Rouse on Transformation

I am pleased to report that IOS Press released “Engineering the System of Healthcare Delivery” this week in Amsterdam.  Denis Cortese and I edited this 500-page compendium of the insights and ideas of a wide range of luminaries in healthcare.  Our goal was to bring together in one place the thought leaders who are transforming healthcare.

The book includes six sections: 1) issues, 2) information, 3) incentives, 4) engineering approaches, 5) perspectives and, 6) prospects.  Readers will gain two overarching impressions from this book.  First, the complex adaptive system of healthcare delivery in the U.S. is extraordinarily complex.  I have characterized this system as a federation of millions of entrepreneurs with no one in charge.  Information systems that are integrated and incentives that aligned with high-value outcomes will go a long way to overcome this extreme fragmentation.

The second overarching impression that readers will gain is that we already know how to deliver high quality, affordable health outcomes.  There are many provider organizations that deliver very high quality care with costs much lower than the national average.  We know what to do; we just have been unable to get everyone to do it.  Information and incentives are also impediments in this area.

In the concluding chapter of this book, Denis and I consider prospects for change.  We conclude that within 10 years, the U.S. system will include 50-60 large, integrated providers.  Several of them may be federations of smallish practices with standardized clinical and back office systems.  The small 2-3 doctor practices that are common across the U.S. will disappear, unable to afford the cost of playing the game independently.

In 20 years, we see the emergence of “retail health.”  The health consumer will have extensive data and tools available to support decision making, including data on provider performance and costs.  This web-based infrastructure, in conjunction with human health coaches, will enable people to take charge of their own health and care.  High quality care and good services will be rewarded.  Well-informed consumers will not tolerate mediocre care and poor service.