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Healthcare Beyond Reform

Doing It Right for Half the Cost

Healthcare Beyond Reform by Joe Flower
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HOW WE GOT HERE

Half Off?
Looking at Normal Countries
Economists Behaving Badly with Smoke and Mirrors
The Fairness Factor
The American Ways of Healthcare
Possible Savings: Getting to Half

Waste
Level 1: Doing the Right Things the Wrong Way
Level 2: Doing the Right Things in the Wrong Place
Level 3: Doing the Wrong Things—and Not Doing the Right Things
How Much?
Where Are the Biggest Savings?
Inappropriate Therapies
How Big Is This Waste?
Heroic End-of-Life Treatment
Insurance Waste
Pharmaceutical Waste
Chronic Disease

Trends: Opportunities
The Economy
Rampaging Geezers
Aging Clinical Workforce
Chronic Disease
Computerization and Automation
Reform and Insurance
Brute Force Cost Reductions

Healthcare Economics 101
Ahmed Buys a Rug
The Convoluted Economics of Healthcare
Competing Influences
No Cost Accounting
Split Buyers, Split Sellers
Why the Ever-Popular "Cost Controls" Do Not Control Costs
Health Systems: More Complex
No More Cost Decanting
It’s About to Get Really Complicated
Inflexible Systems
Unit Costs vs. System Costs
The Two Core Rules of Economics

WHAT MUST BE DONE

The Five Strategies

1) Explode the Business Model
The End of Fee-for-Service Healthcare?
What Are We Buying?
What’s Wrong with Competition?
Emerging Business Models
The Safeway Experience
CIGNA’s Choice Fund
Formula One
On-Site Clinics
On-Site Clinics without Employers?
Medicaid-Based Business Models
Disease Management Programs That Fail
Disease Management Programs That Work
Direct Primary Care
Direct Primary Care—Online
Structure Matters
Share the Risk
A Brief History of Risk in Healthcare
Putting the Customer at Financial Risk
"But Capitation Doesn’t Work"
Putting the Provider at Risk
Providers at Risk Behave Differently
Putting Providers Systemically At Risk
Shopping
Virtuous Deflationary Spiral
Redesigning Markets
Explode the Business Model

2. Build on Smart Primary Care
The Medical Home
How a Medical Home Actually Works
Making More Money by Being a Better Doctor
Taking on Risk
Integration: It’s Not Just "Kumbaya"
From Evidence-Based Medicine to Evidence-Based Health
Explode the Business Model and Build on Smart Primary Care

3. Put a Crew on It
A Team Care Example: Diabetes
Teamwork at All Levels
Getting on the Same Team with the Docs
Alaska Native Healthcare
What Makes a Team? A Scoreboard
Explode the Business Model, Build on Smart Primary Care, and Put a Crew on It

4. Swarm the Customer
The Magic of Mr. Moon
The Pareto Principle in Healthcare
Hotspotting
The 5% That Does the 50%
More Help, Smarter, Earlier

5. Rebuild Every Process
The Tough Business of Caring
Time to Get Fierce
Perfecting Clinical Processes
Evidence or Intuition?
Measure It—and Get It Right
Check It Out, Dude!
Other Industries: "Quality Is Job One"
The Institute for Healthcare Improvement
Comparative Effectiveness Research
Evidence-Based Design
The Lean Medical Practice
Doing It Cheaper
Raise a Glass to Carlos
Big Data
Analytics for the Country
Analytics for Systems
Analytics for You
With the Doctor
Taking It Home
Apps
Extending the Clinic into the Home
India and China: Globalization Cuts Both Ways
India
China
Cheap Biologicals and Biosimilars
Reverse Innovation

MAKING IT ALL WORK

Beyond Healthcare
Len Duhl, the Father of Healthy Communities
Involve Everyone

The Evil Profit Motive and the Virtues of Competition
Arguments for a Single-Payer System
Insurance Companies Are Evil
Extra Transaction Costs
Extra Fundamental Costs
For Profit? Or Not?
Is Healthcare a Right?
It’s Not That Simple

There Ought to Be a Law
Introduction
Scope of Practice
Corporate Practice of Medicine
Certificate of Need
Anti-Kickback Legislation
Transparency
Fraud
Insurance Regulation
ERISA Immunity
End Fraudulent Rescissions and Claim Denials
Swiss Rule
Direct Primary Care
Transparency
Competition
Operating across State Lines?
Malpractice
It’s Not Greedy Patients
Fixing Malpractice
Systemic Effects
Fixing the Pharmaceutical Industry
Pharma Runs into a Wall
Burying Germany in Jeeps
Why We Don’t Get Legislation That Works

The X Questions
A New Mind-Set
The X Questions
Confronting Your Risk

It’s the System
Wait. Half?
Our Shaky Equilibrium
Beyond the Tipping Point: Rapid System Change
True Shoppers
Automatic Cost Reductions

Beyond Reform—The Next Healthcare
Employers
The Poor
Medicare
States
How Fast?

Appendix A: Stupid Computer Tricks: How Not to Digitize Healthcare

Index

CRC Press; April 2012
296 pages; ISBN 9781466562714
Read online, or download in secure EPUB or secure PDF format
Title: Healthcare Beyond Reform
Author: Joe Flower
 
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