Book Review - Redefining Health Care by Michael E. Porter and Elizabeth Olmsted Teisberg
Category Book Reviews
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.
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.
| Permalink |
