On-Demand Medicine Headed for a Perfect Storm

During the last six months I have been struck by how suddenly the economics, culture and technology underpinnings of healthcare are changing.  These changes seem poised to disrupt the on-demand medicine landscape in a major way. 

Our current fee-for-service healthcare system is similar to global warming: there are still many people who deny there’s a problem.  And those who recognize it as unsustainable are overwhelmed with how much needs to change (and how much they need to give up) to embrace a more sustainable reality.

It should not be a surprise that on-demand services will be a major characteristic of value-based healthcare.  That notion has been slow to manifest.  In fact, the early accountable care organizations (ACOs) completely missed including urgent care and retail clinics in their networks.  But that has changed, and as we move forward I’m convinced that on-demand care will become a part of healthcare culture: patients will expect it.  Providers already are measured on access, convenience and satisfaction.  But over the next two decades as millennials become the largest segment of the healthcare population, patients will look for on-demand access to care as an option for the vast majority of care episodes.

New companies and innovations will continue to disrupt primary care during this period.  The disruption started with on-demand offerings like doc-in-the-box centers and retail clinics, and later national urgent care chains.  Here are just a few examples of a new wave of innovations: new companies are now rating physicians based on the value of their prescribing and referral habits, e.g. RowdMap; insurance companies are getting into the provider business, e.g. Optum; retailing and value-based care are intersecting, e.g. CVS-Aetna; coaching platforms are taking a piece of the primary care pie, e.g. Mobe and Accolade; and condition-specific social communities of interest have emerged, e.g. PatientsLikeMe.com.  All of this is playing out in a new generation of narrow networks that are far more advanced than the ones we saw emerge 10 years ago.

These narrow networks and ACOs have at their core the DNA of reducing cost and unnecessary spending (drugs and procedures), combined with on-demand convenience.  And these networks are highly attractive to large employers, particularly those like Walmart who have wide and vast geographies to cover.

We also see the combination of urgent care saturation in most markets and payers getting more aggressive on cost across the board.  The result will be flat or lower urgent care reimbursement.  And given rising labor costs, those who will be most affected in the near term will be smaller private operators who have little or no leverage.

Add to this the continuing evolution of healthcare technology.  The EMR that guides workflow is no longer enough.  We are seeing on-demand algorithms that tell people where to go and when based on consumer preferences that particular day; artificial intelligence that highlights a potential high-risk patient that needs to be escalated in real time; and EMR integration so patients are recognized no matter what provider organization they choose on any given day.

I would call this the perfect storm for urgent care.  It’s a perfect storm in a good way, if you are in the right place at the right time.  And it’s a perfect storm in a bad way, where if you are not prepared, you will need a rapid rescue or end up closing your doors.  

The impending arrival of value-based care and its intersection with on-demand medicine will be the theme of this year’s ConvUrgentCare Strategy Symposium January 21-23, 2019, at the Westin Fort Lauderdale Beach Resort.  To support this theme and the resulting agenda we have been fortunate to land some outstanding keynote speakers:

Adam Stavisky, SVP of U.S. Benefits at Walmart – Mr. Stavisky is tasked with developing Walmart’s vision for the future of employee benefits for their 1.5 million U.S. associates.  As many of you know, Walmart has become a leader in direct contracting with health systems.  Mr. Stavisky will discuss how they are looking at those and other contracting models designed to surface better ways to drive more appropriate and higher quality care.

Mai Pham, VP of Provider Innovation at Anthem — As health care delivery, networks and payment models evolve away from fee-for-service medicine, the relationships between them are also evolving. Dr. Pham will offer a broad perspective on the shifts in what payers and large employers want from urgent care providers and hospitals. She will speak to the ways Anthem is considering and already integrating these new modes of care delivery into its strategy.

David Sanders, M.D., CEO and Co-Founder of Zoomcare — Dr. Sanders and his partner started Zoomcare as a next-generation urgent care chain back in 2006, but with a vision to combine on-demand aspects of convenience with value-based approaches to pricing and the avoidance of unnecessary procedures.  That vision will advance to a much broader reality this fall with the offering of a regional ACO in partnership with Aetna in the Pacific Northwest.  That offering is a Zoomcare-only network of urgent care, virtual care, primary care, specialty care and emergency services, packaged and offered to employers as a lower cost alternative option to employees and dependents during open enrollment.

Over the next several weeks, I’ll be writing blogs that go into more detail on this overall theme, from how primary care will continue to be disrupted by new innovations, to how leadership and culture can create efficiencies, speed and greater patient satisfaction, to the holy grail of direct contracting with employers for a much broader range of healthcare services.

Some basic facts about the symposium:

Dates/Times: Monday, January 21 at 1 pm through Wednesday, January 23 at noon.

Location: Westin Fort Lauderdale Beach Resort, Fort Lauderdale, Florida.  Hotel room rate is $269 until December 31.  Book a room using the event room block discount.

Best Airport: Fort Lauderdale International (FTL), served by all major airlines including Southwest.  Because Fort Lauderdale is a major cruise port, FTL has one of the highest number of non-stop flights to U.S. and international cities.

Registration Cost: $999 (discounted to $749 until November 1).  Register online.

Get the detailed agenda, brochure and more information on the Merchant Medicine website.