Systemtheorie - Methoden und Anwendungen für ein- und mehrdimensionale Systeme (German Edition)

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deep transformation - German translation – Linguee

Click on image to Zoom. Please enter valid pincode to check Delivery available unavailable in your area. Paper Back Publishing Date: Bod Number of Pages: Submit Review Submit Review. Pick Of The Day. Little Book Of Sufi Stories: Buy this book in a Combo. Such a system will transform the terms of competition in the device market, promoting innovations that result in better outcomes for patients. Indeed, such a scenario has already played out in Australia.

Food and Drug Administration. Another important international effort is the International Consortium for Health Outcomes Measurement ICHOM 2 , a nonprofit organization with the mission of bringing together registry leaders, patient representatives, and other leading experts to define and publish globally harmonized sets of outcome metrics. In November , ICHOM published its first set of standardized metrics and risk adjustment variables for four major conditions: This year, the organization plans to develop standardized outcome measures for an additional 12 conditions. It plans to cover more than 50 conditions, representing approximately 70 percent of the disease burden in industrialized countries, by Creating data transparency around outcomes requires collaboration and data sharing—both inside and across provider organizations.

What does this have to do with competing on outcomes? Competition comes in when data start to be made public , putting pressure on laggard performers to improve and the best to remain ahead. The Society of Thoracic Surgery in the U. The ratings allow heart-bypass patients to compare how these groups performed on survival, complications, and other measures of quality care.

Individual surgeons are rated against national standards. Providers that remain ahead of the improvement curve and demonstrate superior outcomes can benefit from increased differentiation, higher patient volumes, and institutional growth. The clinic uses comprehensive data on the health outcomes of its patients, including the documentation of all complications down to the level of individual surgeons, to continuously improve its performance.

Because of this excellent performance, Martini-Klinik nearly tripled its volume of radical prostatectomies in the eight-year period from its founding in through The clinic is now the largest prostate-cancer center in the world and is widely recognized as one of the best centers for research on prostate cancer and its treatment. In some cases, payers have started to use outcomes data to actively channel patients to the most effective providers.

In Sweden, where regional governments are the primary payers for health services, the Stockholm county council recently announced that it was shifting patients who suffer ST-elevated acute myocardial infarctions or STEMI, a specific type of heart attack from the traditionally well-regarded Karolinska Hospital to the neighboring Danderyd Hospital, because the outcomes data showed that STEMI patients at Danderyd had a higher survival rate. And in the U. At the next level of competing on outcomes, payers start linking reimbursement to outcomes in order to reward the providers and suppliers that deliver the best results.

Typically, the link to reimbursement happens for specific medications, medical conditions, or discrete episodes of care, where defining positive outcomes is relatively easy. In a number of European countries, for instance, national health-technology-assessment HTA agencies are increasingly evaluating drugs in terms of their clinical impact versus the total cost of treatment.

Their assessments as to whether a given medication delivers outcomes that justify its cost have a major influence on market access and prescription behavior and can often determine the economic success or failure of a new drug. Such an approach represents a more realistic understanding of the nature of medical innovation—and the challenges of extrapolating from traditional clinical trials to mixed populations in real life.

With greater transparency and a more complete integration of the health-care value chain, the system can evaluate the effect of new products and procedures by the outcomes they achieve. In response to pressure from HTA agencies and payers, some drug companies are developing value data for their products. Relvar, or Breo Ellipta, as the drug is known in the U.

Unlike a traditional clinical trial, the study will provide the manufacturer with data on clinical efficacy in a broad population, as well as effectiveness data on health outcomes that matter to patients and on utilization endpoints.

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The study will also demonstrate to the NHS and regulators what the actual value of the drug will be when it is taken in real-world treatment settings—before it is approved. In , the Stockholm county council established a formal system of value-based reimbursement for hip and knee arthroplasty known as OrthoChoice.

The county provides a fixed bundled payment that covers all activities and procedures—from the initial patient visit and diagnosis through surgery, rehabilitation, and follow-up. Providers are responsible for any additional treatment because of complications, including revision of the replacement procedure.

And a small portion of the bundled payment—approximately 3. In the first two years of the program, complications and revisions have declined by about 20 percent, compared with a control group still enrolled in a traditional reimbursement plan. In September , the county council expanded the bundled-payment model to spinal surgery, with a substantially higher outcomes-based payment of 10 percent. As more and more data about health outcomes become transparent, and as payers embrace value-based reimbursement, some stakeholders are taking on more of the risk associated with managing whole patient health.

Because of the complexity of managing the entire health needs of a broad patient population, this is the most advanced version of competing on outcomes. Only players that have reached a high level of data sophistication, and that understand their patient segments well enough to minimize risk and to provide quality outcomes at relatively low cost, will be successful. Organizations that currently come closest to adopting the whole-patient-health approach are the single-provider integrated-delivery systems in the U. Because these institutions take on the roles of payer and provider simultaneously, they prioritize preventive care—which is generally less costly than acute care—and use only treatments with proven value for patients.

In its core West Coast markets, Kaiser has been able to provide employers with health benefits that cost up to 30 percent less than traditional managed-care plans, without sacrificing quality. And members are happy: Power and Associates study , Kaiser had the highest member satisfaction in its regions. Blue Cross Blue Shield of Massachusetts , for example, has established an alternative quality contract AQC , in which 18 health-care-provider organizations are given a global budget to care for patients who use Blue Cross Blue Shield insurance.

The providers are eligible for bonuses if they meet certain quality or financial targets; conversely, they share the financial risk for any spending that goes over budget. A Harvard Medical School study found that by the second year of the program, average spending at groups in the AQC grew 3. And groups that entered the program from the traditional fee-for-service model achieved even greater savings —6.

Although the vast majority of U. These coordinated groups of health care providers with aligned incentives, known as accountable care organizations ACOs , can benefit from new risk-sharing arrangements that reward Medicare providers for managing costs and achieving better outcomes. In certain situations, it may be that traditional suppliers are in the best position to manage risk for a given population of patients.

Originally a provider of dialysis machines, the company has expanded during the past two decades to offer dialysis care, dialysis medications, and disease management of dialysis patients. Today, Fresenius is a global leader among providers of dialysis-related health outcomes.


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And the company has increasingly been seeking to address the other conditions—such as cardiovascular disease, foot ulcers, and depression—that dialysis patients often develop. As a result, Fresenius has established a leadership position in dialysis care that will be difficult for others to challenge. In the new, more integrated and networked health-care landscape, an innovative set of capabilities will be particularly important in order to compete. The ability to forge partnerships and close collaborations will also be important.

Translation of transformation in German

Finally, we will see new business models emerging, so agility and a willingness to experiment will be necessary. Every health care business should be investing in more and better health-economics expertise, deeper epidemiological and statistical knowledge to analyze the growing quantity of outcomes data, improved key account capabilities in order to form partnerships, and the ability to conduct many pilots, learn from them, and develop differentiated value propositions for the new market.


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  • The strategic implications for any individual organization, however, will depend on its starting position, its location on the current health-care value chain, and type of health care system in the country or countries where it operates. Whether governments or private insurers, for-profit or not-for-profit, payers around the world are driving the shift to competing on outcomes.


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    In reaction to the failure of traditional cost and utilization controls, these companies are increasingly making value a major criterion for reimbursement and pushing financial risk to both providers and suppliers. As a result, payers have a major responsibility to make sure that the health care market is designed so that outcomes-based competition leads to increased innovation, better quality care, and lower costs. There is a huge opportunity for payers to create reimbursement models that deliver better value to patients than do traditional fee-for-service models.

    The key issue for payers to keep in mind is not whether health care is or should be a competitive market. The key issue is what kind of a competitive market it should become. We urge both public and private payers to push for the comprehensive collection and publication of comparable health-outcomes data and to partner with providers and professional societies to make sure that the metrics chosen and data collected are broadly recognized as valid.

    Leaders of government-funded health systems that are already highly integrated should not allow too narrow a view of market competition to fragment what is already a relatively holistic health-care environment. In countries where the health care market is much more fragmented, such as the U.

    Competing on Outcomes: Winning Strategies for Value-Based Health Care

    This trend will create opportunities for private insurers that are able to improve outcomes by coordinating care and making better use of clinical information. As they experiment with new models for reimbursement, all payers need to keep in mind that too much reliance on purely financial incentives—especially in the form of pay-for-performance bonuses—can undermine the central principles of patient benefit and data sharing on which competing on outcomes is based.

    Unless such programs are carefully designed, they can lead to perverse incentives that encourage incomplete or inaccurate reporting or to cherry-picking patients with less complex conditions, where the likelihood of a good outcome is higher. In our experience , innovative organizational designs and norms that make cooperation, transparency, and a clear focus on outcomes winning behaviors for individuals and organizations are as important—if not more—than financial incentives themselves.

    Competing on outcomes could motivate clinicians to develop innovations that improve the health and the lives of their patients.