This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (40)  • Contact me when this article is cited  Related Content  • Related letters  • Similar articles in JAMA  Topic Collections  • Medical Practice  • Health Policy  • Medical Practice, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Michael E. Porter, PhD, MBA; Elizabeth Olmsted Teisberg, PhD, MEngr, MS

JAMA. 2007;297:1103-1111.

Today's preoccupation with cost shifting and cost reduction undermines physicians and patients. Instead, health care reform must focus on improving health and health care value for patients. We propose a strategy for reform that is market based but physician led. Physician leadership is essential. Improving the value of health care is something only medical teams can do. The right kind of competition—competition to improve results—will drive dramatic improvement. With such positive-sum competition, patients will receive better care, physicians will be rewarded for excellence, and costs will be contained. Physicians can lead this change and return the practice of medicine to its appropriate focus: enabling health and effective care. Three principles should guide this change: (1) the goal is value for patients, (2) medical practice should be organized around medical conditions and care cycles, and (3) results—risk-adjusted outcomes and costs—must be measured. Following these principles, professional satisfaction will increase and current pressures on physicians will decrease. If physicians fail to lead these changes, they will inevitably face ever-increasing administrative control of medicine. Improving health and health care value for patients is the only real solution. Value-based competition on results provides a path for reform that recognizes the role of health professionals at the heart of the system.

Author Affiliations: Harvard University, Cambridge, Mass (Dr Porter); Darden Graduate School of Business, University of Virginia, Charlottesville (Dr Teisberg).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Changing the Organization of Health Care
Afschin Gandjour
JAMA. 2007;298(3):286.
EXTRACT | FULL TEXT  

Changing the Organization of Health Care
Truls Østbye and Lloyd Michener
JAMA. 2007;298(3):286-287.
EXTRACT | FULL TEXT  

Changing the Organization of Health Care—Reply
Michael E. Porter and Elizabeth Olmsted Teisberg
JAMA. 2007;298(3):287-288.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Value in Radiology
Gunderman and Boland
Radiology 2009;253:597-599.
FULL TEXT  

The Role of Education in Improving Physicians' Professional Use of Economic Evaluations of Health Interventions: Some Evidence From a Cross-Sectional Survey in Italy
De Vito et al.
Eval Health Prof 2009;32:249-263.
ABSTRACT  

From the Operating Room to the Board Room: An Oculoplastic Surgeon's Perspective on Health Care in America: The 2008 Wendell Hughes Lecture
Bartley
Arch Ophthalmol 2009;127:932-935.
FULL TEXT  

Dr. Harrington replies
HARRINGTON
The Journal of Rheumatology 2009;36:853-853.
FULL TEXT  

The Ethics of Transparency: Publication of Cardiothoracic Surgical Outcomes in the Lay Press.
Jacobs et al.
Ann. Thorac. Surg. 2009;87:679-686.
FULL TEXT  

Standardized care processes to improve quality and safety of patient care in a large academic practice: the Plummer Project of the Department of Medicine, Mayo Clinic
Wood et al.
Health Serv Manage Res 2008;21:276-280.
ABSTRACT | FULL TEXT  

The UK needs an Institute of Medicine
Minhas et al.
BMJ 2008;337:a1623-a1623.
FULL TEXT  

Detection of adverse events in surgical patients using the Trigger Tool approach
Griffin and Classen
Qual Saf Health Care 2008;17:253-258.
ABSTRACT | FULL TEXT  

Clinical Integration Provides the Key to Quality Improvement: Structure for Change
Shields et al.
American Journal of Medical Quality 2008;23:161-164.
 

Perspectives on Medical Outsourcing and Telemedicine -- Rough Edges in a Flat World?
Singh and Wachter
NEJM 2008;358:1622-1627.
FULL TEXT  

The GAAP in Quality Measurement and Reporting
Pronovost et al.
JAMA 2007;298:1800-1802.
FULL TEXT  

Competition on Outcomes and Physician Leadership Are Not Enough to Reform Health Care
Dixon et al.
JAMA 2007;298:1445-1447.
FULL TEXT  

Changing the Organization of Health Care
Gandjour
JAMA 2007;298:286-286.
FULL TEXT  

Changing the Organization of Health Care
Ostbye and Michener
JAMA 2007;298:286-287.
FULL TEXT  

Chronic Kidney Disease and the Public Health: Gaps in Evidence From Interventional Trials
Himmelfarb
JAMA 2007;297:2630-2633.
FULL TEXT  

Access to Care as a Component of Health System Reform
Fontanarosa et al.
JAMA 2007;297:1128-1130.
FULL TEXT