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2. Redefining Health Care- Creating Value-Based Competition on Results

   Redefining Health Care

   Creating Value-Based Competition on Results:
   • Book by Michael E. Porter and Elizabeth Olmsted Teisberg.
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Redefining Health Care- Creating Value-Based Competition on Results

Redefining Health Care

Creating Value-Based Competition on Results:

The U.S. health care system is in crisis. At stake are the quality of care for millions of Americans and the financial well-being of individuals and employers squeezed by skyrocketing premiums-not to mention the stability of state and federal government budgets.

In Redefining Health Care, internationally renowned strategy expert Michael Porter and innovation expert Elizabeth Teisberg reveal the underlying-and largely overlooked-causes of the problem, and provide a powerful prescription for change.

The authors argue that participants in the health care system have competed to shift costs, accumulate bargaining power, and restrict services, rather than create value for patients. This zero-sum competition takes place at the wrong level-among health plans, networks, and hospitals-rather than where it matters most, in the diagnosis, treatment, and prevention of specific health conditions. Redefining Health Care lays out a breakthrough framework for redefining health care competition based on patient value. With specific recommendations for hospitals, doctors, health plans, employers, and policy makers, this book shows how to move to a positive-sum competition that will unleash stunning improvements in quality and efficiency.

• Review:: 'A Flawed Solution to a Real Problem Porter's analysis of the health care system and its problems is right on yet his solutions could not be farther from the direction that the health care system must move to become a real system that serves all Americans. There are so many flaws in the logic of the book and it is so impractical in its recommendations that I am not concerned that anyone will see it as a route to solving the ills of the US healthcare system. Here are some of the main flaws. 1) Most people have very limited choice of providers - specifically the uninsured, people in rural areas, people in managed care plans, people whose employers offer only a limited selection of plans/doctors/hospital. In order for "results" to drive increases in market share - one of Porter's main theses, people have to be able to choose where they will go for care. 2) Competition related to outcomes will slow down progress in medical care dramatically. Hospitals and doctors, rather than rushing to share their newly discovered procedures with others - or share "best practices" for improving surgical outcomes will be incentivized to keep this "results" producing findings to themselves so they can publish better outcome statistics and attract more business. Is this what we want? Don't we want physicians and institutions to openly share best practices to help everyone achieve better outcomes? 3) Porter believes that people should get care from the "best" specialists - even if this means travelling to another city or state for that care. Ridiculous! Once again this will increase the disparities in health outcomes between the rich and poor, the insured and the uninsured, people who have lots of medical knowledge and those who have little medical knowledge. People better equipped, educationally or financially or through insurance coverage may travel to places to get better outcomes while the others get inferior care. Is that what we want from our new health care system? Porter's logic is seriously flawed. It is the result of a profit-oriented mind trying to create solutions for a system that cannot be driven by profit but one which must be driven by concern for all Americans - a desire to achieve excellence wherever people go for care - and a need to raise the level of performance of all doctors and all health care institutions. Porter's solutions create an elitist model where care will improve for a very small number of people at the expense of the general population. It is a non-solution to a complex problem. If any proof is needed concerning how wrong Porter's model can be one must look at the data concerning the degree to which the poor and the uninsured go to hospitals doing low volumes of procedures and therefore, by implication, have worse outcomes. These are the very places where the uninsured, people of color and others of limited means get a majority of their care in urban areas. Just ask how Porter's solutions purport to help these underresourced institutions "compete" and as they loose resources to others, how they will maintain and improve the standard of services they now provide. If you read this book, think about these issues and ask yourself if these are real solutions that serve all Americans. I think you'll see what I mean.
• Review:: 'A vision for what health care could be... I don't think it's news to anyone that health care in the United States is a broken process. There are a multitude of players and entities, and each one doesn't necessarily have goals and motivations that serve the greater good. Redefining Health Care: Creating Value-Based Competition on Results by Michael E. Porter and Elizabeth Olmsted Teisberg offer their take on how to overhaul the process and bring sanity back to healthcare. Contents: Introduction; Scoping the Problem; Identifying the Root Causes; How Reform Went Wrong; Principles of Value-Based Competition; Strategic Implications for Health Care Providers; Strategic Implications for Health Plans; Implications for Suppliers, Consumers, and Employers; Health Care Policy and Value-Based Competition - Implications for Government; Conclusion; Appendix A - Making Results Public - The Cleveland Clinic; Appendix B - The Care Delivery Value Chain; Notes; Bibliography; Index; About the Authors The basic premise here is that the health care delivery system needs to shift to a value-based competition model. The effectiveness of providers over the entire cycle of care for an incident needs to be transparent, so that the best treatments and protocols can be determined. This would also allow those who get the best results to get more business, and those who can't make the grade will eventually be weeded out. The entire care cycle for an incident needs to be integrated, so that you're not getting treatment (and bills) from various providers over the life of your condition. For instance, a knee replacement currently involves separate groups (and billings) from hospitals, doctors, auxillary care, and various other entities. Since there's no real integration, it's far too easy to make mistakes or optimize a single process that suboptimizes the whole. The lack of transparency also means there is little hope to know pricing and make decisions based on the value received for the dollars paid. All the reforms over the years have led us to this point we're currently at, and the norm is making sure the care cycle is optimized for provider reimbursement, not for the best interests of the patient. I really liked the fact that the authors didn't rush down the conventional paths to reform, like single-payer systems. They make very good cases that, while solving a few problems, a single payor like the government would spawn a whole new set of complexities and inefficiencies. The proposed solution to shift the focus to delivering value over the care cycle, making results information transparent and available, and setting "single cost" pricing for care makes sense, but I can see how many of the current players would object. The mystique of the doctor knowing everything would be eliminated, and ineffectiveness could not be covered up. Bits and pieces of their proposed plan are starting to emerge in the market (like publishing hospital results for a set of particular conditions), but it's still largely voluntary and not necessarily standard across the board. To make this work well, you would need to plan on an implementation of a significant portion of the ideas at the same time, so that you don't end up spending time tweaking a partial implementation and straying from the overall destination. This book may not be the perfect answer to fixing the system, but it presents a compelling vision of how it could be changed to deliver on the demands made these days. It's not exactly an easy read, as there is a lot of detail that becomes a bit numbing at times. But if you're part of the overall health care system in America, you really do need to check out the ideas and determine if you can play a part in the solution.
• Review:: 'A must read for anyone involved in healthcare! Porter is probably the most respected writer on "strategy," today. In "Redefining Healthcare" he applies his strategic thinking to a serious issue...healthcare. This is not just an academic treatment of the issue, but Porter gives real world examples of healthcare providers who are changing the way they measure quality at the level of the patient and the impact of what authors Porter and Teisberg define as Integrated Practice Units. The authors examine single payer, governmental systems strengths and weaknesses; what to do about the large number of uninsured in the US; patient responsibility; and most importantly, how to it is possible to build healthcare relationships that can show real, measurable quality at the level of the patient. Porter and Teisberg also examine the parts that insurers, hospitals, doctors, pharmaceutical/biotech companies, diagnostic equipment suppliers, and patients play in impacting both the quality and cost of healthcare. There are ways to fix healthcare, not just for the US, but on an international scope. And if you are at all concerned about the direction US healthcare is going and what true value competition in healthcare should look like, then you need to read this book.
• Review:: 'Outstanding! "Redefining Health Care" begins with data detailing the failures of America's "health system" - the highest and most rapidly rising costs among modern nations, combined with millions of uninsured, high error rates, and an average 17 years for the results of clinical trials to become standard clinical practice. Thus, the puzzle: "Why is competition failing in health care?" Porter and Teisberg's answer is that it focuses far too much on cost-reduction, increasing negotiating power, providing broad-lines of service, and cost-shifting, and instead should focus on long-term value (results vs. costs) for patients. Key to accomplishing this is the collection of standardized patient outcome data (preferably risk-adjusted) that are used to identify providers needing improvement and sources from which that improvement can be gleaned, as well as in guiding patient decision-making. "Redefining Health Care" also asserts that its recommendations are not just theories, but also supported by a number of cited examples. This book provides a clear vision of how the U.S. can reduce health care costs while improving patient outcomes - without increased complexity. It should be read by legislators at both the state and national level, as well as by health care providers.
• Review:: 'Good insight Michael Porter presents a clear insight of the US health system which is flawed in many ways.

• Similar books:
• Redefining Competition in Health Care (HBR OnPoint Enhanced Edition)
• Consumer-Driven Health Care- Implications for Providers, Payers, and Policy-Makers
• The Health Care Value Chain- Producers, Purchasers, and Providers
• The Business of Healthcare Innovation
• Curing U.S. Health Care (HBR OnPoint Collection)