Healthcare’s Disruptive Innovator

Disruptive Innovation is a term widely attributed to Harvard Business School professor, Clayton Christensen. Often used interchangeably with the term, disruptive technology, there is an important distinction: the former represents not just advancements in underlying technology but the innovative application of that technology.

Disruptive innovation is something that concurrently, though at varying speeds, creates a new market while disrupting an existing market in ways that essentially had not been anticipated. Examples frequently cited include the introduction of personal computers and the impact that had on mini and mainframe computers; cellular phones’ impact on fixed line telephony; the iPod’s impact on the music industry; and most recently – retail medical clinics’ impact on traditional physician offices.

Enter The Clinic at Walmart.

Writing in the Healthcare Finance News, Contributing Editor Anthony Brino writes how Walmart is now wading into physician territory. Having already opened over 100 walk-in clinics across the country that provide access to medical care through collaborative agreements with local hospitals and/or physicians, this latest move – directly employing nurse practitioners – is part of a longer term strategy for Walmart to be self sufficiently ingrained as a primary care provider.

And of course, it’s not just Walmart that is seeking to capitalize on the increasing demand for primary care coupled with the escalating cost of that care: according to a 2013 report from Accenture Research the number of retail health clinics is anticipated to double over the next three years from 1,400 to 2,800. The core value proposition is increased access and greater convenience at a substantially lower cost than a visit to a doctor’s office.

What we are really looking at here is the commoditization of Medicine. The underlying premise is that a wide swath of fundamental and routine aspects of primary care can be automated and standardized: treatment of simple acute conditions, preventative care (e.g., vaccinations), wellness screening, diagnostic testing, etc.

There are substantial reasons to be concerned with the promulgation of retail clinics, particularly where they serve in lieu of primary care physician relationships. For starters, nurse practitioners – which undoubtedly must be a critical element in expanding primary care – simply do not have the same level of training and experience as a board certified physician. Their ability to assess, decipher and act upon the nuances of a patient’s conditions are – in general – not going to be the same.

The historical relationship of a patient and his or her physician becomes over time an invaluable knowledgebase that the physician relies upon to identify changes in a patient’s condition that may warrant investigation. And convenience can be a double-edged sword. Being prescribed an antibiotic for a virus that someone then confidently carries with them to their work environment not only prevents that individual from staying home and getting needed rest – it unwittingly exposes coworkers to that virus, which the antibiotic does nothing to control (or treat).

But what disruptive innovation is without its unintended consequences? Look at how much time we now spend in front of computers instead of outside exercising. Cell phones migrated to smart phones that people now use to text their way to oblivion: in 2012 over 3,300 people were killed in distraction-related crashes. Whether the paradigm shift in the music industry is a positive or negative I think depends a lot on  your age – but as with all other such innovations, nothing will ever be the same.

That is true for the healthcare industry and the practice of medicine: nothing will ever be the same – except our resistance to change – that won’t change.


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