Dr. Kevin Most: Convenience Or The Speed Of Change In Medicine, It Is Not All Good
We all like things fast these days, we don’t like to wait in lines and any wait over a few minutes frustrates us. Our blood pressure rises as we are placed on hold for more than a minute or two. We are a society of now. Fast food restaurants do 70% of their business in the drive thru lane. Amazon prime will deliver products on the same day for free. Our need for instant gratification carries across many areas and believe it or not medicine is one of the areas.
You can’t drive down a highway without seeing a billboard touting the waiting time in the Emergency Room of the local hospital, do we really need that? Since when do we plan our emergencies? The distracted driver looking at that sign may find out in real time just how long that wait is. Do we equate speed with quality? Is the Emergency Room with no waiting time better than the Emergency Room with a 1 hour wait? Do we think faster is better? It is interesting in medicine, patient want to get in fast and don’t consider quality in these decisions often. Is there a reason there is a 3 month wait for a specific heart doctor, and no wait for another?
Can you drive thru any suburban or urban area these days without passing a half a dozen Immediate or urgent care facilities? Is this a coincidence? No healthcare systems have identified that people want it now and they want it fast. The days of actually having a doctor’s appointment for anything other than a physical or scheduled BP check are diminishing. We are compressing the medical experience across the spectrum, now some of this is good and others may raise an eyebrow.
Well forget about just the acute visits in an ER or an Urgent care, what about our primary care visits? Well the companies that disrupted the acute care business with walk in clinics in the stores have all decided they want a bigger piece of this trillion dollar industry and they have the assets to deliver in many cases the entire package.
CVS is in their final stages of merging with Aetna insurance and their plans are a bit different. They certainly have the focus with their 1,000 Minute clinics in CVS stores, this will continue but now they have decided to expand outside of the acute care and into managing chronic conditions as well as preventative care with their new HealthHUB stores. 80% of the US population live within 10 miles of a CVS location
HealthHUB stores will focus on preventative care, wellness, health education and management of chronic illness like asthma and diabetes. They plan to open 1.500 of these starting this year. This is their step into chronic care while still having a focus on acute care with their Minute Clinics. This is the first step we are seeing with retail pharmacy extending into chronic care. Does it make sense? Sure the pharmacy would rather have the patient who will take the diabetes medicine for 40 years as a customer, especially when compared to the patient from the Minute Clinic who may get 3 days of pain medication or 10 days of an antibiotic. Couple that now with the referral source being tied in and the days of traditional medicine will be changing.
Walgreens Village MD
Walgreens is also looking at expanding beyond their in store clinics. They recently partnered with Village MD in Houston and will be testing the concept of the primary care office right next to 5 current Walgreen’s stores in Houston. This will be their test of a concept, where the pharmacy owns the practice right next to its retail pharmacy. They also plan on opening health centric stores and have the first pilot here in Chicago.
Walgreens recently renovated a store near their corporate headquarters and it is doing this across the country, testing what services may be best served in this setting. They are considering hearing, vision and lab services. They have partnered with a large national lab company, a hearing aid company as well as Microsoft as they look to see where they will fall in this race to disrupt healthcare
We talked in the past about the thought of what Amazon would do as they took on healthcare in partnership with JPMorgan Chase and Berkshire Hathaway. It appears they have decided how they will jump in. They recently announced the creation of Amazon Care, in Seattle. This is currently only for their local Seattle employees but one can easily see that this is a test to see how it could be advanced to other companies and eventually to the general public. This service allows for employees and their families to have virtual visits via telemedicine, medical clinics and in home visits. They realize that some patients will need more than a telemedicine visit. If the worker needs in person care, a nurse or doctor, is sent to their office or home to treat them. Amazon also has a pharmacy so employees are able to have their medications and any other health supplies a patient may need, like vitamins, needles, dressing for wounds filled and delivered by Amazon, in many cases the same day.
Amazon is looking at controlling the entire experience, from the visit, to the data collection, to prevention to medication and other health related supplies, truly one stop shopping. Not surprising as they looked at the fragmentation we currently have
Amazon is also expanding into the personal health monitoring device business, building health wearable items that will monitor walking, calories burned, weight, Blood pressure, (Think Apple health) It will have data on the exercise patterns of their workers.
This set up gives them a test lab to see how this works, see if it brings down its own corporate health costs and figures out a way to expand it to the masses. The companies already in this field should be concerned as Amazon has a knack of finding industries with a need for an overhaul and doing exactly that.
A success with this business model would probably then be rolled out to Chase and Berkshire Hathaway for the telehealth portion in partnership with local healthcare.
Walmart has opened its first primary care clinic, again stepping into the world of chronic care and away from their acute care in store clinics. They plan to charge 30-50 % lower than what people are currently paying at a doctors office. They plan on doing doctor’s visits, lab, and radiology. If this is successful they plan a second one quickly and then rapid expansion to become the nation’s largest provider of healthcare. Look for their home delivery to try to mimic Amazon with medications and other needs delivered to the patient.
Do you not think that Amazon and Wal-Mart could do this? Well what is going on across the Pacific.
Good Doctor and Alibaba
In China online health is ready to explode. The expectation is that will grow dramatically over the next 5 years adding 10 million families in this time frame. In China the wait to see a physician is often over 2-3 months as the number of physicians in the country does not approach the need. Their healthcare infrastructure is poised for this innovative change. Alibaba has already signed up 15,000 doctors to start their continuing consultation services, as it plans to enter this field. China has set some good restrictions on this field. For example an initial diagnosis cannot be made with online services, it must be done in person and then follow up and medication changes can be made using on line interactions. One would expect that Alibaba could mimic Amazon with full service of the medical visit, the medication and supplies and they also have Alipay which would partner with public and private insurance making the payment for care easy for patients, one source of great frustration here in the US.
Hospital at Home
Does that sound crazy? Well Johns Hopkins and other healthcare systems are now working on the concept of the “hospital at home” and insurance companies and Medicare are watching this very closely. This is a program that provides hospital level care in a patients home. They are finding in many cases it is cost effective, safer, as good of quality outcomes and the patients are happier. The ability for telemedicine, physician and nurse visits, telehealth are going to make some hospitalizations actually occur in the comfort of one’s home, surrounded by family and pets. Is it working? Current data shows a 20%-30% decrease in cost, fewer lab tests and patients like it. You may think this is crazy and not safe but when done properly, the outcomes are better and the cost is less.
Do we think a major disruption is occurring in healthcare? You bet we all do, and the way medicine will be delivered will change dramatically over the next 5 years as we look for convieince as well as quality care.
The drive thru mentality has to be reviewed and noted that one size does not necessarily fit all.