If the furious debate around the state of healthcare in the US has led to any consensus, it's that the system should be delivering better quality for less cost than it does. The truth is that our healthcare system is a sprawling mix of competing interests in which those of the patient are valued least. Too much discussion has devolved to simplistic scapegoating, and too few comprehensive, constructive solutions have been offered. It's time for a fresh vision. In straightforward language, Healthcare at a Turning Point: A Roadmap for Change outlines a new market-based business model that aligns industry financing mechanisms with the goals of prevention, improved quality, and reduced costs.
Drawing on more than 25 years of cross-industry consulting experience, the authors: Articulate a market-based vision of the industry Examine past efforts to reduce costs, their failures and their unanticipated consequences Spotlight perverse incentives that distort the way the healthcare system operates and make it less than it could be Present concrete recommendations for change within the healthcare delivery, insurance, pharmaceutical, device and diagnostics sectors Explain the changes that employers, consumers and policy makers can make to create a more customer-responsive system that delivers more value For all the uncertainty in the current environment, there is also a rare opportunity to fundamentally redefine who wins in this market. Healthcare at a Turning Point provides guidance to executives ready for that contest as well as a roadmap for change.
A Vision for Tomorrow Vision of a Fundamentally Different Future Seeds of Disruption Healthcare Isn't the First Industry in Transition Where Are We Currently? Whose Agenda Controls Your Healthcare? Why a Market-Based Model for Healthcare Is a Good Thing How Did We Get into This Mess? End of the Model Year Understanding Healthcare Reform as Business Model Change Central Role of Payment Reform Unintended Consequences: The Hospital Example Paying for Volume, Not Results Real Impact of CMS on Quality of Care and Costs Unintended Consequences: The Primary Care Example Discouraging the Type of Care That Results in Better Outcomes Creating a Critical Shortage of the "Right" Kind of Doctors Healthcare Is Big Business Recent Example Creating a Competitive, Functioning Market There Is Little Accountability in the Current System There Is Little Information Available on Which to Base Responsible Care Decisions There Is Already Enough Money in the System There Is a Solution, and It's Closer than Some Think Endnotes In the Eye of the Storm: The Role of Consumers and Employers A Personal Example Whose Agenda Controls Your Healthcare? Another Look Perversion of the Concept of Insurance Where Do Employers Fit into the Equation? What Can Consumers and Employers Do? Demand Transparency and Accountability Move Conversation toward a Continuum of Care Create/Become Informed Consumers Create Incentives for Better Health Behaviors Change Is Never Easy, but It Is Possible Comparative Effectiveness Research: Creating an Environment for Change Drivers of CER Role of Cost Containment Role of Political Expediency Why Is the Federal Government Specifically Involved? Focus of CER Expected Criteria for Choosing Priorities Endnotes Redesigning Healthcare Delivery: Hospitals Were Never Meant to Be Destinations of Choice Adapting to the Changing Landscape of Healthcare Needed: A Transfusion of Fresh Thinking Management Infrastructure Misuse of IT Comparative Effectiveness Research Is Shaping Healthcare Delivery Development of Predictive Care Paths Changing Quality Metrics Impact of CER on Hospital Operations Prudent Responses and Defensive Strategies Accountable Care Is Needed, ACOs Are Not Laudable Goals Any Provider Can Provide More Accountable Care What Are You Waiting For? Bundled Payment: The Next Step in Improving Quality and Reducing Cost Why Will Bundled Payment Models Do Any Better? So How Do We Get There? St. Elsewhere: A Case Study in Bundled Pricing Taking a Proactive Approach to a Market in Transition Competing with a Bundled Price Endnotes A Brave New World for Payers Adapting to the Changing Landscape of Healthcare Insurance Needed Here, Too: A Transfusion of Fresh Thinking Rethinking the Customer Rethinking Products Implications for Healthcare Insurers What Payers Can Do Develop Partnerships with Providers Segment Providers Focus Partnerships on the Prevention of Never Events Require and Pay for Predictive Care Paths Change the Basis for Paying Primary Care Physicians Increase Consumer Engagement and Personal Responsibility, Reducing the Abuse of the System by Consumers Reduce Fraud and Abuse by Providers Are You Ready for Disruptive Innovation? Endnotes Big Pharma: How to Regain Success Vulnerabilities of the Current Model Market-Driven Business Model Ensuring Stakeholder Value Strategic Marketing Capabilities Innovation Stewardship Pressures on Innovation Role of CER in the Pharmaceutical Industry Treatment Guidelines Focus on Cost Effectiveness End of the Placebo-Only Controlled Trial Impact of CER on Pharmaceutical Operations Prudent Responses and Defensive Strategies Develop Service Wraps Diversify Revenue Streams Away from Payers Adopt a Rolling Blockbuster Approach Real-World Example Looking Ahead Endnotes A New Day Is Dawning for Medical Device and Diagnostics Manufacturers Getting Products to Market: Change Is in the Wind Implications for the Industry Commercial Challenges CER: The Threat for Medical Devices End of the "Last Version Plus 5%" Business Model Increased Pressure to Rightsize Functionality Increased Competition with Drugs Restricted Qualification for Devices Impact of CER on Medical Device Operations Prudent Responses and Defensive Strategies for Medical Device Companies Adopt Strategies Suited to the New Environment Focus on Reducing the Cost of the Procedure Develop Service Wraps Embrace the Cost-Functionality Trade-Off CER: The Opportunity for Diagnostics Reduced Tolerance for Redundant Testing New Commercial Model Possibility of Mass Screening Impact of CER on Diagnostics Manufacturer Operations Prudent Responses and Defensive Strategies for Diagnostics Diversify the Revenue Base Begin to Develop Partnerships for Custom Diagnostics Where Do Medical Device and Diagnostics Companies Go from Here? Hospital-as-Customer Requires a New Sales Model Endnotes Putting Value at the Center of Healthcare Recent Legislative Solutions and Why They Won't Work Accountability for Care Is a Good Concept ACOs: Their Original Purpose ACOs: Their Role in PPACA Government-Sponsored Payment and Delivery Systems Top-Down Approach to Complex Health Policy Problems ACOs: Key Deficiencies Recommendations for Policymakers: Healthcare Delivery Enabling Markets to Create Access to Care Creating Access to Affordable Health Coverage Recommendations for Policymakers: Access to Care Supporting Innovation: Finding the Right Balance at the Food and Drug Administration Regulation's Impact on Innovation: A Two-Edged Sword Making the Rules Clearer, More Transparent, and Simpler Real-Life Example Patent Life: Shooting Ourselves in the Foot Endnotes Creating a Roadmap for Change Revisiting the Challenge of Industry Transition Safety in Size? The Rush to Affiliation Consolidation and the Challenge for Manufacturers Additional Challenges for Manufacturers Creating Collaborations to Develop Lifetime Value Why Now? Reprising the Consumer Power of Choice Increase Perceived Quality Creating and Sustaining a New Business Model Harnessing Consumer Choice and Competition to Ensure Accountability: Final Thoughts for Policymakers End Game Index About the Authors About NAI