Redefining Health Care

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Edition: 1st
Format: Hardcover
Pub. Date: 2006-06-30
Publisher(s): Harvard Business School Pr
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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

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