From Cost Unaware to Price Competitive

Despite all the efforts made to manage costs over the past 2 decades, most people are still unaware of the expenses associated with health care. The health care system has been “abjectly unresponsive to the consumer,” said O’Neil. As a result, consumers have a tendency to go elsewhere for care that they find compelling, whether to Walmart or to Costa Rica.

From Professional Prerogative to Consumer Responsive

Because of the inpatient orientation of health care, the prerogative of the professional still reigns, whether the professional is a physician, a nurse, a dentist, or a community health worker. Health care professionals train for acute care settings and make much of their money in those settings. Even the cultural icons of health care, such as Dr. House from the television show House, remain focused on acute care. “When Dr. House puts a preventive strategy in place and breaks into the patient’s house to monitor that patient’s exercise and medication, we’ll know” that change has arrived, said O’Neil.

From Inpatient to Ambulatory—Home and Community

Part of the health care reform movement today is focused on building the patient-centered medical home. “But that’s just a way station to locating primary care in the home using new technology,” said O’Neil. New arrangements will be made for the provision of emergency care, the storage of medical information, and services such as health coaching.

From Individual Professional to Team

In the past, large teams of providers with many different areas of expertise have managed individual patients, but that approach was too expensive, says O’Neil, and evidence is scarce that large and diverse teams functioned well. New technologies make it possible for teams to work together without gathering everyone around a large table. The challenge for team members now is to know that information about a patient exists and how to access it. “I love the Fred Hutchinson Cancer Institute,” said O’Neil, “where you can’t really tell who is the oncologist, the housekeeper, the nurse, or the nutritionist, because they all respond in a consumer-oriented way.”

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