Practice Management

Health care, technology, and the future

Major forces combining to reshape care delivery


What will be the role of humans in the future health system?

At first blush, this is a peculiar question. Health care is all about humans. How could one doubt their presence or role? It is working with and for people that attracted many to this profession.

On the cusp of a significant health system reformulation, it is the very question that hospitalists now must ponder. Just as ATMs replaced bank cashiers, online shopping replaced retail stores, and autonomous cars will soon replace drivers, the human landscape of health care is about to change. What pressures will force the changes?

Leonard J. Marcus, PhD, director of the program for health care negotiation and conflict resolution, Harvard T.H. Chan School of Public Health.

Leonard J. Marcus, PhD

Like the massive shifting tectonic plates that spark earthquakes, two major forces are combining to reshape service delivery as we know it.

On one hand, there is increasing demand. The Affordable Care Act opened the insurance door for people previously uncovered. Aging is delivering the baby boomer bubble into their sicker years. Hospitalists witness this phenomenon every day in the ballooning parade of patients they serve. At times, those pressures can overwhelm.

On the other hand, the political will to provide government subsidized health coverage is waning. Washington is tripping over itself to dismantle Obamacare with glancing concern for how it will inflate the ranks of the uninsured. Employers are eager to free themselves from the burden of providing increasingly expensive health coverage benefits. By removing the mandate to buy health care insurance, the current political health system architects are liberating the healthy paying population from their contributions to the overall insurance pool. Simply put, there is and will be less money and less of all that it buys.

Combine building demand with decreasing budget into a system that does not follow general market forces: You get that earthquake. A consumer can forgo that new phone in hard times but not that cardiac procedure. People will be caught in the fissures of the system. Waits, quality, burnout, morale problems, and financial losses will all trend in the wrong directions. The process will evolve in slow motion. Some might argue that we have already arrived.

Enter entrepreneurs, technologic advances, and a growing savvy and willingness to engage tech solutions to everyday problems. If Alexa can turn on your toaster, could it take your blood pressure? If a robot can vacuum your rug, could a different robot provide personal care services? And, if an algorithm can drive your car, could it similarly diagnose what ails you?

On Jan. 30, 2018, one of the greatest disrupters of all time, Amazon, announced that it is joining forces with Berkshire Hathaway and JPMorgan Chase to leap into health care. While they are initially experimenting with health care changes for their corporate employees, the ultimate marketwide goal is to apply technology to both reduce costs and improve patient care. Warren Buffet, Berkshire Hathaway’s founder, said in a statement, “The ballooning costs of health care act as a hungry tapeworm on the American economy.” (And yes, I imagine that many hospitalists would take umbrage with that characterization.) In addition to the Amazon alliance, CVS Health and Aetna also recently agreed to join forces.

The rising health care interest by Amazon begs the imagination. Technology already is far along in automating routine procedures, elevating patient safety protocols, and recalculating patient flows and information. This added corporate interest and investment will further expand new ideas and innovative technologies. And, for sure, it will challenge long held beliefs and practices that shape the health system we have today.


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