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Harvard economist proposes team approach on healthcare

Focus would shift to central services

WASHINGTON -- A renowned Harvard economist unveiled a plan yesterday to revamp the US healthcare system by focusing on the value of care to patients, arguing that improving the quality of medical services can by itself save money and provide a road map to a national health plan.

Michael E. Porter , a specialist in competition and strategy at Harvard Business School , said that doctors should work together in teams and measure their performance afterward to help fix the national health system. Porter outlined his ideas at a briefing in Washington and in an article published today in the Journal of the American Medical Association. His coauthor was Elizabeth Olmsted Teisberg of the University of Virginia.

One of the world's most sought-after and well-paid consultants for corporate CEOs, Porter only recently began examining healthcare issues, but his ideas are gaining a foothold due in part to a book cowritten with Teisberg and published last year called "Refining Health Care." He said at least two leading hospitals, Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and the Cleveland Clinic in Ohio, have embraced the philosophy of putting high priority on quality care.

"As important as insurance coverage is, insurance is just the beginning," Porter said at yesterday's briefing. "If we just fix insurance, but don't fix the delivery of healthcare, we might have a greater crisis than we have today."

The nation's healthcare system is using "21st-century technology delivered with a 19th-century system," Porter said. Medical care, he added, is "the only sector in our economy that has not undergone reconfiguration seen everywhere else."

Porter's talent, according to some who have worked with him, is in breaking down business systems and analyzing how particular strategies affect results. His thinking on business management is taught in nearly every business school in the country.

Most proposals to overhaul US healthcare systems -- including extending insurance to all Americans -- address the "margins" of the problem, Porter said. Doctors, he added, must lead the effort to help create "a system where everyone is rewarded for value."

For example, a patient undergoing treatment for breast cancer typically has to make repeat appointments with different doctors and specialists on different days. Under his model, Porter said, the same patient should be able to walk into one building and meet various specialists on the same day, and those specialists should immediately consult with one another.

Then, he said, the hospital should closely follow its cases, tracking survival rates, recovery times, and patient satisfaction, among other things.

While some people may believe his proposals are too radical for the healthcare system, Porter said, "The good news is it's already happening" at the Cleveland Clinic and Dartmouth-Hitchcock.

Dartmouth-Hitchcock's Norris Cotton Cancer Center has recently revamped its system of care, centralizing services. Gwendolyn Natola , the center's project manager, said cancer specialists meet patients and consult on treatment strategies in a large open space called the "bullpen."

"The patient does not have to go on different visits, or to different buildings at different times," Natola said. "Instead, all the doctors are there."

Dr. Burton Eisenberg , a surgeon and the center's deputy director, said doctors who had worked independently on some cases now work collaboratively on behalf of patients. "The system allows physicians to evaluate the patient in a very concise way so that each physician is responsible for some aspect of care, and is immediately communicating that position to the others," he said.

Natola said the new system can help patients save money.

"We service a rural area and some people travel two to three hours to get care," she said. "If they see five doctors in one day, versus five doctors over six weeks, that obviously is going to save time -- time away from work, time on the road -- and save on gas."

Such examples show that "physicians no longer should see themselves as isolated," Porter said. "They need to see themselves as part of a team."

Porter acknowledged that no two patients would evaluate care the same way.

"We'll get better at this over time," he said. "The only way to know is to start down this path and measure outcomes."

John Donnelly can be reached at donnelly@globe.com

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