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Business

Disrupting rush to the medical home model

This year's hot economist is Dr. Clayton Christensen of Harvard Business School, and just in time for our health reform debate he has a book out on the health care market.
Written by Dana Blankenhorn, Inactive

This year's hot economist is Dr. Clayton Christensen of Harvard Business School, and just in time for our health reform debate he has a book out on the health care market. (Amazon has it for 33% off.)

Christensen is famous for his idea of "disruptive innovation," describing how and why new technologies impact markets.

Simpler and cheaper destroys by creating new markets among people who previously did not buy an industry's product or by taking the low end of the market away from existing vendors.

Consider the PC. It was first seen as a cheaper spreadsheet and word processor, but eventually created a host of new markets. Companies rose, and fell, as new players "disrupted" the old game's assumptions.

What does this have to do with health care? Plenty.

Christensen's new book, The Innovators Prescription, applies his concepts to the health care market, and in the process casually dismisses medicine's latest and greatest business model, the medical home.

I've called this the coach approach. You have a relationship with someone who gets to know you and becomes your advocate with the rest of the system.

Unfortunately, as Vince Kuraitis and David Kibbe noted recently at The Healthcare Blog, Christensen dismisses this in two sentences, saying giving the medical home role to physicians would mean "comingling business models."

He's right. My internist has too much training, and makes too much money, to spend more than a few hours per year on me. The numbers don't work. And we're so short on internists and other primary care physicians in any case it can't work.

This does not mean that a medical home model for health care won't work. If just means that the coaching role needs to be systematized. It needs to become simpler, so other people can take it on, and so patients can have a choice of coaches and coaching styles, with the coaches closely supervised.

Maybe the real model for doctors in this system is the NFL. Steeler coach Mike Tomlin didn't get this team ready to play by himself. He had coordinators, and position coaches, and scouts -- a whole infrastructure.

For doctors to justify their skills and pay in the 21st century they need to be head coaches, leading teams of people and not working alone.

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