Wednesday, November 23, 2011

Wal-Marting of Health Care in America Continued

In 2009 I wrote a paper titled “The Wal-Mart”ing of Health Care in America”. The premise of the paper was that consumer driven healthcare was paving the way for clinics in places like Wal-Mart. Over the past several years mini-clinics have been popping up in grocery stores and strip malls across the country. In March of that year, an article announced that “Wal-Mart will partner with its Sams Club division with Dell and eClinicalWorks to begin offering low-cost electronic health record systems to physicians”. Well Wal-Mart did not go forward with the EMR, but instead is going straight to the mini med clinic with the headline: “Wal-Mart wants to be your MD: Retailer seeks to use medical services to lure shoppers, boost traffic."

In that 2009 paper I observed that “America has been facing a crisis in a shortage of primary care physicians. For the past few decades the number of graduating medical students going into family and general practice has been steadily declining. According to a study published by the American Osteopathic Association, in 1984 56.4% of all graduating D.O.’s chose family practice. That number has dropped to 42.6% while general internal medicine has significantly jumped from 4.7% to 9.5%. It seems that Wal-Mart “now wants to dominate a growing part of the health care market, offering a range of medical services from basic prevention to management of chronic conditions like diabetes and heart disease, according to a document obtained by NPR and Kaiser Health News.” First, general practice is not a growing part of health care, thus there is no domination. Wal-Mart “intends to build a national, integrated, low-cost primary care healthcare platform.” Isn’t this what Obamacare is all about? So what's wrong with Wal-Mart doing it sooner and cheaper?

In my opinion, Wal-Mart will succeed because Medicine is a business. Back in 2009, I wrote that “physicians, like all technicians, understand the art of medicine, that is their training, and they are effective in their art. However, medical schools do not teach physicians how to relate to the enterprise of medicine or to the business of medicine.” Wal-Mart will succeed because they appreciate the patient and they can offer low prices; prices lower, in fact, than the standard family practice physician. Physicians become their own worst enemies by constantly micro managing their practices and their staff; as a result, they will be unable to compete with Wal-Mart.

"Maybe Walmart can deliver a lot of this stuff more cheaply because it is an expert at doing this with other types of widgets, but health care is not a widget and managing individual human beings is not nearly as simple as selling commercial products to consumers," says Ann O'Malley, a physician and senior health researcher at the Center for Studying Health System Change, a nonpartisan Washington think tank.” Unfortunately, this is incorrect: in a recent post, I noted that medicine has already moved to a standardized format and consumers want simple medicine.

Health care leaders will need to deal with many issues if they want to maintain supremacy (or at least market share) in Health Care in America over Wal-Mart. There are many barriers standing in their way to achieve the change necessary to stay viable. One is the culture of the current state of how medicine is managed here. If physicians are making the decisions without input from the administrative people and medical ancillary personnel working in the health care field, then there is a 50-80 percent chance of failure. Norma Hagenow, President of CEO Genesys Health System Source stated that “Culture eats strategy every day of the week. Culture is people. You can set up the best strategies in the world, but if you do not have the hearts and souls of the people behind that enterprise, it’s nothing.”

Back in 2009, these were my concluding thoughts: “The Health Care perfect storm has been brewing for several decades, since the failures of HMO’s in the 1970’s, Phil Donahue lambasting against health care in the 1980’s, the Clinton initiative in the 1990’s and now Wal-Mart has entered the picture. At each time of conflict the physicians clung to their culture and refused to work towards change. As a result, change will come to them in the form of Wal-Mart clinics, consumer driven healthcare and electronic records. Based on all evidence, physicians will not address the changes and as all failed organizational structures, the current physician driven medical system will fade into oblivion.”

It seems the future is now.
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