Gawande doesn't just give speeches. In nearly every sentence, he reflects the emotion of his point with movement of his brow, a dip of his chin or a fretful look in his eye. I think that's why he's such an effective speaker. One really sees that he speaks his words with a measured, but discernible passion.
"Fifteen autonomous free people providing care for patients with the choice of whatever they wanted to do, at whatever given moment in time, has proved to be chaos," remarked Gawande. "This is the way we all experience it when we've been sick, when our families have been sick."
The human resources of healthcare (the providers themselves) reflect the communities they serve, and share the same problems of diseases linked to excessive BMI. But are health providers who are fat effective at telling patients to lose weight?
At Baptist Health South Florida, leaders of the system's seven hospitals are asking that question and entering a lion's den, but one that is innovative and so far, productive.
First, as much as they want the workers to be healthier, the self-insured system also wants to control its spiraling bill for medical costs, which are $20,000 per year on average higher for a worker diagnosed with diabetes than for one who is not.
Corey Heller, Baptist's corporate vice president and chief human resources officer acknowledged that the system is "pushed the envelope a bit" with respect to the Health Insurance Accountability and Affordability Act. Baptist has been offering $150 premium credits if an employee takes an annual screening survey and submits to routine disease screenings, such as a glucose test to show predisposition to diabetes.
The system uses the results to determine interventions for workers who are at risk, even to the point of making home visits to look in their employees' pantries, to give advice on changing their diets.
"We don't make widgets; we take care of people. So let's take care of our own people and make sure that we demonstrate and model that behavior for the community," he said.
"Let's take care of them before they become our patients. Why wouldn't we want to have the healthiest workforce in America?"
With Baptist's coaching, some of the highest risk employees have demonstrated an 11-pound average weight loss and a two point drop in BMI since the program began.
6. There may be an ACO in your HMO
Roaming the hallways and ballrooms, I heard several executives fretting about how health insurers will influence the payment, quality, and alignment structures of the future.
That topic came up in one session, entitled "Chasing Unicorns: A leadership conversation around the future of ACOs."
A member of the audience asked, innocently enough, "What about commercial insurance carriers? Will they drive the ACO?"