Healthcare Beyond Reform: Doing It Right for Half the Cost, 1st Edition (Hardback) book cover

Healthcare Beyond Reform

Doing It Right for Half the Cost, 1st Edition

By Joe Flower

Productivity Press

296 pages | 5 B/W Illus.

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Hardback: 9781466511217
pub: 2012-04-24
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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.


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

Table of Contents


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


About the Author

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.

Subject Categories

BISAC Subject Codes/Headings:
BUSINESS & ECONOMICS / Management Science
BUSINESS & ECONOMICS / Quality Control
BUSINESS & ECONOMICS / Industries / Service Industries
MEDICAL / Administration