The Dreaded Primary Care Department

Over the last 6 years, I’ve met with 20 or so hospital systems and their executive teams to talk about Sherpaa. Here’s how it works:

An innovator finds me

A passionate innovative type (Chief of Innovation or some flavor of the sort) within the organization hears about Sherpaa and reaches out to me to learn more and, eventually, they arrange a meeting with the entire executive team for me to give them an overview of Sherpaa.

I make the pitch

I book my travel and arrive prepared. If there’s one thing I can do, it’s talk clearly and passionately about Sherpaa making the entire service sound so rational and lovely. I’ll speak for 30 minutes or so and then take questions for the final 30 minutes. It’s always “this is absolutely fascinating” followed by many questions. They’re always the same questions so my responses are buttoned up and well thought out.

I leave, the team discusses

The Chief of Innovation, along with my presentation, makes a strong argument to the executive team that the hospital system can’t continue doing the same thing. They have to adjust to the times. The execs are convinced and they invite me back for another discussion. This dance goes on for one or two more meetings. I get excited because I’ve finally found some establishment entity willing to rethink how healthcare is delivered. Then, inevitably, one of the execs, as they should, understands the politics of the situation, and says, “you know, for this next meeting we should invite the primary care department.”

The Primary Care department arrives

“So, you folks at Sherpaa only want me to see the super complicated chronically ill patients? Do you know how much money I make on the simple/moderate issues? I get paid essentially the same for simple vs. chronic cases and you want to take all those cases away from me?”

“You want to turn me into a specialist?”

“My patients love visiting me.”

“There’s no way you can do so much without seeing a patient. This seems shady.”

“Urgent care centers are already stealing a ton of my business.”

The conversation pretty much ends

A few weeks ago, I conducted a highly unofficial twitter poll:

If most industry insiders think there are less than 20 innovative hospital networks in America, out of those 20, how many also have primary care departments willing to innovate and disrupt themselves?

I’m going to wager none.

That’s why urgent care centers arose independently of hospitals. They offered something of real value, accessible care that’s less expensive than an ER. But they did it without sanctioning from the local primary care department. They also sold a widget that insurance companies would pay for because it was an office visit (something an insurance company could wrap their head around) that was less expensive than an ER. For the patient, it was by no means a service innovation. It was still just a doctor in a room. But it was definitely a better deal.

So that’s where we are as a country. Urgent care centers are the most innovative thing we can tolerate.

So…how are we going to disrupt both the urgent care center (they shouldn’t really need to exist if primary care was accessible) and the primary care department? Is this impossible?

Again, fixing healthcare isn’t a tech problem, it’s a political one. And it’s political all the way from the federal government to the local primary care department.