The two authors are Dr. Thomas Lee, Chief Medical Officer, Press Ganey and Michael Porter, William Lawrence University Professor, Harvard Business School.  

If you have never heard of Press Ganey, they are an Indiana organization that supports health care providers in understanding and improving patient experience.  Dr. Lee also serves on the editorial board of the New England Journal of Medicine.  

As a Harvard professor Michael Porter is a leading authority on company strategy and competitiveness of nations and regions.  He is the author of such works as How Competitive Forces Shape Strategy, Competition in Global Industries and Strategy and the Internet.  

If you choose not to read the article, let me summarize their six points for creating a value-based health care delivery system.  

1.    Reorganize care into Integrated Practice Units (IPU’s) around patient medical conditions.

Care is normally organized around specialties:  i.e. Orthopedics, Cardiology, Urology…  A better way would be to organize around the patient’s medical condition.  For example a lower back pain care center that would include primary care, orthopedics, neurologist and rheumatologist.

2.    Measure outcomes that matter and total costs for every patient.

Most outcome measurements focus on measuring adherence to process, but this is not what matters to the patient.  Measure such things as:  ability to return to work, time to begin treatment, ability to live independently, pain level achieved.

3.   Change the payment system by moving to bundled payments for care cycles.

Much has been written about moving away from fee-for-service based payments.  This point promotes a flat rate for all care related to a specific condition.

4.   Integrate care delivery systems.

This point tasks the providers to integrate systems across multi-sites so care could be better coordinated throughout the care cycle.

5.    Expand geographic reach.

After having developed your specialized IPU’s (see point #1) and establishing improved outcomes based on this model, you should draw patients from throughout the region or even nation.  Several examples are given of organizations whose expertise yields both better results and lower costs.  Health plan purchasers are willing to pay for travel expenses for their members because it reduces their over-all costs to treat the patients.

6.    Build an enabling information technology platform.

Don’t look at IT as a solution but as an enabler of restructuring and a means to measure results.

The authors are careful to point out that all six elements are essential.  You can’t just pick one or two to implement.  

Is this “The” strategy that will fix health care?  The authors claim “Organizations that progress rapidly in adopting the value agenda will reap huge benefits, even if regulatory change is slow.” 

However, if it is expected to actually impact the overall industry it would require wide-scale adoption and this seems an unlikely outcome.  

As I read the article my mind kept returning to the question, how would this affect dentistry?  It was not apparent to me as I read it and is not apparent to me now. 

We all know the elements of oral health that play a role in the patient’s overall well-being and it would seem that an oral care provider would have a role in any number of the envisioned IPU’s.  But, independent dentists would still be vital for those who don’t suffer from a significant medical condition.  

Right click or wrong click?  At least a thoughtful theory that deserves consideration even at the expense of a little antacid.  

The next two posts will be about the new healthcare marketplace that has begun operation on October first.  These articles will be written by Tina Taylor, a licensed health insurance and dental insurance agent with the Healthcare Solutions Team.  

Here are Tina’s earlier posts looking ahead at the implementation of the Affordable Care Act and here is what she says we can expect over the next two weeks.

The open enrollment period for consumers needing to secure a Qualified Health Plan by the first quarter of 2014, in order to comply with the requirements of the Affordable Care Act, officially started on October 1st and will continue until March 31, 2014.  Both individual consumers and small business owners will be able to access on-line marketplaces to purchase health insurance.  Part one of these articles will focus on the public Individual Health Insurance Marketplace and part two will focus on SHOP (Small Business Health Options Program).

I’m looking forward to Tina’s perspective, as someone in the middle of this massive change to how we purchase healthcare.

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