Interviews with health leaders - Two More Interviews for ModernMedicine.com - One Bottom-Up, One Top-Down

I would like to thank readers of my last blog, which contained lessons learned from six interviews I have conducted for Modern.Medicine.com on how to help independent doctors in small practices cut costs, improve outcomes, and remain financially viable. You have suggested further people to interview, and I shall pursue some of your leads.

After today and yesterday, days in which I did two more interviews, I have four more interviews to go. Keep coming up with those suggestions. I may do more than four and put them in a book.

In the last two days, I’ve conducted two more interviews – one with Dr. Gregg Alexander, a pediatrician in London, Ohio, a town of 9000 20 miles outside of Columbus, Ohio; and the other with Dr. Kent Bottles, a pathologist who is president of the Institute of Clinical Systems Improvement in the Twin Cities of Minneapolis and St. Paul.

I would characterize the Alexander chat as a bottom-up interview. Gregg has seized the initiative at the local level to develop a technologically advanced pediatric office with all the bells and whistles of modern information technology concentrated in a modernly designed pediatric office. His is an Act Locally, Think Globally approach by using information technologies to harnass and channel the world’s knowledge. Given the Internet and its wonders and applications, a single practitioner can use these technologies as a lever to act on par with doctors in large medical centers.

The Bottles interview, on the other hand, has the elements of a top-down approach. Bottles advocates a regional consortium of hospitals, doctors, patients, health systems, health plans, and employers, acting in concert with each other and following federal guidelines, is the most practical way to reduce costs and improve outcomes. He gives two examples – one of various parties working together to improve outcomes and reduce costs of treating clinical depression through a liaison of doctors and patients and health systems; and two, doctors and patients using common criteria embedded in EMRs to reach an understanding of when to order CT scans. These understandings have reduced imaging costs by $60 million annually and have eliminated the need for pre-authorization. Bottles, it seems to me, advocates a Think Globally, before one Acts Locally.

The bottom-up, top-down approaches sometimes come at collaboration in different directions. Both, however, emphasize we’re all in this together, and innovation will be necessary to achieve efficiencies and economies.