Provider Power in the New Health Care Paradigm

Seth Godin argues here that the original goals of industrial unions needs to be rethought in the post-industrial era. He suggests that rather than continue to seek contracts that preserve an unsustainable status quo, unions have an opportunity to add value to their host companies (and enhance their position) by insisting on greater transparency, communication and connectivity with customers and excellence in operations and product.

There’s a corollary to being a chiropractor or other health care provider in the ‘new world order’ of evolving health care in the US. Is power or equality an important goal? Should we keep trying to do things the same way? What is changing, and what is the opportunity? 

As our ‘health’ care system evolved, a basic inequity became established that’s very close to the problem workers faced as industrialists established a position of economic power. Where the industrialists controlled the materials and locations workers needed to produce goods, health insurance plans have controlled the flow and volume of dollars. Where workers produced goods to sell to pay their salaries, health care providers’ services are sold to consumer/patients, with plans transacting revenues to pay for their services. There are significant differences, though: most doctors (and all non-medical providers) have rarely developed the appetite or capacity to organize, unionize or strike, and are generally publicly regarded as being well-paid, so sympathy for circumstances where that’s not true has been hard to establish.

The economics of the inequity are hard to ignore, however, but have to be looked at in different terms. Due to the ability of allopathic medical providers to specialize, they have been able to exert a degree of control over their compensation that generalists and non-allopathic providers have not been able to enjoy. Within medicine this has created what looks like a de facto caste system, trapping generalists into a role and economic position that they cannot escape or revise–unless they abandon general/primary care and specialize. Efforts to create specialization within non-allopathic professions have not produced a proportionate benefit for those who invest time and money in additional training and expertise.

Providers’ tactics to attempt to address these inequities have typically sought first to seek inclusion, next to broaden and solidify scope laws to establish and preserve roles and importance, and finally to argue for fairness to a system that doesn’t believe in it. It doesn’t appear that’s been very successful.

As the post-industrial world with its increasingly globalized economy has resulted in  workers having less ability to command power as a means of rectifying economic imbalance, the trends in American health care are not improving any leverage generalist allopathic and non-allopathic providers may have. Godin argues that it’s perhaps time to look at revising how unions view their role and relationship both to management and their product customers, and it’s also time that health care providers do the same. There are at least three trends that offer both challenge and opportunity in particular for doctors of chiropractic. What might we do with them?

Trend 1: Online health care commerce. There is no single greater disruptive influence in health care, and although what’s currently available is weak, spotty and immature, those aspects will be corrected more quickly than most of us can imagine. The effect will be to bring consumers into the position of making informed choices about the services they purchase in ways that parallel how shopping is done for shoes and travel. What will we do when there are Expedia-like comparison tools for chiropractic prices? They already exist for many health services in a number of markets around the country, and they’re coming soon to a web portal near you. Should we be afraid of this? It’s unavoidable. What do we do?

The opportunity is to give our prices context to the new health care consumer. Wal-Mart prices have context, as do Target’s, Macy’s, Nordstrom’s, and Neiman-Marcus’. The Joint isn’t going to go away, but neither should offices that price their services higher–fairly set for what is delivered and the amenities provided in terms of environment, customer service, education, concierge care, health system navigation, and others. The upstream effect on the costs of chiropractic education will be something the profession’s schools must deal with…or die. Retail customers shop for value, and health care customers will too.

Trend 2: The democratization of information has collapsed the knowledge gap between patient and provider. (Small ‘d’ democratization has to do with removing hierarchies.) A good part of the social position and therapeutic role providers have enjoyed has been made possible by the fact that patients have had to come to providers for information and care. With the Internet and search algorithms, providers aren’t the sole arbiters or controllers of access to information any more. Should they be? Perhaps a new role is needed in response.

The opportunity is to be a synthesizer of information for the new health care consumer, and to offer consumer/patients the expertise and guidance required to analyze often-complicated and contradictory information. Electronic decision-support tools are coming that will do this as well, but if doctors of chiropractic could organize around the uniqueness and importance of the chiropractic paradigm as a distinguishing basis for making personal health choices, it can only enhance our position with the public.

Trend 3: Weakening economics of provider networks. This trend is probably more challenging to visualize this than the first two, but it’s hard to see how provider networks are going to look the same in a few years; the economics just don’t add up. For one thing, most health care benefits aren’t insurance any more so much purchased access to discounted service prices from contract providers. With more and more consumers paying out of pocket for a good portion of their care, more and more providers are likely to offer to ‘match their competitors prices’ and ‘accept competitors’ coupons.’ Again, going back to The Joint as an example: rock bottom prices; no insurance. Can this be stopped? Not a chance. Do we have an opportunity to actually capitalize on it?

The opportunity is to create new ways to aggregate providers into service networks for the new health care consumer. It’s not hard to imagine businesses proliferating that create new organizations and ways for doctors of chiropractic to band together in new service models, products and pricing–and then take them directly to consumers (see Trend 1) through online exchanges and other shopping/service portals. While not the same as unionizing, this strategy sees opportunity in the same way Seth Godin points out at the top of this article: doctors of chiropractic have an unparalleled opportunity to figure out new ways to speak more directly to prospective patients. And we can’t expect ‘the system’ to suddenly realize our value and turn into acolytes promoting our services.

There are a number of other trends that may matter, but here is the heart of things: if doctors of chiropractic keep these three trends in mind as they look at their services, how they’re priced, how they’re made visible, explained to consumers and prospective patients and how they communicate to the public as well, the hope here is that they will see new ways to capitalize on the immense potential benefit of chiropractic for humanity. Further, it’s probably important as practitioners seek to revitalize their sense of commitment, passion and joy in being the source of such a wonderful way to improve and maintain health.


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