Last Writes: Healthcare Innovation is Not All in the Delivery... Yet

MDNG PediatricsMay 2008
Volume 8
Issue 5

The advent of managed care in the late 1960s was probably the last major "innovation" in healthcare delivery.

This month’s cover story is an indepth profile of Jay Parkinson, MD, a young pediatrician and savvy marketer who has a unique take on how physicians and patients can better interact. Ironically, Parkinson’s approach uses the very latest in technology to turn the clock back to another time in medicine, when physicians visited patients at their homes and had longer than a few minutes to learn about the patient, diagnose, and offer treatment suggestions. Some have called his approach innovative, others have dismissed it—and him—as a mere imitation of earlier efforts, artificially trumped up by an ability to market himself.

For my part, I will reserve judgment until I have a chance to learn more about his new venture with healthcare provider Hello Health and see what kind of uptake the idea has across the medical community. It’s not that I doubt Parkinson’s approach

or that I don’t believe a major shakeup is needed before the primary care model can be saved. Rather, it’s that the recent history of innovation in healthcare delivery can best be described as “checkered.”

Before the e-mails start flying in, let me clarify that I’m not decrying the lack of innovation in care itself. Less than 200 years ago, bloodletting with leeches was a viable medical procedure, and today we see startling innovations in care that run the gamut from the use of lasers and robots, the proliferation of information gleaned from the latest research, the development (if not full deployment) of robust electronic medical records, major advances in genomics that are fueling ever-better pharmaceuticals… the list goes on and on.

But as for how those advances are delivered, changes have been few and far between. The advent of managed care in the late 1960s (arguably begun by Paul Elwood’s Jackson Hole Group and formalized by the Health Maintenance Organization Act of 1973) was probably the last major “innovation” in healthcare delivery, and I use the quotation marks because many physicians now think of managed care as a leading cause of the ills now facing the healthcare system.

While some facets of managed care have come and gone (anyone remember the brief and unsuccessful foray into capitation?), the basics of the employer-provided model of care have remained relatively the same now for more than three decades, as has he griping about it. Take a look at this recent quote posted to Parkinson’s website: “Financing reform without care delivery reform would be a major operational and economic error. Care delivery in the US is uncoordinated, unfocused, inconsistent, unmeasured, extremely ineffi cient, perversely incented, excessively expensive, and sometimes dangerous.” That quote isn’t from one of Parkinson’s buddies; it has been attributed to George Halvorson, the CEO of Kaiser Permanente, one of the nation’s oldest and largest HMOs.

Here and there, pockets of resistance to managed care have surfaced in the form of cash-based practices and boutique medicine. Until now, those have been tiny ripples in the overall landscape. But several factors seem to be coming together at the right time to create a climate for change, including the aging population, genomic research, and an ever-worsening shrinkage of the primary care model. New waves of technology that could help facilitate and support a wholesale change in the delivery of care are on the horizon. I’d include robust PDAs, EMRs, telemedicine, and home monitoring technology among the advances that are already available but have not yet combined to substantially alter the brick-and-mortar-bound gatekeeper model of care. But will they? And if so, when?

Whether Parkinson and the shift he represents turns out to be a footnote to healthcare history or a harbinger of major change remains to be seen. Predicting the rate of innovation in any industry can lead to some laughable results. Healthcare seems to me infinitely more diffi cult to predict than, say, the automobile industry. Yet, in 2004, as I read the annual “innovation” issue of The New York Times Magazine, I could barely control my glee at the thought of being able to purchase my “affordable flying car in 5 years.” Only 12 more months to go.

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