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Alain C. Enthoven
Stanford University
Stanford University
“With ‘Science Teams By Disease When Ill’ ["Patient Science Teams" and "Patient Teams" are synonymous], Chuck Weller is truly propounding a Copernican revolution for healthcare. This new model has doctors, hospital personnel and others in the care process working together to improve quality and efficiency across institutional and professional boundaries. It is new and obviously raises many new questions, but it makes possible clear accountability of teams for quality and outcomes, something that doesn’t exist or barely exists today. This is very important and greatly needed.”
Change the Center of Health Care Thinking from Annual Choice of Health Insurance Plan to Choice of Patient Team When Sick
For more than 1,000 years, Ptolemy's idea that the earth was the center of the universe dominated thinking about the heavens. The theory was that the planets moved on “fifty-five crystal spheres geared to God's crankshaft,” but then Copernicus “proposed the unthinkable,” that “the Sun, not the Earth, was the center of the universe.”
Managed care, annual choice of health insurance, and virtually all reform proposals for the health care equivalent period of time have centered on everything but health care patients and science. None have worked nor are likely to work without a new center of thinking. Their basic limitations are that they are insurance, tax and financing approaches that ignore the fundamental issue, and opportunity: health care.
The reality in health care today is that the incentives for innovation are so “skewed” and dysfunctional that private market “economic laws do not apply.” Although much effort has been made over decades for government to regulate the market failure that results from skewed incentives, all have basically failed.
The problem for government regulation, as brilliantly stated by former Chairman of the President's Council of Economic Advisers Charles Schultze, is that whenever “social problems arise because of distorted private incentives,” government regulation consistently tries “to impose a solution without remedying the incentive structure,” specifying "in minute detail the particular actions that generate social efficiency and then command[ing] their performance,” but “equally consistently, the power of that structure defeats us,” because in “complex areas of human behavior,” such as health care, “neither our imagination nor our commands are up to the task.”
Like the Ptolemaic model that placed the earth at the center of the universe for 1,200 years, health care needs a new center of thinking. Science Teams By Disease When Ill re-group doctors, hospitals and others as a team, including how they are paid, by disease system and reward excellence. There are two requirements:
first, there is a team of doctors, hospitals and others that treat a patient condition such as lung cancer, breast cancer, hypertension or asthma (including co-morbitites), and
second, they have aligned payment incentives to achieve the best patient outcomes, to continuously advance science, to minimize total costs externally for patients and payers, and to maximize internal profits within the Patient Team. Doctors, hospitals and other care-givers would have mutual incentives that are aligned across the treatment team to provide the best care, innovation and science for that disease system, without “command and control” by government or any other third-party.
More detail: Weller, “Science Teams By Disease When Ill,” Chapter 7, in Michael Porter, Peter Staudhammer, Scott Stern & Charles Weller, Unique Value (2004). Order: http://www.atlasbooks.com/marktplc/01314.htm
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, Feb 12 2008, 5:36 PM EST
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Dagher NWOS amicus Weller Byers 9-12-05.pdf (Adobe Portable Document Format - 120k)
posted by cdw2233 Oct 26 2007, 5:08 PM EDT
Supreme Court Antitrust Relief for Physician Innovation
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