Wednesday, June 3, 2009

Michael Porter On Health Care Reform

Michael Porter, writing in the New England Journal of Medicine, proposes "A Strategy For Health Care Reform - Toward A Value-Based System." His proposals are fundamental, lucid and right-on, meaning they're sure to be opposed by some parties to the debate, the so-called "Yes, but..." crowd.

Most important, in my opinion, is this:

"...electronic medical records will enable value improvement, but only if they support integrated care and outcome measurement. Simply automating current delivery practices will be a hugely expensive exercise in futility. Among our highest near-term priorities is to finalize and then continuously update health information technology (HIT) standards that include precise data definitions (for diagnoses and treatments, for example), an architecture for aggregating data for each patient over time and across providers, and protocols for seamless communication among systems.

"Finally, consumers must become much more involved in their health and health care. Unless patients comply with care and take responsibility for their health, even the best doctor or team will fail. Simply forcing consumers to pay more for their care is not the answer. New integrated care delivery structures, together with bundled reimbursement for full care cycles, will enable vast improvements in patient engagement, as will the availability of good outcome data.
It's nice to hear, finally, somebody (a) link the current EMR mania to antecedent process improvement and (b) remind us that it's fundamentally about value delivered to consumers (a.k.a CUSTOMERS!) What a concept. How rare it is to hear "consumer" and "EMR" used in adjacent paragraphs.

Yes, consumers matter, despite the bureaucratic, collectivist approach of most IT vendors and health providers. You'd think it was really about them and their lives and problems! Trust me, it's not and those who think it is suffer from acute strategic cluelessness.

Putting my meager funds where my large mouth is, I'm working on a start-up provisionally described as "Consumer-Controlled Access To Medical Information." Sort of Google Health meets credit card-style merchant processing. And, yes, I have a vested interest in the debate, though - vested interest or not - the more twaddle I hear from cheap health insurance providers about their EMR strategy, the more convinced I am that consumers are merely afterthoughts and I'm on the right track.

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