Page 32 - Layout 1

BUSINESS

continued from page 31

health” produces a strong incen- tion, however, has promised to take a very different approach. As of
tive for mergers, consolidations this writing, their plans are unclear, but signs indicate a heavy em-
and other affiliation agreements phasis on a market-driven approach, through health savings accounts
that will tend to empower the in- and other mechanisms that put the power into the hands of the con-
cumbent and make entry more sumer to navigate the health care system. Thus, in this world, we are
difficult for outsiders. As this likely to see much more disruption in the industry. New entrants and
consolidation continues, we may new types of delivery models are likely to appear on the scene.
also see increased government
regulation around pricing and Given these trends, how should proactive physi-
other factors (8). As a result, we cians respond? Here are a few suggestions:
would expect this movement to • Expand your competencies.
discourage any disruptive inno-
vation, and instead will at best Physician training has historically focused on the clinical side of
lead to efficiency or sustaining health care. While this is obviously still very important, it may not
innovation. be enough to simply focus on clinical care. There is a growing need
for physicians to develop business skills and knowledge, as well as a
On the other hand, there is
also an increasing move towards
consumerism. In 2015, just over
50 percent of those with em-
ployer provided insurance had a
deductible greater than $1,000
and many of these plans also in-
clude a health savings account
(9). These and other trends such
as narrow networks and private
exchanges are shifting the risk to
the consumer in an attempt to
give he or she the power and in-
centive to stay healthy and “shop” for health care services. This move-
ment is likely to be much more open to disruptive innovation. The
consumer (or employer on behalf of the employees) will be looking
for help to overcome the huge information problem he or she is faced
with in navigating the health care sector and understanding their
own health. If the consumer has the ability to choose how to allocate
his or her health care dollars, new entrants will be looked upon more
favorably and it will be much more difficult for the incumbent to
hold on to their territory.

Which of these two movements will dominate is yet to be seen,
and it is also unclear which, if either, will be the solution to our health
care woes. The past 8 years have pushed the industry very heavily
into the supply-side incentives with the Affordable Care Act and
other movements attempting to give hospitals and physicians incen-
tives to manage their patients more efficiently. The new administra-

32 San Antonio Medicine • April 2017