OwenBloggers: Isha - MBA '08

(Net) Impact in T-...

It’s coming. With leaps and bounds approaching and with every second getting closer. You can feel it everywhere: that certain air, the nervous look , the buzz of excitement. Everything seems to be waiting in anticipation for a climax that we all know is coming – Net Impact.

And yet with all that excitement today seems like the perfect day to stay in bed. It’s chilly and a bit foggy; everything is covered in a milky haze. Quite nice really if you are into this sort of thing. But regardless of my personal feelings on the matter today, like all of this week, is packed. I think we are all trying to finish everything up early knowing that over the conference we won’t have time (or energy) to do anything. I’ve volunteered to do press coverage (read: blog more then usual) which means that I will be around the conference starting at registration and ending sometime on Saturday night/Sunday morning. You can read all about Net Impact on Owenblogers.com, including live coverage from the conference.

See you all there in roughly 48 hours...

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Green vs. energy efficient

It’s surprising how many people don’t realize that there is a difference and where it lies. I was in DC while the Solar Decathlon competition was in full swing. I got to see some of the houses (apparently not the right ones because I didn’t see any of the winners), but from the get go it was evident to me that people don’t see the difference between green and energy efficient. One of the teams used petroleum based products for the house’s elevation/isolating material. Definitely not green. However, the energy efficiency was incredible, not wonder since they are trying to run the whole house on solar power. I do wish that there was more emphasis on green in future competitions.

So what is the difference between LEED and green? Well, LEED certification implies that certain measures were taken to improve energy efficiency in the building. Yes, sustainable materials are encouraged, but the focus is on energy and water savings. There are numerous and rigorous rules to qualify a building as conforming to LEED principles. Green on the other hand is sustainable. Materials used in production are from a sustainable source or are themselves sustainable. For example, energy generated by windmills is sustainable, but energy from a coal plant is not. Bamboo - sustainable, oak - not so much… Simple right?

I guess the key is to find a balance between going completely green and LEED certification. Anything government regulated has some special interest involved in it. We should take matters many steps further and ensure that LEED buildings are truly green by removing as many non sustainable materials as we can.

Technorati tags: Owenbloggers.com, Owen Graduate School of Management, Business School, Vanderbilt, LEED, Green Movement

Technorati Tags: Business School, Green Movement, LEED, Owen Graduate School of Management, owenbloggers.com, Vanderbilt

Warm and fuzzy on the inside

In the beginning of October I wrote about the Polish elections, more precisely about a campaign to stop elderly voters. Last Friday there was an article in the WSJ on the topic. It just gives me satisfaction knowing that I’m not the only one who thinks that voting is important. Granted, this was about Poland, but I wonder how many people will vote in the US elections and how many young people care. Honestly, can you complain about the government if you didn’t cast a vote, regardless if you voted pro or con the elected officials? Get involved. Voice your opinion. Because if you don’t, you are giving someone the right to tell you what to do and then you wonder why this country is the way it is.

Technorati tags: Owenbloggers.com, Politics

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Discovering America

We have a saying in Poland when someone makes a “discovery” that is so obvious to everyone else that we refer to it as “discovering America.” A few days ago the WSJ made such a discovery about mortgages in foreign currencies. This financial instrument has been around for quite a while; half of my friends in Poland (half of those that have mortgages) have them in foreign currencies. Granted, those that had them in Euros had a sudden drawback a few years ago, but now with a strong Polish Złoty, their payments are down and the value of the loan has been reduced substantially. It’s a great deal if the local currency is at its lowest. (There is one minor detail that is crucial in this equation, the ability to borrow in foreign funds. If there are no mortgages available then this avenue of financing is simply no longer an option, now is it?)

There is another article that discovers America, this time posted on Reuters’ website: In New Hampshire, health care sways elderly votes. Not to be mean, but haven’t we already established that the US healthcare system is slightly broken and in desperate need of radical repair? Or maybe that was me dreaming about it last week when I was trying to make sense of how anyone expects the system to change when the primary concern of the lawmakers is to get reelected. But more to the point, we are back to the issue of socialized medicine or lack there off, and where exactly should the line be drawn.

I think it’s somewhere in the middle between socialized and private with a definite shift towards preventive medicine. Let’s not kid ourselves, our system is reactive: we get sick so we seek medical attention. What if we focused on not getting sick and early detection? What percentile of healthcare costs could be saved if patients didn’t insist on medication that is useless for a given condition (i.e. antibiotics for a comm on cold) and doctors were firm in their decisions. This almost sounds like evidence based medicine and all doctors treating the same illnesses the same way. I remember in one of my classes the professor explained why the doctors give in. It’s all about money. If that doctor does not prescribe the antibiotics the patient will go to another doctor that will.  Again, what would happen if we would introduce standards of care...?

Technorati tags: Owenbloggers.com, Owen Graduate School of Management, Business School, Vanderbilt, Healthcare

Technorati Tags: Business School, Healthcare, Owen Graduate School of Management, owenbloggers.com, Vanderbilt

Day 4 - Biometrics in the back yard

For the longest time I thought that infrastructure was just roads and buildings and such. Then I started realizing that communication was a crucial part of it. That led to information sharing, etc. Now I see it as a very complicated body influenced by countless factors where one had does not know what the other one is doing. It seems that in HC we have the basics down, the roads and buildings down, but the talking to each other part is still in the realm on the unknown.

We talked to General Harry Raduege who talked about infrastructure issues on the grand scale – state and federal and how everyone has a different system, how the systems are improved just to find out that they don’t work, and how data storage is an issue. Key word of this presentation was standardization. Actually, this seems to be a reoccurring theme in the course: standardization. Standardization of care, protocols, equipment.

We discussed using various forms of communication to bring doctors to soldiers out in the field where medical care in not readily available. Maybe then the Iraq Memorial will have fewer names then the Vietnam Memorial and we won’t  be standing there contemplating why we had to waste so many lives needlessly.

This morning’s USA Today has an article on the increase in mental care cases among veterans. Problem is that after talking various people this week it’s clear that every branch of the military has a different way of dealing with medical cases in that branch – there is no standard of care among them – heck, General Raguege said that different VA hospitals don’t talk to each other and it’s widely practiced for medical service seekers to visit several hospitals to compare what each one offers for the same condition. We are hoping for a nation wide revolution, but we can’t even manage something that we have direct control over. Why? Too many egos in the way, and no one want’s to step on someone else’s toe.

The second speaker of the day was Harry Greenspun from Northrop Grumman talking about the ethical issues involved in implementation of technology, namely electronic health records: how much exactly do you want your doctor to know? Is that weird rash you had after a trip to Vegas relevant to the sore throat you have now? Are you sure?

Quite a bit of his presentation was about usage of technology and possibilities that it brings. We talked of airport security using biometrics and retina scans to skip security lines. There is one issue we did not mention – how much do you want your government to know about you…

The last two speakers were members of the Deloitte’s Center for Health Solutions, Asif Dhar, MD, and Howard Underwood, MD, MBA, MAAA… Both of them added to food for thought. Doctor Underwood talked about the exact science of underwriting insurance. Doctor Dhar discussed the possible usages of electronic health record data. Among them were drug efficacy, efficiency and safety, and even considering using patient data as post market FDA monitoring.

Technorati tags: Owenbloggers.com, Owen Graduate School of Management, Business School, Vanderbilt, Electronic Health Records, Biometrics, Vietnam Memorial, FDA

Day 3 - Presidential candidate

Maybe it’s not the nicest thing to say, but, in a way, every candidate that pulls out of the election is a looser. However, sometimes those that lose have a tremendous influence on those that stay in the race. In this case Tommy Thompson left his mark by opening the Pandora’s Box of healthcare reform. Other Republican candidates are now gently testing the waters while the Democrats seem to have just jumped in head first. It’s interesting to see how different fractions approach elections and issues that they think will play a crucial role in getting elected.

His speech and ideas on healthcare were very interesting as he described the “perfect storm” that is coming and what we ought to expect over the next few years. However his spiel on foreign policy was time wasted for my group. We are not here to alleviate the ills of the world and figure out how America can improve its image in the eyes of the world. We are here to learn how HC policy is set, how HC government agencies don’t talk to each other and how much influence lobbyists really have.

The perfect storm is really simple really. There are four forces converging and quite a bit of it is our doing.

1) There is a shortage of people coming into the field. Anything from nurses and internists to professors that would teach them. We are not allowing foreign doctors to practice because their education is not good enough for us, yet I am pretty sure that they could save a life as easily as an American trained physician. Oh yes, and as the population is getting older, those lovable baby boomers, we will need more of HC services to accommodate them.

2) HC costs will soon double (prediction is 2015) and we will reach $5 trillion mark. That’s 21% of projected GDP. Talk about big spenders… BTW, European countries are hovering between 9% and 12%.

3) The decline in employer sponsored insure will continue and some predict that businesses won’t be able to compete – look at Ford and GM and their pension/HC obligations. Then again American government is yet to acknowledge pension liabilities that it has. It’s nice to use cash accounting isn’t it? And why exactly does GAPP say that companies must use accrual?

4) Last but not least, Medicare will go broke in 2013 and will be completely bankrupt by 2019. We should have thought about it before passing Medicare part D that is almost completely funded through taxes.

In the evening we met with Marc McClellan who talked million miles per hour on FDA and their shoestring budget of $1.9 billion. He mentioned thou the policy making process of bio-generics and associated challenges. We also briefly talked about fees paid to FDA for drug approval and registration. Unfortunately due to time limitations we only covered drugs and in closing remarks we heard about other issues like pet food and imported food safety.

Technorati tags: Owenbloggers.com, Owen Graduate School of Management, Business School, Vanderbilt, Healthcare, Medicare, Politics, Democrats, Republicans, Elections 2008

Day 2 - You met whom?

No one really. We did attend the Tennessee Tuesday, a meeting with Lamar Alexander and Bobby Corker, but this was more a photo opportunity then an actual meeting. They were there to look good to their constituents. This is a spectacular example of how Washington operates. We did meet with one of their aids though, a lady that deals with healthcare issues for Senator Alexander. What was interesting is that she didn’t seem to care about changing US healthcare for the better, it was more about which bill it’s strategic to pass or just get on the agenda. Someone said that it’s about nudging the change in the right direction. But how fast can you nudge before it breaks? It’s like chasing a race car with a bicycle, but it’s not a distance race, it’s a timing thing. We are tying not to make it blow up in our face and it sure seems that it will. Soon.

I am more disillusioned about the state of the affairs. I mean people claim that lobbyists run the country and from the horse’s mouth we heard how happy they are they can influence people on the Hill to vote for their causes. Now that is scary.

But more to the point. After that meeting we went back to Deloitte’s offices and spent some time talking to Martha Priddy Patterson, Principal at the Deloitte's Human Capital Practice, and a layer, about politics and policies. We had yet another view,  completely different form the Senator’s aide, on the same subject. We were in for a treat, because last night we had a reception with a lobbing arm of a large HC service company and they were talking about their perspective on change in policy, influencing their change and how they see it all.

After spending the day listening to three opposing views on the same subject, I am amazed that anything gets done in the government. But I am not surprised when people say that change in HC won’t come. It will, just not fast enough.

Technorati tags: Owen Graduate School of Management, Owenbloggers.com, MBA, Washington DC, Politics, Business School, Vanderbilt

Day 1 - Private night tour of the Hill

Nothing is like it seems. First day of the course was a bit of a refresher. Some of the material covered was a very condensed version of the Landscape course I took last fall, but I found it amazing how much I have learnt since then. Some of the topics came back to me in a flash others needed a second more, but it seems like a great preparation for the rest of the week. Tuesday is filled with meetings with both of Tennessee’s Senators in the morning (at their offices) and then back to Deloitte for more lectures and meetings. So it’s a good thing that we got our bearings straight.

After lunch some of us went for a walk around town. Since we are staying at Lafayette Square, we took 15th all the way down to Washington Memorial. Then we decided that going to the Museum of Natural History seemed like a fantastic idea, so we went there. I don’t recall seeing the Hope Diamond before so this was pretty cool. On the say to the Air and Space Museum we stopped by the Solar Competition. Whole bunch of houses that use solar energy to operate were lined up in the middle of the Mall. Energy efficient they might have been, but green – not so much. One of the houses we saw was using petroleum based siding. That’s not exactly renewable, now is it? Maybe I can see other houses before the competition is over and hopefully they will be greener then the one form University of Texas.

After the 5 mile trek through the city, and a very brief nap, we headed off to the Deloitte’s reception. It was nice. We got to meet several of the firm’s partners working in different areas of healthcare industry and a couple of researchers from Center from Health Solutions. The evening started with a brief introduction of Congresswoman Marsha Blackburn (who had to run because there was a vote at 6:30 pm) and ended with Congressman Jim Cooper joining us and inviting everyone for a night tour of the Hill. I never thought that I would be walking the halls of the Capitol at 8 pm having the history of the building and the US government recited by a Congressman. We even got to listen to the ravings of Emilia Fox (Rep. North Carolina) and to “close” the proceedings of the House.

After the tour we went to take a look at the most spectacular view of the capitol from Jim Cooper’s office window. I mean how cool is that?

Technorati tags: Owen Graduate School of Management, Vanderbilt, Business School, Owenbloggers.com, Washington DC

Day 0 - Price is not the issue here

We arrived in DC just to find out that the hotel reservation had us coming in the next day. Luckily there were rooms available, however yours truly needs to change rooms later on today. Yes, I’m SO excited… We are staying at the Sofitel in Lafayette Square. I wouldn’t mind so much if this wasn’t such an overpriced piece of real estate. First of all there is no wireless here, I mean there is but for additional 10$ a day. This is less then 3% of the room price, so come on! Include it in the price and let no one be the wiser! Have you ever stayed at Hampton Inn? Middle of no where in Arkansas and there was free wireless and a WSJ waiting outside the door. Here, not so much. Again, this is such tiny fraction of the price that no one would notice if you hiked it a bit. I would say it’s the French, but I know too many French hoteliers to insult French owned hotels lightly. Then again, all of my friends worked for Sheraton and  such.

Yesterday we had a chance to explore DC a bit. It was a gorgeous day and we walked around the area. The South Lawn was open to visitors so we got to see the White House gardens. In the evening we walked a bit more, discovered some local night life, found the Deloitte building and had a drink or two. Over all, it was a very enjoyable day.

Technorati tags: Owen Graduate School of Management, Business School, Vanderbilt, MBA, hotels, travel

Short course, long week

This year Owen introduced an extra set of courses during a week long break between mods one and two. In the beginning I was opposed to it, I would have much rather spent that extra week with my family in Poland then here. But that was in the beginning. Now that the short course is almost upon me, I am quite excited about it. I’m going to be spending the next week in Washington DC talking to the big wigs in healthcare industry. Everything is organized with the help of Deloitte’s Center for Health Solutions, especially Paul Keckley (yes, the one that got bashed by Michael Moore). Guest speakers will include Tommy Thompson, Mark McClellan, William Winkenwerder, and General Harry Raduege – just to name a few.

So what’s the purpose of the whole thing? To better understand the interconnections in HC industry focusing on policy, regulations and governmental reform and their effects on state and federal level. If, as some presidential candidates claim, Medicare assumes responsibility for the uninsured what will happen to the system as a whole. Will it go bankrupt? Will our taxes increase to pay for those additional services? What will happen to the wait times for services and procedures? Will the system be overburdened because people won’t behave optimally and abuse it (i.e. visiting a doctor with every cold)? And I hope someone will mention what are the more optimal solutions for this situation. And no, purely socialized medicine is not the answer.

Aside of ton of reading, we will be looking at the political platforms of presidential candidates as they relate to HC. I’ve started looking, but so much of it is gibberish and political “feel good” that it’s hard to sieve through. Take a look at Ron Paul’s spiel, even though many of the statements are correct economically, there is plenty of “all profits go to pharmaceutical companies and HMO’s” inserts. If that is not playing the public, I don’t know what is.

As for healthcare issues that he is willing to put in writing, it seems that the only thing he stands for is curbing the power of the FDA and against vaccinations. Yes, vaccinations are evil, because they are treating kids like puppies, oh wait, vaccinations save puppies from fatal diseases. Any possibilities they could do the same to kids?

Technorati tags: Owen Graduate School of Management, Business School, Vanderbilt, Politics, Healthcare