Disintermediation and Constructive Disruption in U.S. Healthcare

By Jesse Gomez, Executive VP of Sales & Marketing

Retail giants CVS, Walgreens and Kroger, among others, are pushing further into care delivery, putting ever more pressure on traditional providers to up their game on access … or to partner. Private equity dollars are moving to mobile technology, new primary care delivery models and telehealth. Employers are contracting directly with providers for solutions that do more to contain healthcare costs and improve care quality.  

While developments in care delivery may disintermediate traditional players, many bring the promise of better patient outcomes. New models of what consultants call “constructive disruption” can help plan sponsors meet fiduciary responsibilities, while others can nudge our nation from our failed fee-for-service model to value-based healthcare. 

One of the most promising emerging models is value-based surgery benefits. Four years of data show that bundled pricing for scheduled surgeries at centers of excellence brings dramatic cost and quality improvements to employers and employees alike, as well as benefits to participating providers. Available from specialized benefits management firms, bundle-priced benefits can help plan sponsors stand up to the rising scrutiny around fiduciary duties.

Technology offers many examples of disintermediation and constructive disruption. Poised to become a $30 billion market in 2020, telehealth enables doctors and nurses to consult rural providers on operations and specialty care. Handheld devices allow physicians to capture patient data for analysis by a third party in a country halfway around the world. Patients are getting in the game too, submitting blood pressure and glucose readings and receiving treatment protocols without ever leaving the comfort of their home.

Once the domain of hospitals, knee and hip replacements are becoming commonplace at ambulatory surgical centers. Once requiring an office visit, flu shots and sore throats are routinely managed by retail pharmacy and grocery store clinics. Especially exciting is that CVS Health now helps patients comply with their prescription drug schedules. Medication compliance is a major factor in controlling costs and improving population health.

Constructive disruption. Disintermediation. Big words with even bigger, highly promising implications. Tell that to the next person who tells you not to upset the apple cart.

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