Eliminating the middleman in health care

Eliminating the middleman in health care is the latest trend. | Truth in Health Care BlogThe older I get, the more convinced I become that my generation will never fix our health care system. We’ll have to wait for the millennials.

Why millennials? Because shopping for health care is not a daunting task for them, as it is for most of us. They’ve grown up retrieving information about price and quality online before they buy. And they demand whatever information is necessary to make an informed decision, or they go elsewhere.

Millennials looking for health care options

They’re also open to alternatives—like cutting out the middleman. Think Amazon, Netflix, eBay. In finance, they call this “disintermediation.” I myself would never use a word like that in front of you. But in health care today, there are disintermediation possibilities galore—opportunities to get what we want directly from the source.

Here are a few examples:

Hospitals—We need hospitals for their emergency care, intensive care and complex acute care. But imaging and laboratory services? Urgent or ambulatory care? These can all be provided elsewhere with the same quality, greater convenience and at a far lower price.

Drug companies—A massive network of middle men—pharmacy benefit managers, group purchasing organizations, hospitals, insurers, retailers—jacks up the price of every prescription drug before it gets to the consumer. How long before someone figures out how to link patients and drug manufacturers directly?

Insurance companies—the ultimate middlemen. They sit between health care providers and patients, with no particular incentive to improve health care and a poor performance at controlling costs. The push toward bundled payments, reference pricing and employer self-insurance could eliminate a big chunk of what they do.

Physicians—As technology advances, patients could skip the annual physical, monitor their own medical condition on a smart phone, see a doctor when necessary at a retail clinic, and use telemedicine when a physical appointment is inconvenient.

Middlemen might be on their way out

Are all of these possibilities good ones? Perhaps not. But an increased demand for direct connections between health care providers and patients—eliminating the middlemen—is a necessary step toward providing a health care system that improves population health and reduces cost.

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