The document discusses different models for healthcare systems, including the Cathedral model, the Bazaar model, and a proposed hybrid Bazedral model. The Cathedral model is characterized by vertical integration, optimization at the system level, coordination of care, and incentives for outcomes. The Bazaar model lacks coordination, focuses on disease care and volume over value. The Bazedral model proposes using software and services integration to coordinate different aspects of healthcare delivery and payment in a way that dramatically increases value.

1. The Cathedral versus the Bazaar:
Building a 21st Century Health Care System
Scott Shreeve, MD
Chief Executive Officer
April 14, 2009

2. Cathedral vs. Bazaar

3. Care Financing Continuum
Fully Capitated Fee for Service
• Provider Risk • Payor Risk
• Preventive Care • Disease Care
• Coordination of care • Lack of coordination
• Some navigation help • Consumer left to navigate
• Results • Results
– Better Quality – Highly variable quality
– Lower Cost – High costs
– Better Outcomes – Worse outcomes

4. Cathedral Care
Vertical Characteristics:
• Kaiser, Mayo, Intermountain, VA, etc
Ancillary
• Optimization at the system level
Services
• Full coordination of care
• Information technology supports
Hospital
• Incentives aligned for outcomes
Services
• Reward for results
• Patient consumer for life
Physician
Services
• Consumer is guided through process
Patient
Services

5. Bazaar Care
Non - Integrated Characteristcs:
• Fee for Service
Ancillary
• Optimization at the component level
Services
• Disease Care
• Lack of coordination
Hospital
• No Accountability
Services
• Consumer left to navigate
• Incented for volume not value
Physician
Services
• Churn and burn; “treat ‘em & street ‘em”
Consumer
Services
(None)

6. The Bazedral
Virtually Comments:
• Software and services integration layer that
coordinates patients, providers, and payment
Ancillary
Services
with dramatic increase in value
• Key points of “Virtualization”
Organizing Entity
• Financing (payment / business models)
Hospital
Services
• Delivery (new types of arrangements)
• Incentives (increased $ for high value)
Physician
• Examples:
Services
• Medical Home ->
• Accountable Care ->
Consumer
• Health Vitality organizations
Services
(None)