With author permission, Harvard Business School Working Knowledge published an outstanding excerpt from the recently released book Innovator’s Prescription: A disruptive Solution for Health Care by Clayton Christensen, Jerome Grossman, and Jason Hwag.
Christensen, the famed Harvard Business School Professor is taking his concept and research on disruptive technology to the health care industry. He presents a compelling view of how health care can in fact become more affordable and accessible to most people-if the right disruptions and their enablers can occur and that is a huge if given the on-going challenges of dealing with a regulatory and fee for service reimbursement climate that has easily prevented the “disrupters”.
I firmly believe physical therapists in the musculoskeletal medicine arena and in particularly low back pain given its high cost driver certainly qualifies as “industry’s simplest problems first” as the article/book refers.
Per Christensen, disruptions have three enablers: simplifying technology, a business model innovation, and a disruptive value network. I will attempt to apply them and why I believe that PT can be a disrupter.
Enabler #1: The technological enabler transforms a technological problem from something that requires deep training, intuition, and iteration to resolve into a problem that can be addressed in a predictable, rules-based way.
PT as a technology enabler: Clinical prediction rules (CPR) are the simplifying technology enabler and low back pain is where we have the best research and most cost-effectiveness support.
Enabler #2: Business Model Innovation. Within health care it has stalled in the last three decades. Regulations and reimbursement systems currently trap in high-cost venues much care that could be provided in lower-cost, more convenient business models.
PT as a business model innovation: Directly accessing patients, examining, applying CPR’s in low back pain and managing patients through application of appropriate interventions. While not completely new it can easily be deployed and is a “predictably effective solution” to use Christensen’s language.
This blog has trumpeted the problems in regulations and recognizes how they limit innovation. The superimposed rules by CMS and the bondage that we have to a CPT code system which is out of step with modern PT practice (namely the fact that we examine and manage patients versus forced into codes that highlight individual modalities and procedures in a stop watch mentality). Absent those problems, the restrictions for direct access within CMS and many states further prevent us from being true disrupters. Christensen’s pleas are right on target “regulators must beware…of attempts by leading institutions to outlaw business model innovation….What is in the interest of society most often does not coincide with the self-perceived interests of leading institutions.”
Enabler #3: Disruptive value network. Stand-alone disruptions are not plugged into an existing value network of an industry but rather new value networks arise, disrupting the old.
PT in a new value network examples: Many employers are contracting PT’s for direct access and paying them directly rather than thru 3rd party carriers or worker’s comp administrators. Virginia Mason Medical Center and their success in utilizing PT’s to wean from pricey tests is classic example of changing the traditional fee for service reimbursement.
In order to work, a fundamental change must occur within insurance and reimbursement. As the excerpt points out it will take a much higher level of integration than has been the norm and carriers and policy will need to “disrupt themselves”. For this to occur, employers will have to orchestrate the “emergence of this new value network, compared to the reactive nature that they have taken in the past.”
If othesr also believe that we can be “disruptive innovators” the time to get to the table and trumpet our abilities to regulators, employers, and payors is now while everyone agrees that changes in health care are necessary. Opening the doors for PT’s to access many more patients with “aches and pains” by removing regulatory barriers which halt such innovation and working with new value networks in the insurance/reimbursement arena can undoubtedly give us our chance to demonstrate us as one simple solution to part of the many health care woes.
Thoughts?
larry@physicaltherapist.com
