Category Archives: Quality

Crossover Health: Welcome to Next Generation Health Care!

Crossover Health Launches New Model of Primary Care in South Orange County
Innovative membership service delivers Urgent, Primary, and Online Care

Aliso Viejo, CA (PRWEB) October 1, 2010

Crossover Health Medical Group announced today the launch of their flagship membership-based, primary care practice in Aliso Viejo, California. The new clinic will offer urgent, primary, and online care services directly to individual members, families, and employer groups. Membership based health care is a new health care finance and delivery innovation that has gained widespread popularity as the cost of health insurance and ongoing service deficiencies have plagued the current health care delivery system. The Crossover membership model decouples health care from health insurance, and allows individuals and organizations to purchase primary care directly from health care providers who offer increased access, enhanced services, and an exceptional service experience.

“The membership-based practice model allows Crossover Health to fundamentally change the way health care is practiced, delivered, and experienced,” according to Chief Executive Officer Scott Shreeve, MD. “Crossover has been specifically designed to restore and enhance the patient-physician relationship, increase access and convenience, reduce the cost of health care, and deliver an unprecedented patient experience.” The membership fee pays for access to the technology enabled practice and wellness services, as well as affordable prices for office visits, specialty consultations, and ongoing health management followups. A health concierge is assigned to each member to assist in overseeing follow-ups, proactive health maintenance, and care coordination. Crossover also provides health advisory services to guide patients in financial decisions related to the management of their health.

Crossover Health introduces two key innovations to the membership model. First, Crossover members have direct access to their physician via Crossover’s unique online, anytime, from anywhere technology platform that includes options for email, text, and video chat consultations. Second, the technology also enables a direct financial, administrative, and clinical relationship between the patient and their personal physician and the extended Crossover care team of medical specialists, diagnostic testing centers, and other licensed professionals. This inherent connectivity enables the creation of the Crossover Health Network™, a network of specialist providers who commit to deliver to a specific service level, make their prices transparent to members, and communicate on a common platform. The result is a simple, efficient, and affordable care experience.

“Many people, including employers, are surprised to find out how affordable exceptional health care can be when purchased directly from the physician,” said Chief Medical Officer Richard Patragnoni, MD. “Members can typically save a significant amount of money while enjoying a broader range and higher quality of personalized service to meet individual, family, or corporate health needs.” Crossover offers a variety of individual and corporate memberships that provide essential primary and preventive care services as well as targeted wellness programs like medical weight loss, executive health programs, health portfolio management, and virtual clinics.

Crossover Health memberships appeal to individuals looking to establish a personal relationship with a physician, families whose care requires a higher service level, and busy professionals who need flexible access to their physician. Membership care is particularly attractive to employers facing annual double digit health care cost increases. Employers using this model have consistently shown significant reduction in inappropriate utilization, dramatic improvements in satisfaction, and cost savings of up to 50% when bundled with lower premium insurance plans. Crossover Health is currently accepting new members throughout the Orange County area.



Filed under Change Agents, Crossover, Design, Direct Practice, Entrepreneurship, Innovation, Launch, Medical Home, Membership, Primary Care, Quality, Value

Day 48: Data Gathering transitions to Information Analysis

Transition (trăn-zĭsh’ən) n.

  1. Passage from one form, state, style, or place to another.
  2. A word, phrase, sentence, or series of sentences connecting one part of a discourse to another.

In the midst of running Medsphere I became aware that we were onto something very powerful. Somewhere along the line I finally “got it” that what we were actually doing was not implementing electronic health records but rather creating the data collection backbone that would enable future clinicians, researchers, and other interested parties to have access to large volumes of data that they could then turn into useful information and ultimately knowledge about health care delivery. This realization helped me move beyond the mere “features and functions” comparative sales pitch to a much more egalitarian view of how most any standardized information system could most likely serve as an effective tool to gather the data and transform it into clinical relevant and useful information. Since we could offer the tool at a fraction of the price of the other guys, it made perfect sense to me why the customer should select us!

The Veterans Health Administration clearly has led the way in this regard with their implementation (begun in 1996!) and utilization of an enterprise wide electronic health record to radically alter their outcomes. I was fortunate to help  transition this technology to the private sector with OpenVista implementation at Midland Memorial Hospital (and have followed with interest their successes with interest).  Kaiser Permanente also endeavored to initiate one of the largest ever civilian deployments of an EHR to the tune of ~$5Billion dollars across their 35  hospitals. This massive investment has paid off in spades, and we are now just far enough along that we are going to start seeing some of the incredible results enabled by a system wide electronic health record (regardless of variety).

Case in point: An embargoed article was just sent to me by my friends at Kaiser who are just publishing a new article in the Clinical Orthopedics and Related Research journal of the Association of Bone and Joint Surgeons. The paper demonstrates how an EHR-enabled, large-scale total joint replacement registry has enhanced patient safety, quality of care, cost-effectiveness and research, and how a national registry could improve clinical practice and reduce revision rates in the U.S.

Key points from the article include:

  • More than 600,000 total joint replacement procedures are performed each year in the U.S., and the volume and costs associated with these procedures are projected to increase dramatically over the next 20 years
  • Kaiser Permanente’s Total Joint Replacement Registry– the nation’s largest such registry with 100,000+ hip and knee replacement cases – allows caregivers to analyze specific data from standardized forms and Kaiser Permanente HealthConnect (Epic software), the world’s largest private sector electronic health record, to help identify best practices, evaluate risk factors for revision surgeries, assess the clinical effectiveness of implants, and study patient demographics, implant characteristics and surgical techniques related to post-operative infections, revisions and re-operations.
  • Data from the registry has been integrated into a risk calculator that surgeons and patients use to make decisions about treatment. Research from the registry on implants and surgical techniques has influenced changes in clinical practice and optimized both techniques and implants.

The article features some of the authors, surgeons, and even a patient case study of how the registry was used to make an informed clinical decision (my friends at Dartmouth would be proud!).  We are clearly just at the front of this curve wherein we actually start getting into outcomes, accountability, and real shared medical decision making with legit data on the various treatment options. It is going to be an exciting journey to be a part of this data to information transition.

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Filed under EHR, Innovation, Quality, Rational Choice, Transparency, VistA

Healthcare Pioneer: EHR Vendors start their outreach

Pioneer (ə-nîr’) adj.

  1. Of, relating to, or characteristic of early settlers
  2. Leading the way; trailblazing

When I worked shifts in the ER, I was trained and learned to be weary of people who were overly complimentary or attempted to become too familiar. It is a personality defect seen in those with borderline personality and often in drug seeking behavior. The appeal to the ego can provide a tug into the deep waters, but that natural hesitancy and wariness kept me in the safe shallows more than once. The often innovative ways these people appeal to the ego is almost as interesting as the sudden shift into the vicious when you don’t give them what they want.

So it is with that familiar wariness in which I review alot of incoming email I have been receiving as of late. The traditional EHR vendors are getting more and more innovative with their marketing approach. Take note of the interesting email from a company that I actually respect for a solid product – Greenway Technologies (see below). I evaluated them very thoroughly in late 2008 and noted that they have a very solid, traditional  system specifically tuned to the current quagmire in which physicians practice. They have a decent EMR, decent practice management, solid PHR, and an interesting twist on population management with their clinical research (glorified registry) functionality.

However, I couldn’t pull the trigger on them because they were tuned for the traditional. I didn’t see that they were leveraging the concept of the network, or their EHR as a platform, or that their UI technology was fluid or as modern as I wanted. I didn’t get a sense for the flexibility and freedom found in the notion of clinical groupware. And finally, I didn’t get the sense that they were going to take me to the next level. Please – don’t get me wrong,or  attempt to outKLAS me, or bang on their numbers which are impressive. They are a solid player who will do well – but it wasn’t for me or the network of primary care clinics that I am wanting to build.

Needless to say, I found their marketing approach to be quite pioneering:

Healthcare Pioneer,

You are probably wondering how you became designated as a Healthcare Pioneer by Greenway.  We define such an influencer as an organization or individual who is involved in leading the development of the Health IT community, implementing EHR’s at the point of care and optimizing the opportunity at hand presented to us by The American Recovery and Reinvestment Act of 2009/specifically the HITECH Act.  We polled our employee base and asked: “Who in your respective region/professional arena do you hold in high regards and value as it relates to our mutual $45+ Billion market place?” You were nominated for your leadership and dedication to creating the most efficient and effective healthcare transformation through Health IT.  As we grow our network of influential leaders, and jointly capitalize on the media driving our Health IT sector, we extend a gratuitous “Thank You” to you for being a part of our success.

In an effort to provide continued educational awareness, as well as provide mutually beneficial opportunities, we will begin disseminating periodic, customized Corporate Communications outlining current Industry news, industry achievements & milestones, Webinars, as well as pertinent Health IT Transformation and Healthcare Reform activity from Capitol Hill.

Did You Know?

  • 27,000 Healthcare Providers and Professionals call upon Greenway’s integrated EHR, Practice Management, Interoperability and Clinical Research solution everyday … denoted by the name PrimeSuite®.
  • 315 plus dedicated Greenway employees have driven over 30% annual revenue growth the past 3 years consecutively.
  • Over 19 Million Electronic Records are managed comprehensively and efficiently throughout 49 states (and the Nation’s Capitol) by highly satisfied Greenway customers.
  • Over 1,375 unique interfaces from 115 plus 3rd party vendor participants find themselves internally managed via Greenway’s PrimeExchange® interoperability engine producing hundreds of thousands of transactions monthly and creating a simplistic workflow for our thousands of customers.
  • Best in KLAS, our industry’s “Consumer Reports”, has ranked Greenway Best in KLAS three consecutive years in a row.  In 2008 Greenway was awarded Best in KLAS in 3 categories, including 2-5 Ambulatory EMR, 6-25 Ambulatory EMR and 2-5 Practice Management, making Greenway the only Ambulatory-focused organization to receive multiple Best in KLAS awards in 2008.
  • Greenway is a leading national speaker on how the current EHR “meaningful use” and Certification criteria are evolving. We have testified and/ or addressed Congress as well as both Presidential Administrations on twelve occasions regarding Health IT.

To Learn More:

Without question, there are some remarkable, opportunistic and exciting times before us and
Partnering with you will continue to be a Privilege. Thank you again for thinking Greenway!

Call today at 866.242.3805 or email us at


Filed under EHR, Entrepreneurship, Industry, Quality, Value

Microcapitation: Prometheus Catches Fire

Prometheus (prə-mē’thē-əs) n.

  1. A Titan who stole fire from Olympus and gave it to humankind, for which Zeus chained him to a rock and sent an eagle to eat his liver, which grew back daily.
  2. A personification of the unconquerable will opposing greater power, forever chained and suffering but confident of the ultimate triumph of his cause.

The second health financing innovation with relevance to the Healthcare XPRIZE was highlighted in the most recent New England Journal of Medicine article. The Prometheus Payment Model has been a longstanding project of Francoise De Brantes (of Bridges to Excellence fame) and folks like Doug Emery who have been beating the “episodes of care based” financing for years. I have had some great conversations with Francois and Doug over the years and I am pleased to see their ideas actually being implemented in some pilots sponsored by the Robert Woods Johnson Foundation.

Prometheus is a payment concept based on clearly defined episodes of care  wherein all the services provided can be bundled together in discrete “Care Packages” (not everything fits neatly into this construct as they note). These Care Packages are then assigned a global budget from which all care providers must deliver their services (technical term is Evidence Informed Case Rate). The Care Packages are further adjusted for patient severity as well as for Avoidable Patient Complications (APC). These are things like hospital acquired infections, exacerbation of chronic conditions, or other events that if optimally managed would not have occurred.  This payment model rewards providers for organizing along the entire episode of care. It clearly is a move away from independent, discrete payments for disconnected care to a new model of continuous view of all the events that make up the episode. The global budget for a clearly defineable event creates financial incentives toward high performance and quality outcomes.

I was the first to call this new payment model “Microcapitation“, and describe further in another post. The NEJM article is a good read, and highlights many of the talking points that I strongly believe in:

  • Rewards for value not volume
  • Rewards for quality not quantity
  • Rewards for the organization and coordination of care
  • Provides a financial integration mechanism for non-integrated providers to work together
  • Provides financial incentives to reward the above
  • Leaves plenty of room for innovation and improvements underneath the global budget.

I  hope to see the Prometheus model gain additional traction. A variation of this concept and much simpler to follow is the highly successful “Proven Care” model employed by Geisinger (see their excellent website describing the development process and the elements of their Angioplasty episode of care). I am encouraged to see these begin to flourish as part of the ongoing efforts of health care innovators.

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Filed under Health Finance, Healthcare, Innovation, Quality, Value

The Myth of Prevention and EHR’s?

Prevention (prĭ-vĕn ‘shən) n.

  1. Preventing or slowing the course of an illness or disease
  2. Intended or used to prevent or hinder; acting as an obstacle
  3. Carried out to deter expected aggression by hostile forces.

I was just referred this article which I found to be thoughtfully crafted. Abraham Verghese is a Professor and Senior Associate Chair for the Theory and Practice of Medicine at Stanford University. I found the article interesting, by somewhat anachronistic in terms of his perception of prevention and electronic medical records.

First, he raises an important point about the many overstatements as they relate to prevention. When we talk about how effective screening programs could be in identifying people for early interventions we have to realize what we are saying and what tools we are using for identification. Some tools can be too blunt, and not find the people we are looking for (false negatives), while other tools can be too sensitive and capture too many who actually may not have the disease (false positives). This is brought home in the example Dr. Verghese uses around the pitfalls of new diagnostic imaging equipment (and the situation is much worse with genetic testing at this point in time!). With these newer, more sensitive imaging studies you can pick up calcium deposits in a health individual can lead you down a pretty wild (and expensive) goose chase for someone who is completely asymptomatic. He also demonstrates that the “value” of some prevention recommendations as somewhat questionable  – meaning – that while taking cholesterol lowering drugs has clearly shown to be efficacy reducing cholesterol levels and cardiac risk, is it really worth $150K/additional life year extended?

Well, that depends on if it is your life I assume. My point being, that you need additional information to be able to make these difficult, complex decisions. You need to not only know the relative efficacy of the regimen, but also the cost of the regimen to truly get at the “value” of the intervention. In addition, patients have modifiers to which they will place on the intervention in terms of cost in time, pain, and other inconveniences that are unique to their own values. This is where shared medical decision making can have such an impact – lay out the good, the bad, and the ugly and allow the patient to make a decision based on all the available evidence according to their own value system.

I don’t think these types of decisions can be made with the type of information we have today within the current clinical infrastructure. First, the physician gets paid to order the test and not talk to you about whether or not pros and cons of whether you should get it. Furthermore, the doctor has very little to no data upon which to inform that conversations anyway. In the relatively rare areas in which we have evidence, we might not have other components required for decision making in terms of cost and experience of patients undergoing regimen. In the case of prevention items mentioned above, we might choose not to go on statins at $150K per year but instead invest $10,000 in a personal trainer who is going to get rid of the root problem anyway. Without the underlying information, this would never even surface as part of the decision making process. We absolutely must be gathering, comparing, and sharing result outcomes in order to increase our capacity as healers who use the right treatments for the right patients at the right time and in the right way.

Which leads me to my final point – you absolutely need EMR’s to function as an 21st century physician knowledge worker. We are purveyros, translators, and mediators of medical information for our patients. They can get most of it on their own now, but we can still add significant value through our interpretation, personal experience, and ability to process the myriad data points with our clinical acumen (the sum total of our diagnostic prowess which comes from experience, practice, expertise, and intuition). The EMR can be a very effective tool to help us gather, process, and present this information in a way that is meaningful and useful to our patients (actually most EHR’s don’t do this natively today, but with little effort a physician can lift the required information and present it in a format that is highly useful [alling all designers – get into health care!]). Furthermore, I truly dislike the characterization that the EHR makes the relationship cold and sterile.  I believe the current  generation of physicians, who have all grown up with the internet, see the EHR as an indispensible tool that helps them be more effective, efficient, and caring for their patients.

My sense is that I am more optimistic that we will get there with prevention, and that EHR’s will play a vital role to give us the clinical feedback to know whether our treatments (or prevention) efforts are having the impact that we hoped. Furthermore, I am hopeful, that efforts like the X PRIZE and others will help drive us to associate those outcomes with the total costs required to help us acheive the results so we can begin to understand the true value of the intervention. It is in this setting of data liquidity and information transparency, that they myth dissipates into a new reality of next generation medicine.

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Filed under EHR, Healthcare, Prevention, Quality, Transparency

Transcript to Transformation: Twitterview with @Berci

Twitterview (twĭt’ər vyū) n.

  1. A twitterview is a combination of the terms Twitter and interview.
  2. The Twitter medium of 140 characters forces a concise style of interviewing and response.
  3. The public can join in on the conversation and become participants themselves by following along or tracking hashtags.

On March 26, 2009 the leading health care bloggers (see list below) throughout the blogosphere participate din a Blog Rally to raise awareness for public participation in the Healthcare X PRIZE design. Bertlan Mesko, leading Medicine 2.0 Advocate and author of the popular Science Roll blog, also conducted a “Twitterview” in support of the effort.

Berci: Can we start the twitterview now? I’d have 10 short questions, you may have 10 short answers. So everyone can enjoy it.

HealthXPRIZE: Thanks for taking the time. We appreciate your help in getting the word out. This Twitterview will complement the Blog Rally. Ready!

Berci: Great! First, what is the X PRIZE Foundation? What is the X PRIZE model?

HealthXPRIZE: The X PRIZE Foundation is a non profit organization that conceives and operates large incentivized prizes that lead to revolutionary breakthroughs. The X PRIZE model is based on leveraging a large purse, with a clear set of rules, that allows innovators to break through barriers.

Berci: Please tell us more about Healthcare X PRIZE!

HealthXPRIZE: The Healthcare X PRIZE is intended to be a competition to redefine health and demonstrate how new models of care can dramatically increase health value. We chose to focus on health value as opposed to a new wonder drug or device as our sponsor (WellPoint and WellPoint Foundation) & advisors were most interested in a systems prize. Systems prizes are much more difficult to conceive and operationalize than technical competitions like going to space or even replicating the genome rapidly. We are expecting that teams will need to innovate around health finance, care delivery, and individual incentives to increase health value. We are currently developing a clear set of rules, which provide the parameters of competition, as we believe that “creativity loves constraints”.

Berci: Reforming the US healthcare system is quite a brave mission, isn’t it? Why the focus on health value?

HealthXPRIZE: The US Health reform gets serious this summer and the HXP is well timed to actually demonstrate and prove in practice the principles of reform. Value is powerful organizing principle for reform efforts – we cannot just reduce costs, nor can we just attempt to improve quality without financial accountability. The focus on health value highlights the need to focus on both sides of the equation. Since Value =outcomes/cost, we are challenging teams to improve both simultaneously.

Berci: Why use an incentivized competition?

HealthXPRIZE: Incentivized competitions are very efficient, highly leveraged, and create an “X” factor within the competitive framework. Sponsors only pay the winner, a $10MM purse typical spurs >$100MM of investment, and the X factor creates global media attention to a key problem, inspire hero’s, encourage non-traditional thinking, and creates a powerful incentive for innovation.

Berci: And how can you properly measure health value? I guess you need pre-defined parameters. What are these?

HealthXPRIZE: Health Value has never really been measured within the US Health Care system. There are many efforts underway right now to properly define and measure health value. Many innovators are leading the way and we are attempt to build on their work or actively collaborate with new/ongoing initiatives (Dartmouth, IHI, AHRQ, etc) to solidify the health value measurement framework. In the context of competition, we are trying to make our measurement framework as concrete as possible by focusing on outcomes (mortality, specific morbidity, ED visits, hospitalizations, sick days etc.). Effectively communicating the notion of “health value” remains a challenge; we are considering focusing on aspects of health value (like decreased hospitalizations and sick days) as a more effective way to communicate to the public the hoped for prize breakthroughs.

Berci: How are the Teams and Test Communities Selected?

HealthXPRIZE: Teams will be selected by through a series of concept design and testing evaluations. They will be required to demonstrate or model the impact of their proposed interventions against test database provided by WellPoint. Independent judges will evaluate the merit/validity of the concept in order to advance. Communities will be selected based on specific criteria that are still being worked through. Intent is to have a defined population of 10K participants from which Teams will voluntarily enroll in the intervention. Test community will be matched against a geographically adjacent control group. Both the team and community selection requires further design, detailed analysis, and expert opinion which we are soliciting at this time through our network of national measurement experts.

Berci: When does this competition start and when will it end?

HealthXPRIZE: The “competition” has several phases: Design, Selection, Competition. We are currently in Design phase through our anticipated Launch later this fall. The Design phase includes soliciting public comment on how we can improve our initial concept/construct to create the most viable competition possible. After official “Launch”, we will begin recruiting teams to compete. Teams will then be narrowed as described above through late Spring 2011 when 5 finalist selected. After a brief integration period into test community, HXP competition is planned to officially begin in January 2012.

Berci: How does this shift the paradigm? What kind of outcome do you expect?

HealthXPRIZE: Great question – we believe the current paradigm is based on volume not value, on process not results, and incents the wrong behaviors while delivering bad outcomes. We want to shift the paradigm to rewarding the reduction of hospitalization / sick days and begin to pay for overall health improvement (this is the outcome we want!). We also want to not focus solely on disease care, and aren’t interested in just improving health care; but believe that we must move to an entirely new notion of engaged, activated health called “Vitality”. We want to demonstrate that this CAN be done at scale, with new entrants / new ideas, and want to set the HXP up as a framework from which these efforts can be tackled in the real world. By focusing on outcomes, instead of regimenting care processes or dictating care delivery, let providers/patients innovate and create rewards for those who obtain the best outcomes.

We believe incentivized competitions are a great vehicle from which we can accelerate change, shift the paradigm, and be a catalyst for the transformation that is required for the US healthcare system. We hope the outcome is a new way to think about health, measure health value, and demonstration of new models of care that demonstrate how to improve community health and individual vitality.

Berci: My last question, regarding X-PRIZE – first rockets, then genomics, now healthcare. What do you think? What’s next?

HealthXPRIZE: XPRIZE is a mission driven organization seeking to inspire the very best in human kind for the benefit of all – this isn’t just a nice quote. It is inherent in the DNA of the organization. We are attempting to be the catalyst in any “stuck” industry by creating incentivized competitions that can lead to radical breakthroughs to the grand challenges of humanity. HXP is now looking at education, energy (some really cool stuff), and developing world initiatives that can truly have major impacts. Fortunately for me, HXP is our focus for launch this year. It is quite challenging work, deals with multiple hard to think through issues, but includes the privilege to work with great people and teams including our sponsor WellPoint.

I have been thrilled with the level of commitment to this process and this prize development process has been tremendous experience. They have a very talented innovation team, led by Chad Pomeroy, who is fully supported by senior executives all the way up to Chief Executive Officer Angela Braly. They have been driving this initiative forward far beyond the $10MM prize purse; they are providing operational resources, sharing data, working to create appropriate test communities, altering business practices to accommodate the prize, and are committed to transparency as part of the HXP process. Their commitment to the project is the reason I became involved as I saw an unprecedented opportunity to really implement the innovation in an idealized but competitive test environment. We appreciate WellPoints leadership, foresight,and commitment to engage X PRIZE in developing the Healthcare X Prize for benefit of all. Very cool stuff.

Berci: Thank you very much for the interesting answers! I will publish the transcript on in a few minutes.

HealthXPRIZE: Berci, again, thank you for this twitterivew. We hope to have everyone visit our website, download the initial prize design, comment on our blog, and add their input to the Prize Design process.


Filed under Health Finance, Healthcare, Industry, Innovation, Leadership, Quality, Rational Choice, Transparency, Uncategorized

Cathedral and the Bazaar in Healthcare

Bazaar (bə-zär’) n.

  1. A market consisting of a street lined with shops and stalls, especially one in the Middle East.
  2. A shop or a part of a store in which miscellaneous articles are sold.

Eric Raymond is a famous open source advocate who published a seminal book on the fundamental philosophic basis for the movement. He used the analogy of the Cathedral as contrasted to the Bazaar as the metaphor to compare very top down, overly ornate approaches to software development versus the much more chaotic, decentralized, but ever more vibrant approach of open source.

The Cathedral and The Bazaar

The Cathedral and The Bazaar

Having lived that world for several years, I understand the powerful metaphor, and appreciate its appeal to my natural revolutionary streak.

I see the same thing evolving in healthcare – we are beginning to see the big, monolithic systems like Kaiser, Intermountain, Geisinger, Group Health, and even the VA begin to demonstrate impressive outcomes in terms of cost, quality, IT, and patient experience. This might lead one to think that this is the best way to go and we should all begin to worship within the whited walls of a an integrated, fixed fee provider group (“The Cathedral”).

But while the Cathedral has its place and has its appeal, there is much to be found within the ever more vibrant, chaotic, and pleuripotent Bazaar. In fact, I believe that the bottoms up Bazaar holds far more promise to bring me products and services to meet my personalized needs than could be provided by the Cathedral model. Unfortunately, the very nature of the Bazaar makes it difficult to harness, coordinate, and distribute those services in a scalable way.

My contention, however, is that the tools and technology are arriving that will allow the Bazaar to compete head on with the Cathedral. In my “Bazedral” model, there is a layer of software and services that serves as the virtualization layer to abstract out the current challenges of coordination, mixability, and modularity. This integration layer would enable providers to come together in ways to deliver  analogous if not superior results (given the enhanced competitive nature of trying to be one of the “care modules” that gets plugged into the overall solution). Thus all the component parts of a right hip repair (pre-op workup, surgeon, anesthesia, recovery, rehab, etc) could be put out to bid but brought together in delivery by the virtual integrator to provide a seamless, integrated service experience This could be huge.

Bottom line for me . . . Cathedral Care is superior (for now). However, I believe there are “virtual integration” companies coming that will allow the Bazaar Care model to self organize in ways that will not only challenge but beat the outcomes results we have seen to date from the Cathedral. This would actually be good for the overall health care system, would challenge Cathedral players to continue to improve and adapt, and ensure competitive market alternatives.

Let us pray for the hastening of this day – Amen!


Filed under Conferences, Quality, Uncategorized, Value