Redefining Health Care

by Porter, Michael E.

• ISBN13: 9781591397786
• ISBN10: 1591397782
• Edition: 1st
• Format: Hardcover
• Copyright: 2006-06-30
• Publisher: Harvard Business School Pr

Summary

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 costs--not to mention the stability of state and federal government budgets.In Redefining Health Care, internationally renowned strategy expert Michael E. Porter and innovation expert Elizabeth Olmsted 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.In spite of competition among these systems, the patient care cycle is poorly coordinated. The fractured system undermines both efficiency and quality of outcomes.Redefining Health Care lays out a breakthrough framework for redefining health care competition based on patient value over the full cycle of care-from prevention and diagnosis through recovery or long-term disease management. With specific recommendations for hospitals, doctors, health plans, employers, and policy makers, this book shows how to move to value-based competition on results that will unleash stunning improvements in quality and efficiency.

Author Biography

Elizabeth Olmsted Teisberg is an associate professor at the University of Virginia's Darden Graduate School of Business. Michael E. Porter is Bishop William Lawrence University Professor based at Harvard Business School.

Table of Contents

List of Figures	x
List of Boxes	xii
Preface	xiii
Introduction	1	(2)
The Failure of Competition	3	(1)
Competing on Value	4	(2)
Competing on Results	6	(3)
The Structure of This Book	9	(4)
How Will Redefining Health Care Occur?	13	(4)
Scoping the Problem	17	(16)
Identifying the Root Causes	33	(38)
Positive-Sum Competition on Value	33	(1)
Zero-Sum Competition in Health Care	34	(10)
The Root Cause: Competition at the Wrong Level	44	(2)
Why Is Health Care Competition at the Wrong Level?	46	(25)
How Reform Went Wrong	71	(26)
The Rise of Group Health Insurance	71	(3)
Limiting Payments to Physicians and to Hospitals	74	(2)
Managed Care	76	(2)
The Medical Arms Race	78	(1)
The Clinton Plan	79	(2)
Patients' Rights	81	(2)
Consumer-Driven Health Care	83	(1)
Quality and Pay for Performance	84	(4)
A Single-Payer System	88	(2)
Medical or Health Savings Accounts	90	(3)
Non-Reforms	93	(2)
Reforming Competition: The Only Answer	95	(2)
Principles of Value-Based Competition	97	(52)
Focus on Value, Not Just Costs	98	(3)
Competition Is Based on Results	101	(4)
Competition Is Centered on Medical Conditions over the Full Cycle of Care	105	(2)
High-Quality Care Should Be Less Costly	107	(4)
Value Is Driven by Provider Experience, Scale, and Learning in Medical Conditions	111	(6)
Competition Is Regional or National	117	(5)
Results Information Is Widely Available	122	(18)
Innovations That Increase Value Are Strongly Rewarded	140	(7)
The Opportunity of Value-Based Competition	147	(2)
Strategic Implications for Health Care Providers	149	(80)
The Strategy Vacuum in Health Care Delivery	150	(5)
Defining the Right Goal: Superior Patient Value	155	(2)
Moving to Value-Based Competition: Imperatives for Providers	157	(43)
How Would Industry Structure in Health Care Delivery Change?	200	(2)
Enabling the Transformation	202	(16)
Overcoming Barriers to Value-Based Competition	218	(9)
The Benefits of Moving Early	227	(2)
Strategic Implications for Health Plans	229	(54)
Past and Future Roles of Health Plans	230	(9)
Moving to Value-Based Competition: Imperatives for Health Plans	239	(36)
Overcoming Barriers to Health Plan Transformation	275	(6)
The Benefits of Moving Early	281	(2)
Implications for Suppliers, Consumers, and Employers	283	(40)
Implications for Suppliers	284	(11)
Implications for Consumers as Subscribers and Patients	295	(9)
Implications for Employers	304	(19)
Health Care Policy and Value-Based Competition	323	(58)
Implications for Government
Broad Issues in Health Care Policy	327	(2)
Moving to Value-Based Competition: Improving Health Insurance and Access	329	(9)
Moving to Value-Based Competition: Setting Standards for Coverage	338	(3)
Moving to Value-Based Competition: Improving the Structure of Health Care Delivery	341	(33)
Implications for Health Care Policy in Other Nations	374	(7)
Conclusion	381	(6)
Appendix A: Making Results Public	387	(10)
The Cleveland Clinic
Appendix B: The Care Delivery Value Chain	397	(16)
Notes	413	(32)
Bibliography	445	(44)
Index	489	(18)
About the Authors	507