Sunday, April 10, 2016

Is the disintermediation of hospitals a market reality?

In 5 areas of healthcare ripe for disintermediation, Becker’s Hospital Review, March 30, 2015, Emily Rappleye, outlined five areas Paul Keckley, Ph.D., managing editor of “The Keckley Report” made in identifying areas of disintermediation.  Three players-  large health systems, pharmaceutical retailers, and major insurers have the ability to take out several healthcare layers. Just click on the embedded link in the title of the story to read.

On an aside, I can see a lot of vendors whose data solutions and services like those provided by Truven Health (soon to be an IBM/Watson Health Company) and others face disintermediation as well. But that is a subject for another day.

In reading the article, I started to consider the broader implications of disintermediation, and how population health may have a greater impact on those three players as well.  If society desires real healthcare reform resulting in improved quality and lower price, then the model needs to change, and hospitals become disintermediated.

Hospitals are ripe for disintermediation.

Let me repeat hospitals are ripe for disintermediation and in many cases; it’s already happening.

If you consider from my last post on the idea of healthcare beginning to look like a distributive computer network, “Is the transformation of healthcare leading to a distributive network?” LinkedIn, March 28, 2016, then this isn’t such a crazy idea.

Now, we will always need hospitals in some form, but do they need to be at the center of the healthcare universe? 

Not if more of the current inpatient and hospital-based outpatient clinical services can be done by others more cost effectively, efficiently and with an acceptable level of quality with a better experience. And that my friends, is disintermediation at its finest. New entrants and innovation are driving the disintermediation of the hospital at an ever accelerated rate.  

A distributive care network is a disintermediation concept.  So while health system and hospitals in some cases, attempt to figure out how to manage risk capturing a significant portion of the $1 trillion spent annually on healthcare, hospital disintermediation is the new barbarian at the gate.

In building the hospital system, it should be constructed with a disintermediation strategy that is not dependent on acquiring other hospitals but adding those necessary pieces that can disintermediate, the hospital.  Otherwise, it is a strategy for closure and defeat by not paying attention and responding to the direction and the velocity of change in the market.

After all, what is a hospital needed for in healthcare reform? I can think of three essential items, and they are emergency care, intensive care, and complex medical acute care. After that everything else can be delivered to the individual in a free-standing ambulatory or home care setting, that will be more cost-effective and efficient for the patient or healthcare consumer with comparable if not better quality than in a hospital.

It’s about being in the healthcare business, not the hospital business.


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