Clinical Innovation - Serving the Underserved As a Health Care Innovation Strategy

I keep in touch with successful physician innovators I have known. One of these is Lucien Wilkins, MD, a retired gastroenterologist with homes in Boone and Wilmington, North Carolina. Lucien now heads up his own consulting firm Lucien Wilkins MD Consulting.

Lucien now spends his time setting up, organizing, financing, and otherwise making possible new ventures, new services, and new facilities in underserved parts of North Carolina.

According to the 2000 census, in the 1990s North Carolina rural counties grew by 18% and added 600,000 residents. By comparison, over the same period, urban North Carolina grew by 25%, or 800,000 new residents. Overall, the state expanded from 6.6 million to 8.0 million from 1990 to 2000, a 21% increase.

Net migration, the number of people who moved to North Carolina minus the number who left, accounted for 70% of the population increase. In rural areas, in-migration soared over 70% of growth. Aging of baby boomers and influx of retirees is the changing the age distribution of rural North Carolina, with particularly rapid aging in the Mountain region. Although the fastest growing counties surround the Research Triangle and Charlotte, several rural counties along the coast are also exploding in growth. North Carolina is expected to surpass 12 million in population by 2030.

These stark growth figures did not go unnoticed by Dr. Wilkins. As a practicing gastroenterologist in Wilmington, he could not help but observe many patients with gastrointestinal cancers from rural towns and farms came too late to be treated. He was acutely aware growing rural areas were medically underserved, and he vowed to do something about it.
He learned from executives at the DeWitt Corporation, a real estate and construction firm, that incoming retirees asked two basic questions: 1) What is the price of the property? 2) Where are the medical services?

In partnership with Dewitt, Dr. Wilkins helped scope out the most rapidly growing rural areas and defined their level of medical services. Then, in conjunction with the real estate and construction arms of Dewitt, they built a half-dozen Big MACCs (Multispecialty Ambulatory Care Centers) in underserved rural regions.

Today Dr. Wilkins is an independent consultant. His relationships still involve consulting with DeWitt. Wilkins has expanded his other consulting to include building centers to provide wellness and fitness services, constructing senior centers and housing complexes, organizing more Big MACCs, some in more suburban and urban areas, and cultivating relationships and investors among medical groups, hospitals, and venture capitalists.

What drives Dr. Wilkins are his vivid memories of futilely trying to treat last stage cancer patients from underserved regions. His entrepreneurial philosophy has become to place first-rate facilities and specialists where people work, live, play, and retire so that people in underserved regions can be diagnosed and treated early and appropriately.

This may sound like a simple philosophy, as indeed it is. But like most successful innovators, Wilkins is a strong proponent of simplicity. Many health care participants, he says, make things more complicated than they need be. He maintains the best ideas have a strong sense of direction – and his case – only one moving part – serving the underserved. He is also a major believer in building trust and confidence before launching any innovation. Without the requisite trust and confidence, nothing happens.