Health Care in the Next Curve

(CRC Press: Boca Raton, FL) -- In the book, Health Care in the Next Curve (CRC Press, 2018), author John Abendshien takes an objective and sometimes scathing look at the current industry structure: a silo-driven culture and entrenchment that is driven by self-interest, as well as the complicity of government in preserving the status quo through regulation, licensure, and payment systems. Abendshien provides a fresh perspective unencumbered by current state realities. He deals with major pieces of the puzzle and doesn’t get bogged down by technical or arcane analysis.

Healthcare in the United States is at a critical juncture. We face a sharp upward rise in the number of people with chronic diseases and disabilities. As demands on our current health system grow, so will costs. But as a society we are approaching the upper limit of how much we are willing (or able) to spend on healthcare. Healthcare policy makers know this. That is why major health reform measures are focused on population health and value-based care. These are the so-called second curve objectives. But these initiatives are doomed to failure. We are asking a system to do things that it was not designed to do.

In fact, we don’t have a healthcare “system” as such. We have a parts bin of disconnected silos. Fragmented delivery systems. Specialized caregivers. Professional groups. Trade associations. All with distinct cultures. Each with its own motivations and agendas.

Our payer and regulatory structures have evolved over the decades in response to political and policy initiatives. However well-intentioned (or not), these structures defy logic. They reward and reinforce counterproductive industry behaviors. They pose formidable roadblocks to achieving needed changes.

Current reform initiatives are an implicit recognition that our health model is flawed. The attitude seems to be, “Yes, we know the overall health system is a problem, but we can make failure less severe if we implement these measures.” We can continue to place additional demands on an industry model that has outlived its functional utility, or we can take more of a clean-slate approach and move toward a model that is in keeping with today’s needs.

The outlook is not good if we stay on the current curve. The demands on resources will continue their upward trajectory. The default scenario will be one of rationing and less to invest in new cures and new technologies. The good news is that we are within sight of a future state of healthcare that can really work. In this future state, we have gotten rid of the artificial barriers to effective and efficient patient care. Physicians and other health professionals work in a coordinated, interdisciplinary fashion. They have accountability for the whole care cycle. Caregivers have both the flexibility and encouragement to innovate and come up with optimal delivery approaches. And because they are in a risk-reward relationship with payers, they have the incentives to provide true value. Patients feel intimately connected to a system that is focused on their specific needs.

The key to this future state is good old-fashioned market discipline. Other delivery models must either improve or get out of the way. The market will demand cost-efficiencies and won’t tolerate waste. Much of our regulatory structure will be rendered unnecessary. There will be no rewards for poor performance.

About the author

John Abendshien is founder and president of Integrated Clinical Solutions, a national healthcare consulting firm headquartered in Chicago. He has more than 40 years of experience providing consulting and advisory services to healthcare organizations in the areas of enterprise strategy, integrated clinical service development, management/governance organizational design, mergers, and network formation. He has conducted more than 400 consulting engagements across the United States, Canada, and the United Kingdom with a broad range of organizations, including community hospitals, healthcare systems, county systems, academic medical centers, physician groups, and professional and trade organizations.

Abendshien is a frequent speaker and lecturer on strategic planning and organizational change management. He is a past chair of the American Association of Healthcare Consultants, and has served as a member of the Governance 100. He holds a bachelor’s degree in finance, an MBA, and a master’s degree in health services administration.

About The Author