A couple of weeks ago, a major victory for the ACA was won: the Supreme Court upheld a critical part of the Affordable Care Act and millions of Americans who got covered in health insurance marketplaces can stay covered, no matter where they live (https://www.whitehouse.gov/blog/2015/06/25/live-updates-supreme-court-upholds-key-part-affordable-care-act). However, a lot of things remain to be done in order to improve the quality of care provided and to reduce the overall costs. US is spending up to 17% of GDP in health care while the quality of care provided is often questioned (http://www.oecd.org/unitedstates/Briefing-Note-UNITED-STATES-2014.pdf) (fig 1 and 2).
In their article entitled ”The strategy that will fix health care” Michael E. Porter and Thomas H. Lee present a model of an effective and cost affordable health care (https://hbr.org/search?term=strategy+that+will+fix+health+care). They present their strategy in steps starting by focusing on the first lines of health care system and advancing to more complicated areas (fig 3). However, in a recent editorial at the NEJM they argued that ”Leadership in health care organizations has tended to be more about stewardship than choices” and ”future success depends on the ability of organizations to create value for patients. Leaders must ensure that all activities are aligned around this goal” (http://www.nejm.org/doi/full/10.1056/NEJMp1502419).
But how can we adopt and adapt this strategy to our hospitals and private practices? Here,I share with you my thoughts on a step to step approach, which will help you figure out hoe the Porter-Lee’s health care model is working.
1. Reduce the waste in the Health care: The automobile producer Toyota has been a pioneer on the field with the famous Toyota production system (TPS): (https://en.wikipedia.org/wiki/Toyota_Production_System). The pilars of the TPS are presented below:
- Waste of overproduction (largest waste)
- Waste of time on hand (waiting)
- Waste of transportation
- Waste of processing itself
- Waste of stock at hand
- Waste of movement
- Waste of making defective product
The wasteful spending in the health system has been calculated at up to $1.2 trillion of the $2.2 trillion in United States only (http://www.pwc.com/us/en/healthcare/publications/the-price-of-excess.jhtml). Porter and Lee’s introduction of the intergrated practice (IPU) unit is an adaptation of the TPS in the health care universe: reducing the waste while augmenting the quality of care that the patients’ are receiving.
2. Measure and report outcomes: Outcomes are the ultimate measure of success in health care. Health care authorities want to know the quality of services that you produce and in which price. When seeking treatment, patients want to know what their life will be like after treatment: will I return to work, will I be able to take care of myself, and will my symptoms improve? (http://www.ichom.org/). Measuring and reporting outcomes is essential in order to deliver health care of high quality. You, authorities and your customers should know what kind of services you deliver. In addition, through measurement of outcomes you could stay ahead of your competitors by attaining or sustaining the competitive advantage.
3. Be careful with the implementation: Try to bring your strategy to life and balance attention between strategy and the details of implementation. Physicians are central players in the health care systems and traditionally, they have been reluctant to adapt novel approaches or innovative strategies because they may feel threatened to lose their autonomy or their incomes . Any strategy failing to engage them is doomed. A Weberian behavioral approach, which combines an engagement in a noble shared purpose, a call to self-interest, respect and embracement of tradition will likely increase the probability of effectively engaging physicians (https://hbr.org/2014/06/engaging-doctors-in-the-health-care-revolution).
4. Introducing bundled payment: Traditionally, insurance companies make separate payments to providers for each of the individual services they offer to beneficiaries for a single illness or course of treatment. This approach can result in fragmented care with minimal coordination across providers and health care settings. The Bundled Payments initiative link payments for multiple services the beneficiaries receive during an episode of care (http://innovation.cms.gov/initiatives/bundled-payments/). This approach could maximaze the quality of care which the patient receives and reducing the spending for every episode of care. Working together with a fixed budget for all care delivered for a defined period creates incentives for physicians and hospitals to coordinate the care of the patient and reduce the incidence of for preventable complications that could prolong inpatient admissions or result in a readmission or a new outpatient clinic consultation. The initiative also provides incentives for hospitals to work with community resources to keep patients safe, healthy, and out of the hospital (https://www.aamc.org/newsroom/reporter/april2013/334330/bundled-payment.html).
5. Integrate and expand ”value for patient” in all facilities and across geography: the IPU model, the carefull monitoring of outcomes and the adoption of the bundled payment initiative, could further reduce the costs and augment the quality of care provided across the nation. In addition, a direct comparison of effectiveness, quality of health care provided and cost among diverse facilities become possible and a consumer-driven health care is encouraged (https://hbr.org/search?term=strategy+that+will+fix+health+care).
Creating and implementing a new strategy is not an easy task. Nonetheless, the adoptation and implementation of the long-term strategy of improving outcomes while lowering costs, is an essential step to a better health care system. Social media will have a central role here. Communicating the 5 steps to both medical professionals and patients is important for understanding, supporting and implementation of the new startegy. Blogging about the progress during the implementation, inviting people to like and support through Facebook, using Twitter to inform and engage and Linkedin to get the attention of professionals are some of the ways that social media could be useful.