Conveniencecare trumps value care

We've heard a lot about value based care. The idea is that payers and patients will choose the highest quality at the lowest price if and when choices are made transparent and there are incentives to buy and use the best. But, sometimes, good enough is good enough.

The problem is defining quality, the numerator of the value equation, and the fact that there is a big gap between what doctors think about quality and what patients think about quality.

Except, that is, unless it is too inconvenient to do it. The market is re-evaluating value.

Plus, it is not just about convenience. I mean what good is being able to make an appointment online if the next cardiologist you can see will be in six to eight weeks when your heart is fluttering in your chest?

The traditional model of primary care practices as the main provider of care for acute illnesses is rapidly changing. Over the past two decades the growth in emergency department (ED) visits has spurred efforts to reduce “inappropriate” ED use. We examined a nationally representative sample of office and ED visits in the period 2002–15. We found a 12 percent increase in ED use (from 385 to 430 visits per 1,000 population), which was dwarfed by a decrease of nearly one-third in the rate of acute care visits to primary care practices (from 938 to 637 visits per 1,000 population). The decrease in primary care acute visits was also present among two vulnerable populations: Medicaid beneficiaries and adults ages sixty-five and older, either in Medicare or privately insured. As acute care delivery shifts away from primary care practices, there is a growing need for integration and coordination across an increasingly diverse spectrum of venues where patients seek care for acute illnesses.

Convenience is the value factor du jour. Americans love convenience whether it is where and when they buy groceries (Amazon buying Whole Food), their gas (pay more at the pump? No problem) or , it seems, their sick care services, particularly is they have to travel less to get it. Retailers have long known that offering "free shipping" is the discount shoppers prefer to all others, and thanks to Amazon Prime, getting everything fast and free has become an American consumer expectation.

Sickcare should learn that lesson from the retail apocalypse.

The emphasis patients and self insured payers place on convenience, though, is not universal and depends on whether they are seeking commoditycare (perceived low risk, low complexity intervention like a screening colonoscopy), intermediate complexity (most cases), or highly complex care (something that due to comorbid conditions has a high risk or requires extensive surgical experience. like complex cancer operations, revisions or unusual or rare conditions). In the first, value is a matter of getting "good enough" as everyone else for less money as long as it's convenient. In the case of highly complex care, patients with the resources are willing to travel long distances no matter what it costs.

The fact is that most patients and their families don't want to have to travel too far from home to get care and there has to be a very compelling economic or emotional reason to to it. Consequently, provider networks are working hard to bring the mountain to Mohammed.

At some point, the value value proposition will clash with the convenience one and most likely, good enough with convenience will supercede the "highest" quality that is inconvient to access. At that point, Commoditycare will the model.

There is a fundamental disconnect between what patients want and what doctors and policy wonks this is best for them. Patients take non-clinical factors of care like compassion, comfort, personality and bedside manner into account when choosing a physician, according to a report by Healthgrades and the Medical Group Management Association (MGMA). In brief, patients don't value value.

Cheaper, better, smarter, smaller have some appeal. But faster and easier will eat them for lunch. It's more convenient.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Twitter@ArlenMD and Co-editor of Digital Health Entrepreneurship