Effective Health Care Policy: Improving Value for Patients 2014/Official Opening... ·...
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Copyright © Michael Porter 201112012.3.1_Book Launch_Redefining German Health Care_Porter_Guth
Effective Health Care Policy: Improving Value for Patients
Professor Michael E. Porter
Presentation at HealthAchieveOntario Hospital Association
Ontario, CanadaNovember 3, 2014
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means — electronic, mechanical,photocopying, recording, or otherwise — without the permission of Michael E. Porter. For further information about Value Based Health Care Delivery,please see http://www.isc.hbs.edu/resources/courses/health-care-courses/Pages/health-care-curriculum.aspx
Copyright © Michael Porter 201222012.3.1_Book Launch_Redefining German Health Care_Porter_Guth
• Delivering high and improving value for patients is the fundamental purpose of health care
• Value is the only goal that can unite the interests of all system participants
• Improving value is the only real solution versus further cost shifting, restricting services, or reducing the compensation of health care professionals
Solving the Health Care Problem
• The core issue in health care is the value of health care delivered
Value =Health outcomes that matter to patients
Costs of delivering the outcomes
Copyright © Michael Porter 201232012.3.1_Book Launch_Redefining German Health Care_Porter_Guth
Principles of Value-Based Health Care Delivery
• Value is measured for the care of a patient’s medical condition over the full cycle of care
• Outcomes are the full set of health results that matter for a patient’s condition over the care cycle
• Costs are the total costs of care for a patient’s condition over the care cycle
Value =Health outcomes that matter to patients
Costs of delivering the outcomes
Copyright © Michael Porter 201142012.02.29 UK Plenary Session
Creating a Value-Based Health Care Delivery SystemThe Strategic Agenda
1. Re-organize Care into Integrated Practice Units (IPUs) around Patient Medical Conditions
− For primary and preventive care, organize to serve distinct patient segments
2. Measure Outcomes and Costs for Every Patient
3. Move to Bundled Payments for Care Cycles
4. Integrate Care Delivery Systems
5. Expand Geographic Reach In Areas of Excellence
6. Build an Enabling Information Technology Platform
Copyright © Michael Porter 201252012.3.1_Book Launch_Redefining German Health Care_Porter_Guth
Source: Porter, Michael E., Clemens Guth, and Elisa Dannemiller, The West German Headache Center: Integrated Migraine Care, Harvard Business School Case 9-707-559, September 13, 2007
Primary Care Physicians Inpatient
Treatmentand Detox
Units
OutpatientPsychologists
OutpatientPhysical
Therapists
OutpatientNeurologists
Imaging Centers
Existing Model: Organize by Specialty and Discrete Service
1. Organize Care Around Patient Medical ConditionsMigraine Care in Germany
Copyright © Michael Porter 201262012.3.1_Book Launch_Redefining German Health Care_Porter_Guth
Source: Porter, Michael E., Clemens Guth, and Elisa Dannemiller, The West German Headache Center: Integrated Migraine Care, Harvard Business School Case 9-707-559, September 13, 2007
Affiliated Imaging Unit
West GermanHeadache Center
NeurologistsPsychologists
Physical Therapists“Day Hospital”
NetworkNeurologists
Essen Univ.
HospitalInpatient
Unit
PrimaryCare
Physicians
Affiliated “Network”Neurologists
Existing Model: Organize by Specialty and Discrete Service
New Model: Organize into Integrated Practice Units (IPUs)
1. Organize Care Around Patient Medical ConditionsMigraine Care in Germany
Primary Care Physicians Inpatient
Treatmentand Detox
Units
OutpatientPsychologists
OutpatientPhysical
Therapists
OutpatientNeurologists
Imaging Centers
Copyright © Michael Porter 201272012.3.1_Book Launch_Redefining German Health Care_Porter_Guth
• A medical condition is an interrelated set of patient medical circumstances best addressed in an integrated way
– Defined from the patient’s perspective– Involving multiple specialties and services– Including common co-occurring conditions and complicationsExamples: diabetes, breast cancer, knee osteoarthritis
What is a Medical Condition?
• In primary / preventive care, the unit of value creation is defined patient segments with similar preventive, diagnostic, and primary treatment needs (e.g. healthy adults, frail elderly)
Source: Porter, Michael E. with Thomas H. Lee and Erika A. Pabo. “Redesigning Primary Care: A Strategic Vision to Improve Value by Organizing Around Patients’ Needs,” Health Affairs, Mar, 2013
• The medical condition / patient segment is the proper unit of value creation (and value measurement), in health care delivery
Specialty Care
Primary/Preventive Care
Copyright © Michael Porter 201282012.3.1_Book Launch_Redefining German Health Care_Porter_Guth
Integrating Care Over The Full Care CycleAcute Knee-Osteoarthritis Requiring Replacement
Other Provider Entities
• Specialty office• Pre-op evaluation center
• Operating room• Recovery room• Orthopedic floor at
hospital or specialty surgery center
• Specialty office• Imaging facility
• Nursing facility• Rehab facility• Physical therapy clinic• Home
MONITOR• Consult regularly with
patient
MANAGE• Prescribe prophylactic
antibiotics when needed• Set long-term exercise
plan• Revise joint, if necessary
SURGICAL• Immediate return to OR for
manipulation, if necessary
MEDICAL• Monitor coagulation
LIVING• Provide daily living support
(showering, dressing)• Track risk indicators
(fever, swelling, other)
PHYSICAL THERAPY• Daily or twice daily PT
sessions
ANESTHESIA• Administer anesthesia
(general, epidural, or regional)
SURGICAL PROCEDURE• Determine approach (e.g.,
minimally invasive)• Insert device• Cement joint
PAIN MANAGEMENT• Prescribe preemptive
multimodal pain meds
IMAGING• Perform and evaluate MRI
and x-ray-Assess cartilage loss-Assess bone alterations
CLINICAL EVALUATION• Review history and
imaging• Perform physical exam• Recommend treatment
plan (surgery or other options)
• Specialty office• Primary care office• Health club
• Expectations for recovery• Importance of rehab• Post-surgery risk factors
• Meaning of diagnosis• Prognosis (short- and
long-term outcomes)• Drawbacks and benefits
of surgery
INFORMING AND ENGAGING
MEASURING
ACCESSING
• Importance of exercise, maintaining healthy weight
• Joint-specific symptoms and function (e.g., WOMAC scale)
• Overall health (e.g., SF-12 scale)
• Baseline health status• Fitness for surgery (e.g.,
ASA score)
• Blood loss• Operative time• Complications
• Infections• Joint-specific symptoms
and function• Inpatient length of stay• Ability to return to normal
activities
• Joint-specific symptoms and function
• Weight gain or loss• Missed work• Overall health
MONITOR• Conduct PCP exam• Refer to specialists, if
necessary
PREVENT• Prescribe anti-
inflammatory medicines• Recommend exercise
regimen• Set weight loss targets
• Importance of exercise, weight reduction, proper nutrition
• Loss of cartilage• Change in subchondral
bone• Joint-specific symptoms
and function• Overall health
OVERALL PREP• Conduct home
assessment• Monitor weight loss
SURGICAL PREP• Perform cardiology,
pulmonary evaluations• Run blood labs• Conduct pre-op physical
exam
• Setting expectations• Importance of nutrition,
weight loss, vaccinations• Home preparation
• Importance of rehab adherence
• Longitudinal care plan
Orthopedic Specialist
• PCP office• Health club• Physical therapy clinic
DIAGNOSING PREPARING INTERVENINGMONITORING/PREVENTING
RECOVERING/REHABBING
MONITORING/MANAGING
CARE DELIVERY
Copyright © Michael Porter 201292012.3.1_Book Launch_Redefining German Health Care_Porter_Guth
Integrating Across the Care CycleAn Orthopedic Surgeon Teaches A Course to Independent
Physical Therapists About Treatment Post-Surgery
Copyright © Michael Porter 2012102012.3.1_Book Launch_Redefining German Health Care_Porter_Guth
Attributes of an Integrated Practice Unit (IPU)
1. Organized around a medical condition or set of closely related conditions (or defined patient segments for primary care)
2. Care is delivered by a dedicated, multidisciplinary team who devote a significant portion of their time to the condition
3. Providers see themselves as part of a common organizational unit4. The team takes responsibility for the full cycle of care for the condition
− Encompassing outpatient, inpatient, and rehabilitative care, as well as supporting services (such as nutrition, social work, and behavioral health)
5. Patient education, engagement, and follow-up are integrated into care6. The unit has a single administrative and scheduling structure7. Care is co-located in dedicated facilities to the extent feasible8. A physician team captain or a clinical care manager (or both)
oversees each patient’s care process9. The team measures outcomes, costs, and processes for each patient
using a common measurement platform10. Accepts joint accountability for outcomes and costs11. The team meets formally and informally on a regular
basis to discuss patients, processes, and how to improve results
Copyright © Michael Porter 2012112012.3.1_Book Launch_Redefining German Health Care_Porter_Guth
Volume in a Medical Condition Enables Value
• Volume and experience will have an even greater impact on value in an IPU structure than in the current system
Better Results, Adjusted for Risk Rapidly Accumulating
Experience
Rising Process Efficiency
Better Information/Clinical Data
More Tailored Facilities
Rising Capacity for
Sub-Specialization
More Fully Dedicated Teams
Faster Innovation
Greater Patient Volume in a
Medical Condition
Improving Reputation
Costs of IT, Measure-ment, and ProcessImprovement Spread
over More Patients
Wider Capabilities in the Care Cycle,
Including Patient Engagement
The Virtuous Circle of Value
Greater Leverage in Purchasing
Better utilization of capacity
Copyright © Michael Porter 2012122012.3.1_Book Launch_Redefining German Health Care_Porter_Guth
Fragmentation of Care in the U.S. System
Procedure / Specialty Est. Number of Inpatient
Procedures
% of Procedures at Hospitals Performing <10 Cases per Year
% of Procedures Performed at Minimum
Adequate Volume Hospitals
Rectal cancer surgery 26,692 45% 35%
Bariatric surgery 48,672 28% 49%
Radical prostatectomy 77,030 3% 53%
Breast cancer surgery 120,704 23% 39%
AAA repair 54,819 17% 50%
CABG 427,380 1% 62%
Coronary stenting 558,349 <1% 62%
13 Copyright © Michael Porter 201113 Copyright © Michael Porter 20112012.03.07 Value-Based Health Care Delivery
Patient Experience/
Engagement
E.g. PSA,Gleason score,surgical margin
Protocols/Guidelines
Patient Initial Conditions
Processes Indicators (Health) Outcomes
StructureE.g. Staff certification, facilities standards
2. Measure Outcomes and Costs for Every PatientThe Measurement Landscape
14 Copyright © Michael Porter 20122012.03.07 Value-Based Health Care Delivery
The Outcome Measures Hierarchy
Survival
Degree of health/recovery
Time to recovery and return to normal activities
Sustainability of health/recovery and nature of recurrences
Disutility of the care or treatment process (e.g., diagnostic errors and ineffective care, treatment-related discomfort,
complications, or adverse effects, treatment errors and their consequences in terms of additional treatment)
Long-term consequences of therapy (e.g., care-induced illnesses)
Tier1
Tier2
Tier3
Health Status Achieved
or Retained
Process of Recovery
Sustainability of Health
Source: NEJM Dec 2010
• Achieved clinical status
• Achieved functional status
• Care-related pain/discomfort
• Complications
• Reintervention/readmission
• Long-term clinical status
• Long-term functional status
Copyright © Michael Porter and Elizabeth Teisberg 2011152011.12.08 Comprehensive Deck
6.5%
34.7%
95%
43.3%
75.5%
94%
Incontinence after one year
Severe erectile dysfunction after one year
5 year disease specific survival
Average hospital Best hospital
Measuring Multiple Outcomes Prostate Cancer Care in Germany
Source: ICHOM
Copyright © Michael Porter and Elizabeth Teisberg 2011162011.12.08 Comprehensive Deck
International Consortium for Health Outcomes Measurement (ICHOM) Standard Sets Developed
Conditions in Year One (2013)
Conditions in Year Three (2015)
Conditions in Year Two (2014)
• Coronary Artery Disease• Lower Back Pain• Cataracts• Localized Prostate Cancer
• Parkinson’s disease• Cleft Lip and Palate• Stroke• Hip and knee osteoarthritis• Macular degeneration• Lung cancer• Depression and anxiety• Advanced prostate cancer
▪ Dementia▪ Heart Failure▪ Inflammatory bowel
disease▪ Gastro‐esophageal reflux
disease▪ Frail elderly▪ Brain tumors▪ Breast cancer▪ Colon cancer▪ Pregnancy and childbirth▪ Cystic fibrosis▪ Bipolar disorder▪ Epilepsy▪ Hip Fractures
Burden of Disease Covered
18% 35% 43%
Copyright © Michael Porter and Elizabeth Teisberg 2011172011.12.08 Comprehensive Deck
Measuring the Cost of Care Delivery: Principles
• Cost is the actual expense of patient care, not the charges billed or collected
• Cost should be measured around the patient, not just for departments or the provider organization as a whole
• Cost should be aggregated over the full cycle of care for the patient’s medical condition
• Cost depends on the actual use of resources involved in a patient’s care process (personnel, facilities, supplies, and support services)
- Time-Driven Activity Based Costing (TDABC)
• “Overhead” costs should be associated with the patient-facing resources which drive support services usage
Sources: Kaplan, Robert and Michael E. Porter, “The Big Idea: How to Solve the Cost Crisis in Health Care”, Harvard Business Review, September 1, 2011 and Kaplan, R.S and Haas D.A. (2014). How Not to Cut Health Care Costs. Harvard Business Review. November 2014.
Copyright © Michael Porter 2012182012.3.1_Book Launch_Redefining German Health Care_Porter_Guth
Mapping Resource UtilizationMD Anderson Cancer Center – New Patient Visit
Registration andVerification
Receptionist, Patient Access Specialist, Interpreter
IntakeNurse,
Receptionist
Clinician VisitMD, mid-level provider,
medical assistant, patient service coordinator, RN
Plan of Care Discussion
RN/LVN, MD, mid-level provider, patient service
coordinator
Plan of Care Scheduling
Patient Service Coordinator
Decision Point
Time (minutes)
Copyright © Michael Porter 2012192012.3.1_Book Launch_Redefining German Health Care_Porter_Guth
Major Cost Reduction Opportunities in Health Care• Reduce process variation that lowers efficiency and raises inventory
without improving outcomes• Eliminate low- or non-value added services or tests
− Sometimes driven by protocols or to justify billing• Rationalize redundant administrative and scheduling units• Improve utilization of expensive physicians, staff, clinical space, and
facilities by reducing duplication and service fragmentation• Minimize use of physician and skilled staff time for less skilled
activities• Move routine or uncomplicated services out of highly-resourced
facilities• Reduce cycle times across the care cycle• Process steps that optimize total care cycle cost versus minimizing
investments in the costs of individual services• Increase cost awareness in clinical teams
• Many cost reduction opportunities will actually improve outcomes
Copyright © Michael Porter 2011202011.10.27 Introduction to Social Medicine Presentation
3. Move to Bundled Payments for Care Cycles
Bundledreimbursement
for medicalconditions
Fee for service
Bundled Payment• A single price covering the full care cycle for an acute
medical condition• Time-based reimbursement for overall care of a chronic
condition• Time-based reimbursement for primary/preventive care for
a defined patient segment
Globalcapitation
Global provider budgets
Source: Porter, M.E., Kaplan, R.S. (2014). How Should We Pay for Health Care? Working Paper.
Copyright © Michael Porter 2011212011.10.27 Introduction to Social Medicine Presentation
• Components of OrthoChoice bundle
• Initially applied to all relatively healthy patients (i.e. ASA scores of 1 or 2) • Mandatory reporting by providers to the joint registry plus supplementary
reporting
• The Stockholm bundled price for a knee or hip replacement is about US $8,300
- Pre-op evaluation- Lab tests- All Radiology- Surgery & related admissions- Prosthesis - Drugs- Inpatient rehab
- All physician and staff fees and costs- 1 follow-up visit within 3 months - Responsible for complications and any
additional surgery to the joint within 2 years- If post-op deep infection requiring
antibiotics occurs, guarantee extends to 5 years
Bundled Payment in PracticeHip and Knee Replacement in Stockholm, Sweden
Early Results:‒ Wait times fell dramatically‒ Complications fell 16.9% in the first another 25.9% in the second year‒ Functional outcomes constant‒ Volume shifted toward specialty hospitals and away from full service acute
hospitals‒ Private providers restructured the care process to improve efficiency and lower
complication
Copyright © Michael Porter 2011222011.10.27 Introduction to Social Medicine Presentation
Elements of a Value-Based Bundle
• Condition based, not specialty, procedure or episode based• Risk adjusted, or covering a defined patient group in terms of
complexity- 80/20 rule
• Contingent on outcomes, including care guarantees• Payment based on the cost of efficient and effective care, not
past charges• Specified limits of responsibility for unrelated care needs, and
stop loss provisions to mitigate against outliers• A level of price stability
Copyright © Michael Porter 2011232011.10.27 Introduction to Social Medicine Presentation
Value Based Bundle: Swedish Spine
0
10,000
20,000
30,000
40,000
50,000
60,000
Base Payment Warranty Payment Performance Payment Total Payment
SEK
Standard Payment
Risk Adjustment
54,537 ($8,139*)
* Based on Jan 1, 2012 exchange rate of 6.8 SEK to 1 USD
42,044
4,357
Average 10% of Base
8,136
Base PaymentCovered: Preoperative consultation, surgery, inpatient stay, implants, medications, laboratories, radiology, physical therapy, and follow-up care.
Risk adjustment: Age, gender, patient-reported pre-operative pain measured by Visual Analog Scale (VAS)
Performance PaymentAmount: Average of 10 percent of base reimbursement
Criteria: Based on the actualimprovement in pain at 1 year after surgery (Global Assessment Scale) versus expected pain outcome based on registry data for similar patients
Warranty Payment
Risk adjustments: Age, gender, preoperative VAS, pain duration, smoking, comorbidities, operative treatment, employment status
Covered:•Surgery wrong side/level•Disk herniation•Re-stenosis•Mechanical complication•Pseudoarthrosis
•Cerebrospinal fluid leak•Ongoing Bleeding•Infection•Pain in neck/arm/back•Wound dehiscence•Implant related pain
Condition: Spinal Stenosis Requiring Decompression
Standard Payment
Risk Adjustment
Copyright © Michael Porter 2011242011.10.27 Introduction to Social Medicine Presentation
4. Integrate Care Delivery SystemsChildren’s Hospital of Philadelphia Care Network
CHOP Newborn Care
CHOP Pediatric CareCHOP Newborn & Pediatric Care
Pediatric & Adolescent Primary CarePediatric & Adolescent Specialty Care CenterPediatric & Adolescent Specialty Care Center & Surgery CenterPediatric & Adolescent Specialty Care Center & Home Care
Harborview/Cape May Co.
Shore Memorial HospitalHarborview/Somers Point
Atlantic County
Harborview/Smithville
Mt. Laurel
Salem Road
Holy Redeemer Hospital
Newtown
UniversityMedical Centerat Princeton
Princeton
Saint Peter’sUniversity Hospital
(Cardiac Center)
Doylestown Hospital
Central BucksBucks County
High Point
Indian Valley
Grand ViewHospital
AbingtonHospital
Flourtown
ChestnutHill
Pennsylvania Hospital
University CityMarket Street
Voorhees
South Philadelphia
Roxborough
King ofPrussia
Phoenixville Hospital
West GroveKennett Square
CoatesvilleWest Chester
North Hills
Exton PaoliChester Co.
HospitalHaverford
Broomall
Chadds Ford
DrexelHill
MediaSpringfieldSpringfield
The Children’s Hospitalof Philadelphia®
CobbsCreek
DELAWARE
PENNSYLVANIA
NEW JERSEY
Network Hospitals:
Wholly-Owned Outpatient Units:
Copyright © Michael Porter 2011252011.10.27 Introduction to Social Medicine Presentation
Integrating Care Delivery SystemsFour Levels of Provider System Integration
1. Define the scope of services for each facility and for the system as a whole based on value
2. Concentrate volume by condition in fewer locations
3. Choose the right location for each service based on the medical condition, acuity level, resource intensity, cost level and need for convenience
E.g., shift routine surgeries out of tertiary hospitals to smaller,more specialized facilities
4. Integrate care across appropriate locations through IPUs
Copyright © Michael Porter 2011262011.10.27 Introduction to Social Medicine Presentation
Matching Patient and FacilityRothman Institute, Philadelphia
* Based on Age, Weight, Expected Activity, General Health, and Bone Quality (Clin Orthop Relat Res. 2006)
Ambulatory Surgery Center
Rothman Orthopaedic Specialty Hospital
Jefferson University Academic Medical Center
Bryn MawrCommunity Hospital
Lowest Complexity
LowMediumHighest Complexity
Matching Patients to Facility*
Cost of Total Knee
Replacement: ~$12,000 USD
Cost of Total Knee
Replacement ~$45,000 USD
Copyright © Michael Porter 2011272011.10.27 Introduction to Social Medicine Presentation
Central DuPage Hospital, ILCardiac Surgery
McLeod Heart & Vascular Institute, SCCardiac Surgery
CLEVELAND CLINIC
Chester County Hospital, PACardiac Surgery
Rochester General Hospital, NY Cardiac Surgery
5. Expand Geographic ReachThe Cleveland Clinic Affiliate Programs
Pikeville Medical Center, KYCardiac Surgery
Cleveland Clinic Florida Weston, FLCardiac Surgery
Cape Fear Valley Medical Center, NCCardiac Surgery
Charleston, WVKidney Transplant
St. Vincent Indianapolis, INKidney Transplant
Copyright © Michael Porter 2011282011.10.27 Introduction to Social Medicine Presentation
6. Build an Enabling Integrated IT Platform
Utilize information technology to enable restructuring of care delivery and measuring results, rather than treating it as a solution itself
Attributes of a Value-Based IT Platform• Combines all types of data (e.g. notes, images) for each patient• Uses common data definitions• Data encompasses the full care cycle, including care by referring entities• Allows access and communication among all involved parties, including
with patients• Provides views and templates by medical condition to enhance the user
interface for IPU teams• Creates searchable “structured” data vs. free text• The architecture allows easy extraction of outcome measures, process
measures, and activity-based costing measures for each patient /medical condition
• Enables data exchange and aggregation among different provider (and payor) organizations involved with each patient
Copyright © Michael Porter and Elizabeth Teisberg 2011292011.12.08 Comprehensive Deck
A Mutually Reinforcing Strategic Agenda
1Organize into
Integrated Practice
Units (IPUs)
2Measure
Outcomes and Cost For Every Patient
3Move to Bundled
Payments for Care Cycles
4Integrate
Care Delivery Systems
5Expand
Geographic Reach
6 Build an Integrated Information Technology Platform
Copyright © Michael Porter and Elizabeth Teisberg 2011302011.12.08 Comprehensive Deck
Where to Start?
1Organize into
Integrated Practice
Units (IPUs)
2Measure
Outcomes and Cost For Every Patient
3Move to Bundled
Payments for Care Cycles
4Integrate
Care Delivery Systems
5Expand
Geographic Reach
6 Build an Integrated Information Technology Platform
Copyright © Michael Porter and Elizabeth Teisberg 2011312011.12.08 Comprehensive Deck
40
50
60
70
80
90
100
0 100 200 300 400 500 600
Percent 1 Year Graft Survival
Number of Transplants
Adult Kidney Transplant OutcomesU.S. Centers, 1987-1989
16 greater than predicted survival (7%)20 worse than predicted survival (10%)
Number of programs: 219Number of transplants: 19,588One year graft survival: 79.6%
Copyright © Michael Porter and Elizabeth Teisberg 2011322011.12.08 Comprehensive Deck
8 greater than expected graft survival (3.4%)14 worse than expected graft survival (5.9%)
40
50
60
70
80
90
100
0 100 200 300 400 500 600 700 800
Percent 1-year Graft Survival
Number of Transplants
Adult Kidney Transplant OutcomesU.S. Center Results, 2008-2010
Number of programs included: 236Number of transplants: 38,5351-year graft survival: 93.55%
8 greater than expected graft survival (3.4%)14 worse than expected graft survival (5.9%)
Copyright © Michael Porter and Elizabeth Teisberg 2011332011.12.08 Comprehensive Deck
Measuring and Reporting Outcomes is the Single Most Important Step in Transforming Health Care
• Outcomes define the goal of every health care organization and its accountability to patients
• Outcomes inform the team and the services that should be part of the Integrated Practice Unit (IPU)
• Outcomes highlight and verify value-enhancing cost reduction
• Outcomes are critical to value-based bundled reimbursement models
• Outcomes unite clinicians and administrators around practice improvement
• Outcomes define areas for service line growth
• Ontario should commit to roll out ICHOM standard sets across the province
Copyright © Michael Porter and Elizabeth Teisberg 2011342011.12.08 Comprehensive Deck
Key References1. Porter, M.E., Teisberg, E. (2006). Redefining Health Care. Harvard Business
Publishing.2. Porter, M.E. and Lee, T.H. (2013). The Strategy that Will Fix Health Care. Harvard
Business Review. October 2013. Prod. #: R1310B‐PDF‐ENG.3. Porter, M.E. (2010). What Is Value in Health Care? New England Journal of Medicine;
363:2477‐2481.4. Porter, M.E. (2010). Value in Health Care. Supplement 1 to “What Is Value in Health
Care?” New England Journal of Medicine; Appendix 1.5. Porter, M.E. (2010). Outcomes Measurement. Supplement 2 to “What Is Value in
Health Care?” New England Journal of Medicine; Appendix 2.6. Kaplan, R.S and Porter, M.E. (2011). How to Solve the Cost Crisis in Health Care.
Harvard Business Review. September 2011. 7. Kaplan, R.S and Haas D.A. (2014). How Not to Cut Health Care Costs. Harvard
Business Review. November 2014. 8. Porter, M.E., Pabo, E.A., Lee, T.H. (2013). Redesigning Primary Care: A Strategic
Vision To Improve Value By Organizing Around Patients’ Needs. Health Affairs; 32: 516‐525.
9. Porter, M.E. (2009). A Strategy for Health Care Reform—Toward a Value-Based System. New England Journal of Medicine; 361:109-112.
Additional information about these ideas, as well as case studies, can be found at the Institute for Strategy and Competitiveness Redefining Health Care website at http://www.hbs.edu/rhc/index.html For information about the VBHCD Curriculum please see: http://www.isc.hbs.edu/resources/courses/health-care-courses/Pages/health-care-curriculum.aspx