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84 of 86 people found the following review helpful
4.0 out of 5 stars What rather than who
It is a commonplace that the U.S. healthcare system is broken, but the discussion often degenerates into a debate about who is responsible. This book takes a different approach, focusing on what is wrong with the healthcare system and needs to change so it can work better.

The proposed solution is to discard the current fee for healthcare service model, in...
Published on February 18, 2009 by William Whipple III

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0 of 2 people found the following review helpful
3.0 out of 5 stars Informational albeit a cookie cutter account
Informative, but he is a stymied writer. Felt like a canned commercial from a very tired, controlled pedant. Felt like his observations & recommendations were being forced onto us. Not unlike the square peg into a round hole.
Published 4 months ago by R. OTTO


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84 of 86 people found the following review helpful
4.0 out of 5 stars What rather than who, February 18, 2009
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This review is from: The Innovator's Prescription: A Disruptive Solution for Health Care (Hardcover)
It is a commonplace that the U.S. healthcare system is broken, but the discussion often degenerates into a debate about who is responsible. This book takes a different approach, focusing on what is wrong with the healthcare system and needs to change so it can work better.

The proposed solution is to discard the current fee for healthcare service model, in which healthcare providers are systematically paid to treat illness without recompense for fostering welfare, and create a three-track system:

(1) Fee for service would continue to apply to diagnostic services, where - due to the nature of the patient's condition and the state of medical knowledge - there is a high need for intuitive investigation versus results-based treatment for conditions that are well understood. (The process described brings to mind episodes of House, a TV show in which a brilliant but irascible doctor challenges a team of colleagues to find the problem before the patient dies.)

(2) Fee for result would apply for treating conditions that are well understood and have a clearly defined solution -- colonoscopies, laser eye surgery, implantation of stents, etc.

(3) User networks for patients with chronic conditions/ unhealthy practices to learn how they can help themselves and be motivated to do so.

As is pointed out again and again, disruptive changes will be needed to get from A to B. Thus, hospitals must be redirected to focus on diagnostic services and cede provision of standardized care and wellness coordination to specialized clinics and other agencies. Primary care physicians (the traditional "family doctor") should concentrate on diagnostic services at a lower level rather than acting as "gatekeepers" for referrals to specialists. Enabling changes in reimbursement rules, health insurance arrangements, and medical record keeping are spelled out in detail.

When the dust settles, there will be fewer hospitals (with the survivors focused on enhanced diagnosis, like the Mayo Clinic), fewer medical specialists (who currently operate in narrow niches, often without a full grasp of a patient's situation), more primary care physicians and nurses with augmented responsibilities, a new model for pharmaceutical companies that focuses on targeted medications for precisely defined conditions versus the development and marketing of "blockbuster" drugs that only help a fraction of the users and require enormously expensive mass clinical trials, and a lot of medical work performed by less highly trained personnel with better diagnostic tools.

Andy Kessler presented an analogous vision in "The End of Medicine: How Silicon Valley (and Naked Mice) Will Reboot Your Doctor," Harper Collins (2006). His book is very entertaining, but this one covers the ground in a more disciplined and comprehensive manner. I would recommend "The Innovator's Prescription" for anyone who is seriously concerned about the current healthcare system.

Doctors, hospitals, and other healthcare providers cannot make the needed changes on their own, because they do not control all the levers. Having the government take the lead is said to be problematic, for reasons that are dispassionately stated and I happen to agree with. The authors suggest that the best candidate entities for leading the transition to healthcare in the new mode might be employers that profit from the good health of their employees. Then there is the intriguing possibility of expanding the role of integrated healthcare providers,e.g., Kaiser Permanente.

Let's hope our country chooses the right path.
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22 of 24 people found the following review helpful
5.0 out of 5 stars Brilliant. Far and away the best book on health care reform., February 18, 2009
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This review is from: The Innovator's Prescription: A Disruptive Solution for Health Care (Hardcover)
The decade worth of research spent understanding, studying, and ultimately offering solutions to make the health care system more accessible, higher quality, and affordable is clear. Unlike other books, the authors avoid the traps the plague most other solutions by taking a completely different perspective by looking at other industries where products and services offered were "so complicated and expensive that only people with a lot of money can afford them, and only people with a lot of expertise can provide or use them." Yet convincingly through plenty of examples, it shows how telephones, computers, and airline travel moved from only accessible to those with the resources to become available and affordable to all.

The book tackles every aspect of health care and asks how will those in health care be disrupted and subsequently surpassed by other providers which deliver care that is more convenient, higher quality, and lower cost.

What will hospitals need to do as increasingly more surgical procedures are performed in high volume specialty hospitals?

How will doctor practices sustain themselves as new diagnostic tools and research makes the identification and treatment of problems more precise that nurse practitioners with clear protocols can deliver care previously required by physicians?

What mechanisms exist to streamline and integrate the various players of health care (doctors, hospitals, purchasers, insurers) so that all are focused on the benefit of wellness and outcomes of patient care rather than maximizing each of their own financials? (Hint: large employers will integrate health care and others will only purchase care delivered by integrated healthcare delivery systems).

What should medical schools do to prepare the next generation of doctors as current training is steeped in tradition, relevant a century ago, but woefully inadequate for the future?

How should pharmaceutical, medical device manufacturers, and diagnostic equipment makers position themselves for the inevitable changes that will affect them the same way previous leaders in other industries were overtaken by competitors and disruption?

How must the reimbursement system and regulators adapt to foster the innovation to make these changes occur?

If there is anything close to a crystal ball on what health care delivery will look like in the United States that will be increasingly affordable, higher quality, and accessible to all, this is it. The authors, respected Harvard Business School (HBS) professor, a doctor who also was the Director of Health Care Delivery Policy Program at Harvard Kennedy School, and another doctor and graduate of the MBA program at HBS have convincingly demonstrated the likely path as well as indicated why a single payer nationalized system will stifle the innovation needed to improve our health care system. Those who wish to succeed in the new world of health care as predicted by this comprehensive and thoughtful analysis would be wise to consider this book.

For those trying to navigate the increasingly frustrating, confusing, and expensive health care system as it current exists, Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America's Healthcare System would be the perfect guide book.
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57 of 69 people found the following review helpful
5.0 out of 5 stars An Industry Insider's Review of Christensen's Prescription for a Cure, February 2, 2009
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This review is from: The Innovator's Prescription: A Disruptive Solution for Health Care (Hardcover)
I have been an active participant in healthcare developing and commercializing over twenty medical technologies across nine medical specialties since the 1970's. I have also lectured on the medical industry as an Assistant Professor of Surgery at Creighton University Medical Center and as a guest lecturer at Anderson School of Management (UCLA), Haas School of Business (University of California), and Graziadio Business School (Pepperdine University), and spent significant time in the 1990's on FDA reform.

I have been privileged to have had a front-row seat observing the major changes that have shaped today's healthcare system - industry consolidation for both the supplier (pharma, med-tech, and diagnostic) and delivery (hospital, clinics, physician practice) segments; the move from unregulated fee-for-service to regulated fee-for-service; the growth of medical malpractice and its impact on the cost of healthcare; the use and misuse of technology; the draconian regulatory burden (FDA and CMS) associated with developing new life-improving or life-saving technologies; and, as a result, the growth of healthcare as a share of GDP from 6% to 16%. To this industry insider, healthcare is a system in critical condition and needs radical surgery.

Clayton Christensen who authored one of the best books on innovation ("The Innovator's Dilemma") has now teamed up with Jerome Grossman, M.D. and Jason Hwang, M.D. to bring well-researched insights into a disruptive solution for effective value-added health care in "The Innovator's Prescription." Christensen and company outline the technological enablers of disruption then show us how various aspects of the healthcare system can be effectively disrupted to produce better, more cost-effective healthcare for all Americans. These include the hospital business model, the physician practice business model, the care of chronic disease, the reimbursement system, medical education, the development of pharmaceuticals, medical devices, and diagnostics and regulatory reform. The authors leave no stone unturned and provide an integrated plan to make it happen.

"Innovator's Prescription" is a must read for all who participate directly in the funding and running of our healthcare system whether as members of the private sector or public sector, patients, or voters. Christensen and colleagues have done an extraordinary job in outlining the fundamental issues but more importantly, in providing a thoughtful way out of our current mess.
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8 of 8 people found the following review helpful
5.0 out of 5 stars exceptional. a must read, August 5, 2010
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SDB (California) - See all my reviews
This review is from: The Innovator's Prescription: A Disruptive Solution for Health Care (Hardcover)
First, if you want to see a 90 minute lecture by Dr Christensen on the topic of disruption in health care, you can watch a video of it for free. Just google the title of the book and the video will pop up.

Now to the actual book review: this book is truly exceptional. Dr Christensen is renown for introducing us to the concept of 'disruptive innovation' and has now spent many years researching this from a health care perspective. The output is this fabulous book and it should be a must read for anyone interested in the evolution of the American health care system.

I read Innovator's Dilemma a few years ago. While he used it to introduce a paradigm shift into the world's thinking about innovation, the book was unfortunately very academic, dry and boring. At times, I had to clench my teeth and force myself to continue reading. Not so with Innovator's Prescription. His writing style has evolved considerably in the past 12-15 years and Innovator's Prescription is not written for the academic, but for the health care, government and medical professionals most likely to read it. It is worth the money.

Kudos Dr. Christensen!
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14 of 16 people found the following review helpful
5.0 out of 5 stars A brilliant analysis -- if only Washington would listen, March 25, 2009
This review is from: The Innovator's Prescription: A Disruptive Solution for Health Care (Hardcover)
Clayton Christensen, the groundbreaking thinker behind "The Innovator's Dilemma" turns his mind to the healthcare industry. If you know The Innovator's Dilemma you know that the focus is on disruptive innovation -- specifically on how little, initially imperfect technological solutions (think PCs) can disrupt big, rigid, expensive businesses (think mainframes).

Is there any bigger, more rigid, more expensive business than healthcare?

This exhaustive and extremely well researched analysis (done together with two doctors, the late Jerome Grossman and Jason Hwang) describes in a way that was clear to me for the first time, what's wrong with the health care industry. Basically, it's designed to pay for the wrong things.

The Innovator's Prescription shows how health care businesses are of three types: "solution shops" that use clever people to solve problems, value-adding process businesses that do the same thing well over and over, and facilitated networks (like Alcoholics Anonymous). Because elements of the health care system (like hospitals) do all of these, they can't get good at any one, and they can't shift costs effectively. And the system, as it always does, reject changes that would allow healthcare to be more efficient.

Let's be fair: this book is too long, partly because the health care system is too complex and the authors take on every single problem. But they have a proposed solution to all those problems. I wish the Obama administration would get a good look at this analysis, since it's not overtly liberal or conservative -- instead, it's the only way we could actually get past the cost and quality problems in the health system.

If you've ever sat in a doctor's waiting room wondering "why is this system such a mess -- isn't there any way to make it better," this book is for you. Read it. Then tell your congressman to read it.
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6 of 6 people found the following review helpful
5.0 out of 5 stars A Brilliant Analysis of the Fundamental Problems and Potential Solutions, March 5, 2009
By 
Kenneth M. Riff (Wayzata, MN United States) - See all my reviews
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This review is from: The Innovator's Prescription: A Disruptive Solution for Health Care (Hardcover)
US healthcare is extraordinarily complex, and some very good strategists and analysts have badly missed the mark when they turn their skills to healthcare. These authors have clearly done their homework, and they bring their subject matter expertise of healthcare to Christenson's formidable strategic and analytic skills. The combination is breathtaking in its scope and clarity.

I have long since lost track of how many books and articles I have read, and how many conferences I have attended, over the past decade on the causes and proposed solutions for our healthcare mess. By the time I finished the introduction and Chapter 1 of The Innovator's Prescription, I recognized there is more truth and insight in those forty pages than in all of those books, articles, and conferences combined. The book presents an astonishing way of deconstructing and visualizing the fundamental business model problems- I have never seen it modeled this way before. Once Christenson demonstrates the similarities to other industries that have undergone disruptive innovation, the answer to our healthcare problem becomes obvious. Christenson's logical clarity in articulating the structural nature of the problem, accompanied by clear practical solutions for addressing them, makes this book a pleasure to read and serves as a call to action for those charged with making changes.

The biggest disadvantage to reading this book is that you may despair over the solutions being proposed to address the symptoms that do not address the underlying problem of faulty business models. On the other hand, after a decade of hand-wringing over the intractable nature of our healthcare problems, it is exciting to see that there really is a clear path to building an affordable, high-quality, consumer-friendly healthcare system. This book is truly a pleasure!
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5 of 5 people found the following review helpful
5.0 out of 5 stars A Guide to Unleashing Efficiencies More Rapidly in U.S. Healthcare, July 27, 2010
By 
Donald Mitchell "Jesus Loves You!" (Thanks for Providing My Reviews over 122,000 Helpful Votes Globally) - See all my reviews
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This review is from: The Innovator's Prescription: A Disruptive Solution for Health Care (Hardcover)
"For I know the thoughts that I think toward you, says the LORD, thoughts of peace and not of evil, to give you a future and a hope." -- Jeremiah 29:11 (NKJV)

In The Innovator's Prescription, disruptive innovation expert Professor Clayton M. Christensen teams with Jerome H. Grossman, M.D., and Jason Hwang, M.D. to consider how new technologies, improved business models, changed processes, improved regulation, and better ways of training can greatly expand the amount of health care that can be provided for what is being spent now, opportunities to speed better treatments through development and testing, and patients can be encouraged to do more for themselves. The basic arguments are based on analogies to other major industries where disruptive innovation caused costs to drop as greatly simplification and specialization occurred.

I think that few will disagree that the opportunities described here are mostly real ones. I wasn't convinced that the foundations for change are sufficiently well established to make serious shifts in the United States. I believe that what is described here is very likely to occur rather in the rapidly developing part of the emerging market countries such as India (home of Aravind Eye Care System) where the lack of any health care for many creates a humanitarian incentive to lower regulatory barriers and to push aside old, outmoded habits.

Americans don't seem to be fundamentally unhappy with their system of very expensive health care that produces results in many categories that are inferior to what is achieved in other developed countries. It's a lot like the benefits the U.S. government dispenses when it runs trillion dollar deficits. Most people are getting a lot more back than what they put in. The free lunch will have to stop before the efficiencies will begin.

I was pleased to see that unlike earlier books by Professor Christensen this one attempts to integrate business model innovation into the discussion. The result was unfortunately pretty primitive, describing four categories of business models rather than the full richness of business model innovation. I'm increasingly persuaded that the so-called disruptive innovation school is really just the study of how specialists simplify, streamline, and organize markets that poorly organized generalists are trying to milk through charging as high prices as possible. That's only one category of disruptive innovation, but it is certainly a valid one that has been very important for over 100 years.

The book's other missed opportunity is to look well beyond what today's best practices suggest . . . toward what the ideal way to foster competition to do a great deal more for less and improved health (rather than health care) would look like.

Despite those missed opportunities, I don't know of a better book for proposing some helpful ways to at least allow Americans to get more health care for what is being spent. Nice work!
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12 of 15 people found the following review helpful
5.0 out of 5 stars Every voting adult should read this book., January 2, 2009
This review is from: The Innovator's Prescription: A Disruptive Solution for Health Care (Hardcover)
The Innovator's Prescription. A disruptive solution to healthcare Clayton M. Christensen, Grossman & Hwang. 2008. ISBN 9780071592086. Ten years in the making, this is another very useful analysis by the Christensen team. I quickly found seven immediate money making ideas for the tech industry in healthcare in this book. As ever, the book is clear and well written, with fascinating footnotes in every chapter (almost a book within the book) . The author(s) are no fans of govt all in one funded ( ie Canada-style) healthcare - but they have an equal dislike of the present US model.

He echoes one of the results of the Rocket Builders - NRC Healthcare opportunities study - which was that opportunities lie in the interstitials between silos and layers o f the US and Canada system. He extends it further by illustrating the fundamental and repairable structural flaws in the present systems. The disruptive opportunities he shows up are very near, real and often just waiting for th erigth group to sieze onto them.

As ever he points out how to start with a less than ideal solution for the unserved market - which is easier in the US vs Canada, where we have a poor but working solution - we then require a dramatically better solution for disruption. He also suggests that a democracy is not the tool to effect change, unless the change is so subtle, few notice. For every change proposed in a democracy, someone will lose from the status quo, and they have lots of political levers to pull to keep things the same. He also repeats that it is impossible to effect the change from within- reminding us that IBM was the only company to survive multiple disruptions, each time through first creating a distinct stand alone division , outside of the corporate culture.

Doctors will cry out No! when reading the section on commoditization of health care services - but if they look around they will see that it is happening . Using Christensen's view, hospitals should finally be able to decide what type of business they are in (He IDs three distinct types) and then they will be able to carve ot the metrics to help them change to a sustainable model.

A very good book for all of us. Its our money.
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13 of 17 people found the following review helpful
5.0 out of 5 stars Provocative Perspectives Worthwhile to Anyone Involved in the Health Care Debate, February 24, 2009
This review is from: The Innovator's Prescription: A Disruptive Solution for Health Care (Hardcover)
As the CEO of Walgreens, I'm involved in the health care debate every day. Clayton Christensen's fascinating book provided me with interesting insights on one of my favorite strategies: innovation. I've recommended that all of my senior management team read The Innovator's Prescription. Clayton's provocative perspectives and viewpoints should be of great interest to them as we take our company and its offerings to the next level.
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3 of 3 people found the following review helpful
5.0 out of 5 stars A must read for anyone in the healthcare industry, November 9, 2011
This review is from: The Innovator's Prescription: A Disruptive Solution for Health Care (Hardcover)
A must read for anyone in the Healthcare industry, especially if you want to know what the future may hold for this business sector that represents a whopping 17% of our GDP. Christensen and Grossman cover an amazing amount of ground, first setting the stage for how "disruptive innovation" will soon impact healthcare then describing in detail the potential impact on hospitals, physicians, nurses, and patients as well as pharmaceutical and diagnostic companies.

Particularly fascinating to me is the theory that practicing medicine will continue to evolve from what is mostly an intuitive approach (requiring highly trained physician experts to make sense of "soft" data like symptoms) to one of "precision medicine" that is based on well-established and supported treatment pathways. Such pathways can be easily followed by lesser-trained professionals, such as nurses, significantly reduce healthcare costs.

Also discussed is the need for our healthcare system to become more integrated, while moving away from the very expensive fee-for-service model. Integrated healthcare delivery networks, such as Kaiser, profit from keeping patients well, not from providing an overabundance of services and tests. Not surprisingly, they invest heavily in preventative measures and wellness programs, all geared toward keeping their constituents healthy.

Medicare, which pays for approximately 50% of all healthcare expenses in the US, is now providing incentives to healthcare providers who integrate into what are called "Accountable Care Organizations, or ACO's. As of January 2012, Medicare will offer to share cost savings with ACO's that reach certain healthcare quality and cost-effectiveness standards. In the future, there is no question those healthcare providers who integrate will be much more successful than those who don't.

This book, written in 2009, is proving to be rather prophetic as our healthcare industry evolves at an ever-quickening pace. Highly recommended.

[...]
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The Innovator's Prescription: A Disruptive Solution for Health Care
The Innovator's Prescription: A Disruptive Solution for Health Care by Clayton M. Christensen (Hardcover - December 4, 2008)
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