As our medical system attempts to evolve to better deal with the modern epidemics of lifestyle-driven chronic disease, much time and attention is being placed on the clinical models for prevention. Rightly so, and various viable models are popping up with names like lifestyle medicine, preventative medicine, and functional medicine.
But one area that is hardly addressed is the payment structure and business model of the practices. Are there structures that optimize physician and patient behavior?
This is a question that innovators from New York City to Silicon Valley are trying to answer, and some of the success stories that are emerging provide an exciting opportunity for physicians to, in the words of Bucky Fuller, “build a new system that makes the old system obsolete.”
One of the forefront thinkers in this area is Tom Blue, chief strategy officer at the American Academy of Private Physicians. In our 2014 Evolution of Medicine Summit, he noted that from a big picture perspective, “we’re trapped at the collision of moral and fiduciary responsibility. We have this massive industry that is fiduciarily obligated to continue to maximize profits for investors. Yet, morally, science has revealed that the underlying strategy for creating, restoring, maintaining, growing, and protecting health in this country is, unfortunately, outdated. And so we are pinned at this unfortunate intersection.”
This conflict is probably also apparent on a daily basis in your or practice. Should you do aggressive lifestyle counseling for heart issues? Or just do a procedure that maximizes your revenue? How will your doctor group or accountant view that decision?
In addition, at the micro-level it is clear that, as more and more patients become payers of their own health care through high-deductible plans, a fee for service model encourages underutilization of services. I mean, you don’t like to spend any more time with a lawyer than you have to (right?) because you are on the clock. It’s fundamentally the same equation.
These conflicts have led to innovators looking for new models that provide the right incentives to both doctor and patient, and this is a massively important step because eventually, the money will run out. At the end of the day, it doesn’t matter who is paying. If we don’t decrease the incidence and cost of chronic disease further upstream, no industrialized nation will be able to surmount those costs.
To reduce those downstream costs, two of the key deliverables upstream are education and empowerment — a move back towards the original meaning of doctor: teacher. I recently heard a doctor say that part of his program was to inspire and educate patients to become “medically independent.” An example he gave was that their patients could read their own labs.
So, what are some of these emerging models?
Community events. More and more doctors are putting on events to teach at scale. Cooking classes (working with other providers), grocery store tours, and evening seminars are all proving popular. A truly remarkable medical experience!
Memberships. By providing a membership, doctors can capture the value of uncovered services while providing a framework that keeps patients coming back after the initial symptoms are resolved. They can spend the rest of their membership time learning how to keep themselves well going forward.
Packages. This provides another way to capture value, adding individual and group experiences into a package that patients commit to when they start their program with the clinic. Engaged patients are committed patients.
Online portals. Peer to peer support in a dedicated online portal has been very successful, particularly if they all share a common disease or symptom. People really want to hear others’ experiences. Facebook is a popular tool.
Synergistic providers. Health coaches, nurse coaches, and nutritionists are all becoming more and more popular as synergistic team members of a modern practice. Adding those providers into packages also scales down your time.
We’re already seeing each of these being implemented in a variety of ways, and undoubtedly there is much, much more to come.