It’s a political year – an election year to be precise. The candidates in both the Democratic and Republican primaries have had many ideas, platforms, and strategies about how to fix healthcare. Yet, when you really think about it, the current healthcare system, even though it is perceived as broken, is really just a giant system of cross-sells.
Most people aren’t trained to look for this, and you might actually be surprised that I am describing the healthcare “experience” like that. But think about it:
(Cross-sells are highlighted in bold)
- The moment you go into a doctor’s office, you present an insurance card. In all probability, the insurance referred you to the doctor, or the doctor was within the insurance network (i.e. HMO, PPO, other three letter acronyms…)
- If the doctor (often referred to in the profession as a “primary care physician”) can’t solve your problem, he may refer you to a specialist. The specialist may be within the insurance network, or it may simply be someone he knows well.
- Regardless of whether the PCP or the specialist (SPEC) fixes your problem, most likely they fix it by giving you a prescription, and in doing so recommending a drug or drugs (if you are lucky, you get several options), or alternate treatment avenues.
- Furthermore, if neither the PCP or the SPEC can figure out your problem, they may (here is that word again) refer you to a testing facility, X-Ray clinic, MRI center, laboratory, morgue, etc.. (the last one was a joke)
- And on and on.
Many companies, such as pharma companies, actually deploy reps to try to influence the doctor’s recommendation of which drug to prescribe. Other companies, such as those pesky insurance companies, often hire people like us to “optimize their network in order to maximize the number of in-network referrals.”
All of which leads to an interesting proposal: Isn’t there a better way of cross-selling services and products? One that ensures quality, customer satisfaction, efficacy (i.e. whether it works in getting you better), and customer service rather than focusing solely on costs, revenues, and ultimately, profits?
What about a cross-selling scheme that is accountable to several stakeholders (including the patients, their employers, doctors, and society/government) and not just the insurance firms?
And more important given that we are in an election year, how do the candidates proposals reflect on this system of cross-sells? Will they make it worse by adding seats at the table but not really changing it? Or are they in effect promising wholesale changes?
Stay tuned for my next blog entry (Part II), in which I describe how an ideal physician-level cross-selling system would work, one that would entail a high overhead cost in terms of setup and administration, but along the way would actually deliver lower costs and increased benefits to all the stakeholders involved. And in Part III, I will be taking a look at whether any of the candidates’ platforms will ever come close to emulating that model.
Posted by dagreatguru 
