Praise for The U.S. Healthcare Ecosystem

The term “ecosystem” captures the decentralized, multi-component nature of the U.S. healthcare system. By providing clear overviews of each component, Robert Burns informs us as to why this ecosystem often “works” inefficiently. The U.S. Healthcare Ecosystem will orient students to the “anatomy and physiology” of U.S. healthcare.

  James L. Madara, M.D.

  CEO, American Medical Association

  Former Dean and CEO, University of Chicago Medical Center

  Adjunct Professor, Feinberg School of Medicine, Northwestern University

For decades, Robert Burns has been an exceptional observer and reporter on the complex U.S. healthcare system. As a teacher and mentor of Wharton healthcare students, his expert and wide-ranging understanding of healthcare is now available to all of us. Written with his in-depth mastery of the subject, this textbook covers multiple sectors of the healthcare economy and is a basic primer on the state of the system. It provides a comprehensive overview of the entire healthcare ecosystem, and advances our ability to make informed changes through a more complete understanding of the system’s complexity. I recommend it to professionals in the healthcare sector, as well as to analysts as they consider future policy changes.

  Rick Pollack

  President and CEO

  American Hospital Association

If, like me, you have long wished for a single comprehensive, accessible, and accurate textbook that explains the forms, functions, finance, and performance of the maddeningly complex U.S. healthcare system, your wait is over. Professor Burns knows his subject well, and his book is instantly an essential and peerless guide for students, teachers, and practitioners of health management, medicine, policy, economics, and more, and for the interested general public, as well.

  Donald M. Berwick, MD, MPP

  President Emeritus and Senior Fellow

  Institute for Healthcare Improvement

Over the past 50 years of lecturing about how our healthcare system functions, its many problems and possible policy solutions, I could not find in one manuscript the many interrelated issues involved. That is until now. Professor Burns has written the most comprehensive and detailed analysis of what he has labeled the U.S. healthcare “ecosystem.” I plan to use it in my courses and public lectures and suggest that many of you that are looking for a useful guide to the U.S. healthcare system do so as well.

  Stuart Altman Ph.D.

  Chaikin Professor of Health Policy

  The Heller School for Social Policy and Management

  Brandeis University

In this new text, Professor Burns confronts key topics related to the U.S. healthcare system… The picture that emerges is of a system that is not a coherent system at all, but one in which different components interact in different ways to provide Americans with some of the most advanced care in the world, while at the same time being prohibitively expensive and often out of the reach of many of the people who need it most. Understanding how these components interact is crucial to improving the system’s performance and making affordable healthcare more available to everyone who needs it.

  Stuart Guterman

  Consultant

  Former Director of Research, Development, and Information

  Centers for Medicare and Medicaid Services (CMS)

Explaining how U.S. healthcare works is a daunting challenge, because it has to explain the often disparate and ever evolving perspectives and interests of the broad range of stakeholders that comprise nearly twenty percent of the country’s economy. The U.S. Healthcare Ecosystem promises to become the go-to source, not only for students of health administration, business, medicine, and public health, but also for working professionals in the healthcare industry, the media, and policy makers.

  Robert Berenson, M.D.

  Fellow–The Urban Institute

  Former Vice Chairman, Medicare Payment Review Commission

Robert Burns provides a much needed, clear and comprehensive guide to America’s seemingly complex, growing and increasingly expensive healthcare system. Based on 40 years of experience teaching healthcare management, he explains in logical and understandable detail how our system operates based on a small number of principles. This book will be an essential guide to the novice entering the field, but should also serve experienced administrators throughout their careers. It’s one they should all have on their desk.

  Harold M. Koenig, M.D.

  Vice Admiral, Medical Corps

  United States Navy, Retired

  32nd Navy Surgeon General

Driving real impact in healthcare requires having the ecosystem perspective that Robert Burns carefully constructs in his classroom and now in this comprehensive volume. Now more than ever, scientific innovation and care delivery advancement require systemic changes reliant on cross-sector partnership and creativity. The U.S. Healthcare Ecosystem provides the deep and integrated perspective into how healthcare works in the U.S.

  Maria Whitman, MBA

  Managing Principal, ZS Associates

  President, Wharton Health Care Management Alumni Association

Robert Burns’ textbook is a well-written guide with numerous practical examples and a thoughtfully constructed history of how we have arrived at our current state. More importantly, it provides valuable insight into how to address the problems and challenges of healthcare—including cost, access, and quality—as we move into the future.

  I. Steven Udvarhelyi, MD

  President and CEO

  Blue Cross and Blue Shield of Louisiana

This book will provide a starting point for students learning about this complex industry, but it will also be incredibly valuable to experts working in any one of the many components who wish to understand how the other parts fit in. These other parts can be as different as finance and insurance compared with biochemistry and molecular biology. While experts in these different fields often do not speak the same language, Burns explains in understandable English what these disciplines contribute and how these groups interact to produce important breakthroughs in improved health.

  P. Roy Vagelos, MD

  Retired Chairman and CEO, Merck & Co., Inc.

  Chairman of the Board, Regeneron Pharmaceuticals, Inc.

Robert Burns has been a master analyst of the U.S. healthcare system for decades. For those, who said that “nobody knew that health care could be so complicated,” Burns’ comprehensive guide provides a detailed map of this complex sector, from hospitals and doctors, to insurance companies and pharma, that helps policy advocates see what they are facing. This book, written to educate college and professional school students, should be “must reading” in the policy community as well.

  Ralph W. Muller

  CEO, University of Pennsylvania Health System, 2003–19

I had the good fortune of being one of Rob Burns’ first Wharton MBA students. I would credit his inspiring, truthful, and real-world overview of the healthcare industry as the primary driver of my decision to spend a career dedicated to transforming U.S. healthcare. As Rob comprehensively and insightfully details in this text, reinvention of healthcare is only possible if we see our industry as an ecosystem, and if we work to align and reform the way that payers, providers, suppliers, and consumers interrelate.

  Craig E. Samitt, MD, MBA

  President & Chief Executive Officer

  BlueCross BlueShield Minnesota

At nearly $4 trillion dollars in 2020, the U.S. healthcare system is of the scale and complexity of a large industrial nation. Hospitals, the largest single institutional component of the health system, represent only a third of health spending; the remaining two thirds are lodged in hundreds of thousands of smaller economic units, which depend on one another for patient flow and revenues. The largest payer in the system, the federal Medicare program, is less than a quarter of total spending. To understand this vast and dynamic sector requires a managerial understanding of the interdependency between financing, technology, and care organization which Burns’ volume provides.

  Jeff Goldsmith, Ph.D.

  President, Health Futures Inc.

For students and others seeking to fix healthcare, Burns’ book goes beyond the “anatomy” (structure) of the U.S. delivery system, and brings the “physiology” (processes) to life. His grasp of the players and how they interact allows readers to approach challenges that otherwise might seem overwhelming in their complexity. There are no single, simple solutions for these challenges, but Burns’ descriptions of the dynamics that shape the healthcare ecosystem can help define the multi-pronged approaches needed to provide high value healthcare to all.

  Thomas Lee, MD, MSc

  Chief Medical Officer, Press Ganey

  Professor, Harvard Medical School

We do not have a healthcare “system.” America has a disassociated clutter of well-meaning health providers whose interactions more closely display chaos theory than systemic order. Professor Burns’ book is desperately needed as a presentation and instruction to future healthcare leaders, of today’s disorder contrasted with tomorrow’s potentially coordinated and powerful diagnostic and therapeutic care. His insightful mind and deep experience create a unique opportunity to learn, and then critique, the least functional but most important area of our economy…

  Bryan C. Cressey, JD, MBA

  Founder of Four Prominent Healthcare Venture Capital and PE Firms

  Pioneer of Healthcare Investment and Growth Strategies

  Recipient of Healthcare Lifetime Achievement Award

Robert Burns covers a remarkable range of topics and brings to print what he has uniquely done for so many years in his highly popular introduction to healthcare course. As a physician executive, I would call this a physiological approach rather than the less interesting anatomy and structure of healthcare. I highly recommend this book for students, healthcare executives, physicians, and non-physicians.

  Allen L. Smith, MD, MS

  Former President, Brigham and Women’s Physicians Organization

  Former Asst. Vice President for Strategy and Business Planning, Tufts Health Plan

This book is a “must read” for anyone seeking to understand healthcare’s value chain, and why the process holds much more importance than its overall structure in its ability to provide high-quality, cost-effective care.

  Mark A. Turco, M.D.

  Cardiologist and Medical Device Executive

  Former Vice-President and Chief Medical Officer – Medtronic’s Aortic/Vascular/EndoVenous Division

The U.S. Healthcare Ecosystem offers a comprehensive, up to date, and distinctively holistic view of healthcare. Robert Burns draws from the real-world experiences of those in the field to provide an exceedingly practical guide to how healthcare products are created, services are provided, and bills are paid. The text distills complex subject material, such as the emergence and evolution of the biotechnology industry, down to a few key concepts that matter.

  Eric Schmidt, Ph.D.

  Chief Financial Officer

  Allogene Therapeutics

Finally, the definitive book on the U.S. healthcare industry that academics and professionals alike have been waiting for. Robert Burns, through his detailed research and insightful analysis, illuminates and explains one of the world’s most complex and interconnected ecosystems and renders it understandable to the reader. This is an essential text for those looking to profit from or fix healthcare.

  David Blumberg

  Pharmaceutical Sector Lead Partner at KPMG and Accenture (retired)

Professor Burns has performed a Herculean task, providing a detailed understanding of the inner workings of an ecosystem that represents almost 20% of the GDP of the world’s largest economy.

  Hal Andrews

  President and CEO, Trilliant Health

Burns weaves academic and commercial insights in a well-written, approachable and common-sense way. Having co-taught with Rob on the insurance industry for more than a decade, the book is a “mirror” of how he has taught MBA students – real world learning often through case studies. Well done!

  Jonathan Lord, M.D.

  Chair, Biolase

  Former Chief Innovation Officer and Medical Officer for Humana, Inc

  Former Chief Operating Officer, American Hospital Association

  Former Chief Operating Officer, University of Miami Healthcare System (UHealth)

Insightfully identifying healthcare in America not as an organized system, but as a more organic and dynamic ecosystem, Robert Burns reveals how the healthcare industry really works, from the inside. By focusing more on processes than on structure, he examines the ways in which a remarkable range of players, from specialty clinicians, public and private payers, contractors and medical technology professionals to pharmacy benefits managers and coding and reimbursement specialists, interact, compete, collaborate and sometimes conflict with one another.

  C. Martin Harris, M.D., MBA

  Associate Vice President and Chief Business Officer of the Health Enterprise

  Professor of Medicine

  Dell Medical School

  The University of Texas at Austin

Robert Burns is one of the most thoughtful and insightful observers of healthcare. It is demonstrated again in his newest book The U.S. Healthcare Ecosystem. The book provides an exceptional analysis of the roles, motives, capabilities, and interactions of payers, providers, and suppliers who collectively make up the “ecosystem” of healthcare.

  John Glaser, Ph.D.

  Executive in Residence

  Harvard Medical School Executive Education

  Senior Vice President, Population Health, Cerner Corp

  CEO, Siemens Health Services

  Chief Information Officer, Partners HealthCare

Professor Burns is one of the most astute observers of the entire healthcare system, as witnessed by the depth and breadth of knowledge detailed in this book. I’ve been in the industry for nearly 40 years (and have taught MBAs for over 20) and have not found a text that covers all of this in such depth.

  Bradley Fluegel

  Chief Commercial Officer, Walgreens

  Chief Strategy Officer, Walgreens

  Chief Strategy and External Affairs Officer, Anthem

  Head of National Accounts, Aetna

  Head of Enterprise Strategy, Aetna

Healthcare professionals and employers, equally, will find the process-driven discussion invaluable in better understanding how to operate and navigate within the ecosystem. A timely work for a rapidly changing, post-Covid world of healthcare.

  Mike Taylor

  Principal, MT Healthcare Consulting

  Former Senior Vice President, Delivery System Transformation, Aon plc

  BSc King’s College London, MA SUNY Stony Brook, MS SUNY Stony Brook

  Advisory Board Member, Boston University School of Public Health

  and King’s College London Business School

  Expert Panel Member, Leavitt Health Partners

In our attempt to simplify our complicated healthcare system, we have tended to look at its individual components and not at the processes and interactions of the whole. The result is that we have duplicated our efforts, driven up costs, and compromised quality of care. In The U.S. Healthcare Ecosystem, Robert Burns looks (for the first time that I can tell) at the function of the system as a whole.

  Rulon F. Stacey, Ph.D. FACHE

  Malcolm Baldrige National Quality Award Recipient

  Director of Graduate Programs in Health Administration

  University of Colorado Denver

Rather than do his work from the “ivory tower” of academia, Professor Burns has spent considerable time over his illustrious career interviewing healthcare executives for field research projects and delving into conflicts between healthcare organizations through his work as an expert witness. His understanding of healthcare organizations and how they interact with patients, payers, and each other has prepared him to write a text that students will find to be highly relevant.

  Paul B. Ginsburg, Ph.D.

  Director, USC-Brookings Schaeffer Initiative for Health Policy

  Leonard D. Schaeffer Chair in Health Policy Studies, The Brookings Institution

  Professor of Health Policy and Director of Public Policy, Schaeffer Center for

  Health Policy and Economics, University of Southern California

There is no shortage of books on the U.S. healthcare “system.” While all these books provide value, they often employ a framing that does not lend itself to a more holistic “on the ground” understanding of how the healthcare system works (or doesn’t) and the important interrelationships among its various components. In this text, Burns takes advantage of his decades of business school teaching by employing a no-nonsense, business perspective on how the system operates as an ecological system. The need for such a text is great as students of health administration or business management rightfully expect material that equips them to operate in a challenging and changing industry.

  Jeffrey Alexander, Ph.D.

  Professor of Health Management and Policy, emeritus

  School of Public Health

  University of Michigan

The U.S. Healthcare Ecosystem fills a void in introductory textbooks by providing insightful analysis on how the entire healthcare industry operates. Its unique focus on processes rather than structure is revealing and instructive. The volume is comprehensive in its coverage of the many moving parts that constitute healthcare delivery, including the workforce, which makes the text valuable in courses for nurses, physicians, management, and health policy.

  Linda H Aiken, Ph.D., RN, FAAN

  The Claire M Fagin Professor of Nursing

  Professor of Sociology

  Director, Center for Health Outcomes and Policy Research

  University of Pennsylvania

This is an outstanding textbook, and one that we have needed for a long time. The book’s most distinctive and valuable contribution is the perspective it takes: to improve the U.S. healthcare system, we need to understand how it operates from an ecological perspective that emphasizes how a variety of key actors and systems interact with each other. In short, this book focuses on the physiology of our healthcare system, not simply its anatomy.

  Thomas D’Aunno, Ph.D.

  Professor of Management

  Wagner Graduate School of Public Service

  New York University

What sets this text apart from others in the field is its focus on process—how things get done— within the current and emerging structures of the healthcare ecosystem.

  Jacqueline Zinn, Ph.D., M.B.A.

  Professor Emeritus

  Fox School of Business, Temple University

Over the past 20 years, I have taught an introductory course on the U.S. healthcare system at the undergraduate and graduate level in various settings aimed at students interested in business, medicine, nursing, public health, and public policy. This is the first textbook that covers the key actors in the healthcare system with the right balance of breadth and depth.

  Daniel Polsky, PhD

  Bloomberg Distinguished Professor of Health Policy and Economics

  Carey Business School

  Department of Health Policy and Management, Bloomberg School of Public Health

  Johns Hopkins University

A la Clayton Christensen, Burns differentiates the appearance from the reality of innovation. He provides us with a clear, consistent, and comprehensive account of healthcare flows of money, information, products, and influence. This is “must reading” for management and business students and working professionals in all health disciplines and schools.

  Anthony R Kovner, Ph.D.

  Professor Emeritus of Public and Health Management

  Robert F. Wagner Graduate School of Public Service

The U. S. Healthcare Ecosystem is a novel text and refreshing departure from other introductory books on our healthcare industry. Students will benefit from the emphasis on the strategic decisions and processes involved as opposed to the traditional emphasis on the structure of the system.

  Stephen M. Shortell, PhD, MBA, MPH

  Professor of the Graduate School

  Blue Cross of California Distinguished Professor of Health Policy and

  Management Emeritus

  Co-Director, Center for Healthcare Organizational and Innovation Research (CHOIR)

  Co-Director, Center for Lean Engagement and Research (CLEAR)

  Dean Emeritus, School of Public Health

  Professor of Organization Behavior, Emeritus, Haas School of Business

  UC-Berkeley

In a field that is changing at a breathtaking pace with no signs of letting up, how much more productive it is to help students understand the actions and interactions of healthcare players than having them focus on statistics and descriptions of them that are destined to be out of date before the end of the term. Another advantage of the text is the inclusion of many areas that are not covered by other texts, since a segment of the delivery system that seems insignificant today may be driving important changes tomorrow. This was a book worth waiting for.

  Cindy (Carolyn) A. Watts, Ph.D.

  Professor

  Department of Health Administration

  College of Health Professions

  Virginia Commonwealth University

I fully expect this text to become the standard in U. S. healthcare administration programs, benefiting faculty as well as students. It will be exciting to see its impact in the classroom and beyond.

  Jon B. Christianson, PhD

  James A. Hamilton Chair in Health Policy and Management

  Professor, Division of Policy and Management

  School of Public Health, University of Minnesota

This outstanding text describes how the U.S. healthcare industry functions as an ecosystem of complementary organizations, rather than a set of stand-alone actors. This has become all too evident during the COVID pandemic, where lack of coordination between different organizations in local and national ecosystems has damaged our ability to respond. The book describes the elements of the healthcare ecosystem, identifies the points of contact among actors, and highlights areas where we need drastic improvement.

  Will Mitchell, Ph.D.

  Anthony S. Fell Chair in New Technologies and Commercialization

  Academic Co-director Global Executive MBA in Healthcare and Life Sciences

  Rotman School of Management, University of Toronto

Professor Burns, a seasoned observer of the U.S. healthcare industry, has written a volume of unusual breadth and depth. He includes topics that are rarely covered well in introductory courses – for example health information technology, biotechnology, and medical technology – and brings a thoughtful, critical eye to controversies of each topic.

  Lawrence P. Casalino, M.D., Ph.D.

  Livingston Farrand Professor of Public Health

  Chief, Division of Health Policy and Economics

  Department of Population Health Sciences

  Weill Cornell Medical College

Robert Burns, an internationally renowned healthcare expert, has prepared an outstanding text book on the U.S. system. The book is both comprehensive and insightful as a resource for understanding why and how healthcare is currently delivered. Most impressive is the book’s elucidation of the organizational, financial, and public policy considerations that shape the way healthcare is delivered at every level of the industry. The book thoroughly covers topics that other textbooks on U.S. healthcare tend to overlook, particularly the sectors responsible for medical technology and drugs. It is really a “must read” for students pursuing careers in healthcare management and for healthcare professionals who seek a deep understanding of the world in which they work.

  Gary J. Young, J.D., Ph.D.

  Director, Northeastern University Center for Health Policy and Healthcare Research

  Professor, D’Amore-McMim School of Business and Bouve College of Health Sciences Northeastern University

As the 45th President learned, “Nobody Knew Health Care Could Be So Complicated!” For anyone interested in a career in healthcare, it’s critical to understand all of the pieces and how they fit together—sometimes in competition, sometimes in collaboration, and seemingly always with critical relationships in flux. I know of no other volume that addresses this entire system in such a comprehensive, accessible, and informative manner.

  Kevin Schulman, M.D.

  Professor of Medicine, Stanford University School of Medicine

  Professor of Economics (by courtesy), Stanford Graduate School of Business

  President, Business School Alliance for Health Management

Robert Burns applies his formidable repertoire of deep and broad insights to create a highly useful guidebook for readers seeking to better understand and navigate the complexities of the largest and fastest growing industry in the U.S. With his holistic emphasis on the interactions between and among key actors, Prof. Burns provides a welcome cohesion and coherence as he expertly addresses the functioning (as well as the dysfunctioning) of our healthcare ecosystem. Bravo!

  Edward J. Zajac

  James F. Beré Professor of Management and Organizations

  Kellogg School of Management

  Northwestern University

Any book that describes U.S. healthcare as a “system” must confront the evidence of variability, fragmentation, and disparities, among other challenges. Robert Burns offers a wholly different approach to understanding healthcare in America – as an ecosystem in which different actors and entities transact, innovate, provide, and produce healthcare services and products. His process analysis of how the business of healthcare actually works (or doesn’t) is a welcome addition to understanding the healthcare industry.

  Denise Anthony, PhD

  Professor, Health Management & Policy

  School of Public Health

  Professor, Sociology

  University of Michigan

Few have immersed themselves in the complex inner workings of the U.S. healthcare system like Rob Burns. This expansive yet in-depth survey of the healthcare landscape offers insights not found in typical texts. Recognizing that the U.S. system lacks structural design in its origin, Burns focuses on its evolution—how the diversity of actors have adapted under a mix of market and regulatory pressures, and how their interactions determine the care we get. The book at once applies scholarly rigor to an industry rife with slogans and grounds academic instincts in the reality of how the business works. The result is a must read for thinkers and doers alike.

  J. Michael McWilliams M.D., Ph.D.

  Warren Alpert Foundation Professor of Health Care Policy

  Professor of Medicine

  Dept. of Health Care Policy

  Harvard Medical School