The Great Re-Bundling of Healthcare, Part 2

This post was originally featured on HIStalk.

This is part 2 in a series of posts of how computers are rebuilding healthcare. Check out part 1.

Medicine is organized into disciplines. Many of these disciplines have been around for decades. The medical disciplines appear to make sense in terms of both provider training and patient service. See a cardiologist for heart problems. See a dermatologist for skin problems. See an ophthalmologist for eye problems. See an ENT for ear problems. Each of these disciplines requires years of specialized training, so matching up patients accordingly makes sense.

This model of discipline based care delivery is (partially) broken.

Technology has changed society. As we’ve gotten lazier and fatter, chronic care conditions have come to account for x% of total care costs. Of those, some of the most common and discussed chronic conditions are:


Depending on the patient’s location and preferences, they may see a PCP and a few specialists to manage these conditions. But these PCPs and specialists are also diagnosing and treating dozens of other ailments.

Computers are eating in the world and re-bundling healthcare. Among other things, computers enable providers to seamlessly and instantly communicate.

Instead of training PCPs for seven years to try to support and manage most chronic conditions, why not train mid-level providers to specialize in a single condition and its variations? These mid-level providers could likely be trained in 1-2 years as opposed to seven+ for MDs.

By specializing in a single condition, they can become experts in that condition and provide the best care to patients more cost effectively. There would likely be a healthy dose of self-selection, in which many of these condition-specific providers would have the condition which they help others manage. These condition-specific providers would be particularly adept at empathizing with patients and helping provide guidance and education regarding every of managing life with a chronic condition.

How does technology fit into this? Why would this model work? The proposed model supposes a re-bundled, hyper fragmented care delivery system. Technology will be the connective glue that supports a hyper fragmented care delivery system:

Passive monitoring. Glucose monitors passively feed data to the cloud. So do Jawbones,FitBitsBasis Watches, and a host of other devices that are making their way to the market.AliveCor’s smartphone ECG empowers patients to take a daily ECG. As patients have adopted these devices, critics have argued that PCPs can’t possibly make sense of 25 different passively collected data sets that patients bring to PCPs. PCPs simply don’t have the time or expertise with each data set. They’re right. By narrowing focus, condition-specific mid level providers can work with their patients to passively collect, analyze, and act on the right data together.Qualcomm LifeVerizonAT&T and a host of companies from the recent mHealth Summit are creating the infrastructure to support this future.

Telemedicine. Coupled with passive monitoring, the vast majority of diabetes and asthma management can be delivered virtually. Diabetic specialists should be able to manage a larger diabetic population than a PCP trying to manage that same population in their office. Given the dynamic and variable nature of diabetic visits, a virtual waiting room makes a lot more sense than a physical one. Vheda Healthcare is acting on that vision.

Empathy. I find quite difficult to make the case that providers with the chronic condition that they help others manage won’t be more effective providers than providers that don’t have that chronic condition. See the rise of female OB-GYNs as a harbinger.

Questions and criticisms welcome.