What is New in Health Care from the Institute for Strategy and Competitiveness

This past year has been a busy one for the health care team at the Institute for Strategy and Competitiveness. We have actively engaged in many projects aimed to improve health care using value for patients as a framework. There is ever increasing growth in implementation of value based health care worldwide. This past year, as we have seen in prior years, peer reviewed publications in value based health care have grown exponentially: 

Value Based Health Care Publications through 2018

From: Patrick Clapp, Baker Library, Science Direct, December 2018 

Education in Value-Based Health Care

Education lies at the heart of what the team at the Institute for Strategy and Competitiveness focuses on year round through courses, case writing, and publications.

Courses:  Over the course of the past year we have delivered four courses at the post graduate level to over three hundred students from around the world. I addition we taught value based health care to a cohort of MBA students, and for the first time, we taught value based health care as a part of the required curriculum at the Medical School.

This month we will be delivering three courses at the post graduate level to over 200 clinicians, executives and health care trainees from the Partners teaching hospitals. Our week long Value Based Health Care Seminar had over 400 applications for a class of 85 that will represent over 15 nations. While most of the students are clinicians, a significant number come from government, insurers, suppliers, and the research community:

New Cases:  As you are aware, the Harvard Business School case provides the essential framework for all educational offerings of the school. This year the team introduced three new cases highlighting emerging areas of importance in value based health care.  Medtronic: Navigating a Shifting Health Care Landscape by Robert Kaplan, Michael Porter, Thomas Feeley and Alee Hernandez looks at how a major health care supplier developed a value focused approach to its worldwide medical device business. Navy Medicine: Moving to Value-based Care by Michael Porter, Alee Hernandez, Mary Witkowski and Thomas Feeley examines how the United States Navy implemented value-based health care in one of its major hospitals in Jacksonville Florida. Walmart: Health and Wellness by Michael Porter, Mary Witkowski and Harry Wolberg examines how one of America’s largest retailers has developed health care and wellness programs for both its employees and its customers. Each are available or will soon be available through Harvard Business Publishing.

New Publications

Three publications in the New England Journal of Medicine Catalyst from the ISC highlight some of the newest thinking about value in health care.

What 21st Century Health Care Should Learn from 20th Century Business This article by Michael Porter and Tom Lee discuss the fact that health care today has a complexity problem. Progress has produced major medical advances, but health care’s traditional organizational structure is buckling. The result: Clinicians have trouble collaborating. Patients have trouble navigating the system. And leaders have trouble leading. The development of the integrated practice unit (IPU) in value based health care is analogous to the creation of Strategic Business Units (SBUs) in 20th century corporations who developed program around the needs of customers similar to how IPUs deliver care focused on the needs of patients. 

Hospital-based ACOs Face Challenges in Tracking Performance Indicators This article by Christiana Beveridge, Sofia Warner, and Thomas Feeley, found that that accountable care organizations (ACOs) have not achieved the degree of cost reductions and quality improvements initially hoped for. This analysis of American Hospital Association survey data indicates that a major reason for this failure was poor collection and reporting or quality and cost measures. In the study only about half of respondents (52%) had the ability to track and share performance measures with all providers, and only 32% of all hospital-based ACOs are tracking and sharing financial metrics with their providers. Providers cannot know if they are, indeed, providing higher-quality or higher-value care if they are not aware of the financial implications of the care they are providing for their patients. Most of the data was provided at year end with insufficient time to change any practice and in addition there were major attribution problems as the data was global and not provider, patient or even condition specific. 

Transitioning Payment Models: Fee-for-Service to Value-Based Care Thomas Feeley and Namita Seth Mohta present the results of a survey of the NEJM Catalyst Insights Council asking about what alternative payment methods health care providers and provider organizations are implementing across the United States. The survey found that ACOs and bundled payments were the predominant new payment models being tested and that the three main barriers to these new payment models were infrastructure including information technology, regulatory barriers, and administrative complexity: 

Implementing Outcome and Cost Measurement World Wide

The International Consortium for Health Outcomes Measurement (ICHOM):  The Institute for Strategy and Competitiveness has been integrated with ICHOM since it was formed in 2012. In October of 2018, ICHOM appointed its third President and CEO Dr. Neil Bacon. Dr. Bacon, an internationally recognized leader in patient reported outcomes and digital healthcare transformation joined ICHOM to take the organization to the next level in the rapidly growing field of measuring and reporting health outcomes that matter to patients. With a new executive leadership leadership team of Drs. Mona Khalid and Nicholas Kransz, the team is accelerating its landmark work on developing outcome measures with a focus on digital, data-driven solutions that harness and analyze outcomes data at international scale. ICHOM’s new strategy of "Global Flagship Programs", bringing together the life science industry with providers and payors of healthcare to accelerate the adoption and real-world impact of PROMs, will be launched at this year’s ICHOM Conference in Rotterdam, presented in conjunction with Erasmus University: 

Cost Measurement at HBS:  The cost measurement team led by Professor Robert Kaplan have engaged in a number of multisite projects utilizing time dirven activity based costing to assess the true costs of care delivery. Currently they are working on OUD projects at Bridge Clinic and Hancock County; Medtronic and Siemens projects, VA VISN-9, TB Global Fund project in Zimbabwe, and several primary care projects with Mayo Clinic Northern Wisconsin region.

Alternative Payment Models

New Research

Legal and Regulatory Barriers to Value Based Health Care:  The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School (PFC) in collaboration with the Institute for Strategy and Competitiveness at Harvard Business School (ISC) is developing a new project with the goal of exploring the impact that the legal and regulatory systems have on the implementation of value-based health care in America. The purpose of this Project is to develop scholarship around the legal challenges (both real and perceived) to implementing value-based health care, with the ultimate goal of developing solutions to the actual challenges and supporting the education of stakeholders around the perceived challenges. This Project will take advantage of innovative partnerships to foster innovative work in an area that has neither received sufficient scholarly attention nor proactive approaches to change. Some of the legal challenges relating to value based health care that the Project will explore include: Fraud and Abuse Laws, Antitrust Laws, Data Privacy and Security Regulations, Emergency Treatment and Active Labor Act (EMTALA) regulations, Corporate Practice of Medicine barriers, and Regulations Related to Testing and Endorsing Outcome Measures for Health Care Reimbursement.

Implementing Value Based Health Care:  The ISC team are exploring new collaborations with provider organizations, universities and governments to continue the implementation of the principles of value based health care. In addition to our ongoing collaborations we always welcome the ideas an initiatives from our worldwide network those interested in improving health care.