Once upon a time there were department stores that sold everything. They hardly exist anymore. Why? because we get a better deal from specialty stores. Once upon a time there were record albums where many songs were in one package. We don't buy albums anymore. If we buy any music we buy songs.
We used to rely on advertising. Increasingly we use our trusted personal networks to help us navigate the market.
It used to take millions to make complex things but more and more we are seeing new tools that can do big things for very little cost.
The world of Macy's and Mad Men is over. But not in health care
Today we have a department store model for healthcare. Today we use all the old models of business in healthcare.
So what might a truly modern view of health care look like?
This is where Clayton Christensen's new vision for Healthcare makes so much sense to me.
Here in one page is the guts of CC's case. All of these models are combined today in the healthcare model and are rooted in the most expensive part of the system - the doctor's office and the hospital. It's all Macy's in the 1950's. It's big and aggregated into one high overhead system that has massive organizational friction and so low quality.
Clayton Christensen is advocating that we break this up as happened to the department stores. Then each part of the mix woudl get the best deal!
Imagine each part of this mix being pulled out as CC suggests:
- Fee for Service - Here you pay a lot to get the best shot at finding out what the problem is when what is wrong is not clear. "House" on steroids. The McKinsey model.
- Fee for Outcome - Specialized units that focus on doing one proceedure well - we see this already with hernia operations - you are much better going to a specialist clinic - lower overhead - better operational process - better outcomes.
- Membership as the Model - A social network aggregated around similar issues. Such as Type 2 Diabetes etc. Here prevention and living with a diease or the life changes needed to cure us will take place. None of these tasks can be done by a doctor as we currently organize health. Nor should they. They can best be done by us the pubic. For here the issue is how we live and of course getting off our addictions.
How to do this?
CC offers the playbook here too. It is very unlikley that the system will reform itself to do this. Systems don't do that. The system will have to be disrupted from below.
Diagnosis - Most GP's refer complex cases of all kinds up the line as it is. They are in reality traffic directors. They can treat only very minor problems. Most of the time they simply write a prescription. They are so time pressed that they cannot help with prevention. They are not paid for that anyway. The real issue for most of their patients is that they have a chronic disease such as heart disease or type 2 diabetes. All of these diseases are based on lifestyle. Not the Dr's forte. Drugs are the proxy for health.
CC is suggesting that we see high end diagnosis as a field in itself. This does not have to be based in one hospital.
Just as a hospital or a Dr's office has low skills and high overheads - Specialty Clinics have high skills and low overheads.
In Canada we have a start here in specialty clinics such as the Shouldice Clinic - If you have a hernia you would be silly to go anywhere else. This is what CC means as fee for outcome and this type of clinic can generate such process expertise as to all but guarantee a good result. The Shouldice is the specialty retailer that replaced the department store.
Changing all this above is hard work as it involves changes to the system as it is.
What interests me the most is the largest group at the bottom where groups of people with say Type 2 Diabetes can get together an help each other.
The new frontier for health that can grow up in spite of the system is "Community Health". Where you and I take charge of our health and use simple and powerful tools and each other to stay healthy, get healthy and help each other at rock bottoms costs.
- In using diagnostic and measurement tools - as with all other tools more and more diagnotic tools that used to ve expensive and hard to use are available at prices and levels of complexity that you and I can use.
- In learning more about their condition - as with the publication of the bible in the 16th century, information that was restrricted ony to Dr's is widely available to all of us now. Many know more about their condition that theur GP who has to be so broad.
- In learning about diet - we are learning that diet is at the heart of most of the diseases of medern life. Dr's know nothing abut this. Changing our diet is often beyond our power alone. We need the help of our peers.
- In helping each other makes the hard lifestyle changes they need to take back control. No expert can help here - only peers.
Here the skilled part is in Facilitation. This is where 85% of the system will reside.
Here is I think where the power of social media combined with what we are learning about the true causes of most modern disease offers us so much.
We could all get more healthy at a fraction of the cost of the current system - cost to us as individuals and as societies.
This is the revolution that is ahead.
