Published by: Larry Gage on 4/6/2010 1:00:58 PM
In a recent posting, I applauded President Obama's anticipated selection of Dr. Donald Berwick, president and CEO of the Institute for Healthcare Improvement, as CMS Administrator. Dr. Berwick, through his 100,000 Lives and 5 Million Lives campaigns, has become a patient safety guru to tens of thousands of health care professionals. But even gurus can have gurus, and I don't believe Dr. Berwick would argue that one of his most important gurus is Harvard Business School Professor Michael E. Porter.
Although he is less known in the health care industry than Don Berwick, Michael Porter is considered one of the key architects of the current "value-based care" movement that is at the heart of health system reform. Porter is not a health policy specialist—his career at Harvard has primarily been focused on competitiveness and strategy in all sectors of the economy. But several years ago, he turned his attention on health care. A long article in the Harvard Business Review was expanded into a book (both coauthored by Elizabeth Teisberg ) called ”Redefining Health Care: Creating Value-based Competition on Results” (Harvard Business School Publishing, 2006.). In this book, Professor Porter outlines the needed components of health reform—many of which were included in the recently passed legislation—and lays out the subsequent steps that would be a necessary component of genuine delivery system reform.
Fortunately, Dr. Porter summarized his theories more succinctly last summer in his article, ”A Strategy for Health Care Reform — Toward a Value-Based System” in the The New England Journal of Medicine. In that article, he anticipated the "next steps" that would need to be taken following the enactment of coverage expansions, pointing out that the "far bigger long term driver of success will come from restructuring the delivery system." In sum, Porter believes that this will only be accomplished by:
- Measuring and disseminate health outcomes for every provider and every medical condition;
- Radically reexamine how to deliver prevention, wellness screening and routine health maintenance services;
- Reorganize care delivery around medical conditions;
- Realign the reimbursement system to improve value for patients;
- Require providers to compete for patients based on value;
- Ensure that electronic medical records will support integrated care and outcome maintenance; and
- Involve consumers to a much greater extent in their health and health care.
Don Berwick shares many of Porter's views, as evidenced by an article of his own titled, "What ‘Patient-Centered’ Should Mean: Confessions Of An Extremist" in Health Affairs last May. NAPH members—and any health industry observer committed to genuine reform—would do well to listen carefully to both of these gurus.