means just that—care for the patient
where it makes sense to care for the
patient. The office visit still makes
the list, but not at the top. Why do
we insist on forcing patients into an
antiquated model of care when technological advances tell us otherwise?
Even if we don’t consider the patient’s
convenience, let’s think of ourselves.
Do we really need an office visit to
diagnose common maladies that are
likely as effectively, and undeniably
more efficiently, treated via telehealth
and home-based services? (See “The
After all, waiting rooms are petri
dishes in the making. Arrogance main-
tains the expectation of access and
the office visit. As described by Duffy
and Lee, the office visit should be
“Plan B.” It’s easy to look back—who
doesn’t play Monday morning quarter-
back? But as we reflect, it’s vital that
we use history to model the future.¹
Healthcare systems that employ
physicians lose money on office visits
as segregated services, yet that same
system compensates physicians
based on the direct visit construct.
Today’s reimbursement methodology
simply doesn’t support consumerism.
Many of us don’t want to acknowledge it, but the road to transformation
is a customer journey—yes,
customer—and is rife with opportunity
to create value along the way. Think
about taking a drive—we don’t consistently hit the gas or ride the brakes, or
even stay in the same lane. We adjust
as the journey and the road dictate. Health care is no different—we accelerate or decelerate care as the prognosis and
patient needs demand.
Rotary Phone Era Designs
The advent of Medicare 53 years ago, followed by Blue
Cross’ launch of expanded outpatient services coverage and
subsequent denial of inpatient claims based on its view of
medical necessity, put reimbursement in the driver’s seat
on the provider expedition. Despite the perceived certainty
that health maintenance organizations (HMOs) and capita-
tion would rule the 1990s and value-based incentives would
replace fee-for-service, providers have enjoyed incremen-
talism’s dominance over radicalism. The current clinical
operational model was designed in
the era of rotary phones and postage
stamps to meet the challenges of
answering machines and faxes. Think
about it—the typewriter was once
the hallmark of the word-processing
industry. When was the last time you
used one (if you ever did)?
The current combination of
cost-shifting from payers to individuals—high-deductible plans to preserve
commercial payers’ profits along with
inevitable associated cascades—and
augmented mobile and virtual technology adoption creates the probability
that the consumer will drive evolution
across the healthcare continuum, not
just the physician’s office.
In the era of consumer-driven expectations and demands, high-performing
organizations accept that it’s not
enough to adapt existing workflows,
processes, and systems. It’s imperative
that we engender a discipline of collective idea generation, rapid prototyping,
and continuous testing to match patient
needs and schedules with what is technologically feasible, provides inherent
value, and is a viable organizational
strategy. We’re still playing catch-up
when we should be anticipatory.
Power to the People
Your charge, then, is to stand on the
F Respond in kind to the forward-looking patient’s evolving needs. Compete and ride along on the customer
journey, creating value at every step.
It would be foolhardy
to solely rely on
all, technology is
a tool to help relay
common sense, and
leverage of humanity.
F Transition from a legacy point-of-care model to a population health platform that addresses identified health
improvement opportunities. Do you treat people or
F Today’s patient/consumer has advanced expectations of
the healthcare system. Our measure of access is no longer
the third available appointment. Our greatest competition
isn’t competing healthcare systems, niche providers, retail
clinics, Aetna-CVS, or the payer forces. It’s us.
F The real and virtual worlds are one and the same to the
consumer—likewise for your organization.
The concentration on population health showed tremen-
dous promise—investment in wellness, prevention, and
the management of episodes of care in a highly resourceful i S t