widespread denial of necessary care and a host of TV shows about evil insurance companies and altrustic doctors a la St. Elsewhere. This time around there is a significant leap forward in technology (electronic medical record systems, remote monitoring systems, etc) that can, theoretically, enable effective just-in-time sharing of data about a patient to improve care coordination and minimize unnecessary care. The big risk here is whether or not this will really change provider or patient behavior in a way that produces the goal of better care at lower cost. Time will tell. As a skeptic, one of my concerns is that it could lead to a new era of….
3. Medical homes without walls is what it’s called now. It used to be called Physician Practice Management (“PPM”). Many of you will shudder at the uttering of the words “physician practice management.” The very term conjures up horrific memories of those companies that used to buy up medical practices, install administrative leaders and bureaucracies who oversaw the delivery of care in factory-like rigor, and sucked the souls out of physicians (along with the cash out of their pockets). Some of these companies were well-meaning but ineffectual (the culture clash between physicians and financial managers was too hard to overcome) and some of them were downright amazing for their ability to wreak havoc on physicians’ livelihoods (can you remember FPA and MedPartners? Anyone? Bueller?). There are a few that have successfully survived and thrived, such as US Oncology. However, the general field of PPM was shunned by venture capitalists and others in the financial market. Today, in an effort to establish so-called Medical Homes in areas that are not based on a staff model enterprise (such as Geisinger or Kaiser), the concept of creating an overarching structure to connect independent physicians and groups under a common umbrella has risen like a phoenix from the ashes. No one dares utter the words “physician practice management,” but I can hear the whispers in the wind as practices are getting acquired (or kinda sorta acquired) at a record pace once again. You can call raw dead fish “sushi” and sell a bundle of it, so maybe we can make this whole PPM thing work right this time around. For me the jury is way out on this one.
4. E-prescribing is what it’s called now (and then). Back in the late 1990’s there was a flurry of technology propagated for use by physicians to improve patient care. Some of the hot things at the time were a slew of electronic prescribing products on newfangled things they used to call Palm Pilots and now called smartphones. Part of the explanation for this failure is the same as the general reason cited in the Xconomy article: these smartish phone thingies were too new, the processing power of the time was too rudimentary and the apps were lacking. Tens of millions of venture dollars were invested in companies that failed because the products cost physicians a bunch of money and did not provide the physicians themselves any clear financial return. They were also perceived to be more work than simply writing a prescription the old fashioned way. Oh, and they were illegal in some states–always a buzz kill. Today we have laws favoring e-prescribing and significant technology advances that enable it to work smoothly. Today the products are typically free to providers and reimbursed by others with a stake in the gain, such as payers, so this has overcome a significant barrier to adoption. Further, there has been massive consolidation in this field, with only a few of the strong surviving (e.g., Allscripts). This one is probably here to stay this time around and justifiably so because it just makes clinical and financial sense.
5. Consumer engagement is what it’s called today, but it used to be plain old patient education. Companies such as WebMD and DrKoop.com started out in the mid-1990’s to provide patients with information about health issues so they could become more engaged in taking care of themselves. The idea was that patients, armed with print-outs of articles, would go to their doctors and
