Looking
Back: Reflections from Seasoned CEOs
Featured
Articles
Frist
TF Jr. Historical Perspective on Horizontal Integration. In Herzlinger,
Regina E. Consumer-Driven Health Care. Jossey-Bass. 2002 (in press).
Over the course of the past 30 years, hospitals have emerged from their
cottage industry roots and have adopted business practices developed
in other industries. The author explains the advantages and disadvantages
of a horizontally organized hospital system, through a case study of
the largest system-Hospital Corporation of America. Several advantages
are as follows: the ability to share timely, accurate aggregated patient
care data from a large group of hospitals and physicians (e.g., employee,
patient and physician satisfaction surveys, outcome data, JCAHO results);
standing national panels of physicians; identified best demonstrated
practices; highly qualified workforce; employee benefits; purchasing
power; new products/services; access to more sources of capital and
the equity markets; geographic diversification; and, state-of-the-art
information systems.
Schroeder
SA. Reflections on the Challenges of Philanthropy. Health Affairs. 1998
July/August; 17(4): 209-216.
The author looks back on his tenure and discusses the grant-making approach
employed by the Foundation, as president of The Robert Wood Johnson
Foundation (RWJF). One of the five largest grant-making foundations
and the only one of its size to focus solely on health issues, the mission
of RWJF is to improve the health and health care of the American people.
The author highlights the principal challenges the Foundation faces:
accountability (evaluation, feedback, and disclosure); impact; social
challenges (race and class, role of government); and, internal management
(core commitments, core values).
Warden GL. Challenges and Opportunities in Seeking a Balanced Health
System. In Health and Health Care 2010: The Reactions. Princeton, NJ:
The Robert Wood Johnson Foundation. February 2000.
The article notes the impact of the Balanced Budget Act on the health
care delivery system, specifically, how it severely limited resources.
The author discusses changes, challenges and opportunities in the following
areas: upward cost pressures, demand for efficiency and productivity,
managed care, the voice of consumers, information technology, competition
based on quality, health care as a commodity, personnel shortage, the
purchasers prevail, and the future.
Other
Articles
Warden
GL. Chaotic, Shifting Relationships of Purchasers, Plans, and Providers.
Health Affairs. 1996 Winter; 15(4): 116-117.
The author, as president and chief executive officer of the Henry Ford
Health System in Detroit, MI, provides his view on how purchasers are
shaping the marketplace. Noting that private-sector forces have been
driving health system change at an unpredicted rate, he outlines three
trends: "the assumption of risk by providers in the form of direct
contracting, for either "carve-outs" or full capitation; the
need to develop quality-of-care/outcome measures for providers and provider
networks, not just for health plans; and the weakening financial support
for medical education and research."
Whitelaw
NA, Warden GL. Reexamining the Delivery System as Part of Medicare Reform.
Health Affairs. 1999 January/February; 18(1): 132-143.
The authors, as executives from a large health care system that treats
a number of elderly patients, offer their view of what Medicare reform
needs to accomplish. Medicare reform must support a coordinated health
care delivery system (in place of hospital-centered, fragmented care)
and proactive chronic disease management (in place of episodic, reactive
care). Consumers, government, community-based agencies, employers, health
plans, and others need to develop a shared understanding of what outcomes
we want to obtain, what delivery system reforms are required, and how
financing can support those reforms.
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