REDEFINING HEALTH CARE

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REDEFINING HEALTH CARE
How do we define Value in health care?
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Value equals Outcomes?
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Value equals Outcomes and Cost?
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Health outcomes achieved per dollar of cost
compared to peers.
Three aspects 1. Outcomes 2. Cost 3.
Competition
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Competition in the health care industry today.
Competition is for a piece of the pie
Little or no benefit to the patient
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Zero-sum Competition
1. Cost Shifting to other participants 2.
Costs actually increase 3. Overall no benefit
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Zero-sum Competition
1. Cost Shifting to other participants 2.
Costs actually increase 3. Overall no benefit
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Example - Start
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Example Provider Mandate
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Example Cost Shift to Payer
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Example Cost Shift to Employer
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Example Cost Shift to Employee
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Example Cost Shift to Employee
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Value Based Competition 8 Aspects
1. The focus should be on value for patients,
not just lowering costs. 2. Competition must be
based on results. 3. Competition should center on
medical conditions over the full cycle of
care. 4. High-quality care should be less costly.
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Value Based Competition 8 Aspects
5. Value must be driven by provider experience,
scale, and learning at the medical condition
level. 6. Competition should be regional and
national, not just local.
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Value Based Competition 8 Aspects
7. Results information to support value- based
competition must be widely available. 8. Innovati
ons that increase value must be strongly
rewarded.
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Value Based Competition
1. Value from patients perspective 2. Outcomes
information must be made available to
consumers 3. Health care must move away from
Discrete Interventions to Cycle Of Care.
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Changing Roles - Providers

• Providers not only must be willing to be
• under scrutiny, they must initiate it.
• 2. Fear of litigation lessened if patient is
• making truly informed decisions.
• 3. Provider re-alignment from Service model
• to medical condition via the IPU.
• 4. I.T. cannot be seen as an enemy

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The IPU Integrated Practice Unit

• Health care structured along medical
• condition, not service.
• 2. All treatments, test, etc. aligned by medical
• condition.
• 3. Do not limit by facility nor even geography

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Changing Roles Health Plans

• No fear of I.T. and have gathered much data
• 2. May have more information about patients
• health habits
• 3. May be best suited as keeper of Medical
• Record

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Changing Roles Employers

• Need to be main driver
• 2. Demand health plans contract with quality
• providers
• 3. Providers will have to report to have
• contracts

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Policy

• Some government intervention required
• Do not want nationalized healthcare
• Must have universal health care
• Re-examine medical laws such as Stark
• Free up competition do not restrict
• specialty hospitals

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Conclusions

• How feasible? Is it Pie-in-the-sky?
• Providers may be hardest to convince
• But there are many examples of
• advancement in this area.