cost. Healthcare is fundamentally about solidarity. A market is not. That’s all about supply and demand which inevitably leads to contradicting interests and contention.

Aligning incentives

Popular hybrids are pay-for-performance or value-based healthcare schemes. The proposed ideas are excellent. But they will not achieve the promised breakthrough because the theories do not depart from the fundamental market paradigm. They basically propose checks and balances to a fee-for-service market by adding performance and outcome measures. Years ago, when the CEO of Blue Ocean Med visited healthcare systems in Barcelona Spain, he happened upon a particularly interesting story. It was about the transformation of the former Barcelona Hilton into a general hospital in the late 1970’s. This in itself was a fun and highly practical move. Really remarkable was the finance scheme the hospital adopted. Patients and professionals were actually joint shareholders of the thing. Based on this share and an annual fee, patients received any medical treatment from the hospital or one of its partners. Truly basic medical services were provided by the government. The annual fee of the hospital depended on the financial results of each year. In this set-up connection between patients and the hospital increases and incentives are fully aligned toward keeping everyone healthy at the lowest cost.

Outcome or effort?

This set-up sounds very much like the vertically integrated managed care consortia of today like Kaiser Permanente, only much much smaller in scale. These bigger consortia report impressive cost savings of over 40% (!). In Blue Ocean Med’s case, it is just the local hospital and their regional partners, so the cost savings will be less. But after adopting the shareholder structure, Blue Ocean Med found that when patients have greater access to their physicians and physicians have more time to spend with patients, utilization of services such as imaging and testing decline. With mutual alignment toward sustaining affordable health instead of efficiently delivering/receiving fixed-fee procedures, an environment is created where doing the right things right, first time, every time now reigns supreme. This alignment and sense of shared ownership even helped positioning patients and their families on more level playing field with Blue Ocean Med’s professionals. And all of this could be implemented right away. No more moronic negotiations, no more perverse incentives, no more failed attempts to let a market do a doctor’s job. With the shareholder structure, competition with other hospitals for this Blue Ocean Med is limited to competing for the best patient outcomes at lowest cost instead of delivering the most clinical procedures at the lowest price.

Part 2: Blue Ocean Medical Center

By Uncategorized

Blue Ocean Medical Center

Part three in the series of our famed fictional hospital as it tries on alternatives to the status quo in healthcare. Let it continue to inspire you to think and act a bit differently and engage with me to find a greater truth. For the extended introduction and parts one and two (‘Hospital without a Home’ and ‘Cells instead of Structures’), please follow this link. Still to come in the weeks ahead: When Prediction meets Precision, Evidence Based Only Please and the Ultimate Medical Mall.

Introduction

The mirrored-window facade of Blue Ocean Medical Center, or Blue Ocean Med, only just catches the watery October sun as it sinks below the city skyline. Situated between the edge of a mid-size city and the Atlantic Ocean, Blue Ocean Med is a hub for regional healthcare. The hospital aims to serve the regional community on all relevant aspects of specialist care, offering all regular diagnostics and surgical interventions as well as prevention programs, radiotherapy, e-health and research and development. A truly wonderful organization and a wholly unremarkable general hospital. It is actually almost identical in organization, size and offering to both of the two nearest general hospitals. These also deliver, in about equal measure:

blue-ocean-medical-center-intro

  1. Extensive high-tech facilities
  2. A comprehensive care offering
  3. Fee-for-service
  4. E-health
  5. Qualified and caring personnel
  6. R&D and cutting edge medicine

Blue Ocean Med, like all general hospitals, is struggling with issues of quality, cost and profile. In order to stand out, they know they must make some fundamental changes. But how? What can they do differently with real impact? Can they afford to? And how can they do this without doing the exact same things everybody else is doing?

BOM Two: Cells instead of Structures

Another rainy day on the coast with a sky as uniformly grey as the strategic promise of a general hospital. Blue Ocean Medical Center is  painfully aware that they, like all general hospitals the world over, basically promise that no matter what the ailment or complaint; they’ll soon find out what it is, treat it quickly and effectively with the latest in medicine and technology wielded by caring and competent staff. This concept gets in the way of delivering the promised ready-access to high quality and affordable care.  You see; in order to deliver ‘anything for anyone’ Blue Ocean Med must combine a vast array of capabilities. These include many different medical specialists, facilities and technologies. All these capabilities come with different processes, schedules, operating margins, regulations and even business models. All of this needs to work seamlessly together in a slightly different way each time someone comes through the shiny double revolving doors. Not only is this extremely ambitious and fault-prone (the organization, not the revolving doors), it also diverts attention from professionals and patients to figuring it all out and somehow making it work.

Damned complexity

Organizational complexity is a major factor in things going wrong, resilience to change and burn-out of (healthcare) professionals. It seems very efficient to have all this expert knowledge, departments and facilities organized in a single body. Unfortunately this concentration of capabilities also exponentially increases organizational complexity, outstripping the capability to effectively manage it all. As the law of requisite variety states: in order to deal properly with the diversity of problems the world throws at you, you need to have a repertoire of responses which is (at least) as nuanced as the problems you face. This repertoire of responses is not only pretty limited considering the number of states to control, it also costs tons of coordination, task division, reporting, registrations, accounting, ict, coffee machines and parking lots.  The CEO also realized that none of these are on his shopping list should a congenital heart failure catch up with him.

Why focus is not the answer

The best known alternative to the general hospital is a focused clinic. These clinics are far less complex and regularly outperform general hospitals on both quality and costs. But they also have a downside. Human beings are not a set of organs held up by bone and skin. A body works as an integrated organic whole. Therefore patients are likely to need more than a single specialism when seriously ill. And with the increase of chronic disease and comorbidity through the ageing of the population, we need more professionals to be working together in more multidisciplinary teams. Are such things not easiest organized within a single healthcare system? Besides, the complexity and interconnectedness of general hospitals are the main reasons why general hospitals cannot and will not make meaningful portfolio choices. They cannot fully foresee the consequences to the plate of spaghetti if they start pulling strings out. They are more or less cemented to their comprehensive care offering.

Organism instead of organization

blue-medical-center-01

Blue Ocean Med’s CEO realized he was long past the point where he could effectively manage the complexity of Blue Ocean Med when yet another improvement programme failed. It all started out brilliantly, but trouble started when the words ‘budget’, ‘governance’ or ‘ownership’ came to the table. They always do. He was painfully reminded that he actually does not run a single organization. He heads a federalized union of semi-independent sub-organizations, like most general hospitals. He also realized that because these units are relatively small and focused, they reduce some of the complexity and overhead for their members, but not for the whole. But more focus means better results. Lower overhead and interference means greater sense of entrepreneurship. That is why performance and change within the boundaries of a unit is usually good. Things go south when two or more units/departments/divisions need to work together. Even when working in those multidisciplinary teams we need so badly.  He remembered reading a book called ‘Eckart’s Notes’. In it, Eckart Wintzen, founder and CEO of BSO/Origin, describes how he used to split-up any organizational unit exceeding 30 members. Eckart goes on to describe how each unit was expected to function independently from a central organization. These small units did almost everything themselves, within company boundaries. Personnel, office-equipment, leasing cars. These small units act like cells in a living organism. Each cell interconnected to form a whole, but seemingly functioning independently. Governed only by the company’s DNA, not some totalitarian central organ.

Within BSO/Origin this set-up maximized agility and entrepreneurship of each unit, while reducing central HQ to a bare minimum. So why could this not work in his hospital? Never afraid to take a different tack, Blue Ocean Med started to de-compose itself into these very small independent units or cells. These are preferably not organized around medical specializations, rather on client-centred propositions. They started out with units focusing on organ specific care, disease specific diagnosis, patient-group research, technology development: you name it. As long as there is a clear value proposition, target group and a viable business model, it is a go. Because of their focus and very small size, everyone soon found that they absolutely needed other cells in order to function. That helped things move along nicely on the cooperation front. They also found they could not decentralize everything of the central HQ. The Blue Ocean Med central organization needs to offer some support in matters of compliance, knowledge transfer, ICT and finance. It also supports initiative and cooperation by providing a safe internal environment for budding initiatives and innovation.

Small rules Big

Without centralizing structures getting in the way or to hide behind, each cell needs to actively work together and show vitality. Entrepreneurship, ownership and local responsibility also makes cells look for superior offerings both inside as outside the organization. That meant that Blue Ocean Med lost some non-viable units and functions to the market. They did not choose to, but things sorted themselves out. The end-result is a focused general hospital based on healthy cells, interconnected both inside and outside the organization, with minimal central rule. The market and network doing the pruning of unviable functions, combinations and cells. A truly vital organism. Most general hospitals however are turning to growth through mergers, geographical expansion, broadening of portfolios and innovation. All of these adding complexity, increasing cost and further outstretching the already limited grasp on running things smoothly. Blue Ocean Med’s energy is aimed at actually improving health the way they know best instead of managing ever increasing and redundant complexity.