Our Bipolar Health Care Future

The future ain’t what it used to be.

Yogi Berra (born 1924)

The mail this week brought the December issue of the Harvard Business Review’s Alumni Bulletin and a review of A Year with Peter Drucker, HarperBusiness, $29.99) by Joseph Maciariello, professor of Claremont Graduate University and longtime collaborator of Drucker.

The HBS Alumni Bulletin contains this forecasting quote from Robert Wah, MD, President, American Medical Association.

“We’re entering the third phase of medical information technology. The first phase was to get off paper and onto a digital platform. Then we networked that digital information together. And now we can analyze that information in new and powerful ways. That’s really going to the big payoff from the feeding of the electronic health records process. Because right now it is a feed process; we have to put the information in. And once it is in there, it is my belief that it will give back to the health system. Patients, doctors, hospitals, government, insurance companies, and researchers will all make better decisions in health care with better information.”

Matthew Rees, senior fellow at Dartmouth’s Tuck School of Business, weighs in with these observations on the Drucker book.

“While he (Drucker) is best known for this study of management, his writings also explored leadership, social transition, education, demographics, civil society, and religion.. Management seeks to overcome natural , ever-present entrophic forces towards bureaucracy, deterioration, and decay..Many of the ideas for which Drucker become famous –privitazation, decentralization, the knowledge worker of the information age, management by objectives – seem anodyne today but they were well outside the main stream when he advanced them… private enterprise cannot be justified as being good for business. It can be justified as being good for society.”

Doctor Wah may be right. The digital age may make health care better. And so too do many of Drucker’s view disciplined management approaches.

The future will be bipolar.

On the one pole, hospitals and other large organizations will rule the health care roost with a combination of being the most visible central figures of the system with marketing, skills for dealing with bureaucracy, access to capital, the capacity to bring technologies and specialties together, and the tools to drive data-driven diagnosis and treatment.

On the other pole, consumers will seek more personalized, quicker, more decentralized access to individual doctors outside the hospital and government mainstreams. This access will manifest itself in several forms - specialized facilities, which Regina Herzlinger, HBS professor, has dubbed “focused factories,” and concierge medical and surgical practices, where the consumer’s and doctor’s desires and needs reign supreme, and where consumers spend more of their own money, with less intervention by government and insurance companies.