Millennial Health Care Delivery

Millennial (adj.)

1. Of or pertaining to the millennium, or to a thousand years
2. Generation of Americans younger than 29 in 2007 with unique social, cultural, and market identity

The highlight of last month’s Health 2.0 conference was the segment in which three enterprising physicians discussed their next-generation practice models. We heard from Enoch Choi, MD at Palo Alto Clinic who has a traditional, but technology enabled practice; Jordan Shlain, MD of San Francisco On Call which provides a cash only mobile practice; and from Jay Parkinson, MD who has attained the most notoriety through his unique approach, clinical skill set, and artistic flair. These services are representative of a growing number of similar practices that serve as an example of another important concept to consider in preparing for next generation health care. Millenial patients will demand a new range of services, many of which currently do not exist within the current medico-industrial insurance construct. In fact, the provision of niche services which have traditionally fallen outside the concept of traditional health care may prove to be the biggest opportunity to impact care delivery.

This conceptual framework can be understood within the technology description of The Long Tail. First described in the popular press by Wired Magazine Editor Chris Anderson in 2004, it is basically descriptive of unique markets wherein distribution and storage costs approach zero and therefore the provision of small numbers of less popular items actually is more profitable than the provisions of large number of popular items. The math works out as such that the area under the “long tail” part of the curve is as big or bigger than the area under the curve to the left. This long tail represents all the niche, specialty offerings that can be purchased so that when aggregated, the niche market opportunity is bigger than the mainstream.

The anatomy of the long tail shows that most patients consume a relatively small number of core health care related services. These have been provided in a prescribed way for decades and have address most basic health care needs. However, as science and technology advance, there have been, and will continue to be new, more efficient, and hopefully effective treatment options. Over time these new therapeutic options themselves become more personalized and specialized in order to address the needs of niche target populations. The number of personalized services will ultimately outstrip the traditional health care service offerings.


But niche products are not for everyone. Most people have gotten and can continue to get traditional health care services. However, newer technologies that create new value propositions might fill an entire set of health care needs just as well, or perhaps even better. The personalization of medical services allows them to be consumed “wherever the consumer is” along the health care delivery continuum based on their unique value equation. So while not everyone will want to speak live with a physician for $1.99/minute, there are certainly some who will, and they can be recruiting into the next generation health care system via health care delivery offers that occurs within the long tail of healthcare.


Scott Shreeve is a physician and entrepeneur based in Laguna Beach, California. After a long career in medicine, Scott founded the open source electronic medical record company MedSphere. He currently serves as entrepreneur in residence at Lemhi Ventures. If you enjoyed this piece you may also enjoy his earlier piece examining the potential impact of Long Tail economic theory on the healthcare industry. Scott is a frequent contributor to both THCB and the Health 2.0 Blog.

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5 replies »

  1. Next-Gen Delivery
    I couldn’t agree with this post more, especially after reading a new book on customer service, “The New Age of Innovation”, by CK Prahalad and MS Krishnan, [McGraw-Hill, 2008].* The thrust of their core service philosophy is the mathematical concept, N = 1.
    Here is a brief excerpt. As you read, just replace the word “customer or consumer” with “patient” in your mind’s eye. The bracket insertions are my own for Next-Gen medical practitioner emphasis:
    “We believe that the movement toward N=1 is not a choice. The focus of the young on websites like MySpace, YouTube, Orkut, Facebook and others suggest that a whole generation of customers will grow up expecting to be treated as unique individuals, and they will have the skills and propensity to engage in a [medical] marketplace defined by N=1.
    This is not about a single [doctor or medical practice] and its success. This is about the acceleration of a social movement toward a personalized, co-created experience. Value for this new generation of consumers is not embedded in traditional motions of quality. That is a given. These consumers want to be involved in shaping their own experiences.” (Chapter 1, page 40).
    The relevancy of this book to emerging fields of genomics [medical R&D], consumer directed health plans [insurance], retail health clinics [service delivery], health information technology [HIT], as well as customers [patients], medical practitioners [vendors], hospitals [malls and stores] and all stakeholders of the healthcare industrial complex, is staggering.
    And, for those doctors and healthcare executives who enjoy this type of read, a similar book “Excellence Every Day”, has been released by industry thought leader Lior Arussy.*
    For more on this topic from a financial and economic perspective:
    * I am not affiliated with these books or authors.
    Dr. David Edward Marcinko; MBA
    Chief Executive

  2. Unless new models of health care are developed, the health care system will continue to be less than adequate. If no one is willing to try new ideas, how then do we find innovative and more efficient ways of getting patients through the system? As clinicians and scientists physicians and other should be more trial and error oriented and less observational. The system will not fix itself just by a wait and see attitude.

  3. There are some interesting ideas in here but way too convoluted. Like when a chef tries to get creative with too many ingredients and ends up a mess.

  4. If there is a clinician w/ limited time on the other end of the virtual medical transaction or the clinician has to come and see you, the carrying costs of the capacity you are using is hardly zero. It is far higher than the cost of storing an MP3 file on some server, or even warehousing books that may not sell more than one or two copies a year. Presently, physicians are drowning in overhead, so a virtual practice model could help spread costs, but costs do not disappear as in most long tail examples. There is a lot of promise in these virtual practice models, but it is stretching to put them into a long tail framework.