 Presentation to Center for Public Leadership, Harvard Kennedy School:

 Access?  Availability?  Equity?  Cost containment?  VALUE = Outcomes -:- Costs

 Multidimensional  Over time…

 Total cost of all services for full care cycle

1. Organize system around patient 2. Measure outcomes and costs 3. Pay in “bundles” 4. More connection, less all-service stand- alone 5. Break down and out of narrow geographies 6. IT, but not for a broken system

 “From organizing around the exception to organizing around the rule”  Primary Care: organize around specific patient populations  Volume for specialization and dedicated facilities

 Now: only measuring processes…  Must measure outcomes

 Establish universal measurement and reporting  Shift reimbursement systems  bundled  Medicare to lead…  Remove obstacles to integration  Stark Laws limiting referrals (“conflict of interest”)?  Separate payments to hospitals and doctors?  Illegal to hire a doctor as an employee?  Open competition  Encourage patient responsibility  Set standards and mandate EMR adoption