The Innovator's Prescription: A Disruptive Solution for Health Care

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A groundbreaking prescription for health care reform--from a legendary leader in innovation . . .

Our health care system is in critical condition. Each year, fewer Americans can afford it, fewer businesses can provide it, and fewer government programs can promise it for future generations.

We need a cure, and we need it now.

Harvard Business School’s Clayton M. Christensen—whose bestselling The Innovator’s Dilemma revolutionized the business world—presents The Innovator’s Prescription, a comprehensive analysis of the strategies that will improve health care and make it affordable.

Christensen applies the principles of disruptive innovation to the broken health care system with two pioneers in the field—Dr. Jerome Grossman and Dr. Jason Hwang. Together, they examine a range of symptoms and offer proven solutions.


  • “Precision medicine” reduces costs and makes good on the promise of personalized care
  • Disruptive business models improve quality, accessibility, and affordability by changing the way hospitals and doctors work
  • Patient networks enable better treatment of chronic diseases
  • Employers can change the roles they play in health care to compete effectively in the era of globalization
  • Insurance and regulatory reforms stimulate disruption in health care

Customer Reviews:

  • Brilliant. Far and away the best book on health care reform.
    The decade worth of research spent understanding, studying, and ultimately offering solutions to make the health care system more accessible, higher quality, and affordable is clear. Unlike other books, the authors avoid the traps the plague most other solutions by taking a completely different perspective by looking at other industries where products and services offered were "so complicated and expensive that only people with a lot of money can afford them, and only people with a lot of expertise can provide or use them." Yet convincingly through plenty of examples, it shows how telephones, computers, and airline travel moved from only accessible to those with the resources to become available and affordable to all.

    The book tackles every aspect of health care and asks how will those in health care be disrupted and subsequently surpassed by other providers which deliver care that is more convenient, higher quality, and lower cost.

    What will hospitals need to do as increasingly more surgical procedures are performed in high volume specialty hospitals?

    How will doctor practices sustain themselves as new diagnostic tools and research makes the identification and treatment of problems more precise that nurse practitioners with clear protocols can deliver care previously required by physicians?

    What mechanisms exist to streamline and integrate the various players of health care (doctors, hospitals, purchasers, insurers) so that all are focused on the benefit of wellness and outcomes of patient care rather than maximizing each of their own financials? (Hint: large employers will integrate health care and others will only purchase care delivered by integrated healthcare delivery systems).

    What should medical schools do to prepare the next generation of doctors as current training is steeped in tradition, relevant a century ago, but woefully inadequate for the future?

    How should pharmaceutical, medical device manufacturers, and diagnostic equipment makers position themselves for the inevitable changes that will affect them the same way previous leaders in other industries were overtaken by competitors and disruption?

    How must the reimbursement system and regulators adapt to foster the innovation to make these changes occur?

    If there is anything close to a crystal ball on what health care delivery will look like in the United States that will be increasingly affordable, higher quality, and accessible to all, this is it. The authors, respected Harvard Business School (HBS) professor, a doctor who also was the Director of Health Care Delivery Policy Program at Harvard Kennedy School, and another doctor and graduate of the MBA program at HBS have convincingly demonstrated the likely path as well as indicated why a single payer nationalized system will stifle the innovation needed to improve our health care system. Those who wish to succeed in the new world of health care as predicted by this comprehensive and thoughtful analysis would be wise to consider this book.

    For those trying to navigate the increasingly frustrating, confusing, and expensive health care system as it current exists, Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America's Healthcare System would be the perfect guide book....more info
  • An Inspiring Masterpiece
    It has been 12 years since Clayton Christensen published his ground breaking and seminal book - The Innovators' Dilemma. In the twelve years that has passed since The Innovator's publication, Christensen has written many ground-breaking articles and books. Each time he provided clarity and unique insights that helped shape our views about strategy, innovation, and growth. Then along came The Innovator's Prescription, Christensen's inspiring masterpiece on healthcare.

    While we are used to Christensen and his team distilling complexity into understanding to provide insight, The Innovator's Prescription has a "voice" that speaks to the reader with a rare clarity and resonance.

    Using the frameworks of disruptive innovation, Christensen and his fellow authors drill down to understand the causal factors and mechanisms that lie below a system that many view as out of control. This search for fundamental understanding continues to be one of the tremendous strengths of his work.

    An example of the insight and understanding developed in this book is the application of disruptive solutions for the care of chronic diseases. The authors classify a number of diseases by the degree to which behavior change is required and the motivation to comply with the best known therapy. Diseases such as type 2 diabetes, the consequences of not treating the disease are often deferred and treatment often requires significant behavioral changes. Finding effective treatment of "behavioral-dependent diseases with deferred consequences" is therefore much different from diseases that have immediate consequences where little behavioral change is required For many of those suffering from diseases such as type 2 diabetes and for those who are trying to provide effective therapy, these insights ring true. They will enable us to find better solutions - ones that will actually work. The book is loaded with such treasures - better healthcare solutions that are easier to access, cost less, are more effective, and are widely available.

    Looking into the future is nothing new for Christensen and his team. He has published numerous articles and books in this vein (e.g., Seeing What's Next) that have foretold with uncanny accuracy changes to come in the very nature of industries. The Innovator's Prescription paints a landscape of change for all aspects of healthcare: hospitals, physicians, pharmaceutical and device companies, patients, government, etc. It speaks clearly of the changes to come. It is an inspiring masterpiece of solutions for our healthcare crisis. Let's hope the world is listening!
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  • The future of medical education concept deserves a book of its own
    In Innovator's Prescription, the authors spend less time reviewing the failures of the past, as was the case in Innovator's Dilemma. Exhaustive examination of failed technology business models is replaced by more of what the future of the health care industry will look like. Hospitals as we know them are not yet extinct. Also, the inefficiencies of care remain insulated from full market elasticity. However, this is changing with HSA-driven, consumer cost consciousness, and quality-inducing Medicare/Medicaid reimbursements.

    Unlike contemporary books on this topic, the authors are careful not to blind readers with best technologies yet to come. More importantly, topics such as medical education and fee-for-service delivery models are deliberated with understandable eventuality amidst validated economic and market forces.

    The compelling vision that is the future of medical education deserves a book of its own. The diminishing role cited of today's medical schools slaps a wake up call onto the face of this traditional cash cow. As the Toyota Production System impacts time, cost, and quality with a jump from series to parallel processes, it's suggested that the same will happen for the medical school. Just how science learning and clerkship will merge together remains to be seen. Absent from this dialogue is the "speed to competency" movement gaining ground for medical simulation and certification.

    The unsustainability of medical education meeting the needs of the masses receives no better example than the following field and need disparity:
    -more are being trained and less are needed (specialists)
    -less are trained when more are needed (nurses)

    To resolve this issue, the current Administration seeks to adopt incentives (student loan reimbursement, etc.) to offset the imbalance. This trend, however, feeds the ongoing demand for specialty hospitals as maximized quality follows free market models versus mandated models.

    Innovator's Prescription concludes that `fee for service' and `direct to consumer' health care will become more prevalent. The successful business models of the future in this market space reflect disaggregation of `hospital care as we know it' services. Point-of-care diagnostics, outpatient surgery clinics, retail health clinics, are among the spectrum of simplifying innovations in health care standards of the future.
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  • Every voting adult should read this book.
    The Innovator's Prescription. A disruptive solution to healthcare Clayton M. Christensen, Grossman & Hwang. 2008. ISBN 9780071592086. Ten years in the making, this is another very useful analysis by the Christensen team. I quickly found seven immediate money making ideas for the tech industry in healthcare in this book. As ever, the book is clear and well written, with fascinating footnotes in every chapter (almost a book within the book) . The author(s) are no fans of govt all in one funded ( ie Canada-style) healthcare - but they have an equal dislike of the present US model.

    He echoes one of the results of the Rocket Builders - NRC Healthcare opportunities study - which was that opportunities lie in the interstitials between silos and layers o f the US and Canada system. He extends it further by illustrating the fundamental and repairable structural flaws in the present systems. The disruptive opportunities he shows up are very near, real and often just waiting for th erigth group to sieze onto them.

    As ever he points out how to start with a less than ideal solution for the unserved market - which is easier in the US vs Canada, where we have a poor but working solution - we then require a dramatically better solution for disruption. He also suggests that a democracy is not the tool to effect change, unless the change is so subtle, few notice. For every change proposed in a democracy, someone will lose from the status quo, and they have lots of political levers to pull to keep things the same. He also repeats that it is impossible to effect the change from within- reminding us that IBM was the only company to survive multiple disruptions, each time through first creating a distinct stand alone division , outside of the corporate culture.

    Doctors will cry out No! when reading the section on commoditization of health care services - but if they look around they will see that it is happening . Using Christensen's view, hospitals should finally be able to decide what type of business they are in (He IDs three distinct types) and then they will be able to carve ot the metrics to help them change to a sustainable model.

    A very good book for all of us. Its our money....more info
  • Intelligent and thought-provoking
    It's rare to find a book that provides a new conceptual approach to anything, let alone health care, and then presents ideas in a dynamic, interesting way. This book does both, combining a sophisticated understanding of business models with an appreciation of the way systems work in real life.

    Essentially, the authors say that medical providers play different roles, needing different types of institutions. A diagnostician needs different skills, tools and techniques than a surgeon or someone who's managing a long-term condition. Their second point is that normally, the market replaces outmoded forms naturally, through entrepreneurial innovation.

    For instance, Netflix offers competition to storefront video rental stores. In the medical world, the Netflix equivalent would not be available to consumers because all the players in the system can protect their turfs.

    There are only a few questions I would raise.

    First, end of life care is the most costly part of our health care system. Other books - often by physicians - acknowledge that these costly measures tend to be invasive and actually force people to endure a painful, degrading experience just before they die. The authors barely acknkowledge this reality, noting only that end of life costs are related to chronic conditions such as diabetes or heart disease. Regardless, even after a healthy lifestyle, end of life costs can be overwhelming.

    Second, the authors praise HMOs, such as Kaiser or Group Health. These models do offer more efficient health care delivery, but participants pay a price: impersonal treatment, limited choice of providers, and few opportunities to appeal decisions. Providers are rewarded for conserving resources. Usually it's a win-win but sometimes patients suffer consequences.

    Third, I can't help wondering if the growth in alternative treatments represents a consumer response to an innovation. The same people who complain about $25 copays often pay hundreds or thousands or dollars for vitamins, supplements and alternative therapies, yet feel satisfied. It's worth exploring.

    Finally, the authors seem to assume employers will always be part of the health care system. This assumption has become increasingly dangerous as more people seek self-employment.

    Alas, prescriptions don't work unless you fill them and take as directed. The authors point out the challenges of getting any change into the system. Knowledge and awareness may be first steps but it's hard to imagine where they will take us. ...more info
  • This Is What We Need to Fix The Health Care Industry
    I can't say enough about this book. The analysis is spot on with plenty of data to back it up. The combination of a Harvard business professor with a practicing MD as authors bring a level of insight and credibility to the book that you can't get with other books written by senators and academics with no medical and/or business experience.

    I won't go too much into the content because it is summarized nicely above. But it's important to note that as a medical student, I've reviewed many proposed health plans. This one doesn't play politics and advocate for or against government intrusion into health care, it goes deeper and analyzes why the business model of the industry is flawed, and how we can fix it. No changes can be made unless we address fundamental problems with how the industry is set up, this book will explain to you these flaws and what we can do to encourage a shift in the culture of health care.

    These ideas will fix the health care industry, no questions asked. It is, however, much harder to sell ideas like "disruptive innovation" to the public that it is to sell "universal coverage" and "insurance regulations". I can only hope we one day have a leader who can come to his or her senses and apply the proven concepts presented in this book. Time is ticking....more info
  • Clayton Christensen once again enable us to understand what really happens!
    Clayton Christensen describes one of the most important industries in the world in a total new setting. While most ohters describe this sector as a sector with a lot of problems, he enables us to see a lot of new business opportunites. Business model innovation whithin this sector will enable business entrepeneurs to find new ways to get the job-done. I have given a copy of the book to the minister of healtcare in Norway. PS, it could be an idea to read the Innovators Solution first! ...more info
  • Ignore This Book At Your Peril! Read It To Gain An Unbeatable Competitive Edge!
    A must read for CEOs, directors and top managers in healthcare - and any other industry! If you are responsible for leading your company or organization into an uncertain future, Clay Christensen's insight into innovation - how it can disrupt your world - will astound you! You'll learn how to read the "tea leaves" all around you. You may be very surprised to learn that getting bigger and controlling more and more of your market may be strategies for disaster rather than success!

    It also is a must read for entrepreneurs - in large companies and small. You'll learn what to do and not do to successfully disrupt the establishment. Specifically, you'll gain insight into the forces driving the healthcare world and what you must do to capitalize on them.

    Understanding Clay's theory is like getting a new pair of glasses. It helps make sense out of apparent nonsense, order out of apparent chaos. You'll never again see events surrounding your business, community or world the same way. You'll understand why/how companies lose their way, new companies succeed beyond anyone's dreams (except those of their founders), how a political upstart like Barack Obama can defeat a seasoned politician like Hillary Clinton, and how the incredible turbulence in healthcare may offer the opportunity of a lifetime!
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  • Innovation Roadmap for the Club of Cos
    Guided by Prof. Christensen's robust innovation theories, Drs. Grossman and Hwang join in to provide an insightful review of medicine's evolution, an overview of barriers to reform and a road map for organizations that can lead the charge.

    I found the discussions on the technological enablers for innovation, business model innovation and the "jobs to be done" analyses to be very informative. This framework for examining the health care system has helped me understand many of the disconnects and interdependencies in health care.

    10 years from now health care leaders (health plans, health care providers, employers) will share a common early understanding and adoption of the key concepts in this book.

    Anyone searching for the places in our health care system where their time and energy can help bring effective changes should read this book....more info
  • An Industry Insider's Review of Christensen's Prescription for a Cure
    I have been an active participant in healthcare developing and commercializing over twenty medical technologies across nine medical specialties since the 1970's. I have also lectured on the medical industry as an Assistant Professor of Surgery at Creighton University Medical Center and as a guest lecturer at Anderson School of Management (UCLA), Haas School of Business (University of California), and Graziadio Business School (Pepperdine University), and spent significant time in the 1990's on FDA reform.

    I have been privileged to have had a front-row seat observing the major changes that have shaped today's healthcare system - industry consolidation for both the supplier (pharma, med-tech, and diagnostic) and delivery (hospital, clinics, physician practice) segments; the move from unregulated fee-for-service to regulated fee-for-service; the growth of medical malpractice and its impact on the cost of healthcare; the use and misuse of technology; the draconian regulatory burden (FDA and CMS) associated with developing new life-improving or life-saving technologies; and, as a result, the growth of healthcare as a share of GDP from 6% to 16%. To this industry insider, healthcare is a system in critical condition and needs radical surgery.

    Clayton Christensen who authored one of the best books on innovation ("The Innovator's Dilemma") has now teamed up with Jerome Grossman, M.D. and Jason Hwang, M.D. to bring well-researched insights into a disruptive solution for effective value-added health care in "The Innovator's Prescription." Christensen and company outline the technological enablers of disruption then show us how various aspects of the healthcare system can be effectively disrupted to produce better, more cost-effective healthcare for all Americans. These include the hospital business model, the physician practice business model, the care of chronic disease, the reimbursement system, medical education, the development of pharmaceuticals, medical devices, and diagnostics and regulatory reform. The authors leave no stone unturned and provide an integrated plan to make it happen.

    "Innovator's Prescription" is a must read for all who participate directly in the funding and running of our healthcare system whether as members of the private sector or public sector, patients, or voters. Christensen and colleagues have done an extraordinary job in outlining the fundamental issues but more importantly, in providing a thoughtful way out of our current mess. ...more info
  • What rather than who
    It is a commonplace that the U.S. healthcare system is broken, but the discussion often degenerates into a debate about who is responsible. This book takes a different approach, focusing on what is wrong with the healthcare system and needs to change so it can work better.

    The proposed solution is to discard the current fee for healthcare service model, in which healthcare providers are systematically paid to treat illness without recompense for fostering welfare, and create a three-track system:

    (1) Fee for service would continue to apply to diagnostic services, where - due to the nature of the patient's condition and the state of medical knowledge - there is a high need for intuitive investigation versus results-based treatment for conditions that are well understood. (The process described brings to mind episodes of House, a TV show in which a brilliant but irascible doctor challenges a team of colleagues to find the problem before the patient dies.)

    (2) Fee for result would apply for treating conditions that are well understood and have a clearly defined solution -- colonoscopies, laser eye surgery, implantation of stents, etc.

    (3) User networks for patients with chronic conditions/ unhealthy practices to learn how they can help themselves and be motivated to do so.

    As is pointed out again and again, disruptive changes will be needed to get from A to B. Thus, hospitals must be redirected to focus on diagnostic services and cede provision of standardized care and wellness coordination to specialized clinics and other agencies. Primary care physicians (the traditional "family doctor") should concentrate on diagnostic services at a lower level rather than acting as "gatekeepers" for referrals to specialists. Enabling changes in reimbursement rules, health insurance arrangements, and medical record keeping are spelled out in detail.

    When the dust settles, there will be fewer hospitals (with the survivors focused on enhanced diagnosis, like the Mayo Clinic), fewer medical specialists (who currently operate in narrow niches, often without a full grasp of a patient's situation), more primary care physicians and nurses with augmented responsibilities, a new model for pharmaceutical companies that focuses on targeted medications for precisely defined conditions versus the development and marketing of "blockbuster" drugs that only help a fraction of the users and require enormously expensive mass clinical trials, and a lot of medical work performed by less highly trained personnel with better diagnostic tools.

    Andy Kessler presented an analogous vision in "The End of Medicine: How Silicon Valley (and Naked Mice) Will Reboot Your Doctor," Harper Collins (2006). His book is very entertaining, but this one covers the ground in a more disciplined and comprehensive manner. I would recommend "The Innovator's Prescription" for anyone who is seriously concerned about the current healthcare system.

    Doctors, hospitals, and other healthcare providers cannot make the needed changes on their own, because they do not control all the levers. Having the government take the lead is said to be problematic, for reasons that are dispassionately stated and I happen to agree with. The authors suggest that the best candidate entities for leading the transition to healthcare in the new mode might be employers that profit from the good health of their employees. Then there is the intriguing possibility of expanding the role of integrated healthcare providers,e.g., Kaiser Permanente.

    Let's hope our country chooses the right path....more info
  • Phenomenal Book - Clayton has done it again
    Once again, Clayton has written, this time with the help of two MDs, a phenomenal book extending the theory of disruptive innovation into the health care industry.
    To me, this is his most important book because it discusses how disruptive innovation will impact health care over the next years. It does this by category: hospital, doctors, pharmaceutical companies, medical device companies, insurance companies, etc. And, it is accomplished in a very analytical and straightforward manner - just the facts please.
    And there are the examples - this book is chock full of real world examples of companies, e.g. hospitals, insurance companies, etc., who are already doing it.
    As I'm telling everyone in this field, if you are in the health care field, you need to read this book. And then, use it to analyze your own company's situation.
    It appears to me that major disruption is just around the corner in the health care industry and this will help you to be proactive, prepare for it and be a winner in the realities of the future....more info
  • Innovator's prescription
    This book is a must read for any stakeholder in medical care, whether they are a health care professional, manager or a purchaser of health care. Christensen describes in this book where health care will end up if we are all lucky enough to survive the transition....more info
  • Provocative Perspectives Worthwhile to Anyone Involved in the Health Care Debate
    As the CEO of Walgreens, I'm involved in the health care debate every day. Clayton Christensen's fascinating book provided me with interesting insights on one of my favorite strategies: innovation. I've recommended that all of my senior management team read The Innovator's Prescription. Clayton's provocative perspectives and viewpoints should be of great interest to them as we take our company and its offerings to the next level....more info
  • What healthcare needs - a prescription for disruptive innovation
    Can the lessons of innovation derived from other domains be usefully applied to healthcare? Once you have read "The Innovator's Prescription" you will have no doubt and you will be able to explain why!

    Clayton Christensen, who coined the term disruptive innovation and wrote the classic "Innovator's Dilemma" has, with two physician co-authors, made a provocative and important contribution to the debate on the future of healthcare. No prior work has addressed the issue of innovation in healthcare with anything approaching this much insight, clarity and wisdom.

    For anyone with an interest in the future of healthcare reading "The Innovator's Prescription" will be time well spent. This is especially true for physicians and pharmaceutical company employees....more info


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