Managed Care - January 2009 - (Page 14)

work and sometimes the guesses are wrong,” says Paul Keckley, PhD, executive director of the Deloitte Center for Health Solutions and a past executive director of the Center for Evidence-Based Medicine at Vanderbilt University. “The EMR is the way nurse practitioners are able to diagnose more completely and direct people to a therapeutic intervention that is more appropriate, or refer people who have more complex conditions to a physician.” As with many disruptive innovations, low-cost providers take less complicated work away from high-cost providers and deliver it in a new venue. About 90 percent of clinic visits are for 10 simple conditions, such as conjunctivitis, ear infection, and bronchitis, according to a Rand study, “Retail Clinics, the Medical Storefront,” in the September– October 2008 issue of Health Affairs. A clinic visit costs $40–$75, while a typical physician office visit can run $55–$250. Of the more than 1,100 retail clinics that have opened since 2000, at least 65 percent are in drugstores; the balance are in discount and grocery stores such as Target, Wal-Mart, Kroger, and Publix. CVS Caremark is the largest clinic retailer, with 554 MinuteClinics in 27 states. In November, the company hired Troyen Brennan, MD, JD, a former chief medical officer at Aetna, to be executive vice president and chief medical officer with oversight of the clinics. According to a forecast in “Health Care in the Express Lane: Retail Clinics,” prepared in 2007 for the California HealthCare Foundation, there will be 6,000 clinics by 2012. Though the amount of business that clinics siphon from doctors is small today, that could change if their numbers grow significantly and if frustratingly long waits to see physicians continue, Keckley says. Already, doctors have expressed opposition to clinics through their trade groups. The academies of pediatrics and family physicians argue that clinics disrupt continuity of care, have no uniform quality standard, A disruptive technology, or technological enabler, is a new and do not support the concept of a medtechnology that unexpectedly displaces an established technolical home because they fragment care. And ogy, but only if it is accompanied by an innovative business physicians are skeptical about whether model. The enabler is generally cheaper, simpler, smaller, and NPs actually make referrals for chronic or frequently more convenient to use. It is initially embraced by the seriously ill patients. least profitable and usually the poorest customers in a market. However, self-insured employers and An example is the microprocessor, which so simplified the probinsurance carriers support clinics because lems of computer design and assembly that Steve Wozniak and they steer patients away from more costly Steve Jobs could slap together an Apple computer in a garage emergency rooms, urgent care centers, and and Michael Dell could build personal computers in his dorm physician offices, reducing the cost of care. room. In health care, technological enablers are those that proBlue Cross & Blue Shield of Minnesota vide the ability to precisely diagnose by the cause, not the physiwaived copayments to clinics to encourage cal symptom, and displace physician intuition with precision. These technologies include molecular diagnostics, diagnostic their use. That angered the Minnesota imaging technology, and widespread telecommunication. Medical Association, since doctors are not A disruptive innovation is one that brings to market prodpermitted to waive fees. In 2007, BCBSM ucts and services that are much more affordable, and, in the end, saved $1.25 million on patients who used much higher in quality. It improves a product or service in ways the clinics, according to a report in the that the market does not expect, typically by being lower priced Twin Cities Pioneer Press. Some other baror being designed for a different set of consumers. Examples inriers to acceptance are continuous legislaclude personal computers, the Kodak camera, and Google advertive scrutiny of NP scope of practice, sutising. They used disruption to transform markets that had been pervision restrictions, and prescriptiondominated by complicated, expensive services and products writing challenges. into simple and affordable ones. Disruptive innovations are the Disruptive products are almost always key to ushering in affordable health care. An example of a health introduced by new entrants rather than care disruptive innovation is Medco, which disrupted retail pharmacies. In addition, drugs that lower cholesterol are disruptive to the dominant players, Hwang notes. Some angioplasty, just as angioplasty was disruptive to open heart of the new guys are RediClinic, Take Care surgery. Health Systems and the Little Clinic. A few incumbents, such as the integrated deliv- What is a disruptive technology? 14 MANAGED CARE / JANUARY 2009

Table of Contents Feed for the Digital Edition of Managed Care - January 2009

Managed Care - January 2009 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Health Care's Disruptive Innovations Q&A With Clayton Christensen 'Disruption' May Be Plans' Best Bet Avoid the PBM Rebate Trap HealthPartners Puts Diabetes on Notice Formulary Files Plan Watch Tomorrow's Medicine Ad Index Outlook Unmet Needs in the Management of Plaque Psoriasis Impact of RSV: Implications for Managed Care

Managed Care - January 2009

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