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December 01, 2008

Convergence of Health 2.0 and medical home?

Two items that entered my consciousness this morning: group medical appointments as a manifestation of the medical home and order-your-own labs as a manifestation of Health 2.0.

At 700-plus-doctor Atrius Health here in the Boston area, CEO Gene Lindsey still sees patients, but only in 90-minute group appointments.  Other large group practices across the country have already implemented this practice, and it's growing at Atrius (which includes Harvard Vanguard Medical Associates and a number of other groups).  Patients opt in and benefit from longer contact with the physician and discussion of issues that may be of general concern to all of them (Lindsey is a cardiologist; he can fit many more "canned" speeches to his patients into a 90-minute visit, and his patients seem to appreciate it).

This innovation addresses a couple of issues simultaneously: PCP shortage, under-reimbursement of cognitive services and patient dissatisfaction with too-short office visits.

Scott Shreve is not your typical patient, but as the linked post in his blog argues, patient-directed lab ordering makes better use of the office visit: you can discuss results with your doc, rather than discussing which tests to have ordered.  Scott further argues that consumer-directed health care, as exemplified by this service, is ineluctable, just as we cannot turn back the clock on consumer-directed financial services (e.g., on-line trades) which cut out the financial advisory intermediary.  Given the recent dip in our collective net worth, the unmediated access to stuff that matters (retirement funds, health care data) cannot yet be counted an unqualified success.  However, Scott's point that we can't fight it, and that it may offer some benefits, is well taken.

The order-your-own labs innovation, like the group physician visit innovation, is a neat solution to a bundle of problems.  These are the sorts of leaps that are necessary to get us out of the current downward spiral that will otherwise leave us all without adequate access to appropriate levels of medical care.

(Tip of the hat to Bob Coffield for the Scott Shreve post.  That's a link to Bob's twitter post, not blog post.  For those of you not yet following me on twitter, please do so right here: @HealthBlawg.)

David Harlow
The Harlow Group LLC
Health Care Law and Consulting


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What type of activity are you seeing for walk-in-order-your-own labs? Doesn't this cut into PCP revenue?

There's a very big and too often undiscussed difference between trading your own stocks and ordering your own labs: level of expertise required to DIY. I, like many people, am perfectly comfortable being a Fool (as in reading, deciding what companies are worth my money, and then buying their stocks online.

I would be a true fool, though, if I believed myself to be qualified to order my own labs or diagnostic tests based on something I read on WebMD.

Self-service has it's place, but it's place in medicine is very small.

Mike, Brendten -- Substitute a call to the doctor's office for the DIY approach (i.e., have the labs ordered within your PCP's practice or usual reference lab) and you can still reap the benefit of an office visit focused on test results rather than test ordering.

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