The new cost-conscious doctor: Changing America’s healthcare … · The new cost-conscious...

The new cost-conscious doctor: Changing America’shealthcare landscapeBy Chuck Farkas and Tim van Biesen

Rapidly shifting attitudes amongphysicians on critical issues suchas managing costs, drug anddevice usage, and standardizedcare are transforming healthcarebusiness models.

Copyright © 2011 Bain & Company, Inc. All rights reserved.Content: Manjari Raman, Elaine CummingsLayout: Global Design

Chuck Farkas is a partner with Bain & Company and a leader in the firm’sHealthcare practice. Tim van Biesen is a partner with Bain & Company andleads Bain’s Healthcare practice in the Americas.

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The new cost-conscious doctor: Changing America’s healthcare landscape

Rapidly shifting attitudesamong physicians aretransforming healthcarebusiness models.

For those who believe that America’s physicianscontribute to the country’s spiraling healthcarecosts by demanding more—more unnecessarytests, more expensive prescriptions, morecomplex treatment regimens—change is on theway. Increasingly aware and concerned aboutthe growing cost of healthcare, for the first timea majority of physicians show an increasedwillingness to consider the cost implicationsof the products they use. They recognize a press-ing need to adjust their clinical practices toaccommodate healthcare cost considerations(see Figure 1). As the shift in attitude gathersmomentum, it promises to have a profoundimpact on the approach to managing health-

care costs in the US. A Bain & Company surveycaptures the rising tide of change currentlyunder way in physician behavior and high-lights how these shifts will fundamentallytransform the way healthcare companies con-duct business.

Of all the changes sweeping across healthcarein the US, perhaps the least documented—but potentially most direct—factor likely tohelp reduce healthcare costs in the future isthis shift in physician behavior. To capture thetrend, we surveyed more than 500 physiciansfrom across the nation, including primary carephysicians, surgeons and other specialists.Respondents included physicians with varyingyears of experience, ranging from just fiveyears to more than 40 years. The sample rep-resented a balance in factors such as geography,practice type and physician payment method. Thesurvey included diverse physicians’ organizations,including multi-specialty and single-specialty

Percent of physicians

Note: n=502; Right�hand chart excludes physicians responding “agree more than disagree”

0 20 40 60 80 100%

PCP

Rural

Male

Specialist

Private practiceNot private practice

<15 yrs. experience>15 yrs. experience

Urban

SalariedProductivity�based

Female

Relative percent of physicians

Q: To what extent do you agree or disagree with the following statement: “I feel it is part of my responsibility as a physician to help bring healthcare costs under control.”

0

20

40

60

80

100%

1–Strongly disagree

5–Strongly agree

4–Agree more than disagree

“Cost conscious”

“Cost insensitive”

“Moderatelycost conscious”

2–Disagree more than agree

3–Neither agreenor disagree

Cost consciousCost insensitive

Figure 1: Most physicians, regardless of demographics, believe their role includes controllinghealthcare costs

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group practices, health systems and hospitals ofall sizes and types—including physician-ownedhospitals, academic medical centers, ambula-tory surgery centers and specialty hospitals.

Regardless of demographics, physicians sent anunequivocal message: increasingly, America’sdoctors are ready to adjust their clinical practicesto accommodate economic considerations. Theydisplay greater price sensitivity to the productsthey use and are aware of procedure costs topatients and providers. More likely to align withhospitals than ever before, physicians expectthey will increasingly respond to rather thanresist initiatives such as incentives to decreaseutilization; measures to promote preventivecare; limits on the practice of “defensive” med-icine; and the application of generally acceptedclinical treatment protocols. How quickly morephysicians move down that path will dependon payers and hospital providers. They canset the pace, ideally with active and thoughtfulengagement of physicians, by developing theright approaches that will align incentives toreduce the total cost of care.

Significant changes in physician behavior

Such fundamental shifts create both challengesand opportunities for the healthcare industry.They are also a wake-up call for those whocling to the belief that these changes are tem-porary and physician habits—for example,buying behavior for new drugs and devices—will revert to the old ways. Straddling nearlya decade of perceptions, the survey shows thatphysicians are not just reacting to the recessionor months of recent debate on healthcare reform.These findings represent systemic changerather than a reactive distortion.

We believe these changes in physician behaviorare so significant, they represent a tippingpoint. They will require stakeholders acrossthe healthcare value chain to react in substantial

ways, perhaps, in many cases, redefining theirbusiness models. By identifying these emergingattitudes and understanding their implications,leaders can get ahead of the changes and createnew sources of value in their respective sectors.

In this section, we take a detailed look at thesurvey findings and discuss the implications forstakeholders in the healthcare ecosystem. Next,we share some “no-regret” actions that can helphealthcare companies tap into the opportunity—and calibrate their business models to get themost out of changing physician behavior.

Physicians increasingly see controllingcosts as part of their job

Currently, the reimbursement system for prod-ucts and procedures creates a barrier betweenthe cost and efficacy of care. Physicians are thusable to focus on providing the most effectivecare for patients, but that is often done regard-less of cost. In the past, physicians functionedwith the entrenched belief that managing costswas the responsibility of payers. But in recentyears, physicians have begun to consider thecost-effectiveness of a treatment in addition toits efficacy when making healthcare choices.

The Bain survey shows that more than 80 per-cent of physicians “agree” or “strongly agree”that they consider bringing healthcare costsunder control as part of their responsibility.That was a consistent finding across the board,regardless of demographics such as age, prac-tice type, geography or specialty. Driven in partby the highly visible national debate on health-care costs and in part by physicians’ increasingalignment with providers, the new attitude marksa significant shift from the past. Increasingly,America’s doctors want to embrace the oppor-tunity and play a leading role in reducinghealthcare costs.

While some physicians are further along thanothers, even the least cost-conscious physicians

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expect costs to wield a much greater influenceon their actions over the next two years. Nearly70 percent of these “cost-insensitive” physicians,already in the minority, respond that cost willhave more influence on their decisions in twoyears’ time (see Figure 2). In addition, physi-cians who are already relatively cost consciousstate they will be even more conscious aboutcosts in the future.

The implications are significant. Pharma andmedtech companies must develop and com-mercialize products with a focus on provingsignificant differentiation versus standard ofcare, keeping a keen eye on delivering prod-ucts with clear health economic value. Payersand providers can expect more physicians towork in collaboration with them on initiativesthat bring down the cost of care.

Helping these trends is the growing alignmentof incentives. Today, physicians can directly

contribute to improved practice and hospitalprofitability by reducing the cost of consumables(medical devices and products) and decreasing in-patient lengths of stay (or using outpatient sitesof care). Both approaches result in improvedprofitability for providers and can contributeto lower system costs overall. While the fee-for-service model has not provided physicianswith incentives to drive preventive care, decreasesystem utilization, limit the practice of “defen-sive” medicine or curtail overuse of medicalprocedures, the changing attitudes, combinedwith the potential for payment reform, arepriming the market for change. For example,much of today’s healthcare debate focuses onstructural solutions such as accountable careorganizations (ACOs), medical homes andintegrated delivery networks. While these areearly days in this “final frontier” of fully alignedincentives, our survey data reinforces thatthe physician community may respond morequickly to such approaches than ever before.

Percent of “cost�insensitive” physicians

Note: n=94

Q: To what degree is the influence of cost on your clinical decisions changing?

0

20

40

60

80

100%

Five years ago

Same

Significantly more

Moderately more

Two years from now

57% 67%Percent more influenced:

Figure 2: Even cost-insensitive physicians expect to be much more influenced by cost in theimmediate future

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For players in the healthcare industry, the mes-sage is clear: physicians may no longer be thebarriers to change that they have been accusedof being in the past. Each part of the healthcarevalue chain needs to reevaluate its value propo-sition and ensure long-term alignment withclinical innovation and cost management.

Physicians demand more before tryingnew drugs or devices

In the past, product improvement was synony-mous with innovation. Physicians wholeheart-edly embraced most new products with thebelief that the more current a drug or device,the superior the product. Physicians focusedon bringing the latest—and therefore, thegreatest—drugs and devices to their patients.

In contrast, physicians are now looking at newproducts with increasing skepticism. Morethan 50 percent of physicians say the “burdenof proof” for trying new products is now high-er than ever. One private practice family doctorwe interviewed admitted, “Physicians havebecome jaded with pharma companies andthe new drugs they want us to use. There are alot of me-too drugs out there that offer minimalbenefits.” A pediatrician added, “The moreexperience you have, the more skeptical youare. Physicians are aware of the pressures ofthe industry where everyone is trying to pushthe newest product.”

In further support of this trend, our analysispoints to a significant number of physicianswho are less likely to try new products than inthe past. Approximately 25 percent of physi-cians say that they are less likely to try newproducts as soon as they become availablecompared with five to 10 years ago.

This wariness about using new products hasincreased for several reasons. While physicianscite payer restrictions as one of several barriers

to using new products, importantly, a rangeof individual motivations are also at play. First,doctors express a high level of overall satis-faction with the drugs and devices currentlyavailable (see Figure 3). In fact, the biggestunmet need they perceive in both drugs anddevices is cost-effectiveness. Second, physiciansexpress concern about the long-term safetyprofile of new drugs and devices. Perhaps influ-enced by a number of recent high-profile productrecalls and greater regulatory scrutiny overall,physicians no longer feel “new” axiomaticallyimplies “improved.”

In addition, only 50 percent believe that newdrugs generally offer valuable benefits andonly 30 percent believe that they actually offersufficient value. In the case of devices, thelack of differentiation between some brandsfurther influences physicians’ unwillingnessto try newer products. In short, physicians areincreasingly joining the calls of payers anddemanding clear evidence of clinical differ-entiation and economic value before they usenew drugs or devices.

Physicians are comfortable with morestandardized care

The era of the fiercely independent physicianis waning. Most physicians in our survey believethat care should be more standardized than itis today. Moreover, an interest in standardizedcare is correlated with a focus on cost man-agement—suggesting that the two issues areincreasingly linked in the minds of physicians.A number of recent studies1 address thisrelationship in detail. Our data describe theunderlying reason why physicians may now bepredisposed to change their clinical practiceto manage costs. Nearly 75 percent of “cost-conscious” physicians believe care should bemore standardized versus less than 50 percentof “cost-insensitive” physicians (see Figure 4).

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Note: Question asked in context of a condition the physician treats frequently


Q: How well does each of the following statements describe the RX drug treatment(s) currently available?

Q: How well does each of the following statements describe the devices and tools currently available?

0

20

40

60

80

100%

Strongefficacyprofile

Safeand

tolerable

Easy todose andadminister

Cost�effective

Stronglyagree

Agree

Neutral

Disagree

0

20

40

60

80

100%RX drugs (n=325) Devices (n=177)

Stronglyagree

Agree

Neutral

Disagree

Enable effectivetreatment

Safe Easy to use Cost�effective

Figure 3: Physicians show a high degree of satisfaction with existing drugs and devices

Percent of physicians agreeing to statement

Q: Which of the following best describes your feelings on the current level of “standardization” of patient care through the adoption of practice guidelines?

Note: Practice guidelines are defined as systematically developed statements to assist practitioners and patient decisions about appropriate healthcare for specific clinical circumstances; developed by physician organizations, government, insurers or other such groups. n=502

0

20

40

60

80

100%

Cost conscious Cost insensitive

Care should be a little less standardized

Care should be significantly more standardized

Care should be a little more standardized

Care isadequately standardized

Care should be significantly less standardized

Figure 4: A majority of physicians believe care should be more standardized; this is especiallytrue of the cost conscious

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It appears that those physicians who advocatemost strongly for standardization see it as aneffective way to address healthcare costs.

The survey also shows that physicians adhereto clinical guidelines more today than everbefore. The average number of patients forwhom guidelines were applied rose from athird five years ago to nearly half today, andthat number is expected to increase furthertwo years from now (see Figure 5). Youngerhospital-employed specialists tend to applyguidelines the most: physicians with less than15 years of experience say they refer to practiceguidelines for more than 60 percent of theirpatients. The survey projects that across allphysician segments, guideline usage willincrease over the next two years. Says a primarycare physician at a private practice: “There areso many treatments out there that are ineffec-tive or downright harmful. By using treatmentguidelines you feel more secure that you aredoing something ‘tried and true’ and notresponding to advertising.”

The growing acceptance of more standardizedcare combined with enabling technology suchas electronic access to guidelines promises togenerate a virtuous cycle. Doctors visit onlineresources like UpToDate, ModernMedicine,MDLinx and Epocrates in large numbers.UpToDate currently reports more than 400,000users. Hospitals are also pushing standard-ization, often by incorporating “checklists”into the software physicians are required touse. Our survey shows that while only a limitednumber of physicians worked with hospital-enforced checklists five years ago, by 2012,this number may exceed 50 percent.

Physicians are giving up private practice—and decision rights—in greater numbers

In response to declining practice economicsand a growing administrative burden, private

practice physicians are increasingly turningto employment in hospitals or larger practices.When asked how likely they were to switchpractice type, almost 25 percent of privatepractice physicians said they “are somewhatlikely” or “extremely likely” to change practicetypes in the next five years. Nearly two-thirdsof these physicians indicated they would belikely to move to a hospital or health system(see Figure 6).

In response to why they would switch practices,most respondents cite the drop in reimburse-ment rates coupled with rising costs. Three-quarters claim the autonomy of running theirown practice would no longer be worth theassociated economic pressures. These trendshave had a dramatic impact on a number ofspecialties. For example, says a cardiologist,“Most cardiology practices have experienceddramatically reduced reimbursement ratesand a vast majority of cardiologists have movedto hospital employment.”

As physicians become employed or aligned withmore integrated systems, we see a reallocationof decision roles in the healthcare landscape.In the US, increasingly, both clinicians andadministrators will influence decisions on whichguidelines to follow, which drugs to prescribeor which medical technology to use. Five yearsago, almost 40 percent of the physicians sur-veyed felt they had complete discretion over allmedical supply and device decisions; fewerthan one in five feel they will have the samecontrol two years from today (See Figure 7).

In recent years, this transition led to an “us-versus-them” mentality between cliniciansand hospital administrators. But in reality,the most sophisticated buyers have developedtruly collaborative approaches where both clin-ical and economic considerations are weighedand evaluated by value analysis teams (VATs)comprised of physicians and procurement

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Average percent of patients for whom guidelines are applied

Q: For what percentage of your patients do you refer to practice guidelines for some aspect of their care?

0

20

40

60%

Five years ago

37%

Today

48%

Two years from now

57%

Note: Practice guidelines are defined as systematically developed statements to assist practitioners and patient decisions about appropriate healthcare for specific clinical circumstances; developed by physician organizations, government, insurers or other such groups. n=502

Figure 5: Physicians report increasing use of practice guidelines in providing care

Percent of private practice physicians

Q: How likely are you to switch your practice type within the next 5 years? (private practice physicians only)

Note: Other includes government entity, university or medical school, management service organization or physician practice management company, and insurance company or managed care organization. Physician ownership is defined as physicians owning at least 50% of the practice.

0

20

40

60

80

100%

Likelihood of private practice physicians to switch practice

Somewhat unlikely

Not at all likely

Neither likely nor unlikely

Extremely likely

Somewhat likely

347

Target of possible future switch

Other

Hospital owned

Health system owned

83

Physician owned

Figure 6: Private practice physicians will continue to shift toward employed models

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professionals. When done well, this approachcan lead to better informed health economicdecisions, strong alignment between cliniciansand administrators, and improved economicsfor all stakeholders.

Taking “no-regret” actions

Changes in physician behavior of this magni-tude are likely to rearrange the healthcarelandscape in significant ways. For pharma andmedtech companies, the change in physicianattitudes will require engagement with stake-holders—such as CFOs and procurementprofessionals—beyond their historical physi-cian base. Manufacturers will need to focusincreasingly on new product innovations thateither offer true clinical differentiation ordemonstrably improve the overall cost of care.

With a market primed with physicians moreready to accommodate change, payers and

providers must determine how best to alignincentives and reduce overall system costs.Physicians must maintain sufficient independ-ence to exercise appropriate clinical judgmentwhile being rewarded for new models of caremanagement and longer-term patient out-comes. This study demonstrates their will-ingness to adapt to approaches focused oncost management.

Over the next two years, physicians expect afivefold increase in the prevalence of elec-tronic access to clinical treatment guidelines,nearly an eightfold increase in pay-for-per-formance programs and approximately one-third expect they will participate in a medicalhome or ACO model. A majority of physiciansendorse the need for comparative effective-ness research and believe electronic access toguidelines will improve the quality of health-care (see Figure 8).

Percent of physicians who agree with statement

Q: To what extent do you agree or disagree with the each of the following statements?

Note: n=350

0

20

40

60%

38%

22%17%

42%

27%

21%

29%

19% 18% 19%

43%

57%

Hospital significantlyregulates interactions

with pharma/meddevice reps

17%

40%

52%

I have complete discretion over all

medical supply and device decisions

MDs have majority representation on

purchasing committees

Hospital enforcesuse of checklist

I have complete discretion over all Rx drug decisions

Today Two years from nowFive years ago

Figure 7: Physicians confirm their waning influence over decisions made in the hospitalenvironment

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Each such insight represents opportunity.Different stakeholders in healthcare will reactdifferently based on how slowly or quickly theysee these changes in attitude gather momen-tum. Let’s consider some concrete actionscompanies can take.

Manufacturers (pharmaceuticals, diag-nostics and medical technology)

Selling products in this new environmentwill require a fundamentally different businessmodel for manufacturers of pharmaceuticals,medical products, diagnostics and medicaldevices. Increasing recognition that “new” isnot equivalent to “clinically differentiated”raises the bar for innovators. Next-generationproducts with incremental improvementswill no longer command a premium in themarket; instead, they will find themselvescompeting with prior-generation products orother low-cost substitutes. Given that the exist-

ing R&D pipelines of many manufacturersconsist of products that don’t meet the “dif-ferentiated” hurdle, many pharma and medtechcompanies will need to cull such productsfrom their portfolio to improve the returns ontheir investment in R&D.

For example, in surgical endo-mechanicalinstruments, an entire industry has sprungup to recycle single-use surgical instruments.These “reprocessors” such as Ascent (nowowned by Stryker), SterilMed and others tapinto the current market demand for “goodenough” products, in which the latest featuresare often traded off for lower prices. Moreover,companies like GE find that “de-engineering”products such as ultrasound machines or ECGdevices not only helps penetration in emergingmarkets but also opens up new opportunitiesfor expansion in developed markets. In someproduct categories, medtech products strippedof little-used features can help defend share of


Q: How likely is it that in the next 2 years your organization will participate in each of the following approaches? Do you already participate in such an approach?

Note: n=502

EMR

Already participatingLikely to participate

0

20

40

60

80

100%

80%

Electronicaccess topractice

guidelines

72%

EMR inter�

operability

64%

Comp.effectiveness

55%

Payfor

performance

50%

Physicianextenders

49%

Publicsafety &outcomes

data

48%

Bundledpayments

39%

Patient�centeredmedicalhome

35%

Sharedsavings

34%

ACOs

31%

Figure 8: Physicians indicate a growing openness to new approaches for care delivery

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wallet, serve a broader range of customersand sometimes even expand profit pools.

Due to these shifts, in some ways the definitionof “innovation” is expanding. In addition todelivering true clinical differentiation andimproved patient outcomes, innovation willincreasingly include products that improvecare economics: products that may not havedifferential clinical impact, but improve effi-ciency and reduce total costs. This new approachto innovation will require more collaborativeengagement with both payers and providers.Manufacturers will need to understand theircustomer’s processes and work flows betterand deliver programs that focus on the metricspayers and providers deem most relevant. Theywill need to build product pipelines influencedby an increasingly broad range of inputs, includ-ing clinical, administrative and economicconsiderations. Ultimately, manufacturers willbe compelled to self-fund comparative effec-tiveness studies to demonstrate the economicsuperiority of their products.

The commercialization of products will alsodepend on a broader set of skills beyond thosein predominant use today. The ability to com-municate both clinical and economic impactwill only increase in significance and willinvolve engagement with physicians and admin-istrators. Sales reps will continue to play ameaningful role, but they will be supplementedby account managers who understand their cus-tomers’ profit and loss situation and can engageprocurement professionals and service-lineleaders in a more comprehensive discussion.

Payers

Our research highlights an opportunity forpayers to work in partnership with physiciansto restructure the payment system and alignincentives with high-quality, cost-effectivecare. Now, more than ever before, physicians

expect payment reform, and will becomeincreasingly amenable to new incentive andrisk arrangements.

For example, to arrest spiraling medical costs,Blue Cross Blue Shield of Massachusetts (BCBS-MA) developed the Alternative Quality Contract(AQC). Under the terms of the five-year contract,providers receive a global monthly budgetper patient and are allowed to keep the savingsif care costs less than this amount; they sharethe risk if care costs more. They can also earnsubstantial bonuses for exceeding process andoutcome quality standards. Incentives encourageeliminating wasteful care while robust per-formance measures create accountability forquality and safety. Payers also provide indi-vidual physicians with information on theirpractice patterns relative to others, armingthem with data that can help them rethinkchoices in the context of quality and cost andhelp successfully manage the risk.

In the future, expect more payers to invest insuch change. A good starting point: develop-ing tools and support that allow providers todeliver more cost-effective care and track theirperformance. These might include member-specific care alerts and the provision of careguidelines that are integrated into physicians’work flows.

The growing acceptance of guidelines by physi-cians allows physicians, providers and payersto press ahead on standardizing care basedon evidence. By investing in comparative effec-tiveness research and partnering with providersin their network, payers can develop a strongset of guidelines with support from physicianswho will use them. BCBSMA found that physi-cians became “passionate” frontline championsagainst clinical waste when they saw clinicallyand specialty-specific data on how practicepatterns could vary. By transparently revealingthe wide variations between doctors in treatment

The growingacceptanceof guidelinesby physiciansallows physi-cians, providersand payers topress ahead onstandardizingcare basedon evidence.

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components—lab tests, office visits, pharma-cies—for a host of conditions like hypertension,arthritis, depression and skin inflammation,BCBSMA quickly and effectively proved itscase for standardized guidelines.

Finally, as they rethink their business models,payers can consider opportunities that assumea more collaborative relationship with physicians.For example, payers can aspire to emerge asthe trusted source for patients’ clinical andlifestyle information needs. With physiciansbacking their efforts, payers can also providebetter tools to patients to manage their health;create more sophisticated informatics and deci-sion support systems for providers to improvecare and reduce costs; and even create theinfrastructure for provider teaming, ACOsand other coordinated care models.

Providers

With more physicians giving up private practiceto join hospitals and health systems, providerscan build more captive referral networks andbetter align incentives, and at the same timeredesign care in a coordinated way. A consor-tium of top medical centers in the US—includingthe Cleveland Clinic, Dartmouth-Hitchcock,Denver Health, Geisinger Health System,Intermountain Healthcare and Mayo Clinic—plan to share data with one another in an effortto lower costs and improve the delivery of carein specific areas of focus, such as knee replace-ment procedures. More than 300,000 totalknee replacements take place every year in theUS, but the costs vary across the country from$16,000 to $24,000 per surgery. The projectfocuses on identifying best practices in eightconditions that show a wide variance in thecost of treatment and the quality of outcomesacross the country.

As physicians show a growing willingness toembrace new healthcare models, providerscan collaborate with payers to restructure the

payment system. That will not be easy—providerrevenue models will be altered, risk manage-ment capabilities developed and reinforcingcompensation structures created. But thiseffort has the potential to realign incentivesin a way that can truly enable effective andefficient delivery of care. Providers can then har-ness the trends we now see among physiciansand empower them to rethink delivery of care.They can do this effectively by developing strongpractice guidelines and protocols—grounded incompelling, evidence-based information andcost data—and provide the tools and incentivesto ensure broad use.

Preparing for change

Of course, it would be a mistake to imaginethat all these changes in physician attitudeswill resolve all of the industry’s cost and qualitychallenges. In addition to cost-consciousness,the survey surfaced some disquieting trends,too. About 40 percent of physicians voice theconcern that cost pressures force them to makedecisions that are not always aligned with thebest patient care. These physicians fret thatin two years more than 50 percent of theirpatients might not get the best care due tocost-cutting (see Figure 9). The two areasphysicians are most concerned about: restric-tions on their ability to prescribe the best drugsor treatments and limits to their use of nec-essary tests and diagnostic methods.

Over the next two years, physicians predictthat cost will play a great role in all care deci-sions across the board: prescription drugs,devices, diagnoses, procedures and referrals.That shift will require action from companiesthroughout the healthcare value chain. Thesechanges spell opportunity, but they also implyresponsibility. Increasingly, as physicians shifttheir focus on costs, the onus of finding thebalance on ensuring quality care will also getreallocated across the industry.

As physiciansshow a growingwillingness toembrace newhealthcare mod-els, providerscan collaboratewith payers torestructure thepayment system.

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It’s our belief that the shift in physician attitudeswill enable substantial change in the health-care industry. Ignoring the shifts or betting ontoo slow a pace of transformation will steercompanies into a dangerous place: they riskbeing swept away by disruptive forces. Instead,leading companies can take charge of the

Percent of physicians*

*n=502**n=206, physicians who agreed that cost pressures can cause misalignment with best patient care

Average percentage of patients**

Q: To what extent do you agree that cost pressures force you to make decisions that are not always

aligned with the best patient care?

Q: For what percentage of patients were care decisions impacted in a way that was not in the best interests

of their long�term care due to cost pressures?

0

20

40

60

80

100%

Disagree

Strongly disagree

Neutral

Agree

0

20

40

60%

5 years ago

20%

Today

34%

Two years from now

51%

Strongly agree

Figure 9: Physicians express growing concern over the quality of patient care in the face ofcost pressures

1 NEHI. “Improving Physician Adherence to Clinical Practice Guidelines.” February 2008. See also O’Malley, Ann, Pham, Hoangmai H. and Reschovsky,James D. “Predictors of the Growing Influence of Clinical Practice Guidelines.” Center for Studying Health System Change, March 2007.

future by embracing change. They can reviewtheir current model through the lens of evolv-ing physician attitudes and identify practicalapproaches that will deliver results as trendsgather even more momentum. By getting aheadof the swell, they can position themselves forsuccess now as well as in the future.

Bain’s business is helping make companies more valuable.

Founded in 1973 on the principle that consultants must measure their success in terms of their clients’ financial results, Bain works with top management teams to beat competitors and generate substantial, lasting financial impact. Our clients have historically outperformed the stock market by 4:1.

Who we work with

Our clients are typically bold, ambitious business leaders. They have the talent, the will and the open-mindedness required to succeed. They are not satisfied with the status quo.

What we do

We help companies find where to make their money, make more of it faster and sustain its growth longer. We help management make the big decisions: on strategy, operations, technology, mergers and acquisitions and organization. Where appropriate, we work withthem to make it happen.

How we do it

We realize that helping an organization change requires more than just a recommendation. So we try to put ourselves in our clients’ shoes and focus on practical actions.


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