I got it from “patient privacy advocates” who keep us chained to paper. From “fat is beautiful” advocates spreading diabetes and heart disease. From doctors who claimed all automation is evil, and from a host of entrenched interests who see only their own little corner of the world.
I’m glad to be out of it, frankly, covering renewable energy, where entrepreneurs say “yes” and know they’re doing well by doing good.
But there is something I want to talk about before I leave. Business models. If anything unites my whole career, from 1978 to now, it is the study of entrepreneurs and business models. These are the main change agents in a capitalist society. And nothing needs change as much as health care.
In Mark Knopfler’s song “Boom Like That,” the McDonald brothers have the formula for success, but Ray Kroc is the entrepreneur who knows how to get “one of these in every town.”
While covering health IT at ZDNet for almost four years I found several folks who came close to the formula for health care the McDonald brothers perfected in Bakersfield.
Jay Parkinson was one. His Hello Health has a lot of the elements that made the McDonald brothers a success. It lifts the management and IT hassles from the doctor, leaving him free to practice medicine.
But Parkinson is short on capital, and on operations expertise. A truly efficient doctor is at the top of a pyramid of para-professionals who do most of the patient care. If he’s seeing every patient he can’t spend more than a few minutes with each one. But if someone with a $30-50,000 salary is seeing your patients they can take their time, develop a trust relationship, and call in the doctor only when he or she is needed.
Every good business works this way. It’s easy to condemn the whole idea by saying “McDonald’s makes unhealthy food,” but the only way forward is through an automated business practice.
We know it works. When Ralph Snyderman replaced sick care with wellness care at Duke, Duke saved money.
Get all the data you can. Treat people while they are still well. Get them the coaching they need to exercise and eat right, so they can avoid the chronic conditions that represent so much of our national health care bill.
What I found is that takes a scaled system. Not just a scaled IT system – a scaled business system. Kaiser has one. Intermountain has one. They capture billions of dollars in savings every year by simply practicing wellness.
That’s what health reform was really all about. Bring everyone into the system, eliminate risk rating, and the route to profit comes from practicing wellness, not handling sickness. It comes from bottom line growth, not top line growth.
Uncertainty over reform’s future threatens this business model, but we have no choice but to let that model prevail. As Dr. Klepper notes, the old system was breaking all of us – our health, our fortunes, our doctors.
Screaming no is no longer an option.