Accelerating prevention in healthcare with co-opetition

"Co-opetition is the perfect approach for the health-care industry to avoid the destruction of much that is essential to the continuing health of the American people. It should be required reading by managers of health-care providers and health insurance or HMO managers." In this introductory quote in Co-opetition by Adam Brandenburger and Barry Nalebuff, former COO of Memorial Sloan-Kettering Cancer Center John Gunn suggests that healthcare providers and organizations will thrive by capturing an overlooked opportunity to serve patients and communities.

The costs of marketing, branding and image-building, along with redundancies of facilities and services as well as other pricey endeavors to attract patients, all accelerate the expense of healthcare in America without improving quality, access or prevention. These "wasted resources" should create motivation to change from the current acquisition and consolidation model.

Co-opetition, the act of cooperating on some common activities, such as prevention or wellness, while competing on market share or scarce resources, is very effective. Simply stated, the two complementary goals for potential partners-competitors is to first grow the pie, then equitably divide the larger pie. Increasing involvement among all the participants is easier if an abundance of opportunities and/or resources exists. Thus, growing the pie precedes dividing the pie. 

Collaborating, competing, compromising, accommodating and avoiding are five major ways of relating according to the Thomas-Kilmann Conflict Mode Instrument. These behaviors, used in dealing with others, form part of a person's personality. An institution's culture is also partially defined by these behaviors. The five relations can be combined in many ways when people or institutions agree to collaborate and/or compete. When two opposing ways interface, the business community, following the publication of Mr. Brandenburger and Mr. Nalebuff's book, now calls this interaction "co-opetition."

Two contradictory, polarizing quotes come to mind. Gore Vidal's malicious quote, "It is not enough to succeed. Others must fail," contrasts with Bernard Baruch's optimistic statement, "You don't have to blow out the other fellow's light to let your own shine."

In healthcare, actions should always be positive. Competition does not have to destroy the opposition; the goal is to do well and help others. Building complementary capabilities helps everyone.

Improving the health of a community decreases expenditures for care. This financially advantageous approach makes sense as payment migrates, albeit slowly, from fee-for-service to value. An excellent area for cooperation by multiple healthcare systems is prevention, which eliminates many chronic care costs. Everyone benefits — patients avoid illness, caregivers experience satisfaction and providers mitigate loss.

The U.S., the best in the world for acute care, is among the worst in managing more expensive chronic care. Capitation payment for those in Medicare Advantage (approximately one-third of Medicare participants), managed Medicaid and self-insured employer plans is perfectly aligned with prevention because healthier participants require less care. 

Diabetes and pre-diabetes affect over 40 percent of Americans. Within the next decade, over 50 percent of Americans are expected to be overweight or obese. Cancer will affect one third of people. Heart disease remains the leading cause of death. All these diseases can either be completely prevented or treated with long-term programs focused on prevention.

An on-going, successful example of co-opetition focused on prevention is found in Monterey County, Calif., where Montage Health, Salinas Valley Memorial Healthcare System and Taylor Farms are committed to a common purpose — making a difference in the community they serve. Traditionally, businesses near each other might vie for the attention of potential clients — patients, in the case of healthcare systems. But Montage Health and Salinas Valley Memorial Healthcare System, knowing the demographics of the population, partnered on a Medicare Advantage program, a countywide diabetes initiative, and a population health company. They understood that working together helps improve patients' health, thus requiring less care, while the entire community and their respective healthcare systems also benefit. 

The third noteworthy partner, Taylor Farms, is one of the largest produce growers in America and has been a pillar in the region for generations. Becoming a major sponsor of Monterey County's adopted prevention plan was a natural extension of the Taylor family's desire to help its community's well-being, while also controlling healthcare expenditures for its self-insured medical plan.

Collaborating on common goals conserves limited resources, demonstrates enviable behavior, and produces better outcomes. Trust, a necessary catalyst, grows with success as a virtuous cycle. Having the common goal of a healthy community with healthy citizens is not unique; but what is unusual in Salinas is the cooperation among two major, very successful healthcare systems and a responsible multi-generational family.

Salinas Valley Memorial Healthcare System CEO Pete Delgado and Montage Health CEO Dr. Steven Packer meet monthly to work on common concerns and the Medicare Advantage program. When the opportunity occurred in Salinas to join a recognized North American prevention program, with consideration to extend across Monterey County, the dialogue and trust were already in place. The wonderful support of Taylor Farms creates a community poised for success.

Although enthusiastic supporters for prevention abound, not many success stories for entire communities exist. Monterey County chose a successful program that has demonstrated effectiveness across fifty communities in North America, including over 3 million people.

In sum, co-opetition, effective in many industries, now also works in healthcare. Competing on market share and brand recognition doesn't save lives — prevention does. Cooperating on helping people stay healthy is both ethically sound and financially prudent for systems that have otherwise, in the past, been at odds keeping beds full and clinics busy.

Allen S. Weiss, MD, is CMO of the Blue Zones Project. He is the former president and CEO of the NCH Healthcare System in Naples, Fla., and practiced rheumatology, internal medicine and geriatrics for 23 years. 

 

More articles on leadership and management:

NewYork-Presbyterian CXO Rick Evans: Healthcare will change, but the human connection you find in hospitals cannot
Former hospital CEO: To make progress on healthcare, let's change the debate 
New Billings Clinic CEO wants to create culture of safety after ex-leader's firing

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