Healthcare in the United States is in an abysmal state for quite some time now. Right from rising medical costs, to sky-high reimbursement rates and the ever changing medical billing and coding altercations, everything seems to be in a haywire situation.

So to answer the questions as to, Does US Healthcare need disruptive solutions? The answer is yes!!

 The number one challenge the healthcare industry in US faces today is, making health care affordable and conveniently accessible to most people. Almost all the industries that we see around us began with services and products. At first they were so complicated and expensive to provide that only people with a good financial backup could participate. The transformational force that has brought affordability and accessibility to these industries is disruptive innovation. Similarly, today the health-care industry screams for disruption. As far as politicians are concerned, they are consumed with how we can afford health care. However, with disruption one can solve the fundamental question: How do we make health care affordable?

Healthcare disruption in stages:

If you read or research about disruptions most of them have three enablers: A simplifying technology, a business model innovation, and a disruptive value network.

Technology: - The technological enabler transforms your technological problem from something that requires deep training, intuition, and iteration to resolve, into a problem that can be addressed in a predictable, rules-based way. Diagnostic abilities in healthcare are the technological enablers of disruption in health care. Precise definition of the problem, in this and in every industry, is a prerequisite to the development of a predictably effective solution. It is similar to the innovation of EMR that simplified the revenue cycle management and physician reimbursement issues via medical billing and coding, which further developed into specialty billing.

Innovation: - Around three decades ago, business model innovation was common in health care. When the technological enablers for the diagnosis and treatment of infectious diseases emerged, most patient care was transferred away from hospitals to doctors’ offices. However, business model innovation has stalled in the last three decades. Healthcare regulations and physician reimbursement systems are currently trap in high-cost venues. Most of this care could be provided in lower-cost, more convenient business models. Such disruptions fail as they lack new value networks that combine business models into coherent ecosystems that allow them to disrupt their predecessors.

Three vital learning’s from the history of disruptive innovation are particularly important in the disruption of health care.

  • The first is that while the technological enablers almost always emerge from the laboratories of leading institutions in the industry, the business model innovations do not. Almost always these are forged by new entrants to the industry. Healthcare regulators must beware, therefore, of attempts by the leading institutions to outlaw business model innovation. Regulation should facilitate it. What is in the interest of society most often does not coincide with the self-perceived interests of the leading institutions.
  • The second critical learning is that disruption rarely happens piecemeal, where stand-alone disruptions are plugged into the existing value network of an industry. Hence, disruptive business models such as value-adding process clinics, retail clinics, and facilitated networks must be married with disruptive innovations in insurance and reimbursement in order to reap the full impact in cost and accessibility. At the outset, merging medical billing and specialty billing together will require a much higher degree of integration than has been the norm in the health-care industry. Even though it looks difficult, it would be good if providers need to disrupt themselves.
  • Lastly, all of us have witnessed the pervasive pattern in every industry that has been transformed through disruption. This same pattern characterizes what has happened to date with disruptive initiatives in health care. The energies, talent, and resources of the leading organizations in an established healthcare system always are absorbed in improving their best products, which are sold to address the most demanding applications in the industry.


Because the high end of most markets is where the most attractive profits are made, serving the most profitable customers. When a disruptive technological enabler arises, the leaders in the industry disparage and discourage it because. The reason given is its orientation toward simplicity and accessibility. They need to remember and understand that disruption just isn’t capable of solving the complicated problems that define the world in which the leading experts work.

Keep in mind that Health care is no different. Disruption in health care requires moving the simplest procedures now performed in expensive hospitals to outpatient clinics, solo clinics, and patients’ homes.

Published By - Medical Billers and Coders
Published Date - Feb-27-2018 Back

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