Medicine is undergoing a pretty significant makeover, and one of the most fascinating aspects of this transformation is the effort by some groups to reexamine their business focus. As the way Americans receive and pay for care changes, some are responding by expanding their reach beyond the business of health care into that of overall health.
The "business of health care" (at least as I'm broadly terming it) is what most people think of when they imagine going to their doctors. It involves all the things that occur within clinic and hospital walls, including cholesterol checks, colonoscopies, and antibiotics given for pneumonias.
In contrast, the "business of health" requires care providers to move beyond those walls into the surrounding communities, working with local partners on issues likes healthier food options in schools and day programs for the elderly. Because they don't always develop symptoms and show up in our hospitals, groups like children with unhealthy diets and older people with poor conditioning have not always received the most attention from the medical community. Instead, they often come to our attention only when they have developed premature heart disease or fallen and broken a hip.
On one hand, this might seem like a surprisingly glaring omission for a group that has long espoused an ethos of compassion, public health engagement, and community involvement. On another, perhaps it isn't so hard to believe given the traditional financial incentives to treat sick people instead of preventing sickness altogether.
Now, however, the ideals that have always been implicitly demanded of medical providers are being explicitly encouraged by changes in health policy and financing. Dollars are in play to prevent social determinants from worsening our nation's health outcomes, with some examples of early successes.
For example, after recognizing that housing instability is a major risk factor for frequent, repetitive emergency department use (a poor and expensive way to receive ongoing care), Montefiore Medical Center in New York City began placing patients into transitional housing units, extending its services into homeless shelters while protecting a respectable, positive operating margin.
Others have started similar initiatives. Some have expanded their community outreach programs and used clinics to offer health promotion programs. Others have hired community health workers to coach and guide patients through their otherwise complex health needs.
Non-clinical groups seem to be catching on as well. Some private insurers have initiated studies and programs that focus on health rather than health care-related activities. Companies like CVS Caremark made a significant change by deciding to stop selling tobacco products in some locations, and others like the Campbell Soup Company have begun working with community partners to improve access to healthier food offerings.
Despite these promising starts, it remains to be seen whether or not these changes will create lasting change. Early examples are far from perfect, and organizations on this path must answer several philosophical and economic questions about the extent of their responsibility. There is always financial risk with investing in community services, and different organizations will have to weigh the suitability of new ventures depending on their resources, competing needs, and community make-up.
Nonetheless, the effort is laudable, and I am hopeful that many of these efforts will continue to grow and display tangible impact. Because if the recent convergence of economic, policy and public pressure is telling us anything, it's that regardless of how it happens, its finally time for a new business focus in medicine.
Note: A related version of this post was first published online in the American College of Physicians Internist September Newsletter.