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Business Model For Medical Care 2020. The Ideal Future State

Posted Oct 28 2012 11:17pm
Stanley Feld M.D.,FACP,MACE


Please click on all the links to study the references to each spoke. It will help you visualize the power of the business model.

The ideal future state business model for the healthcare system must include the execution of ideas in the specific spokes outlined below.. These spokes will serve to align all of the stakeholders’ interests.

The business model must contain appropriate rules for a consumer driven healthcare system, an ideal electronic medial record, and an ideal medical savings account.

The ideal medical saving accounts can work optimally when there is significant tort reform and patients take full responsibility for their health and healthcare dollars.

Consumer education is critical to the business model of the future. Educational modules can be available to consumers 24/7 via the Internet. These educational modules must be an extension of consumers physicians’ care in order to be effective. The education can become available using a series of social networks.

Chronic disease self-management education can be achieved by the use of interactive online teaching programs. Patients can be linked to share their disease experience through private social networks.

Most believe that the healthcare system must have greater integration of care. This integration of care can be done virtually through a series of private integrated networks.

Effective integration can be achieved without disruption of the entire healthcare system. Obamacare has been disruptive to the entire healthcare system.

Obamacare is forced integration by the government will be slow, costly and unsuccessful.

Physicians must be compensated for the presently uncompensated time necessary to execute each one of the spokes of the wheel.

Each spoke is necessary to convert the healthcare system into a system that once more makes the physician patient relationship paramount.

The future business plan removes control of the healthcare system from the government. It permits the patient to have the freedom to choose his own healthcare course.   

Tort reform is vital to the 2020 business model. It will decrease costly over-testing to avoid frivolous malpractice suits. There are many ways to set up a tort reform system that truly protects patients from real harm while eliminating over-testing. It limits the malpractice litigation system. Punitive damages must be lowered. Losers in lawsuits must pay all fees. These two provisions will decrease lawyers’ incentive to sue.


Consumer driven healthcare will create a system that promotes personal responsibility by the consumers’ for their health and health care dollars.


The major spoke necessary to successfully accomplish a consumer driven healthcare system is my ideal medical saving accounts.



The ideal medical savings accounts would provide the financial incentive for consumers to drive the healthcare system. It would dis-intermediate the healthcare insurance industry’s grasp on first dollar coverage and profits. The insurance industry would realize that its profit margin would increase under this system.

In order for consumers to be in a position to lower the cost of healthcare they must be taught to understand how to self manage their disease and be responsible for the decisions they make in their choices for medical care.


In order to decrease patients’ dependency on the government and increase  being responsible for themselves, a system of education using information technology as an extension of their physicians’ care has to be developed and put into place.

Social networking is in its infancy at present. It must be developed and used as an educational tool between physicians, patients and physicians, and patients and patients.

All the social networking must be an extension of the physicians’ medical care to their patients. Social networking must be developed to enhance and promote the physician/patient relationship because this relationship is critical, at its core, to successful medical treatment.

Social networking and information technology can extend physician educational resources for patient care.


Systems of care for the self-management of chronic disease as an extension of their physicians care have already been developed. The unsuccessful chronic disease self-management systems are the programs that are not an extension of physicians’ care. The reason these third party systems are unsuccessful is because they undermine the patient physician relationship.

President Obama has done pilot studies using those third party self-management companies to prove that chronic disease self-management systems work. They have all failed to reduce the cost of care.

Therefore the administration has reached the conclusions that self-management of chronic disease does not work. Nothing could be further from the truth. The government simply does not understand the magic of the physician-patient relationship.


In order to decrease the cost of medical care, medical care must be integrated . At present, primary care physicians recommend specialists. The primary care physicians know whether the specialists are doing a good job by the specialists’ treatment results with their patients.

Most of the time physicians do not know their specialists’ fees. These fees must be totally transparent to primary care physicians and their patients. The primary care physicians can then be in a position to help their patients choose appropriate specialists.

It will also reduce the specialists’ prices because they will be forced to become competitive by the patients in a consumer driven system.

Hospital fees must also be transparent. One of the reasons I am opposed to hospital systems hiring physicians and paying them a salary is the hospital systems would then be able to develop a monopoly in a town or area of town. This would permit the hospital system to raise prices without informing patients or physicians.

Hospital systems could erase physicians’ choices and hindered patients from having the freedom to choose a hospital or specialist of their choice with their primary care physicians. It devalues the patient physician relationship.  


The way President Obama is going about developing a universally functioning electronic medical record is foolish and costly . Most physicians cannot afford a fully functional electronic medical record. This fact is being used to drive physicians into being employees of hospital systems. The problem is hospital systems are paying hundreds of millions of dollars for electronic medical records that are not fully functional.

Many of these records are hard to use and provide inflexible data. The inflexible data leads to healthcare policy decisions that are wrong. The data is also used to commoditize medical care.

Commoditized medical care is not the best quality of medical care.  

If the government is so smart it should develop a fully functional electronic medical record and provide it to all hospital systems and practices for free.

T he EMR should be put in the cloud. Providers should be charged by the click. The government can service and upgrade the EMR in one place and improve the quality of data collected. The data should be used for educational purposes only and be owned by the patients and physicians. It should not be used for punitive purposes. The inaccurate data is now used for punitive purposes. The result has been a lack of physician cooperation.


The healthcare journey to an ideal future state must begin in an orderly way. The principle goal is to be consumer centric. It must be consumer driven and force the secondary stakeholders to be transparent and competitive.

This journey will wring the excess costs out of the healthcare system. It will create a democratic system affordable to all.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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