De-cluttering Healthcare – from 30,000 feet

by Dave Sanders, MD and Albert DiPiero, MD, MPH

Few things rivet the nation’s attention as a plunge in the stock market, rocked last week when giant healthcare companies were hit by the announcement from Jeff Bezos, Warren Buffett and Jamie Dimon that they’d find a way to efficiently meet the healthcare needs of their employees worldwide. See the New York Times June 30, 2018 Amazon, Berkshire Hathaway and JPMorgan Team Up to Try to Disrupt Health Care

Full stop. Do the words ‘efficient’ and ‘healthcare’ go in the same sentence? Only in a board game.

Consider how lasting change occurs.

The power trio promises to slash unsustainable medical costs not by trimming but by inventing. Wisely, Bezos said in an announcement it would take “a beginner’s mind” to reimagine healthcare delivery to more than 800,000 workers across their three companies. If he and his friends succeed in building a model that provides prompt and complete care for their workers at sharply reduced prices, last week’s stock plunge will, in time, seem a flicker. Change beyond their companies – perhaps involving the Congress – would be inevitable.

Yet the word “disruption” attends the news, as if it were the point. It’s not. While Amazon’s expanding presence has disrupted traditional and profitable business models, disruption as a strategy hardly characterizes Warren Buffett’s repeated business successes. Instead, Bezos, Buffett and Dimon in their “beginner’s mind” will likely face down the forces hobbling American healthcare delivery: layers of government oversight and regulation, and the self-interest of large healthcare organizations.

Finding the “beginner’s mind” at all will be key – and difficult. Our healthcare systems – from insurers to regulators to hospitals – are mired in complexity, jargon, duplication, politicization and resistance to change. Who can view it all with wonder, from 30,000 feet?

Impressive advances in data management and the use of digital devices won’t be enough. Fully trained physicians are overqualified to meet the needs of many, perhaps most, patients. Even the impassioned calls by Bernie Sanders to provide Medicare for all do not address the core challenges of clutter removal and providing prompt, affordable services from within fatally bloated, self-centered healthcare systems.

Pew Research has documented the disinclination of many of the nation’s nearly 70 million millennials to engage the medical system and instead seek alternatives – this despite spending billions annually on healthcare. A dissuading challenge to many is finding an available doctor, scheduling the doctor’s appointment and forging a relationship with a doctor over time – at hefty prices to boot. Here the use of smart phones, implicit among millennials, is preferred for making immediate appointments, whether to a generalist or specialist or for another service, and for paying bills.

We run a health system in the the Pacific Northwest in which customers use smartphones to manage their care. Engagement begins with a phone or text “chat” with a healthcare professional. The customer may then visit one of 36 storefront centers that deliver urgent, primary and specialty care, along with pharmacy and laboratory services. Emergency room services are available at one Portland center. We have calculated our overall costs to be at least 15 percent lower than they would be at hospital-based health systems.

This is no tale from fabled Portlandia, though originality is prized hereabouts. It is instead a call from this physician that healthcare transformation, necessary for the country’s economic health just as good vitals are for all its citizens, is possible only if impediments to change are imaginatively addressed and our rising digital fluencies fully employed.

If it takes a nudge from a trio of private sector innovators with huge resources, may it be so: The entire nation stands to gain in prosperity and wellness.

Drs. Sanders and DiPiero are co-founders of ZOOM+Care, which maintains 36 health centers in Portland and Seattle.

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