Healthcare at a Turning Point: A Roadmap for Change

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ISBN: 9781466561526 | 1466561521
Cover: Hardcover
Copyright: 8/16/2012

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This book provides a market-based approach to addressing the 'ills' of the current healthcare system. To provide context, it briefly highlights and puts in perspective the historical events that led to the current challenges. It presents a clear vision of a viable, market-based healthcare system that produces better health outcomes at lower costs and discusses recommendations to realize that vision for the major industry sectors impacted by the healthcare debate. This book provides the reader with concrete recommendation for next steps for each sector of the healthcare industry and includes case studies to illustrate their point.

Foreword	p. xvii
Acknowledgments	p. xxi
Introduction	p. xxiii
A Vision for Tomorrow	p. 1
Vision of a Fundamentally Different Future	p. 1
Seeds of Disruption	p. 6
Healthcare Isn't the First Industry in Transition	p. 7
Where Are We Currently?	p. 9
Whose Agenda Controls Your Healthcare?	p. 13
Why a Market-Based Model for Healthcare Is a Good Thing	p. 13
How Did We Get into This Mess?	p. 14
End of the Model Year	p. 19
Understanding Healthcare Reform as Business Model Change	p. 21
Central Role of Payment Reform	p. 23
Unintended Consequences: The Hospital Example	p. 24
Paying for Volume, Not Results	p. 24
Real Impact of CMS on Quality of Care and Costs	p. 25
Unintended Consequences: The Primary Care Example	p. 28
Discouraging the Type of Care That Results in Better Outcomes	p. 28
Creating a Critical Shortage of the "Right" Kind of Doctors	p. 29
Healthcare Is Big Business	p. 30
Recent Example	p. 31
Creating a Competitive, Functioning Market	p. 32
There Is Little Accountability in the Current System	p. 33
There Is Little Information Available on Which to Base Responsible Care Decisions	p. 33
There Is Already Enough Money in the System	p. 35
There Is a Solution, and It's Closer than Some Think	p. 36
Endnotes	p. 37
In the Eye of the Storm: The Role of Consumers and Employers	p. 39
A Personal Example	p. 40
Whose Agenda Controls Your Healthcare? Another Look	p. 42
Perversion of the Concept of Insurance	p. 45
Where Do Employers Fit into the Equation?	p. 46
What Can Consumers and Employers Do?	p. 46
Demand Transparency and Accountability	p. 47
Move Conversation toward a Continuum of Care	p. 47
Create/Become Informed Consumers	p. 48
Create Incentives for Better Health Behaviors	p. 48
Change Is Never Easy, but It Is Possible	p. 49
Comparative Effectiveness Research: Creating an Environment for Change	p. 51
Drivers of CER	p. 52
Role of Cost Containment	p. 52
Role of Political Expediency	p. 54
Why Is the Federal Government Specifically Involved?	p. 55
Focus of CER	p. 56
Expected Criteria for Choosing Priorities	p. 60
Endnotes	p. 61
Redesigning Healthcare Delivery: Hospitals Were Never Meant to Be Destinations of Choice	p. 63
Adapting to the Changing Landscape of Healthcare	p. 65
Needed: A Transfusion of Fresh Thinking	p. 66
Management Infrastructure	p. 69
Misuse of IT	p. 70
Comparative Effectiveness Research Is Shaping Healthcare Delivery	p. 71
Development of Predictive Care Paths	p. 73
Changing Quality Metrics	p. 73
Impact of CER on Hospital Operations	p. 73
Prudent Responses and Defensive Strategies	p. 75
Accountable Care Is Needed, ACOs Are Not	p. 79
Laudable Goals	p. 80
Any Provider Can Provide More Accountable Care	p. 81
What Are You Waiting For?	p. 84
Bundled Payment: The Next Step in Improving Quality and Reducing Cost	p. 84
Why Will Bundled Payment Models Do Any Better?	p. 85
So How Do We Get There?	p. 86
St. Elsewhere: A Case Study in Bundled Pricing	p. 87
Taking a Proactive Approach to a Market in Transition	p. 88
Competing with a Bundled Price	p. 89
Endnotes	p. 89
A Brave New World for Payers	p. 91
Adapting to the Changing Landscape of Healthcare Insurance	p. 92
Needed Here, Too: A Transfusion of Fresh Thinking	p. 95
Rethinking the Customer	p. 95
Rethinking Products	p. 97
Implications for Healthcare Insurers	p. 98
What Payers Can Do	p. 99
Develop Partnerships with Providers	p. 101
Segment Providers	p. 102
Focus Partnerships on the Prevention of Never Events	p. 102
Require and Pay for Predictive Care Paths	p. 103
Change the Basis for Paying Primary Care Physicians	p. 104
Increase Consumer Engagement and Personal Responsibility, Reducing the Abuse of the System by Consumers	p. 106
Reduce Fraud and Abuse by Providers	p. 107
Are You Ready for Disruptive Innovation?	p. 108
Endnotes	p. 109
Big Pharma: How to Regain Success	p. 111
Vulnerabilities of the Current Model	p. 113
Market-Driven Business Model	p. 115
Ensuring Stakeholder Value	p. 116
Strategic Marketing Capabilities	p. 118
Innovation Stewardship	p. 119
Pressures on Innovation	p. 120
Role of CER in the Pharmaceutical Industry	p. 121
Treatment Guidelines	p. 122
Focus on Cost Effectiveness	p. 124
End of the Placebo-Only Controlled Trial	p. 125
Impact of CER on Pharmaceutical Operations	p. 125
Prudent Responses and Defensive Strategies	p. 127
Develop Service Wraps	p. 127
Diversify Revenue Streams Away from Payers	p. 128
Adopt a Rolling Blockbuster Approach	p. 129
Real-World Example	p. 132
Looking Ahead	p. 133
Endnotes	p. 134
A New Day Is Dawning for Medical Device and Diagnostics Manufacturers	p. 135
Getting Products to Market: Change Is in the Wind	p. 135
Implications for the Industry	p. 138
Commercial Challenges	p. 139
CER: The Threat for Medical Devices	p. 140
End of the "Last Version Plus 5%" Business Model	p. 141
Increased Pressure to Rightsize Functionality	p. 143
Increased Competition with Drugs	p. 144
Restricted Qualification for Devices	p. 144
Impact of CER on Medical Device Operations	p. 145
Prudent Responses and Defensive Strategies for Medical Device Companies	p. 147
Adopt Strategies Suited to the New Environment	p. 147
Focus on Reducing the Cost of the Procedure	p. 148
Develop Service Wraps	p. 148
Embrace the Cost-Functionality Trade-Off	p. 149
CER: The Opportunity for Diagnostics	p. 149
Reduced Tolerance for Redundant Testing	p. 150
New Commercial Model	p. 151
Possibility of Mass Screening	p. 152
Impact of CER on Diagnostics Manufacturer Operations	p. 152
Prudent Responses and Defensive Strategies for Diagnostics	p. 153
Diversify the Revenue Base	p. 154
Begin to Develop Partnerships for Custom Diagnostics	p. 155
Where Do Medical Device and Diagnostics Companies Go from Here?	p. 155
Hospital-as-Customer Requires a New Sales Model	p. 159
Endnotes	p. 160
Putting Value at the Center of Healthcare	p. 163
Recent Legislative Solutions and Why They Won't Work	p. 165
Accountability for Care Is a Good Concept	p. 166
ACOs: Their Original Purpose	p. 166
ACOs: Their Role in PPACA	p. 167
Government-Sponsored Payment and Delivery Systems	p. 169
Top-Down Approach to Complex Health Policy Problems	p. 170
ACOs: Key Deficiencies	p. 172
Recommendations for Policymakers: Healthcare Delivery	p. 174
Enabling Markets to Create Access to Care	p. 177
Creating Access to Affordable Health Coverage	p. 178
Recommendations for Policymakers: Access to Care	p. 179
Supporting Innovation: Finding the Right Balance at the Food and Drug Administration	p. 183
Regulation's Impact on Innovation: A Two-Edged Sword	p. 184
Making the Rules Clearer, More Transparent, and Simpler	p. 189
Real-Life Example	p. 190
Patent Life: Shooting Ourselves in the Foot	p. 192
Endnotes	p. 193
Creating a Roadmap for Change	p. 197
Revisiting the Challenge of Industry Transition	p. 197
Safety in Size? The Rush to Affiliation	p. 201
Consolidation and the Challenge for Manufacturers	p. 203
Additional Challenges for Manufacturers	p. 205
Creating Collaborations to Develop Lifetime Value	p. 206
Why Now?	p. 208
Reprising the Consumer	p. 208
Power of Choice	p. 209
Increase Perceived Quality	p. 211
Creating and Sustaining a New Business Model	p. 212
Harnessing Consumer Choice and Competition to Ensure Accountability: Final Thoughts for Policymakers	p. 213
End Game	p. 216
Index	p. 219
About the Authors	p. 245
About NAI	p. 249
Table of Contents provided by Ingram. All Rights Reserved.

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Healthcare at a Turning Point: A Roadmap for Change

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