Before talking about the medical field, let's talk about Bitcoin, which has been hotly discussed recently. Although there are countless predictions and comments about Bitcoin, I think that this kind of cryptocurrency allows us to have a clearer understanding of the future of the medical industry: Bitcoin and similar cryptocurrencies are self-organizing systems that are completely in the tradition of financial transactions. Operate outside the system and rules.
The same is true for the Internet. On New Year’s Day in 1983, the pioneering developers of ARPANET adopted a set of communication protocols called TCP/IP, allowing computer scientists, academic researchers and others to build a self-organizing system for sending News and data. In fact, this is another ecosystem built from scratch, and it has its own set of governance rules and practices.
So can the medical industry break the traditional rules that have been in use for decades and rebuild a new, self-sufficient and efficient operating ecosystem that puts consumers first? The answer is yes. Up to now, a business model based on this ideal new ecosystem has emerged and is gradually improving.
Regarding the mode of operation of this new ecosystem, we can learn from Kaiser Permanente. Kaiser Permanente Medical Group has integrated insurance and healthcare services for nearly 12 million policyholders. Kaiser Permanente operates with a traditional network of hospitals and clinics across multiple states, and 23,000 non-employee doctors provide medical care entirely through Kaiser's own health plan. But in this medical ecosystem, the old rules of insurance, co-payment of medical expenses, appointments and outpatient clinics are changing rapidly, because patients now often use e-mail and video chat for health consultations.
CVS recently spent nearly $71 billion to acquire Aetna, which is another step towards self-aggregation, integrating retail pharmacies, pharmaceutical benefit management agencies (PBM) and insurance companies. It is expected that in the next year or two, this medical group will acquire one or more doctor organizations, and may also supplement CVS's in-store "micro clinics" with an independent network of community emergency treatment centers that do not require appointments. UnitedHealth Group has embarked on the same path. Last month, it announced the acquisition of DaVita Medical Group for nearly US$5 billion. This marriage will allow UnitedHealth to own about 300 clinics across the country, consolidating its current service network of 30,000 doctors. (Both transactions are subject to regulatory approval.)
However, what will continue to promote self-aggregation in the future is not the same factor that promoted integration in the past-that is, saving costs through "new efficiencies." The goal is also to create a sufficiently strong and independent ecosystem and to write its own set of rules. If those rules ultimately benefit patients and provide more value at a lower cost, the system will flourish. Otherwise, these new multi-billion dollar systems will fall apart.
Many hospitals are already struggling. Bryan Roberts, who has always been a sharp point of view, once said that hospitals are “actually a huge capital asset, constantly churning people into it.” From floor to ceiling, these often complex institutions are full of fixed costs: expensive beds, CT scanners, Magnetic resonance imaging (MRI) and other large equipment, nursing staff and laboratories, etc. Roberts said that although such capital assets have been a strategic advantage for hospitals for decades, "because of the liquidity of data, analytical tools and software, we are entering a period when all these capital assets are now actually restricting development. Obviously, these Capital assets consume a lot of costs, reduce profits, and at the same time may severely restrict business models."
In order to keep the inefficient 12-cylinder engine running, hospitals have to spend a lot of financial resources: in 2016, the US expenditure was as high as 1.1 trillion US dollars, which is more than double the expenditure in 2000 and four times the expenditure in 1990. Today in the United States, 32 cents of every dollar of health care costs are spent on hospital care. However, in an era where companies, insurance companies, and governments are increasingly reluctant to bear this cost, and patients themselves are incurring a higher proportion of the cost, this model no longer works.
As mentioned above, Kaiser Permanente is looking for ways to attract patients outside the hospital network. Caesars CEO Bernard Tyson told me not long ago: "They built the hospital, and built various facilities inside and outside the hospital, and then patients came to the hospital and got the medical care they needed. We said,'No, you don't have to do this. How much An entry point, a hospital or clinic is just another entry point."
However, in the upcoming medical ecosystem, a large number of new entry points may bring medical care services that are completely aside from traditional medical centers. Small professional surgical institutions and high-end outpatient clinics have diverted patients from the original downtown medical center. This trend is expected to intensify. At the same time, high-quality home care solutions will also prevent patients from having to go to the hospital at the beginning. High-quality home care solutions depend to a large extent on digital medical innovation, telemedicine, and a new payment system. Or even if the hospital insists on admitting patients in, it can let the patients go home early.
In my opinion, only a medical system that embraces these changes will survive, otherwise there will be a dead end.