On a more personalized level, concierge care features doctors who oversee all aspects of a patient’s health care, including advice and treatment, for a flat fee. Today, concierge care is a service mostly for the wealthy. In the future, it may address a broader range of patients; we’ll probably see concierge offerings tailored to children, chronic-disease sufferers, the aged, and other populations for whom the service represents a reasonable value.
Hospitals, too, are devising new formats and products. Some have developed specialties in complex diseases such as heart disease and cancer; greater volume in treating a specific disease often translates into enhanced efficiency and quality of care. Increasingly, the retail marketplace requires that hospitals rethink everything they do to focus tightly on the patient–customer. Hospitals must consider which services really need to be provided within their own walls; whether to relocate certain services, like diagnostic testing, to convenient settings in shopping malls or physicians’ offices; whether to outsource their back-office and other functions, including aspects of radiology; and whether services should be bundled to provide soup-to-nuts care in such areas as obstetrics and orthopedics.
Michael E. Porter and Elizabeth Olmsted Teisberg promote that last scenario in their recent book, Redefining Health Care: Creating Value-Based Competition on Results (Harvard Business School Press, 2006; see “Does Health Care Have a Future?” by Joe Flower and David Knott, s+b, Spring 2007), and we agree it is the best path forward. Porter and Teisberg are correct to note that what little competition there is today on the supply side is at the wrong level: It’s health plan competing against health plan, or hospital against hospital. Competition will work best for all when it takes place on the level of solutions to medical conditions, as in one knee-repair team or one diabetes-care team versus another. If and when that happens, we’ll finally have true competition that gives consumers quality and value.
Advances in Technology and Connectivity. Enabling these changes will be advances in medical technology and health information technology (IT). Connectivity among providers is crucial, as is the ability to monitor and consult with patients from afar. The technology already exists to help monitor chronic conditions from home: Diabetics can test their blood sugar levels using a device that automatically sends the data to their physicians or a third-party monitoring service. Similar technology is being developed for distance monitoring of asthma and cystic fibrosis. Cleveland Clinic now has an electronic second-opinion service on the Internet, as well as a comprehensive e-services product line that provides patients and non–Cleveland Clinic doctors access to an individual’s electronic medical record and test results.
But additional investments in health IT and greater connectivity among providers will be needed to ease sharing of patient health information and enable consumers to better manage their own health. Leading providers have implemented electronic prescribing, electronic medical records, and clinical decision-support systems, but the market is still relatively unconnected — “islands of automation” exist. Connectivity among systems and between providers and patients is limited. Comprehensive interoperability among systems and players is a must for the retail market.
There has been progress on this front. Intel, Wal-Mart, and BP, among others, recently announced a pathbreaking initiative to store digital health records for their employees in a data warehouse linking hospitals, doctors, and pharmacies. This program could be the first step on the path toward giving patients access to their own health records in order to coordinate their own care. The big question here is whether consumers will actually trust employers to have access to their medical records.
Aligning Supply-Side Incentives. In order for the supply side to better align with consumer needs, the right incentives must be in place. The incentives today for health-care providers and other suppliers are simple: Get, keep, and grow your business. Health plans from the private and public sector alike squeeze doctors on reimbursement rates, driving some doctors to bump up the number of patients they see and the number of services they recommend. Furthermore, suppliers have no financial reason to provide patients with the advice and information they need.