Illustration by Harry Campbell
Joe Flower
Healthcare beyond Reform: Doing It Right for Half the Cost
(Productivity Press, 2012)
Otis Webb Brawley, M.D., with Paul Goldberg
How We Do Harm: A Doctor Breaks Ranks about Being Sick in America
(St. Martin’s Press, 2012)
Pursuing the Triple Aim: Seven Innovators Show the Way to Better
Care, Better Health, and Lower Costs
(Jossey-Bass, 2012)
Although it reflects an industry on the brink of deep and shuddering structural change, the healthcare bookshelf offered surprisingly few big, new ideas this year. Perhaps this is due to the damming up of ideas and initiatives behind the ongoing battle over healthcare reform in the United States. The Supreme Court’s decision to uphold the Affordable Care Act (ACA) in June 2012 should have released lots of pent-up energy, but, in a presidential election year rife with calls for repeal and a political atmosphere more akin to sectarian violence than civil discourse, uncertainty still hangs in the air.
Somewhat ironically, this year’s healthcare books are focused mainly on the provider sector of the industry, even though the more revolutionary aspects of the ACA — mandatory coverage, state-run insurance exchanges, and the banning of some extremely unpopular practices, such as annual and lifelong limits and denials for preexisting conditions — are aimed at the payor sector. This may be a function of the size of the audience: A few big insurance companies will drive reform on the payor side, whereas reform in care delivery will involve many providers, including more than 5,000 hospitals and 850,000 licensed doctors in the U.S. — a much larger potential readership.
In one way or another, most of the books dealing with healthcare this year are about the ACA. Naturally, many of them either are loaded with ideological and political rhetoric or are simply jeremiads — long on now-familiar indictments of the healthcare system, but short on useful insight. The fact that the system is fundamentally flawed stopped being news at least 10 years ago. What are we going to do about it?
Happily, there are a few insightful books that address this question, which is of interest to us all. Executives in all industries are dealing with the unsustainable rise in healthcare insurance and benefits costs and, of course, everyone deals with the healthcare system on a personal level. Each of this year’s best business books examines the vital issues in healthcare, offers ideas well within the grasp of educated citizens, and makes a meaningful contribution toward a better future.
The $100 Billion Question
Healthcare beyond Reform: Doing It Right for Half the Cost, by Joe Flower, a veteran journalist who has written for strategy+business on several occasions, is the most well-organized, comprehensive, and sensible “big picture” book about improving care delivery this year. It belongs on the shelves of leaders and thinkers within the industry, and is still sufficiently jargon-free to appeal to a broader audience. What sets the book apart is its powerful framework for sorting out what’s most important in the quest to provide higher-quality care to more people at lower cost, some commonsense metrics that keep our eyes on the prize, and a blame-free approach to causality that is refreshing. Oh yes, and Flower’s priorities and recommendations are persuasive.
Flower borrows a proven framework from operational strategy and adapts it to focus on three levels of care delivery improvement: avoidance (do we really need to do this?), coordination (do the components function effectively?), and efficiency (are we working smart and fast enough?). He uses this framework to identify the points of greatest leverage in the attack on healthcare’s problems by defining major cost and performance drivers and, at a high level, quantifying the opportunities. Of even greater usefulness is his characterization of the improvements and savings available from each of these three levers. Flower uses a stubby-crayon methodology here — his “savings scale” is calibrated from “gobs” and “vast sums” to “fascinating amounts” and “interesting amounts.” Unsurprisingly, the biggest opportunities reside at the avoidance level.
