Last month, after delivering a keynote address in Orlando and spending a little time visiting Disney attractions, I wrote a piece that pondered what it might be like if Disney did healthcare. Last week I was in Washington, D.C., for the World Health Care Congress. The closing keynote was provided by Lee Scott, President and CEO of Wal-Mart Stores. In his keynote, Mr. Scott shared information about Wal-Mart's plans to open healthcare clinics in their stores. They already have more than 40 clinics operating in Wal-Mart stores. The clinics are primarily staffed by nurse practitioners who provide basic primary care services. Mr. Scott said Wal-Mart wants to partner with providers around the country to open perhaps 600 more clinics in the next couple of years. He sees a potential for more than 2000 clinics to one day be operating in Wal-Mart facilities.
In addition, Wal-Mart, Intel and other major employers have announced their intent to provide a transportable personal health record for employees. In fact, the retail health movement which includes organizations such as MinuteClinic and RedClinic, is very focused on using technology to improve care quality and safety as well as to enhance the "patient experience". Price transparency, a factor that is all but absent in services offered in traditional care facilities, has become a hallmark for the retail movement. Likewise, retail clinics go overboard when it comes to savvy marketing, customer relationship management, and patient convenience. And although organized medicine has taken some pot-shots at the clinics, patients seem to love them.
Where is all this going? I think the trend is generally healthy. People want affordable, convenient, high quality care. They are demanding more value for their healthcare dollar. They are looking for a healthcare industry that behaves more like other industries; one that is responsive to market forces and customer demands offering cycles of continuous quality improvement, improved productivity, and lower costs. As my colleague John Goodman of the National Center for Policy Analysis points out, healthcare would behave like other industries were it not for the perverse effects of traditional insurance programs on the supply side of the business. He writes;
Suppose we passed a law tomorrow prohibiting all insurance companies (including Medicare and Medicaid) from paying any medical bills less than $5,000. What would happen? The medical marketplace would transform almost overnight. Within a couple of months, there would be no such thing as a primary care physician (PCP) who did not post prices - at least for routine procedures. PCPs would offer telephone and email consultations. They would keep patient records electronically (just like lawyers and accountants). Overall, there would develop a teeming, bustling, entrepreneurial marketplace for primary care, diagnostic tests and most prescription drugs. Specialty markets would develop for the chronically ill, as doctors competed for their business instead of trying to avoid them. Patient education would become an emerging field, with providers offering to teach diabetics, asthmatics, etc. how to manage their own care. Internet drug sales would double, triple and quadruple, as brand drugs faced increasing competition from generic, therapeutic and over-the-counter substitutes. At the same time, overall health care spending would plummet.
What if Wal-Mart did healthcare? Yeah. What if?
Bill Crounse, MD Worldwide Health Director Microsoft Corporation
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