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The Days Are Over When We Could Thrive By Bankrupting Our Customers

Writing in MedCity News, Dr. Westby G. Fisher (a.k.a. the blogosphere's Dr. Wes) offers one of the best forecasts I've seen of health care's future. 

Whether under Obamacare, AnyCare or WeDon'tCare, health care simply costs too much and delivers too little value in return.  And to most observers, the delta (the required magnitude of improvement) is way beyond a few percentage points, more like 20-50% - a challenge few providers can even fathom, let alone deliver.

Predictably and frantically, providers are responding by trying to get bigger, faster.   Buying everything in sight, merging with what can't be bought.  Yet the notion that, in health care, 'big' produces better, more economical results than 'small' is  (putting a charitable face on it here) decidedly unproven.   The next big health system merger that actually delivers on its efficiency-seeking promises will be the first.  (Oops, that's not charitable at all, is it?)

I'm told that spreading the cost of a very expensive EMR system over a bigger entity, for example, makes it more affordable for all.  Obviously it's better to divide $25 million a hundred ways instead of fifty.  I get the math.  I just wonder whether the problem is the math, the EMR or the strategy, which seems uncomfortably reminiscent of the Soviet Union building block after ugly block of apartment complexes.  They called them 'workers' paradises' but try coaxing heat from the radiators.

While I was writing this, a quote came across my e-mail transom:
"Here's to the crazy ones. The misfits. The rebels. The troublemakers. The round pegs in the square holes. The ones who see things differently. They're not fond of rules. And they have no respect for the status quo. You can quote them, disagree with them, glorify or vilify them. About the only thing you can't do is ignore them. Because they change things. They push the human race forward. And while some may see them as the crazy ones, we see genius. Because the people who are crazy enough to think they can change the world, are the ones who do." (Steve Jobs)
I'm a contrarian.  I love being small and nimble while everyone else gets big and slow.   For a 20-50% improvement, health care needs small and nimble, needs paradigm-busters, innovators, maybe a few trouble-makers.  It does not need big for bigness's sake or because the herd's warmth feels so good.   Herds occasionally run off large cliffs, taking their consultants with them.

And on the edge of health care's cliff is a big warning sign reading "The Days Are Over When We Could Thrive By Bankrupting Our Customers."  Who knew?  Apparently only a few troublemakers.


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