Foreword |
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xvii | |
Acknowledgments |
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xxi | |
Introduction |
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xxiii | |
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1 | (12) |
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Vision of a Fundamentally Different Future |
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1 | (5) |
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6 | (1) |
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Healthcare Isn't the First Industry in Transition |
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7 | (2) |
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9 | (4) |
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2 Whose Agenda Controls Your Healthcare? |
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13 | (26) |
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Why a Market-Based Model for Healthcare Is a Good Thing |
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13 | (1) |
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How Did We Get into This Mess? |
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14 | (5) |
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19 | (2) |
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Understanding Healthcare Reform as Business Model Change |
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21 | (2) |
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Central Role of Payment Reform |
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23 | (1) |
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Unintended Consequences: The Hospital Example |
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24 | (4) |
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Paying for Volume, Not Results |
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24 | (1) |
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Real Impact of CMS on Quality of Care and Costs |
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25 | (3) |
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Unintended Consequences: The Primary Care Example |
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28 | (2) |
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Discouraging the Type of Care That Results in Better Outcomes |
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28 | (1) |
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Creating a Critical Shortage of the "Right" Kind of Doctors |
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29 | (1) |
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Healthcare Is Big Business |
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30 | (2) |
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31 | (1) |
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Creating a Competitive, Functioning Market |
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32 | (4) |
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There Is Little Accountability in the Current System |
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33 | (1) |
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There Is Little Information Available on Which to Base Responsible Care Decisions |
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33 | (2) |
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There Is Already Enough Money in the System |
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35 | (1) |
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There Is a Solution, and It's Closer than Some Think |
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36 | (1) |
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37 | (2) |
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3 In the Eye of the Storm: The Role of Consumers and Employers |
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39 | (12) |
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40 | (2) |
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Whose Agenda Controls Your Healthcare? Another Look |
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42 | (3) |
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Perversion of the Concept of Insurance |
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45 | (1) |
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Where Do Employers Fit into the Equation? |
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46 | (1) |
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What Can Consumers and Employers Do? |
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46 | (3) |
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Demand Transparency and Accountability |
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47 | (1) |
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Move Conversation toward a Continuum of Care |
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47 | (1) |
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Create/Become Informed Consumers |
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48 | (1) |
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Create Incentives for Better Health Behaviors |
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48 | (1) |
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Change Is Never Easy, but It Is Possible |
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49 | (2) |
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4 Comparative Effectiveness Research: Creating an Environment for Change |
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51 | (12) |
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52 | (3) |
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52 | (2) |
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Role of Political Expediency |
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54 | (1) |
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Why Is the Federal Government Specifically Involved? |
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55 | (1) |
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56 | (5) |
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Expected Criteria for Choosing Priorities |
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60 | (1) |
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61 | (2) |
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5 Redesigning Healthcare Delivery: Hospitals Were Never Meant to Be Destinations of Choice |
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63 | (28) |
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Adapting to the Changing Landscape of Healthcare |
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65 | (6) |
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Needed: A Transfusion of Fresh Thinking |
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66 | (3) |
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Management Infrastructure |
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69 | (1) |
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70 | (1) |
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Comparative Effectiveness Research Is Shaping Healthcare Delivery |
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71 | (8) |
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Development of Predictive Care Paths |
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73 | (1) |
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73 | (1) |
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Impact of CER on Hospital Operations |
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73 | (2) |
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Prudent Responses and Defensive Strategies |
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75 | (4) |
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Accountable Care Is Needed, ACOs Are Not |
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79 | (5) |
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80 | (1) |
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Any Provider Can Provide More Accountable Care |
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81 | (3) |
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What Are You Waiting For? |
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84 | (1) |
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Bundled Payment: The Next Step in Improving Quality and Reducing Cost |
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84 | (5) |
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Why Will Bundled Payment Models Do Any Better? |
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85 | (1) |
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86 | (1) |
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St. Elsewhere: A Case Study in Bundled Pricing |
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87 | (1) |
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Taking a Proactive Approach to a Market in Transition |
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88 | (1) |
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Competing with a Bundled Price |
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89 | (1) |
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89 | (2) |
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6 A Brave New World for Payers |
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91 | (20) |
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Adapting to the Changing Landscape of Healthcare Insurance |
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92 | (3) |
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Needed Here, Too: A Transfusion of Fresh Thinking |
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95 | (1) |
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95 | (2) |
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97 | (1) |
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Implications for Healthcare Insurers |
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98 | (1) |
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99 | (9) |
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Develop Partnerships with Providers |
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101 | (1) |
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102 | (1) |
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Focus Partnerships on the Prevention of Never Events |
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102 | (1) |
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Require and Pay for Predictive Care Paths |
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103 | (1) |
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Change the Basis for Paying Primary Care Physicians |
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104 | (2) |
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Increase Consumer Engagement and Personal Responsibility, Reducing the Abuse of the System by Consumers |
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106 | (1) |
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Reduce Fraud and Abuse by Providers |
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107 | (1) |
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Are You Ready for Disruptive Innovation? |
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108 | (1) |
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109 | (2) |
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7 Big Pharma: How to Regain Success |
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111 | (24) |
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Vulnerabilities of the Current Model |
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113 | (2) |
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Market-Driven Business Model |
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115 | (5) |
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Ensuring Stakeholder Value |
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116 | (2) |
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Strategic Marketing Capabilities |
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118 | (1) |
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119 | (1) |
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120 | (1) |
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Role of CER in the Pharmaceutical Industry |
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121 | (6) |
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122 | (2) |
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Focus on Cost Effectiveness |
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124 | (1) |
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End of the Placebo-Only Controlled Trial |
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125 | (1) |
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Impact of CER on Pharmaceutical Operations |
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125 | (2) |
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Prudent Responses and Defensive Strategies |
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127 | (6) |
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127 | (1) |
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Diversify Revenue Streams Away from Payers |
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128 | (1) |
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Adopt a Rolling Blockbuster Approach |
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129 | (3) |
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132 | (1) |
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133 | (1) |
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134 | (1) |
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8 A New Day Is Dawning for Medical Device and Diagnostics Manufacturers |
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135 | (28) |
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Getting Products to Market: Change Is in the Wind |
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135 | (5) |
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Implications for the Industry |
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138 | (1) |
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139 | (1) |
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CER: The Threat for Medical Devices |
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140 | (7) |
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End of the "Last Version Plus 5%" Business Model |
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141 | (2) |
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Increased Pressure to Rightsize Functionality |
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143 | (1) |
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Increased Competition with Drugs |
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144 | (1) |
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Restricted Qualification for Devices |
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144 | (1) |
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Impact of CER on Medical Device Operations |
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145 | (2) |
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Prudent Responses and Defensive Strategies for Medical Device Companies |
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147 | (2) |
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Adopt Strategies Suited to the New Environment |
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147 | (1) |
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Focus on Reducing the Cost of the Procedure |
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148 | (1) |
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148 | (1) |
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Embrace the Cost--Functionality Trade-Off |
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149 | (1) |
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CER: The Opportunity for Diagnostics |
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149 | (4) |
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Reduced Tolerance for Redundant Testing |
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150 | (1) |
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151 | (1) |
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Possibility of Mass Screening |
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152 | (1) |
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Impact of CER on Diagnostics Manufacturer Operations |
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152 | (1) |
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Prudent Responses and Defensive Strategies for Diagnostics |
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153 | (2) |
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Diversify the Revenue Base |
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154 | (1) |
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Begin to Develop Partnerships for Custom Diagnostics |
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155 | (1) |
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Where Do Medical Device and Diagnostics Companies Go from Here? |
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155 | (5) |
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Hospital-as-Customer Requires a New Sales Model |
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159 | (1) |
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160 | (3) |
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9 Putting Value at the Center of Healthcare |
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163 | (34) |
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Recent Legislative Solutions and Why They Won't Work |
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165 | (1) |
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Accountability for Care Is a Good Concept |
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166 | (11) |
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ACOs: Their Original Purpose |
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166 | (1) |
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ACOs: Their Role in PPACA |
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167 | (2) |
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Government-Sponsored Payment and Delivery Systems |
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169 | (1) |
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Top-Down Approach to Complex Health Policy Problems |
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170 | (2) |
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172 | (2) |
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Recommendations for Policymakers: Healthcare Delivery |
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174 | (3) |
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Enabling Markets to Create Access to Care |
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177 | (6) |
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Creating Access to Affordable Health Coverage |
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178 | (1) |
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Recommendations for Policymakers: Access to Care |
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179 | (4) |
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Supporting Innovation: Finding the Right Balance at the Food and Drug Administration |
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183 | (9) |
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Regulation's Impact on Innovation: A Two-Edged Sword |
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184 | (5) |
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Making the Rules Clearer, More Transparent, and Simpler |
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189 | (1) |
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190 | (2) |
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Patent Life: Shooting Ourselves in the Foot |
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192 | (1) |
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193 | (4) |
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10 Creating a Roadmap for Change |
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197 | (22) |
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Revisiting the Challenge of Industry Transition |
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197 | (4) |
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Safety in Size? The Rush to Affiliation |
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201 | (4) |
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Consolidation and the Challenge for Manufacturers |
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203 | (2) |
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Additional Challenges for Manufacturers |
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205 | (3) |
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Creating Collaborations to Develop Lifetime Value |
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206 | (2) |
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208 | (1) |
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208 | (4) |
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209 | (2) |
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Increase Perceived Quality |
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211 | (1) |
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Creating and Sustaining a New Business Model |
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212 | (1) |
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Harnessing Consumer Choice and Competition to Ensure Accountability: Final Thoughts for Policymakers |
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213 | (3) |
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216 | (3) |
Index |
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219 | (26) |
About the Authors |
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245 | (4) |
About NAI |
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249 | |