Thinking About How Patients and Providers Can Get Health Care Done Without Any of What We Use Today

We’ve all heard about flash mobs. The first one was organized by a guy named Bill Wasik in 2003. He used social media, text messaging and email to organize about a hundred people to gather around an expensive rug on the ninth floor of Macy’s in New York. They told approaching sales and management staff that they all lived together in a warehouse and were choosing a “love rug” for their collective living room. It spawned a movement. Today, you can find hundreds of YouTube videos of crowds dancing, singing, clapping or chanting together for no other apparent reason than they wanted to do it together as a group.

The distinguishing features of flash mobs are what they aren’t. Flash mobs are not promotional. They aren’t sponsored. Flash mobs are 100 percent grass-roots driven. They have organizers but no command and control. Participation is optional. They are, by definition, local and assembled for no other purpose than to scratch some collective social itch. They happen and then fade instantly out of public view.

Flash mobs are a blueprint for fixing a lot of what doesn’t work in health care, and all the tools to build powerful solutions based on these premises are already lying around. Let’s see why.

The Social Itch That Needs Scratching

No one seems happy about health care. Policy makers and pundits (me among them) go on about how broke and broken the system is. Patients can’t spend the time they want with their doctors. Doctors can’t spend the time they want with their patients. There’s too much information to sift through on the Internet but not enough decision support to make sense of it. There’s no accountability on the procedures, drugs and technologies we choose to use, and no connection between the effective prices we pay and the actual costs of providing services.

We all furrow our brows and dream a slightly different version of a common vision. We imagine what the world would be like if there were no health insurance companies. We think about calling our physicians and having them actually answer their phones. We stare at our email, Facebook page or Twitter accounts and think, “This is pretty powerful stuff. I should use it for something besides just talking to people I only vaguely knew in high school.” We dream of teamwork and engagement, and of connecting health care to our day-to-day community and lives. It’s a big itch and the worse things get in health care, the more we’re desperate to scratch it.

Envision the Mob

Imagine 1,500-2,000 people getting together to build a new health care model unencumbered by the system that is. They all have some affinity in common; it could be a common university they attended, a common business they share, a common gym, a common golf club, whatever. They share the same health care resources and, so by definition, are clustered within a relatively small geography. You, as a member of the group, know some (but not necessarily all) of the members of this group. You’re connected by several different social media tools. You follow each other on Twitter. You have an invite-only Facebook or LinkedIn page. You occasionally run into members at the grocery store, at a baseball game or at Starbucks. This group/team/club is your mob.

Next, someone stands up to organize you. He is an established physician in your area. He is fed up with all the same things that you are—too much oversight; too much paperwork; too much government, state and insurance company involvement in the job he’s trying to do. He decides to go “concierge.” That means that he limits his total patient base to no more than 2,000. He charges an annual up-front subscription fee and guarantees high-touch, responsive, primary health care. He charges a fixed price for each office visit and only accepts cash. He approaches your mob and proposes a flash.

This doc proposes being your mob’s exclusive provider of primary care medical support. His principal role as such will be to assure your mob access to him when and where they need it (yes, he will do house calls). More importantly, he will also function as your mob’s health advisor and coach. He’ll send emails to you individually and post advice within your group’s private social network spaces. He’ll tweet exclusively to your mob on items he’s seeing that are relevant. He’ll forward articles he has read and offer collective advice on how to improve the group’s aggregate health by measurable means. He will cheer successes and encourage change where it’s needed—all within a strict privacy framework you all agree upon.

Flash

The mob starts to opt in. The doc sets up a private social network that is relatively secure. He also provides a cloud-based electronic medical record that your mob can access through this portal that is HIPAA compliant and adheres to all security standards that would otherwise be found in his office. Someone blogs on the issue of getting care for catastrophic events (car accidents, cancer, etc.) and gets your mob access to a high-deductible plan that’s accepted by your local hospital. Someone else mentions that she has had a great experience with an alternative medicine practice in town and adds an optional benefit to your mob’s “plan.” The same thing happens again when the local gym hears what you’re doing.

Things start to get serious. Your mob starts chatting about upping the annual subscription price but including more options in your plan—still local, still driven through social media, still managed by your primary care provider and health coach. Your physician organizer finds specialist peers that he trusts and who could add real health value to your mob’s unique health profile. You add physical therapy, as well.

A few of your mob’s members work together at a large insurer and offer to help on pricing the next year’s subscription price. They add up everything your mob spent the previous year and carefully calculate what your entire group will likely spend next year. They pay a small fee to their employer for their actuarial data and propose that the mob buys reinsurance in case their model turns out to be slightly off. Everyone looks it over together (because it’s posted on your network page) and agrees to use it as the basis for next year’s subscription.

Change Your Flash to a Sparkle

A funny thing starts to happen. The doc’s postings get picked up and comments are posted. People encourage each other through the private social network. Tweets start flying about good classes at the gym, success stories at checkups. People share Groupon coupons for healthy alternative dining options. No one picks on anyone else online. No one gets called fat or gets called out for bad behavior that could affect the group’s aggregate health. It turns into something local, real and positive. People like their physician and can connect what they do to how they feel. Their outcomes improve. They are accountable. The group is running like every HMO wishes they were, just at a micro level.

Now the punch line...

This is a 78-year-old story with a little technology and context thrown in. In 1933, Sidney Garfield, a then newly graduated medical student from USC, moved to a small community called Desert Center in California. He signed a contract with a local construction group to take care of 5,000 workers who were working on the federally funded California Aqueduct project. His contract stipulated that, for a fixed 17.5 percent of their wages, he would coordinate the workers’ general health care, assure them access to high-acuity care when and where they needed it, and stabilize their injuries in the event they were hurt until they could be transported back to Los Angeles. He charged an incremental $1.50 per day for add-on services not related to the execution of their construction jobs. Sidney Garfield was the founder of Kaiser Permanente.

That is NOT to suggest that our health care flash mob needs to strive toward something as big and bulky as the Kaiser model. While it is true that Kaiser is arguably one of the most successful and sustainable health care organizations in the world today, the lessons to draw from the model are simple for us. Sidney Garfield’s genius was recognizing that local and specific health care needs of a specified population (the construction workers in Desert Center) could be managed effectively through an ongoing health care management program. He separated primary care from catastrophic care. He saw that partnership was critical to delivering the right care at the right time in the right place. He had a vision that didn’t depend on the existing health care infrastructure.

We’re at a similar moment now. We don’t need huge systems to deliver effective care. We don’t need millions of covered lives to appropriately spread insurance risk. We have a plethora of communication tools and practically free analytic capabilities that make the possibility of a micro-HMO feasible. We have a clear need in the market for something new. Our challenge is to think about where and how we can put it together and the role we, as established stakeholders in the space, want to play.

Maybe the better way to think about it is to decide if we want to be part of the mob or someone standing on the sidelines watching it happen without us. Think back to Bill Wasik’s original flash mob. Do you really want to end up as one of the confused salespeople on the ninth floor of Macy’s? I say embrace the market signals already around us. Otherwise, the joke’s on us, and we’ll just stand there with a kind of blank look on our faces wondering what a “love rug” is for.

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