This is a draft of Part III in a three-part series on the current, and potential future, of healthcare delivery economic models. The full series will be available on xchangehealth.wordpress.com in the next week. A quick synopsis of parts I and II are extracted as an introduction.
I was recently invited to participate in a Storyvine for Stride (on twitter). While reading through the questions that had been prepared, I was thinking about the way in which Stride is poised (intentionally) to disrupt our current healthcare delivery model by bringing together stakeholders from startups and the institutional healthcare system.
As a company that’s been around for 35 years, MINES & Associates is certainly in that latter category in many respects; however, one of the reasons that I have decided to make MINES my home is that, as a company, we have embraced technology as a tool to reach our organization mantra: to “save lives, and influence the course of human events.”
There may be a shift to consumer-directed healthcare in the very near future. One of the opportunities (or threats, depending on your viewpoint) of consumer-directed healthcare may be the collapsing of the system within which the decisions in healthcare are made at an administrative level. As a fellow Health 2.0 Denver/Boulder chapter member of mine, Sumanth, mentioned while on a panel regarding open-innovation models in healthcare, ‘We have a sickcare system, we’re working toward a healthcare system, but I’m interested in a health system.’ When we begin empowering people by giving them purchasing power, we also saddle them with the responsibility of that decision and we need systems in place to make those decisions reasonable.
Is 4PHealth going away?
If you’re not familiar with my concept of 4PHealth, check out my earlier blog post for details (secretly hoping I can stop linking to this post at some point!) but the long and short of it is that there are four P’s in the healthcare system: payer, patient, provider, and the patient’s peers. Truthfully, there’s actually a fifth P that was not originally contemplated in that post but comes to light when you consider a consumer-directed healthcare model: purchaser.
For most people in the US, the purchaser is an employer. But now that is shifting as organizations are actually sending their employees to the health insurance exchange. Increasingly, I expect this to grow; and that’s a good thing. When the purchaser and the patient are the same, there is a shift in the financial onus for having a particular benefit plan; which means we need more informed consumers (patient-purchasers). But it also creates an opportunity for further collapsing of our very-tiered silo. If the consumer could then also become the payer, we could very well see a one-to-one relationship between the provider and the consumer (patient-purchaser-payer).
Part III: The sharing economy
What does the sharing economy have to do with the consumer-directed healthcare system? First, let’s look at what is at the core of purchasing: economic offering.
Levels of economic offering
As products increase in differentiation (customization), a higher asking price for that product can generally be realized. In this way, value to the consumer comes in the ability to match the need with the offering and in healthcare, this means enabling smart, simple decisions.
In a consumer-directed healthcare system, shifting healthcare transactions to goods, rather than experience, and focusing the overall healthcare purchasing and maintenance up to that of an experience will be critical to success. Again, an awareness of this intentional effort to differentiate based on total experience. This can be done when the exchange, for example, becomes broker, maintenance organization (think HMO), and coordinator of one’s health record (not an Electronic Health Record as we know them, but a coordinator of the health profile mentioned earlier).
For such a situation to work, the exchange then will need to either build out, or partner with organizations with experience in guiding human behavior, to successfully engage those patient-consumers in maintaining their profile as well as actively pursuing greater levels of health.
Examples that work
The sharing economy is also making significant changes to the way that we engage as consumers. This economic shift allows for individuals to make transactions with little to no broker (for example, a bank) in order to make purchases. Most of the sharing economy relies heavily on technology to enable people to come together. A chart of examples is below:
|Organization||Primary offering||Industry disrupted||Innovation Description|
|Uber/Lyft||Car service||Taxis||By allowing individuals to directly contact a driver, users interact with an app that can manage their payment and reservation.|
|AirBnB||Housing||Hotels||Users submit their social network credentials as “proof of trust” for user-to-user reservations of rooms|
|Car-2-Go and many others||Cars||Every car company||Cars placed around the city, can be “rented” for one-direction travel.|
|Bitcoin and other cryptocurrencies||Currency||Banks||Distributed, “proof-of-work” based cryptocurrency which allows for peer-to-peer exchange of value.|
|Kiva||Microfinance||Lending companies||Individuals can register their needs for financing and other members of the Kiva network can make those loans direct to the borrower without a traditional lender.|
|GoFundMe and other crowd-sourced finance platforms||Project Funding||Investors||Individuals can create a project page with donation-level rewards for contributing to the financing of a project or product.|
Considering these examples, I believe that there may be some interesting opportunities for alternative funding and insurance when it comes to healthcare. Consider this: what would it look like if traditional insurers were no longer the primary location to insure oneself. In the current healthcare system, some groups (usually smaller companies with less leverage than bigger companies) might choose to pool their collective employees into what’s called a captive insurance group.
What if a similar model were to be contemplated where individuals were to select a captive group of similar patients, almost self-selecting to become a part of a patient-centered medical home model. Exchanges could do the same with their patient population by segmenting those patients into population groups.
Now, what if those groups could be funded by individuals wanting to bet on the success or failure of those groups. This allows for more direct funding for investors and patients that could result in dividends for the patients and investors when benchmarks are achieved or maintained. What other possibilities for alternate funding models might still be out there to be explored?
The core of the sharing economy
At the very core of the sharing economy is a redistribution of trust networks. By decentralizing trust models from institutional to peer-to-peer, the sharing economy refocuses and reinforces a community around the exchange of goods and services by moving brokerage to a fluid, and seemingly direct brokerage for those exchanges.
The other side of this change to the sharing economy is supply and demand monitoring and connection. Uber has the ability to simplify the exchange of need for transportation with the supply of excess time (and access to a vehicle) on the part of the driver all while it is in the process of cutting out the institutional (and very infrastructure heavy) taxicab industry.
What that means for institutional healthcare
So WHAT DOES this mean for institutional healthcare? Great question! It could mean realignment around roles within the healthcare system. It could mean small market-share loss if the idea doesn’t take off easily. It could mean more competitive models. I’m interested to hear your thoughts.
Questions for Health IT
#HITsm T1: Is a sharing economy model realistic for the healthcare industry, in whole or in part? Where? How?
#HITsm T2: What should a sharing economy model prepare for with the current status of #HealthIT and #Healthcare?
#HITsm T3: If a sharing economy model were to come about, who wins and who loses in #HealthIT and #healthcare generally?
#HITsm T4: What other technology models are out there that #HealthIT can borrow from to enable those changes?
#HITsm T5: Any other thoughts on #healthcare economic models and how #healthIT can help?