Most people without medical training drastically overestimate the sensitivity and specificity of the traditional physical exam as a means of diagnosis. In reality, for the vast majority of medical conditions, it is one minor data point that leads to a diagnosis. In fact, many, if not most, conditions have almost zero physical findings. Of course, some things are diagnosed exclusively by physical exam. But those … Continue reading The physical exam is a surprisingly uncommon critical piece in determining a diagnosis.
Patients view doctors as problem-solvers. And this perception works extremely well in doctors’ favor throughout your life. When you’re young, you get sick or hurt. You go to the doctor. They cast your broken arm or prescribe you your bubble gum-flavored amoxicillin and soon you’re all better. From day one, your doctor works miracles. Then you turn 18 or so and graduate from your pediatrician … Continue reading Primary Care fails people surprisingly often.
Primary care is the entry point for people to get care. It comes in a few flavors that fluctuate in popularity over time: • Dr. Google • Nurse triage lines • Retail clinics • Traditional PCP office visits • On-site employee clinics • Urgent Care • Traditional specialist office visits • Emergency Rooms As you see, I define primary care not by who’s delivering the … Continue reading Every company needs a primary care strategy
What if your company could hire doctors and arm them with services and partnerships that could support a higher quality and cost-effective practice of medicine? What if, at any point in care, your doctor could be aware of health benefits available to you and leverage them to maximize the quality of your care and decrease your costs? The biggest disruption we’ll see in healthcare is … Continue reading What is a “benefit-aware” doctor?
Companies have tried the High Deductible thing. If the goal was to control costs, the evidence is clear they don’t accomplish that goal. They just make people spend their own money in an extremely opaque, hostile industry. And they penalize the sickest. So if high deductibles failed, what’s next? “Go online first to get care” plus a bundle of cost-saving services on top of that … Continue reading Keep away from Fee for Service
Think about that statement for a second. That’s the secret behind Google, Uber, Lyft, Seamless, Ticketmaster, Waze, Airbnb, Silvercar, Hotel Tonight, etc, etc, etc. If you go online first, new processes can emerge. Those new processes are designed to scale at a fraction of the cost of the past. Sure, the library could bring in a computer instead of microfiche, but it’s still a trip … Continue reading Go online first instead of doing what you used to do.
A doctor gets sick and visits his doctor friend. The sick doctor is in a very weird situation where he is uninsured this month (long story) and has to spend cash on determining a diagnosis and getting treated. So, he and his doctor friend talk through the situation with two goals in mind: How can we confirm the diagnosis at the lowest cost? How can … Continue reading How to find the lowest cost to treat anything
Last week, I defined the characteristics of each new primary care model in America and, in the following post, determined the kind of person who would most benefit from each new model. This is important because primary care is literally just a process. And you’ve got to design and build the process that’s best able to solve specific problems. Since we all don’t have the … Continue reading Costs can change only if there are new different processes to solve the same problems.
This is Part I of two posts. Part II outlines how each model fits into the unique needs of different kinds of healthcare users. One of the very few redeeming qualities of healthcare in America is entrepreneurs are free to create healthcare services and people can purchase those services with their hard earned money. It spurs innovation and it offers Americans a choice. We are … Continue reading A summary of today’s primary care models in America
Doctors get paid exclusively for office visits. So, they keep happening, because money. But what would happen if the primary means of communicating with your doctor and care team was online and a message could be sent at any time of any day and you could expect a response within 12 minutes? Or, if needed, you could pick up the phone or jump on a … Continue reading What would happen if we blew up the concept of the doctor office visit?