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Key elements to transition from volume to value

Posted Oct 21 2013 4:57pm

by Kenneth H. Cohn

Autumn in New England seems like a fitting metaphor for healthcare reform, in that it requires us to let go of the past and prepare for an uncertain future.

Recently, I spoke to the Physician CEO Healthcare Roundtable on "Healthcare: What's Next." To deal with my uncertainty, I used Prof. Michael Porter's Framework1, which states that healthcare organizations must meet seven different conditions to move from a volume-based to a more value-based healthcare system.

1. Mandatory measurement and dissemination of healthcare outcomes over the entire cycle of care rather than separately for each intervention, including survival, degree of recovery achieved, time needed for recovery, discomfort of care, and sustainability of recovery;

2. Prevention, screening, and health maintenance services, such as the patient-centered medical home, to deliver specific services and wellness bundles to defined patient populations;

3. Care delivery organized around integrated practice units that encompass all the skills and services required over the full cycle of care for each medical condition;

4. Reimbursement that aligns everyone's interests around improving value for patients;

5. Requiring providers to compete for patients based on value;

6. Electronic medical records that support integrated care, outcome measurement, and hardwiring of lessons learned into care processes; and

7. Patients and families getting more involved in their health and healthcare, using coaches, navigators, and community organizations to facilitate engagement and decrease the risk of caretaker burnout.

I contended that all seven conditions have a common element: improved communication and collaboration.

As I noted in " Collaborative Moderation ," with enhanced communication and collaboration, physicians built on their training of making major decisions in the face of limited information to improve care for their communities. . Dealing with the disruptive innovation occasioned by healthcare transformation can help us all find our niche and leave a lasting legacy about which we can be proud. Let's make this journey together.

1 Porter, M.E. (2009). "A Strategy for Healthcare Reform." New England Journal of Medicine. 36(12): 109-12.

Ken is a practicing general surgeon/MBA and CEO of , who divides his time between providing general surgical coverage and working with organizations that want to engage physicians to improve clinical and financial performance.

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