Health Care Will Not Reform Itself: A User's Guide to Refocusing and Reforming American Health Care

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ISBN: 9781439816141 | 143981614X
Cover: Hardcover
Copyright: 5/27/2009

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Written by one of the leading authorities in the industry, this book provides a basic primer on the American health care system. Using simple-to-understand language supplemented by insightful anecdotes and examples, the author cuts through the thicket of health care reform rhetoric to offer a step-by-step blueprint for achieving real improvements in health care delivery, as well as putting curbs on growing health care costs. He explains how health insurance works in the U.S. compared with the rest of the world and outlines the barriers to American reform. He also discusses why health care costs are going up so rapidly and sets realistic goals for care improvement.Multi/Card Deck Copy

Acknowledgments	p. xiii
Introduction	p. xv
Health Care Won't Reform Itself	p. 1
Many Treat-Few Prevent	p. 3
Studies Prove the Inconsistency of Care	p. 3
Care Linkage Deficiencies Abound	p. 4
No Money, No Tools, No Accountability for Linkages	p. 5
Paper Records Are Entirely and Almost Criminally Inadequate	p. 6
Providers Don't Create the Economics Reality	p. 7
Is Care Too Complex to Coordinate Anyway?	p. 7
In Other Industries, Lower Prices Increase Sales	p. 9
Screw-Ups Can Be Profitable	p. 10
Screw-Ups Aren't Deliberate	p. 11
We Need the Courage to Reform Care	p. 11
We Need Universal Coverage	p. 12
Tools Need a Use or They Are Useless	p. 13
Strategic Modifications Are Needed	p. 14
Why Are Health Care Costs Going Up?	p. 17
Normal Inflation Is the Bottom Line, First Level, and Basic Cost Driver for Health Care Cost Inflation	p. 18
Worker Shortages Add to Cost Increases for Care	p. 18
New Technology, New Treatments, and New Drugs Increase Costs	p. 21
Few Standards of Value Exist	p. 23
Other Countries Use Screening Programs for "New" Care	p. 24
Untested, Purely Experimental, Unproven Care	p. 25
The Dilemma-For Some Patients, There Is No Other Hope	p. 25
Caregivers Sometimes Own the Businesses	p. 26
Only in America Does "It Might Work" Work	p. 26
Let's Require Disclosure of Effectiveness Research	p. 29
Massive Care Coordination Deficiencies Add Expenses	p. 29
Multiple Caregivers Don't Link Well	p. 30
Perverse Financial Incentives Also Increase Costs	p. 31
Problematic Insurance Benefit Design	p. 32
Changes in Fee Payment Approaches Face Resistance	p. 34
We Are Getting Older and More Expensive	p. 36
Inflation, Technology, Inefficiency, Perverse Incentives, and Getting Old Are an Expensive Package	p. 38
As a Pure, Self-Serving System-Health Care Is Winning	p. 38
Consumers Pay the Price for More Expensive Care	p. 39
Care Costs Create Premium Costs	p. 39
"Pass through" to the Customer	p. 40
The Answer Is "Right Care"	p. 41
Set Goals and Improve Care	p. 43
Data Isn't Shared	p. 45
Random Tools Create Random Results	p. 47
Begin with Goals	p. 47
We Don't Need a Thousand Goals	p. 48
Work Backward from the Goal to the Strategy	p. 48
Asthma Care Needs Computerized Data	p. 52
We Need Computerized Asthma Care Data	p. 53
Universal Coverage for Children Can Improve Asthma Care	p. 54
Being Insured Creates a Database	p. 55
Care Won't Get Better without Goals	p. 55
Goals for Key Diseases	p. 56
The Tool Kits Look a Lot Alike	p. 57
EMRs Need Support Tools	p. 57
Patient-Focused EMRs Are Key	p. 58
Benefit Packages Channel Cash	p. 58
We Don't Need to Change the Entire Payment System	p. 59
Data Is the Secret Sauce	p. 60
Health Care Can Do This Kind of Work	p. 61
Three Provider Payment Changes Are Needed	p. 61
We Need Goals	p. 62
Connectors Are Magic	p. 65
Older Patients Often Have Major Connection Problems	p. 66
Medical Home and Packages of Care	p. 67
A New Generation of Connectors	p. 68
Connectors Come in Various Versions	p. 68
Virtual Integration Can Mimic Vertical Integration	p. 70
EMR Plus Care Support Tools	p. 71
Denver Improved Outcomes	p. 71
The Death Rate Dropped	p. 72
Triple Co-Morbidities in Hawaii	p. 72
Preventing ER Visits Is a Very Good Things to Do	p. 73
Care Registry Worked for "Safety Net" Patients	p. 73
Hospital Admissions Were Reduced by 70 Percent	p. 74
We Need to Connect Everyone Who Needs to Be Connected	p. 75
Buyers Need to Change the Cash Flow	p. 75
Buyers Should Specify the Context for Care	p. 76
The Point of Connectors Is to Connect	p. 76
Claims Data Can Be Used	p. 77
The Perfect System	p. 79
All, All, and Then All	p. 79
Information Security Is Essential	p. 80
CQI Is Needed-And CQI Needs Data	p. 80
American Health Care Needs a Culture of Continuous Learning	p. 82
Most of Health Care Is Splintered	p. 82
One-Third Reduction in Broken Bones	p. 85
Make the Right Thing Easy to Do	p. 86
The Patient Should Be the Focus of Care Data	p. 87
Ten Criteria for Ultimate System Design	p. 87
Six Million E-Visits	p. 87
All New Systems Should Be Connectable	p. 88
The Perfect System Is Possible	p. 89
Personal Health Records Can Fill Part of the Gap	p. 90
Hub and Spoke Connectivity Can Be Computer Supported	p. 91
Virtual Care in Remote Sites	p. 91
Next Step - Connectivity	p. 92
We Need Universal Coverage, Care System Reform, and Care System Competition	p. 95
Intermittent Coverage Disrupts Care	p. 96
Care Improvement Needs Coverage Continuity	p. 97
Data Should Be Longitudinal	p. 97
What Kinds of Health Plans Should Compete?	p. 98
No One Is Accountable if No One Is Accountable	p. 99
"Insurance Exchanges" Should Offer Care Team Options	p. 100
Risk Sharing Works Quite Well, Thank You	p. 103
Risk Pooling Is the Key	p. 104
Co-Ops Set Quotas	p. 104
Ugandans Understand the Cost/Premium Connection	p. 105
Blame Your Fever on Your Thermometer	p. 105
The Basic Business Model of Insurances	p. 106
The Key Is Spreading/Sharing Risk	p. 106
Swiss Rejected Canadian Model	p. 107
The Double Mandate	p. 108
Why Do American Insurers Screen Risk?	p. 108
Large Numbers Are Not Magic	p. 110
Risk Pools Don't Cure Cancer	p. 111
Pooling Small Groups Isn't Magic, Either	p. 112
95 Percent Defines the Business Model	p. 112
Five Percent of Privately Insured People Had Health Screens	p. 113
Hassles and Disagreements Are Minimized with Inclusion	p. 115
Individual Enrollees Have Individual Motivations	p. 115
Using Someone Else's Money Is Often Attractive	p. 116
Expensive New Members Increase Average Costs	p. 116
Death Spirals Can Be Unfortunate	p. 117
A Single Mandate Can Destroy Risk Pools	p. 118
The Best Approach Is to Cover Everyone	p. 118
People Who Need Heart Transplants Should Get Heart Transplants	p. 118
Focus, Tools, and Better Health	p. 119
Begin with Chronic Care	p. 120
Chronic Care Is the First Priority	p. 121
The Low-Hanging Fruit Is to Bite the Bullet	p. 122
Focus, Tools, Health	p. 123
Money Talks	p. 124
Choices Should Affect Premiums	p. 124
Registries Should Not Dictate Care	p. 125
Science Changes	p. 126
Health May Be the Highest Priority	p. 127
The Girth of America Is Expanding	p. 127
Americans Are Also Inert	p. 129
We Need a Culture of Health	p. 129
Eliminate, Label, Reduce, and Persuade	p. 130
We Need Half as Many People to Become Diabetic	p. 131
We Need an Agenda of Health Improvement	p. 132
We Also Need to Set Goals to Directly Reduce Costs	p. 133
We Need a National Forum for Cost Reduction	p. 135
We Need a Commission	p. 136
We Need Complete Data about Cost Drivers for Care	p. 137
The Goal Should Be to "Bend the Trend"	p. 138
Health Care Could Be Moving to a Golden Age	p. 138
Endnotes	p. 141
Index	p. 149
About the Author	p. 159
Table of Contents provided by Ingram. All Rights Reserved.

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Health Care Will Not Reform Itself: A User's Guide to Refocusing and Reforming American Health Care

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