From the AMA:
The health care policy debate is stuck in a place that undermines physicians and the nation’s health. The real problem is not cost, but value, according to an article in the March 14 issue of JAMA, a theme issue on access to care. The only real solution to the national health care problem is to dramatically increase the value of the care delivered for all the money being spent. And that, the authors argue, is an effort that must be market based, medically sound and physician led.
Michael E. Porter, Ph.D., M.B.A., of Harvard University, Cambridge, Mass., and the Harvard Business School, presented the article today at a JAMA media briefing on access to care at the National Press Club.
Dr. Porter and Elizabeth Olmsted Teisberg, Ph.D., M.Engr., M.S., of the University of Virginia, Charlottesville, examined the status of health care today, and propose a strategy for reform. The authors write that the health sector today has the wrong kind of competition. Each player in the system gains not by increasing value for the patient but by taking value away from someone else. This does not improve health outcomes per dollar spent–in fact, it often does the opposite. Health care competition does not have to be zero sum. The authors make the positive case for realigning competition around patient value, and they call on physicians to lead this change and return the practice of medicine to its appropriate focus: enabling health and effective care.
The authors’ proposal highlights three principles that will put competition on the right track: 1) the goal is value for patients, (2) medical practice should be organized around medical conditions and integrated care cycles, and (3) results–risk-adjusted outcomes and costs for each medical condition–must be measured.
The Goal Is Value for Patients
“Improving value for patients is clearly the only valid goal for ethical reasons. It is also the only goal that aligns the interests of patients, physicians, health insurance plans, employers, and government. If physicians improve value for patients, they will be able to credibly engage Medicare and health plans in new contracting and reimbursement practices that reward such value.”
Organize Around Medical Conditions and Care Cycles
Dramatic improvements in value will require the restructuring of health care delivery, the authors argue. “Organizing care around medical conditions, rather than specialties or procedures, is key to improving value to patients. A medical condition is a set of interrelated patient medical circumstances that are best addressed in an integrated way. This encompasses conditions as physicians usually define them, such as diabetes, congestive heart failure, arthritis, or breast cancer. But this definition differs by including all needed specialties and the prevalent co-morbidities, such as diabetes combined with vascular problems or hypertension.”
“For virtually every condition, the cycle of care begins with screening and prevention and extends all the way through preparation, treatment, recovery, ongoing monitoring, and active disease management in the case of chronic conditions. Multiple specialties, services and even entities are involved in the cycle of care. Value for patients comes from the overall effect of the entire sequence of activities, not from any individual service.” The authors note that physicians are beginning to organize care around medical conditions and are forming institutes, centers, and other types of integrated structures that bring needed specialties and expertise together and encompass the care cycle.