In 1999 I wrote “No Margin, No Mission” for The Physician Executive. The article opened with this paragraph,
“A tough-minded Catholic nun, the CEO of a major not-for-profit health system on the West Coast, captured the dilemma of our health system with this down-to-earth comment:” No margin, no mission.” This article and many others indicate any organization, however noble its mission , whether “for-profit” or “not-for-profit,” must make a profit to survive as an institution and to serve its constituents. Whether a business or a charitable organization runs the enterprise makes little difference. Both need to make profit to survive. No mission is more noble than caring for the sick. That's what medicine and hospitals are for. But to say openly that one must "make a profit" running a hospital, medical practice, or health insurance company or "compete for patients" is unseemly.”
The proposed NEJM Catalyst is a “resource’ will “provide health care leaders with information to provide these leaders with information that can help them redesign patient care, change the structure of their institutions, contemplate new relationships with outside organizations, and reconsider the ways in which incentives are being used.
The NEJM Catalyst will have 4 overlapping themes.
1) The “New Marketplace,” which will focus on health policy and markets impacts on payer and provider consolidation, value-based payment, competition and consumer choice.
2) “Care Redesign” which will concentrate on how to create and sustain the teamwork needed to provide high-value care, and the practical ways of organizing care to enhance health as well as sick care.
3) “Patient Engagement: Behavioral Strategies for Better Health.” This will focus on what is known about the use of incentives (financial and non-financial ) to engage patients in improving their own health.
4) “Leadership.” This will be about engaging clinicians in to enhance the value of care .
Mass General, which is closely linked to the NEJM, is experimenting in creating a new marketplace, redesigning care, engaging a new set of patients to provide for the old set of patients , and taking a leadership role in health reform.