President’s letter: Considering the amazing future of health care delivery

Wednesday, January 01, 2014 11:05 AM

John Lumir Bender, MD, FAAFP
President, Colorado Medical Society

“If I had asked people what they wanted, they would have said faster horses”
– Henry Ford, inventor of the Model T automobile and the assembly line

Salutations! Today, I ask you to take a moment to consider the amazing future of health care delivery.

Our industry is on the verge of incredible change, as payment reform, the digitalization and exchange of health care information, robotics, genetics, cognitive computing and regulatory forces rapidly usher in new opportunities and new challenges for the marketplace. We can actually predict what behaviors and skills will be required of the disruptive innovators that will transform health care in the next decade. Here are some ideas you can take back to your organization to help create a vision for our state’s future. This “consumer mind share” vision for future products and services must be communicated across Colorado, and a strategic architecture built to develop the core competencies needed to distribute innovative products and services to future markets.

This industry foresight will establish your company as the intellectual, competitive leader in terms of influence over the direction and shape of industry transformation. That foresight must include a point of view about the consumer benefits, organizational competencies and future consumer interface that can be produced via a “directed evolution” or created future. Acquisitions alone are not enough to establish industry foresight, as they generally rely on profits in existing markets. “Skunk works” projects deny the developing competency of the full spectrum of the enterprise’s collective intelligence by fragmenting implementation of the new business unit apart from the rest of the organization’s resources and resourcefulness. The physician practice instead must first acknowledge not that the future is unknown but that it will be different. We must evaluate what “could be” and then work backward to what must happen in the new created future to come.

Health care industry leaders have been laggards to expand their opportunity horizons and to see their core competencies as the portfolio, rather than their business units as their portfolios. This has been especially true for the 1970s paper-based independent private practitioner locked into a mindset of delivering cottage age industry health care. It is also true of the marketplace dominant incumbent, the hospital system, adding layers and layers of new expensive technology upon outmoded care delivery and payment systems. Health care has not generally seen the future with a “wide-angle lens” that is envisioning a world with less clinics and fewer hospitals, or a world with more actual health care access and more personalized technology leverage and consumer empowerment. Traditional systems ignore vast segments of the population that do not even use clinics or hospitals…until they are dying and someone else calls for the ambulance!

Physicians and hospital administrators are not genetically encoded in their training or hierarchy to embrace rebellious or subversive ideas. They eschew breaking the rules as unprofessional conduct or patient profiteering. The patient safety flag is flung referee style without regard to whether actual outcomes with a new idea are producing inferior results. The benchmark for patient safety is mired in the past and reflective of case law, outdated scientific articles, and pre-digital systems of organized care delivery. Health care leaders traditionally respect seers over unorthodoxy, which limits their ability to master true industry foresight. Regulators are now forcing patient satisfaction surveys down the throats of hospital systems as part of measuring the value of care delivery and to determine prospective payments. Although customer feedback is important, this approach by regulators may have the unfortunate side effect of compelling hospital systems to design care delivery based on what consumers are currently valuing from other competing providers who have already made it to the future. This will limit the hospital systems as incumbent to merely “satisfying” their customers, not actually amazing them.

The winners in the next round of this directed health care evolution will exploit unserved and unarticulated patient-consumer needs, and focus on solutions to the human condition. Large disparities in health care also mean large opportunities for entrepreneurs focused on true health care access. While payment reform will provide more insurance cards in 2014, it will not create more access or more physicians in the workforce. Innovators who can preempt significant increases in emergency room utilization as the substitute means of primary care for the newly insured have the best opportunity for reducing costs and delivering value.

I believe one of the greatest opportunities for our industry in expeditionary marketing and global preemption is the smart phone’s potential to be a valuable tool in health care access. The rampant deployment of Bluetooth-enabled body sensors, along with apps that can deliver personalized health care information directly to the clinician, will allow us to deliver safe, effective asynchronous or real-time care remotely, creating a new convenience that has the potential to disrupt both traditional hospital and ambulatory clinic-based care. By marrying the new technologies of lower-cost, readily available smartphones, Bluetooth-enabled body sensors, encrypted FaceTime remote clinical visits, and a cloud-based, accessible patient health care record, patients will feel more empowered going to their health care app than perhaps calling an ambulance, googling for answers, running to the ER, or leaving a message to schedule a doctor’s appointment next week. The opportunity even has a potential for global preemption, due to the ubiquitous nature of smartphones and the Internet.

According to Diamandis (2012) smartphones are even now used by Masai Warriors on the plains of Africa, who commented “they can communicate better than Ronald Reagan could, and have more access to data than a United States president 20 years ago.” The development of a smartphone “tricorder,” effective distribution of cognitive computing by IBM Watson’s natural-language style customer interfaces, and full digitalization and centralization of the health record will usher in a new era of health care access, cost reduction, safety and consumer amazement. The mind share (and market share) will go to the industry leaders with the foresight to capture the core competencies necessary to deliver the integrated product ahead of schedule.

Please feel free to share with me your ideas about the future of health care delivery and making it real here in Colorado. I can be reached by email at jlbender@miramont.us.