Consumer Driven Health Care Goes Astray

consumer driven health careWhile consumer-driven health care aims to increase the transparency, accountability, and quality of U.S. medicine, occasionally this concept goes off the rails. Here are two business models that miss the mark.

The first, ZocDoc, professes to help its clients “by revealing the ‘hidden supply’ of appointments… [and] get access to care in just 24 – 72 hours.” It’s an online service where you type in your desired specialty, zip code, insurance plan and presto! out comes a list of available providers. It’s as easy as making a dinner reservation on Open Table. In fact, founder Cyrus Massoumi often makes the same comparison when discussing his new company.

ZocDoc’s business model assumes that correctly diagnosing your chest pain as cardiac, pulmonary, or gastric origin is as simple as determining whether you want Vietnamese or Thai food tonight. And while the consequences of choosing poorly on Open Table is a lousy meal, the result of selecting the wrong specialty can be disastrous: you might spend days, or even weeks, traveling down the wrong diagnostic path — or worse. In medicine, we refer to this as “delay of diagnosis,” and it’s a common cause of injury to patients (and malpractice lawsuits).

Furthermore, inefficient workups can be really costly. In this era of shrinking health plan benefits, those costs are yours to bear.

And once you’ve self-selected your specialty, how do you choose the provider? ZocDoc provides user reviews. But online reviews have their own pitfalls, as this recent New York Times article describes.

On the company’s website, Mr. Massoumi writes that “after I ruptured my eardrum on a flight, I couldn’t find a doctor for four days. I knew there had to be an easier way for patients to find doctors.”

What’s missing from Mr. Massoumi’s complaint is that this delay was almost certainly because he didn’t have a primary care doctor. If he had been connected to a primary care physician, Mr. Massoumi could have called and described his symptoms, and likely received a prompt appointment.

Additionally, while the success of ZocDoc indicates there are plenty of providers with time on their hands (as evidenced by the fact that they will pay $300/mo to advertise their open appointments on the ZocDoc platform), our experience is that most well-respected, popular physicians have long waiting lists.

Sadly, many consumers are choosing to follow Mr. Massoumi’s siren call and become their own clinicians — instead of demanding better primary care from their health insurers.

The second alarming trend in consumer-driven health care is the rapidly morphing convenience clinic. Originally designed to provide limited services as a complement to the more intensive (and expensive) hospital emergency department, convenience clinics do a great job at offloading non-critical injuries and illnesses.

But when there’s money and market share at stake, no one is content to stick to their core competency. Remember when toaster ovens were small, convenient little miniature ovens? Now they’re the size of microwaves and can cook a small turkey. Convenience clinics are headed in the same direction, trying to provide continuity care, urgent care, onsite corporate medical care, and heaven knows what else.

Trouble is, convenience clinics are not continuity clinics. They’re primarily run by mid-level practitioners, have a rotating staff, and are ill-equipped to manage the complexities of chronic health problems.

Good chronic care requires time, something most urgent care clinics are not designed to provide. Take a look at the chronic care scheduling for ZoomCare, one of several urgent care chains in town: they have only 15 minute appointment slots. That approach works great for diagnosing sore throats, but is more challenging to pull off when you have a hypertensive, obese, poorly controlled diabetic patient sitting in front of you.

And while most urgent care issues can be addressed in one visit, chronic care requires multiple visits with the same provider — something urgent care clinics are not accustomed to providing.

Consumer-driven health care has great potential. In fact, the Baskin Clinic model of direct primary care is part of this initiative. But like many social movements, consumer-driven health care has plenty of subversive elements eager to redirect that energy. And those alternatives don’t always benefit the public.

Posted in Medical Blog Posts. RSS 2.0 feed.

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