Tuesday, May 10, 2016

DIY Health to the Rescue

Experts often compare how slowly the health care system is "reforming" to how hard it is to turn a battleship.  They're so big that they can't turn on a dime (much less on $3 trillion!), and there is as much risk in trying to oversteer as in not turning at all.  Things are changing, we're assured, but it will take time to get on the desired new course.

Maybe.  But maybe it is time to jump off the obsolete battleship onto something more nimble.

Some call it Do-It-Yourself Health (there are both .org and .com sites devoted to the topic, among others).  PwC declared it to be one of the top ten trends of 2015.  Dave Chase believes that "DIY health reform is now leading the way for the highest performing reform" -- not Medicare, health insurers, not even employers.
Americans spent some $34b on "alternative and complimentary" medicine way back in 2009, even without firm proof that they work, so imagine what we might be willing to pay for "traditional" care that was more convenient, more self-directed, and faster.  

In case anyone still needs confirmation about how slowly our health care system is edging towards reform on its own, some cases-in-point:

  • A new study has updated the famous IOM 1999 estimate of 100,000 annual deaths due to avoidable medical errors, believing that the number is more like 250,000 -- making medical errors the third leading cause of death in the U.S.
  • The Senate Finance Committee has issued a report warning that physician with ownership interests in medical device distributors are -- what a surprise! -- much more likely to perform surgery using those devices, .  This is coming from a bunch of Republicans, mind you, so the problem must be bad.
  • The U.S. has spent some $35b to move providers to EHRs, but as Vice President Joe Biden just said, "we didn’t realize five [EHR] companies would create their own silos. What the heck are we doing?"
  • The move to value-based purchasing is supposed to help combat our perverse incentives, but early indicators are not so positive.  Two new studies looked at Medicare's Hospital VBP program, and found that (a) it ended up rewarding not just low spending but also low quality hospitals, and (b) it doesn't seem to actually have any positive impact on patient mortality.  
What the heck are we doing indeed.

I'm increasingly thinking that the solution will not be to reform the system, but to work from outside it.  I offer a few examples:

The Wall Street Journal wrote about one in Tech Savvy Families Use Home-Built Diabetes Device.  It profiles how, by WSJ's count, some 50 families have developed their own artificial pancreas device to help themselves or their children manage their diabetes.  Fifty families in a big country like the U.S. doesn't sound like many, but, hey, I'm amazed there are 50 families bold enough and capable enough to build such a device.  Put those specs on the Internet, and maybe an instructional YouTube video or two, and that number could easily skyrocket.  

It wasn't prescribed by their doctor, and it wasn't purchased from a medical device company, because such devices aren't yet on the market.  Several medical device companies are working on similar devices, and the FDA says approving them will be a priority, but nothing is through the regulatory process yet.  The FDA can't stop individual families from building their own, as long as they don't them sell or further distribute them.  

So, it is a device highly desired by the market, and the technology is simple enough that people can literally build them at home, yet it is not available within our health care system.  Something is wrong with that picture.  

Then there are hearing aids.  If you know anyone with a hearing aid, you're probably heard them complain about how expensive they were, on average about $5,000 for a pair.  The New York Times reports how those prices are under attack from the consumer electronics industry, which is selling products under the unwieldy name of "personal sound amplification products," or PSAPs.

To escape FDA regulation, PSAPs can't be marketed as hearing aids or even purport to be used for hearing loss (which would make it a medical condition), but canny consumers are looking at what PSAPs can do, weighing their much lower cost, and using them anyway.  The audiology profession warns about such self-diagnosis and the limits of PSAPs, but it's not like they're doing such a bang-up job already: it is estimated that less than a third of the people who could benefit from hearing aids actually use them.  

The competition seems to be working; The Street reports that hearing aid prices are starting to tumble.  
If only we had "competition" for other services from outside the traditional health care system.  Oh, wait, we do.  For example:
I'll bet medical device manufacturers, the FDA, and even some clinicians are eager to wrap these in under the cloak of our existing health care system, which would no doubt end up making them both more expensive and harder for us to obtain.  Let's hope they are not successful (although we still need to demand proof of efficacy).    

Some see a future where we sequence our own DNA to identify genetic risks, have implantable health monitors, do at-home diagnostic tests, even 3D print our own prescriptions.   Throw in peer-to-peer financing for big bills (more on that in a future post) and more providers selling their services DTC (like direct primary care or concierge medicine), well, I'm not sure we'll even need to be on the stodgy old battleship anymore.  

You have to believe that Walmart, Walgreens, and CVS are preparing for a DIY future.  Other health care providers are going to have to decide if they will do so as well -- or risk going down with the battleship.


  1. Kim, I think the battleship analogy is accurate, especially when the captains don't want to change course. Decreasing reliance on doctors and meds to fix lifestyle-based health problems by having a greater hand in our health is the answer; it's working for me!

  2. What you describe is classic Clayton Christensen--an industry ripe for disruption because it has expanded the technical features of its product until it is higher cost than the market really wants. Think about the 40,000 healthcare apps. What if a diabetes app for $0.99 could do a better job of engaging a patient to manage nutrition, exercise and medications? No FDA, CMS, insurance referral...just sneaks in, as you say "from outside"

  3. What if some of the 40,000 healthcare apps wrecked creative disruption on the industry. What if a diabetes app for $0.99 could do a better job than conventional medicine in managing nutrition, exercise and medication? No FDA, CMS or insurance referral.