Article 109. Implementation of State Collaborative Reforms

Implementation of State Collaborative Health Reforms (updated)

Lawrence Rosier Consulting
12143 Cedar Grove Rd.  Rolla, Missouri 65401 Phone 573 426 2997 cell 573 578-4716
About Lawrence Rosier: See Article 102. Lawrence Rosier Consulting Blog.
States who are interested in learning more about this collaborative effort or have questions or want to become a subscriber may respond by Email to: LawrenceRosier4@gmail.com

State governments are currently facing large Medicaid health expenditures which most states will find difficult to meet.  This is exacerbated by health care cuts by the Federal Government.  This collaborative solution would provide an average saving of up to $1billion for each subscribing State annually when fully installed throughout the State (This is obviously a long term saving).

Lawrence Rosier Principal Consultant is making the following proposal to State Governments and other interested parties:
In the interest of quickly bringing my recommended health care reforms to as many States as possible allowing them to benefit in savings in Medicaid and Medicare health care (saving the State 60% of current routine Medicaid hospital costs).

Each participating State will work through Lawrence Rosier Consulting (to prevent duplicated work) with other states in the development of shared efficiently designed Daily Plans by Lean Teams organized for each routine Procedure.  This will allow up to 15 or more Daily Plans to be developed and implemented in the time it would take for only a few Procedures by an on-site Consultant. 

After review of each State’s submitted Daily Plans by Lawrence Rosier Consultants they are made available for implementation to all of the subscribing States.  This is a continuous process until all selected routine hospital Procedures have been developed and made available to all subscribers.

Daily Plans will vary to meet expected patient backlogs which arise by the size of the metro area. Some Daily Plans may simply be doubled to accommodate larger metro patient backlogs. Note that nearly all routine Procedures performed in a metro area may be done by a single hospital due to its low cost for routine Procedures. 

After the Daily Plan has been developed it will be used to reorganize the selected General Hospital facility.  As many as 15   routine Procedures will need to be organized at the general hospital facility grounds all with access to the ER. 

Each Subscribing State will Agree to the following Requirements:
1. Pay an annual modest subscription fee to Lawrence Rosier Consulting in return for access to Daily Plans and Consulting assistance by remote conferencing including training sessions.

2. Enter into agreement with or acquire in each of the state’s major cities at least one Primary Care Hospital that performs routine operations and agrees to implement Enterprise Lean and reorganize to install a Daily Plan for each of their routine Procedures.   

3. The reforms include:  Enterprise Lean Teams which develop efficiently designed Daily Plans.  Daily Plans are not easily developed and should not be developed without input from the Lean Team familiar with the details of the Procedure.  This is what makes them so valuable they can be simply implemented by states doing the same Procedures and start receiving the savings.  The receiving State may also make continuous improvement to the Daily Plans and coordinate these with the consultant.  Ref: Article 110. Example Cataract Surgery 90% reduction in costs.

4. Video Conference training is planed to be available for each participating State’s Facilitators who will facilitate the organization of the Lean Teams for each function and the development of their Daily Plans.  Ref: Articles: 110, 107,106, 105, 104, 101.

I Recommend Enterprise Lean
Enterprise Lean developed by Toyota is currently being used in: Washington State, Iowa and Minnesota governments to make continuous improvements in State Government Functions. It has also been successfully implemented in the Cleveland Clinic well known for its health care.  The process consists of working teams that meet regularly (once a week) to review and discuss how the work they are doing can be improved. For those Lean Teams involved with routine Procedures, their first task is the design and implementation of their Daily Plan.  I recommend that Enterprise Lean be implemented throughout each medical facility.  Employees become excited about their jobs with their involvement providing continuous innovative solutions to work problems. 

 Routine Procedure Criteria:

• Repeatable processes (relatively routine)

• Sufficient Backlog of patients for Continuous operation   

• Patients must be able to wait in a backlog 

• Daily Plan efficiently designed by each Lean Team

• Balanced Operations (no one waits for others to do their jobs)

Recommendations for Smaller Rural General Hospitals
The savings from the metro hospital is based on high patient backlogs for routine Procedures based on the Daily Plan. High patient backlogs are not available in rural areas.  An alternative for rural General hospitals to meet lower patient backlogs is: to train Lean Teams to use several Daily Plans for routine Procedures and be able alternate between them.
 
Update March 9, 2018:
36 State Governors were contacted by social Media (Twitter) all showed some interest in the project. 15 Governors showed above average interest and 12 Governors were very interested.