This presentation draws heavily on Professor Porter’s research in health care delivery including Redefining Health Care (with Elizabeth Teisberg), What is Value in Health Care, NEJM, and The Strategy That Will Fix Health Care, HBR (with Thomas Lee).
A fuller bibliography is attached. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means — electronic, mechanical, photocopying, recording, or otherwise — without the permission of Michael
E. Porter. For further background and references on value-based health care, see the website of the Institute for Strategy and Competitiveness.
Value-Based Health Care Delivery:
The Agenda for Surgery
Professor Michael E. Porter
American College of Surgeons’ Clinical Congress
Boston Convention Center
Boston, MA
Wednesday, October 24, 2018
Copyright 2018 © Professor Michael E. Porter
Disclosure
2
Michael Porter
I have a relevant financial relationship with the following companies:
Company Role
Vanderbilt University Medical Center Advisor
Allscripts Advisor
AZTherapies Advisor, Investor
Ascent Biomedical Ventures Investor
Biopharma Credit Investments Investor
Advanced Aesthetic Tech. Investor
Merck & Co. Investor
Merrimack Pharmaceuticals Investor, Former Board Member
Molina Healthcare Investor
Royalty Pharma Investor
Thermo Fisher Scientific Investor
Copyright 2018 © Professor Michael E. Porter
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The Health Care Problem Remains a Global IssueHealth Care Spending vs GDP and Income
1. Sweden changed reporting methodology and included long-term care spending in 2011, but not prior to 2011; thus HC spend for Sweden is indexed 1995-2010 and 2011-2016 with GDP growth 2010-11. Notes: All indexes based on local currencies; Income = Personal Disposable IncomeSource: WHO, EIU (May 2017), BCG analysis
Index
(1995=100)HC expenditure 2016:
17.2% of GDP
HC expenditure 2016:
11.4% of GDP
HC expenditure 2016:
11.6% of GDP
Index
(1995=100)
Index
(1995=100)HC expenditure 2016:
11.8% of GDP
Index1
(1995=100)HC expenditure 2016:
10.9% of GDP
Index
(1995=100)
Index
(1995=100)HC expenditure 2016:
9.2% of GDP
Personal Disposable Income Gross Domestic Product (GDP) Health Care Spending
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Copyright 2018 © Professor Michael E. Porter
Issues Facing Surgeons Today
4
The • role of surgeons in future health care delivery
The • implication for surgeons of a cost-sensitive world
How to • measure quality and performance in surgery
Where surgery fits • in new reimbursement models
How to address administrative burdens • and burnout
Copyright 2018 © Professor Michael E. Porter5
Incremental “Solutions” Have Had Limited Impact
Evidence• -based medicine
Safety/eliminating errors•
Prior authorization•
Patients as paying customers•
Electronic medical records•
• “Lean” process improvements
Care coordinators•
Programs • to address high cost areas
(e.g. readmissions, post acute)
Mergers and consolidation•
IBM Watson•
Personalized medicine•
Restructuring health care delivery• is needed, not incremental improvements
Copyright 2018 © Professor Michael E. Porter
Creating a Value-Based Health Care System
Today• ’s care delivery approaches reflect legacy organizational structures,
management practices, and payment models based on historical medical
science and delivery practices
There have been • significant advances medical science yet service
delivery practices have not evolved.
Health care has gotten lost in the • complexity of the system and the pursuit
of multiple goals including patient experience, safety, efficacy, access,
research and training, etc.
6
In order to transform the system, we need a • single, unifying goal
that aligns all interests
Copyright 2018 © Professor Michael E. Porter
Solving the Health Care Problem
The • fundamental goal and purpose of health care is to improve value
for patients
Delivering high value health care is the • definition of success
Value is the only goal that can • unite the interests of all system
participants
Improving value is the • only real solution
The question is how to design a health care delivery system that •
substantially improves patient value
Value =Health outcomes that matter to patients
Costs of delivering these outcomes
7
Copyright 2018 © Professor Michael E. Porter8
Principles of Value-Based Health Care Delivery
Value =The set of outcomes that matter for the condition
The total costs of delivering these outcomes over the full care cycle
In • primary and preventive care, value is created in serving
segments of patients with similar primary and preventive
needs
The medical condition is the proper unit of • value creation
and value measurement in health care delivery
• Value cannot be understood at the level of a hospital, a
care site, a specialty, an intervention, a primary care practice
or a broad population
• Value is created in caring for a patient’s medical condition
(acute, chronic) over the full cycle of care
Copyright 2018 © Professor Michael E. Porter
1. Re-organize care around patient conditions, into integrated
practice units (IPUs)
For primary and preventive care, IPUs serve − distinct patient
segments
Measure 2. outcomes and costs for every patient
Move to 3. value-based reimbursement models, and ultimately
bundled payments for conditions and primary care segments
Integrate multi4. -site care delivery systems
Expand or affiliate 5. across geography to reinforce excellence
Build an enabling6. information technology platform
9
Creating Value-Based Health Care Delivery The Strategic Agenda
Copyright 2018 © Professor Michael E. Porter
Existing Model:
Organize by Specialty and Discrete Service
New Model:
Organize into Integrated Practice Units (IPUs) Around Conditions
Source: Porter, Michael E., Jain, Sachin, The University of Texas MD Anderson Cancer Center: Interdisciplinary Cancer Care. February 26, 2013.
Outpatient
Oncologist
Surgical
Oncologist Speech &
Swallow
Dentist
Primary Care
Physician
Radiation
Oncologist
RadiologistPathologist
Re-organize Care Around Patient Medical ConditionsHead & Neck Cancer Care at MD Anderson
10
Copyright 2018 © Professor Michael E. Porter11
Integrating Over The Cycle of Care Acute Hip and Knee-Osteoarthritis
• Operating room
• Recovery room
• Orthopedic floor at hospital or
specialty surgery center
Specialty office•
Pre• -op evaluation center
• Specialty office
• Imaging facility
SURGICAL
Immediate return to OR for
manipulation, if necessary
MEDICAL
Monitor coagulation•
LIVING
Provide daily living support •
(showering, dressing)
Track risk indicators (fever, •
swelling, other)
PHYSICAL THERAPY
Daily or twice daily PT sessions•
ANESTHESIA
Administer anesthesia (general, •
epidural, or regional)
SURGICAL PROCEDURE
Determine approach (e.g., •
minimally invasive)
Insert device•
Cement joint•
PAIN MANAGEMENT
Prescribe preemptive •
multimodal pain meds
Meaning of diagnosis•
Prognosis (short• - and long-
term outcomes)
Drawbacks and benefits of •
surgery
IMAGING
Perform and evaluate MRI and •
x-ray
-Assess cartilage loss
-Assess bone alterations
CLINICAL EVALUATION
Review history and imaging•
Perform physical exam•
Recommend treatment plan •
(surgery or other options)
Nursing facility•
Rehab facility•
Physical therapy clinic•
Home•
MONITOR
• Consult regularly with patient
MANAGE
• Prescribe prophylactic
antibiotics when needed
• Set long-term exercise plan
• Revise joint, if necessary
Specialty office•
Primary care office•
Health club•
• Expectations for recovery
• Importance of rehab
• Post-surgery risk factorsINFORMING AND ENGAGING
MEASURING
ACCESSING
Importance of exercise, •
maintaining healthy weight
Joint• -specific symptoms and
function (e.g., WOMAC scale)
Overall health (e.g., SF• -12
scale)
• Baseline health status
• Fitness for surgery (e.g., ASA
score)
Blood loss•
Operative time•
Complications•
• Infections
• Joint-specific symptoms and
function
• Inpatient length of stay
• Ability to return to normal
activities
Joint• -specific symptoms and function
Weight gain or loss•
Missed work•
Overall health•
MONITOR
Conduct PCP exam•
Refer to specialists, if •
necessary
PREVENT
Prescribe anti• -inflammatory
medicines
Recommend exercise regimen•
Set weight loss targets•
Importance of exercise, weight •
reduction, proper nutrition
Loss of cartilage•
Change in • subchondral bone
Joint• -specific symptoms and
function
Overall health•
OVERALL PREP
Conduct home assessment•
Monitor weight loss•
SURGICAL PREP
Perform cardiology, pulmonary •
evaluations
Run blood labs•
Conduct pre• -op physical exam
• Setting expectations
• Importance of nutrition, weight
loss, vaccinations
• Home preparation
Importance of rehab adherence•
Longitudinal care plan•
Orthopedic Surgeon
PCP office•
Health club•
Physical therapy clinic•
DIAGNOSING PREPARING INTERVENINGMONITORING/
PREVENTING
RECOVERING/
REHABBING
MONITORING/
MANAGING
CARE DELIVERY
Copyright 2018 © Professor Michael E. Porter
The Playbook for Integrated Practice Units (IPUs)Organized around a 1. medical condition, or group of
closely related conditions.
Defined patient segments for primary care−
Care is delivered by a 2. dedicated, multidisciplinary team
devoting a significant portion of their time to the condition
In− -house staff and affiliated staff with strong working relationships
3. Co-located in dedicated facilities. A hub and spoke structure connecting
multiple or affiliated sites, incorporating telemedicine where appropriate
Takes responsibility for the4. full cycle of care
5. Patient education, engagement, adherence, follow-up, and prevention
are integrated into the care process
The unit has a clear 6. clinical leader, a common scheduling and intake
process, and unified financial structure (single P + L)
7. A physician team captain, clinical care manager or both
oversees each patient’s care
The8. IPU routinely measures outcomes, costs, care processes,
and patient experience using a common platform
The team 9. accepts joint accountability for outcomes and costs
The team 10. regularly meets formally and informally to discuss individual
patient care plans, process improvements, and how to improve results12
10.
Copyright 2018 © Professor Michael E. Porter13
Volume Matters for IPUs and Value• More patients with the same condition enables higher value
Better Results,
Adjusted for RiskRapidly Accumulating
Experience
Rising Process
Efficiency
Better Information/
Clinical Data
More Tailored Facilities
Rising
Capacity for
Sub-Specialization
More Fully
Dedicated Teams
Faster Innovation
Greater Patient
Volume in a
Medical
Condition
Improving
Reputation
Costs of IT, Measure-
ment, and Process
Improvement Spread
over More Patients
Wider Capabilities in
the Care Cycle,
Including Patient
Engagement
The Virtuous Circle of Value
Greater Leverage in
Purchasing
Better utilization of
capacity
Copyright 2018 © Professor Michael E. Porter14
Focuses on • low-income older adults living in under-served urban
communities
Four severity tiers–
Multidisciplinary team • covering the full care cycle: physicians, PAs, NPs,
RNs, medical assistants, scribes, care managers, social workers, clinical
informatics specialists, and others
Co• -located in dedicated facilities. 40 sites across the Midwest
Explicit processes to • engage patients and reduce obstacles
to accessing care such as free rides/home-visits, in-house pharmacy
and selected events for community residents
Selected in• -house specialty services such as behavioral health and
podiatry. Close relationships with outside specialists selected based on
outcomes, cost and ability to work with integrated model
Meet daily and weekly • to discuss patient care plans and process
improvement
Measure and accountable • for outcomes, cost, and patient experience
Single full• -risk value-based payment covering overall care
Includes specialty and post– -acute care
Value-Based Primary CareOak Street Health
Copyright 2018 © Professor Michael E. Porter
Patient Experience/
Engagement/ Adherence
E.g., PSA,
Gleason score,
surgical margin
Protocols/Guidelines
Patient Initial
Conditions,
Risk Factors
Processes Indicators
Structure
E.g., Staff
certification,
facilities standards
Measure Outcomes for Every PatientThe Quality Measurement Landscape
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Outcomes
Copyright 2018 © Professor Michael E. Porter
Survival
Degree of health/recovery
Time to recovery and return to normal activities
Sustainability of health/recovery and nature of recurrences
Disutility of the care or treatment process (e.g., diagnostic errors and ineffective care, treatment-related discomfort, complications, or adverse effects, treatment
errors and their consequences in terms of additional treatment)
Long-term consequences of therapy (e.g., care-induced illnesses)
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The Outcome Measures Hierarchy
Tier
1
Tier
2
Tier
3
Health Status
Achieved
or Retained
Process of
Recovery
Sustainability
of Health
Source: NEJM Dec 2010
Achieved clinical status•
Achieved functional status•
Care• -related pain/discomfort
Complications•
Re• -intervention/readmission
Long• -term clinical status
Long• -term functional status
• Time to diagnosis and treatment
• Time to return home
• Time to return to normal activities
Copyright 2018 © Professor Michael E. Porter
Source: ICHOM
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9.2%
17.4%
95%
43.3%
75.5%
94%
Incontinence after one year
Severe erectile dysfunction after one year
5 year disease specific survival
Average hospital Best hospital
Measuring Multiple Outcomes Prostate Cancer Care in Germany
Source: ICHOM
Source: ICHOM
Copyright 2018 © Professor Michael E. Porter
Source: ICHOM
18
9.2%
17.4%
95%
43.3%
75.5%
94%
Incontinence after one year
Severe erectile dysfunction after one year
5 year disease specific survival
Average hospital Best hospital
Measuring Multiple Outcomes Prostate Cancer Care in Germany
Source: ICHOM
Source: ICHOM
Copyright 2018 © Professor Michael E. Porter
Localized Prostate 1.
Cancer *
Lower Back Pain 2. *
Coronary Artery 3.
Disease *
Cataracts 4. *
Standard Sets
Complete
(2013)
Breast Cancer*13.
Dementia14.
Frail Elderly15.
Heart Failure16.
Pregnancy and 17.
Childbirth
Colorectal Cancer*18.
Overactive Bladder19.
Craniofacial 20.
Microsomia
Inflammatory Bowel 21.
Disease
Standard Sets
Complete
(2015-16)
Parkinson5. ’s Disease*
Cleft Lip and Palate*6.
Stroke 7. *
Hip and Knee 8.
Osteoarthritis*
Macular Degeneration*9.
Lung Cancer*10.
Depression and 11.
Anxiety*
Advanced Prostate 12.
Cancer *
Standard Sets
Complete
(2014)
Chronic Kidney 22.
Disease*
Congenital Upper 23.
Limb Malformations
Pediatric Facial Palsy24.
Inflammatory 25.
Arthritis
Hypertension26.
Standard Sets
Complete (2017-18)
Standardizing Minimum Outcome SetsICHOM Standard Sets
* Published Thus Far in
Peer-Reviewed
Journals (14)
19
27. Oral Health
28. Diabetes
29. Atrial Fibrillation
30. Overall Adult Health
31. Pediatric Health
32. Hand and Wrist
33. Neonates
34. Head and Neck Cancer
35. Congenital Heart
Disease
36. Mental Health in Children
and Young People
Committed/
In Process
Copyright 2018 © Professor Michael E. Porter20
Measure Cost for Every Patient Principles
Cost is the • actual expense of patient care, not the sum of
charges billed or collected
Properly • measuring the cost of care requires different cost
accounting methods than prevailing approaches such as
departmental, charge-based, or RVU-based costing
Cost should be measured for • each patient over the full cycle
of care for the condition, or by primary care segment
Cost • is driven by the use of all the resources involved in a
patient’s care (personnel, facilities, supplies,
and support services)
– Time and actual costs, not arbitrary allocations
Understanding costs requires • mapping the care processSource: Kaplan, Robert and Michael E. Porter, “The Big Idea: How to Solve the Cost Crisis in
Health Care”, Harvard Business Review, September 1. 2011
Copyright 2018 © Professor Michael E. Porter21
Mapping Resource UtilizationMD Anderson Cancer Center – New Patient Visit
Registration and Verification
Receptionist, Patient Access
Specialist, Interpreter
Intake
Nurse,
Receptionist
Clinician Visit
MD, mid-level provider, medical
assistant, patient service
coordinator, RN
Plan of Care
Discussion
RN/LVN, MD, mid-
level provider, patient
service coordinator
Plan of Care
Scheduling
Patient Service
Coordinator
Decision Point
Time (minutes)
Source: HBS, MD Anderson Cancer Center
Copyright 2018 © Professor Michael E. Porter22
Major Cost Reduction Opportunities in Health Care
Utilize • physicians and skilled staff at the top of their licenses
Eliminate • low- or non-value added services or tests
Reduce • process variation that increases complexity and raises cost
Reduce cycle times• across the care cycle
Invest in additional services or higher costs inputs that will • lower overall
care cycle cost
Move uncomplicated services • out of highly-resourced facilities
Reduce • service duplication and volume fragmentation across sites
Rationalize redundant • administrative and scheduling units
Increase • cost awareness in clinical teams
Decrease cost of • claims management and billing processes
Our work reveals typical • cost reduction opportunities of 30+%
Many cost improvements also • improve outcomes
Copyright 2018 © Professor Michael E. Porter
Accountable for costs and outcomes, •
patient by patient, and condition by condition
• A single risk-adjusted payment for the overall care for a life
Emerging Value-Based Payment Models
Capitation (Population-Based) Bundled Payment
Responsible for • all needed care in the covered population
Accountable for • population level quality metrics
At risk for the difference between the •sum of payments for the population and overall spending
Providers take − disease incidence risk, not just execution/outlier risk
Accountable• for overall cost and population level quality measures
• A single risk adjusted payment for the overall care for a condition
− Not for a specialty, procedure, or short episode
Covers the • full set of services needed over an acute care cycle, or a defined time period for chronic care or primary care
• Contingent on condition-specificoutcomes
− Including responsibility for avoidable complications
At risk for the difference between the •
bundled price and the actual cost of all included services
Limits of responsibility− for unrelated care and outliers
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Copyright 2018 © Professor Michael E. Porter
Walmart Centers of Excellence Programs
Conditions:Cardiac•
Cancer•
Joint replacement•
• Spine• Transplant• Weight loss
Partnerships:
Cleveland Clinic (OH)
Geisinger (PA)
Kaiser Permanente (CA)
Johns Hopkins (MD)
Mayo Clinic (MN)
Memorial Hermann (TX)
Northeast Baptist (TX)
Virginia Mason (WA)
Emory (GA)
Source: Compiled from news.Walmart.com and through publically available news and press releases . 24
Copyright 2018 © Professor Michael E. Porter
Defining the 1. overall scope of services for each site, and for the
facility/system as a whole, where it can deliver high value
− Affiliate when this creates value
Concentrate2. volume of patients by condition in fewer locations to support
IPUs and improve outcomes and efficiency
Perform the 3. right services in the right locations based on acuity level,
resource fit, and the benefits of patient convenience for repetitive services
E.g., move – less complex surgeries out of tertiary hospitals to smaller facilities and
outpatient surgery centers
Integrate the care cycle 4. across sites via an IPU structure
Common– scheduling
Digital services – and telemedicine can help tie together the care cycle
25
Four Levels of Provider System Integration
Copyright 2018 © Professor Michael E. Porter26
Delivering the Right Care at the Right LocationRothman Institute, Philadelphia
Lowest Complexity
LowMedium
Highest Complexity
Facility Capability
Price of Total Hip
Replacement:
~$12,000 USD
Price of Total
Hip
Replacement
~$45,000 USD
Patient Risk Factors: Age, Weight, Expected Activity, General Health, and Bone Quality
Ambulatory Surgery Center
Rothman Orthopaedic
Specialty Hospital
Bryn Mawr
Community Hospital
Jefferson University
Academic Medical Center
Copyright 2018 © Professor Michael E. Porter27
Build an Enabling IT PlatformAttributes of a Value-Based IT Platform
Combines 1. all types of data for each patient across the full care cycle (notes, lab
tests, genomics, imaging, costs) using standard definitions and terminology
Tools to capture, store, and extract 2. structured data and eliminate free text
Data is captured in the3. clinical and administrative workflow
Data is stored and easily extractable from a common warehouse. Capability to 4.
aggregate, extract, run analytics and display data by condition and over
time
5. Full interoperability allowing data sharing within and across networks, EMR
platforms, referring clinicians, and health plans
Platform is structured to enable the capture and aggregation of 6. outcomes,
costing parameters, and bundled payment eligibility/billing
Leverages 7. mobile technology for scheduling, PROMs collection, secure patient
communication and monitoring, virtual visits, access to clinical notes, and patient
education
Copyright 2018 © Professor Michael E. Porter28
How Can Surgeons Create Value?
Think 1. beyond the operating room
Move away from − surgical silos and partner with caregivers in preventative
care, perioperative care, rehabilitation, short-term follow up, surveillance
Institute 2. universal outcome measurement and public reporting to drive
improvement and demonstrate high value care
Utilize 3. time-driven activity-based costing methodology covering the full
cycle of care to demonstrate overall impact on efficiency and value
Actively engage in 4. bundled payments with employers, government
payers and private payers advocate for broader implementation
5. Reorganize care within a region to optimize resources
Aggregate volume by− condition in fewer sites
E.g.− lower acuity surgery in community hospital settings, higher
acuity/complexity surgery in tertiary care hospitals
Copyright 2018 © Professor Michael E. Porter
29
Shifting to a Value-Based Mindset
Technician Condition Expert
Solo ActorHold a Key Role in the
IPU Team
Focus on SafetyInfluence Multiple
Patient Outcomes
Maintain Volume Across
Many Procedures
Become Expert in a
Few Conditions
Control Cost of a
Specific Procedure
Reduce Cost Over the
Complete Care Cycle
Drive Volume of
Services
Get Paid for High-Value
Care
Commodity Player Deliver Distinctive Value
Copyright 2018 © Professor Michael E. Porter30
Expanding the Role of Surgeons in the Care CycleThinking Beyond the Operating Room
Medical
Management
Preoperative
Care
Surgical
Intervention
Postoperative
CareRehabilitation Surveillance
Partner with •
medical
specialists to
manage
complex cases
and the ongoing
evaluation of
need for
surgery
Develop • non-
surgical
options with
other providers
• Collaborate with
primary care,
anesthesiologist
and applicable
specialized to
prepare patient
for successful
surgery
• Be accessible
to primary care
team for pre-
operative care
questions
Optimize the •
surgical
process
• Co-develop
best practices
with post-
operative teams
• Ensure
seamless
transition to
post op care
Shift post• -acute
care to
appropriate
settings (e.g.
home, rehab,
etc.)
Extended •
clinic hours
and after-hours
hotline
Educate• home
health team and
PT on best
practices
Ongoing •
monitoring of
patients for
recurrence
Measure longer •
term outcome
measurement
Prevention &
Detection
Work with •
primary care to
prevent
progression of
disease
Advise primary •
care on
accurate
diagnoses and
timely referral
Copyright 2018 © Professor Michael E. Porter31
Value-Based Care Models are Already Taking Off in Surgery
• Multiple value-based health care models emerging, such as in trauma, bariatric,
and cancer care
• Well-established IPU models exists within transplantation
− Mandated outcome reporting by the National Organ Transplantation Act (NOTA)
− Multidisciplinary care model became the standard of care
− Early bundled payment for kidney transplant (UCLA & Kaiser)
− Rapid dissemination of best practices and scientific breakthroughs
Copyright 2018 © Professor Michael E. Porter
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50
60
70
80
90
100
0 200 400 600 800 1000
Source: Scientific Registry of Transplant Recipients, http://www.srtr.org
Adult Kidney Transplant Outcomes1987 - 1989
32
Percent
1-year
Graft
Survival
Number of Transplants 1987 – 1989 (Three Year Period)
Number of centers: 219
Number of transplants: 19,588
1 Year Graft Survival: 79.6%
16 Greater than expected graft survival (7%)
20 Worse than expected graft survival (10%)
Copyright 2018 © Professor Michael E. Porter
40
50
60
70
80
90
100
0 200 400 600 800 1000
94.7%
Number of programs included: 209
Number of transplants: 38,370
1 Year Graft Survival:
4 Greater than expected graft survival (1.9%)
5 Worse than expected graft survival (2.4%)
Percent
1-year
Graft
Survival
Number of Transplants 2011 – 2013 (Three Year Period)
Adult Kidney Transplant Outcomes2011 - 2013
33
Copyright 2018 © Professor Michael E. Porter
The Health Care Transformation is Well Underway
We • know the path forward
Value for patients • is the True North
Value based thinking • is restructuring care organization, outcome
measurement, health system strategy, and payment models across
multiple countries
Standardized outcome measurement • and new costing practices are
beginning to accelerate value improvement
Employers• , suppliers, and insurers can be the next accelerators
Government policy • is beginning to reinforce value improvement
We are anxious to • work with all of you in accelerating this
transformation34
Copyright 2018 © Professor Michael E. Porter
Selected References on Value-Based Health Care
Porter, M.E., Teisberg, E. (• 2006). Redefining Health Care: Creating Value-Based Competition on Results. Harvard Business
Publishing.
Porter, M.E., Teisberg, E.O. (• 2007). How Physicians Can Change the Future of Health Care. JAMA;297:1103‐1111.
Porter, M.E. (• 2008). Value‐Based Health Care Delivery. Annals of Surgery; 248: 503‐509.
Porter, M.E. (• 2010). What Is Value in Health Care? New England Journal of Medicine.
Kaplan, R.S and Porter, M.E. (• 2011). How to Solve the Cost Crisis in Health Care. Harvard Business Review. September 2011.
Porter, M.E., Pabo, E.A., Lee, T.H. (• 2013). Redesigning Primary Care: A Strategic Vision To Improve Value By Organizing Around
Patients’ Needs. Health Affairs; 32: 516‐525.
Porter• , M.E. and Lee, T.H. (2013). The Strategy that Will Fix Health Care. Harvard Business Review. October 2013.
Porter, M.E. and Lee, T.H (• 2015). Why Strategy Matters Now. New England Journal of Medicine.
Carberry K., Landman Z., Xie M., Feeley T. (• 2015) Incorporating Longitudinal Pediatric Patient-Centered Outcome Measurement into
the Clinical Workflow using a Commercial Electronic Health Record: a Step toward Increasing Value for the Patient. Journal of
American Medical Informatics Association.
Ying A.,• Feeley T., Porter M. (2016) Value-based Health Care: Implications for Thyroid Cancer. International Journal of Endocrine
Oncology
Porter M.E., Larsson S., Lee, T.H. (• 2016). Standardizing Patient Outcomes Measurement. New England Journal of Medicine
Porter M.E. and Kaplan R.S. (• 2016) How to Pay for Health Care. Harvard Business Review. July 2016
Thaker N.G., Ali T.N., Porter M.E, Feeley T.W., Kaplan R.S., Frank S.J. Communicating Value in Healthcare using Radar Charts:• A
Case Study of Prostate Cancer. Journal of Oncology Practice. September 2016.
Witkowski M., Hernandez A., Lee T.H., Chandra A., Feeley T.W., Kaplan R.S. and Porter, M. E. The State of Bundled Payments, •
Working Paper. Unpublished. May 2017.
Websites Including Videos •
http://www.isc.hbs.edu/–
https://www.ichom.org/–
Case studies and curriculum guide available at: – http://www.isc.hbs.edu/resources/courses/health-care-courses/Pages/health-care-
curriculum.aspx
35