Chaos and Organization in Health Care

One of the most daunting challenges facing the new U.S. administration is health care reform. The size of the system, the number of stakeholders, and ever-rising costs make the problem seem almost intractable. But in Chaos and Organization in Health Care, two leading physicians offer an optimistic prognosis. In their frontline work as providers, Thomas Lee and James Mongan see the inefficiency, the missed opportunities, and the occasional harm that can result from the current system. The root cause of these problems, they argue, is chaos in the delivery of care. If the problem is chaos, the solution is organization, and in this timely and outspoken book, they offer a plan.

In many ways, this chaos is caused by something good: the dramatic progress in medical science—the explosion of medical knowledge and the exponential increase in treatment options. Imposed on a fragmented system of small practices and individual patients with multiple providers, progress results in chaos. Lee and Mongan argue that attacking this chaos is even more important than whether health care is managed by government or controlled by market forces.

Some providers are already tightly organized, adapting management principles from business and offering care that is by many measures safer, better, and less costly. Lee and Mongan propose multiple strategies that can be adopted nationwide, including electronic medical records and information systems for sharing knowledge; team-based care, with doctors and other providers working together; and disease-management programs to coordinate care for the sickest patients.

I The Problem Is Chaos
1 Chaos 3
2 Progress 19
3 Fragmentation 37
II The Solution Is Organization
4 What Does Organization in Health Care Look Like? 55
5 What Kinds of Systems Improve Health Care? 71
6 Tightly Structured Health Care Delivery Organizations 97
7 Organizing the Mainstream of U.S. Medicine 119
8 What Can Payers, Employers, and Patients Do? 143
III How Do We Get There?
9 Evolution or Revolution? 163
10 Provider Change 175
11 Payment Change 195
12 Market Change 211
13 Accelerating Evolution 229
References 249
Further Readings 263
Index 267