Saturday, February 24, 2007

Health Care System 2.0: Surrogate Providers

Trial and Error

The mechanisms by which we will transition from an established platform for delivering health care (Patient-Physician relationship) to an emerging platform for delivering health care (Patient-Information Technology relationship) are not new. They are just new to patients and physicians within the context of their current relationship. Both groups are moving outside their comfort zones to test the alternatives that are becoming available. Learning through trial and error is in the nature of human beings. As we learn, we incorporate new information and blend it into the existing network of information. Moving from one paradigm to another happens the same way. It is gradual right up until the time it isn't and then it becomes obvious to everyone. The transition has already begun. The change is already happening at the most fundamental level. This is in the nature of the Patient-Physician relationship. It has become a Patient-Provider relationship and even the nature of the Provider is changing.

Non-Physician Providers

There are more sources of Providers available today than ever before, and many of those sources are becoming more readily acceptable (Retail Clinics, Chiropractors, Nurse Practitioners, Physician Assistants, Advanced Practice Nurses, Medical Spas). The Internet and television have also become valuable sources of health care related information (Google, Pub Med, Web MD, Dr. Gupta). Many of these options are based on ideas created by physicians but this is not true for all of them. Physicians are also breaking out of their mold. Not only are they offering alternative methods of accessing health care information but they are developing the fundamental concepts for the basis of these information warehouses. Often this comes in the form of protocols and guidelines but it can also be in the form of an IT based evaluation. When the established paradigm for delivering health care was at its peak it was the physicians who were the primary gatekeepers of this type of information. Patients could only access this storehouse of information and services directly through contact with a physician. Times are changing and people no longer have to do this. So why is this?

What People Want

It is no secret that people want three things from the health care system. They are access, quality and low cost. Physicians are slowly beginning to realize this and are struggling to achieve these "customer demands". As they do this they must compete at a different level. They must use alternative methods of delivering health care services and they must begin to deliver them using the older established platform for delivering health care. This traditional platform for delivering health care is relatively slow to perform in this on-demand world we live. So how do we transition from the established platform (Patient-Physician) to the emerging platform (Patient-IT based Provider)? It will be through a series of surrogates.

Surrogate Providers

Surrogate Providers come in two forms. One is human the other is technology based. Access to medically related information is the starting point for both types. The human form is represented by the non-physician providers of health care. Examples include Nurse Practitioners and Physician Assistants. In recent years we have seen the growth of Nurse Practitioners and Physician Assistants who are also providing needed information and services. They do it with improved access and lower cost. Some may argue that the quality is not up to par with that of physicians but the people paying for these services tell us something different. The growth of the retail based clinics such as Minute Clinic demonstrates that people approve of them and think they are of value. The Nurse Practitioners and Physician Assistants who staff them use an algorithm base artificial intelligence to guide their decision making. As retail based clinics expand they will confront greater competition to deliver more services, maintain access, improve quality and drive cost down even further. In time even the Nurse Practitioners and Physician Assistants will find they have competition.

Built To Last

It is the other form of non-physician provider that will be the main form of competition. This is the information technology based provider. Currently it is in its most immature state of existence. As technology improves and medical information systems become more advanced they will begin to compete with the human forms of providers. Initially they will augment and support human providers but in time as people begin to trust IT based support they will seek out the IT based provider. An IT based provider will be available 24/7. It will have all available information regarding the patient, their health related problem and its treatment. It will constantly be up to date. It will cost substantially less than any of the current forms of providers. The day will come when we will have virtual reality environments that will simulate a Physician for those who wish to interact with a visual entity. What is amazing is that I think it will ultimately be physicians who usher in this era. Why is that you say?

Self Interest & Survival

There are two reasons. The first is because it will deliver a better Health Care System. That is Health Care System 2.0. It will deliver better quality care, with improved access to care and at a lower cost. The second reason is because physicians will see it as in their best interest. Retail based clinics are a form of low end disruptive innovation. As they mature they will carve out more and more of the role that physicians have traditionally maintained. This is, as distributors of medical advice and as gatekeepers of the health care system. The IT based providers will in time act as a disruptive innovation and carve out more and more of the retail based clinics territory. Both of these entities have and will continue to have limitations. Each of these types of providers have algorithms that have exit points. These are decision nodes that refer the patient to a physician or other human provider for a specialty service. It will be in the best interest of physicians to position themselves as the natural selection for those referrals. For most physician specialists it will be immaterial who refers them patients. It won't matter if the gatekeeper and referral source is human or IT based. For the patient with an IT based provider they will know instantly who is the closest physician specialist, what is their availability, how much will they cost and how do they compare with other specialists in their field of expertise. In order to compete physicians will need to participate in systems that will optimize their access, cost and quality of care. Everybody keeps clamoring for transparency in our Health Care System. The only transparency that will be needed is that related to access, cost and quality. Beyond that anything goes in Health Care System 2.0.

1 comment:

snachtigall said...

I am a general Internist.

Your various writings are quite remarkable, you have presented a rather impressive and likely very accurate vision of future medicine.

At the same time, as a 56 year old dinosaur do, I wonder, what the heck can I do to adapt, survive and/or succeed in thi brave new world?