Tuesday, January 17, 2012

The Digitization of Health Information: Why Primary Care Is At A Moneyball Moment

In a yesterday's post, the Disease Management Care Blog used Edie Weiner's video presentation on digitization and commoditization to launch into its own version of health care futurism.  While it struggled with notions of "opportunity costs," it concluded that a) highly evolved patient data bases, b) biometric monitoring systems, c) artifical intelligence-based decision support and d) growing consumer acceptance of informatics will make the need for many traditional outpatient visits obsolete.

Thanks to inspiration from the movie Moneyball, the DMCB explains why.  The movie chronicles the decision of the Oakland A's General Manager (or "GM" played by Brad Pitt) to apply a more scientific approach to recruiting players. Eschewing the largely subjective evaluation process used by his veteran scouts, the GM decides to focus on a few key player statistics.  As a result, he recruits players with high "on base" metrics and comparatively low salary demands. Success follows, and not only does he build a championship team, but he is offered a job with the legendary Red Sox. There is a telling scene filmed at Fenway Park in which the Sox owner salutes the new revolutionary approach to baseball by giving a small solilloquy on the merits of adapting or dying. Building a winning team is no longer a highly tailored and subjective approach to individual players, but data, information and insights.

Lesson learned.

The DMCB suggests outpatient primary care may be at a similar Moneyball moment.  Patients can digitize and transport their health care information from afar and, thanks to decision support paired that can be managed by non-physicians or patients themselves, use a data driven approach to get the advice and treatment options they need without having to step into a doctor's office.

What are the implications?  The DMCB can think of seven.  There are probably more:

1.   While this isn't happening tomorrow, it's a lot closer than most persons suspect.  The DMCB thinks it's a threat to all those 5 year business plans.

2. Primary care office visits remain the most vulnerable because, even with the support of government with extra payments and medical home support, a higher proportion of its common "bread and butter" acute and chronic medical issues are particularly amenable to digitalization.

3. Not all primary care office visits will go away. Patients needing a diagnosis that defies the usual algorithms will still need to be seen. That means doctors will need to refocus on being diagnosticians and caring for patients that fall outside the algorithms.  It's the usual "treat and street" clinic visits for routine follow-up of common problems will decrease considerably.

4.  This will erode not only primary care offices, but be an important hit to the business model of "urgent care" clinics.  The architects of these clinics will be well advised to start building remote access capabilities.

5. Think that that special something that can only be achieved in a one-on-one relationship with a physician who really really knows you will be lost?  Think again because its availability will still be a function of data, not doctors, chips not one-on-one care.  That being said, there will still be a market for personalized physician attention: it's called concierge practices.

6. Given the willingness of political opponents to quote from writings without accounting for context, the DMCB, thanks to its posts on the commoditization of health care, will never become President of the American Medical Association.

7.  While most of the digitization-commoditization threatens the business model of primary care, don't think that physicians that offer invasive procedures or surgery are immune from what is going on.  Patients are increasingly willing to transport themselves longer distances in exchange for value (across the state or, in the case of medical tourism, overseas), but a far more fascinating application of the digitization and easy transport of patient information is robotic telesurgery.

Image from Wikipedia


Jaan Sidorov said...

Thanks Glass! I struggled with this post. It's provocative, but the topic is worth thinking about.

Naveen Rao said...

Dr. Sidorov, Long time reader, first time commenter. When reading your list of implications, HealthPartners' Virtuwell platform jumped to mind as an example of this trend in action. I heard they've been approved for CMS reimbursement...would love to hear your thoughts!