Disruptive Changes Are Coming to the Delivery of Medical Care - The Future of Healthcare Delivery

We have grown accustomed to disruptive scientific research , such as those I wrote about in The Future of Medicine — Megatrends in Healthcare, changing the landscape of medicine  However,  some very disruptive changes are coming soon in how medical care will be delivered to you by your doctor or hospital. The Future of Health Care Delivery– Why Medicine Must Change and How It Will Affect You details these disruptive changes in healthcare delivery and how you can prepare for them   If you are properly prepared, you can actually use these disruptions to your benefit. Indeed, we sometimes need transformative disruptions to make the changes necessary for real progress in medicine.

Some examples of coming disruption in healthcare delivery include:

Team-based chronic illness care. The combination of an aging population and the ongoing prevalence of adverse behaviors, such as  overeating, not exercising and smoking, have created  worldwide epidemics of diabetes,  cardiovascular disease, and other  chronic illnesses that last a lifetime and are difficult to treat. These complex illnesses require team-based, multi-disciplinary care. Team-based care is not the norm today, and the lack of it substantially increases the costs and diminishes the quality of care. The primary care physician must become the team coordinator and be more an orchestrator and less an intervener.

Echelons of care for acute illness. Advances in the care of as heart attacks and strokes also demand a different delivery model. A potential  model for this new method of delivery is trauma medicine  In trauma, there is a triage system where people with relatively minor injuries are sent to a local ER, more severely injured are sent to a regional trauma center, and the most severely injured are sent to a Level 1 dedicated trauma center. This approach is accepted for trauma but not yet for other acute types of episodes, such heart attacks and stroke. Today the gold standard of care for a heart attack is immediate angioplasty with stent placement to stop the heart attack in progress and reduce heart muscle damage. However, this standard of care is often not available at small community hospitals Thus, the heart attack or stroke patient brought to a small community hospital should be referred on to a larger center equipped with trained interventional cardiologists, an expert staff, and the needed equipment — all available 24/7. Although this will result in higher-quality care and better survival rates, it will undoubtedly disrupt the economics of many doctors and small community hospitals who treat heart patients.

More high-tech hospitals. More serious illnesses means there will be a need for more hospitals, more beds (especially ICU beds), and more operating rooms with highly sophisticated technologies. This marks a departure from recent decades, when the mantra has been "too many hospitals and too many beds." Since smaller hospitals will have difficulty accessing the credit markets to finance expensive technology and facilities, we can expect to see a wave of hospital mergers and fewer stand-alone hospitals.

Patient-centric medicine. There is an emergence of consumerism in health care. ("The patient will no longer be patient.") So, our current provider-oriented culture will have to change to a patient-oriented culture. Patients will insist on prompt service, improved safety and quality, greater respect, much more convenience, and a closure of the current information gap between doctor and patient. Absent satisfaction, patients will go elsewhere. These are very disruptive changes indeed from the present provider-centric approach to care delivery.

Delegation of care. Shortages of physicians will mean more reliance on others to deliver care — e.g., nurse practioneers and physician's assistants for primary care, social workers and psychologists for mental health care, and optometrists for vision care. Physicians will need to change their attitudes toward these providers by involving them more in care decisions and embracing their full value to the care team.

A new value proposition for technology. We think of new technologies as being of value, only if they improve diagnosis, treatment, or prevention while providing a decent return on investment.  However, in the future, we will also expect a new technology to help compensate for shortages of certain kinds of care providers, enhance their responsiveness to more demanding patients, control rather than exacerbate costs, and enhance safety and quality. This is very different from today's value proposition.

Employee physicians. Physicians' expectations are changing as much as those of patients.  Although most physicians in the U.S. today are in private practice, a growing number — especially younger ones — want to be employed by a larger organization, such as a large group practice or hospital. They also want to spend less time on administrative tasks and more time on family activities. Women are now 50% of graduates from medical school; many will want time off for child-rearing, further exacerbating the shortage of doctors.

E-health. The internet and digital medical information will have a major disruptive effect on the practice of medicine. Many physicians eschew these technologies today — often because insurers don't reimburse them for the time involved. But, in the near future they will be expected by their patients to keep them informed using e-mails, telemedicine and telediagnosis, ePrescriptions, and an electronic medical record. If doctors want to keep their patients, they'll have to accept these changes.

Retainer Based Practices – Primary care physicians find that their incomes have been flat or reduced, their work hours increased, their time with each patient shortened, and their frustrations with insurers heightened dramatically over recent years. Some are saying “I just can’t take it any longer” and switching to a different type of practice model. Others simply will not accept Medicare anymore, telling their older patients that they must either pay out of pocket or go elsewhere. Still others are converting to “retainer-based” practices, where the patient pays a flat fee each year, often $1500 to $2000, in return for having their PCP available by cell phone 24/7 and responsive by email. Appointments within 24 hours are guaranteed. In this scenario, the physician will see you in the ER, take care of you in the hospital, and do home or nursing home visits as needed at no extra charge. You still need your insurance, however, in case you have need to see a specialist, have tests or imaging studies, or are hospitalized. So, the cost to the patient is extra. This is very disruptive of the standard approach today, but I predict it will become very common in just a few years.

Smart Phones– Physicians, especially younger physicians and residents, are becoming very reliant on these devices. They use them to stay well informed and to communicate, argue, and debate with one another, which is an excellent form of learning. As smart phones keep being refined, more and more physicians will want to rely on them and will become more effective physicians as a result.

Wireless Medicine – Closely affiliated with the rise of smart phones is the rise of wireless medicine. Among them are devices to measure heart rate, blood pressure, electrocardiogram over long periods of time, blood glucose, and weight. There are now many wireless medical devices on the market, and many more coming at a rapid rate that can have profound implications for medical care and health/wellness promotion. These are new techniques and technologies that are going to change the way medicine is practiced; This is one of the medical megatrends that is unfolding  before our eyes.

These are but a few of many changes coming in healthcare delivery. All will have significant and ultimately disruptive effects on the way medicine is practiced in the very near future.

Last Modified: November 20, 2011.

Copyright (c) Stephen C. Schimpff, MD