It’s time to free doctors from their boxes


The American health care system is set up to care for a certain subset of the population — sick people — people with chronic disease, acute illness, acute injury, and complex disorders like cancer or metabolic issues. The problem is, this set up doesn’t create market incentives to care for the well effectively, or to identify those at risk for disease and efficiently and reliably intervene, at scale. To reconcile this cognitive dissonance between sick-care and health-care, government agencies like CMS, are now funding population-based care strategies. The idea is, the health care system should anticipate patient needs at the population level, stratify those needs by risk, and disseminate preventative interventions locally, based on traditional indices like blood tests and screening protocols and emerging metrics like ICD-10 Z codes to identify social determinants of health. Now that the federal government is redefining the relationship between communities and health systems, it seems logical to anticipate future opportunities to redesign one of the most outdated physician roles: the “doc in the box.” But the baffling thing is, that is not what is happening.

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