Repairing a broken health care system

In their new book, Unraveled: Prescriptions to Repair a Broken Health Care System, physicians William B. Weeks and James N. Weinstein look at the health care experience through the eyes of patients and families, and prescribe practical, effective remedies for a dysfunctional system.

"We spend far too much money on health care, and the impact of all that spending varies significantly based on where one lives and where one obtains care," Weeks and Weinstein write. "Few players in the health care arena – whether patients, providers, or payers – are satisfied; most find the current construct of health care delivery inconvenient, incoherent, and even scary."

In Unraveled, Weeks and Weinstein offer simple steps that patients can take now to ensure that their care is effective, efficient, and satisfying, and that they have the information necessary to make the best health care decisions for themselves and their families. In a series of scenarios based on actual clinical experience, Weeks and Weinstein analyze the entire health care process, from gaining access to the health care system, to the office visits, through testing and diagnosis, to treatment and payment, and through end-of-life issues. Each chapter frames an issue through a case study, discusses its background and context, and proposes a solution.

For Weinstein, the leader of a nationally recognized health system, the book is deeply personal: he writes, in part, based on the experiences of his family through the illness and death at age 12 of his daughter Brieanna, who battled cancer for 10 years.

"I have had a very personal – and unfortunate – experience, one that has transformed my life and that of my family forever, and has encouraged me to write this book. I want others to better grasp the challenges inherent in the current health care system, to see what is possible, and to understand why health care delivery needs to move from a system based on volume to a system of value based on outcomes," he writes. "We need a sustainable health system that is focused on the health of communities and populations and not on growing market share; a system that moves away from fee-for-service reimbursement … toward reimbursement contingent on achieving the best possible outcomes at the lowest possible cost."

"The irony is that America has the best health care available in the world – it has pockets of excellence wherein exceptionally delivered, high-value care is the norm," writes Weeks. "But it also has enormous problems with access to care, the ability to consistently deliver high-value care, and waste. I fear that if we do not get health care costs under control – now – the debt that will continue to be created will bankrupt the next generation, a generation already hampered by high levels of debt. We have the tools necessary to improve health care efficiency. We need to install required supportive structures, carefully evaluate the effectiveness of health interventions, show the results of that deployment, and work together to improve the nation's health."

With easy-to-understand language and real-life examples, Weeks and Weinstein explain how and why the health system works as it does, and what we can do to fix it. And they give a glimpse of a not-too-distant future where care will be built around the needs of the patients and delivered conveniently, seamlessly, with greater effectiveness and at lower cost. It's a future that offers greater satisfaction for patients AND for their providers, many of whom now feel trapped by an overly complex, bureaucratic system that robs them of the joy they once experienced in caring for patients. The Affordable Care Act provided millions with access to health care. Unraveled tells us how we can take the next steps to make health care work for all of us.

Dr. William B. Weeks is a Professor at The Geisel School of Medicine at Dartmouth, where he studies health care value creation. He has been honored as the 2008 National Rural Health Association Outstanding Researcher and the 2016 Fulbright-Toqueville Distinguished Chair and IMéRA Visiting Professor at Aix-Marseille University.

Dr. James N. Weinstein is CEO and President of Dartmouth-Hitchcock Health system where he is a leader in advancing 'informed choice' to ensure patients receive evidence-based, safe, effective, efficient, and appropriate care. An acclaimed spine surgeon and researcher, he is a member of the National Academy of Sciences Institute of Medicine, an Ellis Island Medal of Honor recipient, and has been named one of "The 100 Most Influential People in Healthcare" by Modern Healthcare magazine.

Unraveled: Prescriptions to Repair a Broken Health Care System (ISBN-13: 978-1518609251) is available on Amazon for $12.95 ($9.99 Kindle version).

All proceeds from the sale of the book go to support the physical, emotional, and educational needs of children with severe illness and their families.

ABOUT DARTMOUTH-HITCHCOCK – Dartmouth-Hitchcock (D-H) is a nonprofit academic health system that serves a population of 1.9 million in New England. Anchored by Dartmouth-Hitchcock Medical Center in Lebanon, NH, the system includes the Norris Cotton Cancer Center, one of only 45 Comprehensive Cancer Centers in the nation; the Children's Hospital at Dartmouth-Hitchcock; affiliate hospitals in Keene and New London, NH, and Windsor, VT; and 24 Dartmouth-Hitchcock Clinics that provide ambulatory services across New Hampshire and Vermont. D-H provides access to more than 1,000 primary care doctors and specialists in almost every area of medicine. In partnership with the Audrey and Theodor Geisel School of Medicine at Dartmouth and the White River Junction VA Medical Center in White River Junction, VT, it trains nearly 400 residents and fellows annually, and performs world-class research.

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