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

Healthcare Beyond Reform
Doing It Right for Half the Cost

ISBN 9781466511217
Published April 24, 2012 by Productivity Press
296 Pages 5 B/W Illustrations

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Book Description

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.

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


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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