1st Edition
Health Care Will Not Reform Itself A User's Guide to Refocusing and Reforming American Health Care
Health care reform is within our reach. According to George Halvorson, CEO of the nation's largest private health care plan, only 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
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
George Halvorson has been the chief executive officer of health plans, hospital systems, and care delivery systems in the United States for over three decades. He has also helped start health plans in Jamaica, Chile, Nigeria, Spain and Uganda.He is the current chair of the International Federation of Health Plans and he also served as chair of the Health Governors for the 2009 World Economic Conference in Davos, Switzerland.Kaiser Permanente, his current employer, is the largest not-for-profit health plan and care system in America — with over eight and a half million members, 160,000 employees and roughly forty billion dollars in annual revenue.He is the past chair of the American Association of Health Plans and has served on the Board of Directors for the American Diabetes Associations, The Alliance of Community Health Plans, and Safest in America.He also currently chairs the Alliance for Quality — and serves on the Commonwealth Commission for a High Performing Health System.He is a long time proponent of health care reform — regularly writing articles and books and making presentations advocating reform. Recent books include Epidemic of Care (Jossey-Bass, San Francisco) and Health Care Reform Now! (Jossey-Bass, San Francisco).Kaiser Permanente has been a pioneer in the use of electronic medical records and computer connectivity between patients and caregivers — successfully completing a four billion dollar project to computerize the medical information for its members and patients.He is a husband, father of five sons, and grandfather to five wonderful grandchildren. He is headquartered in Oakland, California.
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 BerkeleyClear, 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 MillenniumGeorge 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 LeaderGeorge 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 HealthHalvorson’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
