Oak Street Health opened its first primary care center for seniors in underserved communities in 2013. By 2022 the company had 169 centers and a market valuation exceeding $10 billion. Oak Street created value by accepting risk-adjusted, capitated payments for Medicare enrollees and reducing the expected spending for these enrollees through high-quality, high-touch primary care. In 2023 CVS Health acquired Oak Street on the thesis of substantial synergies across its various businesses. Which among these synergies was most important to prioritize, and what tradeoffs might be created by pursuing these opportunities?

Grit, a combination of passion and perseverance, predicts success in many demanding fields. A perfect example is health care, where the grit of individual doctors and nurses has saved many lives. But today providing superior care is so complex that no lone practitioner can do it all. Great care requires gritty teams that never stop striving for improvement and institutions that exhibit grit across entire systems of providers. In this article Duckworth, the author of the best seller Grit, and Lee, a clinician and health care leader, describe health care's new model of organizational grit. It begins with hiring people with grit--who love what they do, always want to get better, and are resilient in the face of setbacks. Their single-minded determination stems from a clear personal-goal hierarchy, in which shorter-term objectives support a top-level goal that gives direction to everything they do. To be gritty, organizations must have a similar clarity about priorities, and their top-level goal and their employees' must be aligned. If everyone is pursuing a separate passion, a culture won't be gritty. The gritty health care organizations the authors have seen (such as Mayo Clinic and Cleveland Clinic) all make "putting patients first" their overarching goal and use it to guide every decision. They also work to cultivate grit by, for example, setting high expectations; offering the resources, support, and trust people need to keep learning and growing; and establishing strong social norms that promote their top-level goal. While the objectives of organizations in other sectors may differ, they can apply the principles the authors outline here to become gritty, too.

The U.S. health care system is inefficient, unreliable, and crushingly expensive. There is no shortage of proposed solutions, but central to the best of them is the idea that health care needs more competition. In other sectors, competition improves quality and efficiency, spurs innovation, and drives down costs. Health care should be no exception. Yet providers and payers continue to try to stymie competition. Many are actively pursuing consolidation, buying up market share and increasing their bargaining power. In this article, the authors argue that health care payers and providers must stop fighting the emergence of a competitive health care marketplace and make competing on value central to their strategy. All stakeholders in the health care industry--regulators, providers, insurers, employers, and patients themselves--have roles to play in creating real competition and positive change. In particular, five catalysts will accelerate progress: Put patients at the center of care, create choice, stop rewarding volume, standardize value-based methods of payment, and make data on outcomes transparent.

A health care revolution is underway, and doctors must be part of it. But many are deeply anxious and angry about the transformation, fearing loss of autonomy, respect, and income. Given their resistance, how can health system leaders engage them in redesigning care? In this article, Dr. Thomas H. Lee, Press Ganey's chief medical officer, and Dr. Toby Cosgrove, the CEO of the Cleveland Clinic, describe a framework they've developed for encouraging buy-in. Adapting Max Weber's "typology of motives," and applying behavioral economics and other motivational principles, they describe four tactics leadership must apply in concert: (1) Engaging doctors in a noble shared purpose; (2) Addressing their economic self-interest; (3) Leveraging their desire for respect; and (4) Appealing to their sense of tradition. Drawing from experiences at the Mayo Clinic, Geisinger Health System, Partners HealthCare, the Cleveland Clinic, Ascension Health, and others, the authors show how the four motivational levers work together to bring this critical group of stakeholders onboard.

In health care, the days of business as usual are over. Around the world, every health care system is struggling with rising costs and uneven quality, despite the hard work of well-intentioned, well-trained clinicians. Health care leaders and policy makers have tried countless incremental fixes--attacking fraud, reducing errors, enforcing practice guidelines, making patients better "consumers," implementing electronic medical records--but none have had much impact. It's time for a fundamentally new strategy. At its core is maximizing value for patients: that is, achieving the best outcomes at the lowest cost. We must move away from a supply-driven health care system organized around what physicians do and toward a patient-centered system organized around what patients need. We must shift the focus from the volume and profitability of services provided--physician visits, hospitalizations, procedures, and tests--to the patient outcomes achieved. And we must replace today's fragmented system, in which every local provider offers a full range of services, with a system in which services for particular medical conditions are concentrated in health-delivery organizations and in the right locations to deliver high-value care. The strategy for moving to a high-value health care delivery system comprises six interdependent components: organizing around patients' medical conditions rather than physicians' medical specialties, measuring costs and outcomes for each patient, developing bundled prices for the full care cycle, integrating care across separate facilities, expanding geographic reach, and building an enabling IT platform. The transformation to value-based health care is well under way. Some organizations, such as the Cleveland Clinic and Germany's Schon Klinik, have undertaken large-scale changes involving multiple components of the value agenda. The result has been striking improvements in outcomes and efficiency, and growth in market share.

The problem with medicine, the author writes, is people like him: Fifty-something doctors trained in an era of autonomous hero-practitioners. These lone cowboy physicians may work hard, but they don't provide the best possible care, because they're embedded in a fragmented, chaotic, performance-blind system. Fixing this will require a new kind of leader who can organize doctors into teams, measure their performance not by how much they do but by how their patients fare, deftly apply financial and behavioral incentives, improve processes, and dismantle dysfunctional cultures. Drawing on examples from best-practice institutions such as the Cleveland Clinic, Seattle's Virginia Mason Medical Center, Intermountain Healthcare in Utah, and his own organization, Partners HealthCare System of Boston, Lee shows how a "new breed of leader" is orienting strategy around patients' needs (a more radical idea than it might sound) and raising the quality, efficiency, and value of care. A sidebar written by Partners strategy director Kelly W. Hall looks at how peer pressure can drive improved performance.

Whether it's a basic Mr. Coffee or a gadget that sports a snazzy device for grinding beans on demand, the office coffee machine offers a place for serendipitous encounters that can improve the social aspect of work and generate new ideas. What's more, a steaming cup of joe may be as good for your health as it is for the bottom line, says Lee, a professor of medicine at Harvard Medical School and the CEO of Partners Community HealthCare. Fears of coffee's carcinogenic effects now appear to be unfounded, and, in fact, the brew might even protect against some types of cancer. What's more, coffee may guard against Alzheimer's disease and other forms of dementia and somehow soften the blow of a heart attack. Of course, its role as a pick-me-up is well known. So there's no need to take your coffee with a dollop of guilt, especially if you ease up on the sugar, cream, double chocolate, and whipped-cream topping.