It's All About The Doctors

Posted by Don McDaniel on Aug 3, 2017 11:00:00 AM

I recently attended a great health care industry “futures” conference, a chance to get the pulse of the industry through discussion with key thought leaders.  Despite all the noise around ACA, “repeal and replace”, “skinny repeal”, etc., there were two take-aways that reinforced what I’ve already been feeling.

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The first is the need for much better, much deeper, much more transparent payer and provider collaboration.  Call this “joining the dark side”, coopetition, etc. – the demands of new health care consumers and their surrogates will demand more seamless collaboration.  Collaboration is a vague, over used phrase; in my estimation, both those paying for and financing care (purchasers and their payer representatives; often health insurers) and those delivering and (increasingly – see high deductibles and higher co-pays) financing care (providers) must be more willing to work together to solve problems.  This requires compromise, and a long-view.  One of my favorite sayings is, “Pigs go to feed, hogs go to slaughter”; we have too many hogs and not enough pigs. 

The second take-away, amazing in that it felt like an original idea to some, is that physicians and physician leadership – not an oxymoron - are critical to a successful reset.  Regardless of what happens in Washington around regulatory reform, the facts are that our health care industry is the least industrialized in our business climate; it’s opaque, bloated, too autocratic and just plain mediocre.  It’s not terrible; it can be the best on many levels, but it’s not great.  It’s also being marketized – that is, being exposed to market principals, and it's painful.  You’ve heard about sausage-making.

Why are physicians so important?  There are obvious reasons.  They are a critical and highly compensated supplier, they have first-mile access to consumers/patients, they are still, despite their employment disposition, still highly individualized.  The most important role they can play is that of navigator, choreographer, and pilot.  As many physicians have migrated away from hospital-based practice, leaving that work to specialist brethren; many are based solely in communities.  Simultaneously, we are learning that consumers increasingly seek services and supports that are convenient, sensitive to their needs, and generating a great return on their investment of time, money, opportunity cost and more.  Given this intersection, we have great visibility to the massive opportunity to engage with community based physicians in industrializing this archaic industry, requiring them to pivot to a consumer-centric, community-based, retail-savvy 21st century business model.

Historically, the industry has been sickness-focused, therapeutic-focused and acute-event focused.  Industrial health care, or what Professor Regina Herzlinger coined as “Market-Driven Healthcare” will be focused on the consumer, across all stages of their health – some starting the journey when they are well, some when they are in transition, some when they are in distress, some when they suffer from chronic illness and some as they naturally age.  Physician-leaders and entrepreneurs will be in the pivot – building the supply-chain as a foundation of health status improvement and designing new systems of care, and financing.  Only those that enter value at every stage of the consumer experience will thrive.  I envision great physician-led enterprises, embracing partnerships and the unique assets and endowments of their communities, leading this charge.  They will unleash the power of innovation, moving from the stifling regulatory yoke of FFS payments, to managing under globally-budgeted payments, and will increasingly create innovative, direct-to-consumer products.  They will arbitrage the historical waste in the system to deliver on the market promise of increasingly better quality and results at ever increasing prices.  If they do this right, our new health care system, a decidedly-more market-driven system, will improve the health status of many without regard to insurance status and will start to converge – the ultimate positive externality.  Here’s for the coming Physician Renaissance.


Topics: ACA, Payer Provider Collaboration, Physician Success, Community Based Physicians

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