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Much of the healthcare debate is centered on cost - the skyrocketing cost of direct patient care, the cost to insure millions of currently uninsured people, the administrative costs that eat up a large chunk of every healthcare dollar, the cost of defensive medicine to avert malpractice lawsuits. How can it be that we spend more than $700 billion each year on medical care that fails to improve patients’ health and often harms them?
The problems are cultural. We “know,” for example, that modern medicine is largely backed up by solid science. We boast that our delivery system is superior because we offer access to more and newer services than any other country. We’ve focused a great deal on safety improvement over the past decade. Our physicians and hospitals are paid to deliver the right care. Our medical schools are the envy of the world. All of this we know.
There is no easy fix to these problems, of course. But there is a best place to look: focus on quality. This is a book about debunking healthcare myths through the lens of quality. Poor healthcare quality derives from uncertainty in clinical decision-making, from persistent unexplained variation in physician practice patterns, from still-inadequate accountability for quality and patient safety, from payment for piecework and from medical training curriculum that is decades behind the curve. Reclaiming quality by addressing each of these deficiencies will transform the economics of our healthcare system.
This is not a utopian critique. It is based on a quality revolution that is already underway and is gradually transforming the way medical care is delivered in the U.S.
This is a pivotal moment in American healthcare delivery, marked by tremendous innovation. Much of that innovation is aimed at “busting” our counterproductive myths: improving physician decision-making, building a better research base to compare the effectiveness of different treatments for the same medical condition, devising accountability mechanisms that work, piloting second-generation pay-for-performance models, paying greater attention to quality improvement in medical training curriculum and expanding access to quality care in non-traditional venues.
Even the reader who thinks he or she knows all about some of the topics in this book will appreciate the manner in which DEMAND BETTER! integrates these topics into a cohesive appraisal of core problems and cutting-edge solutions that are of great interest to them. DEMAND BETTER! synthesizes for the healthcare executive the many trends, initiatives, reports, organizations and policies that look beyond our healthcare myths and stand on the front lines of the quality and safety revolution.
|About The Authors|
Sanjaya Kumar, M.D., M.P.H., is President, CEO and Chief Medical Officer of Quantros, Inc., a leader in web-based healthcare quality, data management, and patient safety applications. Quantros products are used in one out of every three US hospitals. Dr. Kumar is driven by an agenda aimed at improving the quality of care provided to patients by today’s evolving healthcare delivery systems. He has been the clinical lead on many cooperative clinical quality improvement projects. Dr. Kumar serves on numerous quality improvement committees, task forces and working groups, both at the national and state levels and is a frequent speaker at national healthcare conferences and meetings. Dr. Kumar has been published widely in peer reviewed medical journals and has hosted various healthcare industry conferences. Dr. Kumar authored the book Fatal Care: Survive in the US Health System which was published in 2008.
David Nash, M.D., M.B.A., is the Founding Dean of the Jefferson School of Population Health on the campus of Thomas Jefferson University in Philadelphia, Pennsylvania. Dr. Nash is also the Dr. Raymond C. and Doris N. Grandon Professor of Health Policy and this endowed professorship is one of a handful of such chairs in the nation. The appointment as the Founding Dean culminates a nearly twenty-year tenure at Jefferson.
Dr. Nash, a Board Certified Internist, founded the original Office of Health Policy in 1990. Thirteen years later, the Office evolved into one of the first Departments of Health Policy in an American medical college. In 2008, the Board of Jefferson University approved the creation of the new school. The Jefferson School of Population Health represents the first time a health-sciences university has placed four Masters Programs under one roof, namely a Masters in Public Health, Health Policy, Healthcare Quality and Safety and Chronic Care Management. The goal of this innovative school is to produce a new type of healthcare leader for the future.
Dr. Nash is internationally recognized for his work in outcomes management, medical staff development and quality-of-care improvement; his publications have appeared in more than 100 articles in major journals. He has edited nineteen books, including A Systems Approach to Disease Management by Jossey-Bass,Connecting with the New Healthcare Consumer by Aspen, The Quality Solution by Jones and Bartlett, Practicing Medicine in the 21st Century by ACPE, and most recently, Governance for Healthcare Providers by Performance Press. In 1995, he was awarded the Latiolais (“Lay-shee-o-lay”) Prize by the Academy of Managed Care Pharmacy for his leadership in disease management and pharmacoeconomics. He also received the Philadelphia Business Journal Healthcare Heroes Award in October 1997 and was named an honorary distinguished fellow of the American College of Physician Executives in 1998. In 2006, he received the Elliot Stone Award for leadership in public accountability for health data from NAHDO. Dr. Nash received the Wharton Healthcare Alumni Achievement Award in 2009.
Repeatedly named by Modern Healthcare to the top 100 most powerful persons in healthcare list, his national activities include The Care Continuum Alliance, Chair of an NQF Technical Advisory Panel, membership in the American College of Surgeons’ Health Policy Institute and a recent appointment to the ACP Clinical Guidelines Project - four key national groups focusing on quality measurement and improvement. He continues as one of the principal faculty members for quality of care issues of the American College of Physician Executives in Tampa, Florida, and is the developer of the ACPE Capstone Course on Quality. For the last decade, he was a member of the Board of Trustees of Catholic Healthcare Partners in Cincinnati, Ohio – one of the nation’s largest integrated delivery systems and he chaired the Board Committee on Quality and Safety. He recently was appointed to the Board of Main Line Health – a four hospital system in suburban Philadelphia, PA.
Dr. Nash was recently appointed to the Board of Directors of Humana, a Fortune 200 company headquartered in Louisville, KY. He is a consultant to organizations in both the public and private sectors including the Technical Advisory Group of the Pennsylvania Health Care Cost Containment Council (a group he has chaired for the last decade), and numerous corporations within the pharmaceutical industry. From 1984 to 1989, he was Deputy Editor, Annals of Internal Medicine, at the American College of Physicians. Currently, he is Editor-in-Chief of four major national journals including P&T, Population Health Management, Biotechnology Healthcare and the American Journal of Medical Quality. Through his writings, public appearances and his digital presence, his message reaches more than 100,000 persons every month.
Dr. Nash received his BA in economics (Phi Beta Kappa) from Vassar College, Poughkeepsie, New York; his MD from the University of Rochester School of Medicine and Dentistry, where he was recently named to the Alumni Council, and his MBA in Health Administration (with honors) from the Wharton School at the University of Pennsylvania. While at Penn, he was a former Robert Wood Johnson Foundation Clinical Scholar and Medical Director of a nine physician faculty group practice in general internal medicine.
Unfortunately, we have a long way to go before we can depend on safe, effective health care in American
hospitals. I’m grateful to thought leaders like Drs. Sanjaya Kumar and David Nash who bring rare clarity
to both the problems and the solutions. This book is an excellent overview of complex and sensitive issues,
and a well-lit roadmap for those of us determined to bring about real change.
Leah F. Binder, MA, MGA
Chief Executive Officer, The Leapfrog Group
Doctors Sanjaya Kumar and David Nash have written what will undoubtedly be one of the most important
books in the history of American healthcare. DEMAND BETTER! Distinguishes itself because it pulls no
punches in laying bare the truth: America’s healthcare non-system is not what we have mythologically
believed it to be. Grossly overpriced and half as effective as the systems of many nations, American
healthcare stands alone as a perverse engine of perpetual illness, the fee-for-service financial model
succeeding only if the level of medical need among Americans remains the same.
Literally every sentient American needs to read this book, and every state legislator, governor and member
of Congress has a responsibility to acknowledge its hard-hitting lessons. There is a pathway to true
excellence and real reform, and Kumar and Nash are lighting the way.
John J. Nance, JD
International Speaker on Patient Safety and Quality Care, Attorney, Pilot, Aviation Analyst for
ABC World News and Good Morning America. Author of Why Hospitals Should Fly, the James A. Hamilton
2009 ACHE Healthcare Book of the Year
Demand Better! Revive Our Broken Healthcare System by Drs. Sanjaya Kumar and David Nash
makes a significant contribution to the rapidly evolving literature documenting the current healthcare crisis
in America. Take this book seriously! All of us should read it with the safety of our friends, families and
ourselves firmly in mind.
Doctors Kumar and Nash have given us a burning platform from which to mandate quantum improvement
in American medical practice. That massive reorientation will not be easy to accomplish, but it is
necessary, if we are to improve the results they cite as placing us at the bottom of so many international
health status indicators. It is the right thing to do not only for our patients but for our children and our
Glenn W. Mitchell, MD, MPH, FACEP
Chief Medical Officer
Sisters of Mercy Health System
Title: Demand Better! Revive Our Broken Healthcare System
Authors: Sanjaya Kumar, MD, MSc, MPH and David B. Nash, MD, MBA
Format: Hardcover - This book is also available in Paperback
Publisher: Second River Healthcare
Pub. Date: March 2011
Edition Number: 1st
Product Dimensions: 8.4" x 5.6" x .8"