Definition"New concept of healthcare wherein all the constituents (patients, physicians, providers, and payers) focus on healthcare value (outcomes/price) and use competition at the medical condition level over the full cycle of care as the catalyst for improving the safety, efficiency, and quality of health care."  by Scott Shreeve

Scott has been very active in the health 2.0 space for a number of years.  He is a very intelligent and insightful ER doc who is now committed to improving the US Healthcare system with Health 2.0 technologies.  I wonder if his definition reaches wide enough to grasp the needs of the docs, the patients, the payors  and the machine that is the US Healtcare system as it stands today.  

Clearly, patients should demand a model that serves their unique values and needs.  Docs should demand a system that allows them to spend time with their patients and not with a slew of full time employees who we need to wade through the mess of paperwork that the payors and govt demand of us.  The payors should demand a system that is evidence based...to the extent that it can be, where good outcomes are rewarded and docs practicing medicine that is off the grid are punished.  Such a system will not balance easily on the scales of greed ( receivables or shareholder value) that exists in today's healthcare environment. 

Skeptics abound... but the system as it exists today is not sustainable and something will have to be done.  Physician skeptics state that  their hands are being tied by the bureaucracy and that the payors are denying care that they (the physician) believe is in their patients best interest.  That is a problem unto itself.  Simply read Overtreated by Shannon Brownlee.  There is little room in medicine for non evidence based treatments ---on a routine basis.   Sure, medicine by nature involves significant experimentation.... and that is how new discoveries are made. BUT, the patient should be informed of the risks and the physicians involved should probably not have an equity interest in the company whose treatment is being prescribed

 Docs will also complain that technology will diminish the quality of care given to patients.  I think this is a false assumption.  Technology will empower the patient and allow us to communicate with them in a much more effective, friendly and efficient manner.  How many patients call us at the end of the day stating that they had another question to ask, but they were too nervous in the office and forgot to ask it then.  We need to provide these "niche" patients with a means of communicating with us that is far more comfortable to them when they don't feel rushed, hurried or nervous because of the usual harried office environment most of us practice within. 

Who knows exactly what the payors are thinking.  Transparency is not a term used to describe their plans for the future.  

When HMOs first appeared the market was clearly vertically oriented... as their markets changed, a horizontally oriented structure appeared.  That structure is changing once again... but to whose advantage?  Did a vertically oriented structure, where they controlled the docs and hospitals result in a better outcome for the patient or a better outcome for the shareholder?  Did they ration care to improve patient outcomes or their price/share?

The market changed to a horizontally oriented strategy which is still around today. Now the plans are aligning and merging together, they have spun off their physician and hospital practices and are seeking to control as many "lives" as possible.  Will this result in better outcomes for patients or shareholders? 

Now that the horizontally oriented forces have gone nearly as far as they can in this environment, what is next?   Who will prosper and who will be left behind?  I' m very skeptical that concern over patient outcomes data is prominently displayed in the executive summaries of the newest concepts the payors are dreaming up right now. 

  anyway....

 As only one in  a long list of wonderful posts on the subject... I encourage you to read this latest post by  Scott

... I am struck by how this explosion of personalized technology, and how much opportunity there appears to be to service the “Long Tail of Health Care” - the vast majority of underaggregated, underanalyzed, and underadvised niche patients who are looking for niche services. These niche services, as demonstrated at both Health 2.0 conferences, are the first attempts to use technology to personalize the health care consumer experience, to meet them where they are, in the way they want to be reached, in a language they understand, and with means that meet their unique values. This perhaps, becomes an even better definition of Health 2.0