Healthcare at a Turning Point

This book is a compelling and thought provoking analysis of critical choices facing health care leaders. It offers a detailed prescription for stakeholders on how to proceed and how to implement genuine accountability at each stage of care management. ... Numerof and Abrams offer a road map for sustainable market reform with remarkable clarity and vision.
—Book review byPeter Boland, PhD, appearing in The Journal of Ambulatory Care Management, Vol. 37, No. 1, pp. 38–41Everyone complains about the state of healthcare in this country—patients feel uninformed, mistrustful and lost; clinicians and hospitals are frustrated in their efforts to improve the quality of care while meeting demands for lower costs; employers are burdened with the rising expense of employee health insurance; payers who provide the coverage are pushing for greater evidence before approving reimbursement for new drugs, technologies, procedures and tests; the medical product industry is struggling under the weight of increasing costs, longer development timeframes, shifting regulatory requirements and resistance from the other stakeholders to pay for new products; and politicians and state and federal government agencies are mandating a patchwork of fixes that seem to only make things worse. What we have lacked are tangible solutions that can actually work—until now.Rita Numerof and Michael Abrams in their new book,Health Care at a Turning Point: A Roadmap for Changehave offered a fresh look at the current state of healthcare in America, providing a detailed diagnostic assessment of what’s wrong, and importantly offer a comprehensive strategy to fix the problems. They begin with a vision of what a viable future state could look like in 10 years for providing affordable, accessible healthcare that promotes innovation in business models, products and services. Numerof and Abrams identify clearly and objectively the obstacles that must be overcome and gaps that must be closed by each of the important participants in the healthcare ecosystem, and then as the book's title implies, they deliver a roadmap, which is not only plausible, but if followed, will undoubtedly succeed in getting all of us there.
—Harlan F. Weisman, M.D., Former Chief Scientific and Technology Officer, Medical Devices and Diagnostics, Johnson & Johnson

Numerof and Abrams have crafted a thoughtful, and often provocative, analysis of the challenges and opportunities facing the healthcare industry today. At its heart is a clarion call for the sector to become much more patient and consumer-centric -- before their existing business models become obsolete.—Paul Howard, Director and Senior Fellow, Center for Medical Progress, Manhattan Institute for Policy Research

A pair of strategic management consultants intelligently scrutinize America’s healthcare industry. ... The authors’ blueprint for healthcare redesign is impressively conceived yet decidedly business-minded. Chapters defining their proposed remedies emphasize a market-based approach that objects to recent legislation and ideas of federally financed accountable care organizations (ACOs) while promoting models of bundled payment systems in which services are funded through a fixed-price schedule. ... they offer fresh, clear approaches to restructuring the healthcare system and place appropriate emphasis on the fostering of informed, accountable consumers. ... Numerof and Abrams’ ambitious study succeeds in illuminating problems within the multifaceted system ... . An elucidating, relevant discourse on the precarious future of medical care.—Kirkus Reviews, August 2012

The authors present thought-provoking ideas for the 'disruptive innovation' needed to uncover pragmatic solutions for our country's healthcare delivery system. ... this suggested blueprint for market-based action is a must-read for all sides of the healthcare reform debate.—Marc Boutin, Executive Vice President & Chief Operating Officer, National Health Council

Everyone agrees that the American healthcare system needs to change, but there is little agreement about how it should change. Abrams and Numerof paint a picture of how healthcare could look in an ideal future, and offer to manufacturers, payers, and providers a way to get there. Examining the healthcare system today, changes already taking place in attitudes towards innovation and medical education, ... they show how the key players in healthcare must change their thinking to survive. ... The main, and certainly provocative, message: if we move to a value-based system based on patient choice, rather than a cost-based system that assumes one size fits all, the consumer of health care is the ultimate beneficiary.

The book will stimulate the thinking of industry across functions, and should be read not only by management but by R&D, Strategic Planning, and Sales. Sections on the need to form partnerships and alliances can change the way industry, payers, and providers think about each other. By examining the four forces they see as dominating our healthcare environment today, namely changes in the regulatory environment, a changing competitive landscape, shifting technology, and changing market expectations, Abrams and Numerof have indeed provided an insightful guide to how the industry needs to change its strategic thinking.—David L. Horwitz, MD, PhD, FACP, Chief Medical Officer, Johnson & Johnson Diabetes Institute

Here it is inHealthcare at a Turning Pointhealthcare must restore control and accountability for intimate, personal decisions to each of us as our own consumer. No one else can define our quality-value-price equation, and discipline our providers ... Such is the economics, humanity, history, and even politic of western innovation…it is time for the Renaissance of those principles, just as articulated here inHealthcare at a Turning Point.
—Steve Bonner, President and Chief Executive Officer, Cancer Treatment Centers of America®

Numerof and Abrams have conducted a thorough analysis of the implications of market and non-market forces on all players in the health industry -- carriers, care providers, governments, consumers and employers. They have hit the nail on the head that it will take disruptive innovation and a collaborative approach across all these stakeholders to drive solutions to the fundamental problems of high cost and poor quality in health care.I appreciate that Numerof and Abrams focus in on three major principles: 1.) Rethink the customer: It’s really the consumer, the end-user of health care services. The consumer needs to be at the center of the work that we are undertaking. It is imperative that we provide them transparency to cost, quality and value. 2.) Watch out for non-traditional competitors: There are many other industries which have been historically very close to the consumer. The players in our industry are changing, and all of those who serve the consumer need to rapidly evolve ourselves in order to differentiate and succeed. 3.) Segment care providers: We need to apply the discipline of market segmentation to our relationships with care providers. That is, we cannot assume that a one-size-fits-all approach on paying for value or outcome will succeed with each and every physician or hospital. Rather, we must segment our networks and identify which care providers are most likely to succeed in a partnership to reform payment in a particular way, work with them closely and then allow that success to breed other success in the market place.—Elena McFann, VP Network Strategy and Implementation, UnitedHealthcare

For every professional engaged in the financing and delivery of medical care, this book is essential. Like it or not, sparked by the renewed debate over the controversial Affordable Care Act, we find ourselves in the midst of a major transformation in the health care sector of the economy. The convergence of biomedical breakthroughs, new medical technologies, new organizational structures is upon us. But the authors got it right: change will be frustrated, and energies will be diverted into unproductive channels, unless and until we change health care financing and put the patient in the center of the process as the key decision-maker.—Robert E. Moffit PhD, Senior Fellow, Center for Policy Innovation, The Heritage Foundation

Congratulations on the publication of Healthcare at a Turning Point. …[You] really hit the ball out of the park with this book. First, you identified the real root problem in our healthcare system [payment], and then provided the key solution, a consumer-driven market model. This book should be the new reference text for healthcare reform and should be read by every healthcare provider, administrator, insurer, product developer, and lawmaker. Thank you for delivering such remarkable insight and strategic guidance to a very complex and polarizing issue in the U.S.—Kurt Weingand, D.V.M., Ph.D., Chief Science Officer, Central Garden & Pet

Have there ever been three not-so-little words that turned an industry upside down, virtually paralyzed the planning process and left providers and consumers alike adrift as much as "health care reform"? The authors bring a calm, dispassionate tone to the dialogue, underscoring the unsettling nature of transition (a much more palatable word than change) and offer reasonable strategies that override politics. I found the emphasis on collaboration especially comforting and doable.—Ellen Sherberg, Publisher, St. Louis Business Journal

...it is important to have a clear bridge between the issues of today and the possibility of a much brighter future. Without glossing over serious issues…this book describes a way forward for those inside and outside the Healthcare system.—Jeff Thompson, MD, Chief Executive Officer, Gundersen Lutheran Health System

I appreciate that Rita and Michael call out the "ultimate objective" in the debate—to improve health outcomes at lower cost. It would seem that all sides can agree we save money when we decrease and change the demand for services. There are two approaches that allow us to do it. Approach 1 is to ration care. Approach 2 is that we incentivize and align consumers AND providers toward a plan for health which the authors rightly refer to as the consumer-driven market model.
—Amanda L. Adkins, General Manager and Executive, Healthcare Information Technology, Cerner Corporation