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

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

Endnotes

Index

About the Author

Biography

Health care reform is within our reach. The financial morass and the lack of quality that define our health care services are related in ways that might surprise you. According to George Halvorson 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

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