Sunday, March 23, 2014

Health Reform Disruptions and Discontinuities 

Disruption - Forcible separation or division into parts.

Discontinuity - Lack of continuity; lack of uninterrupted connection; irregularity; break or gap.


In his 1968 book,  The Age of Discontinuity,  Peter F. Drucker (1909-2005), said social discontinuities, abrupt and irregular disruptions influence  how people think and respond to change.  Discontinuities,   rather than massive trends,  shape the future.

Health reform is undergoing a series of  disruptions and discontinuities.  It’s one disruption and one discontinuity after another.


The first change or discontinuity is caused by disruption.   Four years ago today, ObamaCare passed.  It was a massive change.   It was designed to overhaul 1/6 of the U.S. economy.   It was going to consolidate government control of healthcare.  It was going to build a series of integrated healthcare organizations offering completely bundled services for entire episodes of illness,  from first symptom, to terminal care, to death.   It was going to lower costs,  provide universal access, improve quality.  

Instead, it did the opposite.   It disrupted both the health care economy and the national economy. It did not deliver on its premises and promises.  It raised costs.  It lowered quality, at least in the minds of patients and physicians.  It caused patients to lose their physicians and health plans.  It  threw everyone, even the uninsured who it was intended to help,  into a state of confusion and disruption and disrespect for big government.

The government overhaul created  disruptive innovation  and  creative destruction.    Nurse practitioners, physician assistants, and other midlevel practitioners replaced physicians.  Algorithms,  guidelines and standards replaced human judgment.   Health consumers began to get most of  their information,  almost everything they needed to know, they thought, from each other or through the social media, from the all-knowing, all-inclusive Web.   Telemedicine ,  remote sensors, and audiovisual devices stood in for physicians and other caregivers.   Hospitals closed, academic health centers shriveled, primary care physicians dwindled.


The second change  leads to a discontinuity called  decentralization .  We were going to transition smoothly  from private care to government care, from personal individual care by individual physicians to collective team care by squads of  healthcare professionals, from human relations  to online communication, from treatment in doctors’ offices to treatment in medical malls, to retail clinics in big drug or big box stores,  to integrated institutions, from fee-for-service to salaried physicians guided by health care management experts deploying computer-gathered information collected at the site of care and focused on outcomes.  Instead, we harvested and provoked  resentment and suspicious that government was intruding into our lives and spying on or manipulating  our personal affairs.

Return to Individualism and Humanism

Decentralization, with a return to individualism,  surprised  many government policy makers and collectivists, who thought consolidation of the system under government control was the answer.    You see this decentralization and humanization n many forms:   millenials connecting to and trusting only each other, distrusting and even abandoning  government and other institutions and not signing up for ObamaCare health exchange plans; a Gallup poll indicating   the public regards  big government as the biggest single threat to democracy;  physicians abandoning 3rd party insurance coverage,  no longer accepting new Medicaid or Medicare patients, and setting up concierge, direct cash practices;  and patients rejecting ObamaCare health  exchange plans in favor of  lower cost, more patient-intensive, cash-only care.

Human Flexibility and Adaptability

People it seems, are  beginning  to rethink the human condition.  They are deciding that maybe, just maybe,  that as social creatures,  they  need more socialization, more  people talking to each other,  more people sharing experiences in face-to-face rather than click-to-click  settings,  more physicians reading patients’  facial expressions, tones of voice,  and body languages; more time spent with each other.

 Doctors are redesigning  practices to spend more time with patients,  to cater to patients’  individual needs. Patients , in turn, are seeking more individual attention,   doctors who have more  time to listen to their stories, to  counsel them about their worries,  being  available on short notice.  Patients and physicians alike have grown aware regulations and outside management.  New rules and new bureaucracies  cost money, wastes time, delays, and limits choice. Both patients and doctors seek more direct relationships.

When it comes to their health  and happiness, people are open to change, to  anything that gives them freedom and choice, even it upsets government  continuity and  centralized decision-making, which brings to mind the title of an old Broadway musical,  Anything Goes, containing a song with these lyrics to a song called "It's Delovely," a title which might apply to the health law. The song comments on the human condition and its foibles and joys.

It’s  delightful, it’s delicious,
It’s delightful, it’s delirious,
It’s dilemma, it’s delimit, it’s deluxe,
It’s delovely.

Tweet:   Health reform is in an age of discontinuity, with sharp turns away from past government dictated trend towards more individualism, humanism, and choice.

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