Renewal: Focus! Focus! Focus!

So it’s not the easiest read and I can’t say I agree with the authors on every point – but Porter and Olmsted Teisberg make a strong argument for reform in Redefining Health Care: Creating Value-Based Competition on Results

Here is a quick excerpt on how to create value on a patient (as consumer) level. I especially appreciate their attention to the service level of "medical condition." When someone goes to a hospital for a breast exam...they are likely not going to ask about your kidney transplant program:

“Patient value in health care delivery . . . can only be understood at the level of medical conditions. Overwhelmingly, value is determined by how well a provider delivers care in each medical condition, not its overall breadth of services. The value delivered in a medical condition arises from the full set of activities and specialties involved. It is not the individual roles, skills, or functions that matter, but the overall result. Moreover, for each aspect of care, value is determined by how well the needed set of skills and functions come together. In surgery, for example, value depends on not only the surgeon but also the anesthesiologist, the nurses, the radiologist, the skilled technicians, and others, all performing well. Yet no matter how skilled the surgical team, the overall care cycle is crucial. Unless the patient's problem is accurately diagnosed, the patient is properly prepared, and recovery and rehabilitation are managed well, patient results will suffer. Indeed, the impact of the cycle of care is even broader. Value may be enhanced by not performing the surgery at all, and treating the case in a different way. Value may be still greater if preventive care and advice is provided over time so that little or no treatment is needed at all.”

With respect to adding value on a hospital basis, we hear a strong argument for focusing services (synonymously with the argument above). While the thought of not "doing everything" may seem heretical to some...a strong argument is made for focusing on areas we do best:

“In value-based competition, most hospitals and physician groups will retain an array of service lines but will stop trying to offer everything. Most institutions should narrow the range of medical conditions served, or at least the types of cases they seek to address. Some practices may be phased out completely, while others are significantly reorganized. In most businesses, it is common sense to concentrate on products and services that create unique value. For many hospitals and other health care providers, however, doing so will require a significant change in mind-set in a field used to handling any patient who walks in the door. And deciding what not to do is an even more radical idea. In health care, the need for strategic choice of services has been avoided because of the lack of information and the lack of accountability for results.”

While I think they may glaze over the cross-subsidization of services within hospitals...and consequently fail to address who will deliver the least profitable services...it is certainly worth the read (I think).

Still interested? You can buy the book here.