Harbus

Issue date: 1/26/09 Section: Features

The course began, as most do, with an introduction provided by the Faculty, however, this introduction was different than most. Professor Teisberg recounted the story of a child, her child, who suffered from an undiagnosed disease for most of their early childhood. She talked about the difficulties she had navigating the system, even as an informed and educated consumer of healthcare, and the struggles she faced as the mother of a sick child. Her closing words "Surely we can do better" served as motivation and as a backdrop for the rest of the week. As the week progressed we examined a variety of different organizations and providers who had begun to compete based on delivering value. These included nationally recognized medical centers including MD Anderson Cancer Center in Texas, the Cleveland Clinic, the Joslin Diabetes Center in Boston, and the Dartmouth-Hitchcock Medical Center in New Hampshire. We studied several payer organizations including a major health plan in Germany, KKH, which was able to build market share in the ultra-competitive German insurance market by supporting specialized migraine care for patents, and Commonwealth Care Alliance, which was able to profitably serve poor elderly patients, most with several chronic diseases. In both cases, the organizations were able to demonstrate improved health outcomes at lower costs that conventional systems. We were also able to pick the brains of the individuals responsible for implementing the successful strategies, as the CEO's and executives from each case attended class, and then discussed the case and answered questions for almost an hour and a half.

Over the course of the week, a number of key lessons began to emerge. 1) The need to shift physician compensation from a fee for service system to a salaried one; 2) The need to re-engineer the reimbursement system from one that provides discrete payments to individual providers, to disease specific capitated payments that cover the entire cycle of care - especially preventive and primary care; 3) The importance of changing the structure of delivery organizations from traditional academic departments to integrated practice units (IPU's) which are designed to provide multi-disciplinary care across the entire cycle of a specific disease or condition; and finally 4) the importance of developing effective and replicable outcome measures which are accessible and transparent to consumers. However, more than remembering any one principle, I was left the course with a tremendous sense of opportunity and optimism. It is undeniable that in its current form, the healthcare system in this country faces some major challenges. Rising costs and unequal quality of care are simply inexcusable in a country that should and could do better. Porter and Teisberg have tackled the problem head-on and have presented a framework that, although incomplete and in no way perfect, provides a glimpse of a better way. Armed with examples of organizations who have successfully implemented many of these lessons, the participants of the Value-Based Health Care Delivery IXP are thus charged with a mandate to change the status-quo. Given the level of passion and enthusiasm exhibited by everyone that week, I have no doubt that they will.

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