The Hippocratic oath says, “First, do no harm.” The early 21st century push to make health care more convenient seems to add, “and make it snappy!”
Retail clinics are perhaps the most prominent and market-proven aspect of this change. There are about 2,100 retail clinics in the country. CVS executives have said they hope to have 1,500 of their MinuteClinics up and running next year. Research by Ateev Mehrotra, MD, an assistant professor at Harvard Medical School and a member of our Managed Care editorial advisory board, has found that in some respects, the quality of care at retail clinics is slightly better, not worse, than the care delivered in the offices of the country’s primary care physicians. Word of mouth is statistically dubious but impossible to ignore, and here at Managed Care the word of mouth about retail clinics from coworkers and spouses has been a solid thumbs up.
Surging telemedicine is more evidence of the growing importance of the convenience factor in health care. As Thomas Morrow, MD, reports, more than 4,000 people attended the annual meeting of the American Telemedicine Association in Minneapolis last month. Vendors are in a mad scramble for position in a market of uncertain size. Telemedicine is gaining ground as a more efficient way to deliver care within the conventional health care system; the routine post-op appointment seems like an ideal application. But we’re in a frothy period. The where, when, how, and by whom of telemedicine—they’re all up for grabs.
The same might be said about thousands of health care apps. The plain fact of the matter is that many apps go unused—a little like all those exercise bikes that only get used on the road of good intentions. The health care app is nothing but convenient—all that information and functionality right there on your phone at your fingertips. But the fact that many only gather digital dust shows that convenience only goes so far. You can lead people to apps. But what can you do to make folks actually use them?
Meanwhile, CMS and other payers are experimenting with the old-fashioned house call for people with multiple health problems. Are these throwback efforts a matter of convenience? That characterization is rejected by some providers. But if you relieve convenience of its negative connotation and see it as a way to knock over the hurdles of access and lack of mobility, then the house call falls squarely into this larger trend.
Convenience has limitations, and the boundaries between it and health care delivered in a more conventional way are in flux. Primary care physicians are pushing back on the possibility of retail clinics moving further into their turf by taking on the care of people with chronic care. Mehrotra’s research has identified some worrisome quality problems with some applications of telemedicine. Payers are still puzzling through how to compensate providers for care guided by convenience.
So there is plenty of uncertainty. Except maybe this: Americans’ tolerance for waiting is disappearing fast, and the technology that enables digital encounters is getting better all the time. How long will it be before doctors and patients will meet via Oculus or through some other 3-D technology? We may soon be looking back and wondering how people ever tolerated so much inconvenience in their health care, in the same way that’s hard to imagine now how we ever got by without the car, the personal computer, and the cell phone.