REFORM: The Whac-a-Mole Effect

Finally. Whac-A-Mole comes to health reform.

Dr. Mark Smith, president of the California HealthCare Foundation, was one of the speakers at a Health Affairs forum in DC today, which addressed medical homes, primary care and "disruptive innovation." Smith wrote a really good perspective essay saying we need to shift away from a model that rewards innovation regardless of cost to one that promotes quality care at lower cost. But as good as the essay was, it wasn't anywhere near as enlightening as his slides. Hence the Whac-a-Mole.

Smith argued that the status quo health system "incumbents" (both provider and regulators) tended to regard innovators as a threat. So they try to whack'em (metaphorically speaking). Pediatricians tell their patients not to run into that convenient retail clinic to just make sure that the kid's sore throat isn't strep, or an OB/GYN might discourage a woman from stopping at a retail clinic to check out a possible UTI. (Health Affairs also published some research on retail clinics, we'll get to that later this week).

With Jamie Robinson, a professor of health economics at UC Berkeley, Smith wrote:

The health care sector groans under the burden of regulations that prescribe and proscribe what can be done, to and by whom, where, when, how and why. Many provisions are well-intentioned efforts to protect patients against low-quality products, providers, facilities or forms of care. Others are transparent attempts to appropriate patient revenues, thwart competition, obscure information on price or performance and otherwise sacrifice the common good to that of the politically connected special interests. The problem of course is that the patient is often protected against the ability to economize—to use a producer, provider or facility that is "good enough" to get the job done well but not so good as to be priced at the top of the relevant range.

Smith wasn't recommending that traditional doctors and hospitals close up shop and start offering strep tests on a cart under an umbrella next to the hot dog vendor. But he was saying that they need to think differently, to see innovators as part of a solution, not a threat to their prerogatives, economic or clinical knowledge. Instead of trying to crush the new providers, be they pharmacy-based clinics, online medical portals or new diabetes managers, doctors should think about partnering with them. Why shouldn't a busy mom (stay-at-home or working, all moms are busy) have her kid's throat checked out quickly nearby, instead of waiting for a pediatrician appointment, driving to the pediatrician, and waiting in the waiting room? Getting those routine tasks taken care of (in a proper partnership with appropriate quality and communication) free up the overburdened, overworked, overstressed pediatrician to spend more time on a patient's more complex needs, including wellness and prevention. If a patient finds an effective way to manage diabetes, isn't that something a physician should welcome?

Instead of trying to stamp out innovators, the "incumbents" should embrace them. Because innovation, Smith said, "is a good thing for patients and it's a good thing for the system." So to push his analogy, in the health care arcade, docs should put down the Whac-a-Mole mallet and share a little boat with the nearest retail clinic into the tunnel of love.