Healthcare Futurist: Joe Flower

What's working in healthcare . . .

Featured keynote talk topics

15 Ways To Make Healthcare Cheaper - by Making It Better

Healthcare Samurai: Heroes in Suits and Scrubs

The Real Questions Providers Need to Ask

(From the July 7, 2009 Hospitals and Health Networks Weekly)

How can we tell what health care "reform" will mean for providers, really, on the ground?

Politicians, the "chattering class," and especially broadcasters whose income depends on their ratings, tend to frame the debate in terms of private vs. public, "choice" vs. "the nanny state," the "free market" vs. "socialism." The realities, as they are embodied in legislation, fleshed out in regulations and hashed out in the courts, will be far more mixed, fine-grained and subtle. This is the United States. We don't tend to do anything with massive, one-size-fits-all programs.

No one central to the 2009 debate has been suggesting a truly socialist system (which would look like the National Park Service, with the government owning all providers and putting everyone on government salary). Even a straight single-payer system (like Medicare for all) is not getting much interest, or a blanket voucher system like the one proposed last year, pre-election, by Dr. Ezekiel Emanuel, now President Obama's White House health care policy adviser. We are in the land of the politically possible, and that means a mixed and messy reform, with the devil in the details, in the regulations and in the response of the industry.

How do we evaluate the bits and pieces of reform? What would be the markers that will help us plan our strategies for the coming years? Let's take a look.

What's the Future for Specialists?

On June 18, SunTrust Bank sponsored a webinar for its physician clients (most of them specialists), in which I discussed the future of business models and care models: How will medical specialists make a living in the future? And how will they care for patients?

I have prepared a white paper summarizing the webinar on the future of healthcare for specialists.

A recording of the presentation itself, a 40-minute audio and PowerPoint, is available here.

Health Care as a Complex Adaptive System

(by Joe Flower, from TheHealthCareBlog.com)

You want healthcare reform. I want healthcare reform. Grandma Jenkins wants healthcare reform.

What is healthcare reform? What kind of animal are we talking about? How would we recognize it if it came up and bit us? What are its markings, its behavior, its habits?

From observing the systems of other countries, from the results of local experiments and variations in the U.S. system, and from serious research over decades into outcomes and comparative effectiveness, we can actually outline what the marks of a better healthcare system would be.

But healthcare in the United States is a complex adaptive system. If we want to capture it fully, we have to take one step back and revisit what we know about the nature of complex adaptive systems and how that knowledge might apply to reform of this system.

Health Care as a Complex Adaptive System - Part 2: Eight Points

(by Joe Flower, from TheHealthCareBlog.com)

We can actually say what a better healthcare system would look like, if we look at healthcare in the United States as a complex adaptive system stuck in a Nash equilibrium.

The ideal reformed healthcare system would be universal, possible, understandable, cheaper, better, market savvy, incremental, and self-reinforcing.

Time for Turnaround

(by Joe Flower, from H&HN [Hospitals and Health Networks] Weekly, 5/5/09)

“Turning and turning in the widening gyre,
the falcon cannot hear the falconer;
Things fall apart: the center cannot hold . . .”

                                            —William Butler Yeats

It must seem, indeed, to many, that we are come apart, that this great lumbering patchwork ad-hocracy we call a health system is finally and beyond rescue falling to ruin, strewing pieces across the landscape, hissing steam, groaning in the joints and couplings, its old iron wheels plowing great furrows in the sand before the last gasping halt.

Maybe. There is plenty of evidence. Hospitals across the country are skirting bankruptcy while the number of people who can’t pay is soaring. As of this writing, some 3.6 million Americans have lost their jobs (and often their health insurance) in this recession, half since last September. At a time when we are really starting to hurt for physicians (particularly in primary care), half of all U.S. doctors are planning to reduce the number of patients they see or to stop practicing entirely in the next three years, according to a recent Physicians’ Foundation survey.

There is, though, a different possibility: that eventually we will look back on 2009 as the great hinge point in the history of U.S. health care, the year of the great shift, the year when we took a new direction and built something magnificent.

I believe in this possibility. The seeds of this possibility are in the vast federal stimulus package known as the American Recovery and Reinvestment Act of 2009, and in the growing momentum in Washington for comprehensive health care reform. But they are only seeds. It will take leadership and strong forward thinking by those of us in the industry to turn the possible into the real.

The difficulties in health care—the high cost, the erratic coverage, the low quality—are all systemic. We cannot cure them by fighting symptoms, or blaming any one sector. The problem, and the solution, is not in the pieces; it’s in the relationships and connections and influences among the pieces.

What this means for providers: At the core of the possibilities of this oh-so-pregnant moment is the struggle of providers to gain control over their processes and to redefine their relationships with clinicians. Each depends on the other; you cannot do either alone.

15 Ways to Make Healthcare Cheaper - By Making It Better

I'm going to say something that may surprise you. There are lots of ways to make healthcare cheaper by making it better.  It's not like getting your fender fixed. People who use healthcare - you and me - have no way to tell what's good and what's not, or even what it really costs - all we know is that we want it to cost less, and be worth more. On the other hand, people in healthcare have no incentive for doing it cheaper - in fact, they are often rewarded for making decisions that end up driving up costs. Like when a hospital gets a new MRI imaging machine - their question is: How do we get people to use it, so we can pay it off? So of course healthcare costs too much, and gives back too little. We need to change the incentives inside healthcare - what people work for, what they actually get paid to do, and we need to bring healthcare into the 21st Century.

15 Ways: Smart Medicine

Here are three more ways to make healthcare cheaper by making it better. These three are about smart medicine.

15 Ways: Smart Medicine 2

Here are three more "smart medicine" ways to make healthcare cheaper by making it better.

15 Ways: Getting Into Details

Here are three different ideas that are about what we do, for whom, for how much.

NEWEST VIDEO - 15 Ways: The Big Picture

I count at least 15 ways to make healthcare better, faster and cheaper for everyone. All of them are about value: finding what works and what doesn't at what price, finding ways for people who use healthcare and whoever pays for it to choose that value, and finding ways for the doctors, nurses, hospitals, and clinics to give us that value - more good stuff per dollar - just as many other industries have learned to do. These last two are about the big picture.