April 29, 2014
'Component Medicine': The Medical Team Will See You Now
by Bob Wilson
Historically, medicine was driven by a central force -- the primary-care physician -- but dynamics are changing.
It was an unmistakable conclusion from the recent, eight-hour Medical Institute program that was part of the IAIABC 2014 Forum. Across multiple sessions ranging from opioid abuse to insurance reform; physician dispensing to medical marijuana, one thing was clear. Medicine in this country is headed for an abrupt change, and the way workers’ compensation manages medical care will need to change with it. In reality, we can provide support and focus to that effort.
One of the most interesting points for me was the potential decentralization of medical treatment that may soon be upon us. Historically, medicine has been driven by a central force — a primary-care provider who examines, refers and directs care for the patient. That doctor generally selected the lab, the specialists and the facilities to be used. Very few questioned these doctors, and many relied upon them for a labyrinth of health decisions. But now, economic forces and insurance reforms are dramatically changing that dynamic.
Please indulge me for a moment while we envision a different medical world, one that I call “Component Medicine,” where doctors with less individual time to commit meet more-empowered patients with new healthcare options available to them.
Everyone is aware that shrinking reimbursements and increased operational costs are forcing doctors to see more and more patients in the course of their day. At the same time, we see a rise in the utilization of physician assistants and nurse practitioners. This is reducing the singular importance of the primary-care physician and spreading the responsibility of care to other disciplines in a manner not seen previously in this country. Nurse practitioners (NP) will be on the front lines of this change as our medical models gradually shift to one of prevention and outcome-based efforts. Likewise, other traditional medical-related services are undergoing dramatic change. The traditional lab may be replaced by a clinic in your local pharmacy, where you can get your blood tests in a more convenient and less expensive location. NPs may also be at that location, or even in your workplace, where they will be able to diagnose and treat illnesses, as well as work with patients on established prevention regimens.
In Component Medicine, care will be closer to home and proactive in nature, as we begin to rely on multiple professionals to meet our healthcare needs of the future. Those professionals will be selected for cost, convenience and consistency in an overall health regimen, giving the consumer more power and influence over the care they receive. Component Medicine will be team-driven, with the centralized role of primary-care physician playing an important, yet less critical, position than previously held.
Technology will also have a hand in this. Video conferencing and mobile monitoring equipment will provide better information to these members of the Component team. That improved information will lead to more accurate care and better results.
Even alternative medicines, those historically shunned by traditional medical providers, may find a playing position on this squad. Even though they may be lacking hard scientific evidence of effectiveness, some alternative and holistic approaches hold value simply because people believe they work, and therefore should not be kept from medical care.
Workers’ comp is, in my opinion, uniquely positioned to help develop and influence the adoption of this concept. Our industry, in its role as a health provision service, has more control over the various elements of care than any other singular entity. We have access to employers, patients and the medical community. In states with directed care, we could have even more immediate impact. As an industry we could help create those systems that provide effective, affordable care close to the patient’s home, and to a greater degree work to provide and support preventive care for those in our system.
Several months ago, I attended a presentation given by Dr. David Pate, CEO of Boise’s St. Luke’s Health System, the largest medical provider in Idaho. He spoke of the need for modern medicine to “get to where the people are” in a proactive sense: in their homes, their schools, their work and their churches. The problem, he noted, was that they had not figured out a way to get paid for doing that, with the result that the “broken” fee-for-services model still ruled the day.
His concept is a classic leveraging of the time-honored adage, “An ounce of prevention is worth a pound of cure.”
Today, the workers’ compensation industry can drive that theory to reality, and with the advent of the PPACA (Obamacare), we might not even have to pay for it all. The level of control that we employ in many states, along with the access and sway we have with key players in the country, mean that we could help channel convenient Component Medical care that offered strong preventive focus for not just those in our system, but their uninjured coworkers, too.
The physician of the future isn’t an individual, rather a comprehensive medical team. It is Component Medicine, and it provides the key to effective, flexible and affordable care for our population in the future.