Information for your Consideration…
The Disintermediation Is Coming – Disintermediation is the process of taking apart and putting back together in new, more consumer-centric ways. It is the process of giving the user or the consumer direct access to information that otherwise would require a mediator, such as a salesperson, a librarian, a lawyer – or, even a doctor. Whereas in the past “intermediaries” were required for interpreting the information – like priests reading the Bible - through the use of technology users hold direct access to medical, legal information, travel, or comparative data and information directly. The “disintermediation” comes by way of removing the doctor, lawyer, salesperson or other individual from the process. Before the coming together there is the tearing apart. Some examples include:
- Walgreens (LabCorp) and CVS (Aetna) are building clinics and mobile apps to provide immediate, 24x7 access to their services – and, that does not include the efforts by Walmart and others. Sears should have listened to me 30 years ago when I suggested that they tear out the carpet section and install clinics instead.
- At last count over 900 Direct Primary Care or Concierge Medicine practices have been established or, a 230+% increase from 2015.
- Amazon, Berkshire Hathaway & JPMorgan Chase have teamed up to form an independent healthcare company and hired Atul Gwande, MD – an innovator and thought leader of the first order – as their new CEO.
- And, not to be left behind – Google, Apple, Microsoft, Express Scripts Holding or, GAME, among others – are eyeing the healthcare industry for opportunities to participate in the disintermediation party. Their insights and analysis into how and where “health” happens and is delivered will change the way we think about “health care” on into the future.
Actually, the disintermediation is not coming – it has arrived!
Trump Administration Recommends More Consumer Responsibility – The Congressional Quarterly recently noted that the Trump Administration in a report on how to increase competition in health care recommended that Congress and the states could take steps to decrease health care spending by lowering “…spending is to expose consumers to more costs and allow them to ‘pay directly’ for health care.” The posit that consumers are in a better position to avoid unnecessary and expensive care rather than the insurance companies which they argue are incentivized to prioritize more expensive services. Hmmm. One of the ways to foster such consumer attentiveness is through expansion of health savings accounts. With more than 50 other recommendations, the Administration’s plan entitled “Reforming America’s Healthcare System Through Choice and Competition” provides a lens on the thinking of the leaders currently occupying the HHS offices. At 120 pages, the full report is worthy of a download if you’re into the nits and nats of where US health policy might be headed. No doubt, implementation of the recommendations will be yet another story.
But, on the telehealth front, we have not seen the type of adoption that could truly reduce costs and drive efficiency (my perspective). According to the Centers for Medicare and Medicaid Services (CMS), only one quarter of one percent (0.0025%) of the Medicare beneficiaries took advantage of telehealth services in 2016. To bring it back full circle to the Trump Administration’s report; however, their recommendations were woefully weak. Of the entire 120 pages, only four short recommendations were noted and they are mini-steps forward. They include
- States should consider adopting licensure compacts or model laws that improve license portability by allowing healthcare providers to more easily practice in multiple states, thereby creating additional opportunities for telehealth practice. Interstate licensure compacts and model laws should foster the harmonization of state licensure standards and approaches to telehealth.
- States and the federal government should explore legislative and administrative proposals modifying reimbursement policies that prohibit or impede alternatives to in-person services, including covering telehealth services when they are an appropriate form of care delivery [emphasis added]. In particular, Congress should consider proposals modifying geographic location and originating site requirements in Medicare fee-for-service that restrict the availability of telehealth services to Medicare beneficiaries in their homes and in most geographic areas.
- States generally should consider allowing individual healthcare providers and payers to mutually determine whether and when it is safe and appropriate to provide telehealth services, including when there has not been a prior in-person visit.
- Congress and other policymakers should increase opportunities for license portability through policies that maintain accountability and disciplinary mechanisms, including permitting.
These are obvious minor steps. To solve the problem requires a much more aggressive – if not assertive – approach toward solving the problem. The technology is available. The resources can be mobilized. The impediments remain. Relatively empty recommendations won’t get us there although hope is on the horizon. The Bipartisan Budget Act of 2018 will allow MA plans, starting in 2020, to provide additional telehealth benefits. The proposed rule would allow for telehealth services from a patient's home for Medicare Advantage patients only. So, at least we are moving in the right direction – if ever so slowly…