Think about the headline question a little. If the real aim of health care is care delivered at the right time, in the right place, at the right cost, it follows that the centralization of health care around a hospital is probably on its way out.
Think about this similar to a distributive computer network model sharing the work across many computers instead of a single large computer. The same concept could work very well for healthcare.
Now that being said, we will always need hospitals in some form. There are medical conditions, and procedures can only be done safely in a hospital at present.
I admit that the idea could be considered counter institutive thinking since we as an industry tout the advantages of economies of scale. But I would argue that with the current centralized model of care, what economies of scale have been achieved anywhere in the U.S. based upon the centralization of medical services around a hospital that has reduced cost, eliminated clinical redundancy and improved quality?
If one examines the pace of change and innovation, it’s easy to envision a time where innovation in technology and treatment combined in a distributive model significantly lessen the need for a hospital and its inpatient or outpatient services.
Scanning the horizon, technology for health information exchange connectivity, EHRs, Google Glass devices, advances in remote monitoring, telemedicine, wearable devices, surgical procedures in an ambulatory setting, and pharmaceuticals, etc., the concept of distributive healthcare is a reality.
When adding in other advances and capabilities not mentioned all networked into the care system, the reliance on the big box hospital which is the most costly setting inpatient or outpatient though not eliminated becomes very limited.
Instead of the centralization of work and workflow which at this time is the most expensive and average quality setting, the patient or healthcare consumer for that matter, now moves in a system of care that is potentially more cost efficient and effective with a greater opportunity for higher quality care that meets the Triple AIM. Instead of the patient moving to the beat of the system needs, the system is more responsive and moves to the patient needs.
It is also potentially more user-friendly resulting in greater engagement, experience, and adherence. Now, of course, more thought and detail would need to be added, but the point of this is to start a discussion if anyone cares too, about what health care could look like 5 to 10 years down the road. The technology, systems, and processes are already present, though not currently configured or used in this type of way, but it could be.
Maybe my thoughts here are just the ravings of a lunatic, or it could also spell the fast approaching end of the big box hospital of inconvenient, centralized care and scale to dominate markets for pricing increases or limiting competition.
Now, what does this model taken from the computer world do to all those hospital mergers to create “scale” when the patient care, for the most part, available without ever setting foot in a hospital.
Just think about it for one more moment.
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