Outcomes are also starting to be incorporated in real time into the process of care, allowing providers to track progress as they interact with patients. The outcomes that matter to patients for a particular medical condition fall into three tiers. If providers can improve patient outcomes, they can sustain or grow their market share. Hospitals with private-practice physicians will have to learn to function as a team to remain viable. Around the world, every health care system is struggling with rising costs and uneven quality despite the hard work of well-intentioned, well-trained clinicians. A recurring theme is the need for reforms in the health care sector. Market forces are driving increasing numbers of hospital mergers and acquisitions, and the number of hospital beds has declined in the U.S. from 3 beds per 1,000 people in 1999 to 2.6 in 2010. Here is a quick summary: The goal is ‘value’ Patients, health plans, employers, and suppliers can hasten the transformation by taking the following steps—and all will benefit greatly from doing so. In the U.S., an increasing percentage of patients are being covered by Medicare and Medicaid, which reimburse at a fraction of private-plan levels. It is now moving toward giving patients full access to clinician notes—another way to improve care for patients. And prices can vary by more than 50% for the same procedure in the same hospital, depending on the patient’s insurer and the insurance product. Then the cost of caring for a condition can be compared with the outcomes achieved. Patients, health plans, employers, and suppliers can hasten the transformation—and all will benefit greatly from doing so. Yet the benefits of concentration can be game-changing. Most hospitals and physician groups still have positive margins, but the pressure to consider a new strategic framework has increased dramatically. The right kind of medical record also should mean that patients have to provide only one set of patient information, and that they have a centralized way to schedule appointments, refill prescriptions, and communicate with clinicians. Around the world, every health care system is struggling with rising costs and uneven quality despite the hard work of well-intentioned, well-trained clinicians. In this environment, providers need a strategy that transcends traditional cost reduction and responds to new payment models. Big Med - Quality Control for Patients Everywhere. Templates make it easier and more efficient for the IPU teams to enter and find data, execute procedures, use standard order sets, and measure outcomes and costs. All this is now changing. In value-enhancing systems, the data needed to measure outcomes, track patient-centered costs, and control for patient risk factors can be readily extracted using natural language processing. All this is now changing. Organizing into IPUs makes proper measurement of outcomes and costs easier. In the U.S., an increasing percentage of patients are being covered by Medicare and Medicaid, which reimburse at a fraction of private-plan levels. The strategy that will fix health care: Providers must lead the way in making value the overarching goal. Those providers that increase value will be the most competitive. The cost of care at the regional facilities is estimated to be about one-third less than comparable care at the main facility. If care coordinators are simply layered on top of a fragmented and dysfunctional delivery system, savings are modest (4% to 7% at best). The number of stroke cases treated at University College climbed from about 200 in 2008 to more than 1,400 in 2011. Summarize the scenario, but do not restate the scenario. (For more, see Robert Kaplan and Michael Porter’s article “How to Solve the Cost Crisis in Health Care,” HBR September 2011.). At the individual IPU level, numerous providers are beginning efforts. While health care organizations have never been against improving outcomes, their central focus has been on growing volumes and maintaining margins. The Strategy That Will Fix Health Care Providers must lead the way in making value the overarching goal @inproceedings{Porter2013TheST, title={The Strategy That Will Fix Health Care Providers must lead the way in making value the overarching goal}, author={M. E. Porter and T. H. Lee}, year={2013} } (For more, see Michael Porter’s article “Measuring Health Outcomes: The Outcome Hierarchy,” New England Journal of Medicine, December 2010.) If Tier 1 functional outcomes improve, costs invariably go down. The transformation to a high-value health care delivery system must come from within, with physicians and provider organizations taking the lead. In an IPU, a dedicated team made up of both clinical and nonclinical personnel provides the full care cycle for the patient’s condition. Information technology is a powerful tool for enabling value-based care. Improving value requires either improving one or more outcomes without raising costs or lowering costs without compromising outcomes, or both. These were called hyper-acute stroke units, or HASUs. The current structure of health care delivery has been sustained for decades because it has rested on its own set of mutually reinforcing elements: organization by specialty with independent private-practice physicians; measurement of “quality” defined as process compliance; cost accounting driven not by costs but by charges; fee-for-service payments by specialty with rampant cross-subsidies; delivery systems with duplicative service lines and little integration; fragmentation of patient populations such that most providers do not have critical masses of patients with a given medical condition; siloed IT systems around medical specialties; and others. Teams improve and excel by tracking progress over time and comparing their performance to that of peers inside and outside their organization. Patient-centered system organized around patient need. In the prevailing approach, patients receive portions of their care from a variety of types of clinicians, usually in several different locations, who function more like a spontaneously assembled “pickup team” than an integrated unit. Governments, insurers, and health systems in multiple countries are moving to adopt bundled payment approaches. A common IT platform enables effective collaboration and coordination within IPU teams, while also making the extraction, comparison, and reporting of outcomes and cost data easier. But the days of charging higher fees for routine services in high-cost settings are quickly coming to an end. Organize into Integrated Practice Units (IPUs) At the core of the value transformation is changing … The second emerging geographic expansion model is clinical affiliation, in which an IPU partners with community providers or other local organizations, using their facilities rather than adding capacity. For example, high readmission rates and frequent emergency-department “bounce backs” may not actually worsen long-term survival, but they are expensive and frustrating for both providers and patients. The strategy for moving to a high-value health care delivery system comprises six interdependent components: organizing around patients’ medical conditions rather than physicians’ medical specialties, measuring costs and outcomes for each patient, developing bundled prices for the full care cycle, integrating care across separate facilities, expanding geographic reach, and building an enabling IT platform. “The Strategy that Will Fix Health Care,” Harvard Business Review, October 2013; Other organizations, such as the Cleveland Clinic and Germany’s Schön Klinik, have undertaken large-scale changes involving multiple components of the value agenda. Providers remain nervous about bundled payments, citing concerns that patient heterogeneity might not be fully reflected in reimbursements, and that the lack of accurate cost data at the condition level could create financial exposure. They are expert in the condition, know and trust one another, and coordinate easily to minimize wasted time and resources. Many employees in these plans are increasingly unwilling or are simply unable to pay historical charges, and providers incur losses or bad publicity, or both, as they try to collect on the debts. Implementing the value agenda is not a one-shot effort; it is an open-ended commitment. Similarly, health insurers that are slow to embrace and support the value agenda—by failing, for example, to favor high-value providers—will lose subscribers to those that do. Provider organizations understand that, without a change in their model of doing business, they can only hope to be the last iceberg to melt. The paper "The Strategy That Will Fix Health Care" is a worthy example of an article review on health sciences& medicine. We must shift the focus from the volume and profitability of services provided—physician visits, hospitalizations, procedures, and tests—to the patient outcomes achieved. Even in today’s most advanced systems, the critical capability to create and extract such data remains poorly developed. Reimbursement rates are under pressure. The six components of the value agenda are distinct but mutually reinforcing. For example, many hospitals routinely have patients return to see the cardiac surgeon six to eight weeks after surgery, but out-of-town visits seem difficult to justify for patients with no obvious complications. In deciding to drop those visits, clinicians realized that maybe local patients do not need routine postoperative visits either. 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