1st Edition

Healthcare Beyond Reform Doing It Right for Half the Cost

By Joe Flower Copyright 2012
    296 Pages 5 B/W Illustrations
    by Productivity Press

    There is a secret inside healthcare, and it’s this: We can do healthcare for a lot less money. The only way to do that is to do it a lot better. We know it’s possible because it is happening now. In pockets and branches across healthcare, people are receiving better healthcare for a lot less. Some employers, states, tribes, and health systems are doing healthcare a little differently.

    Healthcare Beyond Reform: Doing It Right for Half the Cost explains how this new kind of healthcare is not about rationing and cutbacks. It’s not about getting less, it’s about getting more. Getting better and friendlier healthcare, where you need it, when you need it.

    How? The answer is mostly not in Washington, it’s not conservative or liberal. The answer is mostly not about who pays for healthcare. The answer is mostly about who gets paid, and what we pay them for.

    Healthcare Beyond Reform: Doing It Right For Half The Cost shows you how the system works. It explains how we got here, why we pay so much more than anyone else, and why we don’t get what we pay for.

    You’ll learn the five things healthcare can do to turn this around. You will see what some employers are already doing to make that happen, and what patients, families, doctors, and anyone else who cares about healthcare can do to help make it happen.

    There are only five and we need all five. All of them can be done right now, with the current healthcare system as it is. Joe Flower shows you how.

    In 1980, healthcare took no more of a bite out of the U.S. economy than it did in other developed countries. By 2000, healthcare cost twice as much in the U.S. as in most other developed countries. We can change that.
    —Joe Flower

    Joe Flower explains how we can make healthcare better for a lot less.



    Half Off?
    Looking at Normal Countries
    Economists Behaving Badly with Smoke and Mirrors
    The Fairness Factor
    The American Ways of Healthcare
    Possible Savings: Getting to Half

    Level 1: Doing the Right Things the Wrong Way
    Level 2: Doing the Right Things in the Wrong Place
    Level 3: Doing the Wrong Things—and Not Doing the Right Things
    How Much?
    Where Are the Biggest Savings?
    Inappropriate Therapies
    How Big Is This Waste?
    Heroic End-of-Life Treatment
    Insurance Waste
    Pharmaceutical Waste
    Chronic Disease

    Trends: Opportunities
    The Economy
    Rampaging Geezers
    Aging Clinical Workforce
    Chronic Disease
    Computerization and Automation
    Reform and Insurance
    Brute Force Cost Reductions

    Healthcare Economics 101
    Ahmed Buys a Rug
    The Convoluted Economics of Healthcare
    Competing Influences
    No Cost Accounting
    Split Buyers, Split Sellers
    Why the Ever-Popular "Cost Controls" Do Not Control Costs
    Health Systems: More Complex
    No More Cost Decanting
    It’s About to Get Really Complicated
    Inflexible Systems
    Unit Costs vs. System Costs
    The Two Core Rules of Economics


    The Five Strategies

    1) Explode the Business Model
    The End of Fee-for-Service Healthcare?
    What Are We Buying?
    What’s Wrong with Competition?
    Emerging Business Models
    The Safeway Experience
    CIGNA’s Choice Fund
    Formula One
    On-Site Clinics
    On-Site Clinics without Employers?
    Medicaid-Based Business Models
    Disease Management Programs That Fail
    Disease Management Programs That Work
    Direct Primary Care
    Direct Primary Care—Online
    Structure Matters
    Share the Risk
    A Brief History of Risk in Healthcare
    Putting the Customer at Financial Risk
    "But Capitation Doesn’t Work"
    Putting the Provider at Risk
    Providers at Risk Behave Differently
    Putting Providers Systemically At Risk
    Virtuous Deflationary Spiral
    Redesigning Markets
    Explode the Business Model

    2. Build on Smart Primary Care
    The Medical Home
    How a Medical Home Actually Works
    Making More Money by Being a Better Doctor
    Taking on Risk
    Integration: It’s Not Just "Kumbaya"
    From Evidence-Based Medicine to Evidence-Based Health
    Explode the Business Model and Build on Smart Primary Care

    3. Put a Crew on It
    A Team Care Example: Diabetes
    Teamwork at All Levels
    Getting on the Same Team with the Docs
    Alaska Native Healthcare
    What Makes a Team? A Scoreboard
    Explode the Business Model, Build on Smart Primary Care, and Put a Crew on It

    4. Swarm the Customer
    The Magic of Mr. Moon
    The Pareto Principle in Healthcare
    The 5% That Does the 50%
    More Help, Smarter, Earlier

    5. Rebuild Every Process
    The Tough Business of Caring
    Time to Get Fierce
    Perfecting Clinical Processes
    Evidence or Intuition?
    Measure It—and Get It Right
    Check It Out, Dude!
    Other Industries: "Quality Is Job One"
    The Institute for Healthcare Improvement
    Comparative Effectiveness Research
    Evidence-Based Design
    The Lean Medical Practice
    Doing It Cheaper
    Raise a Glass to Carlos
    Big Data
    Analytics for the Country
    Analytics for Systems
    Analytics for You
    With the Doctor
    Taking It Home
    Extending the Clinic into the Home
    India and China: Globalization Cuts Both Ways
    Cheap Biologicals and Biosimilars
    Reverse Innovation


    Beyond Healthcare
    Len Duhl, the Father of Healthy Communities
    Involve Everyone

    The Evil Profit Motive and the Virtues of Competition
    Arguments for a Single-Payer System
    Insurance Companies Are Evil
    Extra Transaction Costs
    Extra Fundamental Costs
    For Profit? Or Not?
    Is Healthcare a Right?
    It’s Not That Simple

    There Ought to Be a Law
    Scope of Practice
    Corporate Practice of Medicine
    Certificate of Need
    Anti-Kickback Legislation
    Insurance Regulation
    ERISA Immunity
    End Fraudulent Rescissions and Claim Denials
    Swiss Rule
    Direct Primary Care
    Operating across State Lines?
    It’s Not Greedy Patients
    Fixing Malpractice
    Systemic Effects
    Fixing the Pharmaceutical Industry
    Pharma Runs into a Wall
    Burying Germany in Jeeps
    Why We Don’t Get Legislation That Works

    The X Questions
    A New Mind-Set
    The X Questions
    Confronting Your Risk

    It’s the System
    Wait. Half?
    Our Shaky Equilibrium
    Beyond the Tipping Point: Rapid System Change
    True Shoppers
    Automatic Cost Reductions

    Beyond Reform—The Next Healthcare
    The Poor
    How Fast?

    Appendix A: Stupid Computer Tricks: How Not to Digitize Healthcare



    Joe Flower is an independent healthcare analyst and futurist, a veteran of 30 years of studying, reporting on, consulting with, and speaking to organizations across the industry. His clients spread from the World Health Organization and the Department of Defense, to Fortune 100 pharmaceutical companies, manufacturers, and health plans, to local community hospitals, free clinics, physician groups, nursing associations, start-up companies, and small employers. He is on the board of the Center for Health Design, and on the speaking faculty of the American Hospital Association.

    Joe Flower provides us all with reason for hope for the future of healthcare that we can make it better, faster, and cheaper no matter what happens in Washington or the state capitals. Joe's clear insight about meaningful transformation of healthcare delivery coupled with compelling stories from the front, provides a blueprint for organizations to make progress to a better future.
    Ian Morrison, author, consultant, and fellow healthcare futurist

    Flower has done a terrific job. This book truly needs to be read by the entire healthcare industry. In fact, this book is a must read for anyone even remotely associated with healthcare. Because it really can be done better for half the cost, the impact of this book will not only benefit Americans everywhere, but bless the lives of generations to come.
    —Darrell Moon, healthcare consultant and CEO of Orriant

    Joe Flower’s optimism is in scarce supply these days, and it may be the most compelling reason to read his book. Flower believes a lot of our health system’s problems can actually be solved, and not by people in Washington, but rather people on the front lines. Worth reading.
    —Jeff Goldsmith, author, consultant, and fellow healthcare futurist

    Joe Flower has produced a realistic blueprint for aligning America's medical marketplace with today's clinical, economic, and political realities. This book meets the need for a new and better approach to reform.
    — Jeffrey C. Bauer, Ph.D., medical economist and healthcare futurist

    Flower clearly outlines and untangles the many complex forces that act upon and create the U.S. healthcare ‘system.’ More importantly, Flower thoughtfully proposes the way forward. This is an impressive contribution to creating better health and healthcare in the U.S.
    —Deryk Van Brunt, Associate Clinical Professor, UC Berkeley School of Public Health; and CEO of the Healthy Communities Institute