The Well-Being Journal

The Central Tendon


By: John Anderson, MD, FACS, Senior Vice President, Navvis Healthways

As a young surgeon some years ago, I had wonderful teachers and mentors who imparted to me a number of fundamental principles of practicing medicine. Though initially intended to be applied in clinical settings, a number of these principles I learned early on have sensible application to the complex domain of healthcare more broadly defined than traditional medicine and surgery. I’ve discovered this as I’ve increasingly devoted my career in recent years to the administrative side of medicine and healthcare.

For example, one mentor used to say that every patient – and more specifically, every surgical patient and every operation – had a “central tendon” which, when identified and “clipped,” made everything else seem minor and secondary. I quickly learned that this principle was significantly true in a clinical setting and have since realized it has much broader relevance.

As the Patient Protection and Affordable Care Act, aka ObamaCare, has swung into full gear with the opening of the exchanges and the expansion of Medicaid in 2014, virtually everyone believes that the healthcare industry has crossed into a very different place. This new reality has already begun to challenge our market’s brightest and most innovative minds to generate solutions that will position the American healthcare system as one to be emulated, rather than one that lags behind in virtually every imaginable dashboard metric. We as a country can do better…much better.

That said, here are a few observations regarding the current situation that I believe to be essential, beginning with my own view of what the “central tendon” might actually be. This short list is by no means intended to be comprehensive, rather just one person’s view of a few things that should be top of mind when thinking about how we fundamentally change and innovate our way out of the current reality with all of its issues.

Issue 1 – Physician Engagement

Others might have a different view, but I believe that “physician alignment” or perhaps preferably, “physician engagement” is just that central tendon issue, from which most all else in healthcare flows. Still the most respected and admired profession in the world, doctors always have and always will have a distinctive and irreplaceable role in the so-called conscience of the healthcare debate. (That in no way is meant to disrespect or undervalue the role of so many other healthcare professionals, especially that of nurses who will forever be the most intimate of partners with physicians at the sharp end of care. Enough said on that lest I be misunderstood.)

While not everyone will agree with me, I for one believe that our historically bifurcated payment schemes have ­– more than anything else over the last 75 years – driven doctors and hospitals further apart. Doctors ran the doctor business, and hospital administrators did likewise for facilities. Meanwhile, patients always thought of their care as “integrated,” and likely didn’t fully understand the distinction between professional and technical services. Nevertheless, we collectively have messaged within the industry something like this: “You take care of your business and I will take care of mine.”

The economic reality of where we are today, with our total healthcare spend being in excess of $2 trillion, cannot – and should not support – that kind of inefficiency and misalignment. We need the collective insight that both, really all, parties bring to the table. It is my belief that those hospitals and healthcare systems that “crack the code” when it comes to solving the physician relationship and engagement issue will be advantaged in the marketplace, regardless of local market forces and dynamics. The models for such alignment are numerous and certainly not confined to full employment and all should be fully explored.

Issue 2 – Healthcare Leadership

Second, and very much tied to the issue above, is the whole topic around leadership in healthcare. No, we don’t just need to train up an army of physicians with graduate business degrees to take over and fix what needs to be fixed. Rather, we need to thoughtfully and respectfully look at how leadership in healthcare has evolved and how narrowly focused we’ve been – something I think has happened from natural progress and isn’t anyone’s fault.

Regardless, our thinking about what healthcare is, where does it start and stop, who are the crucial stakeholders, where are the boundaries, and not least the question of role clarity are critical. We need to be intentional about leadership re-design, and we need to be bold. We need to build upon the strengths of the current leadership model, but not be constrained by it.

Much is said in today’s environment about taking risk, and most of the time we are talking about financial risk associated with the healthcare premium dollar. But we also need to think about bold risk-taking around leadership, empowering leaders to boldly redesign a model that is better suited and adaptable to where we are going, and not where we have come from. What are the skills and competencies that we need to anchor around? What perceived, but outdated, strengths do we need to jettison? Simply put, where do we need to build muscle, and how do we get the new muscle to work with the old.

This kind of change won’t just happen on its own, but needs to be led by a few brave organizations that will take it head-on. I believe that those organizations will be advantaged in the marketplace. In considering this challenge, organizations should think about the following three things:

  1. Are our leaders currently equipped with the necessary skills and competencies to navigate the changing environment?
  2. Is our leadership and shared governance model the right one for us?
  3. Who do we need to engage to help us get from where we are to where we need to be?

Issue 3 – The Role of Boards

And one final thought: who is going to be the primary catalyst for change even if the only change we focused on were the two issues above? I for one believe that it is those who govern. One thing that has NOT changed in the current whitewater of healthcare is who has the final accountability for the long-term welfare of the organizations that make up the bedrock of our American healthcare system – our boards.

Given their connection to local communities, as well as their fiduciary responsibility to do what is best for those same communities, who else is better positioned to drive the challenging, and sometimes uncomfortable changes, that must take place? No longer can boards simply rely on what they learn from management regarding the current reality. They’re going to have to move into a posture that perhaps might be a little uncomfortable for all parties and begin to truly embrace a shared governance model. This shared model will more frequently challenges the status quo and isn’t reluctant to take the organizations that they serve to places that might seem a little daunting at first. A board might ask, “How much must we own, manage or control in order to have the kind of influence that we want to have on healthcare in this (our) market?” Make no mistake, boards will have a key and critical role in how the system of tomorrow is shaped.

As you see, the list is woefully incomplete, but we have to start somewhere. Many believe that the traditional players in healthcare cannot transform an industry as large and entrenched as is ours. I respectfully disagree and believe that real transformation from episodic acute care to true population health and comprehensive well-being can and should most effectively be led by those same people.

So as for me ….

  • Transformational physician engagement partnered with a …
  • Transformational leadership paradigm that is insisted upon by …
  • Transformational boards of governance willing to push the envelope

Not a bad place to start and we’re happy to help out!

This article will also be published on the Navvis Healthways blog and appears with permission of the author.

As senior vice president for Navvis Healthways, Dr. Anderson provides strategic counsel, planning and implementation support for physician integration and alignment, accountable clinical management, and strategic planning for the organization. Before joining Navvis Healthways, Dr. Anderson served as a senior vice president and chief medical officer for Baylor Health Care System in Dallas from 1995 until 2004, and held the same position at Catholic Health Initiatives (CHI) in Denver from 2004 until 2008. Dr. Anderson’s clinical background is that of a general and vascular surgeon. He holds an M.D. from the Baylor College of Medicine and a B.S. from Baylor University.

Topics: Healthcare Medical Costs & Utilization

New Study Reveals a Better, More Comprehensive Way to Measure Well-Being

Madison Agee

Improving well-being can create a vast range of positive outcomes, such as better quality of life, increased longevity, greater on-the-job productivity and lower healthcare costs. Research has shown that overall well-being is a stronger predictor of health and performance outcomes over time than factors such as people’s demographic characteristics, the amount of healthcare they’ve used, and their behavioral and physical health risks alone.* According to Jim Clifton, Gallup chairman and chief executive officer, “The most important dial on any leader’s dashboard for the next 20 years will be well-being”.

If your organization understands that well-being is an important aspect of its success, step one in putting this knowledge to work, then, is to establish a baseline measure of well-being. This will enable you to determine the effectiveness of any programs you put in place to improve well-being. Sounds easy, right?

It’s actually a highly complex endeavor. Health risk assessments abound in the market, but well-being is much more than physical health. Therefore, measurement tools need to capture information about all five of the interrelated elements of well-being: purpose, social, financial, community and physical.

A recent study published by Population Health Management details the development and ultimate success of such a tool, known as the Gallup-Healthways Well-Being 5. The study, co-authored by researchers at the Healthways Center for Health Research, Gallup and Pro-Change Behavior Systems, shows that the Well-Being 5 comprehensively measures, reports and tracks well-being at individual, local, national and global levels.

The Well-Being 5 is based on decades of scientific research by Gallup and Healthways. Experts evaluated hundreds of well-being questions and millions of responses to determine specific question and response wording and question order. The final set of questions in the Well-Being 5 was chosen based on its power to identify risk, comprehensively capture well-being, and predict outcomes with optimal validity, accuracy and precision. The survey experience is designed to maximize both engagement and action, applying principles that include:

  • Making the best choice the easy choice
  • Suggesting direct action
  • Moving the individual through the experience in increments that allow for learning
  • Providing feedback on what is most valuable to that individual

The new study concludes that the Well-Being 5 “comprehensively captures the known constructs within well-being, is reliable and valid, significantly relates to health and performance outcomes, can be diagnostic and informative for intervention, and can be used to track and compare well-being over time and across groups. Using the Well-Being 5 instrument, well-being issues within a population can be effectively identified, prioritized and addressed, yielding substantial improvements to the health status, performance, functioning, and quality of life for individuals.”

As more organizations look to well-being improvement to help them reduce healthcare costs and improve performance, a reliable and validated tool such as the Well-Being 5 can help. Learn more about the Well-Being 5.

* This sentence was edited on August 28, 2014 to include the word "alone."

Topics: Well-Being In the News Science and Research

Infographic: More Americans Now Have Health Insurance, New Gallup Data Shows

Madison Agee

New data from the Gallup-Healthways Well-Being Index® demonstrates that, despite the many hiccups associated with rolling out provisions of the Patient Protection and Affordable Care Act (ACA), the healthcare law has led to a tremendous shift in health insurance coverage. In the third quarter of 2013, 18 percent of Americans were without health insurance; by the first quarter of 2014, that number was down to 13.5 percent, its lowest point in years.

Check out our newest infographic, which reveals some fascinating insights from Gallup-Healthways research, including which states are seeing the greatest percentage of their residents without insurance as well as how health insurance coverage affects well-being.

For a deep dive into the data, Dan Witters, research director at Gallup, extensively discussed trends associated with health insurance data in a Healthways-sponsored webinar last month.

To learn more about the Well-Being Index, visit

The ACA's Impact on Health Insurance Coverage Nationally, Regionally and Individually


Topics: In the News Healthcare Gallup ACA

More than 40 Percent of Americans Have Past-Due Debts

Madison Agee

In a report released in July, the Urban Institute found that 5.3 percent of American adults have a debt past due – meaning anywhere from 30 to 180 days late. To become current on these debts, these individuals would have to pay an average of approximately $2,300 per person. Even more alarming, the study also revealed that 35 percent of American adults have a non-mortgage debt in collection (more than 180 days past due). These 77 million Americans owe an average of about $5,200 each.

As we’ve discussed before in this blog, financial well-being is one of the five inter-related elements of well-being – along with purpose, social, community and physical. Because these elements are interdependent, low financial well-being can negatively affect the other elements. Low financial well-being can adversely impact physical and emotional health, put incredible strain on family and social relationships, decrease people’s interest or ability to engage in their community, and otherwise act as a barrier to people living their best lives. At work, it can make an employee less productive (imagine trying to get an important project finished if your water is in danger of being shut off) and less willing to engage in any well-being improvement programs offered by the company. In short, financial well-being matters – a lot. We should all be talking about it and devising ways to improve it.

Dave Ramsey is someone who talks about financial well-being and the ways in which individuals and families can alleviate financial stress. Considered America’s trusted resource on money, his straightforward approach to financial management, household budgeting, debt reduction and savings has been put into practice by millions of Americans. Perhaps most importantly, Ramsey understands that the key to improving financial well-being is achieving and sustaining behavior change, one step at a time.

One of the millions of people Ramsey has helped, a guy named Vince, recently garnered some media attention when he posted a hilarious online advertisement listing an amp for sale. In the ad, Vince laments, “Dave Ramsey ruined my life” by advocating “tightening the old spending belt and saving all of your disposable income.” The tongue-in-cheek tone of the ad has Vince remembering with nostalgia a former period in his life when he could buy things that brought him fleeting enjoyment but added to his household debt. To keep faithful to Ramsey’s philosophy, Vince is selling his amp to earn enough cash to purchase an acoustic guitar he’s been eyeing.

Vince listed his amp for sale so he could earn enough cash to buy an acoustic guitar. Vince decided to sell his amp so he could earn enough cash to buy an acoustic guitar. With this kind of savvy approach to money, he hopes to avoid being one of the 40% of Americans with past-due debts.

A follow-up article to the ad captures Vince’s more sincere feelings toward Ramsey’s approach. Vince says, “[I]t's given my wife and me something concrete that we can be together on regarding finances,” noting that “having unified financial goals plays a big role in marital harmony.”

Although Vince’s ad puts a humorous spin on raising your financial well-being, it’s an incredibly serious issue. Unless people are able to adopt new attitudes and behaviors toward their money, we’ll likely continue to see staggering statistics like those in the Urban Institute study for some time to come.