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Better Management is Key for Health Reform

Most proposals for Health Care change concentrate on insurance reform: how can we cover more people, how do we pay for it, and what level of care is delivered?

And these policy decisions are important, but they miss a big opportunity to reduce costs and improve patient care through better business management practice, says Richard M.J. Bohmer, a physician and professor at Harvard Business School.

As he tells HBS Working Knowledge:

"It is hard not to feel that the cart has been put before the horse. We ought to think about the optimal way of caring for a particular type of patient and then how to pay for that optimal way rather than say, 'Here's the payment regime, what can we do in this context?'''
Bohmer argues we should be asking four questions:
  1. What is the best way of configuring and managing services?
  2. Who are the professionals we need?
  3. What is the optimal setting and context in which they should be delivering care?
  4. What processes should they use?
For example, we should be conducting more care delivery experiments such as substituting nurse practitioners for physicians for certain routine care, using in-store clinics to treat simple diseases, and technology that allows patients and doctors to conduct real medical conversations at a distance. All three allow more doctors to concentrate their skills on improving disease management rather than on routine care.

Medical institutions also need to get better at what many businesses already do routinely: capture knowledge gained from day-to-day successes and failures that can be used to improve practice.

"At the national level we don't hear much about these innovations -- yet they present an equally important set of issues," Bohmer argues. "We need to make a distinction between debating how it will be paid for and what the 'it' is that is paid for."

Read the entire interview.

Can better management cure what ails health care? What do you think?

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