OncologyNEJM Explores The Value-Based System Approach To Health Reform
In a New England Journal of Medicine perspective published online last night, Harvard Business School Professor Michael E. Porter outlines a national health care strategy. Recognizing "a new openness to changing a system that we all agree is broken," Porter emphasizes the need for a "value-based system" that both moves toward universal insurance coverage and restructures the care delivery system. Porter offers six steps critical to achieving such a system:
"First, we must change the nature of health insurance competition. Insurers, whether private or public, should prosper only if they improve their subscribers" health ... Second, we must keep employers in the insurance system ... Third, we need to address the unfair burden on people who have no access to employer-based coverage, who therefore face higher premiums and greater difficulty securing coverage ... Fourth, to make individual insurance affordable, we need large statewide or multistate insurance pools, like the Massachusetts Health Insurance Connector, to spread risk ... Fifth, income-based subsidies will be needed to help lower-income people buy insurance .... Finally, once a value-based insurance market has been established, everyone must be required to purchase health insurance so that younger and healthier people cannot opt out."
He also points to some mutually reinforcing mechanisms to restructure the delivery system. They include emphasizing the measurement and dissemination of health outcomes; creating a reimbursement system focused on improving value for patients; using electronic medical records that support integrated care and outcome measurement; and ensuring that consumers become more involved in their own health care. Porter concludes: "This undertaking is complex, but the only real solution is to align everyone in the system around a common goal: doing what"s right for the patients" (6/3).
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