Table of contents for Redefining health care : creating positive-sum competition to deliver value / Michael E. Porter, Elizabeth Olmstead Teisberg.

Bibliographic record and links to related information available from the Library of Congress catalog.

Note: Contents data are machine generated based on pre-publication provided by the publisher. Contents may have variations from the printed book or be incomplete or contain other coding.


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TABLE OF CONTENTS
Preface
Acknowledgements
Acknowledgements	Not Included
Introduction	I-1 to I-18
	Not IncludedValue for Patients
The Need to Redefine Competition
Creating Value-Based Competition on Results
The Structure of This Book
Redefining Health Care in Practice
Chapter 1: Scoping the Problem	1-1 to 1-115
Chapter 2: Identifying the Root Causes	2-1 to 2-36
Positive Sum Competition on Value	
Zero Sum Competition in Health Care	
Competition to Shift Costs	
Competition to Increase Bargaining Power
Health Plan Bargaining Power
Provider Consolidation	
Competition to Capture Patients and Restrict Choice	
Competition to Reduce Costs by Restricting Services	
All of this Dysfunctional Competition Increases Proliferates Lawsuits	
The Root Cause: Competingtion at the Wrong Level	
Why is Health Care Competition at the Wrong Level?
The Wrong Conception of Health Care Itself: The Commodity Mindset
The Wrong Objective
The Wrong Geographic Market
The Wrong Strategies
The Wrong Industry Structure
The Wrong Information
The Wrong Patient Attitudes and Motivation
The Wrong Incentives for Health Plans 
The Wrong Incentives for Providers	
The Wrong Response from Employers Went Along	
Chapter 3: How Reform Went Wrong	3-1 to 3-32
The Rise of Group Health Insurance
Limiting Payments to Physicians and to Hospitals	
Managed Care	
The Medical Arms Race	
The Clinton Plan	
Patients' Rights	
Consumer Choice	
Quality and Pay for Performance	
A Single Payer System
Medical/Health Savings Accounts	
Non-Reforms
Reforming Competition: The Only Answer	
Chapter 4: Principles of Value-Based Competition	4-1 to 4-4023
Focus on Value, Not Just Costs	
Unrestricted Unrestricted Competition Based on Results	
Competition Centered on Disease or Medical Conditions Over the Full Cycle of Care
Quality and Cost Will Often Improve Simultaneously 
Value Improvement is Amplified by Addressing the Full Cycle of Care
Health Care Value is is Driven by Provider Experience, Excellence, and Uniqueness at the Medical Condition Level	
Competition That That is Is Regional or National	
Information to Support Value-Based Competition Must Be Widely Available
Innovations that Increase Value and Control Costs are Must Be Strongly Rewarded
The Payoff of Value-based Competition
	
Chapter 5: Strategic Implications for Health Care Providers	5-1 to 5-49
The Strategy Vacuum in Health Care Delivery
Strategies Based on Value and Uniqueness
Moving to Value-Based Competition
Redefine the Business Around Distinct Medical Conditions
Choose the Range and Types of Services Provided, Both Within and Across Locations
Matching Services and Locations.
Separating Providers and Health Plans.
Organize and Manage Around Medically Integrated Practice Areas
Moving to Practice Areas.
Create a Distinctive Strategy in Each Practice Area
Design and Implement Processes and Facilities That Enable These Strategies
Defining the Care Delivery Value Chain. 
The Process of Process Improvement. 
Collect Comprehensive Results and Process Information in Each Practice Area, Covering the Complete Care Cycle 
Collecting and Acting On Clinical Information.
Assembling Comparative Information.
Making Information Transparent.
Accumulate Costs by Practice Area and Activity over the Care Cycle 
Build the Capability for Single Billing for Episodes and Cycles of Care, and Migrate to New Approaches to Pricing
Marketing Based on Excellence, Uniqueness, and Results
Grow Locally and Geographically in Areas of Strength, Using a Medically Integrated Care Delivery Approach
Information Technology as an Enabler of Value-Based Competition
What Would Industry Structure Look Like?
Overcoming Barriers to Value-Based Competition
External Barriers 
Health Plan Practices. 
Medicare Pricing. 
Regulation. 
Internal Barriers 
Attitudes and Mindsets. 
Governance. 
Management Capabilities.
Medical Training.
The Structure of Physician Practice. 
Addressing Traditional Medical Structures
The Benefits of Moving Early
The Strategy Vacuum in Health Care Delivery	
Strategies Based on Uniqueness and Value	
Moving to Value-Based Competition
 	Redefine the Business aAround Sets of Medical Conditions	
	Choose the Range and Types of Services Provided, Both Within and Across Locations	
	Organize and Manage Around Medically Integrated Practice Areas	 
	Create a Distinctive Strategy in Each Practice Area	 	
Design and Implement Processes and Facilities That Enable These Strategies	 	
Collect Comprehensive Process and Outcome Information in Each Practice Area, Covering the 
 	 Complete Care Cycle	
	Accumulate Costs by Practice Area and Activity over the Care Cycle	
	Build the Capability for Single Billing for Episodes or Cycles of Care, and Migrate to New Approaches to 
 Pricing	
	Market Based on Excellence, Uniqueness, and Results	
	Grow Locally and Geographically in Areas of Strength, Using a Medically Integrated Care Delivery Approach	
Information Technology as an Enabler of Value-Based Competition	
What Would Industry Structure Look Like?	
Overcoming Barriers to Positive Sum Value-Based Competition
	External Barriers to Value
Internal Barriers to Value
Internal Barriers
Addressing Traditional Medical Structures
The Benefits of Moving Early	
Chapter 6: Strategic Implications for Health Plans	6-1 to 6-70
Past and Future Roles of Health Plans
Enable Choice and Health Management
Measure and Reward Providers Based on Results
Maximize the Value of Care over the Full Care Cycle
Simplify Reimbursement Systems Dramatically By Eliminating or Minimizing Administrative Transactions
Compete on Subscriber Health Results
Moving to Value-Based Competition: Imperatives for Heath Plans
Improving Health Information and Patient Support for Diagnosis, Treatment, Disease Management and Prevention
Organize around Medical conditions, Not Administrative Functions
Develop and Assemble Information on Providers and Treatments
Actively Support Patient Choice with Information and Unbiased Counseling
Organize Patient Information and Interaction around the Full Cycle of Care
Provide Comprehensive Disease management and Prevention Services to Subscribers, Even Healthy Ones
Restructuring the Health Plan-Provider Relationship
Shift the Nature of Information Sharing
Reward Provider Excellence and Value-Enhancing Innovation for Patients
Streamlining Contracting, Transactions, Billing and Pricing
Move to Single Bills for Episodes and Cycles of Care, and Single Prices
Simplify, Standardize, and Eliminate Paperwork and Transactions
Move to Multi-Year Subscriber Contracts With Gain Sharing, and Shift the Process of Subscriber Plan Contracting
End Cost Shifting Practices, Such as "Re-underwriting" Subscribers, that Erode Trust in Health Plans and Breed Cynicism
Developing the Ability to Mange Subscriber Medical Records
Provide the Service of Aggregating, Updating, and Providing Access to Patients' Complete Medical Record under Strict Standards of Privacy and Patient Control
Overcoming Barriers to Health Plan Transformation
Trust
Information
Health Plan Resources
Provider Resistance
Medicare
Mindsets
Culture and Values
The Benefits of Moving Early	
 
Roles of Health Plans	
Implications for Health Plan Strategy and Operating Practices	
	Health Information and Services	
	Transactions, Pricing and Billing	
	The Role of Industry Standardization
	Patient Medical Records
Implications for Health Plan Resources
Barriers to Health Plan Transformation
The Benefits of Moving Early
Chapter 7: Implications for Suppliers, Consumers, and Employers	7-1 to 7-39
Implications for Suppliers
Moving to Value-Based Competition: New Approaches for Suppliers
Offer Unique Value Over the Full Cycle of Care
Demonstrate Value Based on Careful Study o Long-Term Results and Costs
Ensure that Products are Used by the Right Patients
Insure that Drugs/Devices are Embedded in the Right Care Delivery Processes
Build Marketing Campaigns Based on Value, Information, and Customer Support
Offer Services to System Participants that Add Value rather Than reinforce Cost
Implications for Consumers as Subscribers and Patients
Moving to Value-Based Competition: New Responsibilities for Consumers
Participate Actively in Managing persona Health
Expect Relevant Information and Seek help
Make Provider Choices Based on Excellent Results, Not Convenience or Amenities
Choose a Health Plan Based on Value Added
Build a Long-Term Relationship with an Excellent Health Plan
Act Responsibly
Implications for Employers
Missed Opportunities
Promising Initiatives
Moving to Value-Based Competition: 	New Roles for Employers
Set New Expectations for Health Plans, including Self-insured Plans
Provide for Health plan Continuity of Employees, Not Plan Churning
Enhance Provider Competition
Support Employees in Making Health Choices and in Managing Their Own Health
Find Ways to Expand Insurance Coverage and Advocate Reform of the Insurance System
Measure the Hold Staff Accountable for the Company's Health Value Received
Chapter 8: Health Care Policy And Value-Based Competition: Implications for Government
	8-1 to 8-64
Broad Issues in Health Care Policy	
Moving to Value-Based Competition: Health Insurance and Access	
Limit Unproductive Insurance Competition
Eliminate Unproductive Billing Practices
Clarify Legal Responsibility of Medical Bills
Eliminate Balance Billing
Encourage Higher Deductible Plans Together With Health Savings Accounts
Enact Mandatory Health Coverage
The Cost of Mandatory Coverage
Moving to Mandatory Coverage
Moving to Value-Based Competition: What Care Should Be Covered?
Moving to Value-Based Competition: The Structure of Health Care Delivery
Open Up Competition at the Right Level
Antitrust
Buying Group Practices
Network Restrictions
Conflicts of Interest in Referrals
Regulation of New Entry
State Level Licensing
License Renewal Based on Performance
Tax Treatment of Medical Travel
Ensure the Collection and Dissemination of the Right Information
Government and Information Collection
Information Standards
Mandatory Reporting
Collection and Dissemination Infrastructure
IT Standards to Enable Assembly of Records and Secure Information Sharing
Private Sector Roles in Information
Require Better Pricing Practices
Transparent, Bundled Pricing
Limits on Price Discrimination
Reform Malpractice
Redesign Medicare Polices and Practices
Limitation of Medicare Pricing Practices
Medicare Pay for Performance
Towards new Pricing Models
Align Medicaid with Medicare
Moving to Value-Based Competition: Investing in Medical Research and Technology
Continue Supporting Basic Scientific and Medical Research
Create and Adoption of Innovation Fund
Implications for Health Care Policy in Other Nations
Conclusion: Redefining Health Care: Creating Value-Based Competition on Results	
	C-1 to C-6
Bibliography	
About the Authors

Library of Congress Subject Headings for this publication:

Medical care -- Quality control.
Medical care -- Cost control.
Medical care -- Cost effectiveness.
Value analysis (Cost control).
Competition.
Delivery of Health Care -- economics -- United States.
Economic Competition -- United States.
Quality of Health Care -- economics -- United States.
Health Care Costs -- United States.