Michael Porter and Others Show How to Deliver Better Care in Value-based Healthcare Documentary

Glimpsing the future of healthcare, in its new value-based form, doesn’t require a psychic, a crystal ball, or a time machine. Value-based healthcare can be seen flourishing today, and to see it simply requires a quick trip around the world to visit a few brave, forward-thinking healthcare pioneers.

Measured Outcomes: A Future View of Value-Based Healthcare did just that. This video documentary, featuring professor Michael Porter of the Harvard Business School, follows 12 healthcare innovators, leaders, physicians, and administrators, from Hamburg, Germany; Gothenburg, Sweden; and Boston, Massachusetts, as they discuss value-based healthcare and outcomes improvement in their respective fields.

How is it that Martini-Klinik, a clinic of 10 surgeons in Hamburg, Germany, performs 2,200 prostatectomies a year when the average hospital in Germany performs only 50 (and Mayo performs only 1,600)? And how is it that the success rate of the clinic as measured by those treated with a nerve-sparing procedure is 88 percent, while the rest of the country is at 32.8 percent? (It’s no wonder a whopping 98 percent of patients recommend the clinic after their treatment.)

The secret to the clinic’s success is the standardization of what gets measured and then comparing those measurements regularly. The surgeons understand that there can be no improvement without knowing the results of the care they provide for their patients. Another secret is the permanence of the surgical team. When Prof. Dr. Hartwig Huland founded the clinic, he hired nine of his former associate professors, each with their own prostate cancer subspecialty, to join him for life because he knew that with this life-time commitment, behavior would change and motivation for long-term projects (e.g., outcomes improvement studies) would be different.

A third secret to their success is how they follow their patients after discharge. In 1914, a pioneering Boston-area surgeon named, Ernest Codman said, “Every hospital should follow every patient it treats long enough to determine whether the treatment has been successful, and then to inquire ‘if not, why not’ with a view to preventing similar failures in the future.” It may have taken 100 years, but we’ve come full circle to what is really important, the concept that tracking outcomes is key to success in value-based healthcare.

Martini-Klinik is one of the few clinics in Germany to have a “gapless data documentation system,” where the results of all patients are recorded and processed long term.

Dr. John Meara is the plastic surgeon-in-chief at Boston Children’s Department of Plastic and Oral Surgery, the largest provider of its kind in the world. He considers outcomes to be critical; they form the basis for all decisions and changes in best practice. He praises the hospital’s leadership team for linking quality, safety, and outcomes together with cost. He also states that it’s important to have a dataset with information that flows in both directions so a surgeon can view it in real time, look at costs in real time, and then overlay that with outcomes metrics in real time.

Sahlgrenska University Hospital in Gothenburg Sweden took on a value-based approach to its healthcare delivery in an attempt to financially help a troubled three-hospital merger. Dr. Barbro Friden, managing director at the hospital, looked at how to take the organization to the next level beyond financial solvency, how to increase the motivation of doctors, how to increase the innovativeness of the teams, and how to bring innovation closer to the patient more quickly. Dr. Stefan Larsson of The Boston Consulting Group states that value-based healthcare is really a simple concept, but once you start applying it, it becomes transformative and changes how you think about the organization and remuneration.

Professor Michael Porter of the Harvard Business School is a long-time prominent voice on value-based healthcare. In the documentary, he puts a fine point on defining what value-based means: “If today, you’ve improved outcomes without escalating any costs, you’ve succeeded. If today, you’ve delivered equally good outcomes more efficiently, you’ve succeeded. And if today, you didn’t do one of those two things, you’ve failed.”

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