Primary care, the sort of routine, first line checkups that most people associate with the doctor’s office, is incredibly important. When done well, it can help catch things early, helping avoid more costly care down the line. Better primary care is essential if we’re going to reduce the growth of healthcare costs.
Unfortunately, it’s one of the weakest parts of our healthcare system. Specialty care is more profitable, so doctors and resources get diverted there.
Add to that the fact that we’re going to see a widespread shortage of doctors, and you have a crisis in the making. At the same time, this is the type of care that’s most in demand, so it could be a huge opportunity.
Part of the solution is getting the most out of doctors. Cleveland Clinic CEO Dr. Delos Cosgrove told us that his hospital does it with things like group visits. Doctors will see 10 people with the same problem at the same time, so they don’t duplicate advice and effort. Hiring more nurse clinicians and physician assistants means doctors spend time on the things that only they can do.
But the real place we’re going to see disruption is outside of the hospital.
“Disruption is going to happen at the pharmacy rather than the teaching hospital,” Dr. Cosgrove said. “I mean, it’s going to be hard to change heart surgery or neurosurgery very fast. But you can change that primary care stage, and you’re going to be able to do more and more things at that primary care level as you disperse the care to where the population is.”
When you have fewer doctors, you’re going to have fewer doctors in less populated places. That first line of healthcare doesn’t always have to come from doctors. It can be cheaper when it doesn’t.
“We think everybody needs to see a doctor every time,” Dr. Cosgrove said. “I talked to the CEO of Walgreens the other day; they have 8,000 facilities across the United States where their pharmacists have come out from behind the counter. They’re now giving flu shots. I think that you’re going to see a disruption in primary care from those locations.”
We’re already seeing the beginning stages, but given the sheer size of the demand for primary care services, there’s a lot more to come.
Because large, established businesses don’t want to focus on something that’s difficult and has lower margins, there’s a huge space for pharmacies and others to fill. It’s a script that’s played out before in many other industries.
“Disruption always starts at the bottom end of the food chain,” Dr. Cosgrove said. “Look at the mini mills that started doing rebar. Honda started making motor cycles, then cheap cars, then very sophisticated cars. Clay Christensen talks about that all the time. Disruption starts where you don’t expect to see it, at the low end of things. I think that’s going to happen in healthcare, and I’ve been looking for it.”
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