A diversion into the world of high fashion in this week’s post… It’s an area that everyone who knows me would admit I know nothing about. Nevertheless, here we go…
Martin Schulte, a Partner at Oliver Wyman management consultants, recently posted a fascinating article on, of all things, fashion industry supply chain management. It contains some interesting nuggets for healthcare.
Background: before the 1980’s, couture was customized, reserved for the wealthy, and slow to diffuse into popular culture from biannual fashion shows.
Two disruptive changes shook up the fashion industry in the 1980’s and 1990’s: The first was a move to what is called the “fast-fashion business model” where couture was “translated” from the runways and quickly mass-produced. The second disruption was the emergence of discount realtors like H&M and Topshop, which offered extremely fashion-sensitive clothing (at cut-rate prices) to the masses. These two trends quickly democratized fashion.
(Stepping away from health policy and business this week, a quick post on alternative careers in medicine).
Wrapping up a great week spent with emergency medicine friends attending this year’s American College of Emergency Physicians national meeting in Boston. Over the course of a few receptions and dinners, more than one old friend has stopped to ask me about how I made the decision to step away from caring for patients in the emergency department and into a nonclinical role at a progressive startup healthcare company. A few friends confessed that they love the idea of getting their hands dirty fixing a broken healthcare system– but don’t know where to begin.
I have a very limited perspective and I’m no expert on career pivots. But I often look to an article I came across a few years ago, written by Whitney Johnson in the Harvard Business Review. Her article is called Disrupt Yourself.
In the piece (and later in her book) Johnson argues that people can successfully transition into satisfying roles in new businesses but often need to “disrupt” themselves and their current careers. This disruption is needed because moving to another job or field (even one adjacent to the one you’re in) is hard. I think that this is particularly true in medicine where the time and money needed to become a doctor creates incumbents, inherently resistant to change. Physicians are, by nature of our training and regulation, IBMs and Microsofts. We are slow to change. We can plateau.
I’ve been thinking a lot about “big data” and how it is going to affect the practice of medicine. It’s not really my area of expertise– but here are a few thoughts on the tricky intersection of data mining and medicine.
First, some background: these days it’s rare to find companies that don’t use data-mining and predictive models to make business decisions. For example, financial firms regularly use analytic models to figure out if an applicant for credit will default; health insurance firms can predict downstream medical utilization based on historic healthcare visits; and the IRS can spot tax fraud by looking for fraudulent patterns in tax returns. The predictive analytic vendors are seeing an explosion of growth: Forbes recently noted that big data hardware/software and services will grow at a compound annual growth rate of 30% through 2018.
Big data isn’t rocket surgery. The key to each of these models is pattern recognition: correlating a particular variable with another and linking variables to a future result. More and better data typically leads to better predictions.
It seems that the unstated, and implicit belief in the world of big data is that when you add more variables and get deeper into the weeds, interpretation improves and the prediction become more accurate.Continue reading…
About seven years ago, the California Healthcare Roundtable and HealthAffairs sat down to prepare a white paper on the emerging “phenomenon” of urgent care centers, and what it might mean for primary care. At the time the group couldn’t agree that urgent care was a “disruptive” innovation, but it seemed clear to all participants that it represented a threat to primary care: The rise of UC, the group noted, would lead to 1) less preventive care and 2) concentrate acuity in primary care clinics. They wrote: “[Urgent care] means fewer patients per day, a higher intensity environment for providers, and potentially lower reimbursement.”
In particular, the group couldn’t understand if patients were choosing to leave primary care because they didn’t value having a PCP, or if they were settling for the inherent limitations of UC because cost and convenience outweighed its disadvantages.
Seventy-five percent [of UC customers] are women ages 28 to 42 and their children. Some hypothesize that this consumer group thinks of its health care relationships differently than do people of the baby boomer generation and older. The younger cohort often has no “medical home,” while baby boomers and older people tend to view the primary care physician as the center of their medical care. Discussants concurred that what the data do not reveal, however, is whether the medical “homelessness” of this younger group and its high relative use of retail clinics reflect how these consumers want to receive their care or is instead merely their experience (or is a function of the fact that they have fewer chronic conditions and thus need less care and care coordination).
Since the roundtable in 2007, there has been a flood of urgent care centers with ongoing rapid growth. The American Academy of Urgent Care estimates that there are around 9300 UCs nationally. Across the country, clinics are sprouting like flowers, sometimes fueled by private equity investors, but often by hospitals and health systems who are reflexively installing UCs in repurposed strip malls, sometimes without a clear strategy other than “keeping market share” in an otherwise low margin business.
The reasons for growth, according to the American Academy of Urgent Care? Primarily extended hours (as compared to primary care) and better wait times and lower prices than the ED.
As the private-equity fueled urgent care bubble expands, here’s my prediction on how this all plays out: Don’t bet the farm on UCs being the final answer to the consumer’s search for value. For all of UC’s utility, it’s also possible that urgent care may just get out- maneuvered by the next generation of primary care.