Newtown, CT – August 14, 2015
It was bound to happen, and it has. Uber-Doc has entered the market – While the new company's name isn't Uber-Doc, it could as well be. In case you hadn't noticed – and you likely wouldn't if you don't live on the West Coast – there's a new way to get care the old-fashioned way and it's called heal. For a flat fee, known up front (like Uber), the doctor will come to your home (or office, or anywhere else) and take care of you (like Uber). Given that almost all routine sick care is paid out of pocket today, why wouldn't consumers turn to a physician who will provide convenience and timeliness instead of forcing them to go to their office on their schedule? The pundits and other hand-wringers will worry that care coordination will be lost, that without the expensive (and mostly unnecessary) overhead of an "accountable care organization" the patient will fall through the cracks, that unintended consequences will be unleashed and perhaps the end of the world as we know it. On that last point, they will be right, witness the Uber effect on the stock of TAXI, or look at the change in valuation of a Medallion license in New York City. What was once a safe bet no longer is, what was once a monopoly has been destroyed. And the consumer wins.
What this means to you – If you stop and really think about what makes coordinated care or "integrated" care holistic, it's the free flow of information on the patient. Today, despite a trillion dollars spent by the federal government, patient information only flows freely within the confines of a medical practice, a medical group or a health system that each operate on a single electronic medical record platform. The fear of Uber-doc is exactly what has motivated today's health systems to lock up their data in non-interoperable EHRs, and of course the vendors are happy to make it tough because it locks them into their customer base. Everyone on the receiving end of the health care dollar benefits at the expense of the consumer. However, that is changing, and changing rapidly. While true interoperability has remained elusive, it is very much a near term possibility, and with that, the full disruptive power of heal/Uber-doc will be unleashed, to the benefit of consumer-patients. So now start imagining the patient-centric power of a model where the heal PCP comes to your home, refers you to a specialist and transfers the pertinent clinical information so that your specialist knows why you're coming and what to do. Because if she doesn't, the heal PCP will stop referring patients and find someone else that will be more patient-centric. Pods of physicians that don't have to glom together in some administrative superstructure can instead flexibly assemble to care for your needs as they change. If that was an option, which would you prefer, the corner ACO or the flexible network? For those who select the latter (and I suspect it will be a majority), think about shorting some hospital stocks because they'll look a lot like TAXI in a few years.