April – HMOs Can Do It; So Can You

We have been a member of the Kaiser Permanente HMO for many decades. Overall, we have been very happy with the service and it shows what an HMO approach to health insurance can do. I’ll share three stories that have some lessons for planning and development departments.

  1. Electronic Files
    I was able to observe firsthand how the doctors and nurses struggled as they switched from paper to computer files. But they stuck with it and today it works great. They enter the data while we are with them. Files automatically go to the pharmacy, lab, or other specialists. All the historic records are readily at hand including x-rays. I don’t need paper; I can go to any of the many Kaiser pharmacies and they have the doctor’s request in hand. By the time I get home, the doctor’s report is already in my email.
  2. Electronic Communication
    I can do all my prescription renewals online and have them mailed to me. I can email questions directly to my primary care doctor and he answers them; same day or at the latest the next day. I don’t pay anything for this but assume it is picked up in Kaiser overhead.
  3. Counter Service At The Pharmacy
    The historic norm was always a 20 to 25 minute wait. Starting a few months ago, the times have been only 5 minutes. Today I asked the staff person who was helping me, what made the difference? I had assumed they had added staff. She said no, it was all do to a new computer program.

So get with it planners, if HMOs can do it, so can you.

The Management Doctor

P.S. Just in case Kaiser should see this, I don’t want it to go to their head. In today’s visit, my wife needed a flu shot and was given the form below to fill out. Can you spot the problem?  Technology is great, but don’t overlook simple things like out-of-date forms or forms you can’t read.

Reader Responses

Where I practice, we all agree we can do better with electronic systems and we have some robust systems here (and I am very thankful) but we are constantly looking to improve. We are in the process of examining replacement permit systems that will handle the workflow, permitting, payments, GIS, the webpage, and has a robust customer portal, etc. Everyone agrees we want an efficient system that has enough bells and whistles to allow us to do more, faster, with less, in a cost effective way; we all get it. Inevitably friction slows us down and it comes from interesting places; too many features, engineers, and IT (don’t get me wrong, I love engineers and IT folks…an engineer would insert planners in this statement and that’s OK too). Anyway, too much complexity and over analysis leads to paralysis. Engineers and plan checking software/hardware present challenges (it’s a significant change in how they work, planners too, and are the monitors big enough). The copyright on the California Building Code doesn’t help if you want to efficiently use it to create plan corrections. Whether or not your IT department likes a particular database provider can be a sticking point as well. You are right; these issues are not insurmountable, as you said, if healthcare can do it, why can’t we do it. We can and we will. The most important decision to get there is the identification of the correct management strategy and a qualified project manager. I can’t stress this enough.

IT should not manage this effort, sorry guys. Their expertise, input, and buy-in is absolutely critical to success of this evolution. Finance should not manage this either, but again you need them so payments are processed and budgets are met. Both of these departments perform a support function to the users. IMHO, one must (must) manage this from the department that uses the system the most on a daily basis. Almost always it will be community development because of the volume of planning applications and building permits. If a system can handle complex planning applications and a large volume of building permits effectively, the system can handle public works permits, special events, park reservations, short-term lodging permits, or whatever other permits a jurisdiction might have. They can ride the coattails and planners are the best to make sure their needs are met, it’s what planners do for a living.

The project manager in community development is the key. He or she must be that utility player who actually knows how a computer system works; who knows all the players including what they do and how they do it; who has excellent communication and organizational skills; and who likely could become the IT manager if they wanted to. This is a rare bird and when an organization doesn’t have one, they often hire a consultant who doesn’t have the same level of commitment, or they let the wrong department do it because there is no other choice and the job needs to get done. Pick wisely.

Paul, I think the reason our industry has not kept pace with health care is simple – we don’t have enough rare birds and we don’t pick wisely. Other factors (excuses?) are out there, but we need to push ahead nonetheless, address the friction, and accomplish the task.

Lastly, we have a rare bird here in community development, but he’s ours so stay back everyone.

Jim Campbell