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1 " One quarter of Medicare beneficiaries have five or more chronic conditions, sees an average of 13 physicians each year, and fills 50 prescriptions per year. "
― Clayton M. Christensen , Innovator's Prescription
2 " There are more than 9,000 billing codes for individual procedures and units of care. But there is not a single billing code for patient adherence or improvement, or for helping patients stay well. "
3 " It turns out that for most people who have chronic diseases with deferred consequences, "improve my financial health" is a much more pervasively experienced job than "maintain my physical health. "
4 " this is a serious development for our medical training establishment is that a host of technological enablers will fuel the disruption of specialists by primary care physicians in the future. "
5 " Keeping high-volume procedures within general hospitals allows hospitals to subsidize the unique, low-volume specialized capabilities that are so central to the value proposition of their solution shops- being able to diagnose and embark on a therapy for anything that might be wrong. "
6 " The fact that hospitals and physicians' practices are not job-focused, but instead aspire to do anything for anybody, has caused them not to be integrated correctly. In their current configuration, they cannot be consumer-driven. "
7 " Reimbursement has become the primary mechanism through which the regulation of doctors occurs in the United States.2 To the extent that doctors cannot afford to do things they are not paid to do, and will gladly do more of those things they are paid handsomely to do, the decisions about whether, when, and how much to pay doctors for the various things they do has unwittingly become one of the most pervasive and powerful regulatory mechanisms ever devised. "
8 " What makes the encumbrance of reimbursement even more distortive and binding is that most prices insurers pay are not set by market forces. Rather, they are administered prices that reek of the pricing algorithms and backroom negotiations used in communist systems. Those "
9 " The structure of today's health-care industry is essentially structured around taking our problems to the solution. In the other industries we've studied, disruption inverts this system, so the solution is delivered to the problem. Downloadable "
10 " Meanwhile, expecting expensive institutions to become more cost efficient, and asking expensive professionals to take pay cuts while squeezing in more and more patients, are not viable avenues for making health care affordable and available. Afford-ability and accessibility come instead from disruptive innovations that enable less expensive caregivers, and less expensive venues of care, to become capable of doing progressively more sophisticated things, with equal or better quality than their high-cost counterparts. "
11 " Finally, we recommend most strongly that medical educators must begin teaching tomorrow's doctors to become much better at creating, improving, and managing processes and systems. "
12 " What would the cost of [a] hamburger at TGI Fridays be if, instead of paying for the outcome of good food delivered in a congenial location by friendly service, we actually just paid for the number of cooks . . . and how many wait staff that went by . . . What would happen to the price of a hamburger? "
13 " As Medicare, Medicaid, and private health assistance companies pervasively inserted themselves between patients and providers, the market ultimately evolved toward what economists call monopsony—where a few huge, powerful buyers essentially determine the prices they will pay to their more fragmented suppliers. "
14 " Interestingly, even though MinuteClinic employs no doctors in its clinics, it has never been sued for malpractice. The reason is that malpractice lawsuits arise primarily in cases of mis-diagnosis and flawed therapeutic judgment.16 Because MinuteClinic practices in the realm of precision medicine, its diagnoses are precise and its therapies predictably effective. "
15 " We will get growth and affordability in health care not by replicating the expertise of today's physicians in the form of new physicians. We will get it by embodying their expertise in devices and equipment, so expertise becomes widely available, more affordable, and much easier to obtain. This "
16 " People who don't want to do something that they know they should do have marvelously inventive abilities to ignore what they know. They "
17 " On the other hand, the shortage of primary care physicians is so severe that 43.7 percent of the 21,885 residency positions in internal medicine in 2005 were filled by graduates of foreign medical schools30—because most of those coming out of American medical schools opt for training as specialists. This "
18 " Rather, in our distorted fee-for-service world, the work to coordinate and oversee care just isn't as profitable as other activities. "
19 " The job that an EHR is designed to do is a systemic job, not a local one. It is designed to enable different providers in different locations to see what kinds of care other doctors and institutions have given or are rendering to a patient. It "
20 " Few people have physically and emotionally survived more than one SAP implementation project.42 "