Medical Device Daily Executive Editor

FORT LAUDERDALE, Florida — Some of the current solutions proposed for solving the problems of U.S. healthcare include an emphasis on cost-reduction; implementation of a single-payer, governmental system; improvement in the processes of care delivery; and providing patients more information about healthcare.

Elisabeth Teisberg, author and professor of business at the University of Virginia’sDarden School of Business, disagrees.

In her presentation at this year’s annual meeting and exhibition of the Society of Thoracic Surgery (STS; Chicago), Teisberg offered a variety of contrarian perspectives based on her personal experience with what she called the “overwhelming paradoxes” of U.S. healthcare. And this experience, in turn, fueled the insights concerning healthcare competition in the book she co-authored with Michael Porter, “Redefining Health Care.”

The current competitive paradigm of U.S. healthcare is wrong, she says, and similar to the presentation the day before by John Mayer, outgoing STS president (Medical Device Daily, Jan. 30, 2008 ), she emphasized the need for broad physician collaborations to change healthcare’s zero-sum thinking into win-win results.

But let’s look at the above-mentioned proposed solutions for healthcare and what Teisberg said about them.

• Cost-reduction: Teisberg argued that the emphasis on cost-reduction — especially as represented in the current debates by the current crop of presidential candidates — is simply “cost-shifting” and that the primary goal should be quality and the improvement of quality.

“The more we focus on reducing costs, the more we drive them up [by] shifting costs from one bucket to another,” she said.

The primary goal should be “value improvement,” she said, and that when “value increases significantly it’s possible to deliver far better outcomes for the money spent” — and “better outcomes relative to the cost of achieving them.”

Further, she said, the result is a win for all – besides the benefits to the patient, “the clinical team wins, the [health] plan wins, the family wins, the employer wins.” The reason, she said, is “an alignment of interests” of all of these players, rather than competition between them.

• Government healthcare and patient responsibility: “We need universal coverage, we do,” Teisberg said, for “equity and efficiency.” Those without insurance coverage, when they are sick, she said, present in “more complex, more costly places, like the emergency room.”

But she said that healthcare quality improvement can only be done by the main players in healthcare itself.

“Consumers can’t fix the broken system, they can’t drive the delivery of care. We can’t rely on the government to fix it for us ... We won’t get there through a government-run system or consumer-driven system.”

Rather, she emphasized the need for “a very different conception of market-based change.” That change, she said, should be “results-driven and patient-centered and physician-led.”

• Process improvement: The results defined by Teisberg can’t be achieved by the current emphasis on tracking the processes of healthcare delivery, she said. Requiring adherence to a menu of processes, she characterized as “paper compliance, not results.”

“Process compliance and results aren’t the same thing,” she said, going on to cite instances in which different levels of clinical compliance had achieved essentially the same results and, conversely, similar compliance with processes had produced highly varied results.

The measurement of healthcare value, she said, was in looking at the results for patients, such as return to work and to normal activity, and by tracking the “sustainability of recovery.”

• More quality information to patients: Results of care are best produced and shared among physicians, Teisberg said.

While not entirely dismissing the value of information to consumers/patients, she argued that the normal scenario, when a person is sick, is not to pick and choose and do in-depth research concerning doctors and hospitals. “Too often,” she said, “patients tend to rely upon their physicians.”

She said that the key is broad information-sharing among physicians, this shared information serving to drive learning and outcomes improvement.

In this process, she said that the role of patients is “engagement” in their care.

Echoing Mayer concerning the society’s emphasis on broader information through data registries, she praised the STS emphasis on information sharing as a way of improving outcomes and reducing errors.

But how is all of the above done in practical terms?

Teisberg’s most pragmatic recommendation was to emphasize the integration of care, and the integration of care specialties, using the problem of migraine treatment as an example.

Migraine sufferers, she said, often move from one physician, and physician specialty, to another to find the right therapy.

Citing the example of a practice offering a combination of specialties, she said that the results were the faster diagnosis of the problem and a large reduction in clinical contacts and costs.

“Bringing clinical teams together is different than what is done traditionally,” she said, citing as an example the Cleveland Clinic in “reorganizing its service line.”

Bringing these teams together, she said, serves to look at “the full cycle of care” and “sharing insights in different ways,” rather than “focusing on a condition.”

Instead of “fractured care,” Teisberg said, the results would include the “redesign of care cycles,” greater efficiency in the roles of the non-physicians of the team and improved patient outcomes.

“Imagine ... rather than a health system that’s about reimbursement and cost-shifting and what’s to be paid for, a system that’s truly about health — and care.”