Newtown, CT – May 11, 2012
Clay Christensen's seminal work on innovation offers important lessons for healthcare – The most important is that disruptive innovations will force the centralization of skills to become decentralized. In other words, many aspects of care and care decision-making will be pushed down from the current center of skills – hospitals – to the outer edges of skills, the consumer. That seems hard to believe for the many professionals who have spent years learning their medical skills, and it was also hard to believe for the engineers who ran the supercomputers of the 70s, or the scientists who developed synthetic compounds in the same era. And yet the diffusion of disruptive innovations pushed knowledge to the outer edges of skilled workers: the average consumer. Don Berwick, in his talks, mentions a young swede who performs his own dialysis. He also mentions new, low cost tech tools that allow Alaskans to receive care close to home instead of having to travel miles to the "big hospital". These are only the beginning signs of the disruption to come. And that disruption will be vastly accelerated by payment reform. If physicians and hospitals can actually improve their operating margins by finding more efficient ways of managing patients and avoiding useless tests and excessive medication, they'll do it. Much of this starts by listening to the customer. And until now, the main customer in health care has been the provider, much like in the 70s, the main customer of the computer industry was the engineer.
What this means to you – The customer has to be the patient. And consumer-patients are increasingly demanding to become the customer because their wallets are being affected by their decisions. Benefit buy-downs and high co-insurance or deductible health plans are turning an increasing number of Americans into active consumers. Plans are responding. For example, United HealthCare has made significant modifications to their member web site to provide plan members with real time information on the member's costs of care for a specific event/procedure, with a comparison of that cost by provider using actual negotiated fee schedules. Providers are also responding. Practices in the Wellspan system in South-Central PA, an Aligning Forces site, are pairing up with patient "buddies" to listen to the "voice of the customer" in affecting practice process redesign. This is only the beginning. For some, it's the beginning of the end for they will die off like the mainframes of old. For others, it's the beginning of a bright future for they will flourish like smartphones. Which will you be?
Francois de Brantes
Health Care Incentives Improvement Institute, Inc.