It seems nearly everyone believes U.S. health care needs some transformative change to improve quality, expand access or lower costs. Many of the contemporary approaches toward that change involve making it easier for patients to see doctors, particularly primary care doctors. While that seems intuitive, we think it is the wrong path: If we continue to define health care as a service that happens when patients see doctors, we limit our possible productivity gains.
Writing in The New England Journal of Medicine, we argue that the doctor-patient relationship is health care’s choke point. There’s no technical reason why a variety of common medical conditions — high blood pressure, diabetes, high cholesterol — can’t be managed by a bot and overseen by a nurse with support from a physician only if needed. And as our experience and the supporting evidence increase, more conditions might be handled in similar ways, allowing physicians to direct more of their time to where they’re really needed.
Much is made of the comforting aspects of personal relationships between patient and clinician. But do we really need that soft touch to manage hypertension? Maybe sometimes, but certainly not always. So why is it heretical to suggest replacing some of health care with the facilitated self-service that has transformed the financial, retail and travel industries? We think the resistance reflects our social conventions rather than our technical limitations.
In order for the U.S. to embrace technology in health care as we described, we need to solve three technical problems:
First, the insurance industry — government and commercial — must get better at its job. They are ill-equipped to determine whether care was truly needed or appropriately delivered. It’s hard to explore new and potentially better models of care when only traditional approaches get reimbursed.
Second, state-based regulation of insurance and clinician licensure must be replaced by a system that recognizes that health care is not always best delivered locally. Facilitated self-service creates efficiencies across state lines. It’s likely that occasionally some of Wyoming’s 600,000 residents would benefit from care delivered by someone outside the 1,000 physicians practicing in that state — perhaps by a bot with second-line back up from a nurse or a physician elsewhere. State licensure of physicians and insurance regulations reflect federalist principles harder to justify in a connected world.
Third, we should require the same standards of safety and efficacy for automated approaches to health care that we have come to assume for pharmaceuticals. Whether that regulation comes from the Food and Drug Administration or elsewhere, it needs to be ramped up to address the volume of potential new approaches.
If there is a fourth problem, it is our sense of nostalgia. The health care changes we want, or at least the opportunities to try them, are held back by a combination of technical limitations and social conventions. But our social conventions present the greater obstacles. The lesson from other industries is that transformational change requires productivity change. And in health care that means we must find ways to move past approaches to facilitate care with doctors toward approaches that facilitate care without them.
Copyright 2019 Harvard Business School Publishing Corp. Distributed by The New York Times Syndicate.