Today at the WEDI ICD-10 Forum in Fairfax Virginia, Robert L. Guenther, Technical Director for the U.S. Department of Health and Human Services at the Centers for  Medicare and Medicaid Services concluded that “All States are at high risk” in terms of their ability to complete CMS requirements at a state level to implement ICD-10.

The key issue will focus not on technical, IT oriented approaches but on leadership and a view of the real business issues around implementing ICD-10.

Iowa however is one of the few states that appears to be ahead of other states.  Iowa Medicaid Enteprise (IME) is successful due in part to the early realization by IME leadership that:

Best practices include:

• A collaborative environment
• Complete operational procedure documents
• Comprehensive systems documentation
• IME completed a MITA State Self-Assessment (SS-A) completed in May 2009 which covers the 79 business processes that all states need to master and document which would have business, system and process impact.

There is a business architecture that spans all operational functions.  In addition IME performed a gap analysis that helped guide them by using “high,” “medium,” and “low” as the impact rating system.

They scored their strategies with benefits, drawbacks, costs, best use as well as the costs to implement.

IME’s performance based model implies higher weights toward categories that influcence program integrity and quality:

The high level estimated percentages for weighting were established which focused in context of ICD-9, ICD-10 and mapping both directions.  The benefits, drawbacks, and best use categories were considered.  The cost range for the State of Iowa was between $8 million and $10 million for a level of compliance that didn’t meet all requirements, an “intermediate” level of compliance would cost up to $11 million, and “optimal” compliance would cost $14.6 to $17.6 million.  This estimate is nearly twice the estimate of CMS for a state to implement ICD-10.

Other IME considerations:

Challenges with NPI translation approach

• Project estimates are much larger than anticipated (2-3 times NPI [national provider id] project costs).  For most, NPI was a difficult and expensive task for health care companies.
• Project impacts and recommendations need to be communicated effectively to the executive team
• System replacement options and implications

Our team would be happy to help develop your plans using our experience and best practices.  Contact us at assesssments@noworldborders.com

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I recently read and enjoyed Paul Sloane’s latest book, The Innovative Leader. Here are a list of just some of the gems from this book. It’s available at Amazon.com (click the title of the link above and go directly to the page on the Amazon web site).

1. Have a vision for change
You cannot expect your team to be innovative if they do not know the direction in which they are heading. Innovation has to have a purpose. It is up to the leader to set the course and give a bearing for the future.
You need one overarching statement that defines the direction for the business and that people will readily understand and remember.
Great leaders spend time illustrating the vision, goals and challenges. They explain to people how their role is crucial in fulfilling the vision and meeting the challenges. They inspire men and women to become passionate entrepreneurs, finding innovative routes to success.

2. Fight the fear of change
Innovative leaders constantly evangelise the need for change. They replace the comfort of complacency with the hunger of ambition. They’ll say, “we are doing well but we cannot rest on our laurels, we need to do even better.” They explain that while trying new ventures is risky, standing still is even riskier. They must paint a picture that shows an appealing future that is worth taking risks to achieve. The prospect involves perils and opportunities. The only way to get there is by embracing change.

3. Think like a venture capitalist
VCs use a portfolio approach and balance the risk of losing with the upside of winning. They like to consider lots of proposals. They are comfortable with the knowledge that many of the ideas they back will fail. These are all important lessons for corporate executives who typically consider only a handful of proposals and who abhor failure.

4. Have a dynamic suggestion scheme
Great suggestion schemes are focused, easy to use, well resourced, responsive and open to all. They do not need to offer huge rewards. Recognition and response are generally more important. Above all, they have to have the whole-hearted commitment of the senior team to keep them fresh, properly managed and successful.

5. Break the rules
To achieve radical innovation you have to challenge the assumptions that govern how things should look in your environment. Business is not like sport, with its well defined rules and referees. It is more like art and is rife with opportunity for the lateral thinker who can create new ways to provide the goods and services customers want.

6. Give everyone two jobs
Give all your people two key objectives. Ask them to run their current jobs in the most effective way possible and at the same time to find completely new ways to do the job. Encourage your employees to ask themselves—what is the essential purpose of my role? What is the outcome that I deliver that is of real value to my clients (internal and external)? Is there a better way to deliver that value or purpose? The answer is always “yes”, but most people never ask the question.

7. Collaborate
Many CEOs see collaboration as key to their success with innovation. They know they cannot do it all using internal resources. So they look outside for other organisations to partner with. A good example is the Mercedes and Swatch collaboration, which produced the Smart car. Each brought different skills and experiences to the team.

8. Welcome failure
The innovative leader encourages a culture of experimentation. You must teach people that each failure is a step along the road to success. To be truly agile, you must give people the freedom to innovate, experiment and to succeed. That means you must give them the freedom to fail, too.

9. Build prototypes
People’s Bank has a refreshingly original attitude to new ideas. “Don’t debate it, test it,” is the motto of this innovative American financial services organisation. Try the new idea at low cost in a section of the market and see what the customers’ reactions are. You will learn far more in the real world than you will in the test laboratory or with focus groups.

10. Be passionate
Focus on the things that you want to change, the most important challenges you face and be passionate about overcoming them. Your energy and drive will translate itself into direction and inspiration for your people. It is no good filling your bus with contented, complacent passengers. You want evangelists, passionate supporters. You want people who believe that reaching the destination is really worthwhile. If you want to inspire people to innovate, to change the way they do things and to achieve extraordinary results, then you have to be passionate about what you believe in and you have to communicate that passion every time you speak..

Paul Sloane is an Advisor to No World Borders, and the founder of Destination Innovation (www.destination-innovation.com). He writes and speaks on lateral thinking and innovation. His book, The Innovative Leader, is published by Kogan-Page.

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