How will healthcare be distributed in the future? In ways that bear only some resemblance to the way it is distributed today.
The changes will be driven by the new economics of healthcare embedded in the “volume to value” movement, based as it is on “provider-sponsored risk,” the basic, obvious and yet startlingly opaque logic that you deliver what you are paid to deliver—so if you are paid differently you will deliver differently. If you are paid fee-for-service, you will deliver it in ways that derive the maximum of fees for the maximum of services. If you are paid based on being at risk in one way or another for the health of the patient, you will invent, implement and evolve the most efficient ways to deliver the health.
We are right at the beginning of this change.
Let's examine it.
What way of distributing care is best for health?
Care should be easily and widely available, especially in an emergency or crisis. When we need it, we should have easy access to the best that medicine has to offer.
The rest of the time, care should be seamlessly woven into our lives, expertly helping us prevent or manage disease and fine-tune our own body systems. And it should not bankrupt us. It should never force us to choose between buying our cancer drugs and paying the rent or buying food for our children.
The fee-for-service system encourages, indeed demands, that healthcare organizations provide care in some kind of opposite-land construct, making it scarce, hard to access both physically and financially, based entirely on episodic care delivered only face-to-face with the individual clinician in the clinician's preferred place of business.