Numerof / Abrams Healthcare at a Turning Point

A Roadmap for Change
Erscheinungsjahr 2013
ISBN: 978-1-4665-6153-3
Verlag: Taylor & Francis
Format: PDF
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, 276 Seiten

If the furious debate around the state of healthcare in the US has led to any consensus, it’s that the system should be delivering better quality for less cost than it does. The truth is that our healthcare system is a sprawling mix of competing interests in which those of the patient are valued least. Too much discussion has devolved to simplistic scapegoating, and too few comprehensive, constructive solutions have been offered. It’s time for a fresh vision.

In straightforward language, Healthcare at a Turning Point: A Roadmap for Change outlines a new market-based business model that aligns industry financing mechanisms with the goals of prevention, improved quality, and reduced costs. Drawing on more than 25 years of cross-industry consulting experience, the authors:

- Articulate a market-based vision of the industry

- Examine past efforts to reduce costs, their failures and their unanticipated consequences

- Spotlight perverse incentives that distort the way the healthcare system operates and make it less than it could be

- Present concrete recommendations for change within the healthcare delivery, insurance, pharmaceutical, device and diagnostics sectors

- Explain the changes that employers, consumers and policy makers can make to create a more customer-responsive system that delivers more value

For all the uncertainty in the current environment, there is also a rare opportunity to fundamentally redefine who wins in this market. Healthcare at a Turning Point provides guidance to executives ready for that contest as well as a roadmap for change.

Autoren/Hrsg.

Numerof, Rita E.

Abrams, Michael

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizin, Gesundheitswesen Gesundheitssystem, Gesundheitswesen

Inhaltsverzeichnis

A Vision for Tomorrow
Vision of a Fundamentally Different Future
Seeds of Disruption
Healthcare Isn’t the First Industry in Transition
Where Are We Currently?

Whose Agenda Controls Your Healthcare?
Why a Market-Based Model for Healthcare Is a Good Thing
How Did We Get into This Mess?
End of the Model Year
Understanding Healthcare Reform as Business Model Change
Central Role of Payment Reform
Unintended Consequences: The Hospital Example
Paying for Volume, Not Results
Real Impact of CMS on Quality of Care and Costs
Unintended Consequences: The Primary Care Example
Discouraging the Type of Care That Results in Better Outcomes
Creating a Critical Shortage of the "Right" Kind of Doctors
Healthcare Is Big Business
Recent Example
Creating a Competitive, Functioning Market
There Is Little Accountability in the Current System
There Is Little Information Available on Which to Base Responsible Care Decisions
There Is Already Enough Money in the System
There Is a Solution, and It’s Closer than Some Think
Endnotes

In the Eye of the Storm: The Role of Consumers and Employers
A Personal Example
Whose Agenda Controls Your Healthcare? Another Look
Perversion of the Concept of Insurance
Where Do Employers Fit into the Equation?
What Can Consumers and Employers Do?
Demand Transparency and Accountability
Move Conversation toward a Continuum of Care
Create/Become Informed Consumers
Create Incentives for Better Health Behaviors
Change Is Never Easy, but It Is Possible

Comparative Effectiveness Research: Creating an Environment for Change
Drivers of CER
Role of Cost Containment
Role of Political Expediency
Why Is the Federal Government Specifically Involved?
Focus of CER
Expected Criteria for Choosing Priorities
Endnotes

Redesigning Healthcare Delivery: Hospitals Were Never Meant to Be Destinations of Choice
Adapting to the Changing Landscape of Healthcare
Needed: A Transfusion of Fresh Thinking
Management Infrastructure
Misuse of IT
Comparative Effectiveness Research Is Shaping Healthcare Delivery
Development of Predictive Care Paths
Changing Quality Metrics
Impact of CER on Hospital Operations
Prudent Responses and Defensive Strategies
Accountable Care Is Needed, ACOs Are Not
Laudable Goals
Any Provider Can Provide More Accountable Care
What Are You Waiting For?
Bundled Payment: The Next Step in Improving Quality and Reducing Cost
Why Will Bundled Payment Models Do Any Better?
So How Do We Get There?
St. Elsewhere: A Case Study in Bundled Pricing
Taking a Proactive Approach to a Market in Transition
Competing with a Bundled Price
Endnotes

A Brave New World for Payers
Adapting to the Changing Landscape of Healthcare Insurance
Needed Here, Too: A Transfusion of Fresh Thinking
Rethinking the Customer
Rethinking Products
Implications for Healthcare Insurers
What Payers Can Do
Develop Partnerships with Providers
Segment Providers
Focus Partnerships on the Prevention of Never Events
Require and Pay for Predictive Care Paths
Change the Basis for Paying Primary Care Physicians
Increase Consumer Engagement and Personal Responsibility, Reducing the Abuse of the System by Consumers
Reduce Fraud and Abuse by Providers
Are You Ready for Disruptive Innovation?
Endnotes

Big Pharma: How to Regain Success
Vulnerabilities of the Current Model
Market-Driven Business Model
Ensuring Stakeholder Value
Strategic Marketing Capabilities
Innovation Stewardship
Pressures on Innovation
Role of CER in the Pharmaceutical Industry
Treatment Guidelines
Focus on Cost Effectiveness
End of the Placebo-Only Controlled Trial
Impact of CER on Pharmaceutical Operations
Prudent Responses and Defensive Strategies
Develop Service Wraps
Diversify Revenue Streams Away from Payers
Adopt a Rolling Blockbuster Approach
Real-World Example
Looking Ahead
Endnotes

A New Day Is Dawning for Medical Device and Diagnostics Manufacturers
Getting Products to Market: Change Is in the Wind
Implications for the Industry
Commercial Challenges
CER: The Threat for Medical Devices
End of the "Last Version Plus 5%" Business Model
Increased Pressure to Rightsize Functionality
Increased Competition with Drugs
Restricted Qualification for Devices
Impact of CER on Medical Device Operations
Prudent Responses and Defensive Strategies for Medical Device Companies
Adopt Strategies Suited to the New Environment
Focus on Reducing the Cost of the Procedure
Develop Service Wraps
Embrace the Cost–Functionality Trade-Off
CER: The Opportunity for Diagnostics
Reduced Tolerance for Redundant Testing
New Commercial Model
Possibility of Mass Screening
Impact of CER on Diagnostics Manufacturer Operations
Prudent Responses and Defensive Strategies for Diagnostics
Diversify the Revenue Base
Begin to Develop Partnerships for Custom Diagnostics
Where Do Medical Device and Diagnostics Companies Go from Here?
Hospital-as-Customer Requires a New Sales Model
Endnotes

Putting Value at the Center of Healthcare
Recent Legislative Solutions and Why They Won’t Work
Accountability for Care Is a Good Concept
ACOs: Their Original Purpose
ACOs: Their Role in PPACA
Government-Sponsored Payment and Delivery Systems
Top-Down Approach to Complex Health Policy Problems
ACOs: Key Deficiencies
Recommendations for Policymakers: Healthcare Delivery
Enabling Markets to Create Access to Care
Creating Access to Affordable Health Coverage
Recommendations for Policymakers: Access to Care
Supporting Innovation: Finding the Right Balance at the Food and Drug Administration
Regulation’s Impact on Innovation: A Two-Edged Sword
Making the Rules Clearer, More Transparent, and Simpler
Real-Life Example
Patent Life: Shooting Ourselves in the Foot
Endnotes

Creating a Roadmap for Change
Revisiting the Challenge of Industry Transition
Safety in Size? The Rush to Affiliation
Consolidation and the Challenge for Manufacturers
Additional Challenges for Manufacturers
Creating Collaborations to Develop Lifetime Value
Why Now?
Reprising the Consumer
Power of Choice
Increase Perceived Quality
Creating and Sustaining a New Business Model
Harnessing Consumer Choice and Competition to Ensure Accountability: Final Thoughts for Policymakers
End Game

Index
About the Authors
About NAI

Über Autor(innen)

Rita E. Numerof, Ph.D., President of Numerof & Associates, Inc., is an internationally recognized consultant and author with more than twenty-five years of experience in the field of strategy development and execution, business model design, and market analysis. Her clients have included Fortune 500 companies such as Johnson & Johnson, Eli Lilly, Pfizer, Westinghouse, AstraZeneca, Merck, Abbott Laboratories, major healthcare institutions, payers, and government agencies. The focus of her consulting addresses the challenges of maintaining competitive advantage in highly dynamic and regulated markets.

Dr. Numerof has been a consistent advocate for the importance of strategic differentiation, organizational alignment of structure, competencies and metrics to ensure effective implementation, and anticipating, rather than reacting to industry trends. She’s been a pioneer in the area of economic and clinical value, anticipating the impact of changing global payer attitudes on the fundamental business model of the healthcare industry. Her work across the entire healthcare spectrum gives her a unique perspective on the challenges and needs of manufacturers, physicians, payers, and healthcare delivery institutions.

Under her leadership, NAI has developed proprietary approaches that provide precise insight and practical solutions to some of the industry’s most complex business challenges. Taking a systemic approach, Dr. Numerof has addressed such diverse issues as comparative effectiveness research, accountable care, bundled pricing, consumer engagement, operationalizing compliance and transparency, portfolio management and the identification of growth platforms that provide sustainable differentiation through economic and clinical value, and effective commercialization based on value propositions that matter to key constituencies.

Dr. Numerof is widely published in business journals and has authored five books. She serves as an advisor to members of Congress on healthcare reform and comparative effectiveness research. She was a senior advisor with the Center for Health Transformation, a regular contributor to the Manhattan Institute, and wrote the Heritage Foundation’s policy paper, "Why Accountable Care Organizations Won’t Deliver Better Healthcare—and Market Innovation Will." She led a tri-partisan, cross-industry work group on payment reform and developed recommendations for new payment models that incent better health outcomes at lower cost. In addition, Dr. Numerof provides guidance to policy organizations and agencies on the relationship between innovation and regulation, working to support innovation and ensure responsive regulatory oversight.

Dr. Numerof graduated magna cum laude from the Honors College, Syracuse University and received her MSS and PhD from Bryn Mawr College.

Michael N. Abrams, M.A., Cofounder and Managing Partner of Numerof & Associates, Inc., has served as an internal and external consultant to Fortune 50 corporations, major pharmaceutical and medical device companies, healthcare delivery institutions, the financial services industry, and government agencies for over twenty-five years. He has worked extensively in the areas of strategic planning and implementation, product strategy and portfolio development, market analysis, consumer engagement, and operational improvement.

Abrams is well known for his expertise in the design and implementation of strategies for building competitive differentiation, defining sustainable value, identifying market influence mechanisms, and translating white space analysis into the creation of innovative solutions to meet unmet needs. His ability to identify market opportunities and to effectively improve organizational performance has been an invaluable resource to client companies on a global basis across industries.

Abrams has structured and managed innovative programs to evaluate care delivery and payment models, thereby defining the internal change processes necessary to translate business opportunities into effective market position, operations, product portfolio management, and new product design consistent with changing regulatory requirements. He has provided solutions to healthcare delivery systems to improve the management of care transitions, thereby reducing unnecessary hospitalizations, and reduced length of stay by identifying and managing factors causing extended stays, changing admissions and patient care management processes, and managing across the continuum of care while maintaining or improving clinical outcomes and reducing costs.

He is experienced in the design and execution of econometric modeling and analysis and decision support systems for a variety of science-driven industries and applications. He has designed technology solutions to meet a wide range of needs, including strategic account planning and management, thought leader interface, and key opinion leader management. His ability to manage the process of technology integration to support business objectives across multiple business environments ensures return on investment (ROI).

Abrams has written extensively on economic and clinical value creation and the need for integrated, systemic solutions to the challenges facing the global healthcare industry. His articles have appeared in more than a dozen leading business journals, and he coauthored the book Solving the Healthcare Crisis. As an adjunct faculty member of Washington University in St. Louis and LaSalle College School of Business Administration in Philadelphia, Abrams has taught MBA courses in strategic management, product planning and evaluation, quantitative decision making, and market analysis.

Michael Abrams completed his doctoral work in Business Policy at St. Louis University. He received his MA from George Washington University in Washington, DC.