Managed Care - January 2009 - (Page 24)

were put into place 100 years ago in response to which affordability comes. If you are not an inconditions that existed 100 years ago. We need to tegrated system, the idea that you want to get pareplace them with innovative business models tients out of the hospital is anathema to their that will do a much better job of focusing the profit model. They want to keep patients in the right resources on the right problem. And behospital, which drives cost higher. Because Kaiser cause health care is a systemic problem, only has a system point of view, they can profit by carcompanies that have the scope to wrap their ing for patients in the appropriate business arms around the whole system are going to be model. They can provide care at the lowest posable to change it. A few institutions, Intermounsible cost. They have the ability to disrupt themtain Healthcare, Kaiser Permanente, Geisinger selves while a nonintegrated entity simply canHealth System, and a few like that, are integrated not do it. fixed-fee sorts of providers that are MC: Is this happening today? really building on what HMOs Our assertion is that CHRISTENSEN: It’s beginning to haporiginally were. They have the institutions like Kaiser pen. Our assertion is that institutions scope to rethink the creation of Permanente, Geisinger like Kaiser, Geisinger, and Internew systems that have disruptive Health System, and mountain are structured to lead the business models. disruption in the health care indusIntermountain Health- try. They have only recently begun MC: Will the role of companies such care are structured to do that. In five years, the evidence as Aetna and WellPoint decline? to lead the disruption will start to roll in that it significantly CHRISTENSEN: Yes and no. We beimproves quality and lowers cost. lieve independent stand-alone in- in the health care surance companies are going to industry. MC: Have you been advising the have a very hard time remaining management of these companies? viable unless they aggressively change their stratCHRISTENSEN: We have. We’re hoping they have egy. They have got to begin merging with proaccepted the gospel. viders. If it is one entity, like a Kaiser that has it’s MC: You have said that many types of medical proarms around both, it can do a system-optimizcedures can be handled by people with lesser ing innovation. This comes from our study of the skills. How far will it go? Will consumers evenhistory of business. Whenever a company has tually be giving themselves flu shots? not been able to get a cost effective supply of a CHRISTENSEN: I think it can go a fairly long way, critical input, it has integrated back to provide its but the gate to that is to be able to diagnose preown supply. When Henry Ford started to mancisely. Once you know exactly what the disorder ufacture his Model T, he couldn’t get steel that is, then a predictable rules-based therapy can be was good enough quality, so he had to build his developed. What assures quality is following the own steel mill at River Rouge to feed into his rules, rather than drawing upon your intuition. stamping plant. Patients who are on home dialysis sing its praises in place of going to a dialysis center. Thirty years MC: You suggest that health care can become more ago, it would have been unthinkable that a affordable and accessible if we change providers patient and his family would apply dialysis at and venues. How do we do that? home. But as the equipment has become more CHRISTENSEN: You get affordability by bringing to reliable and foolproof, patients can do things outpatient clinics the simplest of things that had that required a doctor. in the past required a general hospital. Then bringing to a doctor’s office the simplest of proMC: You claim one of the things holding up discedures that in the past had to be done in an amruptive innovations is political clout. Can you bulatory clinic. Then bringing to the home the give an example? simplest of things that had in the past required CHRISTENSEN: For disorders that are precisely a doctor’s office. It’s by enabling lower cost vendiagnosable and have rules-based therapy, you ues of care through technology to become prodon’t need to be a doctor to provide that care. gressively capable of doing more and more soHalf of the states allow nurse practitioners to phisticated things — that’s the mechanism from diagnose and prescribe independently without 24 MANAGED CARE / JANUARY 2009

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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