John Casillas Keynote – Day One Post 2

Posted by ED Wednesday a.m.

This is a placeholder post. When I get a copy of John’s well received keynote I’ll link it here. [ Update: Please check the "Continue Reading" link below for John’s transcript. ]

Tangentially, I had lunch with John and John H. English. John E. studies the effectiveness of conferences as tools of persuasion.

I want to invite you on a journey – a digital pathway to better health. You know, one of my favorite movies growing up was The Wizard of Oz. I loved the journey following “the yellow brick road” into a land of imagination and fascination. We watched the Tin Man, who needed a heart, the Lion who wanted Courage, and the Scare Crow who wanted a brain. If ever there was need for these three things – a heart, courage and a brain full of wisdom – now is the time as we face a broad and deepening healthcare crisis in America. Now, I’m no wizard, but I’ve been on a journey for the past 11 years that I believe, in fact I’m positive, will solve one of the most vexing problems our country has ever faced – universal access to quality healthcare at a reasonable cost.

If you’re a first timer I’d like to welcome you to a group that thinks outside the “lockbox”. Our conference is composed of visionaries with great imagination who have entered their own “medical banking” journeys and have fascinating stories. They join our journey – a journey of imagination, a journey of discovery, a journey of seeking answers to a quagmire that has stumped an entire industry, in fact, it has stumped an entire nation.

Soon you’ll hear exciting new terms that form the basis for a holistic approach to the solution we’ve been searching for. Terms like Bank-Driven Revenue Cycle Management, Bank-driven Electronic and Personal Healthcare Records, Value-In-Health, Health Record Banks and the Mega-community. That last one was coined by Booz Allen in a global study examining how diverse stakeholders successfully converged to solve complex social issues. Most well-informed, reasonable folks agree that our healthcare crisis demands a community approach. This is a key element of what the Institute offers you – a cross-industry gathering place.

So if you’re a first timer, like the National Governors Association, Office of the National Coordinator, American Dental Association, Centers for Disease Control or the Pentagon, we’re going to take you on a journey in search of Oz. I’d ask you to keep an open mind to free up your imagination because many people here today – powerful, articulate, intelligent, imaginative people – have reached the same conclusion about unlocking the magical key of banking to finally attain the goal of which I speak.

I must confess, the journey at times has been terribly lonely…but not anymore! Take a look at our Membership – over 50 leading firms that have embraced our journey, fueling the medical banking movement. I’m happy to say that one by one the groups assembled here have engaged. My heartfelt thanks goes out to the President’s Council, Track Chairs and our Speakers. I want to especially acknowledge the Members of the Medical Banking Project for without your support, our journey to build a better future would come to an end. You are contributing valuable insight to where we should be going; like the CIO of Walt Disney. This week Tony Scott is promoting MBProject in New York to the C-Level brass of the Top 50 companies in America. Like Tony, I invite you to contribute the medical banking ideas you’ve learned here and to fully engage in the dynamic collaborative process here at the 5th National Medical Banking Institute.

During the next 2 days we’re going to tell you about exciting developments to streamline runaway healthcare costs. You’ll see vivid, concrete examples of how banks have demonstrated beyond a shadow of doubt that this plan of which I speak of has amazing potential. Indeed PNC’s case study will show how one healthcare group saved $4 million last year alone. These early successes solidify our position that banks can save our healthcare system over $35 billion annually just in remittance management, which we consider phase one of the medical banking build-out. That means there’s a whole lot more in savings to go!

I invite you to focus on Three Big Ideas this morning that have the power to transform healthcare. First, I’m going to tell you about MBProject’s Pilot Programs, what they are and why you should support them. Second, I want to introduce you to the idea of Banks serving as Infomediaries, which is crucial for grasping the holistic role of banks driving better value in healthcare, and finally, I want to share our deep conviction that a Common Medical Banking Platform will galvanize our industry and pave our digital pathway to better health.

So let’s start with our Pilot Programs. MBProject has worked hard to establish 2 new Pilot Programs, both managed under our C.O.M.B.A.T. Initiative we started in June 2005 at the Vanderbilt Center for Better Health. It stands for “Cooperative Open-source Medical Banking Architecture & Technology”, and our mission with this is to combat the rising cost of healthcare using medical banking principles and technology. The first one, our HSA Accumulator Use Case, supports pricing transparency in healthcare and lays the groundwork for real time payments. I want to thank PricewaterhouseCoopers for managing this program, and Exante Bank, who some people may not know ponied up $110,000 for this Use Case. I applaud their vision and leadership to help us to continue our journey; in fact, we dedicated our Educational Grantorship to them to recognize what they’ve done. I believe they deserve a lot of credit. By the way, a volunteer for a follow-up Use Case has already surfaced – ACS – that will prove out a model that prices the claim at point of service. Together, the Use Cases get us nearer to our goal of ubiquitous real time payment solutions for healthcare.

Our second Pilot Program represents an historic opportunity for a sponsor who understands the potential returns just like Exante did. This pilot program will enable banks and healthcare groups to establish a Medical Internet that will make Personal Healthcare Records accessible to every family in America, and at the same time provides access to Electronic Medical Records to every physician. This is a key element in any national healthcare information build-out because less than 15% of our doctors use EHRs today, and before we can have real time access to our data it must be lifted off the paper! This Use Case offers a formula that achieves this goal in a profitable way.

Now, a word about these Pilot Programs: Global events herald the inevitability of an emerging eHealth ecosystem linked to banks – a medical banking ecosystem. Ask the UK, Australia, Germany, the European Union, Canada and you’ll find that Banks acting as Infomediaries is where this is all heading. They see the writing on the wall. So I ask the question: Is your bank an eHealth infomediary? You ask what’s that? Fair question: let’s break the term down into three components so that you can answer this question for your organization.

First, an Infomediary delivers administrative efficiency – using your IT capabilities to transform the extreme paper chase in healthcare to a digital stream that automates timely and accurate information to your business and retail costumers; second, it involves creating a new mechanism within your existing IT infrastructure to support clinical data exchanges; and, finally, an infomediary delivers quality information that improves the health of your account holders in your new role as health information brokers. I bet most banks didn’t think in 2000 that they’d be health information brokers in 2007. The change is happening fairly quickly. And you know, it doesn’t take a rocket scientist to see the health-wealth equation: healthy HSA holders means more assets for your bank. Now that describes a holistic attitude for banks in the new area of consumer-driven healthcare. The numbers are just too compelling and the incentive for banks is as clear as the noon day.

I know someone out there is asking the question, why banks? In 1995 I interviewed 125 bank CEOs and since then hundreds more to develop the thesis of medical banking. This question drove me on a fascinating journey and fuels my desire to make events like this happen.

In short, banks offer existing processes, systems and infrastructure, coupled with billions of dollars in ongoing investments that assure identity, high value data movement with amazing levels of integrity, and consumer and community-focused public relations. It’s a powerful package that the healthcare system can use today, but without another critical element we haven’t discussed yet, its not complete: and that is Public Trust. Banks have it and you know that without you’re nothing. All successful banks thrive on Public Trust; thus reputational risk must be carefully evaluated to ensure that this towering standard is met for all medical banking services. By the way, the OCC and Federal Reserve are on record as agreeing with our position that banks can offer health data exchanges. And we will continue to engage Privacy Groups to help steer our important journey.

Ladies and gentlemen, we are accelerating towards a digital world and the possibility of being left behind is very real. Who wants to be left behind? Getting involved is imperative, especially if we want to help our healthcare system, and I know that the members of MBProject do. We’ve mapped out a digital pathway for you today but its up to you to take the journey; its up to you to participate. Its not dependent upon you, because the environment will drive us there, but as a mega-community effort we’ll get there faster, and if you look at the rate of inflation in healthcare you know we have a very limited amount of time.

Because timing is of the essence, the 3rd Big Idea I speak of today is our commitment to launch a Common Medical Banking Platform and an associated Accreditation Council or Board of Governors. This effort will achieve a powerful breakthrough for solving the vexing riddle of healthcare. The platform will energize the medical banking community to better serve the needs of healthcare, government, employers and the public.

Just like the ACH for executing electronic funds transfers, banks understand that if they follow common rules codified in bilateral trade and operating agreements, there will be continuity, consistency and accountability in transactional exchanges. This supports the bank’s reputation as a Trusted Entity for business – how important this is in a conservative industry like healthcare! Yet the current medical banking environment, like any new industry taking flight, has undergone the type of bumpy ride that the Wilbur Brothers experienced – but this didn’t stop them from pressing forward with their dream that man can fly.

Likewise, a Common Medical Banking Platform will help the medical banking community to take flight. It will serve all of our constituencies – banks, vendors, associations, like the Medical Group Management Association, that contacted MBProject to help solve an EFT riddle related to the National Provider Identifier. The platform would help these groups manage the complexity of ramping onto a digital environment. It will iron out the bumpy rides we might otherwise experience with ERAs, HSAs and PHRs, so that everyone benefits.

To meet this goal, MBProject is appointing a committee to draft plans for this platform and establishing a Board. We will focus on core “hybrid” transactions that will rapidly commoditize. The platform will create unity in standards and processes, but the sky will be the limit for competition. Supplemented with continuing education, so critical for navigating the complexities of this newly emerging segment, we will optimize our members’ chances for success. Finally, as investments in this space gather momentum it is critical to facilitate efficiency. It’s really MBProject’s obligation to the industry to lay the groundwork for that efficiency, and it will propel us towards reaching our destination of better health for everyone.

I was fascinated by Nebraska Senator Chuck Hagel’s recent Report recommending that a Federal Reserve Board-like commission could manage a healthcare transformation in America. It’s the second time in recent months that the Federal Reserve Board was referred to as an important model for healthcare – the other being the House version of the Independent Health Record Bank Act. Using this approach, a market-proven model for managing multiple layers of environmental complexity, is good and sound thinking.

Now, some folks take the idea of convergence between banks and healthcare too far. You never want a banker with a scalpel leaning over you on the operating table. But do you want to get online to get your financial and healthcare data using an ultra-secure site? According to a 2006 Global Security Survey by Unisys, the answer is emphatically yes; in fact, consumers will change banks for that kind of security. That same survey asked who should be trusted for your identity management? Guess what the answer was? Banks are who people trust the most.

Today, I challenge you to think more holistically when you use the term “medical banking”. The eHealth Lockbox is a really gateway that heralds a paradigm shift in multiple relationships – bank and providers, banks and health plans, banks and employers, the government, and the consumer. As an Infomediary the bank progressively moves the solution set from monetary exchanges to “health data liquidity” – both involve highly confidential data exchange systems. And don’t buy the argument that these systems can only move “thin” information – you absolutely can move much more complex information like healthcare records. As you do, and you most likely will, banks will support much greater efficiency in administrative transactions, clinical data exchanges, and consumer-friendly healthcare research that will help individuals live healthier lives.

You know I’m tired of the naysayers that say it can’t be done. They must not have read the headlines of the December 2006 issue of HealthLeaders screaming: THE BANKS ARE COMING! THE BANKS ARE COMING! Well I have some news for HealthLeaders, THE BANKS ARE HERE!

Friends, its time to follow the yellow brick road. Financial institutions are prepared to revolutionize healthcare to take us on a journey to where we’ve never been before. And the good news is that in the process this industry is going to make a lot of money, and while that sounds so self-serving its so very important, because we all know what happens to models that aren’t profitable and self-sustaining. A new medical banking ecosystem will bring down the costs of quality healthcare for everyone. Saving money in healthcare as a bank really makes money for everyone – a great win-win-win.

Did you know that there are more banks in attendance at this Institute than ever before? I think they must have realized just like many of us here that there’s a pot of gold at the end of this rainbow. And you know what? Sitting in the audience today are some investment bankers who 48 hours from now will be knocking down the door to be first in line to help launch this new mega-community.

I challenge you to get involved in the medical banking movement. Its shaping new ideas that will improve global healthcare. Our HSA Use Case, E/PHR Use Case, and Common Medical Banking Platform will challenge the status quo and its failing approach to healthcare.

In the process of creating this new Land of Oz all of us must have a holistic consciousness of serving the community at large, because in approaching this task with that in mind in the long run, that approach will benefit everyone. It will help manage the cost, underwrite a robust bottom line, modify consumer behavior, and be socially responsible – in essence everyone will benefit from the pot of gold at the end of the rainbow.

So many people talk to me with dollar signs in their eyes, anxious to take that pot of gold and place it in their profit column. But the critical interdependencies in healthcare are so broad that everyone must benefit, or we all will fail. This isn’t an individual endeavor, its a mega-community effort and its fruits are programs that are self-sustaining. We’ve already proved that so far with the eHealth Lockbox model and its really these types of programs that have a far better chance of guaranteeing we can provide universal access to healthcare at a reasonable cost.

A February 2007 article in the Harvard Business Review sketches an interview with the chairman of one of the largest banks in the world, who claimed that civil society groups like the Medical Banking Project, have realized that carefully calibrated business models can unleash powerful forces for good, and at the same time open the door to new profitable markets. That’s what MBProject is all about. Our mission is to convert digital savings into charitable resources.

Sometimes it seems that we want to kill the goose that lays the golden egg. We must be realistic about what employers can do to help families realize the American dream of a quality livelihood. That’s why we are joining with large employers to forge a new alliance between banks and healthcare groups. Our healthcare is our collective responsibility.

In the final analysis this isn’t a question of technology, is it? It’s a question of passion and will. It’s a question of where the public really puts its trust. It’s a question of what consumers, of what you will do to keep your family safe and secure, both today and during the difficult times of natural and man-made disaster. That’s why MBProject supports our Unified Platform Initiative that links financial, healthcare and homeland security functions. Look at the aftermath of Katrina and you’ll find an acute need for a platform that does just this – emergency access, with positive ID, to financial and healthcare records, and to eliminate fraud and abuse during this time of severe stress.

To save our healthcare system takes strategic players who understand consumerism – another plus for banks – and it is especially important to address the immense stresses of our community safety net. Banks and employers cannot offer HSAs while winking at the problem of the underserved. Our journey to solve the healthcare crisis will stop dead in its tracks if we don’t solve the underserved and unbanked problem. Both of these camps come together in a medical banking paradigm. Do you see that? In the solution of which I speak, a person without a bank account – which could be a Universal Health Account – couldn’t access their healthcare record because these two are systemically linked in the banking and healthcare systems. This is why MBProject will continue to support what we call a “community care platform” and our version of it, Charitable Communities Network.

I like the old sports adage that you’ve got to keep your eye on the ball. We must stay focused. To build a bank infomediary requires focusing on the communities where we live and work – something banks excel at – especially as federal, state and local governments develop healthcare policy, standards and regulations. Well informed in medical banking means forewarned. Do you know who your state CIO is for healthcare?

In closing, I was on a panel at a national event in Chicago with naysayers when the moderator leaned over to me and said, “Medical banking is all about solutions, isn’t it?” I couldn’t have said it better. Our digital path to better health is a fascinating journey that is ripe with opportunity. My question today is will you help? You might ask how. I think I’ve provided that answer this morning.

Stay active in the Medical Banking Project by supporting our Use Cases that target strategic areas that move this industry forward. Learn about our Common Medical Banking Platform as we lay plans to make this available. And above all, think holistically about the bank’s role in healthcare. Let us help you to connect the dots during the next two days and bring you to the conclusion that the bank acting as an Infomediary, holistically deploying its assets with a profit motive, is a powerful idea that will support better healthcare for a long, long time.

Keeping these important ideas in mind you’ll join a growing mega-community of supporters who are on a medical banking journey, building uniquely powerful solutions that support universal access to quality healthcare at reasonable costs. Yes, we’re off to see the Wizard, the wonderful Wizard of Oz!