“The health sector has never been so good. The health system is a disaster.
Dr. Robert Califf, a Duke-trained cardiologist who was confirmed by the Senate last week for his second term as commissioner of the Food and Drug Administration, recently borrowed this quotation from a colleague to describe the American healthcare system.
The quote captures a well-known paradox in the United States, where exorbitant and ever-rising healthcare costs exist simultaneously with poorer health outcomes compared to other high-income countries. Rising US healthcare spending is driven in part by rising prices for goods, including drugs, devices and imaging, which probably comes as no surprise to most patients. In addition to the cost of goods and labor, however, about 8% of health care in the United States spending is on administrative costs, compared to 1-3% in the other 10 highest income countries. In turn, high administrative costs are partly due to the value Americans place on choice. Having a choice of insurance plans, for example, leads to payer fragmentation, billing complexity, and higher marketing costs for plans competing with customers.
In this context of an expensive and fragmented healthcare system, the healthcare market continues to experience a flood of new choices. A growing number of companies are bringing stylish healthcare products and new models of care delivery to their customers, who also happen to be patients.
One Medical, a for-profit chain of primary care clinics owned by 1Life Healthcare and backed by Google’s parent company Alphabet, was recently integrated into the Duke Primary Care Network. For an annual fee of $199, members have access to 24/7 video chat with providers, appointment scheduling, and medication refills through their app. The brick-and-mortar One Medical clinics, including a new Brightleaf Square location in Durham city centre, operate much like standard primary care practices, but with beautiful interiors that look more like a tech company than a at a doctor’s office. the contribution, which “covers the costs associated with access to the proprietary 1Life Healthcare technology platform” is not required to see a doctor at a One Medical primary care office. Even with membership fees, all other costs (eg, lab tests, medications, copays) still apply and are billed by the patient’s insurance or paid out of pocket. Taken together, the core business model appears to offer a high-tech concierge medicine experience at a lower cost.
Another approach to healthcare delivery adopted by many insurance companies and venture capital-backed startups is the virtual-first primary care model. Catalyzed by the rapid adoption of telehealth during the pandemic, these companies are making virtual appointments the norm and offering them at lower prices than traditional healthcare plans. A virtual first primary care startup, Firefly Health, also offers an innovative care team for each patient, consisting of a physician, nurse practitioner (NP), and health guide.
Companies like One Medical, Firefly Health, and the first virtual insurance plans have promising cost-cutting potential — triaging symptoms with a virtual provider can reduce unnecessary urgent care visits, and user-friendly virtual visits, prescription refills and planning can reduce administrative costs and improve the healthcare experience. Additionally, integrating NPs, mental health providers, and health coaches into longitudinal care teams like those offered at Firefly is an innovative strategy to support overall patient well-being often overlooked by healthcare systems. traditional health.
However, as two Harvard doctors point out, these same companies are also more likely to attract younger patients of higher socioeconomic status (SES) who tend to use the healthcare system the least, making these companies highly likely to be profitable. Additionally, while each company markets a modern, integrated healthcare experience for its individual users, their impact on the entire US healthcare system is unmeasured at best.
At worst, the ever-increasing variety of for-profit care models may lead to further fragmentation of the US health care system and widening health care disparities based on SES and access to health. digital technology. These businesses may turn out to be clear examples of suboptimization, the inefficient process of optimizing individual fragments of a system (in this case, business performance) without considering the whole. Now FDA Commissioner Dr. Califf describe under-optimization as a key dysfunctional factor in the US healthcare system.
Certainly, having technology-enhanced healthcare with an attractive user interface should appeal to patients and providers alike. In a functioning healthcare ecosystem, medical practices should be as welcoming and modern as a tech company workspace. Perhaps the interpretation of “patient-centric” as “consumer-centric” will push the healthcare industry to catch up with the standards of convenience and functionality set by all other industries. However, as with any innovation in healthcare, it is critical that clinicians, community leaders and patient advocates are involved in shaping the healthcare enterprise.
Kathy Dai is a third-year medical student at Duke University. His “Follow the Money” column airs every third Friday.
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