Wednesday, September 4, 2013

Converging Health Care Landscape
Man is a singular creature.  He has a set of gifts which make him unique among the animals: so that, unlike them, he is not a figure in the landscape – he is the shaper of the landscape.
Jacob Bronowski (1908-1974), The Ascent of Man (1973)
For physicians, the health care landscape is converging from individualism to corporatism, from vertical thinking to lateral thinking.
Edward deBono, MD (born 1933), who founded a thinking institute on the island of Malta and who has written more than 50 books on thinking, explained the old landscape in this way. 
de Bono said there are two kinds of health care thinkers – vertical thinkers who view the landscape laterally as a vast interconnected social enterprise  and vertical thinkers who see it as a series of unconnected entities where individuals and organizations dig ever and ever deeper vertical holes. At the bottom of each hole, you will find a world-class expert. The problem is: the holes don’t interconnect.
Well,  Obamacare, private and public economic pressures to reduce costs and rationalize care,  the advent of the Internet, mobile devices, and deployment of Big Data to judge and justify care, have changed the landscape. 
The landscape is converging, new mindsets are emerging.
·         Hospitals are acquiring and hiring physicians at an unprecedented rate.  By 2015, hospitals will employ 75% of physicians.

·          Physician mindsets are changing.   According to a 2012  Physician Foundation survey of 630,000 physicians, to which 13,575 physicians responded,  59% of doctors were pessimistic about reform efforts,  92% were unsure where the system was going, and many appeared on the verge of  picking economic security of hospital employment over uncertainty of independent practices.   The supermarkets of care were winning over the mom and pop corner groceries of care, with the notable exceptions of concierge practices and other forms of retainer and cash-only practices. 

·         Health policy types and integrated systems executives are beginning to  pay capitated rates for  “value,” data-based on outcomes and performance,  rather individual rates tied to t “volume,” the number of patients seen or procedures done.

·         Integrated hospital-based systems,  are becoming insurers,  insurers are acquiring physician groups, and the lines between physicians,  hospitals, health plans, and who ho pays for what and does what,  are becoming blurred.

·         Primary care physicians are rising to the ascendancy in Accountable Care Organizations and Medical Homes, with specialists are perceived as secondary actors, to be cut in or out of networks,  based on the value they bring to the organization,  or so the cost-cutters hope and dream.

·         The Internet, and its spillover into clinical algorithms, artificial intelligence applications,  and its ubiquitous presence in the hands of consumers seeking health care information, is becoming a huge point of leverage driving conversion

A Messy Process
This convergence is a messy process.   Specialists – in the cancer, orthopedic,  heart, neurological, surgical,  imaging arenas- remain, now in the near future, hospitals’ leading profit generators.  Hospital marketers know full well that  medical breakthroughs – like nonsurgical  gamma knife treatment and less-invasive, quicker recovery robotic surgeries for a variety of clinical conditions – attract specialists. Consumers, and profit margins.   And, given the American capitalistic system’s proclivity for competition over government control, calls for more “coordination,” “integration,”  and “transparency” of one’s pricing structure and outcomes data sometimes go unheeded.    Besides,  individualism, a desire for choice, and multiple options  are still alive and well in America.    There is  clear evidence that hospital-acquired physician practices, because of government-approved  facility-fees, raise rather than lower costs of seeing physicians.
Tweet:    The landscape may be  transitioning from  individual care delivered by doctors,  to coordinated care, delivered by teams and  organizations

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