Hospital of Tomorrow: Experts Call for Improving Value in Health Care
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Brad Kimler, left, moderates a discussion about navigating a new era in health care with Dr. Gary S. Kaplan, Dr. Elizabeth G. Nabel and Carl S. Armato during the opening keynote session of the 2014 Hospital of Tomorrow Conference in Washington, D.C., on Oct. 6.
"We must make progress in dramatically improving the value that we deliver," said Harvard Business School professor Michael Porter, called the "father of the modern strategy field" by Brian Kelly, U.S. News & World Report editor and chief content officer.
At its core, delivering value for patients is not a medical science challenge, according to Porter, but rather a managerial, organizational and leadership challenge.
Porter defined value as the health outcomes that matter to patients divided by the costs of delivering those outcomes over the full cycle of care, not just individual episodes of care. However, he said it was "impossible" to measure the value of a hospital. "We can't measure the value of a department,” he added. “We can't measure the value of a specialty."
It is only realistic to measure the value of care for a patient's medical condition, which is why Porter advised realigning care around the things patients need, not around medical specialties. Organization around specialties is inherently inefficient because it doesn't get expertise and experience together into teams that deliver the most efficient, effective care.
"We've got to reorganize the care," Porter said.
"The organizations that learn how to this and do it well and can prove it are the organizations that will succeed over the long term," he said.
Porter, co-author of the 2006 book "Redefining Health Care: Creating Value-based Competition on Results," outlined a six-point strategy for creating a value-based care delivery system:
1. Organize care into "integrated practice units" around distinct patient needs and segments, such as adult care and geriatric care. "This is a substantial organizational transformation. This is hard," Porter said.
2. Measure outcomes and costs for every patient. "That's where U.S. News has been such a pioneer," he said, praising the company's 25-year history of rating hospitals. "Health care is almost a fact-free zone about value," Porter quipped.
3. Move away from fee-for-service payment toward bundled payments for care cycles, not just the type of capitation that gained favor in the 1980s.
4. Turn health care delivery systems into truly integrated care systems, where everybody does the right work in the right place and people are "practicing at the top of their licenses," Porter said. "That's very rare today."
5. Extend health organizations’ reach. "We've got to expand our geographic footprint in many cases," Porter said. Care has become localized and fragmented to the point that there is little coordination. Plus, he added, numerous studies have shown that organizations that perform certain procedures the most often tend to do them better than occasional service providers. In Porter's eyes, the Cleveland Clinic has been successful extending its brand through affiliations rather than outright mergers.
6. Put in place the information technology to enable the first five points. "Just having an [electronic medical record] doesn't create value… It's what the EMR does that creates value," he said
Both Brigham and Women's Hospital in Boston and Virginia Mason Health System in Seattle have been retooling work processes, though in markedly different ways. Virginia Mason famously adopted the Toyota Production System in advance of installing much of its IT, while Harvard-affiliated Brigham and Women's used technology as a reason to rework processes. "It's a huge investment for us, but we think the ROI is going to be tremendous for us," in both financial and clinical terms, said Brigham and Women's President Dr. Elizabeth G. Nabel.
source:us news
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