Consumer-Friendly Health Care Delivery May Be Next Big Change


WASHINGTON — The advent of health savings accounts and consumer-directed health plans has inspired entrepreneurs and academicians to design innovative delivery systems that cater to patient demand, experts said at a conference on technology and health care innovation.

“The next big change in health care will be patients managing their own care,” said John Goodman, Ph.D., president of the National Center for Policy Analysis. “Last year 95 million people got on the Internet to research their health problems. They didn't always get the best information. They didn't always get accurate information, but they were out there searching for answers.”

Patients are already turning to online services for consultations, discounted drugs, simple blood tests, and even home strep tests, said Dr. Goodman. Increasingly, patients will also demand market-based bundling and pricing of health care services.

“Most of the entrepreneurs out there in this market are people who have stepped outside the third-party payment system,” he said.

One of those entrepreneurs is Michael Howe, chief executive officer of MinuteClinic, which offers “retail health care” through more than 100 sites in 15 states. Chain drug store giant CVS Corp. bought MinuteClinic earlier this year, and many of the health care centers are located in CVS/pharmacy stores.

The health care centers are staffed by nurse practitioners and physician assistants trained to deal with a limited number of conditions including routine infectious diseases and to administer common vaccinations.

The clinics have done for health care what automatic teller machines did for banking, said Mr. Howe.

“You wouldn't go to an ATM for a small business loan, and you wouldn't go to a MinuteClinic to reset a femur.”

For that reason, each location maintains a relationship with physicians' practices where they can refer patients whose needs are beyond the scope of the clinic's providers. The company is also working to ensure that patients' records can be transmitted to physicians' offices, he said.

The clinics use technology such as electronic health records, best-practice protocols, and quality monitoring to keep costs down, said Mr. Howe.

“On average, [our costs are] about 50% of what it cost at a primary care physician office, about 40% of urgent care, and significantly less than an ER,” he said. Patients also save time by coming to the walk-in clinics rather than waiting hours for medical attention somewhere else.

And private companies are not the only innovators making health care more consumer friendly.

At the Arizona Telemedicine Program's UltraClinic, if a woman has a positive result on her mammogram, she can undergo a core biopsy, have a pathologist read the slides, and receive a oncology consult all within 4 hours of walking in the door rather than the 4 weeks it can take to go through this process, said the program's Dr. Ronald Weinstein.

This approach saves a lot of suffering, he said. “Eighty percent of the problems I have to deal with, as the head of a large laboratory, is women waiting for their pathology results on their breast lesions.”

The program is possible only because of the availability of telemedicine technology allowing consultation between physicians at different hospitals and the development of an ultrarapid virtual slide scanner that allows a pathologist to assess the biopsy within minutes of the procedure.

“We were motivated because of the fact that consumer-driven health care is an emerging area, and that is essential to supporting these kinds of bundled services,” he said.

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