Healthcare Beyond Reform: Doing It Right for Half the Cost

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ISBN: 9781466511217 | 1466511214
Cover: Hardcover
Copyright: 4/24/2012

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Along with being the biggest sector of the U.S. economy, healthcare is also the most dysfunctional. This book presents a compelling vision of how healthcare can work better and how we can get there with the current resources. Providing a comprehensive, positive, and intriguing vision of the future, this book tells healthcare providers how they can reposition their organizations to thrive regardless of what the government does in regards to policy. It also outlines how employers can save money by changing the way they provide healthcare to their employees. Check out Joe Flower discussing his new book, Healthcare Beyond Reform.

Acknowledgments	p. xiii
About the Author	p. xvii
The Facts	p. xix
First, a Story: Tom Johnson's Belly Encounters Healthcare as It Has Been	p. xxi
Introduction	p. xxxiii
How We Got Here
Half Off?	p. 3
Looking at Normal Countries	p. 3
Economists Behaving Badly with Smoke and Mirrors	p. 6
The Fairness Factor	p. 7
The American Ways of Healthcare	p. 9
Possible Savings: Getting to Half	p. 10
Waste	p. 13
Doing the Right Things the Wrong Way	p. 13
Doing the Right Things in the Wrong Place	p. 14
Doing the Wrong Things-and Not Doing the Right Things	p. 14
How Much?	p. 14
Where Are the Biggest Savings?	p. 16
Inappropriate Therapies	p. 16
How Big Is This Waste?	p. 22
Heroic End-of-Life Treatment	p. 23
Insurance Waste	p. 25
Pharmaceutical Waste	p. 26
Chronic Disease	p. 26
Trends: Opportunities	p. 31
The Economy	p. 31
Rampaging Geezers	p. 32
Aging Clinical Workforce	p. 34
Chronic Disease	p. 35
Computerization and Automation	p. 37
Reform and Insurance	p. 38
Brute Force Cost Reductions	p. 39
Healthcare Economics 101	p. 41
Ahmed Buys a Rug	p. 42
The Convoluted Economics of Healthcare	p. 43
Competing Influences	p. 46
No Cost Accounting	p. 48
Split Buyers, Split Sellers	p. 49
Why the Ever-Popular "Cost Controls" Do Not Control Costs	p. 52
Health Systems: More Complex	p. 54
No More Cost Decanting	p. 55
It's About to Get Really Complicated	p. 56
Inflexible Systems	p. 57
Unit Costs vs. System Costs	p. 58
The Two Core Rules of Economics	p. 59
What Must Be Done
The Five Strategies	p. 63
1. Explode the Business Model	p. 67
The End of Fee-for-Service Healthcare?	p. 68
What Are We Buying?	p. 69
What's Wrong with Competition?	p. 69
Emerging Business Models	p. 72
The Safeway Experience	p. 72
CIGNA's Choice Fund	p. 74
Formula One	p. 75
The Boeing Experience	p. 76
On-Site Clinics	p. 77
On-Site Clinics without Employers?	p. 79
Medicaid-Based Business Models	p. 79
Disease Management Programs That Fail	p. 80
Disease Management Programs That Work	p. 81
Direct Primary Care	p. 82
Direct Primary Care-Online	p. 83
Structure Matters	p. 84
Share the Risk	p. 85
A Brief History of Risk in Healthcare	p. 86
Putting the Customer at Financial Risk	p. 87
"But Capitation Doesn't Work"	p. 89
Putting the Provider At Risk	p. 90
Providers At Risk Behave Differently	p. 91
Putting Providers Systemkally At Risk	p. 92
Shopping	p. 94
Virtuous Deflationary Spiral	p. 95
Redesigning Markets	p. 96
Explode the Business Model	p. 98
2. Build on Smart Primary Care	p. 99
The Medical Home	p. 100
How a Medical Home Actually Works	p. 102
Making More Money by Being a Better Doctor	p. 103
Taking on Risk	p. 103
Integration: It's Not Just "Kumbaya"	p. 104
From Evidence-Based Medicine to Evidence-Based Health	p. 105
Explode the Business Model and Build on Smart Primary Care	p. 106
3. Put a Crew on It	p. 107
A Team Care Example: Diabetes	p. 108
Teamwork at All Levels	p. 109
Getting on the Same Team with the Docs	p. 110
Alaska Native Healthcare	p. 111
What Makes a Team? A Scoreboard	p. 113
Explode the Business Model, Build on Smart Primary Care, and Put a Crew on It	p. 114
4. Swarm the Customer	p. 115
The Magic of Mr. Moon	p. 116
The Pareto Principle in Healthcare	p. 118
Hotspotting	p. 121
The 5% That Does the 50%	p. 124
More Help, Smarter, Earlier	p. 125
5. Rebuild Every Process	p. 127
The Tough Business of Caring	p. 127
Time to Get Fierce	p. 128
Perfecting Clinical Processes	p. 129
Evidence or Intuition?	p. 130
Measure It-and Get It Right	p. 132
Check It Out, Dude!	p. 133
Other Industries: "Quality Is Job One"	p. 135
The Institute for Healthcare Improvement	p. 136
Comparative Effectiveness Research	p. 138
Evidence-Based Design	p. 140
The Lean Medical Practice	p. 143
Doing It Cheaper	p. 144
Raise a Glass to Carlos	p. 146
Big Data	p. 147
Analytics for the Country	p. 148
Analytics for Systems	p. 150
Analytics for You	p. 151
With the Doctor	p. 153
Taking It Home	p. 153
Apps	p. 154
Extending the Clinic into the Home	p. 156
India and China: Globalization Cuts Both Ways	p. 157
India	p. 158
China	p. 159
Cheap Biologicals and Biosimilars	p. 159
Reverse Innovation	p. 160
Making It All Work
Beyond Healthcare	p. 165
Len Duhl, the Father of Healthy Communities	p. 167
Involve Everyone	p. 169
The Evil Profit Motive and the Virtues of Competition	p. 173
Arguments for a Single-Payer System	p. 174
Insurance Companies Are Evil	p. 174
Extra Transaction Costs	p. 174
Extra Fundamental Costs	p. 175
For Profit? Or Not?	p. 176
Is Healthcare a Right?	p. 180
It's Not That Simple	p. 182
There Ought to Be a Law	p. 187
Introduction	p. 187
Scope of Practice	p. 187
Corporate Practice of Medicine	p. 188
Certificate of Need	p. 189
Anti-Kickback Legislation	p. 190
Transparency	p. 190
Fraud	p. 192
Insurance Regulation	p. 193
ERISA Immunity	p. 193
End Fraudulent Rescissions and Claim Denials	p. 194
Swiss Rule	p. 197
Direct Primary Care	p. 198
Transparency	p. 199
Competition	p. 200
Operating across State Lines?	p. 200
Malpractice	p. 201
It's Not Greedy Patients	p. 204
Fixing Malpractice	p. 205
Systemic Effects	p. 208
Fixing the Pharmaceutical Industry	p. 209
Pharma Runs into a Wall	p. 210
Burying Germany in Jeeps	p. 212
Why We Don't Get Legislation That Works	p. 214
The X Questions	p. 215
A New Mind-Set	p. 215
The X Questions	p. 216
Confronting Your Risk	p. 220
It's the System	p. 221
Wait. Half?	p. 222
Our Shaky Equilibrium	p. 222
Beyond the Tipping Point: Rapid System Change	p. 223
True Shoppers	p. 226
Automatic Cost Reductions	p. 227
Beyond Reform-The Next Healthcare	p. 229
Employers	p. 230
The Poor	p. 230
Medicare	p. 231
States	p. 231
How Fast?	p. 232
Stupid Computer Tricks: How Not to Digitize Healthcare	p. 239
Index	p. 245
Table of Contents provided by Ingram. All Rights Reserved.

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Healthcare Beyond Reform: Doing It Right for Half the Cost

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Healthcare Beyond Reform: Doing It Right for Half the Cost

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