In the new world order of health care reform, a profession that is unconnected to market trends is a profession that will either soon need or already require life support. Chiropractic is no exception; in fact, I’d argue that the stakes are even higher for us than they have been for a long time. Much as the frog in the water that’s being slowly heated has no clue it’s in trouble until it’s too late, we seem to have a faint sense that something’s wrong, but no idea exactly what that may be.
As much opportunity as there is for developing a stronger connection with consumer/patients given the market reforms that the Affordable Care Act is pushing through, there is at least as much danger: the reforms are not just structural, but run deeper. They are fundamentally going to change the business paradigm our health care system is built on.
This is true because of the fundamental revisions that are being put in place regarding how insurance options are presented, evaluated, compared, and paid for. The role insurance companies have played in developing insurance ‘products’–long a joke for anyone who tracks their development, sales cycle and competitive business set–will diminish until they revert to the transaction-based businesses they really are. The stranglehold that the health care supply side has had on the demand side (we, the consumers have never had any real power on the demand side) is going away. What’s been described over the last decade as ‘the emerging retail healthcare marketplace’ is finally beginning to take shape. As it continues to evolve, there is going to be only one force for reform that really matters: what the consumer wants.
We tend to think of our marketplace as either patients or prospective patients. But the reality is that people don’t think of themselves in that way, and while many debate the appropriateness of the word ‘consumer,’ the reality is that people consume health care services, much as they consume other professionals’ services. What has been different for us as health care consumers, as opposed to going into Target for some toiletries, is that we’ve had no real ability to comparison shop, understand what we were purchasing, what we could do if we were unhappy, or how to get a better sense of value out of what we were paying for.
That’s changing, though, and after a long time of watching these events play out, there are three trends I want to highlight that are likely to have a significant impact on how doctors of chiropractic practice, and how the profession fares.
Trend #1: The increasing personalization of services. Genomic assays for $50, anyone? Telomeric inventories? Personalized compounding pharmacy orders? Customized “insurance” (read: discounted purchasing options) packages for your age and stage? Wearable technology that tracks your systems and sends warnings to your doctor when something’s amiss? All coming to a marketplace near you, folks. While reform efforts aim to pool the largest aggregated population so that averaging risks makes the most economic sense, literally thousands of vendors and startups are rushing products and services through R&D to market that are designed to appeal to very specific segments of the market, no matter how big a part of the pool they are.
Trend #2: The increasing customization of environments. While retail clinics in your local pharmacy may have seemed a radical business concept seven or eight years ago, the disruptive role they played will seem inconsequential over the next few years in contrast to how distributed health care services are going to come to be. There’s a broad understanding that the vertical integration of health care systems is a horribly ineffective, top-heavy structure for delivering services that, for the most part, can be pulled out and offered in outpatient, retail and other unusual settings. Health care services in the future will be extremely distributed, and any role technology can play in this, it will. Mash Marcus Welby, Mark Zuckerberg and the Jetsons together, and you get some idea of what’s coming.
Trend #3: The increasing ownership of information. Our own personal health information, or PHI, has largely been monetized on our behalf–largely without our awareness, understanding, participation or shared benefit. The risk-based actuarial models that our health care costs are based on have given us, without our explicit consent, a kind of weighted value that is based on the problems we are expected to develop and the costs of treating them. As wellness efforts come to be better understood, and the return on any investment for these comes to be more widely applied, consumers are likely to wake up some day and realize that they don’t have any real control over their own personal health information. They’ve (we have) abdicated and handed our data off to everyone else, not thinking we shouldn’t or that we might want to track who knows what. The prospect of social, technological and financial solutions that give us control over the management of own information and who has access to it is one that will carve a very different landscape for data management and the roles we all play in it. Health professionals are going to occupy a very, very different role than they do today.
These three trends create a nexus that visually describes, to me, what is likely to be a dynamic and challenging marketplace we’ll all be operating in. If we can understand this, organize around it and handle it well, I predict we can be very, very successful. If we don’t do what’s necessary, however, I predict we will be marginalized by those who do.
Steps you can take
There are some very concrete and positive things you can do to respond to these trends. However, every one of them requires that you begin to redefine your relationship with your patients–and begin to treat them like consumers. If you don’t see the value in that, don’t bother. And…good luck.
Trend #1: Craft services to match your customers’ needs–and identities. Not everyone wants the same service set from a provider–whether that provider is a car mechanic or a doctor. Consumers see themselves as unique, with specific concerns and needs. If all you’re selling is a single wellness plan that’s not tailored to individuals’ needs, life circumstances, gender, age, family structure….you get the idea. Then you are asking all your customers to see themselves as the same, and many will simply unconsciously reject the overture.
Trend #2: Develop customized environments. The Samueli Foundation has spent years researching the benefits of optimal healing environments (OHE). There are some very specific clinical benefits and enhanced outcomes available where variations in color, light, sound, and other environmental characteristics are used. Read more about them, and consult with your patient customers what kinds of environmental adaptations in your offices they would respond to and recommend to others.
Trend #3: Begin developing strategies for shared information stewardship. Patient records may be the property of a clinic, but the information in them is the property of the patient customer. Begin to act like it. Hold a focus group meeting with your patients to begin to discuss information management, access, maintenance, and care. If consumers understood the social contract they have with providers, and began to be more consciously engaged by the potential for participating in those responsibilities, you will have gone a long way to creating a new, stronger relationship with consumers–one they will reward you for as health care reform continues to play out similares al viagra.
Our professional education and our professional culture have long implicitly held and valued a special characteristic: that we should hold ourselves out as authorities, terminal resources that make us The Best Place For Everything. It may have been possible to satisfy that expectation in a captive set of patients, but with health care consumers slowly coming to understand that they are now their own case managers, finance managers, relationship managers, and information managers, it’s time we adjust our positioning in those relationships. It’s likely to make a lot of us uncomfortable. But from where I sit, any failure or unwillingness to mobilize around this opportunity will have a very direct outcome: we’ll be out of business, and we won’t have to care.