Healthcare beyond reform: doing it right for half the cost

Abstract

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 Reductions Healthcare Economics 101 Ahmed Buys a Rug The Convoluted Economics of Healthcare Competing Influences No Accounting Split Buyers, Split Sellers Why the Ever-Popular Cost Controls Do Not Control Costs Health Systems: More Complex No More 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 On-Site Clinics On-Site Clinics without Employers? Medicaid-Based Business Models Disease Management Programs That Fail Disease Management Programs That 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 Reductions Beyond Reform-The Next Healthcare Employers The Poor Medicare States How Fast? Appendix A: Stupid Computer Tricks: How Not to Digitize Healthcare Index