The "Perfect Storm" in Healthcare: Crisis or Opportunity?

  1. Health Leaders Comment

    By Francine R. Gaillour, M.D., for HealthLeaders News, Jan. 6, 2003

    In the past several months I have been intrigued by various "future trends" and "forecasts" and their relevance to healthcare delivery and business.

    Aside from nanobots in toothpaste to fight plaque and the first Bionic Olympics coming sometime in 2020, what I find most interesting is the "perfect storm" brewing as a result of the confluence of these five major trends:

    The growing population of aging adults

    The increasing demand for "friction-free" experience: no wait, no errors, no delay

    The self-forming communities of like-minded individuals made possible by the Internet

    The disintermediation of the priest class: Priests, doctors, and other "experts" are being bypassed by "consumers" who are getting their needs met from other sources

    The increased discernment and sophistication on the part of consumers and their "advocates"

    As individual trends, these forces are manifesting in healthcare in ways that are not difficult to see. What might happen when two or more of these forces begin to affect our already dynamic industry? Here are a few observations and thoughts on how their combined effects will manifest in the future of healthcare delivery and business.

    The aging baby boomers will push the burgeoning number of Medicare recipients to a critical level and will also bring an unprecedented demand for additional services. Boomers want wellness services covered; they also want the most advanced treatment options NOW, and they know how to look up the latest in evidence-based practice for what they have.

    The Internet has been the catalyst for people with similar interests to create self-moderated communities. This is especially true for those who define their interest as a condition, symptom, or diagnosis. These communities are a becoming a primary source of support and up-to-date medical information. Opportunities to capitalize on these groups are not lost on the pharmaceutical industry, with its creative and increasingly frequent solicitations for clinical trial participation among these communities. Another opportunity is for the enterprising physician to become a "cyber-moderator" of these groups. It is the group-visit in the clinic idea, but on a much broader scale.

    Primary care physicians will be disintermediated by the Internet's patient-driven communities, by specialists (boomers want to shop direct) and by alternative practitioners. Family physicians will voluntarily leave the profession in droves as their incomes drop below a certain threshold. Their only hope: Start a premium medical practice or expand to include integrative services.

    A new medical specialty will emerge: The Patient Advocate. Not providing any direct patient care, this doctor will play the role of translator of medical knowledge and facilitator of treatment decision-making. Much like the role that a "doctor in the family" plays with her loved ones and relatives, the Patient Advocate will help his client sort through the many options of where to go for diagnosis, treatment, before- care, after-care, alternative care and additional care. This professional will be comfortable with Western, Eastern, and Alternative medicine, having no bias in favor of any one modality, but at the same time demanding professionalism and accountability from all.

    We have already seen the emergence of "premium" service medical practices in some large cities. For an extra fee, patients get same-day service, house calls and a good bedside manner. Look for these service models to go mainstream, with at least 30 percent of families in large cities opting for such "premium" service.

    The use of computerized physician order entry (CPOE) and decision-support applications in some hospitals and clinics will mark them as "credentialed" by the growing number of sophisticated consumers who understand more about evidence-based medicine than the average physician. Physicians who don't go along and learn how to use technology to their advantage will be on the fringe.

    But not so fast: having computerized physician order entry will not be enough! A hospital or physician will also have to offer a broader range of "integrative medicine" options to be considered "credentialed" and enlightened. These will include deep relaxation, Yoga, acupuncture, herbal medicine, and Reiki to name a few.
    Many healthcare organizations, physicians, and healthcare businesses have chosen to ignore these trends and continue to go about their business, wringing their hands or cursing the forces that seem out of their control. Others are moving, shifting and positioning themselves to ensure they will be a player. Where are you?
    Francine R. Gaillour, M.D., FACPE, is a strategic advisor for healthcare industry executives and a professional speaker on healthcare leadership, technology and innovation. She may be reached at 425-885-5753 or
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