Sunday, October 7, 2012

"What are you learning from all of the rejects"?


What is a “best practice” for the prevention of Healthcare Associated Infections(HAI)? The following link should be a good “start” in my opinion. As emphasized in the past, programs like “Patient Safety First” developed by Anthem Blue Cross are changing healthcare both in safety and efficiencies and in this case actually reducing elective deliveries, do not ask me to explain, I am just the messenger!


 Why start here, in my opinion, because it is a proven process, to improve upon these gains will be exponentially more challenging, perhaps requiring the resources of a much larger group, the “low lying fruit has been picked”! But even at the current success rates the slight variation between, say, two hundred different programs across the nation, could yield a large body of data concerning prevention of HAI right out of the gate!

 The California Department of Public Health has expressed interest in exploring the feasibility of developing something like a “Database of Best Practices for the Prevention of HAI” so all healthcare facilities can “start” where programs like Anthem Blue Cross’s “Patient Safety First” left off, from all that I have learned this may well have to be a very robust program, add elective deliveries to the list. Perhaps the greatest gain will be to maximize the return on investment on the current surveillance system. The first thing a good quality engineer will ask, as in our shop, is “what are you learning from all of the rejects”, I am not sure penalizing for a better outcome is going to get you off the list, constantly improving a standard process just might help you land some more work!   

 Please let us hope that the good science finds its way to help out our Veteran’s!

 

"If we can improve the quality of care, that will translate into lower cost," Anthem President Pam Kehaly said. "These are real dollars”

                                                                    http://h-a-i-5.blogspot.com/

“hai-five” and “have fun” wash and dry your hands first please!

 

Michael H. Slavinski

ps: the caliber of professional that I have been exposed to over the past year concerning the development of the advocacy for the prevention of Healthcare Associated Infections in our Veteran’s Hospitals “hai-five” has been most overwhelming! O.K., this link is no exception, “congratulations”!


 

The picture, another parade, “Pioneer Days” here in Paso Robles, CA this weekend!

Sunday, September 23, 2012

HAI, process improvement = Best Practice


 

September 23, 2012   

Jorge Palacios

   California Department of Public Health (CDPH-CHCQ-HAI)

Re: Prevention of Healthcare Associated Infections in our Veteran’s Hospitals

Dear Mr. Palacious,

 Once again thank you and the staff for your interest in our advocacy for the prevention in Healthcare Associated Infections (HAI) in our Veteran’s Hospitals and most recently the development of the concept of a “Database of Best Practices for the Prevention of HAI”.

 Below you will see one of my recent responses to an online forum. This group is attempting to implement “Lean” and Toyota quality teachings to the healthcare industry. The reason for my engagement in this forum as well as others was to challenge the concept of a database of best practices for the prevention of HAI.

 In my opinion, the reason why none of these healthcare quality professionals are having any luck on the issue is because currently the healthcare industry is monitoring “patient outcomes”, much as the CDPH is currently doing, modern manufacturing is focused on “process control”, final output is little more than verification of a good process. The concept of monitoring thousands of independent processes state wide is hard for me to comprehend, using you current monitoring process to monitoring one “best practice” state wide with the opportunity to improve that “best practice” would not only be efficient but would also save the lives of our mothers, fathers, daughters, brothers and Veteran’s in my opinion, let alone the cost of developing thousands of processes!

 My advocacy is dedicated to “supporting those who help others” so I left these professionals on a positive, “evidence based medicine” is a product developed by the medical community, specifically for the medical community and it is very impressive, even Deming would have been impressed, what he would not be impressed with, correct me if I am wrong, is that management seems to be a “no show” in the debate and seem to be headed back to the “innovation” world, some of it I have read about before in a book about the auto industry recent collapse, it is a quick read but our healthcare leadership may soon be there: OVERHALL by Steve Rattner.

 The attached video, I did not identify for the healthcare quality professionals, they should know this stuff, the project is more than likely a masters project for a Process Engineer, the process itself actually predates the Greeks, I do believe it is bronze, so I am going the “bronze age”, the significance of making 10 parts is to verify process repeatability and reliability, if you do get comments on the issue that has trouble identifying what they are looking at I would suggest a reference check! This young man in the video will return to his day job making engine castings the size of a house, just my call, I have trouble reading English let alone the title and there is no way those were Mil-spec threads but the attempt was most impressive!

 Once again, thank you for your valuable time and interst in helping others!

“hai-five” and “have fun”, just be sure and wash your hands first!

Michael H. Slavinski

Start: there was no need to post the preceding posts of title, “trust me”!

http://www.medicalofficetoday.com/article/should-medical-offices-embrace-auto-manufacturing-strategies
"5s", Monitoring spots a spike in C.DIFF, limited variables in the process due to limited amounts of cleaners available, EPA bans the best one, mystery solved, 5s on it's best day, would not have countered the spike in my opinion!


Start to responce:
 

Good point Mr. XXX, perhaps we are even past the whole "Cheese Cake Factory" process and the short lived "Taylorism" reinvention!

 More than likely they are posting these “low lying fruit” topics due to the entertainment value of my posts, obviously, little do I know about a Hospital other than that we have been making parts for ventilators for the past decade and I had no idea these things were killing so many people, some of the motivation to get out there and make a fool out of myself!

 Lean and waste, monitoring thousands of uncontrolled processes, you do not have to be a rocket scientist to figure out we are going to solve the unemployment problem long before we make any tangible and sustainable progress in the prevention of Hospital Associated Infections, "database of Best Practices for the Prevention of Healthcare Associated Infections", "evidence based medicine", the "creation" of the Medical System, you in the healthcare quality programs should be proud of the achievement and start evangelizing today!

  Oh well, now that I have totally ended this link, my work is done, so much for the fun, most of my stuff from here on out will start “Dear Honorable”, time to go to the "action" part, you guys are going to miss me so I will leave you with a small part of our culture, bear in mind I use my dad's tool box and some tools my grandfather made while building Baldwin locomotives! This is not me but how many of you healthcare professionals made the “hammer” in high school shop class complete with the sand cast aluminum handle, mine is in my dad’s toolbox, Walter Chyrsler’s office on top of the Chyrsler Building, adorned with the tools he made, no fooling! Thank you for your valuable time and our advocacy is dedicated to supporting those who help others, just like everyone on this site!

 


 

"hai-five" and "have fun" but be sure and wash your hands first!           

 


 

"If we can improve the quality of care, that will translate into lower cost," Anthem President Pam Kehaly said. "These are real dollars”
 
PS, a happy customer at the tree nuserey, they chopped all ot theirs down for fire wood but today it is a "smile" via U.S. Peace Corps!

Tuesday, September 11, 2012

"Best Practices for the Prevention of HAI"


“9/11/12”

 

 “Best Practices Database for the Prevention of HAI”

                              

 

Today the Advocacy for the prevention of Hospital Associated Infections(HAI) in our Veteran’s Hospitals  are going to begin the process of supporting the development of the  “Best Practices Database for the Prevention of Hospital Associated Infections” in support of those who help others and to be made available, free of charge, to all Hospitals in the United States. The Great State of California is where I live and the California Department of Public Health is in the best position to make this database happen with the results ultimately giving our veterans access to the very best practices currently underway in our private hospitals.

 The following is a letter addressed the United Sates Secretary of Veteran’s Affairs from one year ago which identifies the motivation behind the effort. Many positive things have happened over the past year, the United States Department of Health and Human Services declaring HAI a “preventable disease” being the most profound, “thank you”!

 

“hia-five”

 
 

Michael H. Slavinski

_______________________________________________________________________ 

 
To: General Eric Ken Shinseki

       United States Secretary of Veteran’s Affairs

 

Date: 11/6/11

 

Re: Infection prevention in ventilators at V.A. hospitals, page 1 of 2.

 

Dear General Shinseki,

 

 At this time I will humbly ask your office to investigate the opportunity to implement a  cost and life saving innovation currently underway in the private sector.

 





http://articles.latimes.com/2011/aug/23/business/la-fi-hospital-infections-20110823
 

 Following the teachings of  W. Edwards Demming, “quality must start from the top”, the reason for my request to your office and my enthusiasm for the effort.

 The L.A. Times did an outstanding job of identifying all of the stake holders and the benefits to society, identifying the entrepreneurial spirit from the “top”, Ms. Pam Kehaly, President, Anthem Blue Cross, Blue Shield.

 The L.A. Times has also in the recent past highlighted the great strides the Veterans hospitals have made in inpatient care, giving me the confidence that the Veteran’s hospitals are either ahead of the curve or open to improvement. 

 This program would fit well within the parameters of President Barack Obama’s current cost cutting efforts, one of his current "key initiatives"!

Although not involved in the medical field, A.S.Q. allowed me to have some insight into the complexities of the workings of hospitals, in the 90’s several nurses gave our local chapter presentations on how to implement quality programs from the “middle down” and the less than desirable results. Dissecting the space shuttle disaster was the work of the decade, keeping a few people alive for a week in space was far less complicated than running a hospital. Personally, I struggled to figure out what motivated these nurses to go to work every day during that period for the consensus was that it was far safer in the space shuttle than it was in our local hospitals. Recently a nurse auditor at Anthem Blue Cross helped me resolve the issue, “ I strive to help at least one person every day”, our veterans deserve nothing less, even in these challenging times, in my opinion.

 

Semper Fi

 

Michael H. Slavinski  

 

Continued on next page!

 

 

Re: Infection prevention in ventilators at V.A. hospitals, page 2 of 2.

 

 

Cc:                                                                                                              

 

The Honorable United States President Barack Obama

      

 The Honorable United States Senator Barbara Boxer

 

The Honorable United States Senator Dianne Feinstein

 

The Honorable Majority Whip Congressman Kevin McCarthy

 

The Honorable United States Secretary of the Navy Ray Mabus

 

General James A. Amos

Commandant of the United States Marine Corps

 

Ms. Pam Kehaly

President, Anthem Blue Cross, Blue Shield

 

Mr. Eddy W. Hartenstrin

Publisher and Chief Executive Officer, Los Angeles Times

President and Chief Executive Officer, Tribune Company

 

Staff

Anthem Blue Cross, Blue Shield

 

 

"If we can improve the quality of care, that will translate into lower cost," Anthem President Pam Kehaly said. "These are real dollars."
 
 


___________________________________________________________

Ps: the movie, as my knowledge develops concerning the advocacy, in the private sector, “culture” seems to be the key to preventing HAI. Thinking of our veterans , at some point someone sits down and say’s “ I want to spend over a billion dollars on training in the next three months”, no fooling! This process has been developed over the past couple of hundred years. No, the film did not cost a billion but you can clearly identify what is of value but to learn from this movie, watch the “eyes”, it is the small things that make it all work in my opinion and I really appreciate the Marine who took the time to document the complete process.

The “drowning tank”at the beginning, “train like you fight, fight like you train”, due to gravity and high temperature alloys, most things you fight in, without warning, head the bottom of the ocean upside down and on fire, from what I hear, in wartime, things do not improve very much!

Give a Veteran a break, a job and perhaps your support, think of the families of these volunteers, ten years of continuous wars, they deserve the best in my opinion and with any luck, that will happen!




http://www.youtube.com/watch?v=YxtCaGqiScI
 
The picture, baby weighing in Africa, courtesy U.S. Peace Corps!
 
 




 

 

Saturday, August 25, 2012

HAI "Best Practices" database?


August 26, 2012   

Jorge Palacios

   California Department of Public Health (CDPH-CHCQ-HAI)

Re: Prevention of Hospital Associated Infections in our Veteran’s Hospitals

Dear Mr. Palacious,

 Once again, thank you and the staff of the California Department of Public Health (CDPH) for the work being done concerning patient safety.

 My advocacy for the prevention of Hospital Associated Infection (HAI) in our Veteran’s Hospitals and my review of the revised CDPH web site has led me to a few basic questions. Perhaps these questions should be directed to the Healthcare-Associated Infection Advisory Committee (HAI-AC), please let me know for future inquires.

1.      There is no reference to either accepted, planned or surveillance of “best practices” in the State of California concerning HAI on your website, do you agree with this statement?

2.      Is the CDPH monitoring developments concerning “best practices” concerning the prevention of HAI programs being funded by the U.S. Department of Health and Human Services in other states?

3.      Would the CDPH or the HAI-AC object to my advocacy, “hai-five”, soliciting California elected officials concerning the development of a “best practices database” for the prevention of HAI in the State of California to be followed  by the solicitation of our United State’s Federal elected officials to locate granting opportunities to establish and operate a pilot program.

4.      Could this database be offered “free of charge” combined with an initial “voluntary” participation to all California Medical Facilities, perhaps categorized System, Hospital, ACS?

 

Please understand my request does not ask for the “development” of the “best practices”, they already exist, in my opinion, some in the Government sector but most in the private sector but I would imagine the private sector HAI programs would be, if accepted, purchased at fare market value.

 Good or bad “practices” to start would not matter, your current “surveillance” system would be an excellent method to drive continuous improvements and drive the entire process to the level of “evidence based medicine” our Veteran’s deserve in my opinion!

 No response to this e-mail by September 11, 2012 would be considered a “no-comment” and would give my advocacy the direction to elevate my enquires to my State of California elected officials.  

 Do bare in mind that our  advocacy, “hai-five”, is dedicated to “supporting those who help others”, including all of the staff at the CDPH and hopefully the CDPH will consider our activities as an asset in the long term goal of “preventing” HAI in our medical facilities!

 

Sincerely,

Michael H. Slavinski 

 


 

"If we can improve the quality of care, that will translate into lower cost," Anthem President Pam Kehaly said. "These are real dollars”

 

Ps The attached picture is another U.S. Peace Corps project, a community incinerator. It is actually part of a “food security” project, not what you might think! It starts with a “micro bank” for the farmers, next teaching women groups how to process “shea” in the dry season to generate income to procure food in the non-productive seasons and the incinerator, if the pigs eat the plastic bags they “die”, you can understand the exemption of the “carbon footprint”, it also takes out a lot of mosquito breeding containers.

How important is “food security”, they are farmers, not enough land or anything else and the “rainy season” was three months late this year, “thank you global warming”!

 Sometimes I think my advocacy for the prevention of HAI in our Veteran’s Hospitals is just a bit too much but just watching what our kids are doing on the other side of the world makes my efforts seem quite humble!

Sunday, August 19, 2012

Preventing HAI and a quiet revolution!


Preventing HAI and a quiet revolution!



One plan to "prevent" Hospital Associated Infections(HAI) in our Veteran's Hospitals!



 The "hai-five" advocacy for the prevention of Hospital Associated Infections (HAI) in our Veteran's Hospitals is progressing well. After spending the first year attempting to understand the mechanics of the medical system and why HAI is in them, well, one of our observers used the cliché "Rome was not built in a day", in my opinion, scale wise, you would have to toss in the Mongol Hoards as well to come even close to the complexity of  the human body and our current medical system.

 How to help our Veterans, that was easy, "fix the entire system", no problem, the men and women of our armed forces never gave up on us!

 What revolution, in my opinion, it started recently at the U.S. Department of Health and Human Services:



  Re: Public comment of Phase 3 in the 5-year National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination (HAI Action Plan).



OK, cut paste, wooo, rewind! "Prevention" I have been reading the "religion" of "reducing" the occurrence of HAI for the past year, in my opinion, the term "reducing" in a long term goal is a free pass for HAI to cost our mothers, fathers, sisters, brothers and veterans their lives for a long time and cost our "medical system" a.k.a. "us" billions of dollars every year!

"Evidence based" medicine is the "answer" for most ailments, there are just too many variables to rely on the human mind, 99% correct most of the time! In the case of HAI, Ventilator Acquired Pneumonia (VAP) in particular, easily preventable, it is evidence of the fact that patient safety is still dependant upon the commitment of the health care provider and may well lead to your or a loved one's death! To prevent V.A.P., just follow the documented procedures, many facilities have not had an occurrence of V.A.P. in years and we need to start certifying these V.A.P. free facilities in my opinion and pass the success story with the Veteran's Hospitals A.S.A.P.



Where is the "revolution", here we go, August 16, 2012,  U.S.A. Today, "C.diff hits half-million Americans every year", bad story, most of the problem is the E.P.A. making some bad decisions concerning disinfectants, the real story, the press is very well educated on the issue, the origin of my advocacy:








Where is the "Beef",



Hospital Consumer Assessment of Healthcare Providers and Systems Survey

 (HCAHPS pronounced "H-caps") Scores:



A 27-item survey for measuring patient's perceptions of their hospital experience!

 My comment to this:



Will H.C.A.H.P.S. scores have a tight correlation with H.A.I. occurrences?  The question is yet unanswered but I do believe HCAHPS will be no friend of HAI!



Hospital Readmission Rates, currently hospitals will forfeit about $280 million according to Kaiser Health News, 2012, in Medicare funds over the next year as the government begins a wide-ranging push to start health care providers based on the quality of care they provide.



Through in some random score cards and it will soon be easy to distinguish a safe and efficient healthcare facility, the Patient Protection and Affordable Care Act, not great but the center of the "Revolution"!

 The focus of my advocacy is directed at the good people of the California Department of Public Health for the U.S.D.H.H.S. is waiting for "best practices" to be developed at the State level with the intent of standardizing the process of "Preventing" HAI in our medical facilities and the Veteran's Administration is watching the actions at both  levels.

 In the mean time I am going to encourage the Veteran's Administration to investigate Anthem Blue Crosses "Patient Safety First" program until the U.S.D.H.H.S. starts implementing these "best practices", this one is in plane English:



"If we can improve the quality of care, that will translate into lower cost," Anthem President Pam Kehaly said. "These are real dollars”





The picture, it is not about the bike, in one of my professional communications, in error, I described the genitic link between the Irish and Tater-tots, so behind my desk I have a picture of my Irish Grandmother and my Grandfather from somewhere east of France and described my wife as Brooklyn Irish. The responce, " I think your sense of humor might be a family trait"! The family tree on that side of the family, pretty much a "woodpile" until now! This advocacy is dedicated to "supporting those who help others", it is pretty cool to see how these people work and I have a different view of the picture and my family tree, "thank you and have fun"!










Sunday, July 29, 2012

Healthcare-Associated Infections Action Plan Update



  OHQ@hhs.gov


Healthcare-Associated Infections Action Plan Update



To: United States Department of Health and Human Services,

      Centers for Disease Control And Prevention (CDC)





Re: Public comment of Phase 3 in the 5-year National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination (HAI Action Plan).







From: Michael H. Slavinski

           “hai-five”                       http://h-a-i-5.blogspot.com/

           Citizen Advocate for the Eradication of Hospital Associated Infection in our Veteran’s Hospitals!

           Paso Robles, CA







Re: input





To Whom it may concern,



 1: Would it to be too much to ask that we change the goal of “reduction of Hospital Associated Infections” (HAI) to the goal of “eradication of Hospital Associated Infections” and treat HAI just as any other disease?  Healthcare professionals have clearly identified the fact that all forms of HAI are “preventable” and exist due to the lofty goal of “reduction”? Incremental improvements are acceptable when manufacturing automotive parts or the need to improve the unknown but I personally believe we are at the "Action" phase of the "Plan, Do, Check, Action" according to Edwards Deming concerning the eradication on Hospital Associated Infections!



2: Could we please certify and register Ventilator Acquired Pneumonia “free” medical facilities in the United States, perhaps a two year documented period, just pick one, I think there are quite a few of them! Sure, it will put pressure on underperforming facilities, that is the point, a VAP free facility should be safer and a more efficient facility, capitalism should drive the process in my opinion!



Please view my input from the prospective of a taxpayer, small business owner, ratepayer and a veteran. Personally I do not view the victims of HAI as statistics, they are mothers, fathers, brothers, sisters and veterans and their survival is dependent  upon variable levels of commitment, I find this fact just as unacceptable as the fiscal burden HAI places on our entire nation.

 If you get a chance, please include the following statement, the inspiration for my advocacy to “support those who help others”:



"If we can improve the quality of care, that will translate into lower cost," Anthem President Pam Kehaly said. "These are real dollars”



Your efforts and request for public comments will be posted on my blog and once again, “thank you so much for all that you do at the CDC”, I really appreciate it and at this time I offer my services and resources, as limited as they are, to support the C.D.C.’s effort to reduce HAI in our hospitals and my attempt to “support those who help others”!



Sincerely,



Michael H. Slavinski



Ps: Perhaps my comments are global verses your focus in phase 3 but the level of concern expressed by the general public concerning the recent “grading” of our nations medical facilities may well expose the need to evaluate all opportunities to improve in my opinion!




The picture is the production of "neem cream" which is produced from neem tree leaves and other indigenous plants cooked to produce an affordable mosquito repellant in Africa. The area where this is being produced via the United States Peace corps, in a recent survey of over 6000 residents, over 1500 tested positive for malaria. Mosquito nets were also provided courtesy the U.S. Peace Corps. Neem cream is much easier and safer to produce than soap, both are in production, Dad's advice, always read the M.S.D.S. prior to cooking!

Have "fun", thank you for reading!

"hai-five"



                                                                                                    OHQ@hhs.gov

Sunday, July 22, 2012

California Department of Public Health, "support those who help others"!




July 15, 2012

Ron Chapman, MD, MHA

Director,

 California Department of Public Health

Re: Advocacy for the eradication of Hospital Associated Infections in our Veteran’s Hospitals

Dear Dr. Chapman,

 My advocacy for the eradication of Hospital Associated Infections (HAI) over the past year has directed me to the efforts of the professionals working under your leadership at the California Department of Public Health (C.D.P.H.). As you may be aware the U.S. Department of Health and Human Services (D.H.H.S.) are funding and waiting for “best practices” to be developed at the State level concerning the reduction of H.A.I. and the U.S. Veteran’s Administration is following the efforts of the D.H.H.S. In addition, I was also directed to your efforts by Ms. Pam Kehaly, President, Anthem Blue Cross and her staff, the “hai-five”, concerning your work regarding the reduction of HAI in the Great State of California.

 At this time I would like to introduce my advocacy as “supporting those who help others”, my resources are limited but as a small business owner, a rate payer, a tax payer and a veteran I do have a vested interest supporting the efforts of the C.D.P.H. concerning HAI. My interest is deeply rooted in the “can do” attitude expressed in an article in the L.A. Times concerning the success of Anthem Blue Cross’s “Patient Safety First” program. The definition of my advocacy is still undefined other than “supporting those who help others” in a positive manner and will encompass both the public and private sector.  “Thank you” for the hard work you and your staff have committed to the safety of our mothers, fathers, brothers, sisters and veterans in our hospitals! Currently I am advocating support nationwide for the proposed 2013 fiscal year budget for the National Healthcare Safety Network under the C.D.C., certifying the first “V.A.P. free” medical facility in the United States and to categorize Anthem Blue Cross’s “Patient Safety First” as a “Best Practice”, our Veteran’s deserve nothing less in my opinion!! Please have your staff contact me if there is anything my advocacy can do to support the efforts of the C.D.P.H. concerning the eradication of HAI from our hospitals, the World Health Organization claims that “time is not on our side”!

Sincerely,

Michael H. Slavinski                              http://h-a-i-5.blogspot.com/

Continued on page 2





               Page 2 The eradication of Hospital Associated Infections (HAI)  in our Veteran’s hospitals!  July 15, 2012


Honorable United States President Barack Obama            


Honorable United Stated Senator Dianne Feinstein


Honorable United States Senator Barbara Boxer

Honorable Majority Whip United States Congressman Kevin McCarthy

Honorable Congresswoman  Lois Capps

Honorable Governor Edmond G. Brown Jr.               The Great State of California

Honorable California Senator Sam Blakeslee

Honorable California Senator Ed Hernandez ,                                Chair, Health Committee

Honorable California Assemblymember William W. Monning,     Chair, Committee on Health Care



Honorable California Assemblymember Katcho Achadjian



Honorable Supervisor Frank Mecham,                San Louis Obispo County



Secretary Kathleen Sebelius,                         United States Department of Health and Human Services



Ms. Donna M. Beiter, RN, MSN,                   Director, V.A. Greater Los Angeles Healthcare Systems



J. Eugene Grigsby, 111,   President, CEO,      National Health Foundation



Mark R. Chassin, M.D., F.A.C.P., M.P. P., M.P.H.         President,     The Joint Commission



Ms. Amy Panagopoulos,              Senior Director,   The Joint Commission



Ms. Mary Stahl, RN, MSN, CCNS-CMC, CCRN, ACNS-BC        President, Association of Critical Care Nurses



Board of Directors,      WellPoint, Inc.



Ms. Pam Kehaly,                    President, Anthem Blue Cross



Mr. Eddy W. Hartenstrin

Publisher and Chief Executive Officer, Los Angeles Times

President and Chief Executive Officer, Tribune Company



Staff, Anthem Blue Cross



"If we can improve the quality of care, that will translate into lower cost," Anthem President Pam Kehaly said. "These are real dollars”