Consumer Driven Health Care: Challenges for Imaging Leaders

Health care has become a serious problem. Health care costs are threatening the competitiveness of U.S. firms, and uneven health care quality is threatening the welfare of U.S. citizens. Last decade’s solution, managed care, is clearly a bust. What to do? Consumer-driven health care (CDHC) is the new solution, one that responds to consumers’ desire for choice with highly-differentiated health plans, control of expenditures, and helpful information. It will be implemented in the next presidential administration through tax reform that enables individuals, and not only corporations, to use tax-protected funds to buy health insurance and care. Advocates hope that CDHC will create a cheaper, better health care system. How will it accomplish these changes and what do they mean for imaging leaders? The consumers newly in charge of the health care system will profoundly change both demand, and supply .Demand will change thorough new insurance policies tailored to consumers’ needs, such as policies sold for a three year or longer period, so that providers can reverse destructive life-cycle habits and better support chronic diseases or disabilities. Consumer-driven insurance innovations will also cause a massive restructuring of the supply of health care. Providers will create three new consumer-sensitive innovations: focused factories that integrate fragmented providers around patients’ needs for care; integrated information records that contain the patient’s entire medical history; and personalized medical technologies. Consumer-driven insurers will bundle these innovations. For example, victims of genetically-linked diseases, such as diabetes, may be offered multi-year policies that feature focused factories and personalized medical technologies, supported by integrated information records. Some insurers may even include the low-cost foreign providers who are now targeting the U.S. market. Focused Factories Focused factories for victims of chronic diseases and disabilities, such as back pain, and the needs of other undertreated populations, such as African-Americans, Native Americans, and women, are modest in scale and designed organically by providers. They resemble mass-customization factories that achieve higher-quality, lower-cost results by inverting conventional notions of manufacturing excellence. Old-economy manufacturers reduced costs by producing huge volumes of goods in cavernous factories, whose workers created small components of the end product. New mass customization factories, in contrast, tailor products to specific customers in flexible factories so small that workers can see the whole. One factory increased quality by 55%, while reducing work space and capacity by 50% or more. Like mass-customization factories, health care focused factories implement an integrated view of the patient. Yet their scale is not so modest as to make their services infeasible and/or inaccessible. For example, the expenditures on diabetes in an average state enable the construction of a number of 300-bed hospitals and hundreds of community facilities. A consumer-driven health care system will naturally inspire focused factories. For example, if diabetics could choose among differentiated health insurance products, they would likely opt out of everything-for-everybody systems into focused factories that offers integrated, demonstrably excellent diabetic care, at a lower cost. Imaging leaders can be central to all of these innovations. They can play an integral, critically important role as part of focused factories; in the provision of personalized diagnoses; and in enabling personalized medical records. CDHC leaders will understand that they are part of a team in all of these activities—one that is focused clearly on the customer, the patient. Imaging followers will cling to the old model: lobbying for Medicare reimbursement and conducting turf warfare with other medical specialties. Which role will you play?