Managed Care - January 2009 - (Page 23)

“… independent stand-alone insurance companies are going to have a very hard time remaining viable unless they aggressively change their strategy. They have got to begin merging with providers.” — Clayton Christensen, DBA MC: Can you foresee a future disruption? CHRISTENSEN: Lipitor and cholesterol-reducing drugs are obviating the need for angioplasty in the next generation of patients. And for disorders where there is a precise diagnosis and rules-based therapy, nurse practitioners working in retail clinics can offer care that is just as good as, and often better than, what doctor’s offices provide — at about 40 percent lower cost. MC: In your past books and articles, you have tackled the problems of business and education. Why medicine? CHRISTENSEN: It was crazy. Maybe by a factor of 100, it is more complicated than any other intellectual problem I’ve tried to wrap my brain around. MC: Did it really take 10 years? CHRISTENSEN: It did. It started when a friend who teaches at the Harvard Medical School and Dr. Jerry Grossman came to me independently and said, “Everyone has been studying health care to reach conclusions. In the end these are really problems of innovation. Maybe if you examined health care through your research on innovation, you could see things from that perspective that other people just haven’t been able to see.” PHOTOGRAPH BY CHRIS FITZGERALD MC: Many have tried to solve the problems of health care. What makes you think a Harvard business professor and two prominent physicians have the right prescription? CHRISTENSEN: Who knows whether we have? But I think what we bring uniquely is that we try to get at the root cause of high cost, inaccessibility, and all the inertia in the system. Health care is a systemic problem. So with any attempt to solve a systemic problem with a point solution, like saying we will change everything with electronic medical records, the system co-opts the solution and makes it conform to the system, so you don’t change anything. I think our research methods have caused us to think truly of health care as a system problem so that we could trace all the interactions and make recommendations. MC: What are those recommendations? CHRISTENSEN: From a provider point of view, the three big recommendations are: Investment in diagnostics, business model innovation, and the creation of a new system by integrated fixed fee providers. Diagnostics that precisely diagnose disease pays off very handsomely in affordability down the road. The business model of medicine, such as the hospital and the doctor’s office, JANUARY 2009 / MANAGED CARE 23

Table of Contents Feed for the Digital Edition of Managed Care - January 2009

Managed Care - January 2009 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Health Care's Disruptive Innovations Q&A With Clayton Christensen 'Disruption' May Be Plans' Best Bet Avoid the PBM Rebate Trap HealthPartners Puts Diabetes on Notice Formulary Files Plan Watch Tomorrow's Medicine Ad Index Outlook Unmet Needs in the Management of Plaque Psoriasis Impact of RSV: Implications for Managed Care

Managed Care - January 2009

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