1st Edition

Health Care Will Not Reform Itself A User's Guide to Refocusing and Reforming American Health Care

By George C. Halvorson Copyright 2009
    184 Pages 25 B/W Illustrations
    by Productivity Press

    Health care reform is within our reach. According to George Halvorson, CEO of the nation's largest private health care plan, only by improving the intent, quality, and reach of services will we achieve a health system that is economically feasible into the future.                                                                       

    This year, Americans will spend 2.5 trillion for health services that are poorly coordinated, inconsistent, and most typically focused on the belated care of chronic conditions. What we have to show for that expenditure is a nation that continues to become more obese, less healthy, and more depressed.

    In Health Care Will Not Reform Itself, Kaiser Permanente CEO George Halvorson proves beyond a doubt that the tragically inconsistent care that currently defines the state of U.S. health services is irresponsible, irrational, but more importantly, fixable. With detail that might shock you, he shows why the nonsystem we now use is failing. Then, applying the same sensible leadership that makes Kaiser the most progressive health care organization in the world, he answers President Obama’s mandate for reform with a profound incentive-based, system-supported, goal-focused, care-improvement plan.

    Halvorson draws from respected studies, including his own, and the examples of successful systems across the world to show that while good health care is expensive, it is nowhere near as costly as bad health care. To immediately curb care costs and bring us in line with President Obama's projected parameters, he recommends that we:

    • Take a preventive approach to the chronic conditions that account for the lion’s share of medical costs
    • Coordinate patient care through a full commitment to information technology
    • Increase the pool of contributors by mandating universal insurance
    • Rearrange priorities by making health maintenance profitable
    • Convene a national committee to "figure out the right thing" and "make it easy to do"

    While this book offers sage advice to policy makers, it is also written to educate the 260 million stakeholders and invite their participation in the debate that is now shaping. What makes this plan so easy to understand and so compelling is that it never strays from a profound truth: that the best health system is one that actually focuses on good health for everyone.

    All royalties from the sale of this book go to Oakland Community Voices: Healthcare for the Underserved

    Health Care Won’t Reform Itself

    Many Treat — Few Prevent

    Studies Prove the Inconsistency of Care

    Care Linkage Deficiencies Abound

    No Money, No Tools, No Accountability for Linkages

    Paper Records Are Entirely and Almost Criminally Inadequate

    Providers Don’t Create the Economic Reality

    Is Care Too Complex to Coordinate Anyway?

    In Other Industries, Lower Prices Increase Sales

    Screw-Ups Can Be Profitable

    Screw-Ups Aren’t Deliberate

    We Need the Courage to Reform Care

    We Need Universal Coverage

    Tools Need a Use or They Are Useless

    Strategic Modifications Are Needed

    Why Are Health Care Costs Going Up?

    Normal Inflation Is the Bottom Line, First Level, and Basic Cost Driver for Health Care Cost Inflation

    Worker Shortages Add to Cost Increases for Care

    New Technology, New Treatments, and New Drugs Increase Costs

    Few Standards of Value Exist

    Other Countries Use Screening Programs for "New" Care

    Untested, Purely Experimental, Unproven Care

    The Dilemma — For Some Patients, There Is No Other Hope

    Caregivers Sometimes Own the Businesses

    Only in America Does "It Might Work" Work

    Let’s Require Disclosure of Effectiveness Research

    Massive Care Coordination Deficiencies Add Expenses

    Multiple Caregivers Don’t Link Well

    Perverse Financial Incentives Also Increase Costs

    Problematic Insurance Benefit Design

    Changes in Fee Payment Approaches Face Resistance

    We Are Getting Older and More Expensive

    Inflation, Technology, Inefficiency, Perverse Incentives, and Getting Old Are an Expensive Package

    As a Pure, Self-Serving System — Health Care Is Winning

    Consumers Pay the Price for More Expensive Care

    Care Costs Create Premium Costs

    "Pass through" to the Customer

    The Answer Is "Right Care"

    Set Goals and Improve Care

    Data Isn’t Shared

    Random Tools Create Random Results

    Begin with Goals

    We Don’t Need a Thousand Goals

    Work Backward from the Goal to the Strategy

    Asthma Care Needs Computerized Data

    We Need Computerized Asthma Care Data

    Universal Coverage for Children Can Improve Asthma Care

    Being Insured Creates a Database

    Care Won’t Get Better without Goals

    Goals for Key Diseases

    The Tool Kits Look a Lot Alike

    EMRs Need Support Tools

    Patient-Focused EMRs Are Key

    Benefit Packages Channel Cash

    We Don’t Need to Change the Entire Payment System

    Data Is the Secret Sauce

    Health Care Can Do This Kind of Work

    Three Provider Payment Changes Are Needed

    We Need Goals

    Connectors Are Magic

    Older Patients Often Have Major Connection Problems

    Medical Home and Packages of Care

    A New Generation of Connectors

    Connectors Come in Various Versions

    Virtual Integration Can Mimic Vertical Integration

    EMR Plus Care Support Tools

    Denver Improved Outcomes

    The Death Rate Dropped

    Triple Co-Morbidities in Hawaii

    Preventing ER Visits Is a Very Good Thing to Do

    Care Registry Worked for "Safety Net" Patients

    Hospital Admissions Were Reduced by 70 Percent

    We Need to Connect Everyone Who Needs to Be Connected

    Buyers Need to Change the Cash Flow

    Buyers Should Specify the Context for Care

    The Point of Connectors Is to Connect

    Claims Data Can Be Used

    The Perfect System

    All, All, and Then All

    Information Security Is Essential

    CQI Is Needed — And CQI Needs Data

    American Health Care Needs a Culture of

    Continuous Learning

    Most of Health Care Is Splintered

    One-Third Reduction in Broken Bones

    Make the Right Thing Easy to Do

    The Patient Should Be the Focus of Care Data

    Ten Criteria for Ultimate System Design

    Six Million E-Visits

    All New Systems Should Be Connectable

    The Perfect System Is Possible

    Personal Health Records Can Fill Part of the Gap

    Hub and Spoke Connectivity Can Be Computer Supported

    Virtual Care in Remote Sites

    Next Step — Connectivity

    We Need Universal Coverage, Care System Reform, and Care System Competition

    Intermittent Coverage Disrupts Care

    Care Improvement Needs Coverage Continuity

    Data Should Be Longitudinal

    What Kinds of Health Plans Should Compete?

    No One Is Accountable if No One Is Accountable

    "Insurance Exchanges" Should Offer Care Team Options

    Risk Sharing Works Quite Well, Thank You

    Risk Pooling Is the Key

    Co-Ops Set Quotas

    Ugandans Understand the Cost/Premium Connection

    Blame Your Fever on Your Thermometer

    The Basic Business Model of Insurance

    The Key Is Spreading/Sharing Risk

    Swiss Rejected Canadian Model

    The Double Mandate

    Why Do American Insurers Screen Risk?

    Large Numbers Are Not Magic

    Risk Pools Don’t Cure Cancer

    Pooling Small Groups Isn’t Magic, Either

    95 Percent Defines the Business Model

    Five Percent of Privately Insured People Had Health Screens

    Hassles and Disagreements Are Minimized with Inclusion

    Individual Enrollees Have Individual Motivations

    Using Someone Else’s Money Is Often Attractive

    Expensive New Members Increase Average Costs

    Death Spirals Can Be Unfortunate

    A Single Mandate Can Destroy Risk Pools

    The Best Approach Is to Cover Everyone

    People Who Need Heart Transplants Should Get Heart Transplants

    Focus, Tools, and Better Health

    Begin with Chronic Care

    Chronic Care Is the First Priority

    The Low-Hanging Fruit Is to Bite the Bullet

    Focus, Tools, Health

    Money Talks

    Choices Should Affect Premiums

    Registries Should Not Dictate Care

    Science Changes

    Health May Be the Highest Priority

    The Girth of America Is Expanding

    Americans Are Also Inert

    We Need a Culture of Health

    Eliminate, Label, Reduce, and Persuade

    We Need Half as Many People to Become Diabetic

    We Need an Agenda of Health Improvement

    We Also Need to Set Goals to Directly Reduce Costs

    We Need a National Forum for Cost Reduction

    We Need a Commission

    We Need Complete Data about Cost Drivers for Care

    The Goal Should Be to "Bend the Trend"

    Health Care Could Be Moving to a Golden Age



    About the Author


    George Halvorson has been the chief executive officer of health plans, hospital systems, and care delivery systems in the United States for over three decades. He has also helped start health plans in Jamaica, Chile, Nigeria, Spain and Uganda.He is the current chair of the International Federation of Health Plans and he also served as chair of the Health Governors for the 2009 World Economic Conference in Davos, Switzerland.Kaiser Permanente, his current employer, is the largest not-for-profit health plan and care system in America — with over eight and a half million members, 160,000 employees and roughly forty billion dollars in annual revenue.He is the past chair of the American Association of Health Plans and has served on the Board of Directors for the American Diabetes Associations, The Alliance of Community Health Plans, and Safest in America.He also currently chairs the Alliance for Quality — and serves on the Commonwealth Commission for a High Performing Health System.He is a long time proponent of health care reform — regularly writing articles and books and making presentations advocating reform. Recent books include Epidemic of Care (Jossey-Bass, San Francisco) and Health Care Reform Now! (Jossey-Bass, San Francisco).Kaiser Permanente has been a pioneer in the use of electronic medical records and computer connectivity between patients and caregivers — successfully completing a four billion dollar project to computerize the medical information for its members and patients.He is a husband, father of five sons, and grandfather to five wonderful grandchildren. He is headquartered in Oakland, California.

    When running for office, President Obama pledged to expand health insurance coverage while reducing the cost of care by $2500 per year for the average family. Skeptics scoffed that industry insiders would block this goal in defense of their interests. Now George Halvorson, CEO of the nation’s largest health care delivery system, says reducing costs while expanding coverage not only should be done, but can be done, and tells us how. His book highlights the important role and many forms of connectivity in health care: electronic medical records for patients and physicians, registries and care coordination programs for chronic illness, mandates and exchanges for health insurance, the alignment of culture and incentives among the many contributors to the wellbeing of patients.
    Dr. James Robinson, PhD, MPH Professor of Health Economics, UC Berkeley

    Clear, concise, and compelling, George Halvorson’s latest contribution clarifies why we must change, how we must change, what we must change, and when we must change. The answer is now. Drawing on the learnings from Kaiser Permanente’s transformation to a fully digitally enabled, integrated system of care, George Halvorson shows all of healthcare how to focus on the right goals and improve our performance in reaching those goals.
    — Ian Morrison Futurist; Author of  The Second Curve: Managing the Velocity of Change and Healthcare in the New Millennium

    George Halvorson offers a timely and compelling prescription to addressing the chronic ills of our health care system. One doesn’t have to agree with every proposal to appreciate the extraordinary contribution he has made here. Students of health reform would do well to consider this book as an invaluable text for our national public policy debate.
    Tom Daschle, Former U.S. Senate Majority Leader

    George Halvorson’s timing couldn’t be better and his message couldn’t be more valuable. He documents in clear, vivid prose why the health care system won’t reform itself which all employers and payers need to understand so they don’t miss this pivotal moment to dramatically reform health care. He offers information, evidence and practical solutions for aggressively attacking the "crushing burden of health care costs," as President Obama described our national challenge. Halvorson also provided ways we can sharply improve quality and safety, as well as save substantial dollars. He reminds us again, through many excellent examples, how essential it is to have electronic health records for effective, appropriate care at a reasonable cost. This book provides a great checklist for healthcare reform for the public and the private sector. I strongly recommend it.
    Helen Darling President, National Business Group on Health

    Halvorson’s simple, direct writing style is remarkable for its clarity. He takes complex problems and makes them understandable. Halvorson’s experience as leader of one of the world’s largest and most successful implementations of health information technology makes his insights into that subject particularly valuable.
    Dr. Alain C. Enthoven, PhD Marriner S. Eccles Professor of Public and Private Management, Stanford University