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POLICY: Porter and Teisberg–I remain baffled

I’ve had my say about these two before (or at least about Porter’s descent into the health care quagmire). Here’s a new interview with them. They talk alot about competition and nothing about structuring incentives. They ask health plans to steer patients to high quality providers, but say that plans shouldn’t limit networks. I really think that they understand the problem but are so determined not to ape Alain Enthoven’s solution, that they just haven’t got one of their own because it’ll look too much like his! Perhaps part of the criteria for getting tenured at Harvard Business School is that you have lots of ideas about healthcare which don’t require any unifying theory.

Apparently I’m going to be sent the book, so I’ll suspend judgment till then…..

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  1. > Perhaps part of the criteria for getting tenured at
    > Harvard Business School is that you have lots of ideas
    > about healthcare which don’t require any unifying
    > theory.
    Well, one hopes their standards for getting tenured are higher than this, but I note there are no standards for staying tenured.
    > [they] are so determined not to ape Alain Enthoven’s
    > solution
    Well, maybe. From the discussion of joint-replacement I get that they are thinking in terms of “course of treatment”. I think maybe you recognized this when you were evidently reminded of the example of the Shouldice clinic. Porter and Teisberg do not much care whether the organization that provides the course of treatment is virtual or “actual” (for lack of a better word). There are advantages and disadvantages either way. Enthoven seems to want them to be “actual” — this might avoid some anti-trust issues in the metropolitan areas. But they don’t have to be. For example, what if the orthopod got paid a global fee, out of which he himself paid for OR time, PT, and anything else he needed? He could contract for these things and pay contracted rates to PTs and hospitals, he could pay for them on a FFS basis (ha!), or he could build his own “Integrated Hip Replacement Clinic” a la Shouldice. What he could not do is avoid responsibility for the outcomes. This kind of thing is fine as far as it goes, but it:
    1) works better for proceduralists than for Family Practice types, and
    2) isn’t quite “patient centered”.
    Enthoven’s idea tends better to address these things, but it will be fiercely resisted by the docs (especially proceduralists) and maybe by the patients if they perceive their cherished “choices” are being constrained.
    In the end, I think Porter and Teisberg do not contradict Enthoven but, not wanting to alienate potential consulting clients, do not want to lay out anything quite so concrete as he has.
    t

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