Toward a 21st Century Health System

Toward a 21^st Century Health System is a collection of thoughtful analyses that explore a key element of the health care delivery system-physician group practices. Edited by policy experts Alain Enthoven and Laura Tollen, and written by a blue ribbon panel of health policy scholars and leaders including Stephen Shortell, Hal Luft, Donald Berwick, James Robinson, and Helen Darling, this resource addresses a variety of topics, including

• Organized delivery systems
• Quality of care in prepaid group practice versus other types of managed care
• The role of physician leadership and culture in group practice
• Prepaid group practice and the formation of national health policy

This comprehensive resource also covers such topics as pharmacy benefit management, technology assessment, health services research, and employer purchasing of benefits– all as they relate to prepaid group practice.

Tables and Exhibits ix

Acknowledgments xi

The Contributors xiii

Foreword xxiii
William L. Roper

Preface xxvii
Alain C. Enthoven, Laura A. Tollen

1 Prepaid Groups and Organized Delivery Systems: Promise, Performance, and Potential 1
Stephen M. Shortell and Julie Schmittdiel

2 Systems and Results: The Basis for Quality Care in Prepaid Group Practice 22
Donald M. Berwick and Sachin H. Jain

3 The Clinical and Economic Performance of Prepaid Group Practice 45
Kenneth H. Chuang, Harold S. Luft, and R. Adams Dudley

4 Prepaid Group Practice and Health Care Policy 61
Jon B. Christianson and George Avery

5 Technology Assessment, Deployment, and Implementation in Prepaid Group Practice 85
David M. Eddy

6 Managing the Pharmacy Benefit in Prepaid Group Practice 108
William H. Campbell, Richard E. Johnson, and Sharon L. Levine

7 Prepaid Group Practice and Medical Workforce Policy 128
Jonathan P. Weiner

8 Prepaid Group Practice and Health Care Research 156
Raymond Fink and Merwyn R. Greenlick

9 Physician Leadership: “Group Responsibility” as Key to Accountability in Medicine 179
Francis J. Crosson, Allan J. Weiland, and Robert A. Berenson

10 The Limits of Prepaid Group Practice 199
James C. Robinson

11 The Relationship Between Prepaid Group Practice and the Employer Community 213
Helen Darling

12 Open the Markets and Level the Playing Field 227
Alain C. Enthoven

Editors’ Introduction to the Epilogue 247

Epilogue: Prepaid Group Practice and Computerized Caregiver

Support Tools 249
George C. Halvorson

Appendix: The Origins of Prepaid Group Practice in the United States 265
Jon A. Stewart

Index 275

ALAIN C. ENTHOVEN, PH.D (editor) is Marriner S. Eccles Professor of Public and Private Management (Emeritus), Graduate School of Business, and Senior Fellow, Institute for International Relations, Center for Health Policy, Stanford University. He was one of the architect's of the managed competition model of health reform, which was subsequently adopted by President Clinton in the Health Security Act of 1996.

LAURA TOLLEN, MPH, (editor) is Senior Policy Consultant for Kaiser Permanente Institute for Health Policy. Prior to joining the Institute, Laura was Senior Analyst and Project Director at the Institute for Health Policy Solutions, a Washington, DC-based think tank.

Toward a 21st Century Health System

Toward a 21st Century Health System's contributors include

George Avery, M.P.H., University of Minnesota School of Public Health and University of Minnesota-Duluth Department of Psychology
Robert A. Berenson, M.D., F.A.C.P., The Urban Institute
Donald M. Berwick, M.D., M.P.P., Institute for Healthcare Improvement
William H. Campbell, Ph.D., University of North Carolina at Chapel Hill, School of Pharmacy
Jon B. Christianson, Ph.D., University of Minnesota, Carlson School of Management
Kenneth H. Chuang, M.D., San Francisco Veterans Affairs Medical Center
Francis J. Crosson, M.D., The Permanente Federation
Helen Darling, M.A., National Business Group on Health
R. Adams Dudley, M.D., M.B.A., U.C. San Francisco, Institute for Health Policy Studies
David M. Eddy, M.D., Ph.D.
Alain C. Enthoven, Ph.D., Stanford University, Graduate School of Business.
Raymond Fink, Ph.D., Medical and Health Research Association of New York City
Merwyn (Mitch) R. Greenlick, Ph.D., Oregon Health and Science University Medical School
George C. Halvorson, Kaiser Foundation Health Plan and Hospitals
Richard E. Johnson, Ph.D., R.Ph., Center for Health Research, Kaiser Permanente Northwest
Sharon L. Levine, M.D., The Permanente Medical Group Harold S. Luft, U.C. San Francisco, Institute for Health Policy Studies
Sachin H. Jain, Institute for Healthcare Improvement
James C. Robinson, Ph.D., U.C. Berkeley, School of Public Health
Julie Schmittdiel, M.A., U.C. Berkeley, School of Public Health
Stephen M. Shortell, Ph.D., U.C. Berkeley, School of Public Health
Jon A. Stewart, The Permanente Federation
Laura A. Tollen, M.P.H., Kaiser Permanente Institute for Health Policy
Allan J. Weiland, M.D., Northwest Permanente, P.C.
Jonathan P. Weiner, Dr.P.H., Johns Hopkins University, Bloomberg School of Public Health

Praise for Toward a 21st Century Health System

After three decades of trying to reform health care by looking for a "silver bullet," I found the "future" has been here for more than a century. Policymakers tired of banging heads and gavels on stone walls need look no further than this well-designed analysis of prepaid group practice for the incentives necessary to enhance health system quality, safety, and performance, expand access and equity, and vastly improve the professional-patient relationship.
—Hon. David Durenberger, U.S. Senator (1978-1995), Senior Health Policy Fellow, University of St. Thomas

If you wonder why the American health system is judged by distinguished experts as "the poster boy of underachievement," read this collection of fine essays by longtime students of that system. The book is a particularly valuable read for students of medicine, health administration, and health policy. Here they will learn how much better value might be wrung out of the health system for the truly ample resources Americans grant it.
—Uwe Reinhardt, James Madison professor of Political Economy, Princeton University