Disrupting the business model of the physician's practice - Chapter 4 Clayton's Book

This chapter carries a simple message.

The physician practice comprise 3 business models in one organisational setup, similar to that of the general hospital. In trying to be all things to all people, physician practices align resources to maximise flexibility rather than cost effectiveness.

The 3 business models are:

1. straightforward diagnosis and treatment of disorders in the realm of "precision medicine", eg. ear ache, flu, red eye, sore throat.

Clayton proposes that the "retail Clinic" such as MinuteClinic staffed only by nurse practitioners will disrupt this business model.

2. Ongoing oversight of patients with chronic diseases eg. diabetes, high cholestrol, lupus.

As in Chapter 6, Clayton proposes that transfer of patients to network facilitated models including disease management networks and network of patients/ families will disrupt this business model.

3. Disorders in the realm of intuitive medicine - primary care physicians, having freed themselves from (1) and (2) above and with the help of disruptive technology enabling diagnosis and testing onsite can disrupt the practice of specialists.

Clayton proposes that there are at least 3 types of technological innovation that will help propel primary care physicians in their move upstream:

(i) technology that brings analytical and imaging capabilities to point of care

(ii) online decision tool that distill massive volumeof published information algorithm that guide diagnosis

(iii) telemedicine.

To "heal" the physician practice, care integration at the system level (not local) will be critical. To do this job well, there is a need for a system level electronic health records. While this need is long recognised but progress has been slow because at the local level physicians do not have the incentive to implement electronic medical records and at the larger healthplan and health system level (eg intermountain, mayo), progress has been made largely in proprietory systems that is difficult to integrate at the systems level.

Healthcare can take a leaf off how standards are developed in other industry in this regard.