Aetna’s Ron Williams on Health Care: What to Expect – BusinessWeek

Aetna’s Ron Williams on Health Care: What to Expect – BusinessWeek

Clay Christensen of Harvard Business School said recently that in health care, competition does not help control costs but rather drives them up. He said the structure of the system pits hospitals that want to fill their beds against insurers that want to minimize reimbursement and access. His answer was the health-care provider and health-care insurer should be one and the same, suggesting an integrated system like Kaiser Permanente in California.
Well, I think it's an interesting idea. But all health care, ultimately, is local. There are communities where that model has worked well. Kaiser and Group Health of Puget Sound are examples of where that's worked very well. But it requires a unique physician culture. And even firms like Kaiser, which has tried to expand into other geographies, have found that it's incredibly hard to replicate. Where it can work, it's a fine model. It's just not going to work in most communities.


Did I miss something or did you just post this without any observations or opinion?

1. What's Ron's basis for saying this?

2. Who said culture change is easy? Identifying a challenge as difficult is no justification for "it's just not going to work." If that were the case, we shouldn't have tried to eradicate smallpox or treat my cancer.

As I recall from talking to people like Kaiser's Kate Christensen and Judy Derman, it took years and tons of work to change the Kaiser culture to its current state. Some people left. And it worked: all that exertion has produced a far better system, and providers who don't like it don't work there anymore.

3. I kind of snort at the idea that the absence of culture to support a method that's proven to work better is reason not to fix the culture. I see no difference between that and car mechanics in a shoddy town responding to quality problems by saying "Yeah, yeah, yer breakin' my heart… look, buddy, dat's how we do it in this town."

I know culture change isn't easy – neither is figuring out how to cure cancer. No reason not to start.

Hey Dave,

I want to differentiate behavior in the moment, where people don't see the impact of what they do, and from that perspective I argue that people do care, they are in places that confuse what caring is. So for example, in the situation above, if it was possible for the nurse to know "the way you are handling this patient is going to cause them to heal slower, and ultimately that will impact you when you are in this bed one day."

I think people understand this when they have a moment to think about what they are doing any why they're here. The role of leaders is to bring this perspective forward, and 99.9% of the time when I see this done, people behave like the exceptional people that they want to be.

As always, I appreciate the things you say in your role that others cannot. That's an important role for you, too,


Hi Dave,

You're correct, I posted this without additional commentary – that's your job :).

Seriously, I'm biased so I wanted to put this up for reflection. The quote shows a respect for the integrated model. I believe the reference is to efforts prior to my tenure to expand into other markets that failed.

Separating that issue from the idea of blaming failure in health care on physician culture. This is an easy/convenient approach because it's so common. Beneath the layers, though, I have really not met a culture of physicians anywhere that wants to perform poorly for patients. Have you?

> I have really not met a culture of physicians anywhere

> that wants to perform poorly for patients. Have you?

Not a culture, no. I have, though, met physicians who didn't particularly care what I wanted – I write briefly about three from my personal experience (long ago) in the book I'm working on.

And in attending conferences and reading blogs, I've met some who (if I may risk paraphrasing from my impression) just want patients to pretty much stay out of the way, so they (the physicians) can do their job.

Similarly, during my hospitalization one nurse "tch'ed" and sighed about my apparently not holding my hand right for some IV insertion, though other nurses had no problem. This one's unspoken message seemed to be "Just hold still so I can do this the way I did it in class."

To return to Ron Williams's statement, I don't know him, but on the face of it I find it incredulous that someone in the high-margin / no-direct-value part of the industry would insist that change is unlikely. I find myself wondering if that's why his own industry hasn't improved – and I have a strong sense that they're not likely to improve as long as people with that attitude are running the show. Is change needed, for our own good, and for the economic safety of the healthcare industry?

Ted Eytan, MD