Harvard's Strategy to Fix Healthcare and Physicians' Solutions

The October 2013 Harvard Business Review's "The Strategy That Will Fix Health Care," by Michael E. Porter and Thomas H. Lee, nails what has to be done, and how it should be done, but, by whom?

"In [healthcare], the days of business as usual are over," say Porter and Lee, and that is where the obvious ends. If there ever was must-read material for physicians and policymakers, this is it.

The real question is not what should be done - Porter and Lee outline the strategies in detail - but who will take the lead and who will follow. That is what makes these strategies so important to physicians.

There is no single solution, but a combination of six essential strategies, each of which is a major task in itself:

1. Integrated Practice Units that are organized around general conditions or groups of conditions managed by a team leader;

2. Measured outcomes and costs for every patient;

3. Bundled payments for care cycles;

4. Integrated care delivery across separate facilities;

5. Expanded excellent services across geography; and

6. Building an enabling information technology platform.

The last, an information technology platform, is not the least. It is, as Porter and Lee point out, the enabler. You cannot manage what you cannot measure, as the saying goes, and there are good reasons for physicians to be in the lead as the managers of healthcare.

Osler Health Independent Practice Association (IPA), is physician owned and managed, employing all six of the Harvard strategies and more. The physicians at Osler make a good case for physician leadership through their enabling platform, since it is they who have to make things work.

Disclosure: I am the CEO of Osler Health Management, Osler Health IPA's management service organization, and use it by example because I know it best.

Their care model has three simple tenets:

• Primary-care physicians manage the whole health dollar by managing all aspects of care as team leaders;

• A common population risk, disease, and cost-stratifying health platform is the keystone to success; and,

• Physicians are freed to focus on clinical management while business professionals tend to business concerns in support.

Osler's information technology platform, called MDclick, takes data from EHRs and other sources and transforms it into usable, actionable information and analytics for physicians, enabling them to use hospitals, allied, and ancillary health providers as resources in support of their clinical management goals.

Their view of information technology is using it as a tool set, not a solution.

All providers have access to the same information in real time, which is monitored and managed through local peer review teams and, ultimately, on an increasing geographic strata of enterprise level reviews to ensure accountability and to identify and communicate best practices.

Physicians using the Harvard strategies in combination with appropriate enabling technology are not only the natural leaders of healthcare reform, they are the natural solution.